Efficacy of Interventions to Prevent Physical and Sexual Dating Violence Among Adolescents: A Systematic Review and Meta-analysis | Adolescent Medicine | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Efficacy of Interventions to Prevent Physical and Sexual Dating Violence Among AdolescentsA Systematic Review and Meta-analysis

Educational Objective To evaluate the efficacy of interventions in reducing physical and sexual violence in adolescents' dating relationships.
1 Credit CME
Key Points

Question  What is the efficacy of prevention programs for physical and sexual teen dating violence?

Findings  In this systematic review and meta-analysis of 18 trials including 22 781 adolescents, the implementation of interventions targeting dating violence among adolescents was associated with a significant reduction in overall physical and sexual violence. However, when examined as separate outcomes, a significant reduction was found for physical violence only.

Meaning  Prevention programs may be effective in reducing physical dating violence among adolescents; unclear evidence on sexual violence outcomes highlights the need for further research studies.


Importance  Sexual and physical dating violence is prevalent among adolescents and is associated with adverse health effects.

Objective  To conduct a systematic review and meta-analysis of randomized clinical trials to assess the efficacy of prevention programs for sexual and physical dating violence in adolescents.

Data Sources  Search terms were combined for dating violence, adolescents, and randomized clinical trials in PsycINFO/Eric/PsycArticles, PubMed, and Web of Science databases from inception through April 2021.

Study Selection  Included studies had a randomized design of any type examining the efficacy of an intervention to reduce dating violence among adolescents and provided at least 1 measure of sexual or physical dating violence.

Data Extraction and Synthesis  Data extraction coded characteristics of trials, participants, and interventions and assessed risk of bias using the Revised Cochrane Collaboration Risk of Bias tool. Outcomes were pooled using a random-effects model. Subgroup and meta-regression analyses were performed to explore the target population and intervention factors associated with positive outcomes.

Main Outcomes and Measures  The odds ratio (OR) was calculated for 3 different outcomes: (1) sexual dating violence, (2) physical dating violence, and (3) composite measures of sexual and physical dating violence. For each outcome, separate analyses were conducted for survivorship and perpetration scores. We also combined the scores of physical/sexual violence and perpetration/survivorship of teen dating violence into a single composite overall outcome including all studies.

Results  Eighteen trials (22 781 adolescents) were included. Overall, interventions were associated with reduced physical and sexual dating violence (OR, 0.78; 95% CI, 0.69-0.89; P < .001). Separate analyses further indicated that this association was significant for physical violence perpetration (OR, 0.74; 95% CI, 0.59-0.92; P = .01) and survivorship (OR, 0.78; 95% CI, 0.64-0.95; P = .01). For sexual violence, the association was not statistically significant. Exploratory subgroup analyses revealed that trials targeting at-risk youth, older adolescents (age >15 years), and trials involving parents in the intervention reported significantly larger effect sizes. Meta-regression analyses did not show any significant associations between intervention effect sizes and length or intensity of the programs. Publication bias was observed, but the adjusted ORs remained significant. Three studies reported iatrogenic associations.

Conclusions and Relevance  Findings from this study suggest that prevention programs may be effective in reducing physical teen dating violence, but there is unclear evidence of the effect on sexual violence outcomes. Further research assessing the active ingredients of interventions, especially in the area of sexual dating violence, is warranted.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Antonio Piolanti, PhD, Health Psychology Unit, Institute of Psychology, Universität Klagenfurt, Universitätsstraße 65-67, 9020 Klagenfurt, Austria (antonio.piolanti@aau.at).

Accepted for Publication: September 7, 2021.

Published Online: November 29, 2021. doi:10.1001/jamapediatrics.2021.4829

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Piolanti A et al. JAMA Pediatrics.

Author Contributions: Dr Piolanti had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Both authors.

Acquisition, analysis, or interpretation of data: Both authors.

Drafting of the manuscript: Piolanti.

Critical revision of the manuscript for important intellectual content: Foran.

Statistical analysis: Piolanti.

Obtained funding: Foran.

Administrative, technical, or material support: Both authors.

Supervision: Foran.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by the Faculty of Cultural Studies and the Public Health Research Cluster of the University of Klagenfurt.

Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank Tina Albert, MSc (University of Klagenfurt), for conducting the second screening and selection of studies, and Isabelle Perle, MSc (University of Klagenfurt), for performing the second independent data extraction. Compensation outside of standard salary was not received.

Wincentak  K , Connolly  J , Card  N.   Teen dating violence: a meta-analytic review of prevalence rates.   Psychol Violence. 2017;7:224-241. doi:10.1037/a0040194Google ScholarCrossref
Stöckl  H , March  L , Pallitto  C , Garcia-Moreno  C ; WHO Multi-country Study Team.  Intimate partner violence among adolescents and young women: prevalence and associated factors in nine countries: a cross-sectional study.   BMC Public Health. 2014;14:751. doi:10.1186/1471-2458-14-751PubMedGoogle ScholarCrossref
Vagi  KJ , O’Malley Olsen  E , Basile  KC , Vivolo-Kantor  AM .  Teen dating violence (physical and sexual) among US high school students: findings from the 2013 National Youth Risk Behavior Survey.   JAMA Pediatr. 2015;169(5):474-482. doi:10.1001/jamapediatrics.2014.3577PubMedGoogle ScholarCrossref
Centers for Disease Control and Prevention. Preventing teen dating violence. Updated March 5, 2021. Accessed March 23, 2021. https://www.cdc.gov/violenceprevention/intimatepartnerviolence/teendatingviolence/fastfact.html
Exner-Cortens  D , Eckenrode  J , Rothman  E .  Longitudinal associations between teen dating violence victimization and adverse health outcomes.   Pediatrics. 2013;131(1):71-78. doi:10.1542/peds.2012-1029PubMedGoogle ScholarCrossref
Silverman  JG , Raj  A , Mucci  LA , Hathaway  JE .  Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behavior, pregnancy, and suicidality.   JAMA. 2001;286(5):572-579. doi:10.1001/jama.286.5.572PubMedGoogle ScholarCrossref
Carroll  BC , Raj  A , Noel  SE , Bauchner  H .  Dating violence among adolescents presenting to a pediatric emergency department.   Arch Pediatr Adolesc Med. 2011;165(12):1101-1106. doi:10.1001/archpediatrics.2011.191PubMedGoogle ScholarCrossref
Olshen  E , McVeigh  KH , Wunsch-Hitzig  RA , Rickert  VI .  Dating violence, sexual assault, and suicide attempts among urban teenagers.   Arch Pediatr Adolesc Med. 2007;161(6):539-545. doi:10.1001/archpedi.161.6.539PubMedGoogle ScholarCrossref
Adhia  A , Kernic  MA , Hemenway  D , Vavilala  MS , Rivara  FP .  Intimate partner homicide of adolescents.   JAMA Pediatr. 2019;173(6):571-577. doi:10.1001/jamapediatrics.2019.0621PubMedGoogle ScholarCrossref
Roberts  TA , Klein  J .  Intimate partner abuse and high-risk behavior in adolescents.   Arch Pediatr Adolesc Med. 2003;157(4):375-380. doi:10.1001/archpedi.157.4.375PubMedGoogle ScholarCrossref
Kann  L , McManus  T , Harris  WA ,  et al.  Youth risk behavior surveillance: United States, 2017.   MMWR Surveill Summ. 2018;67(8):1-114. doi:10.15585/mmwr.ss6708a1PubMedGoogle ScholarCrossref
McNaughton Reyes  HL , Graham  LM , Chen  MS ,  et al.  Adolescent dating violence prevention programmes: a global systematic review of evaluation studies.   Lancet Child Adolesc Health. 2021;5(3):223-232. doi:10.1016/S2352-4642(20)30276-5PubMedGoogle ScholarCrossref
Moher  D , Liberati  A , Tetzlaff  J , Altman  DG ; PRISMA Group.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.   J Clin Epidemiol. 2009;62(10):1006-1012. doi:10.1016/j.jclinepi.2009.06.005PubMedGoogle ScholarCrossref
Fellmeth  GL , Heffernan  C , Nurse  J , Habibula  S , Sethi  D .  Educational and skills-based interventions for preventing relationship and dating violence in adolescents and young adults.   Cochrane Database Syst Rev. 2013;(6):CD004534.PubMedGoogle Scholar
De La Rue  L , Polanin  JR , Espelage  DL , Pigott  TD .  A Meta-analysis of school-based interventions aimed to prevent or reduce violence in teen dating relationships.   Rev Educ Res. 2017;87:7-34. doi:10.3102/0034654316632061Google ScholarCrossref
Edwards  SR , Hinsz  VB .  A meta-analysis of empirically tested school-based dating violence prevention programs.   SAGE Open. 2014;4:1-8. doi:10.1177/2158244014535787Google ScholarCrossref
Russell  KN , Voith  LA , Lee  H .  Randomized controlled trials evaluating adolescent dating violence prevention programs with an outcome of reduced perpetration and/or victimization: a meta-analysis.   J Adolesc. 2021;87:6-14. doi:10.1016/j.adolescence.2020.12.009PubMedGoogle ScholarCrossref
Sterne  JAC , Savović  J , Page  MJ ,  et al.  RoB 2: a revised tool for assessing risk of bias in randomised trials.   BMJ. 2019;366:l4898. doi:10.1136/bmj.l4898PubMedGoogle Scholar
Borenstein  M , Hedges  LV , Higgins  JPT , Rothstein  HR .  Introduction to Meta-Analysis. Wiley; 2009. doi:10.1002/9780470743386
Rücker  G , Cates  CJ , Schwarzer  G .  Methods for including information from multi-arm trials in pairwise meta-analysis.   Res Synth Methods. 2017;8(4):392-403. doi:10.1002/jrsm.1259PubMedGoogle ScholarCrossref
Higgins  JPT , Thompson  SG .  Quantifying heterogeneity in a meta-analysis.   Stat Med. 2002;21(11):1539-1558. doi:10.1002/sim.1186PubMedGoogle ScholarCrossref
Deeks  JJ , Higgins  JPT , Altman  DG . Analysing data and undertaking meta-analyses. In: Higgins J, Thomas J, eds.  Cochrane Handbook for Systematic Reviews of Interventions.
Egger  M , Davey Smith  G , Schneider  M , Minder  C .  Bias in meta-analysis detected by a simple, graphical test.   BMJ. 1997;315(7109):629-634. doi:10.1136/bmj.315.7109.629PubMedGoogle ScholarCrossref
Duval  S , Tweedie  R .  Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis.   Biometrics. 2000;56(2):455-463. doi:10.1111/j.0006-341X.2000.00455.xPubMedGoogle ScholarCrossref
Foshee  VA , Bauman  KE , Ennett  ST , Suchindran  C , Benefield  T , Linder  GF .  Assessing the effects of the dating violence prevention program “safe dates” using random coefficient regression modeling.   Prev Sci. 2005;6(3):245-258. doi:10.1007/s11121-005-0007-0PubMedGoogle ScholarCrossref
Foshee  VA , McNaughton Reyes  HL , Ennett  ST , Cance  JD , Bauman  KE , Bowling  JM .  Assessing the effects of Families for Safe Dates, a family-based teen dating abuse prevention program.   J Adolesc Health. 2012;51(4):349-356. doi:10.1016/j.jadohealth.2011.12.029PubMedGoogle ScholarCrossref
Gonzalez-Guarda  RM , Guerra  JE , Cummings  AA , Pino  K , Becerra  MM .  Examining the preliminary efficacy of a dating violence prevention program for Hispanic adolescents.   J Sch Nurs. 2015;31(6):411-421. doi:10.1177/1059840515598843PubMedGoogle ScholarCrossref
Joppa  MC , Rizzo  CJ , Nieves  AV , Brown  LK .  Pilot investigation of the Katie Brown educational program: a school-community partnership.   J Sch Health. 2016;86(4):288-297. doi:10.1111/josh.12378PubMedGoogle ScholarCrossref
Langhinrichsen-Rohling  J , Turner  LA .  The efficacy of an intimate partner violence prevention program with high-risk adolescent girls: a preliminary test.   Prev Sci. 2012;13(4):384-394. doi:10.1007/s11121-011-0240-7PubMedGoogle ScholarCrossref
Levesque  DA , Johnson  JL , Welch  CA , Prochaska  JM , Paiva  AL .  Teen dating violence prevention: cluster-randomized trial of Teen Choices, an online, stage-based program for healthy, nonviolent relationships.   Psychol Violence. 2016;6(3):421-432. doi:10.1037/vio0000049PubMedGoogle ScholarCrossref
Miller  E , Tancredi  DJ , McCauley  HL ,  et al.  “Coaching boys into men”: a cluster-randomized controlled trial of a dating violence prevention program.   J Adolesc Health. 2012;51(5):431-438. doi:10.1016/j.jadohealth.2012.01.018PubMedGoogle ScholarCrossref
Miller  E , Goldstein  S , McCauley  HL ,  et al.  A school health center intervention for abusive adolescent relationships: a cluster RCT.   Pediatrics. 2015;135(1):76-85. doi:10.1542/peds.2014-2471PubMedGoogle ScholarCrossref
Miller  E , Jones  KA , Culyba  AJ ,  et al.  Effect of a community-based gender norms program on sexual violence perpetration by adolescent boys and young men: a cluster randomized clinical trial.   JAMA Netw Open. 2020;3(12):e2028499. doi:10.1001/jamanetworkopen.2020.28499PubMedGoogle Scholar
Peskin  MF , Markham  CM , Shegog  R , Baumler  ER , Addy  RC , Tortolero  SR .  Effects of the It’s Your Game . . . Keep It Real program on dating violence in ethnic-minority middle school youths: a group randomized trial.   Am J Public Health. 2014;104(8):1471-1477. doi:10.2105/AJPH.2014.301902PubMedGoogle ScholarCrossref
Peskin  MF , Markham  CM , Shegog  R ,  et al.  Adolescent dating violence prevention program for early adolescents: The Me & You randomized controlled trial, 2014-2015.   Am J Public Health. 2019;109(10):1419-1428. doi:10.2105/AJPH.2019.305218PubMedGoogle ScholarCrossref
Rizzo  CJ , Joppa  M , Barker  D , Collibee  C , Zlotnick  C , Brown  LK .  Project Date SMART: a dating violence (DV) and sexual risk prevention program for adolescent girls with prior DV exposure.   Prev Sci. 2018;19(4):416-426. doi:10.1007/s11121-018-0871-zPubMedGoogle ScholarCrossref
Rothman  EF , Stuart  GL , Heeren  T , Paruk  J , Bair-Merritt  M .  The effects of a health care-based brief intervention on dating abuse perpetration: results of a randomized controlled trial.   Prev Sci. 2020;21(3):366-376. doi:10.1007/s11121-019-01054-wPubMedGoogle ScholarCrossref
Sánchez-Jiménez  V , Muñoz-Fernández  N , Ortega-Rivera  J .  Efficacy evaluation of “Dat-e Adolescence”: a dating violence prevention program in Spain.   PLoS One. 2018;13(10):e0205802. doi:10.1371/journal.pone.0205802PubMedGoogle Scholar
Taylor  G , Stein  N , Burden  FF .  Exploring gender differences in dating violence/harassment prevention programming in middle schools: results from a randomized experiment.   J Exp Criminol. 2010;6:419-445. doi:10.1007/s11292-010-9103-7Google ScholarCrossref
Taylor  BG , Stein  ND , Mumford  EA , Woods  D .  Shifting boundaries: an experimental evaluation of a dating violence prevention program in middle schools.   Prev Sci. 2013;14(1):64-76. doi:10.1007/s11121-012-0293-2PubMedGoogle ScholarCrossref
Wolfe  DA , Wekerle  C , Scott  K , Straatman  AL , Grasley  C , Reitzel-Jaffe  D .  Dating violence prevention with at-risk youth: a controlled outcome evaluation.   J Consult Clin Psychol. 2003;71(2):279-291. doi:10.1037/0022-006X.71.2.279PubMedGoogle ScholarCrossref
Wolfe  DA , Crooks  C , Jaffe  P ,  et al.  A school-based program to prevent adolescent dating violence: a cluster randomized trial.   Arch Pediatr Adolesc Med. 2009;163(8):692-699. doi:10.1001/archpediatrics.2009.69PubMedGoogle ScholarCrossref
Foshee  VA , Benefield  T , Dixon  KS ,  et al.  The effects of moms and teens for safe dates: a dating abuse prevention program for adolescents exposed to domestic violence.   J Youth Adolesc. 2015;44(5):995-1010. doi:10.1007/s10964-015-0272-6PubMedGoogle ScholarCrossref
Olivier  J , Bell  ML .  Effect sizes for 2×2 contingency tables.   PLoS One. 2013;8(3):e58777. doi:10.1371/journal.pone.0058777PubMedGoogle Scholar
DeGue  S , Valle  LA , Holt  MK , Massetti  GM , Matjasko  JL , Tharp  AT .  A systematic review of primary prevention strategies for sexual violence perpetration.   Aggress Violent Behav. 2014;19(4):346-362. doi:10.1016/j.avb.2014.05.004PubMedGoogle ScholarCrossref
Velleman  RD , Templeton  LJ , Copello  AG .  The role of the family in preventing and intervening with substance use and misuse: a comprehensive review of family interventions, with a focus on young people.   Drug Alcohol Rev. 2005;24(2):93-109. doi:10.1080/09595230500167478PubMedGoogle ScholarCrossref
Sutton  MY , Lasswell  SM , Lanier  Y , Miller  KS .  Impact of parent-child communication interventions on sex behaviors and cognitive outcomes for black/African-American and Hispanic/Latino youth: a systematic review, 1988-2012.   J Adolesc Health. 2014;54(4):369-384. doi:10.1016/j.jadohealth.2013.11.004PubMedGoogle ScholarCrossref
Miller  S , Gorman-Smith  D , Sullivan  T , Orpinas  P , Simon  TR .  Parent and peer predictors of physical dating violence perpetration in early adolescence: tests of moderation and gender differences.   J Clin Child Adolesc Psychol. 2009;38(4):538-550. doi:10.1080/15374410902976270PubMedGoogle ScholarCrossref
Chase  KA , Treboux  D , O’Leary  KD .  Characteristics of high-risk adolescents’ dating violence.   J Interpers Violence. 2002;17:33-49. doi:10.1177/0886260502017001003Google ScholarCrossref
Rothman  EF , Miller  E , Terpeluk  A , Glauber  A , Randel  J .  The proportion of U.S. parents who talk with their adolescent children about dating abuse.   J Adolesc Health. 2011;49(2):216-218. doi:10.1016/j.jadohealth.2011.05.005PubMedGoogle ScholarCrossref
Skeen  S , Laurenzi  CA , Gordon  SL ,  et al.  Adolescent mental health program components and behavior risk reduction: a meta-analysis.   Pediatrics. 2019;144(2):e20183488. doi:10.1542/peds.2018-3488PubMedGoogle Scholar
Fraguas  D , Díaz-Caneja  CM , Ayora  M ,  et al.  Assessment of school anti-bullying interventions: a meta-analysis of randomized clinical trials.   JAMA Pediatr. 2021;175(1):44-55. doi:10.1001/jamapediatrics.2020.3541PubMedGoogle ScholarCrossref
Flay  BR , Graumlich  S , Segawa  E , Burns  JL , Holliday  MY ; Aban Aya Investigators.  Effects of 2 prevention programs on high-risk behaviors among African American youth: a randomized trial.   Arch Pediatr Adolesc Med. 2004;158(4):377-384. doi:10.1001/archpedi.158.4.377PubMedGoogle ScholarCrossref
Fernández-González  L , Calvete  E , Orue  I .  Adolescent dating violence stability and mutuality: a 4-year longitudinal study.   J Interpers Violence. 2020;35(9-10):2012-2032. doi:10.1177/0886260517699953PubMedGoogle ScholarCrossref
Mumford  EA , Liu  W , Taylor  BG .  Longitudinal trajectories of perpetration of adolescent dating abuse in a national sample.   Aggress Behav. 2019;45(3):327-336. doi:10.1002/ab.21822PubMedGoogle ScholarCrossref
Niolon  PH , Vivolo-Kantor  AM , Tracy  AJ ,  et al.  An RCT of dating matters: effects on teen dating violence and relationship behaviors.   Am J Prev Med. 2019;57(1):13-23. doi:10.1016/j.amepre.2019.02.022PubMedGoogle ScholarCrossref
Welsh  BC , Yohros  A , Zane  SN .  Understanding iatrogenic effects for evidence-based policy: a review of crime and violence prevention programs.   Aggress Violent Behav. 2020;55:101511. doi:10.1016/j.avb.2020.101511Google Scholar
Leen  E , Sorbring  E , Mawer  M , Holdsworth  E , Helsing  B , Bowen  E .  Prevalence, dynamic risk factors and the efficacy of primary interventions for adolescent dating violence: an international review.   Aggress Violent Behav. 2013;18:159-174. doi:10.1016/j.avb.2012.11.015Google ScholarCrossref
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience

Lookup An Activity



My Saved Searches

You currently have no searches saved.


My Saved Courses

You currently have no courses saved.

With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right