Elsevier

Aggression and Violent Behavior

Volume 17, Issue 6, November–December 2012, Pages 540-552
Aggression and Violent Behavior

A systematic meta-review of evaluations of youth violence prevention programs: Common and divergent findings from 25 years of meta-analyses and systematic reviews

https://doi.org/10.1016/j.avb.2012.06.006Get rights and content

Abstract

Violence among youth is a pervasive public health problem. In order to make progress in reducing the burden of injury and mortality that result from youth violence, it is imperative to identify evidence-based programs and strategies that have a significant impact on violence. There have been many rigorous evaluations of youth violence prevention programs. However, the literature is large, and it is difficult to draw conclusions about what works across evaluations from different disciplines, contexts, and types of programs. The current study reviews the meta-analyses and systematic reviews published prior to 2009 that synthesize evaluations of youth violence prevention programs. This meta-review reports the findings from 37 meta-analyses and 15 systematic reviews; the included reviews were coded on measures of the social ecology, prevention approach, program type, and study design. A majority of the meta-analyses and systematic reviews were found to demonstrate moderate program effects. Meta-analyses yielded marginally smaller effect sizes compared to systematic reviews, and those that included programs targeting family factors showed marginally larger effects than those that did not. In addition, there are a wide range of individual/family, program, and study moderators of program effect sizes. Implications of these findings and suggestions for future research are discussed.

Highlights

► We review 25 years of data of youth violence prevention and intervention programs. ► Meta-analyses and systematic reviews find moderate program effects on youth violence. ► Meta-analyses reported smaller program effect sizes than systematic reviews. ► Family-based programs showed larger effect sizes than non-family-based programs.

Introduction

Homicide is the second leading cause of death for young people between the ages of 10 and 24 (Centers for Disease Control Prevention [CDC], 2009a, Centers for Disease Control Prevention [CDC], 2009b). In 2009, 650,843 assault-related non-fatal injuries in youth age 10 to 24 were treated at emergency departments across the U.S. (CDC, 2010). The term youth violence is used to encompass many forms of violence among young people, including more serious forms (e.g., homicide) and behaviors that are less serious in nature (e.g., fighting). Youth violence is thus defined as “the intentional use of force–whether threatened or real–against a person, group, or community that results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation by persons between the ages of 10 and 24 (Centers for Disease Control Prevention [CDC], 2009b, Dahlberg and Krug, 2002).

A number of individual, family, peer, and community factors have been found to increase the likelihood of an individual's violent offending. Such risk factors have been empirically identified through multiple studies and predict violent behavior longitudinally (Hawkins et al., 2000, Murray and Farrington, 2010). A relatively new area of research in youth violence prevention involves examining protective factors (i.e., variables that have a moderating effect on risk factors) related to violence perpetration. This research can also inform prevention efforts, in that it can identify factors that should be bolstered among youth, families, and in communities in order to prevent violence. Research on risk and protective factors for youth violence perpetration provides a critical starting point for prevention, as this literature has informed the factors that can be targeted for prevention programs.

Most youth violence prevention programs target risk and protective factors in order to reduce the likelihood that children and youth will behave violently during adolescence and beyond. Two types of classification systems are frequently applied to prevention approaches: universal/selected/indicated and primary/secondary/tertiary. The universal/selected/indicated (Institute of Medicine, 1994, National Research Council and Institute of Medicine, 2009) distinction describes the intended population of a program, while the primary/secondary/tertiary (Institute of Medicine, 1994, National Research Council and Institute of Medicine, 2009) distinction describes the timing of the prevention approach. In terms of youth violence prevention, universal programs are those administered to everyone within a defined population regardless of risk; selected programs are directed to a population who is at-risk for youth violence but has yet to engage in violent behavior; and indicated programs are those that target individuals who show early signs of engaging in violence (Institute of Medicine, 1994). Primary prevention programs address risk and protective factors to prevent violence before it occurs. Secondary prevention programs take place immediately following violent acts and seek to minimize the short-term consequences of violence. Tertiary programs take place after violent events and deal with the long-term consequences. Although it is the case that primary prevention programs are often also universal programs, primary programs can also target a selected population. As a result, there is some variability in how youth violence prevention programs are classified within these dimensions.

One of the most important advances in the field of prevention over the last 25 years has involved methodological advances in evaluation of preventive interventions. Substantial progress has been made in the development of methods to evaluate the effects of prevention programs; these advances have resulted in the ability to determine whether a prevention program works to prevent violence, for whom, and under what conditions. This information has filled critical gaps in our understanding of the effectiveness of prevention programs; it can inform decisions about how to implement evidence-based prevention programs in communities. A number of prevention programs have been rigorously evaluated, and many programs have demonstrated a significant impact in reducing violence and its associated risk factors. These advances give us greater confidence that violence can be addressed if evidence-based programs and strategies are widely implemented in communities.

One of the challenges to adoption of evidence-based programs in communities is that the literature on what works to prevent violence is fragmented. Rigorous evaluations of prevention programs are represented in a variety of disciplines and contexts. Another challenge to widespread adoption is the sheer volume of research evaluating prevention programs. It is difficult for practitioners, policymakers, and those who have the opportunity to select and implement evidence-based programs in communities to be able to interpret a varied and complex literature.

In addressing the issue of “what works,” systematic reviews and meta-analyses can provide critical information that synthesizes findings across evaluation studies. Systematic reviews and meta-analyses summarize findings and address possible inconsistencies in the literature. They constitute a critical step in the efforts to identify effective strategies in prevention. Most systematic reviews and meta-analyses include reviews of evaluation studies of single programs (e.g., ⁎Chan et al., 2004, ⁎Lipsey, 1992). Often, such reviews address specific categories of programs, or strategies. For example, reviews have examined the effectiveness of school-based programs (Wilson & Lipsey, 2007). This information is valuable for understanding the extent to which programs within those strategies are effective. However, some argue that in order to reduce violence in communities, comprehensive strategies that include multiple programs are necessary. Research indicates that prevention activities should attend to the accumulation of risk factors across multiple levels of the social ecology. While it is important to pay attention to individual- and relationship-level factors (e.g., early aggressive behavior, parental influences, and affiliation with delinquent peers), attention to the larger role sociocultural, economic, and community factors play in the development of youth violence is critical, particularly when attempting to generate community-wide impacts. Comprehensive prevention approaches have the potential to reduce risk factors and to enhance protective factors at the individual, relationship, and community levels.

Comprehensive approaches can be supported by identifying strategies or categories of programs that are effective in preventing violence. For communities to engage in strategic planning efforts to select evidence-based programs, they need information about the different types of programs that are effective. For the purpose of this paper, we use the term strategies to refer to categories of programs that use similar approaches, address similar risk factors, and/or use similar “delivery systems.” Information about the effectiveness of strategies can provide guidance to communities about the types of programs they should consider in their planning efforts. Additionally, summarizing research on the effectiveness of strategies imposes some structure to a diverse literature, in that it organizes findings across evaluations of different types of programs and approaches.

The present study involves a meta-review of the effectiveness of strategies in preventing violence. Similar to meta-analyses and systematic reviews, the purpose of a meta-review is to synthesize information across studies. In the case of a meta-review, the studies synthesized are systematic reviews and meta-analyses. Meta-reviews summarize the commonalities and differences in the major findings and conclusions of the included reviews. To date, three meta-reviews exist in fields related to youth violence (Green et al., 2005, Kumpfer and Alvarado, 2003, Nation et al., 2003). However, these meta-reviews focused only on programs specifically developed for emotional and mental health outcomes (Green et al., 2005), family-based approaches (Kumpfer & Alvarado, 2003), or simply identified program characteristics that were associated with effective prevention programs (Nation et al., 2003). To date, no meta-reviews have included the full range of programs that are intended to prevent youth violence; additionally, no meta-reviews have used both quantitative and qualitative approaches. Given the number of meta-analyses and systematic reviews currently available in the field of youth violence prevention, taking stock of this literature using both quantitative and qualitative approaches can inform: (a) the range of violence prevention strategies that have been addressed by meta-analyses and reviews; (b) the range of program effects; (c) the range in study quality among these research studies; and (d) the moderators of program effect sizes.

The goal of this study was to conduct a meta-review of evaluations of behavioral and psychosocial approaches to prevent youth violence, using both quantitative and qualitative approaches, in order to describe the state of the field in evidence-based youth violence prevention. This meta-review summarized findings across reviews organized by strategy: treatment-specific, family-based, school-based, and community-based prevention strategies. Treatment-specific approaches include programs such as cognitive-behavioral therapy and social skills training that focus on children and adolescents in both clinical and school settings (e.g., Nangle, Erdley, Carpenter, & Newman, 2002). Family-based approaches aim to strengthen the relationships that children and youth have with their family members and also include improving parents' skills for managing child behaviors. An example of such a program is behavioral parent training (e.g., McCart, Priester, Davies, & Azen, 2006). School-based programs occur within school settings and focus on individual children, groups of children, or their peers (e.g., Powell et al., 1995, Wheeler et al., 2010). Finally, community-based approaches are those programs that occur outside of the family and school context and include things like mentoring and wilderness challenge programs (e.g., ⁎DuBois et al., 2002, ⁎Wilson and Lipsey, 2000). Another goal of this meta-review was to identify promising youth violence prevention strategies that are significantly related to reducing violence and related behaviors at each level of the social ecology and by prevention strategy (i.e., treatment-specific, family-based, school-based, and community-based programs).

Section snippets

Search

A systematic search was conducted for all meta-analyses and systematic reviews of youth violence-related prevention programs. First, a list of keywords was generated to search scholarly databases. Keywords were derived from seminal articles in the youth violence literature (e.g., Wilson & Lipsey, 2007), and included terms such as: youth violence, aggression, delinquency, fighting, crime, prevention, intervention, and evaluation.1

General description of sample studies

The 52 reviews included in the current study captured a range of youth violence-related outcomes, including general youth violence (e.g., physical assault, weapon carrying, etc.), externalizing behaviors, criminal activity, aggression, and antisocial behavior. For the purpose of this meta-review, the term youth violence is used to describe all of these outcomes, making note of when meta-analyses or reviews used narrower definitions of youth violence. The reviews included a mean of 65.63 studies

Discussion

The goal of this study was to conduct a systematic meta-review of evaluations of behavioral and psychosocial approaches to prevent youth violence. Another goal was to identify promising youth violence prevention strategies that were significantly related to violence and related behaviors at each level of the social ecology and by prevention approach (i.e., treatment-specific, family-based, school-based, and community-based programs). Six meta-analyses and systematic reviews found strong program

Acknowledgments

The authors would like to thank Kathryn A. Brookmeyer for her contribution to the qualitative database used in the study.

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