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\nMay 30, 2013
\nPhoto by Luis Luque
\nGreta Massetti, PhD, chief, Research and Evaluation Branch, Division of Violence Prevention at the National Center for Injury Prevention and Control talked with CDC Director Thomas Frieden, MD, MPH, about violence prevention on April 29 in a Conversation with the Director.
\nAfter a few minutes of polite, getting-to-know-you questions, Frieden starts taking notes, interested in specifics from Massetti about Triple-P, the Positive Parenting Program, an intervention that helps build healthy family relationships.
\nMassetti discusses the evidence that has built up around Triple-P since its creation some 30 years ago in Australia. Studies have found that the program reduces child behavior problems and teaches parents more effective ways to discipline their children, but more importantly, to bond more closely with them. A CDC-funded trial also found that communities that applied Triple-P had fewer cases of child abuse, child abuse injuries, and out-of-home placements. But taking Triple-P from homes into entire communities is complicated.
\n\u201cThere are some cost limitations for communities to do the full-scale Triple-P, Massetti says, \u201cbut the evidence is strong [that Triple-P works well].\u201d
\nFrieden is quick with questions. \u201cSo, Triple-P, how would you go about peeling out the different components and making them widely available?\u201d
\nMassetti reports that the Division of Violence Prevention is developing a CDC-branded strategy to promote positive parenting. The point is to allow communities to get information online and engage in child maltreatment prevention efforts\u2014but without the price tag of a proprietary program.
\nFrieden also wants to know more about prevention programs tailored to suicide, teen dating violence, rape prevention, and child maltreatment. He even wonders if studies suggest whether breastfeeding affects child maltreatment. The discussion is wide-ranging, but wherever it leads, Frieden keeps returning to two main points: What works? And how do you scale it up? And yet, neither he nor Massetti is naive about the political and economic realities of trying to expand any government program, no matter how effective. Cost is one reason many violence prevention programs are school-based.
\n\u201cWith schools and the Triple-P equivalent,\u201d Frieden says, \u201cwhat you essentially want is the minimum effective dose. How can you get it scaled by saying, \u2018If you do this much, you\u2019ll get a reasonably good impact\u2019?\u201d\u2019
\n\u201cThat\u2019s a good question,\u201d Massetti responds. \u201cI don\u2019t know that there\u2019s a lot of research on that, because I think there\u2019s a confound between dose and content. There are programs that have many more sessions that probably have better content, and so they have better effects, but is it the content, or is it the dose?\u201d
\nIn some areas of violence prevention, most programs only consist of one session, Massetti continues. \u201cWhen it comes to rape prevention, schools may only have a single assembly where they [try to teach] all the kids about preventing sexual violence\u2026and we have lots of research that shows that\u2019s not effective.\u201d But Massetti is enthusiastic about increasing the prevention dose. \u201cWe\u2019re trying to push the envelope a little, and how do we take what\u2019s already happening and\u2014\u201d
\n\u201cOr how do you go to text, and YouTube?\u201d Frieden asks.
\n\u201cRight! How do you reach them in other ways?\u201d Massetti ponders. \u201cBecause the other major barrier in schools is that teachers are not comfortable talking about those topics.\u201d
\nControversial topics are nothing new to Massetti and her team. Teen dating violence is another priority. Their program\u2014Dating Matters\u2122: Strategies to Promote Healthy Teen Relationships\u2014is CDC\u2019s comprehensive teen dating violence prevention initiative based on the current evidence about what works in prevention. It includes a social media and technology strategy to reach youth, with CDC\u2019s first direct-to-youth text campaign. Rather than merely lecturing students during school-wide assemblies, Dating Matters is also at the forefront of social messaging.
\n\u201cFor youth, if you\u2019re not getting to them through text messaging, there\u2019s just no way to reach their eyeballs that will have that potential for impact,\u201d Massetti says. \u201cSo, we\u2019re really excited to see that. And then, because of Facebook and other social media components, students have an opportunity to take ownership of those messages, and not just receive them, but also put them back out into their community. I think youth are engaged in a different way than they were by, say, bus ads 20 years ago.\u201d
\nMassetti knows she faces a difficult challenge in violence prevention. Every day it seems the media uncovers new horrors\u2014the Aurora and Newtown shootings, Chicago gang violence, the Boston Marathon bombings, the Cleveland abductions. But violence prevention is possible. The evidence is there. The question remains, is our society willing to fund the programs? As Frieden would ask next: What would it take to scale up successful violence prevention programs and take them to every community?
\nThis Snapshot by Luis Luque
\nCDC Connects Story Manager: Kathy Chastney
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