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School-Based Violence Prevention Programs
Systematic Review of Secondary Prevention Trials
Julie A. Mytton, MBBS, MRCGP, MSc;
Carolyn DiGuiseppi, MD, MPH;
David A. Gough, PhD;
Rod S. Taylor, MSc, PhD;
Stuart Logan, MSc, MRCP
Arch Pediatr Adolesc Med. 2002;156:752-762.
Objective To quantify the effectiveness of school-based violence prevention programs
for children identified as at risk for aggressive behavior.
Design Systematic review and meta-analysis of randomized controlled trials.
Electronic databases and bibliographies were systematically searched and authors
and organizations were contacted to identify randomized controlled trials.
Standardized, weighted mean effect sizes were assessed by meta-analysis.
Setting Elementary, middle, and high schools.
Participants Children at risk for aggressive behavior.
Main Outcome Measures Violent injuries, observed or reported aggressive or violent behaviors,
and school or agency responses to aggressive behaviors.
Results Of the 44 trials identified, none reported data on violent injuries.
For the 28 trials that assessed aggressive behaviors, the pooled difference
between study groups was -0.36 (95% confidence interval, -0.54
to -0.19) in favor of a reduction in aggression with intervention. For
the 9 trials that reported data on school or agency responses to aggression,
the pooled difference was -0.59 (95% confidence interval, -1.18
to 0.01). Subgroup analyses suggested greater effectiveness in older students
and when administered to mixed-sex groups rather than to boys alone.
Conclusions School-based violence prevention programs may produce reductions in
aggressive and violent behaviors in children who already exhibit such behavior.
These results, however, need to be confirmed in large, high-quality trials.
From the Department of Paediatric Epidemiology and Biostatistics (Drs
Mytton and DiGuiseppi) and Systematic Reviews Training Unit (Dr Logan), Institute
of Child Health, Social Science Research Unit (Dr Gough), and National Institute
for Clinical Excellence (Dr Taylor), London, England. Dr Mytton is now with
the Department of Public Health, Oldham Primary Care Trust, Oldham, England.
Dr DiGuiseppi is now with the Department of Preventive Medicine and Biometrics,
University of Colorado Health Sciences Center, Denver. Dr Taylor is now with
the Department of Public Health and Epidemiology, University of Birmingham,
Edgbaston, England.
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