Effectiveness of universal school-based programs for prevention of violence in adolescents

Objective: Violence is a leading cause of morbidity and mortality amongst young people. Primary preventive programs aimed at reducing the involvement of young people in violence are often implemented in a school setting. This systematic review evaluated the effectiveness of universal school-based programs aimed at the primary prevention of violence in 11-18 year olds. Method: A pre-defined search strategy was used to search various sources (i.e. databases, gray literature, previous reviews, and reference lists of included studies) for randomised design trials and quasi-experimental design trials published between 2002 and March 2014. After screening 8051 abstracts, 21 studies were identified that satisfied the inclusion/exclusion criteria. These studies evaluated 16 different programs based mainly in the US. Results: Due to the heterogeneity meta-analysis was not possible; thus a narrative synthesis was reported. The most effective interventions utilised social development and social norms components. Attitudes towards violence was the most frequently measured outcome with six studies reporting a beneficial effect and two reporting no effect; three of the six studies examining violent behaviour demonstrated a small beneficial effect; and four of the seven studies examining physical aggression demonstrated a small beneficial effect. Conclusions: In general, this review found limited evidence of the effectiveness of universal school-based programs in the primary prevention of violence in 11-18 year olds; however, those that combined social development and social norms approaches appeared to be the most effective. Additional qualitative research/process evaluation is required to establish the processes that underpin the success/failure of such programs in order to inform their refinement, and the future development of effective programs.