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May 28, 1997, Vol 277, No. 20 >
ARTICLE | May 28, 1997

Effectiveness of a Violence Prevention Curriculum Among Children in Elementary School: Title and subTitle BreakA Randomized Controlled Trial FREE

David C. Grossman, MD, MPH; Holly J. Neckerman, PhD; Thomas D. Koepsell, MD, MPH; Ping-Yu Liu, PhD; Kenneth N. Asher, PhD; Kathy Beland, MEd; Karin Frey, PhD; Frederick P. Rivara, MD, MPH
[+] Author Affiliations

Dr Frey and Ms Beland are employees of the Committee for Children, a nonprofit organization that derives income from sales of the curriculum.

This study was presented in part at the annual meeting of the Ambulatory pediatric Association, washington, DC, May 1995.

Reprints: David Grossman, MD, MPH, Harborview Injury Prevention and Research Center, 325 Ninth Ave, Box 359960, Seattle, WA 98104.


JAMA. 1997;277(20):1605-1611. doi:10.1001/jama.1997.03540440039030
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Article
References

Objective.  —To determine if a commonly used violence prevention curriculum, Second Step: A Violence Prevention Curriculum, leads to a reduction in aggressive behavior and an increase in prosocial behavior among elementary school students.

Design.  —Randomized controlled trial.

Setting.  —Urban and suburban elementary schools in the state of Washington.

Participants.  —Six matched pairs of schools with 790 second-grade and third-grade students. The students were 53% male and 79% white.

Intervention.  —The curriculum uses 30 specific lessons to teach social skills related to anger management, impulse control, and empathy.

Main Outcome Measures.  —Aggressive and prosocial behavior changes were measured 2 weeks and 6 months after participation in the curriculum by parent and teacher reports (Achenbach Child Behavior Checklist and Teacher Report Form, the School Social Behavior Scale, and the Parent-Child Rating Scale) and by observation of a random subsample of 588 students in the classroom and playground/ cafeteria settings.

Results.  —After adjusting for sex, age, socioeconomic status, race, academic performance, household size, and class size, change scores did not differ significantly between the intervention and control schools for any of the parent-reported or teacher-reported behavior scales. However, the behavior observations did reveal an overall decrease 2 weeks after the curriculum in physical aggression (P=.03) and an increase in neutral/prosocial behavior (P=.04) in the intervention group compared with the control group. Most effects persisted 6 months later.

Conclusions.  —The Second Step violence prevention curriculum appears to lead to a moderate observed decrease in physically aggressive behavior and an increase in neutral and prosocial behavior in school.

REFERENCES

1 +
Mercy JA, O'Carroll PW.  New directions in violence prevention: the public health arena . Violence Vict . 1988;;3:285-301.
2 +
Huesmann LR, Eron LD, Lefkowitz MM, Walder LO.  Stability of aggression over time and generations . Dev Psychol . 1984;;20:1120-1134
3 +
McCord J.  Family relationships, juvenile delinquency and adult criminality . Criminology . 1991;; 29:397-417.
4 +
Farrington DP.  Childhood aggression and adult violence: early precursors and life outcomes . In: Pepler DJ, Rubin KH, eds. The Development and Treatment of Childhood Aggression . Hillsdale, NJ: Lawrence Erlbaum; 1991;:5-30.
5 +
Moffitt TE.  Adolescence-limited and life-course persistent antisocial behavior: a developmental taxonomy . Psychol Rev . 1993;;100:674-701.
6 +
Tremblay RE, McCord J, Boileau H, et al.  Early disruptive behavior, poor school achievement, delinquent behavior and delinquent personality: a longitudinal analysis . J Consult Clin Psychol . 1992;; 60:64-72.
7 +
Huesmann LR, Eron LD, Lefkowitz MM.  Stability of aggression over time and generations . Dev Psychol . 1984;;20:1120-1134.
8 +
Olweus D.  Stability of aggressive reaction patterns in males: a review . Psychol Bull . 1979;;86: 852-875.
9 +
Yoshikawa H.  Prevention as cumulative protection: effects of early family support and education on chronic delinquency and its risks . Psychol Bull . 1994;;115:28-54.
10 +
Tremblay RE, Craig WM.  Developmental crime prevention . Crime Justice . 1995;;19:151-236.
11 +
Rivara FP, Farrington DP.  Prevention of violence: role of the pediatrician . Arch Pediatr Adolesc Med . 1995;;149:421-429.
12 +
Wilson-Brewer R, Cohen S, O'Donnell L, Goodman IF. Violence Prevention for Young Adolescents: A Survey of The State of the Art . New York, NY: Carnegie Council on Adolescent Development; 1991;.
13 +
Pellegrini DS, Urbain ES.  An evaluation of interpersonal cognitive problem solving training with children . J Child Psychol Psychiatry . 1985;:26:17-41.
14 +
Webster DW.  The unconvincing case for schoolbased conflict resolution programs for adolescents . Health Aff (Millwood) . 1993;;4:126-141.
15 +
Hawkins JD, Van Cleve E, Catalano RF.  Reducing early childhood aggression: results of a primary prevention program . J Am Acad Child Adolesc Psychiatry . 1991;;30:208-217.
16 +
Gottfredson DC.  An empirical test of schoolbased environmental and individual interventions to reduce the risk of delinquent behavior . Criminology . 1986;;24:705-731.
17 +
Kazdin AE, Siegel TC, Bass D.  Cognitive problem-solving skills training and parent management training in the treatment of anti-social behavior in children . J Consult Clin Psychol . 1992;;60:733-747.
18 +
Lochman JE.  Cognitive-behavioral intervention with aggressive boys: three year follow-up and preventive effects . J Consult Clin Psychol . 1992;; 60:426-432.
19 +
Tremblay RE, Vitaro F, Bertrand L, et al.  Parent and child training to prevent early onset of delinquency: the Montreal Longitudinal-Experimental Study . In: McCord J, Tremblay RE, eds. Preventing Antisocial Behavior: Intervention From Birth Through Adolescence . New York, NY: Guilford Press; 1992;.
20 +
Merrell KW.  Using behavioral rating scales to assess social skills and antisocial behavior in school settings: development of the School Social Behavior Scales . Sch Psychol Rev . 1993;;22:115-133.
21 +
Achenbach TM. Manual for the Teacher's Report Form and 1991 Profile . Burlington: University of Vermont Dept of Psychiatry; 1991;.
22 +
Achenbach TM. Manual for the Child Behavior Checklist14-18 and 1991 Profile . Burlington: University of Vermont Dept of Psychiatry; 1991;.
23 +
Hightower AD, Work WC, Cowen EL.  The Teacher-Child Rating Scale: a brief objective measure of elementary children's school problem behaviors and competencies . Sch Psychol Rev . 1986;; 15:393-409.
24 +
Hightower AD. The Parent-Child Rating Scale . Rochester, NY: Dept of Psychology, Center for Community Study, University of Rochester; 1990;.
25 +
Neckerman HJ, Asher K, Pavlidis K. Social Interaction Observation System . Seattle, Wash: Harborview Injury Prevention and Research Center; 1994;.
26 +
Saudargas R, Lentz F.  Estimating percent of time and rate via direct observation: a suggested observational procedure and format . Sch Psychol Rev . 1986;;15:36-38.
27 +
Rosner B. Fundamentals of Biostatistics . Belmont, Calif: Duxbury Press; 1995;:519.
28 +
Hollingshead AB. Four Factor Index of Social Status . New Haven, Conn: Yale University Press; 1975;.
29 +
Greenberg M. Classroom Atmosphere Scale . Seattle: University of Washington; 1994;.
30 +
Zeger SL, Liang KY.  Longitudinal data analysis for discrete and continuous outcomes . Biometrics . 1986;;42:121-30.
31 +
Liang KY, Zeger SL.  Longitudinal data analysis using generalized linear model . Biometrika . 1986;; 73:13-22.
32 +
Green SB, Corle DK, Gail MH, et al.  Interplay between design and analysis for behavioral intervention trials with community as the unit of randomization . Am J Epidemiol . 1995;;142:576-86.
33 +
Reid JB, Eddy JM. The prevention of antisocial behavior. In: Stoff DM, Breiling J, Maser JD, eds. The Handbook of Antisocial Behavior. New York, NY: John Wiley & Sons. In press.
34 +
Tremblay RE, Craig WM.  Developmental crime prevention . In: Tonry M, Farrington D, eds. Building a Safer Society: Strategic Approaches to Crime Prevention . Chicago, Ill: University of Chicago Press; 1995;.
35 +
Hawkins JD, Van Cleve E, Catalano RF.  Reducing early childhood aggression: results of a primary prevention program . J Am Acad Child Adolesc Psychiatry . 1991;;30:208-217.
36 +
Dolan LJ, Kellam SG, Brown CH, et al.  The short term impact of two classroom based preventive intervention on aggressive and shy behaviors and poor achievement . J Appl Dev Psychol . 1993;; 14:317-345.
37 +
Weissberg RP, Elias MJ.  Enhancing young people's social competence and health behavior: an important challenge for educators, scientists, policymakers, and funders . Appl Prev Psychol . 1993;;2: 179-190.
38 +
Denham SA, Alameda MC.  Children's social problem-solving skills, behavioral adjustment, and interventions: a meta-analysis evaluating theory and practice . J Appl Dev Psychol . 1987;;8:391-409.
39 +
Pepler DJ, Craig W, Roberts WL.  Social skill training and aggression in the peer group . In: McCord J, ed. Coercion and Punishment in Long-term Perspectives . New York, NY: Cambridge University Press; 1995;:213-228.
40 +
Greenberg MT, Kusche CA. Promoting the Social and Emotional Development of Deaf Children: The PATHS Project . Seattle: University of Washington; 1993;.
41 +
Cairns RB, Green JA.  How to assess Personality and social patterns: observations or ratings?  In Cairns RB, ed. The Analysis of Social Interactions . New York, NY: Lawrence Erlbaum Associates; 1979;:209-226.
42 +
Bakeman R, Gottman JM. Observing Interactions: An Introduction to Sequential Analysis . Cambridge, England: Cambridge University Press; 1983;.
43 +
Loeber R, Farrington DP.  Problems and solutions in longitudinal and experimental treatment studies of child psychopathology and delinquency . J Consult Clin Psychol . 1994;;62:887-900.
44 +
Koepsell RD, Wagner EH, Cheadle AC, et al.  Selected methodological issues in evaluating community based health promotion and disease prevention programs . Annu Rev Public Health . 1992;; 13:31-57.
45 +
Donner A, Donald A.  Analysis of data arising from a stratified design with the cluster as unit of randomization . Stat Med . 1987;;6:43-52.
46 +
Donner A.  Statistical methodology for paired cluster designs . Am J Epidemiol . 1987;; 126: 972-979.

Figures

Tables

Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Mercy JA, O'Carroll PW.  New directions in violence prevention: the public health arena . Violence Vict . 1988;;3:285-301.
2 +
Huesmann LR, Eron LD, Lefkowitz MM, Walder LO.  Stability of aggression over time and generations . Dev Psychol . 1984;;20:1120-1134
3 +
McCord J.  Family relationships, juvenile delinquency and adult criminality . Criminology . 1991;; 29:397-417.
4 +
Farrington DP.  Childhood aggression and adult violence: early precursors and life outcomes . In: Pepler DJ, Rubin KH, eds. The Development and Treatment of Childhood Aggression . Hillsdale, NJ: Lawrence Erlbaum; 1991;:5-30.
5 +
Moffitt TE.  Adolescence-limited and life-course persistent antisocial behavior: a developmental taxonomy . Psychol Rev . 1993;;100:674-701.
6 +
Tremblay RE, McCord J, Boileau H, et al.  Early disruptive behavior, poor school achievement, delinquent behavior and delinquent personality: a longitudinal analysis . J Consult Clin Psychol . 1992;; 60:64-72.
7 +
Huesmann LR, Eron LD, Lefkowitz MM.  Stability of aggression over time and generations . Dev Psychol . 1984;;20:1120-1134.
8 +
Olweus D.  Stability of aggressive reaction patterns in males: a review . Psychol Bull . 1979;;86: 852-875.
9 +
Yoshikawa H.  Prevention as cumulative protection: effects of early family support and education on chronic delinquency and its risks . Psychol Bull . 1994;;115:28-54.
10 +
Tremblay RE, Craig WM.  Developmental crime prevention . Crime Justice . 1995;;19:151-236.
11 +
Rivara FP, Farrington DP.  Prevention of violence: role of the pediatrician . Arch Pediatr Adolesc Med . 1995;;149:421-429.
12 +
Wilson-Brewer R, Cohen S, O'Donnell L, Goodman IF. Violence Prevention for Young Adolescents: A Survey of The State of the Art . New York, NY: Carnegie Council on Adolescent Development; 1991;.
13 +
Pellegrini DS, Urbain ES.  An evaluation of interpersonal cognitive problem solving training with children . J Child Psychol Psychiatry . 1985;:26:17-41.
14 +
Webster DW.  The unconvincing case for schoolbased conflict resolution programs for adolescents . Health Aff (Millwood) . 1993;;4:126-141.
15 +
Hawkins JD, Van Cleve E, Catalano RF.  Reducing early childhood aggression: results of a primary prevention program . J Am Acad Child Adolesc Psychiatry . 1991;;30:208-217.
16 +
Gottfredson DC.  An empirical test of schoolbased environmental and individual interventions to reduce the risk of delinquent behavior . Criminology . 1986;;24:705-731.
17 +
Kazdin AE, Siegel TC, Bass D.  Cognitive problem-solving skills training and parent management training in the treatment of anti-social behavior in children . J Consult Clin Psychol . 1992;;60:733-747.
18 +
Lochman JE.  Cognitive-behavioral intervention with aggressive boys: three year follow-up and preventive effects . J Consult Clin Psychol . 1992;; 60:426-432.
19 +
Tremblay RE, Vitaro F, Bertrand L, et al.  Parent and child training to prevent early onset of delinquency: the Montreal Longitudinal-Experimental Study . In: McCord J, Tremblay RE, eds. Preventing Antisocial Behavior: Intervention From Birth Through Adolescence . New York, NY: Guilford Press; 1992;.
20 +
Merrell KW.  Using behavioral rating scales to assess social skills and antisocial behavior in school settings: development of the School Social Behavior Scales . Sch Psychol Rev . 1993;;22:115-133.
21 +
Achenbach TM. Manual for the Teacher's Report Form and 1991 Profile . Burlington: University of Vermont Dept of Psychiatry; 1991;.
22 +
Achenbach TM. Manual for the Child Behavior Checklist14-18 and 1991 Profile . Burlington: University of Vermont Dept of Psychiatry; 1991;.
23 +
Hightower AD, Work WC, Cowen EL.  The Teacher-Child Rating Scale: a brief objective measure of elementary children's school problem behaviors and competencies . Sch Psychol Rev . 1986;; 15:393-409.
24 +
Hightower AD. The Parent-Child Rating Scale . Rochester, NY: Dept of Psychology, Center for Community Study, University of Rochester; 1990;.
25 +
Neckerman HJ, Asher K, Pavlidis K. Social Interaction Observation System . Seattle, Wash: Harborview Injury Prevention and Research Center; 1994;.
26 +
Saudargas R, Lentz F.  Estimating percent of time and rate via direct observation: a suggested observational procedure and format . Sch Psychol Rev . 1986;;15:36-38.
27 +
Rosner B. Fundamentals of Biostatistics . Belmont, Calif: Duxbury Press; 1995;:519.
28 +
Hollingshead AB. Four Factor Index of Social Status . New Haven, Conn: Yale University Press; 1975;.
29 +
Greenberg M. Classroom Atmosphere Scale . Seattle: University of Washington; 1994;.
30 +
Zeger SL, Liang KY.  Longitudinal data analysis for discrete and continuous outcomes . Biometrics . 1986;;42:121-30.
31 +
Liang KY, Zeger SL.  Longitudinal data analysis using generalized linear model . Biometrika . 1986;; 73:13-22.
32 +
Green SB, Corle DK, Gail MH, et al.  Interplay between design and analysis for behavioral intervention trials with community as the unit of randomization . Am J Epidemiol . 1995;;142:576-86.
33 +
Reid JB, Eddy JM. The prevention of antisocial behavior. In: Stoff DM, Breiling J, Maser JD, eds. The Handbook of Antisocial Behavior. New York, NY: John Wiley & Sons. In press.
34 +
Tremblay RE, Craig WM.  Developmental crime prevention . In: Tonry M, Farrington D, eds. Building a Safer Society: Strategic Approaches to Crime Prevention . Chicago, Ill: University of Chicago Press; 1995;.
35 +
Hawkins JD, Van Cleve E, Catalano RF.  Reducing early childhood aggression: results of a primary prevention program . J Am Acad Child Adolesc Psychiatry . 1991;;30:208-217.
36 +
Dolan LJ, Kellam SG, Brown CH, et al.  The short term impact of two classroom based preventive intervention on aggressive and shy behaviors and poor achievement . J Appl Dev Psychol . 1993;; 14:317-345.
37 +
Weissberg RP, Elias MJ.  Enhancing young people's social competence and health behavior: an important challenge for educators, scientists, policymakers, and funders . Appl Prev Psychol . 1993;;2: 179-190.
38 +
Denham SA, Alameda MC.  Children's social problem-solving skills, behavioral adjustment, and interventions: a meta-analysis evaluating theory and practice . J Appl Dev Psychol . 1987;;8:391-409.
39 +
Pepler DJ, Craig W, Roberts WL.  Social skill training and aggression in the peer group . In: McCord J, ed. Coercion and Punishment in Long-term Perspectives . New York, NY: Cambridge University Press; 1995;:213-228.
40 +
Greenberg MT, Kusche CA. Promoting the Social and Emotional Development of Deaf Children: The PATHS Project . Seattle: University of Washington; 1993;.
41 +
Cairns RB, Green JA.  How to assess Personality and social patterns: observations or ratings?  In Cairns RB, ed. The Analysis of Social Interactions . New York, NY: Lawrence Erlbaum Associates; 1979;:209-226.
42 +
Bakeman R, Gottman JM. Observing Interactions: An Introduction to Sequential Analysis . Cambridge, England: Cambridge University Press; 1983;.
43 +
Loeber R, Farrington DP.  Problems and solutions in longitudinal and experimental treatment studies of child psychopathology and delinquency . J Consult Clin Psychol . 1994;;62:887-900.
44 +
Koepsell RD, Wagner EH, Cheadle AC, et al.  Selected methodological issues in evaluating community based health promotion and disease prevention programs . Annu Rev Public Health . 1992;; 13:31-57.
45 +
Donner A, Donald A.  Analysis of data arising from a stratified design with the cluster as unit of randomization . Stat Med . 1987;;6:43-52.
46 +
Donner A.  Statistical methodology for paired cluster designs . Am J Epidemiol . 1987;; 126: 972-979.

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