Pediatrics · Medical Literature
Growing up without violence (GWV): Results of a cluster randomised trial of a school-based intervention preventing adolescent sexual abuse and exploitation in Brazil.
Abstract
Child sexual abuse and exploitation (CSAE) are pervasive problems that significantly affect the health of children and adolescents. This paper presents the results of a cluster randomised controlled trial (cRCT) evaluating a school-based intervention designed to prevent CSAE in Brazil through education. We conducted a two-arm cRCT with parallel assignment in two Brazilian municipalities. Sixty schools were randomly allocated to intervention and control arms (30 per group) using stratified randomisation based on municipality and school type (municipal and state-run). We invited 50 randomly selected students, aged 12-17, from each school to complete surveys at baseline and endline. Teachers enrolled in GWV training completed an implementation questionnaire. Our primary analysis focused on a cross-sectional comparison of students' CSAE risk knowledge between control and intervention schools. We found no statistically significant difference in adolescents' CSAE risk knowledge between the study arms (adjusted mean difference: 0.02, 95% CI -0.19 to 0.23, p = 0.87). There was borderline evidence of interaction by gender, with a greater difference in knowledge scores among girls (p = 0.032). No significant association was found between the number of GWV components implemented and knowledge scores. Several factors may contribute to this result: the intervention might not have been implemented with sufficient fidelity or intensity, the true effect of GWV could be minimal and below the study's detection threshold, the intervention may have influenced outcomes that were not measured, or the intervention may simply lack effectiveness. Further rigorous evaluations and implementation studies are essential to ensure that resources are directed toward effective strategies. The American Economic Association's registry for randomised controlled trials (AEA RCT Registry). RCT ID: AEARCTR-0011299, https://www.socialscienceregistry.org/trials/11299.
Clinical relevance
Child sexual abuse and exploitation (CSAE) disproportionately burden pediatric and adolescent populations in low- and middle-income countries, yet rigorous evidence on school-based prevention programs in these settings remains scarce. This cluster RCT addresses a critical evidence gap by evaluating a structured educational intervention (Growing Up Without Violence) in Brazil, a high-prevalence context where scalable prevention strategies are urgently needed. Clinicians and public health practitioners working with adolescents must be aware of which prevention frameworks carry robust evidence before advocating for their adoption.
Key findings
1. No statistically significant difference in CSAE risk knowledge was detected between intervention and control schools at endline (adjusted mean difference: 0.02, 95% CI −0.19 to 0.23, p = 0.87). 2. The trial was a well-powered, two-arm cluster RCT with 60 schools (30 per arm) across two Brazilian municipalities, with stratified randomisation by municipality and school type, and a target sample of approximately 50 students per school aged 12–17 years. 3. Borderline evidence of a gender interaction was identified, with a greater difference in knowledge scores observed among girls compared to boys (interaction p = 0.032), though this was not a pre-specified primary outcome and should be interpreted with caution. 4. No significant association was found between the number of GWV intervention components implemented and student knowledge scores, suggesting a dose–response relationship was not established. 5. The primary outcome was a cross-sectional comparison of CSAE risk knowledge scores at endline; no significant between-arm difference was observed on this measure. 6. The authors identified multiple potential explanatory factors for the null result, including insufficient implementation fidelity or intensity, effect sizes below the study's detection threshold, unmeasured outcome domains, or genuine lack of intervention efficacy.
Practice implications
Pediatricians, school health professionals, and public health policymakers should not assume that school-based educational programs targeting CSAE knowledge automatically produce measurable benefit; this trial underscores the necessity of demanding rigorous efficacy data before scaling such interventions. Future program adoption should prioritize interventions with demonstrated implementation fidelity monitoring and should incorporate a broader range of outcomes beyond knowledge scores — including behavioral and disclosure-related endpoints — to capture the full potential impact. Until higher-quality evidence emerges from replication studies with improved fidelity controls, clinical and institutional resources directed at CSAE prevention should favor programs with an established evidence base.