Integrating The Prevention of Adolescent Substance Use and Dating Violence: Evidence from Systematic, Epidemiologic, and Intervention Studies
type: CreativeWork
description: Dating violence (DV) and substance use (SU) are prevalent, co-occurring behavioral health threats among adolescents, yet prevention research has overwhelmingly addressed them in isolation. This three-paper dissertation advances understanding of DV–SU co-occurrence by examining the evidence base for integrated school-based prevention, the normative mechanisms of a leading bystander intervention, and the etiological specificity of adversity–substance pathways. Guided by the Social-Ecological Model, Bystander Intervention Theory, and etiological specificity frameworks (Self-Medication Hypothesis and Social Pain Overlap Theory), the dissertation progresses across three analytical levels: international evidence synthesis, institutional-level mechanism evaluation, and national population-level analysis.Study 1 is a systematic review of randomized controlled trial (RCT) school interventions that prevent both DV and SU outcomes among adolescents worldwide. Searching six databases (PubMed, EMBASE, PsycINFO, CINAHL, CABI, ERIC) and screening 5,413 records, three cluster-RCTs were identified (N = 78,545), evaluating the Green Dot bystander program and the Fourth R curriculum. Risk of bias was assessed with Cochrane’s RoB 2 and evidence quality with GRADE. Green Dot reduced substance-related sexual violence outcomes despite not explicitly targeting SU, while Fourth R reduced physical DV but did not reduce SU outcomes. The identification of only three qualifying RCTs reveals a critical gap in integrated prevention science. Study 2 is a secondary analysis of data from the Kentucky Green Dot cluster-randomized trial (26 high schools, 2010–2014) testing whether the intervention reduced alcohol-related sexual assault victim-blaming (AR-SAVB). Binomial generalized linear mixed models detected a significant delayed treatment effect: AR-SAVB was 15% lower in intervention schools by Year 4 (OR = 0.85; 95% CI: 0.76, 0.95), robust across sensitivity analyses. Substance-related sexual viol…
abstract: Dating violence (DV) and substance use (SU) are prevalent, co-occurring behavioral health threats among adolescents, yet prevention research has overwhelmingly addressed them in isolation. This three-paper dissertation advances understanding of DV–SU co-occurrence by examining the evidence base for integrated school-based prevention, the normative mechanisms of a leading bystander intervention, and the etiological specificity of adversity–substance pathways. Guided by the Social-Ecological Model, Bystander Intervention Theory, and etiological specificity frameworks (Self-Medication Hypothesis and Social Pain Overlap Theory), the dissertation progresses across three analytical levels: international evidence synthesis, institutional-level mechanism evaluation, and national population-level analysis.Study 1 is a systematic review of randomized controlled trial (RCT) school interventions that prevent both DV and SU outcomes among adolescents worldwide. Searching six databases (PubMed, EMBASE, PsycINFO, CINAHL, CABI, ERIC) and screening 5,413 records, three cluster-RCTs were identified (N = 78,545), evaluating the Green Dot bystander program and the Fourth R curriculum. Risk of bias was assessed with Cochrane’s RoB 2 and evidence quality with GRADE. Green Dot reduced substance-related sexual violence outcomes despite not explicitly targeting SU, while Fourth R reduced physical DV but did not reduce SU outcomes. The identification of only three qualifying RCTs reveals a critical gap in integrated prevention science. Study 2 is a secondary analysis of data from the Kentucky Green Dot cluster-randomized trial (26 high schools, 2010–2014) testing whether the intervention reduced alcohol-related sexual assault victim-blaming (AR-SAVB). Binomial generalized linear mixed models detected a significant delayed treatment effect: AR-SAVB was 15% lower in intervention schools by Year 4 (OR = 0.85; 95% CI: 0.76, 0.95), robust across sensitivity analyses. Substance-related sexual viol…
author: Morales, Mario
language: en
license: http://rightsstatements.org/vocab/InC/1.0/
date published: 2026
date modified: 2026-07-24T00:55:35Z
provider: University of Arizona
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: The University of Arizona.

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property ID: Handle
value: http://hdl.handle.net/10150/680884