This study is a school-based trial of the 7th grade version of Fourth R, a promising teen dating violence prevention program, with 24 ethnically diverse middle schools in one of the nation's largest school districts to determine the impact of the program by comparing students in intervention schools with those in control schools.

The prevalence of teen dating violence (TDV), as well as the adverse mental, physical, and relationship health outcomes associated with it, underscores the need for effective TDV prevention programs, of which there are few.

The study will evaluate a new 7th-grade version of Fourth R, which has been rewritten to be developmentally appropriate and correspond to national health standards for this younger age. The 7th-grade version of Fourth R is innovative because it emphasizes socio-emotional learning, includes lessons on mental health, and addresses technology and cyber TDV. These additional components will strengthen the core social-emotional competencies of youth, competencies that are critical for the creation of healthy relationships and avoidance of unhealthy ones. A TDV prevention program aimed at promoting healthy relationships at this developmentally important age holds tremendous promise.

The primary aim is to determine whether Fourth R reduces students' TDV, as indexed by less perpetration and victimization of physical, sexual, and psychological TDV, relative to students in control schools.

The secondary aims are to determine whether Fourth R, relative to control, 1) improves students' [relationship quality], emotional well-being, and increases their acquisition and use of healthy relationship skills, as indexed by improved problem-solving, communication, and conflict resolution skills; 2) ameliorates the modifiable cognitive and behavioral correlates associated with the perpetration and victimization of TDV, as indexed by fewer attitudes justifying dating violence, decreased substance use, risky sexual behavior, fighting, and bullying, increased school connectedness, improved academic performance, and decreased psychological symptoms; and [3) improves school climate as indexed by student, teacher, and staff reports of school environment as it relates to healthy relationships and TDV; and by reductions in school disciplinary actions related to violence, substance use, and academic failure]. Prespecified differences by gender and ethnicity will be examined, as well as the acquisition and utilization of various program components.

Inclusion Criteria:

• Attending 7th grade health class in Houston area middle schools

Exclusion Criteria:

• n/a

The number of students who were included in the baseline survey analysis.

Participants could self-report any adverse events over the course of the 5-year study. Participants were contacted and took surveys at baseline, when students were in 7th grade and at 12-, 24-, and 36-months post-intervention, when students were in 8th, 9th, and 10th grade, respectively. Participants were given study contact and resource information at each data collection and could contact study staff at any time to report any adverse events.

Staff and teachers were instructed to immediately contact the principal investigator and the project director if any adverse event occurs and appropriate action would be taken. Teachers received information on confidentiality and disclosure issues. At the beginning of the intervention, teachers informed students about restrictions on his/her ability to keep certain information confidential. Any adverse event must also be reported to the Institutional Review Board (IRB).