Looking ahead toward community-level strategies to prevent sexual violence

Connecting to Community: Violence Prevention Barriers, Geography, and Preventionist Perceptions of Community Leadership and Opportunities

Violence is a public health concern, negatively impacting individual and community health and safety. Although violence can be prevented, prevention efforts are complex in part because they require addressing community factors. Despite an increase in funding and support for community violence prevention, relatively little is known about what prevention practice barriers may be related to community factors. This study addressed this gap by surveying a statewide sample of violence preventionists. We explored if coordination and logistical barriers and rural geography are associated with perceptions of two community factors: community opportunities and leadership quality. As part of a statewide assessment of violence and prevention efforts, 130 violence preventionists completed surveys. Results showed that both perceived coordination barriers and rural geography were negatively associated with perceptions of existing community opportunities, representative/influential leadership, and leadership commitment. Perceived logistical barriers were positively associated with perceived leadership commitment. Findings suggest that support reducing community coordination barriers in particular-and to support rural violence prevention work more broadly-is needed.

Preventing sexual violence in sexual orientation and gender diverse communities: A call to action

Background: Members of the lesbian, gay, bisexual, transgender, queer, and other sexual orientation and gender diverse (SOGD) communities are at disproportionately higher risk for sexual violence compared to cisgender heterosexual people. Despite this elevated risk, relatively few sexual violence prevention efforts effectively reduce these victimization disparities based on sexual orientation or gender identity.Objective: This narrative review provides an overview of the prevalence of sexual violence in the SOGD communities, delineates risk factors for sexual victimization among SOGD community members, and reviews and evaluates existing prevention efforts for the SOGD communities. We outline specific recommendations for ensuring that prevention efforts meet the needs of the SOGD communities.Method: Drawing on ecological systems theory and public health approaches to sexual violence prevention, we outline current approaches and opportunities for preventionists and scholars to push the field forward.Results: There have been promising prevention programmes designed to be implemented within SOGD communities specifically; however, it is important that general primary prevention programmes endeavour to specifically address sexual violence perpetrated against SOGD people. While many packaged programmes that endeavour to prevent sexual violence across all gender identities and sexual orientations are inclusive of SOGD participants, more programming is needed that integrates anti-oppression training to target social norms that perpetuate SOGD-specific rape myths and normalize sexual violence against SOGD community members.Conclusion: Ecological prevention strategies in line with a public health approach for primary prevention may be particularly valuable for reducing victimization disparities based on SOGD status and identity. Comprehensive sexual education and anti-discrimination policies should be considered front-line prevention programming. To assess if these strategies are effective, the implementation of large-scale surveillance surveys that use comprehensive assessments of sexual orientation, gender identity, and sexual violence are needed. Using theoretically grounded implementation strategies for prevention programmes can ensure effective programme delivery.

Study protocol for a randomized controlled trial of RealConsent2.0: a web-based intervention to promote prosocial alcohol-involved bystander behavior in young men

BACKGROUND

Sexual violence (SV) is a significant, global public health problem, particularly among young adults. Promising interventions exist, including prosocial bystander intervention programs that train bystanders to intervene in situations at-risk for SV. However, these programs suffer from critical weaknesses: (1) they do not address the proximal effect of alcohol use on bystander decision-making and (2) they rely on self-report measures to evaluate outcomes. To overcome these limitations, we integrate new content specific to alcohol use within the context of prosocial bystander intervention into an existing, evidence-based program, RealConsent1.0. The resulting program, RealConsent2.0, aims to facilitate bystander behavior among sober and intoxicated bystanders and uses a virtual reality (VR) environment to assess bystander behavior in the context of acute alcohol use.

METHODS

This protocol paper presents the design of a randomized controlled trial (RCT) in which we evaluate RealConsent2.0 for efficacy in increasing alcohol- and non-alcohol-involved bystander behavior compared to RealConsent1.0 or to an attention-control program ("Taking Charge"). The RCT is being implemented in Atlanta, GA, and Lincoln, NE. Participants will be 605, healthy men aged 21-25 years recruited through social media, community-based flyers, and university email lists. Eligible participants who provide informed consent and complete the baseline survey, which includes self-reported bystander behavior, are then randomized to one of six conditions: RealConsent2.0/alcohol, RealConsent2.0/placebo, RealConsent1.0/alcohol, RealConsent1.0/placebo, Taking Charge/alcohol, or Taking Charge/placebo. After completing their assigned program, participants complete a laboratory session in which they consume an alcohol (target BrAC: .08%) or placebo beverage and then engage in the Bystanders in Sexual Assault Virtual Environments (BSAVE), a virtual house party comprising situations in which participants have opportunities to intervene. Self-reported bystander behavior across alcohol and non-alcohol contexts is also assessed at 6- and 12-months post-intervention. Secondary outcomes include attitudes toward, outcome expectancies for, and self-efficacy for bystander behavior via self-report.

DISCUSSION

RealConsent2.0 is the first web-based intervention for young men that encourages and teaches skills to engage in prosocial bystander behavior to prevent SV while intoxicated. This is also the first study to assess the proximal effect of alcohol on bystander behavior via a VR environment.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT04912492. Registered on 05 February 2021.

Mixed Methods Community-Engaged Evaluation: Integrating Interventionist and Action Research Frameworks to Understand a Community-Building Violence Prevention Program

While mixed methods research can enhance studies of intervention outcomes and projects where research itself transforms communities through participatory approaches, methodologists need explicit examples. As the field of interpersonal violence prevention increasingly embraces community-level prevention strategies, it may benefit from research methods that mirror community-building prevention processes. A multiphase mixed methods study with sequential and convergent components assessed the feasibility, and impact of a prevention program to change social norms and increase collective efficacy in towns. Joint display analysis created a nuanced picture of the acceptability, feasibility, and impact of the program. This article contributes to the field of mixed methods research by bridging discussions of "interventionist" studies with models of community-based participatory mixed methods research into a combined community-engaged method.

Contradictions in change: Ecological factors in the implementation of outer layer sexual violence prevention

This study examined the adoption and implementation process in early efforts to implement ecological ("outer layer") sexual violence (SV) prevention strategies. Interviews with 28 preventionists from 26 local sites within a large, midwestern state, were conducted to examine individual preventionists' problem definitions of SV and ecological factors surrounding implementation. Findings suggest that SV prevention in the state is primarily implemented at the individual-level; when preventionists described engaging in or anticipating outer layer interventions, they were often tertiary (i.e., responding after perpetration; e.g., Sexual Assault Response Teams). A majority expressed problem definitions rooted within the individual (e.g., perpetration due to a lack of consent education), and a majority of implemented efforts matched this individual-level conceptualization. Yet, contradictions between problem definitions (e.g., SV stemming from oppression) and implemented activities (e.g., single-session educational interventions) emerged. Such contradictions may be best understood in light of contextual implementation influences: diverse preventionist job responsibilities, less training/support for outer layer prevention, preventionist autonomy, leadership messaging, time requirements, partner reticence, and extensive work with schools. Inner layer influences, including identification with job roles, preference for, and a sense of urgency toward inner layer work, appeared to interact with contextual factors. Implications across community psychology domains are discussed.

Reflecting and rejuvenating our work, together: One team's consideration of AJCP publications on gender-based violence

Community psychology has long valued reflexive praxis as a critical part advancing our research and action. In this Virtual Special Issue (VSI), we, a group of community psychologists and gender-based violence (GBV) researchers at many different points in our careers, reflected on GBV publications that have appeared in AJCP. We examine the ways in which community psychology broadly and articles in AJCP more specifically have conceptualized GBV as a sociocultural issue, how GBV intersects with other oppressions and forms of violence, the tension when systems that aspire to support survivors are inequitable and focused on ameliorative change, and the importance of interventions being locally informed and locally driven. By highlighting selected GBV-focused articles published in AJCP, this VSI discusses (a) understanding and transforming culture via robust research and local partnerships, (b) targeting effective interventions for survivors, (c) invoking systems and targeting change in institutional environments, and (d) making connections between local efforts and broader social movements. To continue to move forward, we conclude we must reflect, embrace methodological plurality, partner, and push for structural change. Reflective questions regarding research and action are offered, to address gender-based violence.

New Communities, New Relationships: Reflections from Junior Faculty Engaging in Community-Based Research

Promising community-level approaches to addressing interpersonal violence have increased in popularity over the last few decades. However, the shift towards community-based research has not necessarily extended to all graduate program pedagogies, especially given the range of disciplines from which researchers of interpersonal violence hail. Coupled with the fact that many new doctorates relocate to unfamiliar communities to secure their tenure-track positions, junior faculty may find the task of forming and maintaining rewarding community partnerships to be daunting at best. This article focuses on the process of embarking on community-based research as a new faculty member within a new community. In this article, three tenure-track assistant professors of a psychology department within an urban, Midwestern-based university reflected on their own experiences establishing community-based research collaborations after relocating for their positions. Personal narratives focused on experienced challenges and successes related to building mutually beneficial relationships with community organizations of relevance to addressing interpersonal violence (e.g., victim response services, healthcare providers, school systems) were written. Individual narratives were then compiled and six overarching themes (i.e., establishing initial connections, messaging and marketing one's research to gain buy-in, overcoming misperceptions and distrust, maintaining relationships as an external partner, conducting research with community organizations, balancing community-based research and academic demands) related to challenges and multiple associated strategies and lessons learned were identified. Implications of this article for researchers of interpersonal violence who are building careers in a new community are discussed. Some of these implications include the need for increased mentorship, trainings and resources that are specifically targeted to junior faculty's unique needs, and changes to departmental and college level infrastructures that better support and reward community-based research.

College-level perceptions of drinking, binge drinking, and sexual violence perpetration: A multilevel mediation model

Objective: To determine whether college men's perceptions of campus drinking norms, aggregated at the institution-level, predicted heavy episodic drinking and sexual violence perpetration. Participants: Data were collected from a sample of 1144 first-year male college freshmen enrolled at one of thirty four-year institutions in the state of Georgia. Methods: Four waves of online survey data were collected as part of a longitudinal cohort study completed in 2016. Results: Perceptions of campus drinking norms aggregated at the institution-level significantly predicted college men's heavy episodic drinking. Heavy episodic drinking mediated the relationship between perceptions of the typical students' drinking behavior and perpetration of sexual violence, such that participants at institutions with higher levels of perceived drinking norms reported more heavy episodic drinking and sexual violence perpetration. Conclusions: Findings from this study provide further support for the inclusion of broader campus-level prevention strategies as part of a comprehensive approach to preventing sexual violence.

Sexual and Gender-Based Violence and Vulnerability to HIV Infection in Uganda: Evidence from Multilevel Modelling of Population-Level HIV/AIDS Data

Background: Sexual and gender-based violence (SGBV) is highly prevalent in Uganda and its link with HIV infection and compromising access to HIV/AIDS services is known. However, current evidence is controversial. Most of the studies indicate a positive relationship but a few indicate otherwise. Moreover, there is no research examining the effects of community-level SGBV on HIV infection. Objectives: This research explores the association between SGBV and vulnerability to HIV infection. Methods: Multilevel binary logistic regression is applied to secondary data of Uganda AIDS Indicators Survey conducted in 2011. The survey data comprises 12,153 women and 9588 men. Results: SGBV significantly increases the likelihood of HIV infection, with victims having 34%, 1.34 [1.06–1.70] higher odds than non-victims. At the community level, wealth, and pre-sex alcohol abuse are important determinants. Conclusions: Vulnerability to the risk of HIV infection in Uganda is associated with individual-level and community factors. Effective HIV prevention policies need to pay attention to victims of SGBV using individual- and community-level strategies.

Applying an Ecological Framework to Factors Associated With Non-Spousal Sexual Assault Among Women in Canada

An ecological framework is useful for understanding how individual, relationship, community, and societal level factors can affect women's vulnerability to sexual assault. However, most studies have focused on examining individual and relationship factors only, due to measurement challenges and a lack of data at the societal level. The purpose of this study was to use data from a nationally representative victimization survey to identify salient predictors of sexual assaults not committed by common-law or marital partners among women across all levels of the ecological framework. Out of 16,738 female respondents, 1.9% (n = 319) experienced one or more incidents of non-spousal sexual assault in the 12 months preceding the survey. Logistic regression modeling indicated that at the individual level, statistically significant factors associated with non-spousal sexual assault included age, Indigenous status, marital status, mental disability, education, main activity, and homelessness or precarious housing. Relationship level predictors of non-spousal sexual assault were a history of child sexual abuse and witnessing violence between parents. Community level predictors were a weak sense of belonging in the local community, low likelihood that neighbors would contact police if they witnessed family violence in the respondents' home, and high likelihood that neighbors would contact police if they witnessed other criminal behavior. Societal level factors were perceptions that local police do a poor job promptly responding to calls, perceptions that local police do a poor job treating people fairly, and having experienced discrimination in the previous 5 years. The results demonstrated that community and societal level factors are critical components of an ecological framework and are important to understanding and addressing the many factors which are independently associated with vulnerability to sexual assault.

Prevention of sexual violence among college students: Current challenges and future directions

Objective Preventing sexual violence among college students is a public health priority. This paper was catalyzed by a summit convened in 2018 to review the state of the science on campus sexual violence prevention. We summarize key risk and vulnerability factors and campus-based interventions, and provide directions for future research pertaining to campus sexual violence. Results and Conclusions: Although studies have identified risk factors for campus sexual violence, longitudinal research is needed to examine time-varying risk factors across social ecological levels (individual, relationship, campus context/broader community and culture) and data are particularly needed to identify protective factors. In terms of prevention, promising individual and relational level interventions exist, including active bystander, resistance, and gender transformative approaches; however, further evidence-based interventions are needed, particularly at the community-level, with attention to vulnerability factors and inclusion for marginalized students.

Scope and correlates of high school youths' exposure to dating and sexual violence prevention initiatives

The researchers examined the extent to which high school youth were exposed to dating and sexual violence (DSV) prevention types (e.g., social marketing campaign) across various locations (e.g., in-school) and how exposure to DSV prevention related to perceptions of social norms and collective efficacy. Participants included 877 high school youth who completed in-school surveys across three towns in New England. Most youth (92%) were exposed to DSV prevention. In general, active exposure and active participation, more so than passive exposure, were related to greater perceptions of collective efficacy and perceptions of social norms more intolerant of DSV. Results also suggested that online exposure to DSV prevention was the most consistent correlate of greater perceptions of collective efficacy and perceptions of social norms more intolerant of DSV. These findings provide clues about the types and locations that might be most effective at preventing DSV among youth.

The Girls' Leadership Academy: A Promising, Empowerment-Based Approach to the Prevention of Sexual Violence

Sexual violence (SV) is a pernicious issue that disproportionally impacts girls and women. Although few initiatives have demonstrated effectiveness in leading to reductions in SV, global health organizations have identified empowerment-based programs as a promising approach to SV prevention. The purpose of this article is to discuss the Girls Leadership Academy (GLA), a program of the Nebraska's Women's Center for Advancement, which is a "homegrown," theoretically grounded, practice-based SV prevention program for adolescent girls. More specifically, we discuss previous research relevant to the GLA; the theoretical underpinnings of the GLA; and the history, context, and content of the GLA.

A Novel Model for Generating Creative, Community-Responsive Interventions to Reduce Gender-Based Violence on College Campuses

Currently, the most successful prevention interventions against sexual violence (SV) on United States college campuses target modifications at the individual and interpersonal levels. Community-level interventions have been under-developed for college campuses. To address this gap, we employ a citizen science model for understanding campus community factors affecting SV risk. The model, called Our Voice, starts by engaging groups of college students to collect data in their own communities, identifying factors they view as increasing the risk of SV. In facilitated meetings, participants then review and analyze their collective data and use it to generate actionable community-level solutions and advocate for them with local decision-makers. We share findings from a first-generation study of the Our Voice model applied to SV prevention on one college campus, and include recommendations for further research.

A Promising Approach to Preventing Gender-Based Violence and HIV Among Slum-Dwelling Youth in Nairobi, Kenya

Gender-based violence (GBV) and HIV are interrelated public health problems affecting numerous global communities. To date, few prevention initiatives have demonstrated reductions in GBV and HIV, and thus there is an urgency to identify effective strategies to prevent these interconnected public health crises. The purpose of the current article is to describe a gender-enhanced life skills training curriculum (GE-LSTC) currently being developed in Nairobi, Kenya. We discuss previous research relevant to the GE-LSTC; the theoretical underpinnings of the GE-LSTC; the history and context of the GE-LSTC; preliminary implementation, feasibility, and acceptability data on the GE-LSTC; and plans for further refinement and rigorous evaluation of the GE-LSTC.

Community Conversations on Relationship Violence: Town Variations in Prevention Perceptions through Concept Mapping

To further develop domestic and sexual violence (DSV) prevention strategies at the community level requires an understanding of how community members in towns think about prevention. Using concept mapping, this study sought to better understand community members' perspectives about what DSV prevention strategies would be most feasible, most effective, and generate the greatest community support within their town. Data were collected across four rural Northern England towns. Participants (>90% White) in each town (total sample size = 119) brainstormed, sorted, and rated between 67 and 90 statements per town (x̅ = 75). Based on the results, a 5-cluster solution of school settings, conversations, individual direct action, community building, and community awareness was identified across all four towns as DSV prevention strategies with one town identifying an additional cluster solution of governance. Despite identifying similar prevention strategies, participants from each town rated these clusters of strategies differently on how feasible, effective, and supported they would be in their community. Overall, our results suggest that there were interesting consistencies across four towns in a similar geographic region in terms of how DSV prevention was described. However, individual communities differed in their views of the feasibility and acceptability of the different strategies. These results suggest that different strategies and higher-level actions may be required to address and prevent DSV within different towns and communities and that community narratives can clarify which specific strategies may encounter fewer barriers to implementation.

Exploring the relationship between strip clubs and rates of sexual violence and violent crime

AIMS

We examined whether (a) the number of strip clubs per capita and (b) the proportion of clubs with "high-risk characteristics" were significantly associated with rates of sexual violence (SV) and other violent crime at the county level.

METHODS

Using large, public data sets, we tested effects across 926 counties (13 U.S. states), controlling for percent below the poverty line and alcohol outlets per capita.

RESULTS

We found that rates of strip clubs were significantly associated with violent crime, but not SV, in all but one model (accounting for Saturday hours). Counties with greater proportions of "high-risk" strip clubs (i.e., greater days and hours of operation, drink specials, full-nudity policies, or private rooms) have higher rates of SV. All models, except the full-nudity policy model, demonstrated increased rates of violent crime.

CONCLUSIONS

These results provide information for community-level violence prevention and equips stakeholders with information to create safer communities.

How Community and Peer Perceptions Promote College Students' Pro-Social Bystander Actions to Prevent Sexual Violence

The prevalence of sexual violence crimes on U.S. college campuses is prompting institutions of higher education to increasingly invest in centers to support survivors and programs to prevent the violence before it happens. Understanding bystanders to sexual violence and what may motivate them to step in and help is a promising prevention strategy. The purpose of this study was to understand how potential active bystanders' (first-year college students) perceptions of community (including a sense of one's influence in the community and positive peer norms for helping) and individual beliefs about self (including sense of responsibility and self-efficacy) affect their self-reports of performing bystander behavior to address sexual violence risks. Participants were 948 students at two different universities (one a rural, primarily residential campus and the other an urban, mostly commuter campus) in the northeastern United States. Regression and path analysis quantitative results suggest that individual-level characteristics may mediate some of the impact that community-level norms and perceptions have on bystander outcomes, explaining some of the mixed findings in previous research. Prevention strategies should work to change community norms and perceptions of mattering and perceptions of community influence in addition to the more traditional focus on individual-level violence specific attitudes.

Effects of Dating Matters® on Sexual Violence and Sexual Harassment Outcomes among Middle School Youth: a Cluster-Randomized Controlled Trial

Sexual violence (SV), including sexual harassment (SH), is a significant public health problem affecting adolescent health and well-being. This study extends prior research by evaluating the effectiveness of a comprehensive teen dating violence prevention model, Dating Matters, on SV and SH perpetration and victimization, inclusive of any victim-perpetrator relationship, among middle school students. Dating Matters includes classroom-delivered programs for youth in 6th, 7th, and 8th grades; community-based programs for parents; a youth communications program; training for educators; and community-level activities. Middle schools in four urban areas in the USA were randomly assigned to receive Dating Matters (DM, N = 22) or a standard-of-care intervention (SC, N = 24) over four consecutive school years (2012-2016). The analytic sample included two cohorts who entered the study in 6th grade and completed 8th grade by the end of the study allowing for full exposure to Dating Matters (DM: N = 1662; SC: N = 1639; 53% female; 50% black, non-Hispanic; 6 waves of data collection for each cohort). Structural equation modeling was employed with multiple imputation to account for missing data. Dating Matters was associated with significant reductions in SV and SH perpetration and victimization scores in most-but not all-sex/cohort groups by the end of 8th grade relative to an evidence-based TDV prevention program. On average, students receiving Dating Matters scored 6% lower on SV perpetration, 3% lower on SV victimization, 4% lower on SH perpetration, and 8% lower on SH victimization by the end of middle school than students receiving an evidence-based violence prevention program. Overall, Dating Matters shows promise for reducing SV and SH, occurring both within and outside dating relationships, through middle school. Clinicaltrials.gov Identifier: NCT01672541.

Child Maltreatment and Adult Sexual Assault Victimization: Genetic and Environmental Associations

Despite the pervasiveness of adult sexual assault (ASA), evidence-based knowledge on the risk factors for sexual victimization is insufficient. Here, we investigated the etiology of ASA in a population-based Finnish twin sample. Specifically, we estimated the extent of the genetic and environmental influences on the risk of ASA, and we examined its phenotypic and genetic associations with five types of child maltreatment (CM). We found large unique environmental, but also small genetic influences on the risk of ASA, motivating further research on situational and behavioral conditions potentially exploited by sexually motivated perpetrators. The prevalence of ASA was highest among victims of severe child sexual abuse. However, when accounting for the co-occurrence of multiple types of CM, emotional abuse was the strongest predictor of ASA. We further examined, and could not entirely rule out, the possibility of common genetic and environmental pathways underlying CM and ASA. Lastly, we focused on sex differences. Emotional and physical abuse were the strongest predictors of ASA in women and men, respectively, and genetic influences on the risk of ASA were larger in women than men. However, such higher heritability did not reflect sex-limited genetic effects, but, rather, women's systematic exposure to environmental risk of ASA.

Preventing Teen Relationship Abuse and Sexual Assault through Bystander Training: Intervention Outcomes for School Personnel

The purpose of the current study was to examine the impact of exposure to Bringing in the Bystander-High School Curriculum (BITB-HSC) on school personnel, which included a seven session classroom curriculum for ninth through twelfth graders (student curriculum), a bystander training workshop for school personnel (school personnel workshop), and reading materials (handout). We examined how exposure to these various BITB-HSC intervention components was associated with school personnel's knowledge and bystander efficacy, intentions, and barriers specific to student relationship abuse (RA) and sexual assault (SA). Participants were 488 school personnel from 12 high schools in upper New England who completed the 4-month follow-up survey that assessed for intervention exposure (284 participants completed both the baseline and follow-up survey). Whereas 53% of participants were exposed to no intervention components, the other half of the sample were exposed to a combination of intervention components. Higher baseline knowledge and reactive bystander intentions were associated with subsequent exposure to both the student curriculum and the handout, and fewer barriers to bystander action predicted exposure to the school personnel workshop. Exposure to the school personnel workshop, student curriculum, and handout was associated with subsequent greater knowledge, exposure to the student curriculum predicted reactive bystander intentions, and exposure to the handout predicted higher reactive bystander intentions and bystander efficacy. Findings suggest that despite challenges with engagement, exposure to the BITB-HSC components may be a useful tool in improving school personnel's responses to RA and SA among high school students.

‘No One . . . Saves Black Girls’: Black University Women’s Understanding of Sexual Violence

Although research has found that sexual violence is a serious issue on college campuses, the lack of diversity in previous samples calls into question the findings’ generalizability to non-White populations. Consequently, little is known about how Students of Color conceptualize sexual violence. Using an intersectional and phenomenological approach, we examined how Black/African American university women understand sexual violence, as well as their perceptions of cultural barriers to help-seeking and reporting this violence. Seven themes emerged: (a) Historical Legacy of Racialized Trauma Against Black Women, (b) Stereotypes of Hypersexualized Black Women, (c) Silence and Community Protection, (d) Duality of Black Spirituality and/or Religiosity, (e) Racial Injustice and Systemic Barriers to Help-Seeking and Reporting, (f) Stereotypes of Strong Black Women, and (g) Grassroots Healing and Empowerment of Black Communities. We provide recommendations for counselors and university staff to develop culturally grounded campus prevention initiatives for Black women.

"What Should Sex Look Like?" Students' Desires for Expanding University Sexual Assault Prevention Programs to Include Comprehensive Sex Education

Rates of sexual assault and sexual violence among college-aged adults are much higher than the national rates of sexual assault and sexual violence. Therefore, reduction and prevention of sexual violence among university students is critical and is consistent with national public health priorities. Often times, messages to students focus only on sexual assault and omit larger notions of sexual health. Four focus groups with a total of 24 participants (nine men, 15 women) highlighted three main perceptions about the sexual assault programming offered at this large university: themes of resistance to traditional programming, a need for holistic sexual health programming, and a desire to have an environment, which normalizes conversations surrounding sex, sexuality, and sexual health.

"What would the neighbors do?" Measuring sexual and domestic violence prevention social norms among youth and adults

There is growing attention to how social processes in communities may contribute to domestic and sexual violence (DSV) and be a target for prevention efforts. Three main variables are collective efficacy and descriptive and injunctive norms. To date, few measures exist that assess these variables in the specific context of violence prevention. The current study sampled 3,866 adults and high-school youth in four communities in northern New England. Exploratory and confirmatory factor analyses examined the psychometrics of the scales. Scales reflecting collective efficacy, indirect public, and direct individualized descriptive norms, public and personal injunctive norms, and youth perceptions of adults' prevention actions demonstrated robust factor structures and adequate reliability and validity. These measures may prove useful for a diverse audience (e.g., practitioner, researchers) for assessing the effectiveness of community-level DSV prevention strategies.

Advancing Theory, Methods, and Dissemination in Sexual Violence Research to Build a More Equitable Future: An Intersectional, Community-Engaged Approach

Sexual violence is a devastating trauma with long-lasting effects on survivors' health and well-being. Despite the substantial impacts of the last 25 years of research, the prevalence of sexual violence has remained stable. It will be necessary to reconceptualize our work, challenging our theories, methods, and strategies for dissemination and implementation moving forward. We outline an intersectional, community-engaged approach for sexual violence research to center the stories of survivors who face systemic oppression and inequity. Finally, we suggest applications of this approach for justice, healing, and prevention to inform our collective work to end sexual violence.

Primary and secondary prevention of child sexual abuse

The high prevalence rates and numerous consequences associated with child sexual abuse makes preventing these offences a societal priority. Prevention strategies have traditionally involved only tertiary interventions, implemented by the criminal justice system after an offence has occurred. More recently, some have argued for a public health approach to preventing child sexual abuse, which includes interventions at the primary and secondary levels. Secondary prevention aims to provide treatment and support to those at-risk of sexually offending before any involvement with the legal system. Increased demand for secondary prevention services and early results from current initiatives demonstrate that at-risk individuals are willing to seek treatment without external pressure from the legal system, and often report numerous treatment-related benefits. These findings support the need for widespread implementation of primary and secondary prevention initiatives. The safety of children requires that society stops merely reacting to sexual offences, and instead begins implementing proactive evidence-based strategies that can prevent even initial incidents of child sexual abuse. This article explores some of the many benefits and barriers associated with primary and secondary prevention, as well as strategies for overcoming these barriers. Recommendations for the development and implementation of prevention initiatives are also included.

Impact of Exposure to Sexual Violence Prevention Messages on Students' Bystander Behavior

Bystander intervention is a prevention strategy commonly used to address campus sexual violence. Increasingly, there are calls for prevention efforts to be multilevel and ongoing. The current study investigated the impact of receiving varied prevention messages throughout adolescence and into early adulthood to determine whether it influences college students' awareness of sexual violence, willingness to intervene as a helpful bystander, and actual prosocial bystander behavior. These questions were tested through administration of an online survey to a racially and ethnically diverse sample of 1,047 undergraduate students at a large, urban university in the mid-Atlantic. Results found that most students received information about sexual violence prior to coming to campus from a variety of sources, and that the sources varied significantly by gender and race. Regression analysis found that greater exposure to prevention messages prior to coming to college was significantly associated with greater bystander intentions and behavior even after accounting for gender and race and exposure since coming to college. The findings provide initial support to expand the scope of prevention efforts and to begin them prior to college.

The Causal Influence of Perceived Social Norms on Intimate Partner Violence Perpetration: Converging Cross-Sectional, Longitudinal, and Experimental Support for a Social Disinhibition Model

Across three studies, we develop a model of the direct and indirect paths through which the perceived prevalence (perceived descriptive norms [PDN]) of intimate partner violence (IPV) among peers may influence individuals’ likelihood of engaging in IPV. Study 1 replicated and extended previous cross-sectional research by demonstrating a positive longitudinal association between PDN and subsequent IPV perpetration. Study 2 further showed the influence of PDN on IPV perpetration to be mediated through its relation to perceived peer acceptance of IPV (perceived injunctive norms [PIN]), which in turn predicted personal IPV acceptance. Study 3 built on this model using an experimental paradigm to show that increasing PDN leads to corresponding increases in PIN and, in turn, personal IPV acceptance, which both predicted IPV perpetration. Furthermore, the effects of PIN on personal IPV acceptance and IPV propensity were strongest for dominance-oriented individuals. Results bear important implications for social norms–based interventions for IPV.

Ethics and Issues of Secondary Prevention Efforts in Child Sexual Abuse

This article discusses the ethical, practical, and moral issues surrounding secondary prevention efforts of child sexual abuse from a professional and practice-based perspective. Transcripts of a semistructured consultation event with n = 15 international experts on the secondary prevention of child sexual abuse were analysed using thematic qualitative analysis. The research identified four main critical areas linked to secondary prevention efforts, including, the psychology of self-reporting and disclosure; the interaction with and within existing legal, social, and professional frameworks; the scale and type of an appropriate response; and potential hurdles (i.e., within media, public, politics). The article outlines these areas, highlighting participant perspectives on risk-enhancing and mitigating factors for each domain.

Retrospective evaluation of Project Envision: A community mobilization pilot program to prevent sexual violence in New York City

Sexual violence is a public health problem associated with short- and long-term physical and mental health consequences. Most interventions that aim to prevent sexual violence before it occurs target individual-level change or promote bystander training. Community-level interventions, while increasingly recommended in the sexual violence prevention field, are rarely documented in peer-reviewed literature. This paper is a targeted process evaluation of Project Envision, a 6-year pilot initiative to address social norms at the root of sexual violence through coalition building and community mobilization in three New York City neighborhoods, and reflects the perspectives of those charged with designing and implementing the program. Evaluation methods included a systematic literature review, archival source document review, and key informant interviews. Three themes emerged from the results: community identity and implications for engagement; capacity and readiness for community mobilization and consequences for implementation; and impacts on participants. Lessons learned include the limitations of using geographic boundaries to structure community interventions in urban settings; carefully considering whether communities should be mobilized around an externally-identified issue; translating theoretical frameworks into concrete tasks; assessing all coalition partners and organizations for readiness; critically evaluating available resources; and recognizing that community organizing is a skill that requires investment from funders. We conclude that Project Envision showed promise for shifting institutional norms towards addressing root causes of sexual violence in addition to providing victim services.

Social Norms for Intimate Partner Violence: A Replication With College Students

This study replicated prior research on college students' perceived descriptive norms (i.e., prevalence estimates) for intimate partner violence (IPV). In this study, male and female college students were instructed to estimate the prevalence of physical forms of IPV for "typical students" of their same gender on campus. Perpetrators of IPV-both male and female-made higher estimates than nonperpetrators. When compared to actual prevalence rates, both perpetrators and nonperpetrators overestimated the prevalence of IPV on campus. Findings have implications for prevention programs that address social norms.

Primary Prevention of Sexual Violence in Aotearoa New Zealand

The extensive and sometimes profoundly damaging effects of sexual violence and large numbers of victims necessitate dedicated attention to primary prevention efforts. Few studies have examined the scope of current prevention activities or their fit with empirical research into effective prevention strategies. The current article presents findings from a survey of primary prevention activities in non-Māori and bicultural communities within Aotearoa New Zealand. Forty-four respondents representing 42 agencies responded to a comprehensive survey that canvased types of sexual violence primary prevention activities undertaken, sexual violence primary prevention programs, and barriers and supports to sexual violence prevention work. Consistent with findings from previous international surveys, the focus of primary prevention work in New Zealand was on sexual violence education and increasing awareness. Findings are discussed in the context of the sexual violence prevention literature and what works in prevention more broadly to help identify promising initiatives as well as gaps in current practices. Recommendations for advancing sexual violence primary prevention research are also provided.

Exploring Alcohol Policy Approaches to Prevent Sexual Violence Perpetration

Sexual violence continues to be a significant public health problem worldwide with serious consequences for individuals and communities. The implementation of prevention strategies that address risk and protective factors for sexual violence at the community level are important components of a comprehensive approach, but few such strategies have been identified or evaluated. The current review explores one potential opportunity for preventing sexual violence perpetration at the community level: alcohol policy. Alcohol policy has the potential to impact sexual violence perpetration through the direct effects of excessive alcohol consumption on behavior or through the impact of alcohol and alcohol outlets on social organization within communities. Policies affecting alcohol pricing, sale time, outlet density, drinking environment, marketing, and college environment are reviewed to identify existing evidence of impact on rates of sexual violence or related outcomes, including risk factors and related health behaviors. Several policy areas with initial evidence of an association with sexual violence outcomes were identified, including policies affecting alcohol pricing, alcohol outlet density, barroom management, sexist content in alcohol marketing, and policies banning alcohol on campus and in substance-free dorms. We identify other policy areas with evidence of an impact on related outcomes and risk factors that may also hold potential as a preventative approach for sexual violence perpetration. Evidence from the current review suggests that alcohol policy may represent one promising avenue for the prevention of sexual violence perpetration at the community level, but additional research is needed to directly examine effects on sexual violence outcomes.

Call for research on bystander intervention to prevent sexual violence: the role of campus environments

An important next step for the field is to determine what setting-level factors beyond the individual are critical to fostering campus environments that support pro-social, helpful bystander intervention action to prevent sexual violence. Therefore, the purpose of this paper is to provide a research agenda to investigate key areas of the campus environment and their potential influence on bystander intervention. To create the research agenda, a number of steps were followed including: (1) systematically reviewing the larger bystander literature to identify key environmental areas, (2) assessing what research is available specific to college campuses and sexual assault in each of these areas, and (3) outlining future research to address each of these areas on college campuses and determine their applicability to sexual violence situations. Five main groups of factors were found to influence bystander intervention beyond the individual, group and situational levels, including: social norms, sense of community, pro-social modeling, policies, and the physical environment. Certain areas of research on environmental influences on bystander intervention are more developed such as social norms, with little research on areas such as policies and the physical environment. However, further research is needed in each of the identified five areas to help identify how college campuses can support bystander intervention.

Addressing sexual violence through preventive nursing practice

Approximately 1 in 20 women will experience sexual violence at some point in her life. The negative health consequences to women can be serious and lifelong, prompting the Centers for Disease Control and Prevention and the World Health Organization to declare sexual violence a public health problem. Nurses, in their provision of care to individuals and communities, can contribute to improved outcomes related to the problem of sexual violence through the application of preventive care practices.

Predicting Improvement After a Bystander Program for the Prevention of Sexual and Dating Violence

Although evidence suggests that bystander prevention programs are promising interventions for decreasing sexual violence and dating violence on college campuses, there have been no studies to date evaluating moderators of bystander program effectiveness. The current study evaluates whether different demographic characteristics, attitudes, knowledge, and behaviors at pretest predict change over a 6-month follow-up for students who participated in a bystander prevention program. Participants in the three assessments (pretest, posttest, 6-month follow-up) included 296 college students who were mandated to attend a bystander program during their first year orientation. Analyses showed that with few exceptions, the bystander program worked best for students who were most at risk given their pretest demographics and levels of attitudes condoning dating violence and sexual violence, bystander efficacy, and bystander behaviors. Results are discussed in terms of suggestions for future research.

Correlates of human papillomavirus vaccination among female university students

Human papillomavirus (HPV) is the most frequently occurring sexually transmitted infection in the United States, but only one third of adolescent girls have received the HPV vaccine (Centers for Disease Control and Prevention [CDC], 2012; Committee on Infectious Diseases, 2012). Understanding correlates of vaccination behavior among young women has important implications for health care delivery and public service messages targeting HPV vaccination. Female college students (N = 313) completed web-based surveys during their sophomore (second) year of college, fall 2008. Surveys included questions about HPV vaccination, demographic factors (ethnicity/race, socioeconomic status [SES]), individual characteristics (romantic relationship status, grade point average, religiosity), and sexual behavior. Lifetime HPV vaccination was reported by 46.5% of participants. Being African American/Black was associated with a lower likelihood of vaccination. Having a mother with more education, adhering to religious teachings about sex-related principles, and having engaged in recent penetrative sex were associated with a higher likelihood of vaccination. Health care providers should consider young women to be an important group for HPV vaccine education and catch-up, particularly for African American/Black young women and young women from lower SES backgrounds. Providing vaccine education and access to young women before they become sexually active is critical.

A web-based sexual violence bystander intervention for male college students: randomized controlled trial

Background

Bystander intervention approaches offer promise for reducing rates of sexual violence on college campuses. Most interventions are in-person small-group formats, which limit their reach and reduce their overall public health impact.

Objective

This study evaluated the efficacy of RealConsent, a Web-based bystander approach to sexual violence prevention, in enhancing prosocial intervening behaviors and preventing sexual violence perpetration.

Methods

A random probability sample of 743 male undergraduate students (aged 18 to 24 years) attending a large, urban university located in the southeastern United States was recruited online and randomized to either RealConsent (n=376) or a Web-based general health promotion program (n=367). Participants were surveyed online at baseline, postintervention, and 6-months postintervention. RealConsent was delivered via a password-protected Web portal that contained six 30-minute media-based and interactive modules covering knowledge of informed consent, communication skills regarding sex, the role of alcohol and male socialization in sexual violence, empathy for rape victims, and bystander education. Primary outcomes were self-reported prosocial intervening behaviors and sexual violence perpetration. Secondary outcomes were theoretical mediators (eg, knowledge, attitudes).

Results

At 6-month follow-up RealConsent participants intervened more often (P=.04) and engaged in less sexual violence perpetration (P=.04) compared to controls. In addition, RealConsent participants reported greater legal knowledge of sexual assault (P<.001), greater knowledge of effective consent (P<.001), less rape myths (P<.001), greater empathy for rape victims (P<.001), less negative date rape attitudes (P<.001), less hostility toward women (P=.01), greater intentions to intervene (P=.04), less hyper-gender ideology (P<.001), less positive outcome expectancies for nonconsensual sex (P=.03), more positive outcome expectancies for intervening (P<.001), and less comfort with other men’s inappropriate behaviors (P<.001).

Conclusions

Our results support the efficacy of RealConsent. Due to its Web-based format, RealConsent has potential for broad-based dissemination thereby increasing its overall public health impact on sexual violence.

Trial Registration

Clinicaltrials.gov: NCT01903876; http://clinicaltrials.gov/show/NCT01903876 (Archived by WebCite at http://www.webcitation.org/6S1PXxWKt).

Incidence and cost of sexual violence in Iowa

BACKGROUND

Sexual violence is a serious and costly public health problem. Current research that systematically documents the broad range of economic costs of sexual violence is lacking.

PURPOSE

To estimate the incidence and costs of sexual violence in Iowa in 2009.

METHODS

Using data obtained from population surveys, six Iowa government agencies, and other sources, we estimated sexual violence incidence, costs per incident, and total costs in 2009 dollars, by age and sexual violence category, and for various cost elements. We calculated direct costs of medical care, mental health care, property damage, victim services, investigation, adjudication, and sanctioning, as well as indirect costs for lost work and quality of life. We collected data in 2010-2011 and completed analysis in 2013.

RESULTS

In 2009, an estimated 55,340 individuals experienced sexual violence in Iowa, including 49,510 adults and 5,930 children. Nearly three of every four victims were women. The estimated total cost of sexual violence in 2009 was $4.7 billion, equating to $1,580 per resident. This estimate included $4.44 billion in indirect costs and $265 million in direct costs. In the same year, the government spent an estimated $100.6 million as a result of sexual violence in Iowa, more than half of which ($55.3 million) was spent on perpetrators and little ($0.9 million) on prevention.

CONCLUSIONS

The economic costs of sexual violence are high for individuals and society. Cost information can help identify the burden of sexual violence relative to other social problems in Iowa and prioritize funding for prevention and intervention.

A systematic review of primary prevention strategies for sexual violence perpetration

This systematic review examined 140 outcome evaluations of primary prevention strategies for sexual violence perpetration. The review had two goals: 1) to describe and assess the breadth, quality, and evolution of evaluation research in this area; and 2) to summarize the best available research evidence for sexual violence prevention practitioners by categorizing programs with regard to their evidence of effectiveness on sexual violence behavioral outcomes in a rigorous evaluation. The majority of sexual violence prevention strategies in the evaluation literature are brief, psycho-educational programs focused on increasing knowledge or changing attitudes, none of which have shown evidence of effectiveness on sexually violent behavior using a rigorous evaluation design. Based on evaluation studies included in the current review, only three primary prevention strategies have demonstrated significant effects on sexually violent behavior in a rigorous outcome evaluation: Safe Dates (Foshee et al., 2004); Shifting Boundaries (building-level intervention only, Taylor, Stein, Woods, Mumford, & Forum, 2011); and funding associated with the 1994 U.S. Violence Against Women Act (VAWA; Boba & Lilley, 2009). The dearth of effective prevention strategies available to date may reflect a lack of fit between the design of many of the existing programs and the principles of effective prevention identified by Nation et al. (2003).

Identifying Links Between Sexual Violence and Youth Violence Perpetration: New Opportunities for Sexual Violence Prevention

OBJECTIVE

One promising opportunity for advancing sexual violence (SV) research and identifying new avenues for prevention involves examining other forms of violence that may share risk factors with SV. Youth violence (YV) is ideal for consideration given evidence of overlap in SV and YV risk factors, a large set of established YV risk factors across the social ecology, and the number of evidence-based YV prevention strategies available. The current paper identifies shared and unique risk factors for SV and YV and highlights evidence-based YV prevention strategies that impact these shared risk factors.

CONCLUSIONS

Researchers and program developers should consider adapting and evaluating evidence-based YV prevention strategies to prevent SV. Modifying these programs to address SV's unique risk factors may maximize their potential effectiveness. In addition, expanding SV research at the outer levels of the social ecology is critical to developing community-level prevention strategies. The YV literature suggests several potential risk factors at these levels in need of research for SV, including school connectedness, social disorganization, and availability of alcohol and drugs. Using the YV literature as a starting point for expanding SV research leverages prior investments in YV research, may help identify new SV prevention strategies at a limited cost, and moves the field more quickly toward implementation of cost-effective, multidomain violence prevention strategies in communities.

Low HPV vaccine coverage among female community college students

This study assessed HPV vaccination and its correlates among culturally diverse 18-26 year-old community college women in Los Angeles. Specific research questions were: (1) What proportion of respondents have initiated the HPV vaccine, and what proportion have completed the three-dose series? (2) What demographic (e.g., age, ethnicity), psychosocial (e.g., vaccine-related beliefs, perceived social norms), and health care-related variables (e.g., health insurance status, provider recommendation, health care trust and satisfaction) are associated with vaccine initiation for this sample? Participants were recruited from the campus of a community college in central Los Angeles. All female students between 18 and 26 were eligible to participate. An anonymous web-based survey assessed number of HPV vaccine doses received as well as demographic information, HPV- and HPV vaccine-related knowledge, attitudes, and behavior, perceived social norms, provider & health care system factors, sexual behavior, cervical health, and mother-daughter communication about sex. Analyses were conducted using 178 surveys. Multivariate logistic regression tested the relationships of statistically significant bivariate predictors to vaccine initiation. Those who initiated the vaccine were younger, more often had a health-related academic major, thought the vaccine to be safer, perceived HPV severity lower, and perceived higher social approval for HPV vaccination than those unvaccinated. All who had initiated the vaccine had a doctor's recommendation. To increase uptake among 18-26-year-old women, research should explore provider interventions to increase vaccine recommendation, and also identify individuals and groups who may have negative beliefs about vaccine safety and efficacy to provide support in vaccine decision-making.

Moving forward by looking back: reflecting on a decade of CDC's work in sexual violence prevention, 2000-2010

In 2011, the Division of Violence Prevention (DVP) within CDC's Injury Center engaged an external panel of experts to review and evaluate its research and programmatic portfolio for sexual violence (SV) prevention from 2000 to 2010. This article summarizes findings from the review by highlighting DVP's key activities and accomplishments during this period and identifying remaining gaps in the field and future directions for SV prevention. DVP's SV prevention work in the 2000s included (1) raising the profile of SV as a public health problem, (2) shifting the field toward a focus on the primary prevention of SV perpetration, and (3) applying the public health model to SV research and programmatic activities. The panel recommended that DVP continue to draw attention to the importance of sexual violence prevention as a public health issue, build on prior investments in the Rape Prevention and Education Program, support high-quality surveillance and research activities, and enhance communication to improve the link between research and practice. Current DVP projects and priorities provide a foundation to actively address these recommendations. In addition, DVP continues to provide leadership and guidance to the research and practice fields, with the goal of achieving significant reductions in SV perpetration and allowing individuals to live to their full potential.