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Violence Prevention: Primary Prevention Interventions to Reduce Perpetration of Intimate Partner Violence and Sexual Violence Among Youth


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 28 studies. Twelve studies came from two existing systematic reviews (Whitaker et al., 2013 [search period: 1993-2012] and DeGue et al., 2014 [search period: 1985-2012]). The remaining studies were identified through an updated search for evidence through June 2016.

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to intimate partner violence and sexual violence.


Intimate partner violence and sexual violence are widespread, affect both men and women, and often start early in life (Smith et al. 2017). The effects can include physical injury, substance abuse, poor mental health, and chronic physical health problems (Smith et al. 2017, Coker et al. 2002). Adolescence represents a unique opportunity to promote attitudes and behaviors that could prevent intimate partner and sexual violence across the lifespan.

This systematic review was focused on primary prevention of perpetration of violence. While victimization outcomes were included when the perpetration studies included them, this review did not include studies that evaluated programs focused exclusively on reducing the risk of victimization.

The U.S. Preventive Services Task Force recommends providers engage in secondary prevention by screening women of childbearing age for intimate partner violence and referring them to support services as appropriate (USPSTF 2018 External Web Site Icon).

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 28 studies that reported results for perpetration (21 studies), victimization (15 studies), and bystander action (9 studies). Below are results from the latest follow-up:

  • Perpetration—favorable and consistent decreases
  • Victimization—inconsistent results
  • Bystander action—inconsistent results

Bystander action was stratified by length of follow-up. Results showed consistent increases in bystander action within six months of the intervention. Results were inconsistent after six months.

Included studies evaluated interventions that combined educational information about intimate partner violence and sexual violence with one or more of the following three strategies:

  1. Teaching healthy relationship skills
  2. Promoting social norms that protect against violence
  3. Creating protective environments

Outcomes varied based on the combination of strategies used.

  • Interventions that taught healthy relationship skills OR promoted social norms to protect against violence reported favorable and consistent decreases in perpetration (7 of 8 studies).
  • Interventions that taught healthy relationship skills OR combined teaching healthy relationship skills with efforts to promote social norms that protect against violence reported favorable and consistent decreases in victimization (10 of 12 studies).
  • Interventions that used all three strategies (2 studies) in combination reported decreases in perpetration and victimization.
  • Interventions that promoted social norms to protect against violence through bystander education and empowerment, engaged men and boys as allies in prevention, or both reported favorable and consistent increases in bystander action within six months of intervention completion (9 studies).
  • While interventions that used other strategy combinations led to favorable results for perpetration and victimization there were too few studies or inconsistent results across studies of those specific strategy combinations to draw conclusions about them.

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.


Based on results from the review, findings should be applicable to interventions for male and female youth from different racial and ethnic backgrounds. Most of the included studies were conducted in the United States, but findings should be applicable to other high-income countries as well.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • What combinations of intervention approaches are most effective?
  • What are the best measures for the outcomes of perpetration, victimization, and bystander action? More consensus is needed to increase comparability across studies and the ability to synthesize evidence.
  • How effective are interventions that seek to create protective environments? More interventions are needed that include components at the community and societal levels.
  • How effective are these interventions across different populations, including the following:
    • Students in rural settings?
    • Lesbian, gay, bisexual, and transgender (LGBT) youth?
    • Youth with intellectual and developmental disabilities?
    • High-risk youth?
  • How effective are age-appropriate interventions that target younger children (e.g., primary school-age children)? Rates of violence reported in the included studies suggest some students are already experiencing and perpetrating intimate partner violence and sexual violence in middle school. Age-appropriate interventions for elementary school students need to be developed and tested for later impact on SV and IPV outcomes.

Study Characteristics

  • Most of the included studies were conducted in the United States (25 studies). Remaining studies were done in Canada (2 studies) and the Netherlands (1 study).
  • Most interventions were implemented in schools (5 middle, 6 high, 1 middle and high, 12 college), though some were also done in communities (2 studies), or homes (2 studies).
  • Study participants had the following demographic characteristics across studies:
    • Mean age of 16.5 years (16 studies)
    • 53.0% female (21 studies)
    • Black (median 16.1%, 20 studies), Hispanic (median 10.9%, 17 studies), Asian (median 6.9%, 12 studies), White (median 69.9%, 21 studies), and American Indian (2.2%, 6 studies)