Andra Teten Tharp

Beyond correlates: a review of risk and protective factors for adolescent dating violence perpetration.

Dating violence is a serious public health problem. In recent years, the U.S. Centers for Disease Control and Prevention and other entities have made funding available to community based agencies for dating violence prevention. Practitioners who are tasked with developing dating violence prevention strategies should pay particular attention to risk and protective factors for dating violence perpetration that have been established in longitudinal studies. This has been challenging to date because the scientific literature on the etiology of dating violence is somewhat limited, and because there have been no comprehensive reviews of the literature that clearly distinguish correlates of dating violence perpetration from risk or protective factors that have been established through longitudinal research. This is problematic because prevention programs may then target factors that are merely correlated with dating violence perpetration, and have no causal influence, which could potentially limit the effectiveness of the programs. In this article, we review the literature on risk and protective factors for adolescent dating violence perpetration and highlight those factors for which temporal precedence has been established by one or more studies. This review is intended as a guide for researchers and practitioners as they formulate prevention programs. We reviewed articles published between 2000 and 2010 that reported on adolescent dating violence perpetration using samples from the United States or Canada. In total, 53 risk factors and six protective factors were identified from 20 studies. Next steps for etiological research in adolescent dating violence are discussed, as well as future directions for prevention program developers.

A systematic review of primary prevention strategies for sexual violence perpetration

This systematic review examined 140 outcome evaluations of primary prevention strategies for sexual violence perpetration. The review had two goals: 1) to describe and assess the breadth, quality, and evolution of evaluation research in this area; and 2) to summarize the best available research evidence for sexual violence prevention practitioners by categorizing programs with regard to their evidence of effectiveness on sexual violence behavioral outcomes in a rigorous evaluation. The majority of sexual violence prevention strategies in the evaluation literature are brief, psycho-educational programs focused on increasing knowledge or changing attitudes, none of which have shown evidence of effectiveness on sexually violent behavior using a rigorous evaluation design. Based on evaluation studies included in the current review, only three primary prevention strategies have demonstrated significant effects on sexually violent behavior in a rigorous outcome evaluation: Safe Dates (Foshee et al., 2004); Shifting Boundaries (building-level intervention only, Taylor, Stein, Woods, Mumford, & Forum, 2011); and funding associated with the 1994 U.S. Violence Against Women Act (VAWA; Boba & Lilley, 2009). The dearth of effective prevention strategies available to date may reflect a lack of fit between the design of many of the existing programs and the principles of effective prevention identified by Nation et al. (2003).

A Systematic Qualitative Review of Risk and Protective Factors for Sexual Violence Perpetration

The current review summarized results of 191 published empirical studies that examined the risk and protective factors for sexual violence perpetration. Studies in the review examined factors for perpetration by and against adolescents and adults, by male and female perpetrators, and by those who offended against individuals of the same sex or opposite sex. Factors associated with child sexual abuse (CSA) perpetration were not included. In all, 2 societal and community factors, 23 relationship factors, and 42 individual-level factors were identified. Of these 67 factors, consistent significant support for their association with SV was found for 35, nonsignificant effects were found for 10, 7 factors had limited or sample-specific evidence that they were associated with SV but were in need of further study, and 15 demonstrated mixed results. The factors identified in the review underscore the need for comprehensive prevention programs that target multiple risk and protective factors as well as factors that occur across the social ecology. Moreover, we identified two domains of factors—the presence and acceptance of violence and unhealthy sexual behaviors, experiences, or attitudes—that had consistent significant associations with SV but are not typically addressed in prevention programs. Therefore, SV prevention may also benefit from learning from effective strategies in other areas of public health, namely sexual health and youth violence prevention.

New tricks for an old measure: The development of the Barratt Impulsiveness Scale-Brief (BIS-Brief)

The Barratt Impulsivity Scale (BIS), a 30-item self-report measure, is one of the most commonly used scales for the assessment of the personality construct of impulsiveness. It has recently marked 50 years of use in research and clinical settings. The current BIS-11 is held to measure 3 theoretical subtraits, namely, attentional, motor, and non-planning impulsiveness. We evaluated the factor structure of the BIS using full information item bifactor analysis for Likert-type items. We found no evidence supporting the 3-factor model. In fact, half of the items do not share any relation with other items and do not form any factor. In light of this, we introduce a unidimensional Barratt Impulsiveness Scale-Brief (BIS-Brief) that includes 8 of the original BIS-11 items. Next, we present evidence of construct validity comparing scores obtained with the BIS-Brief against the original BIS total scores using data from (a) a community sample of borderline personality patients and normal controls, (b) a forensic sample, and (c) an inpatient sample of young adults and adolescents. We demonstrated similar indices of construct validity that is observed for the BIS-11 total score with the BIS-Brief score. Use of the BIS-Brief in clinical assessment settings and large epidemiological studies of psychiatric disorders will reduce the burden on respondents without loss of information.

Looking Ahead Toward Community-Level Strategies to Prevent Sexual Violence

The Division of Violence Prevention within CDCs National Center for Injury Prevention and Control recently undertook a systematic review of primary prevention strategies for sexual violence (SV) perpetration. This review identified the lack of community-level strategies to prevent SV as a critical gap in the literature. Community-level strategies function by modifying the characteristics of settings (e.g., schools, workplaces, neighborhoods) that increase the risk for violence victimization and perpetration. Identification of evidence-based strategies at the community level would allow implementation of ecologic approaches to SV prevention with a greater potential for reducing the prevalence of SV perpetration. The field will face several challenges in identifying and evaluating the effectiveness of promising community-level strategies to prevent SV. These challenges include limited knowledge of community-level and societal-level risk factors for SV, a lack of theoretical or empirical guidance in the SV literature for identification of promising community-level approaches, and challenges in evaluating SV outcomes at the community level. Recognition of these challenges should guide future research and foster dialogue within the SV prevention field. The development and evaluation of community-level approaches to SV prevention represent a vital and logical next step toward the implementation of effective, multilevel prevention efforts and a population-level reduction in the prevalence of SV.

Dating Matters™: Strategies to Promote Healthy Teen Relationships

Teen dating violence (TDV) is a preventable public health problem that has negative consequences for youth. Despite evidence that youth in urban communities with high crime and economic disadvantage may be at particularly high risk for TDV, little work has specifically addressed TDV in these communities. The Centers for Disease Control and Prevention (CDC) has developed a comprehensive approach to prevent TDV-Dating Matters™: Strategies to Promote Healthy Teen Relationships-that addresses gaps in research and practice. This Report from CDC describes the programmatic activities, implementation support, evaluation, and surveillance of the Dating Matters™ initiative, which will be implemented in four urban communities.

High rates of burnout among maternal health staff at a referral hospital in Malawi: A cross-sectional study

BackgroundBurnout among maternal healthcare workers in sub-Saharan Africa may have a negative effect on services provided and efforts to mitigate high maternal mortality rates. In Malawi, research on burnout is limited and no empirical research has been conducted specifically among maternal health staff. Therefore, the aims of the study were to examine the prevalence and degree of burnout reported by healthcare workers who provide antenatal, intrapartum, and postnatal services in a district referral hospital in Malawi; and, to explore factors that may influence the level of burnout healthcare workers experience.MethodsIn the current cross-sectional study, levels of burnout among staff working in obstetrics and gynaecology at a referral hospital in Malawi were examined, in addition to individual and job characteristics that may be associated with burnout.ResultsIn terms of the three dimensions of burnout, of the 101 participants, nearly three quarters (72%) reported emotional exhaustion, over one third (43%) reported depersonalization while almost three quarters (74%) experienced reduced personal accomplishment.ConclusionsBased on these findings, burnout appears to be common among participating maternal health staff and they experienced more burnout than their colleagues working in other medical settings and countries. Further research is needed to identify factors specific to Malawi that contribute to burnout in order to inform the development of prevention and treatment within the maternal health setting.

Prevalence of teen dating violence and co-occurring risk factors among middle school youth in high-risk urban communities

PURPOSE This study describes the lifetime prevalence of teen dating violence (TDV) perpetration in a sample of middle school students from high-risk urban communities and examines the relation between TDV and related cognitive and behavioral risk factors. METHODS Surveys were administered to 2,895 middle school students in four U.S. cities; 1,673 students (58%) reported having dated and were included in analyses. The sample was 52.3% female, 48.2% non-Hispanic black/African-American, 38.2% Hispanic, 4.8% non-Hispanic white, and 7.6% other race. Six types of TDV perpetration were assessed: threatening behaviors, verbal/emotional abuse, relational abuse, physical abuse, sexual abuse, and stalking. RESULTS Of the students who had dated, 77% reported perpetrating verbal/emotional abuse, 32% reported perpetrating physical abuse, 20% reported threatening a partner, 15% reported perpetrating sexual abuse, 13% reported perpetrating relational abuse, and 6% reported stalking. Girls were more likely than boys to report perpetrating threatening behaviors, verbal/emotional abuse, and physical abuse, and boys were more likely to report perpetrating sexual abuse. Involvement in bullying positively predicted perpetration of TDV, albeit, in different ways for boys and girls. Other risk factors differed by sex. For instance, alcohol use and sex initiation predicted multiple forms of TDV perpetration for boys, whereas weapon carrying and emotional symptoms predicted several forms of TDV perpetration for girls. CONCLUSIONS The prevalence of TDV was high in our sample. Important sex differences in rates of perpetration and risk factors emerged. Comprehensive prevention programs that target TDV and related risk factors, such as bullying and other risk factors, seem warranted.

Dating Matters™: The Next Generation of Teen Dating Violence Prevention

This Special Section was introduced with the assertion that most programs, to date, have been ineffective in preventing intimate partner violence (IPV) and teen dating violence (TDV) because they do not take into account recent work about the development and nature of IPV/TDV (Capaldi and Langhinrichsen-Rohling 2012). Each contribution highlighted dimensions of relationship functioning that can be used to inform the development of prevention programs. The findings in this issue underscore the importance of considering the independent and interactive effects of risk factors occurring at each level of the social ecology, such as alcohol use (Reyes et al. 2012) and violence in the home (Ehrensaft and Cohen 2012), as well as the importance of developing prevention strategies for high-risk groups (Langhinrichsen-Rohling and Turner 2012) that target both boys and girls (Chiodo et al. 2012; O’Leary and Slep 2012) and are strategically administered at key times in adolescent development to stop the initiation or persistence of violence across time and relationships (O’Leary and Slep 2012; Shortt et al. 2012). As national estimates of the frequency of physical dating violence victimization have remained unchanged over the past decade (Centers for Disease Control and Prevention (CDC) 2011), the translation of these findings into effective prevention programs has the potential to transform the field of partner violence prevention. Although some programs (e.g., Building Lasting Love, Langhinrichsen-Rohling and Turner 2012) that reflect these findings have been developed and evaluated, a transformation of the field would require the refinement of many programs currently in practice and the development of new prevention approaches. As an example of a new comprehensive approach that reflects some of the critical findings in this Special Section, the Division of Violence Prevention at CDC is embarking on a new initiative: Dating MattersTM: Strategies to Promote Healthy Teen Relationships. This commentary describes the programmatic strategies involved in Dating MattersTM, when and with whom these strategies will be implemented, and additional characteristics that have been incorporated to enhance the public health impact of the initiative. Dating MattersTM involves a variety of primary prevention strategies to address gaps in prevention programming for youth in urban communities with high crime and economic disadvantage, who may be at highest risk for TDV perpetration and victimization (O’Leary and Slep 2012). To address boys’ and girls’ dating violence (e.g., Chiodo et al. 2012; O’Leary and Slep 2012) and to accommodate transient and amorphous dating relationships that often occur in early adolescence, Dating MattersTM employs universal primary prevention focused on 11to 14-year-old youth. The initiative is implemented in middle school in order to build a foundation of healthy relationship skills among all youth before dating and/or severe TDV is initiated. Dating MattersTM has the potential to prevent the onset of TDV, which could disrupt the stability of violence across relationships and over time. Moreover, in middle school, parents and educators are strong influences and Dating MattersTM seeks to engage them as key prevention agents. Dating MattersTM takes a novel approach to TDV prevention that bridges diverse areas of public health by The findings and conclusions in this report are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Expect Respect Support Groups: Preliminary Evaluation of a Dating Violence Prevention Program for At-Risk Youth

Expect Respect support groups, a selective prevention strategy, are designed to prevent and reduce dating violence among at-risk middle and high school students. This preliminary, uncontrolled evaluation examined changes in healthy relationship skills and emotionally and physically abusive behaviors in participants’ peer and dating relationships. Self-reports (N = 144) showed significant increases in healthy relationship skills from baseline to program completion, whereas levels of victimization and perpetration remained unchanged. A subgroup of students who reported baseline levels of victimization and perpetration with means at least one standard deviation above the group mean reported significantly less victimization and perpetration at program completion.