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Original article
Assessing the Effects of Families for Safe Dates, a Family-Based Teen Dating
Abuse Prevention Program
Vangie A. Foshee, Ph.D.a,*, Heath Luz McNaughton Reyes, M.P.H.a, Susan T. Ennett, Ph.D.a,
Jessica D. Cance, Ph.D.b, Karl E. Bauman, Ph.D.a, and J. Michael Bowling, Ph.D.a
a
Department of Health Behavior and Health Education, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
b
Department of Kinesiology and Health Education, the University of Texas at Austin, Austin, Texas
Article history: Received September 12, 2011; Accepted December 22, 2011
Keywords: Adolescent dating violence; Prevention of dating abuse
A B S T R A C T
IMPLICATIONS AND
CONTRIBUTIONS
Purpose: To examine the effects of a family-based teen dating abuse prevention program, Families
for Safe Dates, primarily on outcomes related to testing the conceptual underpinnings of the
Results from a randomized
program including (1) factors motivating and facilitating caregiver engagement in teen dating
evaluation of the first family-
abuse prevention activities, and 2) risk factors for teen dating abuse, and secondarily on dating
based teen dating abuse pre-
abuse behaviors. vention program are pre-
Methods: Families were recruited nationwide using listed telephone numbers. Caregivers and sented. The program was
teens completed baseline and 3-month follow-up telephone interviews (n ⫽ 324). Families ran- effective in promoting
domly allocated to treatment condition received the Families for Safe Dates program including six changes in the family context
mailed activity booklets followed-up by health educator telephone calls. that provide a foundation for
Results: There were significant (⬍.05) treatment effects in hypothesized directions on most of the preventing teen dating abuse
factors motivating and facilitating caregiver engagement in teen dating abuse prevention activities over time, decreasing teen ac-
including caregiver perceived severity of dating abuse, response efficacy for preventing dating ceptance of dating abuse, and
abuse, self-efficacy for talking about dating abuse, knowledge of dating abuse, acceptance of dating preventing dating abuse
abuse, communication skills with the teen, and belief in the importance of involvement in their victimization.
male (but not female) teen’s dating. The latter effect was the only one moderated by sex of the teen.
The targeted risk factor affected by the program was teen acceptance of dating abuse. Treatment
was also significantly associated with less physical dating abuse victimization.
Conclusions: Modifications to the program are warranted, but overall, the findings are very
favorable for the first family-based teen dating abuse prevention program to be evaluated.
䉷 2012 Society for Adolescent Health and Medicine. All rights reserved.
Teen dating abuse victimization and perpetration are preva- teens who experience dating abuse are physically injured and
lent for both boys and girls and result in serious consequences require medical attention [2,3].
[1–3]. Consequences identified from longitudinal studies include Few dating abuse prevention programs have been evalu-
binge-eating, cigarette smoking, marijuana and other illicit sub- ated using a randomized design (n ⫽ 10); only four of them
stance use, antisocial behavior, depression, and suicide ideation assessed program effects on dating abuse behaviors. Further,
and attempts [4 – 6]. Additionally, a substantial percentage of with one exception, the teen dating abuse prevention pro-
grams evaluated have been school-based [7]. However, the
difficulties of doing dating abuse prevention in schools be-
* Address correspondence to: Vangie Foshee, Ph.D., Department of Health cause of school objection to taking time away from academics
Behavior and Health Education, Gillings School of Global Public Health, Univer-
and fear of parental responses to sensitive program content
sity of North Carolina at Chapel Hill, 319B Rosenau Hall, CB# 7440, Chapel Hill,
NC, 27599 –7400. suggest a need for developing dating abuse prevention pro-
E-mail address: foshee@email.unc.edu (V.A. Foshee). grams that can be administered independent of schools. This
1054-139X/$ - see front matter 䉷 2012 Society for Adolescent Health and Medicine. All rights reserved.
doi:10.1016/j.jadohealth.2011.12.029
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350 V.A. Foshee et al. / Journal of Adolescent Health 51 (2012) 349 –356
article reports an evaluation using a randomized design of a use of self-administered family-focused interventions for pre-
universal family-based program, Families for Safe Dates (FSD), venting teen health risk behaviors.
designed to prevent teen dating abuse.
Involving families in the prevention of teen dating abuse has
FSD Conceptual Framework
promise because (1) families have a significant impact on dating
abuse risk factors; (2) families’ influence on teens is persistent, The overall goal of FSD is to motivate and facilitate caregiver
suggesting that programs focusing on family change may have engagement in dating abuse prevention activities with their
long-term effectiveness; (3) the family is the primary context in teens that can lead to decreases in risk factors for teen dating
which teens acquire information and values; and (4) family- abuse. Thus, FSD is designed to change two categories of con-
based programs have been found effective in preventing other structs: (1) factors that motivate and facilitate caregiver engage-
teen health risk behaviors [8 –11]. However, parents are substan- ment in dating abuse prevention activities with their teen and (2)
tially less likely to talk to their teens about dating abuse than empirically and theoretically based risk factors for teen dating
other risky behaviors [12]. Reasons given by parents for not abuse.
talking to their teens about dating abuse are that the child will
learn about it from experience, it would be too embarrassing for
Factors motivating and facilitating caregiver engagement in teen
the child, and they would not know what to say [12]. Involving
dating abuse prevention activities. FSD is consistent with a so-
parents in efforts to prevent teen dating abuse is warranted, yet
cial ecological approach in that the practitioner does not in-
to date, no family-based teen dating abuse prevention programs
tervene directly with teens, but instead intervenes with care-
have been evaluated. Mrazek and Haggerty [13] suggest that
givers to promote changes in the family context that lead to
tests of the conceptual model guiding an intervention (Stage 3
teen dating abuse prevention [18]. Because caregivers are the
research) should be conducted before conducting large-scale
change agents, motivating them to deliver intervention con-
efficacy trials on targeted behaviors (Stage 4 research). Because
tent to their teen and to have continuing discussions with
intervening with families to prevent teen dating abuse is a new
them about dating abuse is imperative. According to Protec-
approach, we conducted a Stage 3 study to test the conceptual
tion Motivation Theory [19], four beliefs are needed to moti-
underpinnings of the program. Although the study was not pow-
vate parents to take a preventive action such as talking to their
ered to assess program effects on dating abuse behaviors, we
teens about dating abuse: the first belief parents must have is
conducted exploratory analyses to examine those behavioral
that their teen is vulnerable to dating abuse (perceived suscep-
effects. We determined if sex of the teen modified program
tibility). Second belief is that negative consequences could
effects on all outcomes.
accrue to them and their teen if the teen becomes involved in
dating abuse (perceived severity). The third belief is that they
The Structure of FSD have the potential to influence their teen’s dating abuse be-
Family-based programs for preventing teen problem behav- havior (response efficacy). Finally, caregivers need to feel con-
iors typically place high time demands on families are inconve- fident that they have the skills for talking to their teen about
nient because of the necessity to go to locations outside the home dating abuse (self-efficacy). FSD activities are designed to alter
to receive the program, are expensive because they require de- these caregiver beliefs. FSD is also intended to increase care-
livery by highly trained professionals and large incentives for giver knowledge of dating abuse and to improve caregiver skills
family participation, and often result in low family participation for communicating with their teen because parental lack of
[10,14]. FSD was designed to address some of these limitations. knowledge and poor communication skills are common barri-
The program consists of six booklets delivered to families by ers to parent–teen communication about sensitive topics
mail. The first booklet, Getting Started is for caregivers only. The [20,21]. Additionally, it is designed to decrease caregiver ac-
five subsequent booklets include a variety of interactive activi- ceptance of dating abuse and to increase caregiver belief in the
ties that caregivers and teens do together designed to alter risk importance of being involved in their teen’s dating. Altering each
factors for dating abuse. Booklets are completed in the home at of these constructs is expected to enhance caregiver motiva-
times convenient for the family. A health educator calls the tion to complete the program and to create a family context
caregiver 2 weeks after each booklet is mailed to determine that is conducive to discussing teen dating abuse once the
whether activities were completed, encourage family participa- program is over.
tion, answer questions, and assess caregiver satisfaction and
other reactions to the booklet. Targeted risk factors for dating abuse. FSD activities are de-
This structure is modeled after our earlier program, Family signed to alter targeted risk factors for teen dating abuse. Teen
Matters, which used this same format for intervening with par- attitudes about the acceptability of dating abuse and per-
ents to prevent teen alcohol and tobacco use because a national ceived consequences of dating abuse have been repeatedly
randomized trial of Family Matters obtained high family partici- associated with dating abuse [22–24]. Poor conflict resolution
pation and found significant program effects in preventing teen skills also have been associated with dating abuse [25,26], and
tobacco and alcohol use [8,15,16]. Haggerty and colleagues [17] parental monitoring and rule setting are among the most
found higher family participation in a self-administered with consistent longitudinal predictors of teen dating abuse [27–
telephone support (SA) version of a family-based program for 29]. Therefore, FSD is designed to decrease teen acceptance of
preventing teen problem behaviors than in a group-administered dating abuse, increase teen perceived negative consequences of
(GA) version of the same program. The SA program was effective dating abuse, improve teen skills in resolving conflict, and in-
in decreasing several risk behaviors among African American crease caregiver date rule setting and monitoring. Changes in
teens; program effects tended to be stronger with the SA than GA each of these risk factors are expected to prevent dating abuse
version of the program [9]. Thus, there is evidence of successful victimization and perpetration.
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V.A. Foshee et al. / Journal of Adolescent Health 51 (2012) 349 –356 351
Table 1
Booklet description
Getting started: Introducing To explain to CGs how to do the program, CGs complete a true/false assessment that The four protection motivation
caregivers to the families address potential challenges, offer taps into DA myths and realities. constructs
for safe dates program suggestions for how to encourage teen CG knowledge of DA
participation, and motivate parents to CG acceptance of DA
engage in the activity booklets with
their teens.
Booklet 1: Talking about To improve communication between CG A card game that helps CGs understand CG communication skills with
dating and teen so they can more comfortably current teen dating practices and helps teen
talk about DA and date rape in later teens realize what dating was like for Teen conflict resolution skills
booklets. CGs.
A communication checklist is completed
after each activity to indicate which tips
for successful communication and
communication blockers CGs and teens
used in activity discussions.
Booklet 2: Skills for To increase CG and teen skills for Families are taught skills for settling Teen conflict resolution skills
handling conflict diffusing and dealing with anger and disagreements through the acronym CG communication skills with
settling disagreements. SAFE (stay calm, ask questions, find out teen
feelings, and exchange ideas for
possible solutions).
Families identify the SAFE skills used in a
scripted role play of a teen dating
couple settling a disagreement.
Booklet 3: Recognizing To increase teen and CG awareness of the In scenarios of dating abuse situations, Teen acceptance of DA
dating abuse various types of DA, warning signs of CGs and teens circle which of nine Teen perceived negative
DA, harmful consequences of DA, and control tactics listed were used by the consequences of DA
manipulation tactics used by abusers perpetrator. CG knowledge of DA
to “inoculate” the teen from those
controlling tactics and to introduce
teen to healthy dating characteristics.
Booklet 4: Preventing To challenge certain date rape myths and CGs and teens read a scenario of a date Teen acceptance of sexual DA
dating sexual abuse and beliefs, increase CG and teen rape situation and discuss questions Teen perceived negative
rape awareness of date rape and its harmful that ask about the manipulation tactics consequences of sexual DA
consequences, learn strategies to used by the perpetrator, signs that the CG knowledge of sexual DA
prevent being a perpetrator or victim victim did not want to have sex, and
of sexual DA, and learn about date rape potential negative consequences of the
drugs (including alcohol). rape for the perpetrator and victim.
Booklet 5: Planning for the To help teens think about their goals for Teens list five ways they want to treat the CG date rule setting and
future treating and being treated by dates, people they date and five ways they monitoring
develop a plan with CGs for what to do want to be treated by dates. CG’s also CG belief in the importance of
if they are being treated complete a card listing five ways they being involved in their teen’s
disrespectfully by a date or if they are want their teen to treat and be treated dating
treating a date disrespectfully, and to by a date. CGs and teens discuss. Teen conflict resolution skills
help families develop guidelines and Families work together to develop
rules about dating. guidelines for dating which are posted
on the refrigerator.
FSD Program Content be English speaking and have at least one 13–15–year-old in
residence. Once families were recruited, the primary caregiver
Booklet content that mapped onto each of these constructs (usually the mother) and the teen were administrated a 20 min-
was developed by designing new activities and drawing from ute computer-assisted telephone interview by trained inter-
relevant activities of Safe Dates, one of the few evidenced-based viewers. Pairs of families were matched on the date they com-
teen dating abuse prevention programs [30,31]. Feedback was pleted the interviews, and one family of each matched pair was
obtained on various drafts of the booklets through a series of randomly allocated to either a full or a partial treatment group
multiple focus groups with 86 caregivers and teens. Booklet and the other to a control group. Families in full treatment re-
content was revised accordingly resulting in the final booklets ceived the Getting Started booklet for caregivers and the five
described in Table 1. activity booklets; those in partial treatment received only the
five activity booklets; and those in the control group received no
Methods program materials. Having two treatment groups allowed for
testing the hypothesis that changes in the four Protection Moti-
Study design vation beliefs targeted in Getting Started would increase family
engagement in the program. Because testing that hypothesis is
Families were recruited nationwide via telephone using a not the focus of the current study, analyses are limited to those
targeted telephone sampling frame purchased from GENESYS allocated to the full treatment and control. Three months after a
Sampling Systems (Horsham, PA). To be eligible, families had to treatment family completed the program, the caregiver and teen
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352 V.A. Foshee et al. / Journal of Adolescent Health 51 (2012) 349 –356
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V.A. Foshee et al. / Journal of Adolescent Health 51 (2012) 349 –356 353
Table 3
Measures of the primary outcomes
CG ⫽ caregiver; TN ⫽ teen.
a
Each response efficacy item was recoded so that a response of “strongly agree” was scored “1” and all other nonmissing responses were scored “0.”
b
Each knowledge item was recoded so that correct responses were scored “1” and incorrect responses and responses of “don’t know” were scored “0.”
c
The CG and TN acceptance items were scored so that higher scores indicated less acceptance of dating abuse.
d
The CG acceptance item was dichotomized so that a response of strongly disagree was scored “1” and all other nonmissing responses were scored “0.”
e
The belief items were dichotomized so that “strongly agree” was scored “1” and all other nonmissing responses were scored “0.”
f
The negative consequences items were coded so that higher scores denoted greater perceived likelihood of negative consequences or a lower perceived likelihood
of positive consequences.
asking how many times teens had ever had these things done to Analytical strategy for testing treatment effects
them that were not done in self-defense. Response options and
the dichotomization of the variable were the same as for physical An intention-to-treat approach was used; that is, analyses
dating abuse perpetration. were based on the treatment condition families were assigned to
and not on the amount of treatment received [34]. The effect of
Attrition analysis and results FSD on each primary outcome was tested with linear regression
for continuous outcomes and logistic regression for dichotomous
Loss to follow-up was more likely when caregivers did not outcomes. The follow-up outcome was regressed on treatment
have education beyond high school (p ⫽ .002) and when caregiv- condition, the baseline value of that outcome, the control vari-
ers reported high levels of perceived severity of dating abuse (p ⫽ ables (teen, sex, and race, caregiver education, and family struc-
.01). Significantly more participants in the treatment (39%) than ture), and the interaction between treatment condition and sex
control group (21%) were lost to follow-up (p ⬍ .001) but only of the teen. Cohen’s d (effect size) was calculated for each con-
one of the 27 interactions between treatment condition and the tinuous outcome. Conclusions about the significance (p ⬍ .05) of
baseline measure of the outcomes was significant. In the treat- program effects were identical using and not using multiple
ment group, caregivers lost to follow-up reported significantly imputation procedures (in SAS [SAS Institute, Cary, NC]) [35];
greater belief in the importance of involvement in teen dating therefore, we report results from the sample of 324 families.
than those who remained in the study, whereas in the control When assessing effects on dating abuse behaviors, the sample
group that variable was not associated with loss to follow-up. was limited to those who reported at follow-up that they had
The direction of this interaction would unlikely bias results in ever been on a date. Very few teens reported any physical perpe-
favor of treatment effects; rather, it would potentially bias re- tration (n ⫽ 7) or physical victimization (n ⫽ 17) at baseline.
sults in the opposite direction. Therefore when assessing program effects on physical dating
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354 V.A. Foshee et al. / Journal of Adolescent Health 51 (2012) 349 –356
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V.A. Foshee et al. / Journal of Adolescent Health 51 (2012) 349 –356 355
based teen dating abuse prevention program but also suggest with 13–15–year-olds. Loss to follow-up could have further de-
that modifications to the program are warranted. creased the generalizability of study findings. Also, only short-
term program effects were assessed, not allowing much time for
Indicated program content modification assessing changes in dating abuse behaviors.
The study has many strengths. This is the first evaluation of a
There was a strong significant program effect on decreasing family-based program for preventing teen dating abuse. Program
caregiver use of negative communication with the teen, but only development was guided by a theoretically and empirically
from the caregivers’ report. This suggests that program activities based conceptual model and results from extensive formative
for improving caregiver communication with the teen need to be research with families. The study used a randomized design and
improved. However, it is also possible that the measures of these a nationwide sampling approach, there was high family partici-
skills-based constructs, assessed in a brief telephone interview, pation in the program, and the program effects were the same
do not adequately capture changes in these complex constructs. when using multiple imputation suggesting that loss to follow-up
There were no program effects on teen perceived negative is an unlikely threat to internal validity.
consequences of dating abuse and teen conflict resolution skills,
suggesting the need to modify activities targeted at these con- Acknowledgments
structs. However, it is important to note that in the randomized
This research was supported by funding from the Centers for
trials of the two evidenced-based dating abuse prevention pro-
Disease Control and Prevention (grant Number R49CCV423115-
grams that assessed program effects on these two constructs, no
01-04). The sampling and the baseline and follow-up telephone
effects were found, despite finding strong long-lasting effects on
interviews were conducted by the Survey Research Unit, in the
preventing dating abuse victimization and perpetration [31,37].
Department of Biostatistics at the University of North Carolina at
Thus, changes in these two constructs may not be necessary for
Chapel Hill. The study was reviewed and approved by the Public
dating abuse behavior change.
Health-Nursing Institutional Review Board for the Protection of
FSD also was not effective in increasing caregiver date rule
Human Subjects at the University of North Carolina, Chapel Hill.
setting and monitoring. The longitudinal studies finding that
parental monitoring predicts dating abuse assessed general References
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