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

School-based sexual abuse prevention programs can teach children to recognize mistreatment and might increase self-protective behaviors, according to a new review of studies.

However, the programs have a downside: they could heighten anxieties, making children more fearful of strangers, the review cautions.

“It was a concern that anxiety may be increased as we found in the review, but we were pleased that there was an increase in knowledge,” said lead reviewer Karen Zwi of Sydney Children's Hospital in Australia. “The important issue is whether – in a real life situation – a child could utilize this knowledge.”

The aim of the systematic review was to determine whether school-based sexual abuse prevention and education programs are effective, if they protect children and if they might cause unintentional harm.

The review appears in the latest issue of The Cochrane Library , a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The Cochrane reviewers analyzed 15 studies that included school-age pupils and high school students living in Canada and the United States. The education programs covered topics such as how to identify potential abuse, “good touch” vs. “bad touch” concepts and who to tell if abuse occurs. The studies employed a variety of teaching strategies to educate the children, from films and lectures to puppet shows and role-playing.

One study found that children who participated in an education program were less likely to go with a simulated abductor than children who had not (21.5 percent vs. 47.6 percent).

Nine studies found that children who received sexual abuse prevention education demonstrated greater knowledge of the subject compared to children in a control group.

“Child sexual abuse is a serious problem for school-aged children worldwide,” the reviewers write. According to the Centers for Disease Control and Prevention, a 2004 state and local Child Protective Services study found that 10 percent of U.S. children reported being victims of sexual abuse.

However, the review notes that there is no “consistent definition of sexual abuse.” Some prevention programs define abuse as “instances of sexual body contact” with a child while others consider abuse “any sexual behavior in a child's presence,” the review said.

Experts say most cases of sexual abuse go unreported. Moreover, the Cochrane reviewers said without a uniformly accepted definition, it is difficult to know how often sexual abuse occurs, especially in countries where there have been few studies conducted.

“Rates [of abuse] may vary between countries because of differences in how child abuse is reported rather than true differences,” Zwi said. “The important point is that child abuse is generally under-reported. This is because child sexual abuse is a difficult diagnosis to be certain of, and because many children are reluctant to declare their abuse for a range of reasons.”

Joan Duffell, director of partnership development for the Committee for Children, said school-based prevention programs could help children know when to report abuse. The Seattle-based nonprofit organization develops classroom programs that focus on topics such as youth violence, child abuse and personal safety. Schools should be diligent to select programs known to be effective, she said.

“There are a proliferation of prevention programs around the country, some good and some not so good,” Duffell said. “We always recommend abuse preventions programs that are first based on the most current research and that are also done in a way that will actually teach students skills, such as assertiveness and help-seeking behaviors that will empower them as they grow up.”

The Cochrane reviewers' caution about prevention programs increasing a child's anxiety toward strangers is an outcome that is to be expected, Duffell said.

“A hypothesis among researchers is that in a small percentage of children we do know their anxiety level will increase, but studies have shown that these same kids are the ones who will get anxiety from any educational program. If it's fire prevention, they'll be scared of fire, if it's traffic safety, they'll be afraid of crossing the street,” Duffell said.

Zwi KJ, et al. School-based education programmes for the prevention of child sexual abuse (Review). Cochrane Database of Systematic Reviews 2007, Issue 3.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.