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Interrupting Cycle of Violence before Young Perpetrators and their Victims Reach Adulthood

Georgetown University Medical Center (GUMC)

January 12, 2015

Widespread among adolescents, intimate partner violence and sexual violence can place young people on a lifelong trajectory of aggression -- either as victims or perpetrators -- endangering their sexual and reproductive health now and in the future.

Researchers at the Institute for Reproductive Health at Georgetown University Medical Center and the World Health Organization (WHO) have conducted a review to identify effective or promising approaches for preventing intimate partner violence and sexual violence against adolescents (10- to 19-year-olds).

"Addressing Intimate Partner Violence and Sexual Violence Among Adolescents: Emerging Evidence of Effectiveness," authored by Rebecka Lundgren, MPH, PhD, of the Institute for Reproductive Health, and Avni Amin, PhD, of the WHO, is one of five review articles published in the January 2015 supplement to the Journal of Adolescent Health devoted to adolescent sexual and reproductive health that has been coordinated by the WHO.

"The results of this research show that it is possible to prevent intimate partner violence among youth and we have the tools we need to make a difference," said Lundgren, director of research at the Institute for Reproductive Health. "Our review suggests that working in schools and supporting children and adolescents who have been exposed to violence prevents violence in high income countries such as the United States. It is imperative that we invest resources to adapt and test these successful approaches in other settings to tackle the global problem of violence."

Evidence suggests that the drivers of gender-based violence among adolescents are similar to those identified for adults. In addition to exposure to violence as a child and prior victimization, bullying and homophobic teasing, poor parental practices, harmful alcohol and substance use, unequal social norms that condone gender-based violence, lack of female empowerment, controlling male behavior, as well as laws and policies that perpetuate gender inequality are risk factors.

Girls bear the greatest burden of intimate partner violence and sexual violence. Much of this violence is perpetrated by boys or adult men, although boys can also be victims. According to a 2013 report from the WHO, the London School of Hygiene and Tropical Medicine and the South African Medical Research Council on the prevalence and health effects of violence against women, nearly 30 percent of adolescent girls (15-19 years) have experienced physical and/or sexual violence by an intimate partner.

The authors of the new review found four promising approaches to preventing intimate partner violence and sexual violence among adolescents:

School-based interventions working with students in grades 9 through 11 are shown to be effective in preventing dating violence in the United States and Canada;
Psychological support interventions to improve cognitive, emotional and behavioral functioning of children and adolescents subjected to maltreatment or exposed to parental intimate partner violence are effective in preventing intimate partner violence among adolescents in high-income countries.

Community-based interventions to form gender equitable attitudes have successfully reduced the acceptability or tolerance for intimate partner violence or sexual violence in low and middle-income country settings.

Parenting interventions that seek to decrease corporal punishment and develop skills to address conflict without violence are shown to reduce child maltreatment, which is a risk factor for later perpetration or experience of intimate partner violence.

The review also highlights critical knowledge gaps in what works to prevent gender-based violence among adolescents. Lundgren and Amin call for programs that have been shown to be successful in higher income settings to be adapted and evaluated in low and middle-income country contexts.

There are some current efforts to do this. For example, in partnership with Save the Children, the Institute for Reproductive Health currently is conducting the Responsible, Engaged and Loving (REAL) Fathers Initiative for 16- to 25-year-old fathers in northern Uganda to strengthen positive partnerships and parenting practices among young fathers and reduce the incidence of intimate partner violence and harsh discipline of children.

Publication of the review article in the JAH supplement was supported by the WHO. The opinions or views expressed in this paper are those of the authors and do not necessarily represent the official position of the WHO.

About the Institute for Reproductive Health
The Institute for Reproductive Health at Georgetown University Medical Center has more than 25 years of experience in designing and implementing evidence-based programs that address critical needs in sexual and reproductive health. The Institute's areas of research and program implementation include family planning, adolescents, gender equality, fertility awareness, and mobilizing technology for reproductive health. The Institute is highly respected for its focus on the introduction and scale-up of sustainable approaches to family planning and fertility awareness around the world. For more information, visit

About Georgetown University Medical Center
Georgetown University Medical Center (GUMC) is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC's mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis -- or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing & Health Studies, both nationally ranked; Georgetown Lombardi Comprehensive Cancer Center, designated as a comprehensive cancer center by the National Cancer Institute; and the Biomedical Graduate Research Organization, which accounts for the majority of externally funded research at GUMC including a Clinical and Translational Science Award from the National Institutes of Health.

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