The Effectiveness of Universal School-Based …

1 Morbidity and Mortality Weekly ReportRecommendations and ReportsAugust 10, 2007 / Vol. 56 / No. RR-7depardepardepardepardepartment of health and human sertment of health and human sertment of health and human sertment of health and human sertment of health and human servicesvicesvicesvicesvicesCenters for Disease Control and PreventionCenters for Disease Control and PreventionCenters for Disease Control and PreventionCenters for Disease Control and PreventionCenters for Disease Control and PreventionThe Effectiveness of Universal school -BasedPrograms for the Prevention of Violent andAggressive BehaviorA Report on Recommendations of the Task Forceon Community Preventive ServicesMMWRCONTENTSB ackground .. 1 Introduction .. 3 Results .. 6 Discussion .. 8 Use of the Recommendation in States and 8 Centers for Disease Control and PreventionJulie L.

2 Gerberding, MD, MPHD irectorTanja Popovic, MD, PhDChief Science OfficerJames W. Stephens, PhDAssociate Director for ScienceSteven L. Solomon, MDDirector, Coordinating Center for Health Information and ServiceJay M. Bernhardt, PhD, MPHD irector, National Center for Health MarketingKatherine L. Daniel, PhDDeputy Director, National Center for Health MarketingEditorial and Production StaffFrederic E. Shaw, MD, JDEditor, MMWR SeriesMyron G. Schultz, DVM, MD(Acting) Deputy Editor, MMWR SeriesSuzanne M. Hewitt, MPAM anaging Editor, MMWR SeriesTeresa F. RutledgeLead Technical Writer-EditorJeffrey D. Sokolow, MAProject EditorBeverly J. HollandLead Visual Information SpecialistLynda G. CupellMalbea A. LaPeteVisual Information SpecialistsQuang M. Doan, MBAE rica R. ShaverInformation Technology SpecialistsEditorial BoardWilliam L. Roper, MD, MPH, Chapel Hill, NC, ChairmanVirginia A.

3 Caine, MD, Indianapolis, INDavid W. Fleming, MD, Seattle, WAWilliam E. Halperin, MD, DrPH, MPH, Newark, NJMargaret A. Hamburg, MD, Washington, DCKing K. Holmes, MD, PhD, Seattle, WADeborah Holtzman, PhD, Atlanta, GAJohn K. Iglehart, Bethesda, MDDennis G. Maki, MD, Madison, WISue Mallonee, MPH, Oklahoma City, OKStanley A. Plotkin, MD, Doylestown, PAPatricia Quinlisk, MD, MPH, Des Moines, IAPatrick L. Remington, MD, MPH, Madison, WIBarbara K. Rimer, DrPH, Chapel Hill, NCJohn V. Rullan, MD, MPH, San Juan, PRAnne Schuchat, MD, Atlanta, GADixie E. Snider, MD, MPH, Atlanta, GAJohn W. Ward, MD, Atlanta, GAThe MMWR series of publications is published by the CoordinatingCenter for Health Information and Service, Centers for DiseaseControl and Prevention (CDC), Department of Health andHuman Services, Atlanta, GA Citation: Centers for Disease Control and Prevention.

4 [Title]. MMWR 2007;56(No. RR-#):[inclusive page numbers].Vol. 56 / RR-7 Recommendations and Reports1 The Effectiveness of Universal School-Based Programs for thePrevention of Violent and Aggressive BehaviorA Report on Recommendations of the Task Forceon Community Preventive Services*Prepared byRobert Hahn, PhD1 Dawna Fuqua-Whitley, MA1 Holly Wethington, PhD1 Jessica Lowy, MPH1 Akiva Liberman, PhD2 Alex Crosby, MD3 Mindy Fullilove, MD4 Robert Johnson, MD5 Eve Moscicki, ScD6 LeShawndra Price, PhD6 Susan R. Snyder, PhD1 Farris Tuma, ScD6 Stella Cory, MD1 Glenda Stone, PhD1 Kaushik Mukhopadhaya, PhD1 Sajal Chattopadhyay, PhD1 Linda Dahlberg, PhD21 Division of Health Communication and Marketing, National Center for Health Marketing, CDC2 National Institute of Justice, Washington, District of Columbia3 Division of Violence Prevention, National Center for Injury Prevention and Control, CDC4 Columbia University, New York, New York, and Task Force on Community Preventive Services5 New Jersey Medical school , Department of Pediatrics, Newark, New Jersey, and Task Force on Community Preventive Services6 National Institute of Mental Health, Bethesda, MarylandSummaryUniversal School-Based programs to reduce or prevent violent behavior are delivered to all children in classrooms in a gradeor in a school .

5 Similarly, programs targeted to schools in high-risk areas (defined by low socioeconomic status or high crimerates) are delivered to all children in a grade or school in those high-risk areas. During 2004 2006, the Task Force onCommunity Preventive Services (Task Force) conducted a systematic review of published scientific evidence concerning theeffectiveness of these programs. The results of this review provide strong evidence that Universal School-Based programs decreaserates of violence and aggressive behavior among school -aged children. Program effects were demonstrated at all grade independent meta-analysis of School-Based programs confirmed and supplemented these findings. On the basis of strongevidence of Effectiveness , the Task Force recommends the use of Universal School-Based programs to prevent or reduce violence is a substantial public health problem inthe United States.

6 In a representative national surveyconducted in 2003, adults reported million incidents of victimization by perpetratorsestimated to be aged 12 20 years, representing a rate ofapproximately incidents per 100 persons in this agegroup (1,2). Two thirds of reports by victims concerned simple assaults ( , attacks without a weapon and notresulting in an injury requiring >2 days of hospitalization).The remaining victimizations were serious violent crimes ( , rape, sexual assault, robbery, or aggravated assault).* Points of view expressed are those of the contributors and the Task Force onCommunity Preventive Services and do not necessarily reflect those of CDC,the National Institutes of Health, the National Institute of Justice, the of Justice, or the Department of Health and HumanServices.

7 Author affiliations reflect author s location while this research wasbeing material in this report originated in the National Center for HealthMarketing, Jay M. Bernhardt, PhD, Director; and the Division ofHealth Communication and Marketing, Cynthia E. Baur, PhD, preparer: Robert A. Hahn, PhD, National Centerfor Health Marketing, 1600 Clifton Road, MS E-69, Atlanta, GA30333. Telephone: 404-498-0958; Fax: 404-498-0989; 10, 2007 Because survey respondents were crime victims, murder wasnot included. Since the 1980s, youths aged 10 17 years,who constitute <12% of the population, have beeninvolved as offenders in approximately 25% of serious vio-lent victimizations (3). Homicide and suicide are the fourthand fifth leading causes of death respectively among chil-dren aged 5 14 years and the second and third leadingcauses of death among persons aged 15 24 years (4).

8 Risk factors for youth violence include low socioeconomicstatus (SES), poor parental supervision, harsh and erraticdiscipline, and delinquent peers (3). Delinquent youthscommonly have additional problems (5), including drugabuse, difficulties at school , and mental health problems(as indicated by being in the top 10% of the distributionof externalizing and internalizing symptoms in the ChildBehavior Checklist) (6). These youths are threats not onlybecause of the direct harm they cause but also because ofthe role they might play in the socialization of otherpotential delinquents (7).The prevention of youth violence and aggression is ofvalue in itself and also because early violent and aggressivebehavior is a precursor of later problem behaviors (8).Researchers categorize risk factors for early childhooddelinquency, including violent behavior, as individual, fam-ily, peer, school , neighborhood, and media.

9 Factors in allcategories are thought to contribute to the development ofearly and chronic violent behavior, and all are thought toprovide opportunities for intervention to reduce the devel-opment of these behaviors (9).The most serious forms of violent crime ( , rape, sexualassault, robbery, aggravated assault, and homicide) rarelyoccur in schools (10). During July 1992 June 2000, anannual average of 29 homicides and five suicides occurredthroughout schools, representing <1% of the homi-cides among youths aged 5 19 years and < of sui-cides among youths away from schools during the sameperiod (10). However, a disproportionate amount of non-fatal crime occurred in school facilities or on the way to orfrom school . Although rates of violent crime declined dur-ing 1993 2003, in 2003, approximately 740,000 violentcrimes were committed at schools against adolescents aged12 18 years (rate: per 100 persons) (10).

10 Of thesecrimes, approximately 150,000 ( ) were classified as serious. The Task Force review assessed the Effectiveness of uni-versal School-Based programs in reducing or preventing vio-lent and aggressive behavior among children and programs teach all students in a school or schoolgrade about the problem of violence and its prevention orabout one or more of the following topics or skills intendedto reduce aggressive or violent behavior: emotional self-awareness, emotional control, and self-esteem; positivesocial skills; social problem solving; conflict resolution; andteam used in this report, Universal means that programsare administered to all children in classrooms regardless ofindividual risk, not only to those who already have mani-fested violent or aggressive behavior or risk factors for thesebehaviors.