Article

Preventing Youth Violence and Delinquency through a Universal School-Based Prevention Approach

Department of Public Health, Weill Medical College of Cornell University, 411 East 69th Street, New York, NY 10021, USA.
Prevention Science (Impact Factor: 3.15). 01/2007; 7(4):403-8. DOI: 10.1007/s11121-006-0057-y
Source: PubMed

ABSTRACT

Violence is an important public health problem among adolescents in the United States. Substance use and violence tend to co-occur among adolescents and appear to have similar etiologies. The present study examined the extent to which a comprehensive prevention approach targeting an array of individual-level risk and protective factors and previously found effective in preventing tobacco, alcohol, and illicit drug use is capable of decreasing violence and delinquency. Schools (N=41) were randomly assigned to intervention and control conditions. Participants in the 20 intervention schools received the Life Skills Training prevention program including material focusing on violence and the media, anger management, and conflict resolution skills. Survey data were collected from 4,858 sixth grade students prior to the intervention and three months later after the intervention. Findings showed significant reductions in violence and delinquency for intervention participants relative to controls. Stronger prevention effects were found for students who received at least half of the preventive intervention. These effects include less verbal and physical aggression, fighting, and delinquency. The results of this study indicate that a school-based prevention approach previously found to prevent tobacco, alcohol, and illicit drug use can also prevent violence and delinquency.

Full-text

Available from: Gilbert J Botvin
Prev Sci (2006) 7:403–408
DOI 10.1007/s11121-006-0057-y
BRIEF REPORT
Preventing Youth Violence and Delinquency through a
Universal School-Based Prevention Approach
Gilbert J. Botvin · Kenneth W. Griffin ·
Tracy Diaz Nichols
Published online: 29 November 2006
C
Society for Prevention Research 2006
Abstract Violence is an important public health problem
among adolescents in the United States. Substance use and
violence tend to co-occur among adolescents and appear to
have similar etiologies. The present study examined the ex-
tent to which a comprehensive prevention approach targeting
an array of individual-level risk and protective factors and
previously found effective in preventing tobacco, alcohol,
and illicit drug use is capable of decreasing violence and
delinquency. Schools (N =41) were randomly assigned to
intervention and control conditions. Participants in the 20
intervention schools received the Life Skills Training pre-
vention program including material focusing on violence
and the media, anger management, and conflict resolution
skills. Survey data were collected from 4,858 sixth grade
students prior to the intervention and three months later after
the intervention. Findings showed significant reductions in
violence and delinquency for intervention participants rela-
tive to controls. Stronger prevention effects were found for
students who received at least half of the preventive inter-
vention. These effects include less verbal and physical ag-
gression, fighting, and delinquency. The results of this study
indicate that a school-based prevention approach previously
found to prevent tobacco, alcohol, and illicit drug use can
also prevent violence and delinquency.
Keywords: Adolescence
.
Violence
.
Aggression
.
Prevention
.
Substance use
Violence is a major public health problem that has received
increased attention in recent years. Suicide and homicide are
G. J. Botvin (
) · K. W. Griffin · T. D. Nichols
Department of Public Health, Weill Medical
College of Cornell University
411 East 69th Street, New York, NY 10021
the second and third leading causes of injury-related death in
the United States and homicide risk increases dramatically
during adolescence (Hoyert et al., 2006). A nationwide sur-
vey of high school students (CDC, 2006) found that 36% of
students reported being in a physical fight one or more times
in the 12 months preceding the survey and 19% reported car-
rying a weapon (e.g., gun, knife, or club) on one or more of
the 30 days preceding the survey. Violence is an even greater
problem for inner-city, minority youth who are at the highest
risk for violence (Hammond & Yung, 1993).
Data from several sources suggest a strong interrelation-
ship betweendrug abuse and violence (e.g., Elliott, Huizinga,
& Menard, 1989; US DHHS, 2001). It is not only the case
that drug abuse is a predictor of later involvement in assaults,
but also that homicides and other types of assaultive violence
occur while individuals are under the influence of alcohol or
illicit drugs or are involved in drug-related criminal activity
(Tardiff & Gross, 1986). Suicidal behavior, another form of
violence, has also been found to be related to aggression and
drug use among high school students (Garrison, McKeown,
Valois, & Vincent, 1993).
A common set of demographic, environmental, interper-
sonal, and intrapersonal factors appears to be involved in the
etiology of drug abuse and violence. As summarized in the
Surgeon General’s Report on Youth Violence (US DHHS,
2001) and in review articles (e.g., Elliott, Huizinga, &
Ageton, 1985; Hammond & Yung, 1993), a number of risk
factors have been associated with youth violence. Demo-
graphic factors include poverty, ethnic-minority group mem-
bership, gender (male), age, and living in the inner city.
Family factors include weak family bonding, ineffective
monitoring and supervision; exposure to and reinforcement
for violence; poorimpulse control and problem-solving skills
of caretakers; and the acquisition of expectations, attitudes,
beliefs and emotional responses which support or tolerate
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the use of violence. Dispositional or temperamental factors
such as antisocial personality, attention deficit disorder, or
poor impulse control have also been implicated. Additional
factors include difficulty coping with anger and frustration,
low self-efficacy, poor problem-solving skills, and poor so-
cial skills. Related to this is the use of alcohol and drugs, poor
academic performance, and involvement with a delinquent
peer group where violence is modeled and reinforced. Many
of these same factors have been associated with tobacco, al-
cohol, and illicit drug use (Botvin, 2000; Farrell, Danish, &
Howard, 1992; Hawkins, Catalano, & Miller, 1992).
Substantial progress has been made in developing effec-
tive approaches for preventing the use of tobacco, alcohol,
and illicit drugs. Prevention approaches designed to decrease
the impact of social influences to use tobacco, alcohol, and
illicit drugs by teaching resistance skills and anti-substance
use norms either alone or in combination with teaching
generic personal self-management skills and social skills
have been shown to significantly reduce the rate of adoles-
cent substance use (Botvin & Griffin, 2003). In some in-
stances, reductions in substance use have been observed for
over five years (Botvin, Baker, Dusenbury, Botvin, & Diaz,
1995; Griffin, Botvin, & Nichols, 2006). Moreover, evidence
from recent follow-up studies testing universal, school-based
prevention approaches demonstrates the potential of these
interventions for preventing multiple problem behaviors, in-
cluding some not directly targeted. For example, the Life
Skills Training (LST) program has been found to not only re-
duce several forms of substance use (e.g., Botvin et al., 1995;
Botvin et al., 2001) but also to reduce risky driving among
high schools students (Griffin, Botvin, & Nichols, 2004) and
HIV risk among young adults (Griffin et al., 2006). These
effects are hypothesized to be the result of the relationship
between one or more forms of substance use and other health
risk behaviors (such as alcohol use and risky driving) and/or
the result of one or more common etiologic determinants
affected by the preventive intervention.
The similarity in the etiology of substance use, violence,
and delinquency suggests the possibility that these behaviors
may be prevented by a common intervention strategy. The
purpose of the current study, therefore, was to determine
the extent to which a comprehensive prevention approach
previously found effective for preventing tobacco, alcohol,
and illicit drug use is capable of decreasing violence and
delinquency in a population of inner-city, minority youth.
Method
Sample
The sample consisted of 4,858 sixth-grade students from 41
New York City public and parochial schools. The sample
was 51% boys and 49% girls, and the racial/ethnic compo-
sition of the sample was 39% African-American, 33% His-
panic, 10% White, 6% Asian, 2% Native American, and
10% of other or mixed ethnicity. The sample was com-
posed largely of economically disadvantaged youth (55% re-
ceived free lunch at school), with 30% living in mother-only
households.
Procedure
After informed consent was obtained from students, partic-
ipants completed the pretest assessment in the sixth grade.
Students in 20 experimental schools (n =2,374) then re-
ceived the 15-session prevention program taught by class-
room teachers, and students in 21 control schools (n =2,484)
received the standard health education curriculum normally
provided in New York City schools. Approximately three
months later students completed the posttest assessment.
Questionnaires were administered during a regular class pe-
riod by a team of data collectors who were members of the
same ethnic groups as participating students. Data were col-
lected following a detailed protocol used in similar previous
prevention studies (e.g., Botvin et al., 1995; Botvin et al.,
2001).
Intervention
The preventive intervention tested in this study, Life Skills
Training (LST), was designed to address several important
cognitive, attitudinal, psychological, and social factors re-
lated to tobacco, alcohol, and illicit drug use and violence.
Students were taught a variety of cognitive-behavioral skills
for problem-solving and decision-making, resisting media
influences, managing stress and anxiety, communicating ef-
fectively, developing healthy personal relationships, and as-
serting one’s rights. These skills are taught using a com-
bination of interactive teaching techniques including group
discussion, demonstration, modeling, behavioral rehearsal,
feedback and reinforcement, and behavioral “homework”
assignments for out-of-class practice.
In addition to these general life skills for enhancing per-
sonal and social competence, the LST program taught stu-
dents skills related more specifically to substance use and
violence. Students were taught the application of general
assertiveness skills in situations in which they might experi-
ence direct interpersonal pressure to use drugs or act aggres-
sively as well as anger management and conflict resolution
skills. Material was also provided to reinforce norms against
substance use and violence, and to promote anti-substance
use or anti-violence norms. Intervention materials included
a teacher’s manual with detailed lesson-plans and student
guides.
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Measures
Violence and delinquent behaviors were assessed by ques-
tionnaire. The violence measures assessed verbal aggres-
sion, physical aggression, and fighting. The verbal and phys-
ical aggression items are similar to those used by Elliott,
Huizinga, and Menard (1989). Delinquent behaviors were
assessed using items similar to those used by Hawkins and
his associates (Arthur et al., 2002). Where appropriate, reli-
abilities (Cronbach’s α) for the scales are indicated in paren-
theses in the description that follows.
Verbal aggression
Verbal aggression was measured by seven items (α =.90)
assessing the number of times in the past month that the stu-
dent reported name calling, yelling, cursing, arguing, telling
someone off, saying mean things, or threatening to hurt
someone. Response options ranged from “never” (1) to “5 or
more times” in the past month (5).
Physical aggression
Two measures of physical aggression were used. Mild phys-
ically aggressive acts were assessed by three items (α =.81)
asking students the number of times in the past month they
engaged in pushing or shoving, tripping, or hitting someone.
Response options ranged from “never” (1) to “5 or more
times” in the past month (5).
Fighting
More serious physically aggressive acts were assessed by
four items (α =.81) asking students the number of times in
the past year they engaged in picking a fight with someone,
hitting someone to seriously hurt them, beating someone up
who provoked you, and taking part in a group fight. Response
options ranged from “never” (1) to “5 or more times” in the
past year (5).
Delinquency
Delinquency was measured by six items (α =.76) assessing
the number of times in the past year that the student reported
destroying others property, throwing objects at people or
cars, shoplifting, stealing from others,taking something from
someone by force, or intentionally vandalizing a school or
other building. Response options ranged from “never” (1) to
“5 or more times” in the past year (5).
Implementation fidelity
Project staff in randomly selected classrooms monitored pro-
gram implementation. Using observation forms developed
for each prevention session, trained staff members observed
teachers and recorded how much of the material allocated for
each session was actually covered in the classroom: 65 ses-
sions were observed for an average of 1.85 observations per
teacher. The completeness of the implementation of the pro-
gram was quantified by calculating the proportion of preven-
tion objectives covered during each session observed (num-
ber of objectives covered divided by the total number of
actual curriculum objectives for the particular session ob-
served). The mean number of program points covered across
all observations was 45.5% (SD =17.6) and the range was
21% to 86%.
Data analysis
Data were analyzed to (1) determine the baselines frequen-
cies of verbal and physical aggression, fighting, and delin-
quency in this population; (2) assess baseline equivalence
of conditions; and (3) test for intervention effects. Separate
analyses were conducted for any verbal aggression in the
past month, physical aggression in the past month, fighting
in the past year, and delinquency in the past year. In order to
test for potential intervention effects on more frequent lev-
els of the target behaviors, analyses were also conducted to
determine the effectiveness of the intervention with respect
to the top quartile of the distribution of these behaviors ( 5
events in the past month for verbal aggression, 3 events
in the past month for physical aggression, 3 events in the
past year for fighting and delinquent behavior). In view of
the variability of implementation fidelity, separate analyses
were conducted to determine the effectiveness of the preven-
tive intervention on students who received at least half of the
prevention program.
Because the intervention was randomized and adminis-
tered at the school level, it was necessary to control for intra-
cluster correlations (ICCs) among students within schools.
In the present context, ICCs quantify the degree of similarity
of students’ questionnaire responses within schools and how
aggression and delinquency rates vary at the school level.
Therefore, each analysis was run using the generalized esti-
mating equations (GEE) approach in SAS PROC GENMOD
(SAS Institute, 2005) in order to adjust the estimated stan-
dard error to account for the within-cluster correlation. This
approach generally provides for a more conservative test
of the hypothesis when a positive ICC is present (Norton,
Bieler, Ennett, & Zarkin, 1996).
Results
The frequencies of verbal aggression, physical aggression,
fighting, and delinquent behaviors were relatively high at
baseline. For example, verbal aggressive episodes in the past
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month were reported by 93.5% of the sample, with a median
of 3 episodes for the entire sample. Mild physical aggres-
sion in the past month was reported by 68.3% of the sample.
Serious physical aggression (fighting) in the past year was
reported by 56.5% of the sample, and delinquency in the
past year was reported by 53.2% of the sample. A series of
t-tests revealed that the intervention and control groups did
not differ on any of the violence or delinquency scales at
baseline. Moreover, there were no differences across condi-
tions in terms of gender or academic performance (grades in
school) at baseline. The intervention group had more His-
panic students (36.7%) than controls (30.2%), χ
2
(1) =23.2,
p < .003, while the control group had more black students
(43.8%) than the intervention group (33.1%), χ
2
(1) =59.2,
p < .001.
Intervention effects
Separate GEE analyses were conducted to examine the ef-
fect of the preventive intervention on verbal and physical
aggression, fighting, and delinquency. Each outcome mea-
sure at posttest was used as the dependent variable in separate
analyses, with pretest value, gender, percent black, percent
Hispanic, grades in school, and implementation score as co-
variates. As noted above, separate analyses were conducted
for the full sample and for the subset of students that received
at least half of the intervention (referred to as the “fidelity
sample” below).
Full sample
As shown in Table 1, GEE analyses revealed that for
the full sample the intervention reduced Delinquency in
the Past Year (OR =.684, 95% CI =.477, .982, p < .039).
The intervention also reduced Frequent Fighting in the
Past Year (OR =.742, 95% CI =.566, .972, p < .030), and
Frequent Delinquency in the Past Year (OR =.643, 95%
CI =.478, .867, p < .004).
Fidelity sample
As shown in Table 2, GEE analyses revealed that for the
students who received at least half of the preventive inter-
vention, there were significant prevention effects on Physical
Aggression in the Past Month (OR =.501, 95% CI =.374,
.671, p < .001), on Violence in the Past Year (OR =.525,
95% CI =.374, .736, p < .002), and on Delinquency in
the Past Year (OR =.537, 95% CI =.360, .799, p =.002).
The intervention also had significant preventive effects on
the top quartiles of the outcome variables, including Fre-
quent Verbal Aggression in the Past Month (OR =.503, 95%
CI =.305, .830, p < .007), on Frequent Physical Aggres-
sion in the Past Month (OR =.614, 95% CI =.444, .849,
p < .003), on Frequent Fighting in the Past Year (OR =.559,
95% CI =.397, .786, p <
.001), and on Frequent Delin-
quency in the Past Year (OR =.540, 95% CI =.322, .907,
p < .020).
Discussion
The results of this study indicate that a preventive interven-
tion previously found to be effective in preventing tobacco,
alcohol, and illicit drug use is also effective for preventing
violence and delinquency. Students who received the Life
Skills Training (LST) program were significantly less likely
to engage in physical fighting or delinquent behavior during
the past year. Stronger prevention effects were found for stu-
dents who received at least half of the LST program. These
students were significantly less likely to engage in verbal ag-
gression, physical aggression, fighting, and delinquency than
students in the control condition. For example, LST students
were less likely than students in the control group to argue
or tell someone off, push or shove, and get into physical
fights. They were also less likely than controls to engage in
delinquent behaviors such as destroying property, shoplift-
ing, stealing, taking something by force, or vandalizing a
school or other building.
Table 1 Predicting violence and delinquency at the posttest (full sample)
Outcome behavior OR 95% CI p-value
Any level of outcome behavior
Verbal aggression in past month 0.766 0.442 1.326 0.340
Physical aggression in past month 0.758 0.495 1.162 0.203
Fighting in past year 0.783 0.551 1.115 0.175
Delinquency in past year 0.684 0.477 0.982 0.039
High frequency of outcome behavior (top quartile)
Verbal aggression in past month ( 5 Events) 0.899 0.466 1.734 0.751
Physical aggression in past month ( 3 Events) 0.919 0.626 1.349 0.664
Fighting in past year ( 3 Events) 0.742 0.566 0.972 0.030
Delinquency in past year ( 3 events) 0.643 0.478 0.867 0.004
Note. 2-tailed tests were used in all analyses. OR, odds ratio; CI, confidence interval.
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Table 2 Predicting violence and delinquency at the posttest (fidelity sample)
Outcome behavior OR 95% CI p-value
Any level of outcome behavior
Verbal aggression in past month 0.721 0.358 1.455 0.361
Physical aggression in past month 0.501 0.374 0.671 0.001
Fighting in past year 0.525 0.374 0.736 0.002
Delinquency in past year 0.537 0.360 0.799 0.002
High frequency of outcome behavior (top quartile)
Verbal aggression in past month ( 5 events) 0.503 0.305 0.830 0.007
Physical aggression in past month ( 3 events) 0.614 0.444 0.849 0.003
Fighting in past year ( 3 events) 0.559 0.397 0.786 0.001
Delinquency in past year ( 3 events) 0.540 0.322 0.907 0.020
Note. 2-tailed tests were used in all analyses. OR, odds ratio; CI, confidence interval.
The findings from this study have important implications
for theory and practice. On a theoretical level, these results
provide additional support for a theory of multiple problem
behavior which posits interrelationships among an array of
problem behaviors and a common set of etiologic factors.
Such an integrated, unifying theoretical framework has its
roots in problem behavior theory (Jessor & Jessor, 1977)
and more recent theoretical formulations such as the theory
of triadic influence (Flay & Petraitis, 1994).
The results of this study also provide empirical support for
recommendations to develop and utilize more comprehen-
sive, integrated approaches to prevention (Biglan & Cody,
2003;Flay,2002). Currently, most efforts to prevent problem
behaviors and/or health risk behaviors involve separate in-
terventions targeting each risk behavior. Findings from this
study argue for greater integration of prevention efforts to
more efficiently target an array of theoretically and empir-
ically related behaviors such as substance use, aggression
and violence, delinquency, and risky sexual behavior. On a
practical level, school-based interventions capable of pre-
venting multiple problem behaviors are important because
of the potential for decreasing the burden on teachers and
administrators, class time, and scarce resources—thereby in-
creasing the potential for greater adoption, implementation,
and sustainability.
The prevention strategy incorporated into the LST
approach involves the inclusion of both generic and
domain-specific content taught using interactive intervention
methods (Botvin, 2000). Generic material is designed to tar-
get distal etiologic factors through the teaching of personal
coping skills and general social skills. Domain-specific ma-
terial is designed to target proximal etiologic factors such as
knowledge, attitudes, norms, and skills related to tobacco,
alcohol, and illicit drug abuse prevention. In addition, the
LST intervention tested in this study also included domain-
specific material related to violence prevention such as con-
tent to promote anti-violence norms, resistance to violence-
related media influences, anger management, and conflict
resolution. Additional research should focus on the effec-
tiveness of this type of prevention strategy for preventing
other health risk behaviors with and/or without the inclu-
sion of additional domain-specific material related to those
behaviors.
Prior research shows a relationship between implementa-
tion fidelity and effectiveness, and underscores the need for
interventions to be delivered with fidelity (e.g., Botvin et al.,
1995; Lillehoj, Griffin, & Spoth, 2004). Typically, greater
fidelity is associated with stronger prevention effects and an
increased number of significant outcomes. The same was true
in this study. Yet, as evidence-based prevention approaches
are taken to scale and utilized in real-world settings, im-
plementation fidelity has emerged as an issue of potential
concern. Fidelity varies considerably when evidence-based
programs are delivered by practitioners in real-world set-
tings, often falling below levels achieved during the well-
controlled randomized trials establishing their effectiveness.
Thus, a reasonable concern is that fidelity in real-world set-
tings may fall below the threshold necessary for effective-
ness. The results of the current study may be somewhat en-
couraging in this regard. Prevention effects were found for
the full sample even though the overall level of fidelity was
lower in this study than in previous randomized trials with
LST.
Moreover, anecdotal evidence suggests that adaptations
by practitioners may be one cause of lower fidelity. Indeed,
there appears to be a natural tension between the impera-
tive for fidelity and the natural inclination of practitioners
toward some degree of local adaptation. Resolving this ap-
parent conflict is a challenge to prevention science. Here
again, the results of this study may prove helpful. Using a
minimal standard of fidelity (50% or more of the program),
reasonably strong prevention effects were obtained for most
measures of violence and delinquency, suggesting that there
may be more room for flexibility and adaptation in evidence-
based prevention programs than has been previously
thought.
The current study has several notable strengths includ-
ing a randomized, control group design, standardized data
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collection procedures, a large sample size, a predominantly
minority population, and analyses that controlled for intra-
cluster correlations. However, additional follow up is neces-
sary to determine the durability of these prevention effects.
Moreover, more research is needed to determine the impact
of LST and other similar universal prevention programs on
more serious levels of aggression and violence as well as on
other health risk behaviors.
Prior research has demonstrated the effectiveness of the
LST approach for preventing tobacco, alcohol, and illicit
drug use. Follow-up studies not only provide evidence of the
long-term effectiveness of LST, but have also demonstrated
that it can prevent risky driving among high school students
and reduce HIV risk among young adults. The current study
extends that research and provides new empirical evidence
concerning the application of the LST program to problem
behaviors other than tobacco, alcohol, and illicit drug use.
These data indicate that this type of preventive interven-
tion can reduce verbal and physical aggression, fighting, and
delinquency. More research is needed to determine the dura-
bility of these effects as well as the extent to which this type
of prevention approach can prevent more serious forms of
violence (such as assault, assault with a weapon, and homi-
cide) and other health risk behaviors. This study alsoprovides
further support for the utility of an integrated, unifying the-
oretical framework of multiple problem behaviors to guide
the development or refinement of preventive interventions
designed to more efficiently target a broad range of problem
or health risk behaviors.
Acknowledgements This research was supported by grants DA08905
from the National Institute on Drug Abuse, National Institutesof Health.
Dr. Botvin has a financial interest in the Life Skills Training (LST)
program and his consulting company, National Health Promotion As-
sociates (NHPA), provides teacher training and technical assistance for
LST. Dr. Kenneth W. Griffin is a consultant to NHPA.
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    • "Three domains are especially fruitful: school, community, and family. With respect to the school environment, interventions aimed at increasing the accessibility of teachers and other school personnel to youth, or prevention curricula that are outside of traditional academic instruction, such as the model LifeSkills Training program may help youth view school personnel through a different lens and increase the likelihood of prosocial relationship development (Botvin, Griffin, & Nichols, 2006). Anonymous surveying of youth within a given school may yield surprising suggestions for school activities that may garner substantial participation from those not currently involved in school-related activities. "
    [Show abstract] [Hide abstract] ABSTRACT: Prior efforts suggest that adverse community contexts have the ability to impact juvenile recidivism. However, far less research has examined the indirect effects of community disadvantage on delinquent youth reoffending. As a result, it remains unclear whether several theoretically relevant mechanisms mediate the effects of disadvantage on continued delinquent behavior. Drawing from theoretical models of contextual effects, as well as social control theory, the present study examines whether prosocial bonds are salient mechanisms in the context–recidivism relationship. Using a sample of over 20,000 juvenile offenders, our results indicate that both prosocial relationships and prosocial activities partially mediate the effect of community disadvantage on youth reoffending. Findings from the current study are discussed, along with policy implications and directions for future research in this area.
    Full-text · Article · Mar 2016 · Youth Violence and Juvenile Justice
    • "Benefits. Our estimate of benefits is derived from impacts reported in Botvin et al. (2006). This study identified a statistically significant reduction in delinquency and fighting after 1 year of LST for sixth-grade students. "
    No preview · Article · Dec 2015 · Journal of Benefit-Cost Analysis
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    • "For example, Second Step: Student Success Through Prevention is a violence prevention program for middle school students focused on enhancing empathy, communication, problem-solving, and anger management skills (Espelage et al. 2013). Another example of an individual-level skill-building program is the Life Skills Training Program, which addresses substance use prevention for elementary to high school students (Botvin et al. 2006). The Life Skills Training Program aims to improve youths' self-esteem and skills related to stress and coping, emotion management, resistance against peer and media pressure to use drugs, and social competence (Botvin and Tortu 1988). "
    Full-text · Chapter · Dec 2015
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