This program is for adolescents who are in grades 7, 8, and 9.

Fourth R Health Physical Education (HPE), a school-based, universal prevention program, is designed to encourage and support the development of healthy, non-violent relationships and reduce interpersonal violence, dating violence, substance use, and unsafe sexual behaviors.

Randomized controlled trials (RCTs) have demonstrated mixed results. An RCT among 9th grade students demonstrated significantly lower physical dating violence among youth in intervention schools at the 2.5-year follow-up, and the effect was stronger among boys. Sexually active boys in the intervention group were significantly more likely to report regular condom use compared to the control group; however, sexually active girls in the intervention group were significantly less likely to report regular condom use compared to the control group. At the 2-year follow-up, youth in intervention schools with child maltreatment histories were significantly less likely to engage in violent delinquency compared to their counterparts in control schools. Results from an RCT among 7th and 8th grade students that used a posttest comparison design indicated significant improvements in knowledge about violence, critical thinking around the impact of violence, and identification of more successful coping strategies for stress among the intervention group compared to the control group. There were no differences between groups in general acceptance of violence. Results from a 1-year follow-up of an RCT conducted among 7th grade students indicated no significant differences between intervention and control groups in substance misuse, fighting, and bullying. Among students who had dated, students in the intervention group were less likely to report perpetrating physical relationship abuse compared to students in the control group. Among youth who reported a history of perpetrating physical relationship abuse, those who received the intervention had a significantly lower incidence of repeat perpetration at a 3-year follow-up compared to those in the control group.

Fourth R HPE intends to prevent peer and dating violence, substance misuse, and unhealthy sexual behaviors. The program includes curricula for students in grades 7, 8, and 9. Each grade level focuses on the following:

• Personal safety and injury prevention;
• Substance use, addictions, and related behaviors;
• Human development and sexual health; and
• Healthy eating.

The curriculum also includes access to the Skills for Effective Relationships video resource, which portrays relevant video clips that demonstrate examples of skills such as assertive communication and conflict resolution skills.

Additional Fourth R programs include the Grades 9-12 English Program, the Healthy Relationships Program, the Healthy Relationships Plus Program, and the Uniting Our Nations Indigenous Programs.

Since 2004, over 100,000 students in Canada and the United States have participated in this program annually, and over 1,000 schools in Canada and over 200 schools in 18 U.S. states have been involved. This program has also been used in Australia, Spain, and Portugal.

Classroom teachers deliver this program, and training modules for each grade are available at https://youthrelationships.org/pages/grade-7-8-9-fourth-r-training

Considerations for implementing this program include gaining support and buy-in from school administrators, teachers, parents, and students and making time in an existing curriculum for lessons.

The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email Clearinghouse@psu.edu

If you are interested in implementing Fourth R HPE, the Clearinghouse is interested in helping you! Please call 1-877-382-9185 or email Clearinghouse@psu.edu

The 7th grade curriculum consists of 27 lessons that are 40-45 minutes each. The 8th grade curriculum consists of 28 lessons that are 35-40 minutes each. The 9th grade curriculum consists of 26 lessons that are 70 minutes each.

An electronic copy of the curriculum costs $90. A hard copy of the curriculum costs $150. A hard copy of the curriculum kit, which includes the curriculum, implementation materials, and access to the Skills for Effective Relationships videos, costs $250. Please visit https://youthrelationships.org/collections/health-physical-education-hpe-resource for more information.

To move Fourth R HPE to the Promising category on the Clearinghouse Continuum of Evidence, additional studies would need to demonstrate that the iatrogenic effect on female condom use was an artifact of the earlier study and does not persist and demonstrate positive results on substance use outcomes.

The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email Clearinghouse@psu.edu

Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185  Email: Clearinghouse@psu.edu

You may also contact the Centre for School Mental Health by mail Western University, Faculty of Education, 1137 Western Road, Room 1154, London, ON, Canada - N6G 1G7, phone 1-519-858-5154, email thefourthr@uwo.ca, or visit https://youthrelationships.org/pages/contact-us

https://youthrelationships.org/; https://crimesolutions.ojp.gov/ratedprograms/109#7-0; Crooks, Scott, Ellis, and Wolfe (2011); and Wolfe et al. (2009).