Reading summary #6

RE S E A R C H AR T I C L E

The Evaluation of School-Based Violence Prevention Programs: A Meta-Analysis*

HYOUN-KYOUNG PARK-HIGGERSON, PhDa

SUZANNE E. PERUMEAN-CHANEY, PhDb

ALFRED A. BARTOLUCCI, PhDc

DIANE M. GRIMLEY, PhDd

KARAN P. SINGH, PhDe

ABSTRACT

BACKGROUND: Youth violence and related aggressive behaviors have become seri-

ous public health issues with physical, economic, social, and psychological impacts

and consequences. This study identified and evaluated the characteristics of success-

ful school-based violence prevention programs.

METHODS: Twenty-six randomized controlled trial (RCT), school-based studies that

were designed to reduce externalizing, aggressive, and violent behavior between the

1st and 11th grades were analyzed for assessing the effects of 5 program characteris-

tics by comparing results of intervention groups to control groups (no intervention)

after intervention using a meta-analysis. Electronic databases and bibliographies were

systematically searched, and a standardized mean difference was used for analysis.

RESULTS: There was no significant difference between interventions, although programs

that used non–theory-based interventions, focused on at-risk and older children, and em-

ployed intervention specialists had slightly stronger effects in reducing aggression and vio-

lence. Interventions using a single approach had a mild positive effect on decreasing

aggressive and violent behavior (effect size = �0.15, 95% CI = �0.29 to �0.02, p = .03).

CONCLUSIONS: Unlike previous individual study findings, this meta-analysis did

not find any differential effects for 4 of the 5 program characteristics. In addition, the

significant effect noted was contrary to expectation, exemplifying the complexity of

identifying effective program strategies. This study adds to the current literature by

assessing the program characteristics of RCT studies in an effort to determine what

factors may affect school-based violence prevention program success.

Keywords: school-based violence prevention program; meta-analysis; randomized

controlled trials (RCTs).

Citation: Park-Higgerson HK, Perumean-Chaney SE, Bartolucci AA, Grimley DM,

Singh KP. The evaluation of school-based violence prevention programs: ameta-analysis.

J Sch Health. 2008; 78: 465-479.

aPostdoctoral Fellow, ([email protected]), The Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC 29208. bResearch Assistant Professor, ([email protected]), Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL 35294-0022. cProfessor, ([email protected]), Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL 35294-0022. dAssociate Professor and Chair, ([email protected]), Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL 35294-0022. eProfessor and Chair, ([email protected]), Department of Biostatistics, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107-2699.

Address correspondence to: K.P. Singh, ([email protected]), Department of Biostatistics, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107-2699.

*Indicates CHES and Nursing continuing education hours are available. Also available at: www.ashaweb.org/continuing_education.html

Journal of School Health d September 2008, Vol. 78, No. 9 d ª 2008, American School Health Association d 465

Youth violence and related aggressive behaviors

have become serious public health issues with

physical, economic, social, and psychological impacts

and consequences.1 According to the results from the

2005 national Youth Risk Behavior Survey, 35.9% of

the students nationwide had been in a physical fight in

the previous year,with the prevalence rates across local

surveys varying between 30.4% and 46.5%.2 Because

youth violence has drawn national attention in the

United States, numerous prevention programs have

been developed that focus on teaching children various

attitudes, knowledge, and skills in order to reduce their

involvement in violence.3 However, conflicting reports

about the evaluations of these programs exists between

the published scientific literature and the US Surgeon

General’s4 (2001) report, which concludes that little is

known about the actual effects of violence prevention

programs. Therefore, a systematic analysis and evalua-

tion of these programs are needed in order to identify

and understand the crucial factors that may affect pro-

gram success and fidelity.

Two other meta-analyses have examined school-

based violence prevention programs. According to the

result of Mytton et al5 (2002), school-based violence

prevention programs modestly reduced both student

aggressive behaviors and school or agency actions in

response to this aggressive behavior. However, the con-

tent of the prevention program was not provided,

which makes it difficult to assess either the scope or

the programmatic characteristics that had led to this

reported success. The program content may have ac-

counted for the considerable variation in the reviewed

programs’ effectiveness.

Derzon and Wilson6 (1999) also reported that

school-based interventions were effective in prevent-

ing and reducing violence and other antisocial behav-

iors through influencing various mediating conditions

and behaviors. However, the authors also did not

account for the content of the program and pooled

the data by type of outcome. As a result, it is difficult

to assess how the programs were conducted or how

rigorously each program was evaluated. Because they

conducted their analysis at the group level rather than

at the individual level, themediators identified through

the meta-analysis cannot be interpreted as those that

actually contributed to the success of each program.

Finally, the meta-analysis included studies that were

not randomized controlled trials (RCTs), which might

have reduced the effect of other confounding variables.

Consequently, both meta-analyses did not provide

crucial information nor clarify the process on how

school-based violence prevention programs could be

effective in reducing aggressive or violent behaviors.

Therefore, this study adds to the current literature by

assessing the program characteristics of RCT studies in

an effort to determine what factors may affect school-

based violence prevention program success.

The purposes of this study were to provide

a descriptive overview of the current research on

school-based violence prevention programs, to evalu-

ate those programs in order to identify the factors that

lead to a program’s success, and to explore the eff-

ective strategies needed to develop programs that

prevent or modify the aggression and violence of

children and adolescents (hereafter referred to as

‘‘violence’’).

While most violence prevention program evalua-

tions focused on the characteristics of intervention

(ie, ‘‘increasing knowledge’’ or ‘‘improving social

skills’’), this study focused on the program character-

istics related to program delivery (ie, program target

or program type). From the literature review, the fol-

lowing 5 program characteristics were found most

often in the trials and differentially related to program

success: (1) the application of theory,6,7 (2) the type

of program such as universal or selective,5,8-10 (3) the

number of programs such as single- or multiple-

approach interventions,6,9,11-13 (4) the characteristics

of the target population,8,14,15 and (5) the type of

instructor, such as the use of specialists.16-18 Using

these characteristics, the following 5 hypotheses based

on the effect sizes were proposed:

1. Theory-based programs may have a stronger effect on

reducing violence than non–theory-based programs. Pro-

grams need to be evaluated from their theoretical

perspectives accorded with the program’s design.

Expected outcome should be derived from these

perspectives about the underlying processes that

contribute to the development of violent behavior

and how these developmental processes and paths

can be altered.7 For testing the first hypothesis, a

theory-based program was operationalized as

a study that supported its hypothesized outcomes

with logical or theoretical reasoning. For example,

DuRant et al (1996) and Ngwe et al (2004) both

applied Social Cognitive Theory to their program

for reducing violent behaviors. Although both stud-

ies reported that their program had significant

effects in decreasing violence behavior, DuRant

et al (1996) did not explain how their program could

make significant decreases in violence use. Thus,

this program was classified as nontheory based. On

the other hand, Ngwe et al (2004) clarified the

logical flow on how their program worked by mea-

suring mediators/determinants such as behavioral

intentions, attitudes, and so forth. Therefore, this

program was classified as theory based.

2. Selective programs may have a stronger effect on reducing

violence than universal prevention programs. Universal

programs were defined as primary preventions that

targeted everyone in the school, while the selective

program was a secondary prevention program that

targeted only the at-risk groups in the school.

466 d Journal of School Health d September 2008, Vol. 78, No. 9 d ª 2008, American School Health Association

3. Programs that applied multiple-approach interventions

may have a stronger effect on reducing violence than sin-

gle-approach programs.Amultiple-approach program

involved the parents, peers, and/or the community

in addition to the school’s curriculum. Those inter-

ventions that used the curriculum only in the class

were defined as a single-approach program.

4. Programs focused on younger students (third grade or

lower)mayhave a stronger effect on reducing violence than

programs focused on older students. Steinberg19 (2002)

defined adolescence as the second decade of life (10

through 19). Based on this definition, we compared

the first grade (7 years old) through third grade

(9 years old) to adolescence.

5. Programs conducted by specialists (personnel from outside

of the school) may have a stronger effect on reducing vio-

lence than programs conducted by schoolteachers.

Although the role of teachers in program success is

critical,16 it is not easy to get the support from teach-

ers in reality. They did not deliver all lessons as

planned,20 showed lack of participation,21 or even

felt resentment due to the additional burden of

teaching a new curriculum that was different from

the school’s educational mission.12 Therefore, we

assumed that programs conducted by specialists

may have been more effective for reducing violence

than programs conducted by schoolteachers.

METHODS

To evaluate the school-based violence prevention

programs, a meta-analysis was conducted. The follow-

ing 7 inclusion criteria were established: (1) the pro-

gram was designed to prevent aggression or violence

in children and adolescents; (2) the study population

was students enrolled in the 1st through the 11th

grades; (3) the experimental design randomly as-

signed the participants to either an intervention or

a control group; (4) the study outcome was defined as

externalizing, aggressive, or violent behavior (ie,

scores of aggression, use of violence/violent or exter-

nalizing behavior); (5) the type of intervention was

designed to reduce aggressive or violent behavior by

providing education, improving social skills, or chang-

ing the environment; (6) the program was conducted

in the school; and (7) the study had published the

necessary statistical information in order to determine

the direction of the effect and to conduct the

meta-analysis.

Procedures To identify relevant prevention programs, searches

through electronic databases and by hand were

conducted. For the electronic searches, ‘adolescen*’,

‘violen*’, ‘aggress*’, ‘externalizing’, ‘school’, ‘preven-

tion’, and ‘intervent*’ were the key terms used in the

following databases: Pubmed, Medline, PsychInfo,

Criminal Justice Info, National Institute of Justice,

ArticleFirst, BasicBIOSIS, Educational Resource Infor-

mation Centre (1970-2004), and the National Crimi-

nal Justice Reference Service (1970-2004). The

searches were restricted to studies conducted in the

United States and published in English but not

restricted by ‘‘date.’’

Dissertation abstracts were excluded from the study

because of the problem of accessibility. The hand

searches involved examining the references of the

published articles identified through the electronic

searches. We could contact only 1 author of the eligi-

ble trials to obtain missing data.

While the first author searched the relevant data,

titles, abstracts, and keywords were screened to

exclude ineligible trials. Next, full texts of remaining

reports were reviewed. Therefore, additional ineligible

trials were excluded.

Coding of the Studies Eligible studies were coded directly into an Excel

database by the first author. The coding was reviewed

by the third author, and questions were resolved

through discussion among authors. While coding the

data, several studies were excluded due to the lack of

measurable outcomes. A summary table (Table 1) was

created to record each study’s information pertaining

to the students’ characteristics, research methodology

(research design and assignment), intervention com-

ponents (duration and instructors), time to measure,

applied theory, outcome, measures of violence or

aggressive behaviors, and evaluation. A statistical out-

come table was created to extract detailed data on

outcome measures using statistical analysis but is not

shown because of limited space.

Statistical Analysis The effects of 5 program characteristics were as-

sessed by comparing results of intervention group to

control group after intervention. Because several

studies included in this meta-analysis did not report

pretest results, the effect sizes were calculated from

the posttest results. The unit of randomization (indi-

vidual, class, or school) was not taken into consider-

ation due to the small number of studies available for

the comparisons.

The overall effect size was calculated for the full

sample, and each hypothesis was tested using RevMan

4.2 (Cochrane Centre) program44,45 and SAS 9.1 for

Windows. The study-specific difference between inter-

vention and control groups for each comparison re-

ported in the study was pooled to produce an overall

estimate of the effect. Pooled results were expressed as

standardized mean differences (SMDs) with 95% confi-

dence intervals. Because each study in themeta-analysis

Journal of School Health d September 2008, Vol. 78, No. 9 d ª 2008, American School Health Association d 467

Ta b le

1. Su m m ar y o f Sc h o o l- B as ed

V io le n ce

P re ve n ti o n P ro g ra m s (T o ta l2 6 St u d ie s) *

So u rc e/ P ro g ra m

Ty p e

R an

d o m iz at io n

[U n it ] I, C ,S

In te rv en

ti o n

Ti m e to

M ea su re

P ro g ra m

O u tc o m e

M ea su re m en

t Ev al u at io n

Le e et al 2 2 (1 97 9) :9 th

gr ad e: th eo ry b as ed ,

se le ct iv e, si ng le ,4 th [ ,

sp ec ia lis t p ro gr am

Ra nd om

ly as si gn ed ; N = 30

(m = 24 , f = 6, ag gr es si ve

st ud en ts ) [I]

d 3 co nd iti on s: (1 ) as se rt io n tr ai ni ng :

1 p er w ee k, ei gh t 50 -m

in ut e

as se rt io n tr ai ni ng

se ss io ns ;( 2)

p la ce b o: ‘‘h ow

to m ak e a de ci si on ’’;

(3 ) no

tr ea tm en t

Pr et es t; p os tt es t

A ss er tio n tr ai ni ng

A gg re ss iv en es s;

as se rt iv en es s; as se rt iv e

sk ill

Pe er R, SR ;S R, p ee rR ;

ob se rv at io n

A ss er tio n sc al e in cr ea se

si gn ifi ca nt ly ; sl ig ht

de cr ea se

in se lf- ra te d ag gr es si on ; no

si gn ifi ca nt

ef fe ct

re ga rd in g as

p ee r ju dg m en t

H ue y an d Ra nk

2 3 (1 98 4) :

8t h, 9t h gr ad es :t he or y

b as ed ,s el ec tiv e, si ng le ,

4t h[

,s p ec ia lis t

p ro gr am

Ra nd om

ly as si gn ed ; n = 48 ;

ag gr es si ve

b la ck

m al es

[I]

d 3 co nd iti on s: (1 ) pr of es si on al or

pe er co un se lo r as se rt iv e tr ai ni ng

gr ou ps :t ot al 8 ho ur s (2 p er w ee k

fo r 4 w ee ks ); (2 ) p ro fe ss io na lo r

p ee r co un se lo r di sc us si on

gr ou p s;

(3 ) no -t re at m en t co nt ro lg ro up s

Pr et es t; p os tt es t

A ss er tio n tr ai ni ng

A ss er tiv e sk ill ; an ge r

le ve l; ag gr es si ve

be ha vi or ;c la ss ro om

ag gr es si ve

b eh av io r

A ut ho r; au th or , SR ;

p sy ch ol og is ts

ob se rv at io n; TR

(u si ng

BR PT )

A ss er tiv e tr ai ni ng

gr ou p s sc or ed

si gn ifi ca nt ly lo w er

in cl as sr oo m

ag gr es si on , re sp on de d m or e

as se rt iv el y th an

th e no -

at te nt io n co nt ro l gr ou p s

H er rm

an n an d

M cW

hi rt er 2 4 (2 00 3) :

7t h- 9t h gr ad es :t he or y

b as ed ,s el ec tiv e, si ng le ,

4t h[

,s p ec ia lis t

p ro gr am

Ra nd om

ly as si gn ed

to ea ch

co nd iti on

2 al te rn at iv e

m id dl e sc ho ol s, n = 20 7;

fin al ly , on ly 89

st ud en ts

w er e le ft [S ]

d 2 co nd iti on s: (1 ) SC A RE

pr og ra m :

8- w ee k p er io d 15

se ss io ns ,2

p er

w ee k fo ra p p ro xi m at el y 1 ho ur p er

da y (r ec og ni zi ng

an ge r an d

vi ol en ce

in th e co m m un ity ,

m an ag in g an d re du ci ng

an ge r in

th e se lf, de fu si ng

an ge r an d

vi ol en ce

in ot he rs ) co nd uc te d b y

gr ad ua te st ud en ts ;( 2) co nt ro l

gr ou p: th e En te r H er e cu rr ic ul um

Pr et es t; p os tt es t;

1- ye ar

fo llo w -u p

SC A RE

p ro gr am

(a tt rib ut io n

th eo ry )

A ng er ; ag gr es si on ;

at tit ud e

SR ; SR ; PR ;S R;

di sc ip lin ar y re co rd s

C as e sh ow

ed si gn ifi ca nt ly lo w er

le ve ls of

an ge r an d ag gr es si on

an d a sl ig ht ly hi gh er

le ve l of

an ge r co nt ro l. In

1- ye ar

fo llo w -

up , SC A RE

co nt in ue d to

re fle ct

si gn ifi ca nt ly lo w er

sc or es

on a m ea su re

of ag gr es si ve

an d

vi ol en t at tit ud es

Fe in dl er et al 2 5 (1 98 4) :

p ub lic

ju ni or

hi gh

sc ho ol s (1 2. 5- 15 .7

ye ar s) :t he or y b as ed ,

se le ct iv e, si ng le ,4 th [ ,

sp ec ia lis t p ro gr am

Ra nd om

ly as si gn ed

to ea ch

co nd iti on

ch os en

fr om

a b eh av io r m od ifi ca tio n

p ro gr am

fo r

m ul tis us p en de d

de lin qu en ts [I]

d 2 co nd iti on s: (1 ) 3 tr ea tm en tg ro up

(e ac h n = 6) :1 0 b iw ee kl y 50 -

m in ut e tr ai ni ng

se ss io ns

co nd uc te d b y tr ai ne d th er ap is t.

C on te nt s: b eh av io ra la nd

co gn iti ve

co nt ro ls ;( 2) co nt ro lg ro up

(n = 18 )

Pr et es t; p os tt es t

A ng er

co nt ro l

tr ai ni ng

p ro gr am

(c og ni tiv e

b eh av io ra l th eo ry )

Pr ob le m

so lv in g; lo cu s of

co nt ro l; m at ch in g

fa m ili ar

fig ur es

te st ;

se lf- co nt ro lr at in g

(a gg re ss io n)

TR Re su lts

sh ow

ed th e p ro gr am

p ro vi de s m od es t su p p or t fo r

th e ef fic ac y of

th e co gn iti ve

b eh av io ra l tr ea tm

en t

p ro ce du re s. Si gn ifi ca nt

ch an ge

sc or es

fo r tr ea tm

en t su b je ct s

on p ro b le m -s ol vi ng

ab ili ty

an d

se lf- co nt ro l

D uR an t et al 1 8 (1 99 6) :6 th -

8t h gr ad es :n on th eo ry

b as ed ,u ni ve rs al ,s in gl e,

4t h[

,s p ec ia lis t

p ro gr am

Ra nd om

ly as si gn ed

to on e of

th e cu rr ic ul a, N = 20 9 [S ]

d 2 co nd iti on s: (1 ) vi ol en ce

pr ev en tio n cu rr ic ul um

fo r

ad ol es ce nt s: te n 50 -m

in ut e

se ss io ns

he ld tw ic e a w ee k ov er 5

w ee ks ,d es ig ne d to

b e us ed

in a cl as sr oo m

fo rm

at (k no w le dg e

b as ed )—

sc ho ol 1 (n

= 14 6) ;

(2 ) co nf lic t re so lu tio n: a cu rr ic ul um

fo ry ou th p ro vi de rs am

on g m id dl e

sc ho ol st ud en ts :t en

50 -m

in ut e

se ss io ns .E ac h se ss io n co nt ai ns

at le as t 1 sk ill -b ui ld in g ex er ci se :

m ai nl y ro le -p la yi ng

(S C T b as ed

on b eh av io r ch an ge )—

sc ho ol 2

(n = 63 ); in te rv en tio n co nd uc te d

b y th e sa m e in st ru ct or

Pr et es t; p os tt es t

Th e vi ol en ce

p re ve nt io n

cu rr ic ul um

/c on fli ct

re so lu tio n:

a cu rr ic ul um

fo r

yo ut h p ro vi de rs

(S C T)

H yp ot he tic al us e of

vi ol en ce ; av oi da nc e of

vi ol en ce ; fr eq ue nc y of

us e of vi ol en ce

sc al e;

fr eq ue nc y of fig ht in g;

fr eq ue nc y of in ju ry

du rin g a fig ht

re qu iri ng

tr ea tm

en t

SR Si gn ifi ca nt

de cr ea se

in st ud en ts ’

se lf- re p or te d us e of

vi ol en ce

in hy p ot he tic al si tu at io ns ,

fr eq ue nc y of

us e of

vi ol en ce ,

an d fig ht in g in

th e p re vi ou s

30 da ys . C on fli ct

re so lu tio n

cu rr ic ul um

: m or e ef fe ct iv e in

re du ci ng

th e fr eq ue nc y of

fig ht s

(c on tin ue d )

468 d Journal of School Health d September 2008, Vol. 78, No. 9 d ª 2008, American School Health Association

Ta b le

1. (C o n ti n u ed

)

So u rc e/ P ro g ra m

Ty p e

R an

d o m iz at io n

[U n it ] I, C ,S

In te rv en

ti o n

Ti m e to

M ea su re

P ro g ra m

O u tc o m e

M ea su re m en

t Ev al u at io n

† N gw

e et al 2 6 (2 00 4) ;† Fl ay

et al (2 00 4) :5 th

gr ad e

(f ol lo w -u p un til 8t h

gr ad e) :t he or y b as ed ,

un iv er sa l, m ul ti, 4t h[

, sp ec ia lis t p ro gr am

C lu st er

ra nd om

iz ed

ex p er im en ta l lo ng itu di na l

in te rv en tio n (e ffi ca cy

tr ia l);

12 p oo r A fr ic an

A m er ic an

sc ho ol s b et w ee n 19 94

an d

19 98 , N = 59 7- 67 4 (t ot al

an al ys is sa m p le = 11 55 )

[S ]

d 3 co nd iti on s: (1 ) in te rv en tio n:

co m b in ed

SD C 1

SC I: (a ) SD C :

cl as sr oo m

b as ed ,1 6- 21

le ss on s

fo cu s on

sk ill s; (b ) SC I: SD C 1

p ar en ta ls up p or t, sc ho ol cl im at e

an d co m m un ity

w id e

co m p on en ts ;( 2) co nt ro l: H EC :

nu tr iti on ,e xe rc is e, an d he al th ca re .

Fo cu s on

ris k an d p ro te ct iv e fa ct or s

an d sk ill s re la te d to

th e ta rg et ed

b eh av io rs

Pr et es t—

b eg in ni ng

of gr ad e 5;

p os tt es t—

en d of

gr ad e 5; 3 fo llo w -

up — at

th e en d

of gr ad es

6, 7, 8

(S C T of

b eh av io r

ch an ge )

Vi ol en ce

be ha vi or ;

p ro vo ca tiv e b eh av io r;

sc ho ol de lin qu en cy ;

su b st an ce

us e; se xu al

b eh av io r; m ed ia tin g

va ria b le s

SR SD C an d SC I si gn ifi ca nt ly re du ce d

th e ra te

of in cr ea se

in vi ol en t

b eh av io r, p ro vo ki ng

b eh av io r,

sc ho ol

de lin qu en cy , dr ug

us e,

an d re ce nt

se xu al in te rc ou rs e

an d im p ro ve d th e ra te

of in cr ea se

in co nd om

us e. N o

si gn ifi ca nt

ef fe ct s fo r gi rls

H ar rin gt on

et al 1 7 (2 00 1) :

6t h- 7t h gr ad es :t he or y

b as ed ,u ni ve rs al ,s in gl e,

4t h[

,t ea ch er /

sp ec ia lis t p ro gr am

Ra nd om

iz ed

si ng le -c o ho rt

lo ng itu di na l de si gn , N =

16 55 ; 14

sc ho ol s. M at ch ed

p ai rs of

sc ho ol s b y ci ty ,

w ith in

sc ho ol , ra nd om

as si gn

to tr ea tm

en t [C ]

d 3 co nd iti on s: (1 ) in te rv en tio n 1:

sp ec ia lis t co nd iti on , N = 62 9, 5

sc ho ol s; (2 ) in te rv en tio n 2:

te ac he r co nd iti on , N = 28 7, 3

sc ho ol s; (3 ) co nt ro l: 73 9. A ll St ar s

(c ha ra ct er

ed uc at io n an d

p ro b le m

b eh av io r p re ve nt io n

p ro gr am

) cu rr ic ul um

co ns is ts of

w ho le -c la ss ro om

se ss io ns , sm

al l-

gr ou p se ss io ns

ou ts id e of

cl as s,

an d on e- on -o ne

se ss io ns

b et w ee n in st ru ct or

an d st ud en t.

Ea ch

se ss io n is de si gn ed

to af fe ct

at le as t on e of

th e

m ed ia tin g va ria b le s: b on di ng ,

co m m itm

en t, id ea ls , an d no rm

s

Pr et es t; p os tt es t;

1- ye ar

fo llo w -u p

A ll St ar s p ro gr am

(S C T)

Su b st an ce

us e; se xu al

ac tiv ity ; vi ol en ce ;

m ed ia tin g va ria b le s

(2 ou tc om

es :( a)

sp ec ia lis tv s co nt ro la nd

(b ) te ac he r vs

co nt ro l)

SR ; SR ;S R

M ea n vi ol en ce

di d no t di ffe r

fr om

p re te st to

p os tt es t, cl ea r

in cr ea se

ac ro ss

al l co nd iti on s

fr om

p os tt es t to

fo llo w -u p .

Se xu al ac tiv ity , dr ug

us e, an d

vi ol en ce

in cr ea se d th ro ug ho ut

th e p er io d of

st ud y b ut

m os t

m ar ke dl y b et w ee n th e p os tt es t

an d th e fo llo w -u p

as se ss m en ts . Fo llo w -u p :

te ac he r ef fe ct s de ca y, b ut

sp ec ia lis t ef fe ct s b ec om

e ap p ar en t

O rp in as

et al 1 2 (2 00 0) :6 th

gr ad e: no nt he or y

b as ed ,u ni ve rs al ,m

ul ti,

4t h[

,p ro gr am

Ra nd om

ly as si gn ed

8 m id dl e

sc ho ol

st ud en ts [S ]

d 2 co nd iti on s: (1 ) st ud en ts fo r

pe ac e: (a ) m od ifi ca tio n of th e

sc ho ol en vi ro nm

en t, (b )a

vi ol en ce

p re ve nt io n cu rr ic ul um

,( c) p ee r

le ad er sh ip ,a nd

(d ) p ar en t

ed uc at io n n = 10 20 ;( 2) us ua l

vi ol en ce

pr ev en tio n pr og ra m .

N = 12 26

19 94

6t h- gr ad er s

co ho rt : p re te st ;

p os tt es t;

12 -m

on th

fo llo w -

up

St ud en ts fo r p ea ce

(S C T)

A gg re ss iv e be ha vi or

SR C oh or t an d cr os s- se ct io na l

ev al ua tio n:

no in te rv en tio n

ef fe ct

in re du ci ng

ag gr es si ve

b eh av io r. Th e st ro ng es t

p re di ct or s of

vi ol en ce

in 8t h

gr ad e: vi ol en ce

in 6t h gr ad e

an d lo w ac ad em

ic p er fo rm

an ce

Lo ch m an

an d W el ls 9

(2 00 2) :5 th

gr ad e:

th eo ry b as ed ,s el ec tiv e,

m ul ti, 4t h[

,s p ec ia lis t

p ro gr am

Ra nd om

as si gn m en t fo r

in te rv en tio n an d co nt ro l

gr ou p s, N = 24 5 [C ]

d 4 co nd iti on s: (1 ) in di ca te d

in te rv en tio n (C op in g Po w er :c hi ld

an d p ar en t fo cu se d)

16 -m

on th p ro gr am

,w ith

22 gr ou p

se ss io ns

sc he du le d fo r th e 5t h-

gr ad e ye ar an d 12

gr ou p se ss io ns

fo r th e 6t h- gr ad e ye ar .G ro up

se ss io ns

la st ed

fo r

40 -5 0 m in ut es ;( 2) in di ca te d

in te rv en tio n 1

un iv er sa l( C M ST );

(3 ) un iv er sa lo nl y;

(4 ) co nt ro l

T1 : p re te st ; T2 :1 st -

ye ar

tr ea tm

en t;

T3 : p os tt es t; T4 :

1- ye ar

fo llo w -u p

C op in g Po w er

p ro gr am

(S C T)

Su b st an ce

us e;

ag gr es si ve

be ha vi or ;

so ci al co m p et en ce ;

sc ho ol b on di ng ;

p ar en tin g p ra ct ic es

SR ; PR , SR , TR ,

TO CA -R ;T R,

SR ;S R, PR ;P R

Si gn ifi ca nt

re du ct io n in

ag gr es si ve

b eh av io r; si gn ifi ca nt

ef fe ct

in su b st an ce

us e ra te s;

co nf irm

ed in te rv en tio n ef fe ct s

on so ci al co m p et en ce , se lf-

re gu la tio n,

an d p ar en tin g sk ill s.

Si gn ifi ca nt

ef fe ct

on at

fo llo w -u p

(c on tin ue d )

Journal of School Health d September 2008, Vol. 78, No. 9 d ª 2008, American School Health Association d 469

Ta b le

1. (C o n ti n u ed

)

So u rc e/ P ro g ra m

Ty p e

R an

d o m iz at io n

[U n it ] I, C ,S

In te rv en

ti o n

Ti m e to

M ea su re

P ro g ra m

O u tc o m e

M ea su re m en

t Ev al u at io n

St oo lm ill er et al 2 7 (2 00 0) .

5t h an d 1s t gr ad es :

no nt he or y b as ed ,

un iv er sa l, m ul ti, te ac he r

p ro gr am

Ra nd om

ly as si gn ed

to a 1s t-

gr ad e or

5t h- gr ad e sc ho ol ;

to ta l 32

cl as sr oo m s [S ]

d 2 co nd iti on s: (1 ) in te rv en tio n (n =

38 2) :1 0 w ee ks ;( 2) co nt ro l( n = 28 9) .

Th e LI FT

pr og ra m :u se G BG

to re du ce

ag gr es si on

an d in cr ea se

so ci al co m pe te nc e; co ns is te d of

pa re nt tr ai ni ng ,t he

G BG

pr og ra m ,

an d sy st em

at ic co m m un ic at io n

be tw ee n te ac he rs an d pa re nt s

Pr et es t; p os tt es t

LI FT

p ro gr am

(S C T)

Ph ys ic al ag gr es si on

O bs er ve

M or e ag gr es si ve

th e ta rg et

ch ild

w as

in iti al ly , th e gr ea te r th e

re du ct io n in

ag gr es si ve

b eh av io r. En vi ro nm

en ta l

de te rm

in an ts m an ip ul at ed

b y

th e LI FT

ac co un t fo r ab ou t

99 %

of th e st ab ili ty

of p la yg ro un d ag gr es si on

H ud le y an d G ra ha m

2 8

(1 99 3) :4 th -6 th

gr ad es :

th eo ry b as ed ,s el ec tiv e,

si ng le ,4 th [ ,s p ec ia lis t

p ro gr am

Ra nd om

ly as si gn ed

to 1 of

3 gr ou p s. Se le ct ed

b y

te ac he r an d p ee r

(N = 10 1)

[I]

d 3 co nd iti on s: (1 )a ttr ib ut io na li nt er -

ve nt io n: 12 -le ss on

co gn iti ve

in te r-

ve nt io n to tr ai n ag gr es si ve

bo ys no t

to in fe r ho st ile

pe er in te nt in ne ga -

tiv e so ci al en co un te rs of am

bi gu ou s

ca us al or ig in .2

pe rw

ee k du rin g th e

sc ho ol da y in 40 - to 60 -m

in ut e se s-

sio ns fo r6

w ee ks ,4 ag gr es siv e an d 2

no na gg re ss iv e in ea ch

gr ou p; (2 )

at te nt io n tr ai ni ng

gr ou p: 12 -s es sio n

tr ea tm en t ba se d on

th e ‘‘B ui ld in g

Th in ki ng

Sk ill s pr og ra m ’’; (3 )n o-

tre at m en tc on tro lg ro up

(a gg re ss iv e =

24 ,n on ag gr es si ve

= 12 )

Pr et es t; p os tt es t

A tt rib ut io n th eo ry

Ju dg m en ts of

in te nt /

an ge r/ ag gr es si ve

b eh av io r; ag gr es si ve

be ha vi or ;n um

b er of

fo rm

al re fe rr al s fo r

sc ho ol di sc ip lin ar y

ac tio n

SR ; TR ; sc ho ol

re co rd

A gg re ss iv e su b je ct s in

th e

at tr ib ut io n p ro gr am

sh ow

ed a m ar ke d re du ct io n in

b ot h

th e b ia s to

p re su m e ho st ile

in te nt

an d a p re fe re nc e fo r

ag gr es si ve

b eh av io r an d ra te d

as si gn ifi ca nt ly le ss

ag gr es si ve

b y te ac he rs

O m iz o et al 29 (1 98 8) :4 th -

6t h gr ad er s: no n- th eo ry

ba se d, se le ct iv e, si ng le ,

4t h[

,s pe ci al is tp ro gr am

Ra nd om

ly as si gn ed

to ea ch

co nd iti on .N

om in at ed

by te ac he r, N = 24

(m = 14 ,

f = 10 ) [I]

d 2 co nd iti on s: (1 ) ex pe rim

en ta l: 10

gr ou p co un se lin g se ss io ns

(4 5- 50

m in ut es ), ev al ua te us in g SB C L

(0 -1 00 ); (2 ) co nt ro l

Pr et es t; p os tt es t

G ro up

co un se lin g

in te rv en tio n

A gg re ss io n; ho st ile

is ol at io n

TR Pa rt ic ip an ts in

th e ex p er im en ta l

gr ou p w er e si gn ifi ca nt ly le ss

ag gr es si ve

an d ho st ile

th an

th os e in

th e co nt ro l gr ou p

Fo rm

an 3 0 (1 98 0) :3 rd -5 th

gr ad es

(8 -1 1 ye ar s) :

no n- th eo ry b as ed ,

se le ct iv e, si ng le ,4 th [ ,

sp ec ia lis t p ro gr am

Ra nd om

ly as si gn ed

to ea ch

co nd iti on , N = 18

(r ef er re d

b y sc ho ol

p sy ch ol og is t;

m = 14 , f = 3)

[I]

d 3 co nd iti on s: (1 ) co gn iti ve

re st ru ct ur in g: tw ic e a w ee k fo r ha lf

ho ur ov er 6 w ee ks .F oc us ed

on ag gr es si on -p ro vo ki ng

si tu at io ns ;( 2)

re sp on se

co st :c hi ld re n w er e fin ed

fo r ex hi bi tin g ag gr es si ve

be ha vi or ,

m et w ith

2 gr ad ua te st ud en ts tw ic e

a w ee k fo r3 0 m in ut es ov er 6 w ee ks

to pl ay

b as ke tb al lo r lis te n to

re co rd s an d da nc e; (3 )p la ce bo

co nt ro l: m et w ith

2 gr ad ua te

st ud en ts tw ic e a w ee k fo r 30

m in ut es

ov er 6 w ee ks fo r re ad in g

tu to rin g

Pr et es t; p os tt es t

C la ss ro om

di st ur b an ce ;

ag gr es si ve

be ha vi or ;

di sr es p ec t de fia nc e;

b as ic in ap p ro p ria te

b eh av io rs ;

in ap p ro p ria te

in te ra ct io ns

TR ; TR ;i nd ep en de nt

ob se rv at io ns

Bo th

p ro gr am

s de cr ea se

in ag gr es si ve

b eh av io r an d w er e

si gn ifi ca nt ly m or e ef fe ct iv e

th an

th e co nt ro l p ro gr am

. Re sp on se

co st p ro gr am

af fe ct ed

gr ea te r ch an ge s th an

th e co gn iti ve

re st ru ct ur in g

p ro gr am

G ar ris on

an d St ol b er g3

1

(1 98 3) :3 rd -5 th

gr ad es

(8 -1 1 ye ar s) :t he or y

b as ed ,s el ec tiv e, si ng le ,

4t h[

,p ro gr am

Ra nd om

ly as si gn ed

to ea ch

co nd iti on

ac co rd in g to

C BC L sc or e, N = 30

[I]

d 3 co nd iti on s: (1 ) af fe ct iv e im ag er y

tr ai ni ng

gr ou p: th re e 30 - to

40 -

m in ut e se ss io ns

of af fe ct iv e

im ag er y (f oc us ed

on p hy si ol og ic al

ch an ge s an d th ei r th ou gh ts )

(n = 10 )—

co gn iti ve

in te rv en tio n;

(2 ) at te nt io n gr ou p (n

= 10 ); (3 )

co nt ro l( n = 10 )

Pr et es t; p os tt es t;

sh or t- te rm

fo llo w -

up (a ft er

p os tt es t,

2- 3 da ys

la te r)

A tt rib ut io n th eo ry

A gg re ss iv e be ha vi or ;

co gn iti ve

p er ce p tio n/

at tr ib ut io ns

TR (o b se rv at io n) ;

SR (a ffe ct

qu es tio nn ai re )

St at is tic al ly si gn ifi ca nt

re du ct io ns

in b ot h b eh av io r an d an gr y

co gn iti on s. A ng ry

ch ild re n’ s

p er ce p tio n an d co gn iti on s

sh ift ed

fr om

an gr y to w ar d sa d.

C on co m ita nt

de cr ea se

in ob se rv ed

ag gr es si ve

cl as sr oo m

be ha vi or

(c on tin ue d )

470 d Journal of School Health d September 2008, Vol. 78, No. 9 d ª 2008, American School Health Association

Ta b le

1. (C o n ti n u ed

)

So u rc e/ P ro g ra m

Ty p e

R an

d o m iz at io n

[U n it ] I, C ,S

In te rv en

ti o n

Ti m e to

M ea su re

P ro g ra m

O u tc o m e

M ea su re m en

t Ev al u at io n

M et ro p ol ita n A re a C hi ld

St ud y Re se ar ch

G ro up

3 2 (2 00 2) :2 nd -

3r d gr ad es

an d 5t h- 6t h

gr ad es :n on -t he or y

b as ed ,s el ec tiv e, m ul ti,

te ac he r p ro gr am

Ra nd om

ly as si gn ed

16 sc ho ol s to

4 co nd iti on s

hi gh -r is k su b sa m p le b y

p ee r no m in at io n an d TR F

of C BC L, n = 15 00

[S ]

d 4 co nd iti on s: (1 ) ge ne ra l

en ha nc em

en t 1

pe er sk ill s tr ai ni ng

1 fa m ily in te rv en tio n: co nd uc te d by

tr ai ne d cl in ic ia ns

22 w ee ks ;( 2)

ge ne ra le nh an ce m en t 1

pe er sk ill s

tr ai ni ng :o nc e a w ee k fo r 28

w ee ks

ov er 2 ye ar s co nd uc te d by

gr ad ua te

st ud en ts ;( 3) ge ne ra le nh an ce m en t

cl as sr oo m :t he

le as t in tr us iv e

pr og ra m co nd uc te d b y te ac he r, 2

ye ar s 40

le ss on s, so ci al -c og ni tiv e

cu rr ic ul um

;( 4) no

tr ea tm en t; gr ad es

2 an d 3—

ea rly

in te rv en tio n, gr ad es

5 an d 6—

la te in te rv en tio n

Pr et es t (1 st , 4t h) ;

m id te st (2 nd , 5t h) ;

p os tt es t (3 rd , 6t h)

C og ni tiv e ec ol og ic al

p re ve nt iv e

in te rv en tio n (S LT )

A gg re ss iv e be ha vi or ;

ac ad em

ic ac hi ev em

en t

TR ,P R; sc ho ol

re co rd

(n ot

di sc ip lin ar y)

N on e of

th e in te rv en tio ns

w er e

ef fe ct iv e in

p re ve nt in g

ag gr es si on

am on g ol de r

el em

en ta ry

sc ho ol

ch ild re n.

N o ge nd er

an d et hn ic ity

ef fe ct

on in te rv en tio n

Lo ch m an

et al 3 3 (1 99 3) :

4t h gr ad e: th eo ry

b as ed ,s el ec tiv e, si ng le ,

4t h[

,s p ec ia lis t

p ro gr am

Ra nd om

ly as si gn ed

to co nd iti on

N = 52

[I]

d 4 co nd iti on s: (1 ) ag gr es siv e, re je ct ed

in te rv en tio n; (2 ) re je ct ed -o nl y

in te rv en tio n: co nt en ts :( a) so ci al

pr ob le m so lv in g—

7 se ss io ns ,( b)

po si tiv e pl ay

tr ai ni ng ,( c) gr ou p

en tr y sk ill tr ai ni ng ,( d) de al in g

ef fe ct iv el y w ith

st ro ng

ne ga tiv e

fe el in gs .S oc ia lr el at io ns

tr ai ni ng — 26

ha lf- ho ur in di vi du al

se ss io ns

an d 8 se ss io ns

w ith

sm al l

gr ou ps

of ch ild re n. Co nd uc te d by

so ci al sk ill tr ai ni ng

st af f;

(3 )a gg re ss iv e, re je ct ed

co nt ro l;

(4 )r ej ec te d- on ly co nt ro l

Pr et es t (3 rd );

p os tt es t (4 th );

1- ye ar

fo llo w -u p

(5 th )

So ci al re la tio ns

tr ai ni ng

p ro gr am

(S C T)

A gg re ss io n; p ro so ci al

b eh av io r; ac ad em

ic di ffi cu lti es ;r ej ec tio n b y

p ee rs ;s el f- w or th

ra tin gs

TR an d p ee rR ;S R

In te rv en tio n w as

ef fe ct iv e on ly

w ith

th e ag gr es si ve , re je ct ed

ch ild re n—

si gn ifi ca nt

re du ct io ns

in ag gr es si on , so ci al

re je ct io n,

an d im p ro ve m en t in

p ee r p ro so ci al b eh av io r at

b ot h th e p os tt es t an d th e

1- ye ar

fo llo w -u p

C av el la nd

H ug he s3 4

(2 00 0) :2 nd -3 rd

gr ad er s: th eo ry b as ed ,

se le ct iv e, m ul ti, 4Y

, sp ec ia lis t p ro gr am

Ra nd om

ly as si gn ed

te ac he r-

id en tif ie d ag gr es si ve

(T RF

of C BC L)

to ea ch

co nd iti on , N = 62

[I]

d 2 co nd iti on s: (1 ) pr im e tim

e: m ul tic om

p on en t

in te rv en tio n—

th er ap eu tic

m en to rin g, tr ai ni ng

in p ro b le m -

so lv in g sk ill s, an d co ns ul ta tio n

w ith

p ar en ts an d te ac he rs .

M en to rs vi si t ou ts id e of sc ho ol

ho ur s fo r at le as t 1 ho ur p er w ee k

fo r th e 16

m on th s, co ns ul ta nt

vi si te d p ar en ts an d te ac he rs

m on th ly ,P SS T to ok

p la ce

du rin g

sc ho ol ho ur s in tw o 30 -m

in ut e

se ss io ns

p er w ee k fo r a to ta lo f4 6

se ss io ns ;( 2) st an da rd

m en to rin g—

in fo rm

al m en to r

re la tio ns hi p s. M ed ia to r: so ci al

co gn iti on

(h os til e at tr ib ut io ns ,

b el ie fs ab ou t ag gr es si on ),

m en to rin g qu al ity

Pr et es t; p os tt es t;

1- ye ar

fo llo w -u p

Pr im e tim

e (S LT ,

at ta ch m en t

th eo ry )

A gg re ss io n; ac ce p ta nc e b y

ot he rs ;s oc ia lc og ni tio n

TR (T RF ); Pe er R (C BC L)

PR ;T R, PR ,

Pe er R; SR

Te ac he r- an d p ar en t- ra te d

ag gr es si on

si gn ifi ca nt ly

de cr ea se d at

p os tt es t b ut

co nt ro l gr ou p al so

sh ow

ed th e

p ro gr am

ef fe ct . Pr im e tim

e w as

a b et te r fit

th an

st an da rd

m en to rin g fo r ch ild re n w ho se

p ee rs vi ew

ed th em

as na rc is si st ic or

w ho se

p ar en ts

re p or te d a hi st or y of

p ar en ta l

re je ct io n.

N o di ffe re nt ia l

tr ea tm

en t ef fe ct s em

er ge d at

fo llo w -u p

(c on tin ue d )

Journal of School Health d September 2008, Vol. 78, No. 9 d ª 2008, American School Health Association d 471

Ta b le

1. (C o n ti n u ed

)

So u rc e/ P ro g ra m

Ty p e

R an

d o m iz at io n

[U n it ] I, C ,S

In te rv en

ti o n

Ti m e to

M ea su re

P ro g ra m

O u tc o m e

M ea su re m en

t Ev al u at io n

G ro ss m an

3 5 et al (1 99 7) :

2n d- 3r d gr ad er s: th eo ry

b as ed ,u ni ve rs al ,s in gl e,

4Y ,t ea ch er p ro gr am

A ft er

m at ch in g ra nd om

ly as si gn ed

to ea ch

co nd iti on , N = 12

sc ho ol s,

N = 79 0 [S ]

d 2 co nd iti on s: (1 ) ca se (n

= 41 8) :

th irt y 35 -m

in ut e le ss on s, em

p at hy

tr ai ni ng ,i m p ul se

co nt ro la nd

an ge r m an ag em

en t, ta ug ht

b y

te ac he r; (2 ) co nt ro l( n = 37 2)

Pr et es t; p os tt es t;

6- m on th

fo llo w -

up

Se co nd

st ep

(S LT )

So ci al sk ill s; ag gr es si ve

be ha vi or ;d el in qu en t

b eh av io r

TR ,P R; 60 -m

in ut e

ob se rv at io n

C ha ng e sc or es

di d no t di ffe r

si gn ifi ca nt ly be tw ee n in te rv en -

tio n an d co nt ro l sc ho ol s. Be ha v-

io r ob se rv at io ns

re ve al ed

an de cr ea se

in ph ys ic al ag gr es si on ,

in cr ea se

in pr os oc ia l be ha vi or

C am

p et al 3 6 (1 97 7) :g ra de

2: no n- th eo ry b as ed ,

se le ct iv e, si ng le ,4 Y ,

p ro gr am

Ra nd om

ly as si gn ed

to ea ch

co nd iti on , no m in at ed

b y

te ac he rs [I]

d 3 co nd iti on s: (1 ) ca se :1 2 ag gr es si ve

bo ys .D ai ly ,3 0- m in ut e in di vi du al

se ss io ns

fo r 6 w ee ks ;( 2) co nt ro l:

10 ag gr es si ve

bo ys :n o in te rv en tio n;

(3 )n or m al gr ou p co nt ro l( n = 12 ):

no in te rv en tio n. ‘‘T hi nk

al ou d’ ’

de si gn ed

fo r im pr ov in g se lf- co nt ro l

in 6- to 8- ye ar -o ld bo ys (S BC L)

Pr et es t; p os tt es t

Th in k al ou d

(c og ni tiv e

b eh av io r

m od ifi ca tio n)

A gg re ss io n (S BC L) ;v ar io us

te st s w er e do ne

TR In te rv en tio n gr ou p ’s p at te rn

re se m b le d no rm

al an d di ffe re d

fr om

ag gr es si ve

co nt ro ls .

Pr od uc e si gn ifi ca nt

im p ro ve m en t in

b ot h te st

p er fo rm

an ce

an d cl as sr oo m

b eh av io r in

ag gr es si ve

b oy s.

SB C L ag gr es si ve : no t

si gn ifi ca nt

Br as w el le t al 3 7 (1 99 7) :

1s t- 4t h gr ad er s: th eo ry

b as ed ,s el ec tiv e, m ul ti,

4Y ,s p ec ia lis t p ro gr am

Ra nd om

iz ed

gr ou p de si gn

(s tr at ifi ed

ra nd om

sa m p le );

un it of

ra nd om

as si gn m en t: sc ho ol

di st ric ts w ith

sc ho ol s,

cl as sr oo m s, an d st ud en ts

ne st ed

in di st ric ts ,

N = 30 9

d 2 co nd iti on s: (1 )M

CE I; (a )c hi ld co m -

po ne nt — 18

sc ho ol -b as ed

45 -t o 60 -

m in ut e pe er tr ai ni ng

gr ou p se ss io ns

in 1s t ye ar an d 10

se ss io ns

in 2n d

ye ar ,( b) pa re nt co m po ne nt — ni ne

2- ho ur gr ou p se ss io ns in 1s ty ea ra nd

six 2- ho ur se ss io n in 2n d ye ar ,( c)

te ac he rc om

po ne nt — tw o 2- ho ur

in -s er vi ce

tr ai ni ng

se ss io ns

an d ni ne

45 -m in ut e tr ai ni ng

se ss io ns

in 1s t

ye ar an d on e 2- ho ur in -s er vi ce

se s-

sio ns

an d fiv e 45 -m in ut e in -b ui ld in g

se ss io ns

in 2n d ye ar ;( 2) IA C: fo r

te ac he r, pa re nt s, no t ch ild re n

Pr et es t; p os tt es t 1;

p os tt es t 2 (b ef or e

2n d in te rv en tio n) ;

p os tt es t 3

M C EI (c og ni tiv e

b eh av io ra l

th er ap y)

C hi ld

b eh av io r:

ex te rn al iz in g; se lf- an d

fa m ily

fu nc tio ni ng

TR (B A SC ); PR

M C EI co nd iti on

di d no t p ro du ce

in iti al ou tc om

es b ey on d th os e

ac hi ev ed

in th e IA C co nd iti on s,

an d ne ith er

co nd iti on s re su lte d

in p os iti ve

ch an ge s as

ra te d

b y si gn ifi ca nt

ot he rs ; BA SC

Pr in z et al 3 8 (1 99 4) :g ra de s

1- 3: no n- th eo ry b as ed ,

se le ct iv e, si ng le ,4 Y ,

sp ec ia lis t p ro gr am

Ra nd om

ly as si gn ed

cl as se s in

6 p ub lic

el em

en ta ry

sc ho ol s to

ea ch

co nd iti on ;

se le ct ed

b y te ac he r’s

ra tin g [C ]

d 4 co nd iti on s: (1 ) PC S ag gr es siv e (n 1

= 48 ); (2 )P C S no na gg re ss iv e (n 2 =

52 ); (3 )n o PC S ag gr es siv e (n 1 = 47 );

(4 )n o PC S no na gg re ss iv e (n 2 = 49 ).

PC S: te ac h hi gh -r is k ch ild re n ho w to

co pe

w ith

pe er -r el at ed

so ci al ch al -

le ng es

an d to be co m e pa rt of

a pr os oc ia ls up p or t ne tw or k, 50 -

m in ut e, w ee kl y tr ai ni ng

se ss io n

co nd uc te d ou ts id e of th e cl as sr oo m

du rin g th e sc ho ol da y: gr ou p ru le s,

re un io n, p ro be s (r ol e- pl ay s) gr ou p

ac tiv ity ,a nd

re w ar d (n o. of se ss io n:

19 -2 4) .C on du ct ed

by 2 m em

be r

te am

s. A lth ou gh

PC S tr ai ni ng

is a th eo re tic al ly dr iv en

in te rv en tio n, it

w as no t in cl ud ed

in th eo ry -b as ed

ev al ua tio n be ca us e ag gr es si on

w as

us ed

fo r m ed ia to r, no t ou tp ut

Pr et es t; p os tt es t;

6- m on th

fo llo w -u p

PC S (c op in g-

co m p et en ce

m od el )

C om

m un ic at io n

ef fe ct iv en es s;

ag gr es si on ;s oc ia ls ki lls ;

in te rn al iz in g p ro b le m s;

p ee r ac ce p ta nc e ra tin g

TR C BC L; C om

m un ic at io n

Ef fe ct iv en es s Sc al e fo r

Te ac he rs ;o b se rv e; PR

PC S tr ai ni ng

in cr ea se d p ro so ci al

co p in g vi a in fo rm

at io n

ex ch an ge , im p ro ve d so ci al

sk ill s, an d re du ce d ag gr es si on

in hi gh ly ag gr es si ve

ch ild re n.

N o ch an ge

in p ee r st at us . PC S

di d no t m ov e th e gr ou p ou t

of th e cl in ic al ra ng e fo r

ag gr es si on . In fo rm

at io n

ex ch an ge , im p ro vi ng

so ci al

sk ill s, an d re du ci ng

ag gr es si on

w er e us ed

as m ed ia tin g

fa ct or s. Th us , it is no t cl ea r

ho w ag gr es si on

w as

re du ce d

(c on tin ue d )

472 d Journal of School Health d September 2008, Vol. 78, No. 9 d ª 2008, American School Health Association

Ta b le

1. (C o n ti n u ed

)

So u rc e/ P ro g ra m

Ty p e

R an

d o m iz at io n

[U n it ] I, C ,S

In te rv en

ti o n

Ti m e to

M ea su re

P ro g ra m

O u tc o m e

M ea su re m en

t Ev al u at io n

Pe p le r et al 3 9 (1 99 5) :1 st -

6t h gr ad es

(6 -1 2 ye ar s) :

no n- th eo ry b as ed ,

se le ct iv e, si ng le ,

sp ec ia lis t p ro gr am

Ra nd om

ly as si gn ed

to ea ch

co nd iti on . Re fe rr ed

b y

te ac he rs , N = 74

(m = 63 ,

f = 11 ) [I]

d 2 co nd

it io ns : (1 ) SS T—

lis te n in g,

kn ow

in g yo u r fe el in g s, d ea lin g

w it h an ge r, su in g se lf- co nt ro l,

jo in in g in a g ro up

,f o llo w in g in -

st ru ct io ns ,r es p on d in g to

te as -

in g, ke ep in g ou t of fig ht s, an d

p ro b le m

so lv in g .T w o 75 -m

in ut e

se ss io ns

a w ee k fo r 12 -1 5 w ee ks

(n = 40 ,m

= 33 ,f = 7) ;( 2) W LC

gr ou p (n

= 34 ,m

= 30 ,f = 4)

Pr et es t; p os tt es t; 1

se m es te r la te r; 2

se m es te rs la te r

SS T (S LT , sy st em

th eo ry )

C BC L; TR F (e xt er na liz in g) ;

ag gr es si on

PR ; TR ;p ee r ra tin gs

SS T gr ou p ha d fe w er

ex te rn al iz in g b eh av io r

p ro b le m s af te r p ro gr am

th an

W LC

gr ou p . N o si gn ifi ca nt

gr ou p di ffe re nc es

in p ar en t or

p ee r ra tin gs . 9- m on th

fo llo w -

up m ar gi na l m ai nt en an ce

of tr ea tm

en t ga in s; ef fe ct iv en es s

te st

H ar ris

et al 4 0 (1 99 2) :1 st -

2n d gr ad er s: no n-

th eo ry b as ed ,s el ec tiv e,

si ng le ,4 Y ,p ro gr am

Ra nd om

ly as si gn ed

to ea ch

co nd iti on , no m in at ed

b y

te ac he rs us in g TR F,

N = 58

[I]

d 2 co nd

it io ns : (1 ) ex pe rim

en ta l:

cl as sr o om

-b as ed

in te rv en ti on

fo r

12 w ee ks ,p sy ch ol og

ic al co ns ul -

ta nt s vi si ti ng

an d w o rk in g w it h

te ac h er on

b eh av io ra ls tr at eg ie s,

n = 25 ;( 2) co nt ro l: on

e th ir d

re ce iv ed

co n su lt an t vi si ts ,n

= 33

Pr et es t; p os tt es t

In te rn al iz in g; ex te rn al iz in g;

ad ap tiv e fu nc tio ni ng

TR N o si gn ifi ca nt

di ffe re nc e b et w ee n

2 gr ou p s. Bo th

gr ou p s

im p ro ve d si gn ifi ca nt ly in

TR F

sc or es

Ke lla m

et al 4 1 (1 99 8) .1 st -

2n d gr ad er s: th eo ry

b as ed ,u ni ve rs al ,s in gl e,

4Y ,t ea ch er p ro gr am

3 m at ch ed

sc ho ol s ra nd om

ly as si gn ed

to ea ch

co nd iti on

1 ad de d 4

sc ho ol s, N = 10 84

in th e

b eg in ni ng

[S ]

d 3 co n d it io n s: (1 ) M L (2

sc h o o ls )

in st ru ct io n al st ra te g y in

th e

re ad in g cu rr ic u lu m . D ev el o p -

m en t o f a g ro up

-b as ed

ap p ro ac h to

m as te ry an d a fle xi -

b le

co rr ec ti ve

p ro ce ss ; (2 ) G BG

(2 sc h o ol s) :c la ss ro o m

te am

- b as ed

b eh av io r m an ag em

en t

st ra te g y to

en co u ra g e st u d en ts

to m an ag e th ei r o w n b eh av io r

th ro u g h g ro u p re in fo rc em

en t

an d m ut u al se lf- in te re st ;( 3)

ex te rn al co nt ro l( 4 sc h oo ls );

ta u g h t b y te ac h er

Pr et es t; 1s t- st ag e

as se ss m en t (d id

no t in di ca te

fu rt he r

ev al ua tio n) —

m id te st ty p e

Re sp on se

p ro ce ss

so ci al ad ap ta tio n

A ch ie ve m en t te st sc or es

(C AT ); ag gr es si ve

be ha vi or

Sc ho ol

re co rd

(s co re s) ;

TR (T O C A -R )

N o ef fe ct of

G BG

on ac hi ev em

en t

th ro ug h im pr ov in g ag gr es siv e

be ha vi or .G

BG ha d m ar gi na lly

sig ni fic an t ef fe ct s on

sp rin g

ag gr es siv e be ha vi or

fo r bo th

ge nd er s. Th is st ud y hy po th es iz ed

th at in te rv en tio n fo r ag gr es si ve

be ha vi or

w ou ld ha ve

be ne fic ia l

ef fe ct s on

ac hi ev em

en t, so

it w as

va gu e to

ju dg e if ag gr es -

sio n w as

ou tc om

e or

no t

C on du ct Pr ob le m s

Pr ev en tio n Re se ar ch

G ro up

4 2 (1 99 9) :K

gr ad e: th eo ry b as ed ,

se le ct iv e, m ul ti, 4Y

, p ro gr am

Sc ho ol s in

4 si te s w er e

di vi de d in to

2 se ts

m at ch ed

fo r

de m og ra p hi cs — ra nd om

ly as si gn ed

se ts to

2 co nd iti on s [S ]

d 2 co nd iti on s: (1 ) fa st tr ac k (n

= 44 5)

(a ) un iv er sa l in te rv en tio n:

PA TH S cu rr ic ul um

sk ill s fo r

em ot io na l un de rs ta nd in g,

co m m un ic at io n,

fr ie nd sh ip /s el f-

co nt ro l/ so ci al p ro b le m

sk ill s,

ta ug ht

b y te ac he r, (b ) se le ct iv e

in te rv en tio n: ad d p ar en t

fa ct or s—

es ta b lis h a p os iti ve

fa m ily

sc ho ol re la tio ns hi p ,p ar en ta ls el f-

co nt ro la nd

im p ro vi ng

p ar en tin g

sk ill s: le d b y fa m ily

co or di na to rs ;

(2 ) co nt ro l( n = 44 6)

Pr et es t (K

gr ad e) ;

p os tt es t (1 st

gr ad e)

Fa st tr ac k

(d ev el op m en ta l

th eo ry )

C hi ld

so ci al co gn iti on /

re ad in g;

ch ild

p ee r

re la tio ns /s oc ia l

co m p et en ce ;

p ar en tin g b eh av io r/

so ci al co gn iti on ;

ex te rn al iz in g (T RF )

In te rv ie w ; PR ; PS R; PR ,

TR (T O C A -R ), p ee rR

Th e in te rv en tio n gr ou p ch ild re n

p ro gr es se d si gn ifi ca nt ly in

th ei r

ac qu is iti on

of al m os t al l th e

sk ill s. Pa re nt s de m on st ra te d

le ss

ha rs h p un is hm

en t, m or e

ap p ro p ria te

an d w ar m

p ar en tin g b eh av io rs , an d m or e

p ar en ta l in vo lv em

en t in

sc ho ol

(c on tin ue d )

Journal of School Health d September 2008, Vol. 78, No. 9 d ª 2008, American School Health Association d 473

used different scales to measure violence, an SMD was

used to standardize all outcomes to 1 common scale

measured in standard deviation units. The SMD was

calculated by dividing the difference in the means by a

standard deviation.46

Because meta-analyses summarize results across

studies with varied methods, subjects, and outcomes,

it is important to include a measure of heterogeneity

to assess whether the observed variation between the

results in the studies is greater than what would be

expected by chance alone. Therefore, heterogeneity

tests using the chi-square test at the .05 level of signifi-

cance were reported separately for each hypothesis.

In order to retain as many studies as possible for

the meta-analysis, the standard deviation was

imputed for those studies that reported only a mean

(N = 8). The regression method of imputation given

by Little and Rubin47 (1987) was applied. This method

estimated the sample standard deviations from the

complete samples. Sensitivity analyses were conducted

for each hypothesis in order to assess the effect of

imputing the standard deviations. Because each effect

size for all the hypotheses was within the range of the

model using the complete data, the imputed data did

not have any undue effects on the final results.

RESULTS

Among the total 1997 studies identified through

the electronic search engines, 329 were potentially

relevant to the prevention of violence in children and

adolescents. An additional 66 studies were identified

through reviewing these studies’ references. Through

an in-depth review of those articles, 36 studies were

found to be eligible. All 36 studies had randomized

the students into either an intervention or a control

group. The importance of using randomized studies is

to reduce the possibility of confounding variables

accounting for each study’s results20,48-52 and, thereby,

increasing the confidence of identifying the program

characteristics responsible for decreasing aggression

and violence in school-based programs.

Although school-based violence prevention pro-

grams have been targeted at decreasing aggressive or

violent behavior, outcome measures varied among

studies, such as skill, attitude, social confidence,

achievement test scores, academic confidence, school

attendance, scores of aggression, and use of violence/

violent or externalizing behavior. In order to focus on

behavior change as outcome measures, this study

included only scores of aggression and use of vio-

lence/violent or externalizing behavior. Among these

studies, only 18 had complete data on externalizing,

aggressive, or violent behavior. Eight studies had re-

ported the group means only. As mentioned earlier,

the standard deviations for these 8 studies were

imputed. Thus, 26 studies were analyzed (Table 1).Ta b le

1. (C o n ti n u ed

)

So u rc e/ P ro g ra m

Ty p e

R an

d o m iz at io n

[U n it ] I, C ,S

In te rv en

ti o n

Ti m e to

M ea su re

P ro g ra m

O u tc o m e

M ea su re m en

t Ev al u at io n

A ug us t et al 4 3 (2 00 1) :

th eo ry b as ed ,s el ec tiv e,

m ul ti, 4Y

,s p ec ia lis t

p ro gr am

:K gr ad e

Ra nd o m ly as si gn ed

sc ho ol s

to 2 co nd iti on s; sc re en ed

b y te ac he rs w ith

ag gr es si ve

di sr up tiv e

b eh av io r us in g C BC L [S ]

d 2 co nd iti on s: (1 ) in te rv en tio n:

su m m er sc ho ol p ro gr am

(2 88

ho ur s of p ro gr am

co nt en t) 1

sc ho ol ye ar te ac he r co ns ul ta tio n

an d st ud en tm

en to rin g pr og ra m 1

FL EX :f am

ily pr og ra m (t w el ve

2- ho ur se ss io ns

in ye ar 1 w ith

11 se ss io ns

in ye ar 2) ;( 2) co nd iti on

Pr et es t; m id te st ;

p os tt es t

Ea rly

Ri se rs p ro gr am

A ca de m ic co m p et en ce ;

be ha vi or al se lf-

re gu la tio n; so ci al

co m p et en ce ;p ar en t

in ve st m en t in ch ild

TR , PR ; TR ,P R, TO

C A ,

PO C A ;T R, PR ;P R

Si gn ifi ca nt

im p ro ve m en t on

ac ad em

ic co m p et en ce . N o

si gn ifi ca nt

gr ou p di ffe re nc es

on b eh av io ra l se lf- re gu la tio n,

so ci al co m p et en ce , or

p ar en t

in ve st m en t co m p os ite s. TO

C A :

fe w er

ag gr es si ve

b eh av io r

p ro b le m s

[I] , in di vi du al le ve l; [C ], cl as sr oo m

le ve l; [S ], sc ho ol

le ve l; m , m al e; f, fe m al e; SR , se lf- re p or t; p ee rR , p ee r re p or t; TR , te ac he r re p or t; SC A RE , St ud en t C re at ed

A gg re ss io n Re p la ce m en t Ed uc at io n;

PR , p ar en t re p or t; SC T, So ci al C og ni tiv e Th eo ry ; SD C , so ci al

de ve lo p m en t cu rr ic ul um

; SC I, sc ho ol /c om

m un ity

in te rv en tio ns ; H EC , he al th

en ha nc em

en t cu rr ic ul um

; C M ST , co p in g w ith

th e m id dl e sc ho ol

tr an si tio ns ; TO

C A -R , te ac he r ob se rv at io n of

ch ild

ad ap ta tio n- re vi se d;

LI FT , lin ki ng

th e in te re st s of

fa m ili es

an d

te ac he rs ; G BG

, G oo d Be ha vi or

G am

e; SB C L: sc ho ol

b eh av io r ch ec kl is t; C BC L, ch ild

b eh av io r ch ec kl is ts ; TR F, Te ac he r Re p or t Fo rm

s; SL T, So ci al Le ar ni ng

Th eo ry ; PS ST , p ro b le m -s ol vi ng

sk ill s tr ai ni ng ; M C EI , m ul tic om

p on en t co m p et en ce

en ha nc em

en t

in te rv en tio n;

IA C , in fo rm

at io n/ at te nt io n co nt ro l; BA SC , b eh av io ra l as se ss m en t sy st em

fo r ch ild re n;

PC S, p ee r co p in g sk ill s; SS T, so ci al sk ill s tr ai ni ng ; W LC , w ai tin g lis t co nt ro l; M L, m as te ry

le ar ni ng ; C AT , C al ifo rn ia A ch ie ve m en t Te st ; PS R, p ar en t se lf- re p or t.

BR PT , Be ha vi or al Ro le -P la yi ng

Te st ; PO

C A , Pa re nt

O b se rv at io n of

C hi ld

A da p ta tio n;

4t h[

, fo ur th

gr ad e or

hi gh er .

*T he

da ta us ed

fo r th e an al ys is ar e ita lic iz ed .

† Re se ar ch er s w ro te di ffe re nt

ar tic le s w ith

th e sa m e p ro gr am

re su lts .

474 d Journal of School Health d September 2008, Vol. 78, No. 9 d ª 2008, American School Health Association

Overall, the intervention groups did not have sig-

nificant effects in reducing aggression and violence as

compared to the control groups (ES = �0.09, 95%

CI = �0.23 to 0.05, with heterogeneity p , .00001).

Comparing the attributes within each characteristic

for programs showed stronger effect sizes than their

comparison attributes without significant differences.

Such attributes were to (1) use non–theory based in-

terventions, (2) focus on high-risk populations, (3)

involve children in the fourth grade or higher, and (4)

employ intervention specialists. Programs in which

the interventions involved a single approach (ie, the

curriculum only) had a mild positive effect on

decreasing aggressive and violent behavior. Therefore,

3 of the 5 hypotheses were not supported, and the

significant hypothesis was actually in the opposite

direction than anticipated. These findings may be

associated with the large variation in the results across

the studies as indicated in the heterogeneity test for

the overall analysis (p , .00001).

To test the first hypothesis, 16 theory-based programs

and 10 non–theory based programs were compared.

Contrary to the hypothesis, the non–theory based

program (effect size [ES] = �0.12, 95% CI = �0.44 to

0.20, with heterogeneity p , .00001) showed a larger

effect size than the theory-based program (ES = �0.05, 95% CI = �0.12 to 0.03, without heterogene-

ity p = .25) in reducing violent behavior.

To test the second hypothesis, 19 selective programs

and 7 universal prevention programs were compared.

Comparing the effect size of both types, the selective

programs (ES = �0.07, 95% CI = �0.18 to 0.04, with-

out heterogeneity p = .13) showed a larger effect size

than the universal programs (ES = �0.02, 95% CI = �0.24 to 0.20, with heterogeneity p , .00001) in

reducing violent behavior.

To test the third hypothesis, 9 multiple-approach

and 18 single-approach programs were compared.

Contrary to the hypothesis, when effect sizes of both

types were compared, the single-approach program

produced positive effects on reducing violence (ES = �0.15, 95% CI = �0.29 to �0.01). But the multiple-

approach program did not give any evidence of a

benefit (ES = 0.06, 95% CI = �0.19 to 0.31). The indi-

vidual result for the single-approach program was

statistically significant (p = .03), while the multiple-

approach program was not. Heterogeneity was pres-

ent for each group (Figure 1).

To test the fourth hypothesis, 9 programs that

focused on younger students (third grade or lower)

were compared to 14 programs that were aimed at

older students. Because there was difficulty in distin-

guishing between those interventions implemented in

classes that were lower than the fourth grade and

those that were in the fourth grade or higher, 2 stud-

ies (ie, Forman30 [1980] and Garrison and Stolberg31

[1983]) were included in the fourth grade or higher

group, although they included the third grade in their

analysis. In addition, a study by Braswell et al37 (1997)

was included in the lower than the fourth-grade group,

although they included the fourth grade in their anal-

ysis. Studies by the Metropolitan Area Child Study

Research Group32 (2002) that targeted the second to

third grades and fifth to sixth grades, Pepler et al39

(1995) who targeted the first to sixth grades, and Stool-

miller et al27 (2000) who targeted the first and fifth

grades were excluded from the analysis because their

results were not reported by individual grades. Con-

trary to the hypothesis, the fourth grade or higher

group showed a larger effect size (ES = �0.10, 95%

CI=�0.27 to 0.08,withheterogeneityp, .00001) than

the third grade or lower group (ES = �0.05, 95%

CI = �0.14 to 0.04, without heterogeneity p = .32) in

reducing violent behavior.

To test the fifth hypothesis, 17 specialist programs

and 5 schoolteacher programs were compared. The

studies that applied both or several methods such as

Orpinas et al12 (2000), Conduct Problems Prevention

Research Group42 (1999), and Harris et al40 (1992)

were excluded from the analysis. Comparing the effect

size, the specialist-based program (ES = �0.07, 95%

CI = �0.16 to 0.02, without heterogeneity p = .32)

showed a larger effect size than the teacher-based pro-

gram (ES = �0.03, 95% CI = �0.21 to 0.15, with het-

erogeneity p , .0001) in reducing violent behavior.

In order to assess for potential publication bias (ie,

the impact of missing studies on the meta-analysis),

a sensitivity analysis using a funnel plot was con-

ducted. A funnel plot is a plot of each trial’s effect size

against a measure of its size such as, used in this

study, the standard error.53 Asymmetry in the funnel

plots may indicate publication bias in the meta-

analysis.54 For this study, 5 funnel plots were con-

ducted for each hypothesis. It is not clear as to whether

therewas a publication bias because therewas a contra-

diction between the study results not scattered sym-

metrically around a central locale and small effect size

(figure is not shown due to space limitation). Although

larger standard errors appeared to be in the studies that

favored the intervention over the control group on

these plots, most of the effect sizes were close to 0.

Therefore, in this case, the funnel plot may not be

appropriate.

DISCUSSION

To assist in developing effective school-based vio-

lence prevention programs, a comprehensive litera-

ture review was conducted to identify which factors

should be considered in reducing violent behavior.

Five program characteristics (ie, theory-based inter-

ventions, characteristics of the target population

such as young or older populations, type of program

such as universal or selective, the number of

Journal of School Health d September 2008, Vol. 78, No. 9 d ª 2008, American School Health Association d 475

program such as single or multiple approach, and

type of instructor) were identified as possible sources

for program success. This study assessed these factors

in predicting the success of school-based prevention

programs through the use of a meta-analysis.

Of the 5 characteristics, 1 successful program strat-

egy was identified. The use of single-approach pro-

grams had a mild positive effect on reducing violence

in children and adolescents independently when

compared to programs using multiple-approach pro-

grams that involved the family, peers, and/or commu-

nity. Although multiple approaches to reduce

adolescents’ violence have been broadly recognized as

desirable,11,13,26 this meta-analysis suggests otherwise

and instead supports a focused single-component

approach to reducing school-based violence. Overall,

insufficient implementation of intervention, lack of

cooperation with school organization and staff, lack of

parental attendance, and the extent of adolescents’

high risk were provided as reasons why the multicom-

ponent approach resulted in failure.12,32,37 Therefore,

this meta-analysis indicates that program success can-

not be guaranteed by simply combining multiple com-

ponents of an intervention. It is also important to

consider how thesemultiple components are combined

to produce an effective program and how to maintain

the fidelity and integrity of the intervention compo-

nents continuously.

Previous research had suggested that school-based

violence prevention programs using a theory-based

approach and starting an intervention program at an

early age were effective in reducing violent behav-

ior.6,7,14,15 However, this study did not support similar

conclusions.

Unlike previous individual study findings, the

meta-analysis did not find any differential effects for 4

of the 5 program characteristics. In addition, the sig-

nificant effect noted was contrary to expectation,

exemplifying the complexity of identifying effective

program strategies.

Several observations may explain these differences.

First, and the most important factor, the size of the

effect must be taken into consideration. Most of the

programs included in the meta-analysis reported

Figure 1. Comparison of Single- vs Multiapproach Program

476 d Journal of School Health d September 2008, Vol. 78, No. 9 d ª 2008, American School Health Association

a positive effect of its programs. However, the effect

sizes were quite small, even close to 0 for some com-

parisons. For example, studies that had less than

a �0.3 effect size were 13 (81.3%) of the theory-based

programs and 5 (50.0%) of the non–theory-based

programs. Even in this study’s meta-analysis, the sig-

nificant finding that the single-approach programs

had a mild positive effect in reducing violence com-

pared to the multiple-approach programs was also

associated with a small effect size (ES = �0.15, 95%

CI = �0.29 to �0.02).

Second, the studies in this review used randomiza-

tion in an intervention and control group. Although it

was assumed that given randomization, the pretests

on violent behavior would be comparable, some of

the studies had actually shown a large discrepancy at

the pretest for their particular outcome.18,22,25,30,31,36

As several studies included in thismeta-analysis did not

report both a pre- and a posttest result, only the posttest

results were compared. Given the possibility of group

differences at baseline, the noted significant effect for

single-approach programs may have been overesti-

mated, resulting in the contrary finding.

Third, this meta-analysis focused on actual change

in aggressive and/or violent behavior, whereas the

individual studies included in the study may have

used additional criteria for concluding programmatic

success, including changes in attitude and beliefs.

Thus, a different outcome between the majority of the

individual studies and the meta-analysis might be

expected.

Fourth, a substantial number of the included stud-

ies (approximately 40%) had sample sizes that were

less than 100. The small sample sizes may have

reduced the ability to see an effect size for each study,

which then is expounded in the meta-analysis. It is

debatable how large a sample size is needed to judge

the result of a program as credible. Many programs

that focused on decreasing aggressive behavior used

small sample sizes, and targeted students were

referred from teachers, peers, or parents. Therefore, it

may be difficult to have a large sample size. As with

any study assessing the efficacy of intervention, the

proper sample size should be considered in advance.

Finally, the inclusion criteria established for the

meta-analysis restricted the number of available stud-

ies. Because many programs did not report the means

and standard deviations in their results, the number

of available studies dropped substantially. Therefore,

several important criteria could not be considered

such as requiring similar study designs, interventions,

quality of implementation, or level of randomization.

These differences may have contributed to the hetero-

geneity across studies and the possible negligible ef-

fects noted in the research.

In summary, small effect sizes, missing pretests, dif-

ferences in outcome focus, small sample sizes, and

heterogeneity among the included studies may have

contributed to the lack of significant findings for sev-

eral of the program characteristics. Clearly, our com-

prehensive review of the literature indicates that

there has been no single protocol governing the con-

duct of these kinds of studies. This is emphasized by

our findings with statistical results in the previous

section, which have been contrary to some of the ex-

pectations outlined in our hypotheses.

Overall, the results of this meta-analysis may not

be generalized to all studies examining school-based

violence prevention programs because many studies

were not included due to incomplete statistical data,

limitations to get actual materials (eg, dissertations),

or inappropriate outcome reports. In addition, compo-

nents of each intervention (ie, duration and level

of intervention) were not considered in this meta-

analysis, which may have resulted in heterogeneity

across studies.

CONCLUSIONS

This study added to current knowledge by examin-

ing the program characteristics associated with suc-

cessful school-based violence prevention programs.

Five characteristics were identified; however, only

single-approach programs were shown to have a mild

positive effect on reducing aggressive and violent

behavior even when compared to multiple-approach

programs. However, several factors may have ac-

counted for these negligible effects. In particular, the

lack of pretest reporting or a large discrepancy at the

pretest in the studies makes it difficult to assess

whether the randomization was successful or not.

This is just an example of the challenges a researcher

faces when conducting a meta-analysis. To facilitate

the future use of meta-analyses, researchers should be

encouraged to report the details of their studies and

measurable outcomes, including means and standard

deviations where appropriate.

Future directions may include a research agenda

focused on establishing standards for developing, imple-

menting, and evaluating school-based prevention pro-

grams. For example, the heterogeneity among studies

may be alleviated by research agendas focused on simi-

lar treatments or interventions, including specifying the

components, dose or intensity, duration, and follow-up

of the studies. Funding agencies should encourage fur-

ther quality studies in program and measurement

development. Unless the scientific community has

agreed-upon standards for developing, implementing,

and evaluating school-based prevention programs, the

ability to identify factors that affect school-based vio-

lence prevention program success becomes more com-

plicated, especially using a meta-analysis.

Since school-based prevention programs may re-

quire tailoring a standard intervention to a particular

Journal of School Health d September 2008, Vol. 78, No. 9 d ª 2008, American School Health Association d 477

school environment, meta-analysis techniques be-

come even more valuable as they help bridge these

differences and identify the common characteristics

necessary for effective programs. Thus, the quality of

conducting and reporting studies is paramount for

a successful meta-analysis application.

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