Primary prevention of harmful sexual behaviors by children and young people: A systematic review and narrative synthesis

From a public health perspective, strategies for addressing children's harmful sexual behaviors often focus on secondary or tertiary prevention rather than primary prevention. Prevention efforts have also typically focused on preventing victimization by adults; yet a high proportion of child sexual abuse is perpetrated by other children and young people. We systematically reviewed the research on primary prevention strategies for harmful sexual behaviors in children and young people. We searched 6 databases, extracted data relating to program setting and focus, participant demographics, outcomes measured, and program success., We conducted a narrative synthesis in line with the SwiM guidelines (Popay et al., c2006), and conducted individual quality assessments of the included studies. 20 studies met our inclusion criteria. Primary prevention strategies were typically implemented in schools with primary/elementary, middle, and high school aged students. All programs included harmful sexual behavior within broader abuse prevention programs. Program effects were mixed. Primary-level prevention of harmful sexual behavior is typically addressed through broader sexual violence prevention programs. Around three-quarters of studies evaluating program efficacy found improvements in the outcomes measured, including some behavioral outcomes. Important to program success was who facilitated the program, as well as students' feeling of school connections. We found no evaluations of programs aimed at reducing harmful sexual behavior perpetrated online. Important new directions in program development will be to: (i) address the needs of younger children, as well as youth with disabilities, neurocognitive differences, and who are gender or sexually diverse; (ii) introduce and reinforce the concept that sexual behaviors exist on a continuum from healthy to harmful, providing clear examples; (iii) focus on both preventing perpetration and victimization; (iv) address strategies to support safe environments-in homes, organizations, communities, and online; and (e) identify essential elements for successful harmful sexual behavior prevention and align prevention programs with these features.