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Cited by 319Sexual Assault and Victimization StudiesChild Abuse and TraumaMilitary, Security, and Education Studies

The DOI matches its Crossref record; 198 of the 210 references it cites were found in a registry or an index; 4 of the 66 sources its claims cite were checked for support.

School-based education programmes for the prevention of child sexual abuse

Open access
Walsh, Kerryann, Zwi, Karen, Woolfenden, Susan, Shlonsky, Aron·2015·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd004380.pub3PMC PMC9805791
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Abstract

BACKGROUND: Child sexual abuse is a significant global problem in both magnitude and sequelae. The most widely used primary prevention strategy has been the provision of school-based education programmes. Although programmes have been taught in schools since the 1980s, their effectiveness requires ongoing scrutiny. OBJECTIVES: To systematically assess evidence of the effectiveness of school-based education programmes for the prevention of child sexual abuse. Specifically, to assess whether: programmes are effective in improving students' protective behaviours and knowledge about sexual abuse prevention; behaviours and skills are retained over time; and participation results in disclosures of sexual abuse, produces harms, or both. SEARCH METHODS: In September 2014, we searched CENTRAL, Ovid MEDLINE, EMBASE and 11 other databases. We also searched two trials registers and screened the reference lists of previous reviews for additional trials. SELECTION CRITERIA: We selected randomised controlled trials (RCTs), cluster-RCTs, and quasi-RCTs of school-based education interventions for the prevention of child sexual abuse compared with another intervention or no intervention. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the eligibility of trials for inclusion, extracted data, and assessed risk of bias. We summarised data for six outcomes: protective behaviours; knowledge of sexual abuse or sexual abuse prevention concepts; retention of protective behaviours over time; retention of knowledge over time; harm; and disclosures of sexual abuse. MAIN RESULTS: This is an update of a Cochrane Review that included 15 trials (up to August 2006). We identified 10 additional trials for the period to September 2014. We excluded one trial from the original review. Therefore, this update includes a total of 24 trials (5802 participants). We conducted several meta-analyses. More than half of the trials in each meta-analysis contained unit of analysis errors.1. Meta-analysis of two trials (n = 102) evaluating protective behaviours favoured intervention (odds ratio (OR) 5.71, 95% confidence interval (CI) 1.98 to 16.51), with borderline low to moderate heterogeneity (Chi² = 1.37, df = 1, P value = 0.24, I² = 27%, Tau² = 0.16). The results did not change when we made adjustments using intraclass correlation coefficients (ICCs) to correct errors made in studies where data were analysed without accounting for the clustering of students in classes or schools.2. Meta-analysis of 18 trials (n = 4657) evaluating questionnaire-based knowledge favoured intervention (standardised mean difference (SMD) 0.61, 95% CI 0.45 to 0.78), but there was substantial heterogeneity (Chi² = 104.76, df = 17, P value < 0.00001, I² = 84%, Tau² = 0.10). The results did not change when adjusted for clustering (ICC: 0.1 SMD 0.66, 95% CI 0.51 to 0.81; ICC: 0.2 SMD 0.63, 95% CI 0.50 to 0.77).3. Meta-analysis of 11 trials (n =1688) evaluating vignette-based knowledge favoured intervention (SMD 0.45, 95% CI 0.24 to 0.65), but there was substantial heterogeneity (Chi² = 34.25, df = 10, P value < 0.0002, I² = 71%, Tau² = 0.08). The results did not change when adjusted for clustering (ICC: 0.1 SMD 0.53, 95% CI 0.32 to 0.74; ICC: 0.2 SMD 0.60, 95% CI 0.31 to 0.89).4. We included four trials in the meta-analysis for retention of knowledge over time. The effect of intervention seemed to persist beyond the immediate assessment (SMD 0.78, 95% CI 0.38 to 1.17; I² = 84%, Tau² = 0.13, P value = 0.0003; n = 956) to six months (SMD 0.69, 95% CI 0.51 to 0.87; I² = 25%; Tau² = 0.01, P value = 0.26; n = 929). The results did not change when adjustments were made using ICCs.5. We included three studies in the meta-analysis for adverse effects (harm) manifesting as child anxiety or fear. The results showed no increase or decrease in anxiety or fear in intervention participants (SMD -0.08, 95% CI -0.22 to 0.07; n = 795) and there was no heterogeneity (I² = 0%, P value = 0.79; n=795). The results did not change when adjustments were made using ICCs.6. We included three studies (n = 1788) in the meta-analysis for disclosure of previous or current sexual abuse. The results favoured intervention (OR 3.56, 95% CI 1.13 to 11.24), with no heterogeneity (I² = 0%, P value = 0.84). However, adjusting for the effect of clustering had the effect of widening the confidence intervals around the OR (ICC: 0.1 OR 3.04, 95% CI 0.75 to 12.33; ICC: 0.2 OR 2.95, 95% CI 0.69 to 12.61).Insufficient information was provided in the included studies to conduct planned subgroup analyses and there were insufficient studies to conduct meaningful analyses.The quality of evidence for all outcomes included in the meta-analyses was moderate owing to unclear risk of selection bias across most studies, high or unclear risk of detection bias across over half of included studies, and high or unclear risk of attrition bias across most studies. The results should be interpreted cautiously. AUTHOR

Overview

Integrity signals

Registry

Crossref · 10.1002/14651858.cd004380.pub3

Cites

198 of 198 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

4 of 66 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured

Show all 192 claims

  • Probably not a substantial claim. 255
  • It may state two separate claims as one. 140
  • The quote only partly states this claim. 22
350 of 350

  • The paper relies on this without support.

    School-based education programmes are the most widely used primary prevention strategy for child sexual abuse.

    “The most widely used primary prevention strategy has been the provision of school-based education programmes.”

  • The paper relies on this without support.

    The outcome measures used in included studies (simulation tests, questionnaires, and vignettes) validly measure protective behaviours and knowledge.

    “protective behaviours (as measured by an independently scored simulation test); 2. knowledge of sexual abuse or knowledge of sexual abuse prevention concepts, or both (as measured by questionnaires or vignettes)”

  • The paper relies on this without support.

    The results of the included studies can be pooled in meta-analyses despite heterogeneity.

    “The quality of the evidence for all outcomes included in the meta-analyses (combining of data) was moderate.”

  • The paper relies on this without support.

    The search strategy identified all relevant studies.

    “In September 2014, we searched CENTRAL, Ovid MEDLINE, EMBASE and 11 other databases.”

  • The paper relies on this without support.

    The onset of the alleged abuse reported in disclosure studies occurred before the intervention.

    “the onset of the alleged abuse would have occurred prior to the intervention”

  • The paper relies on this without support.

    Disclosing abuse can prompt the provision of treatment.

    “disclosing abuse, while potentially traumatic, can also prompt the provision of treatment”

  • The paper relies on this without support.

    Identifying and reporting perpetrators may prevent harm to other children.

    “the identification and reporting of perpetrators may prevent harm to other children”

  • The paper relies on this without support.

    The knowledge scales used in the included studies validly measure children's knowledge relevant to child sexual abuse prevention.

    “All studies used unique knowledge scales.”

  • The paper relies on this without support.

    The anxiety or fear scales used in the included studies validly measure harm from programme participation.

    “In these studies, harm was measured via child self report anxiety or fear scales, with all studies using unique measures”

  • The paper relies on this without support.

    Schools currently use a range of interventions to prevent child sexual abuse.

    “Currently, schools implement a variety of interventions aimed at preventing child sexual abuse.”

  • The paper relies on this without support.

    Child sexual abuse is under-identified and hard to prove.

    “However, even large cohort studies may not provide definitive evidence for changes in child sexual abuse incidence, as it is under-identified and difficult to prove.”

  • The paper relies on this without support.

    Most programmes offer multiple participatory opportunities, often in combination.

    “Given that most programmes include multiple participatory opportunities, often in combination, it may be more informative to develop and explore the effects of multidimensional programme typologies as noted above.”
12 of 12

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • A trial without vignette data appears in the vignette analysis

    Major

    The vignette-based knowledge meta-analysis includes Kolko 1989, although its included-study entry explicitly says it had no vignette-based knowledge outcome.

  • A fourth-grade trial is assigned to the younger-only subgroup

    Major

    The questionnaire-based age analysis places Daigneault 2012 among studies with only kindergarten-to-third-grade participants. Its study entry includes fourth-grade students, so it does not meet that subgroup definition.

  • The protocol-differences count disagrees with its numbered list

    Minor

    The section announces five main differences, but its list continues through a sixth, labelled subgroup analyses.

  • Grendel's randomised total is smaller than its group denominators

    Minor

    The Grendel entry states that 100 students were randomised, but its attrition figures use initial intervention and control denominators of 62 and 63. Those denominators total 125.

    Reported 100 · recomputed 125

  • The abstract places participants in secondary schools despite the results

    Minor

    The abstract describes participants as attending primary and secondary schools, while the settings section says no included study took place in a secondary school.

  • Allocation-group categories total 25 rather than 24 studies

    Minor

    The design section assigns 18 studies to two groups, four to three groups, and three to four groups. These mutually exclusive counts total 25, exceeding the review's 24 included studies.

    Reported 24 · recomputed 25

  • A registered ongoing trial contradicts the claim of no trial-register records

    Minor

    The discussion says no clinical-trials-register records were found for this type of study. Elsewhere the review identifies an ongoing registered trial of a school-based sexual-abuse prevention programme.

  • Oldfield is omitted from the count of child-anxiety studies

    Minor

    The outcomes section says six studies measured child anxiety or fear by child report, but Oldfield 1996 also used child self-report anxiety measures and is not among the six named studies.

  • Snyder's allocation unit is both individuals and classes

    Minor

    The design summary counts Snyder 1986 among individually randomised trials, but its study entry identifies classes as the unit of allocation. The distinction matters to the review's clustering adjustments.

  • Cluster-RCT count changes within the study description

    Minor

    The design section classifies 11 of the 24 studies as cluster-RCTs, whereas the sample-size section refers to 13 cluster-RCTs.

10 of 10

Citations

Cites

Flagged first, then by citations

Show all 210 references

12 of the 210 references couldn’t be matched to a known paper.

Research works printed but not linked: 44

  1. Blumberg, 1987, The Effects of Two Sexual Abuse Prevention Training Programs on the Evaluation of Touches [MA Psych thesis]
  2. Chadwick, 1989, A Comparative Evaluation of Two Sexual Abuse Prevention Programs for Children [PhD thesis]
  3. Dawson, 1987, An Evaluation of Cognitive and Affective Outcomes of a Prevention Program for Childhood Sexual Abuse [EdD thesis]
  4. Grendel, 1991, Cognitive and Emotional Effects of a Brief Child Sexual Abuse Prevention Program for First Graders [EdD thesis]
  5. Kraizer, 1991, The Safe Child Program for the Prevention of Child Abuse: Development and Evaluation of a School-Based Curriculum [PhD thesis]
  6. Snyder, 1986, An Evaluation of the "Good Secrets, Bad Secrets" Assault Prevention Program [PhD thesis]
  7. Alexander, 1998, The Assessment of a School-Based Intervention for the Prevention of Child Sexual Abuse [EdD thesis]
  8. Bodzy, 1988, The Effects of a Personal Safety Program on Affective Measures of Child Development [EdD thesis]
  9. Deretzotes, 1989, Evaluation of High School Level CAPTA Child Abuse Prevention Programs [PhD thesis]
  10. Herman, 1987, Evaluation of a Sexual Abuse Curriculum/Prevention Program [PhD thesis]
  11. Johnson, 1994, The Effectiveness and Emotional Consequences of a School-Based Child Sexual Abuse Prevention Program [MSCP thesis]
  12. Kindt, 1995, Evaluation of an Adolescent Sexual Abuse Prevention Program [PhD Thesis]
  13. Michaelson, 2001, Development, Evaluation and Revision of the School-Based Child Sexual Abuse Prevention Program (CSAPP Project) [PhD Thesis]
  14. Pohl, 1990, Reactions of children, parents, and teachers to child sexual abuse prevention programs, Education, 110, 337
  15. Taylor, 1991, An Evaluative Study of the Child Abuse Research and Education Program [Med Thesis]
  16. Tutty, 1991, An Investigation of the Ability of Elementary School-Aged Children to Learn Child Sexual Abuse Prevention Concepts [PhD thesis]
  17. Webb, 1997, An Evaluation of a School Based Sexual Abuse Prevention Program [MHealSc thesis]
  18. Bandura, 1986, Social Foundations of Thought and Action: A Social Cognitive Theory
  19. Battle, 1981, Culture-Free Self-Esteem Inventories for Children and Adults
  20. Binder, 1987, Evaluation of a school-based sexual abuse prevention program: cognitive and emotional effects, Child Abuse & Neglect, 11, 497, 10.1016/0145-2134(87)90075-5 · DOI
  21. Blumberg, 1987, The Effects of Two Sexual Abuse Prevention Training Programs on the Evaluation of Touches [MA Psych thesis]
  22. Chadwick, 1989, A Comparative Evaluation of Two Sexual Abuse Prevention Programs for Children [PhD thesis]
  23. Church, 1988, The prevention of sexual abuse: examination of the effectiveness of a program with kindergarten-age children, Behaviour Therapy, 19, 429, 10.1016/S0005-7894(88)80014-5 · DOI
  24. Cooper, 1991, New Strategies for Free Children: Child Abuse Prevention for Elementary School Children
  25. Finkelhor, 1992, Sexual abuse prevention education: a review of evaluation studies, 150
  26. Flandreau-West, 1984, Protective Behaviors: Anti-Victim Training for Children, Adolescents and Adults
  27. Fryer Jr, 1987, Measuring children's retention of skills to resist stranger abduction: use of the simulation technique, Child Abuse & Neglect, 11, 181, 10.1016/0145-2134(87)90056-1 · DOI
  28. Girard, 1985, Who is a Stranger and What Should I Do?
  29. Grimm, 1994, Red Flag/Green Flag People II: A Sexual Abuse Prevention Program for Older Elementary Age Children
  30. Kraizer, 1981, Children Need to Know Personal Training Program
  31. Kraizer, 1989, Child sexual abuse prevention programs: what makes them effective in protecting children?, Children Today, 18, 23
  32. Macdonald, 2001, Effective Interventions for Child Abuse and Neglect
  33. Mental Health Association of Westchester County, 1984, Good Touches/Bad Touches: A Child Sexual Abuse Prevention Program Part II, for Fourth Through Sixth Grades, Revised Edition
  34. Orpinas, 1995, Students for Peace Project: Second Student Evaluation
  35. Rape and Abuse Crisis Center of Fargo-Moorhead, 2008, Red Flag/Green Flag People: A Personal Safety Program for Early Elementary Age Children
  36. Raven, 1960, Guide to the Standard Progressive Matrices
  37. The Nordic Cochrane Centre, The Cochrane Collaboration Review Manager (RevMan) 2012
  38. Sanderson, 2004, Child-focused sexual abuse prevention programs: how effective are they in preventing child abuse?, Crime and Misconduct Commission Research and Issues Paper Series, 5, 1
  39. Speilberger, 1966, Anxiety and Behavior
  40. Tutty, 2000, What children learn from sexual abuse prevention programs: difficult concepts and developmental issues, Research on Social Work Practice, 10, 275, 10.1177/104973150001000301 · DOI
  41. Williams, 1980, Red Flag/Green Flag People Coloring Book
  42. Wurtele, 1986, Teaching Young Children Personal Body Safety: The Behavioral Skills Training Program
  43. Wurtele, 2007, Body Safety Training Workbook
  44. Wurtele, 2010, Primary prevention of child sexual abuse: child- and parent-focused approaches, 107

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Metadata

Authors
Walsh, K., Zwi, K., Woolfenden, S., & Shlonsky, A.
Affiliations
  • Queensland University of Technology (AU)
  • UNSW Sydney (AU)
  • Sydney Children's Hospital (AU)
  • The University of Melbourne (AU)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2015-04-16
Volume
2015
Issue
4
Pages
CD004380-CD004380
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd004380.pub3
PMC
PMC9805791
OpenAlex
W1717762653
Cited by
318
References
210
Citations by year
2026: 22 · 2025: 17 · 2024: 20 · 2023: 22 · 2022: 24 · 2021: 31 · 2020: 27 · 2019: 15 · 2018: 27 · 2017: 20 · 2016: 25 · 2015: 14
FWCI
9.29
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion, other-oa)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • QUT ePrints (Queensland University of Technology) (submittedVersion)
Topics
  • Social Sciences › Gender Studies › Sexual Assault and Victimization Studies
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Social Sciences › Sociology and Political Science › Military, Security, and Education Studies
Keywords
child sexual abuse prevention, primary prevention, protective behavior, intervention effectiveness, children and adolescents, bystander intervention training
MeSH terms
Adolescent, Child, Child Abuse, Sexual, Humans, Health Knowledge, Attitudes, Practice, Schools, Program Evaluation, Randomized Controlled Trials as Topic

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