Abstract
IMPORTANCE: Sexual violence is a public health problem that affects adolescents globally. To our knowledge, no meta-analysis of prevention programs for adolescent sexual violence has been conducted. OBJECTIVE: To perform a systematic review and meta-analysis of randomized clinical trials evaluating the efficacy of psychosocial programs for preventing sexual violence during adolescence. DATA SOURCES: Peer-reviewed articles published in English were searched in PsycINFO, ERIC, PsycArticles, PubMed, and Web of Science databases through December 2021. STUDY SELECTION: Studies were included if they were randomized clinical trials assessing the efficacy of a psychosocial prevention program targeting sexual violence and delivered to adolescents aged 10 to 19 years. DATA EXTRACTION AND SYNTHESIS: Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify studies. The quality of individual studies was assessed with the Revised Cochrane Collaboration Risk of Bias tool. A random-effects model was used to pool odds ratios (ORs). Exploratory subgroup and metaregression analyses were performed to evaluate the associations between moderators and effect sizes. MAIN OUTCOMES AND MEASURES: Primary outcomes were perpetration of sexual violence, experience of sexual violence, and a composite measure of any perpetration or experience of sexual violence. RESULTS: Data were analyzed from 20 trials involving 37 294 adolescents. Compared with control conditions, prevention programs were associated with a significant reduction in the perpetration (OR, 0.83; 95% CI, 0.73-0.95; P = .005) and experience (OR, 0.87; 95% CI, 0.78-0.98; P = .02) of sexual violence, as well as a 13% significant reduction of any sexual violence (OR, 0.87; 95% CI, 0.78-0.97; P = .009). Exploratory analyses of the combination of program setting and participant age indicated that programs that were delivered in school settings and targeted at adolescents aged 15 to 19 years yielded significantly larger effect sizes (Cochran Q = 4.8; P = .03) compared with programs that were either delivered outside of a school setting or targeted younger adolescents. Quality assessment of trials revealed concerns of risk of bias across several included studies. CONCLUSIONS AND RELEVANCE: In this meta-analysis, evidence suggested that prevention programs were associated with reducing adolescent sexual violence, especially when implemented at school with older adolescents. However, there is need for additional high-quality research. Prevention of adolescent sexual violence remains understudied compared with other similarly important public health prevention targets.