ABSTRACT
Annually, approximately 25% of US teens and young adults sustain physical, psychological, or sexual abuse
by dating partners. Many victims of dating violence (DV) experience negative and long-lasting consequences,
including post-traumatic stress disorder, depression, suicidality, risky sexual behavior, substance misuse,
academic disengagement, and adulthood intimate partner violence. Perpetrators of adolescent DV are at
increased risk for continuing intimate partner violence in adulthood. Moreover, partner violence is costly to
Americans, with one estimate putting the population economic burden at $3.6 trillion over victims' lifetimes.
Given the prevalence, costs, and adverse mental, physical, and social health outcomes, effective and enduring
prevention strategies are critically needed. Thus, we conducted an RCT of the 7th grade version of Fourth R in
24 middle schools (12 intervention schools, 12 control schools; n=2865 students) and found that students who
received the intervention were significantly less likely to perpetrate DV. We propose to extend our school-
based cluster RCT by 1) collecting an additional four years of annual follow-ups, when participants will be, on
average, 21 years old and 8 years post-intervention; 2) augmenting data with school, neighborhood, and
environmental factors that may moderate program impact; and 3) delivering a text-based booster to half of the
students originally randomized to the intervention condition (n=666) and comparing them to students from
control schools (n=1533) and to those who received Fourth R without a booster (n=666).
Specific aims: 1) Determine the long-term impact of Fourth R in reducing DV, as indexed by less perpetration
and victimization of physical, sexual, and psychological DV through adolescence and into emerging adulthood,
relative to participants from control schools; 2) Determine the long-term impact of Fourth R, relative to control,
in a) enhancing emotional well-being and increasing acquisition and use of healthy relationship skills, as
indexed by improved problem-solving, communication, and conflict resolution skills through adolescence and
into emerging adulthood; and b) ameliorating the modifiable cognitive and behavioral correlates associated
with the perpetration and victimization of DV, as indexed by fewer attitudes justifying DV, decreased substance
misuse and risky sexual behavior, increased school connectedness, improved academic performance, and
decreased psychological symptoms through adolescence and into emerging adulthood; 3) Test the hypothesis
that participants receiving an 18-week, 54-message text-based booster five years after receiving the Fourth R
intervention will be least likely to perpetrate and experience DV and other risky behaviors, followed by students
who received Fourth R without the booster, followed by participants in the control group; and 4) Evaluate the
cost-effectiveness and fiscal impact of the Fourth R intervention and text-based booster.
Preventing DV throughout the formative years has the enormous potential to improve the health, relationships,
and wellbeing of countless lives, while also reducing the economic burden of this public health crisis.
