title: Preventing Peer Violence Against Children: Methods and Baseline Data of a Cluster Randomized Controlled Trial in Pakistan.
abstract: Violence against and among children is a global public health problem that annually affects 50% of youth worldwide with major impacts on child development, education, and health including increased probability of major causes of morbidity and mortality in adulthood. It is also associated with the experience of and perpetration of later violence against women. The aim of this article is to describe the intervention, study design, methods, and baseline findings of a cluster randomized controlled trial underway in Pakistan to evaluate a school-based play intervention aiming to reduce peer violence and enhance mental health.
  
  
  
  A cluster randomized controlled design is being conducted with boys and girls in grade 6 in 40 schools in Hyderabad, Pakistan, over a period of 2 years. The Multidimensional Peer-Victimization and Peer Perpetration Scales and the Children's Depression Inventory 2 (CDI 2) are being used to measure the primary outcomes while investigator-derived scales are being used to assess domestic violence within the family. Specifics of the intervention, field logistics, ethical, and fidelity management issues employed to test the program's impact on school age youth in a volatile and politically unstable country form this report.
  
  
  
  A total of 1,752 school-age youth were enrolled and interviewed at baseline. Over the preceding 4 weeks, 94% of the boys and 85% of the girls reported 1 or more occurrences of victimization, and 85% of the boys and 66% of the girls reported 1 or more acts of perpetration. Boys reported more depression compared with girls, as well as higher negative mood and self-esteem scores and more interpersonal and emotional problems.
  
  
  
  Globally, prevalence of youth violence perpetration and victimization is high and associated with poor physical and emotional health. Applying a randomized controlled design to evaluate a peer violence prevention program built on a firm infrastructure and that is ready for scale-up and sustainability will make an important contribution to identifying evidence-informed interventions that can reduce youth victimization and perpetration.
authors.affiliation: Texas Woman's University College of Nursing, Houston, Texas, USA. jmcfarlane@twu.edu.
authors.forename: Judith
authors.initials: J
authors.lastname: McFarlane
authors.affiliation: The Aga Khan University School of Nursing & Midwifery, Karachi, Pakistan.
authors.forename: Rozina
authors.initials: R
authors.lastname: Karmaliani
authors.affiliation: The Aga Khan University School of Nursing & Midwifery, Karachi, Pakistan.
authors.forename: Hussain
authors.initials: H
authors.lastname: Maqbool Ahmed Khuwaja
authors.affiliation: The Aga Khan University School of Nursing & Midwifery, Karachi, Pakistan.
authors.forename: Saleema
authors.initials: S
authors.lastname: Gulzar
authors.affiliation: The Aga Khan University School of Nursing & Midwifery, Karachi, Pakistan.
authors.forename: Rozina
authors.initials: R
authors.lastname: Somani
authors.affiliation: The Aga Khan University School of Nursing & Midwifery, Karachi, Pakistan.
authors.forename: Tazeen
authors.initials: T
authors.lastname: Saeed Ali
authors.affiliation: The Aga Khan University School of Nursing & Midwifery, Karachi, Pakistan.
authors.forename: Yasmeen H
authors.initials: YH
authors.lastname: Somani
authors.affiliation: The Aga Khan University School of Nursing & Midwifery, Karachi, Pakistan.
authors.forename: Shireen
authors.initials: S
authors.lastname: Shehzad Bhamani
authors.affiliation: Elite Research, LLC, Irving, Texas, USA.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Krone
authors.affiliation: Elite Research, LLC, Irving, Texas, USA.
authors.forename: Rene M
authors.initials: RM
authors.lastname: Paulson
authors.affiliation: Right To Play, Hyderabad, Pakistan.
authors.forename: Atta
authors.initials: A
authors.lastname: Muhammad
authors.affiliation: South African Medical Research Council, Pretoria, South Africa.
authors.forename: Rachel
authors.initials: R
authors.lastname: Jewkes
mesh_terms: D058445:Bullying / Q000517:prevention & control*; D002648:Child; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D008297:Male; D010154:Pakistan; D010379:Peer Group; D015397:Program Evaluation / Q000379:methods*; D014754:Violence / Q000517:prevention & control*