Misperception of Norms About Intimate Partner Violence as a Driver of Personal IPV Attitudes and Perpetration: A Population-Based Study of Men in Rural Uganda

Intimate partner violence (IPV) against women is a global public health problem. Conceptual frameworks suggest misperceived norms around IPV might drive perpetration of violence against women in southern and eastern Africa. We conducted a cross-sectional, population-based survey of all men residing in a rural parish in southwest Uganda, eliciting their endorsement of IPV in five hypothetical scenarios and their reported frequency of perpetration of violence against their wife/main partner. They also reported their perceptions about the extent to which most other men in their villages endorsed and/or perpetrated IPV, which we compared against the population data to measure the primary explanatory variable of interest: whether individuals misperceived norms around IPV. We fitted multivariable Poisson regression models specifying personal IPV endorsement and IPV perpetration as the outcomes. Overall, 765 men participated in the study (90% response rate): 182 (24%) personally endorsed IPV, and 78 of 456 partnered men (17%) reported perpetrating one or more acts of IPV at least once per month. Although most men neither endorsed nor reported perpetrating IPV, 342 (45%) men mistakenly thought that most other men in their villages endorsed IPV and 365 (48%) men mistakenly thought that most other men perpetrate IPV at least monthly. In multivariable regression models, men who misperceived most men to endorse IPV were more likely to endorse IPV themselves (adjusted relative risk [aRR] = 2.44; 95% CI [1.66, 3.59]; p < .001). Among partnered men, those who misperceived IPV perpetration to be normative were more likely to perpetrate IPV themselves (aRR = 4.38; [2.53, 7.59]; p < .001). Interventions to correct misperceived norms about IPV may be a promising method for reducing violence against women in rural Uganda.

Integrated Alcohol Use and Sexual Assault Prevention Program for College Men Who Engage in Heavy Drinking: Randomized Pilot Study

BACKGROUND

Sexual assault is prevalent on college campuses and most commonly is perpetrated by men. Problematically, there is a dearth of evidence-based prevention programs targeting men as perpetrators of sexual aggression. The Sexual Assault and Alcohol Feedback and Education (SAFE) program is an integrated alcohol and sexual assault prevention intervention for college men who engage in heavy drinking that aims to address sexual aggression proclivity and alcohol use outcomes by incorporating social norms theory, bystander intervention, and motivational interviewing.

OBJECTIVE

This study aims to examine the initial feasibility-, acceptability-, and efficacy-related outcomes of a randomized pilot trial of an integrated alcohol and sexual assault prevention program for college men who engage in heavy drinking.

METHODS

This study included 115 college men who engaged in heavy drinking, who were randomly assigned to the SAFE program or a mindfulness-based control condition (MBCC). The feasibility of implementation, adequacy of participant retention, fidelity and competency of program administration, and satisfaction and utility of the intervention were evaluated. The primary outcomes of alcohol use and sexual aggression were evaluated at 2 and 6 months after baseline. The secondary outcomes of perceived peer norms, risks for sexual aggression, and bystander intervention were also assessed. The extent to which the motivational interviewing session with personalized normative feedback facilitated changes in the proximal outcomes of drinking intentions, motivation to change, and self-efficacy was also examined.

RESULTS

The study procedures resulted in high program completion and retention (>80%), high fidelity to the program manual (>80% of the content included), high competency in program administration, and high ratings of satisfaction and program utility in addressing sexual relationships and alcohol use. Both groups reported declines in the number of drinks per week and number of heavy drinking days. Compared with the MBCC participants, the SAFE participants reported higher motivation to change alcohol use after the program, as well as greater use of alcohol protective behavioral strategies at 6 months. Compared with the MBCC participants, the SAFE participants also reported lower perceived peer engagement in sexual coercion, perceived peer comfort with sexism, and peer drinking norms at 2 and 6 months. However, no group differences were observed in sexual aggression severity, rape myth acceptance, or the labeling of sexual consent. Results regarding bystander intervention intentions were mixed, with the MBCC group showing decreased intentions at 2 months and the SAFE group reporting increased intentions at both 2 and 6 months.

CONCLUSIONS

The findings provide promising evidence for the feasibility, acceptability, utility, and preliminary efficacy of the SAFE program in reducing alcohol use and positively influencing perceived peer norms and intentions for bystander intervention among college men who drink.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05773027; https://clinicaltrials.gov/study/NCT05773027.

Open pilot trial of an interactive digital application for campus sexual violence prevention

Digital applications, or "serious games" for health address learning goals in a cognitively active, interactive manner, with the potential for widespread dissemination. This study used a mixed methods approach to develop and conduct a formative evaluation of a digital application for sexual assault prevention. Make a change is a digital application that uses the principles of games for health to foster learning, engagement, and skill-building around risk and protective factors for sexual victimization, sexual aggression, and bystander intervention. The digital application includes four narrative chapters, six embedded activities, as well as a user-derived change plan in which individuals establish goals for behavior change following program completion. This multisite study at a 2- and a 4-year college utilized student interviews (n = 14), stakeholder interviews (n = 10), and focus groups with students (n = 40) to inform intervention development. A total of 41 college students then participated in an open trial and completed self-report surveys (pre, post, and 1-month follow-up) to evaluate the feasibility, acceptability, utility, and preliminary outcomes. Most of the sample reported enjoyment, usefulness, and perceived competence after completing the application. Data evidenced a trend to reduce the frequency of heavy drinking, and perceptions of social norms evidenced change over time. Findings support the feasibility and effectiveness of this novel format for the delivery of sexual assault prevention programming.

Risk factors for perpetrating sexual aggression among adolescents: Differences by gender and sexual orientation

Although anyone-regardless of gender or sexual orientation-can perpetrate sexual aggression, most studies examining risk factors for engaging in sexual aggression include samples of boys and men, and do not consider the sexual orientation of the respondent. The current study addresses this gap in the literature by examining how risk factors for sexual aggression vary as a function of gender and sexual orientation in a sample of 1782 high school youth. Participants completed surveys evaluating engagement in consent behaviors, rape myth acceptance, perception of peer rape myth acceptance, perceived peer engagement in violence, and perceived peer support for violence. A one-way MANOVA found that constructs varied as a function of gender and sexual orientation. Specifically, heterosexual boys reported lower engagement in consent behaviors, higher rape myth acceptance, and higher perceived peer support for violence compared to heterosexual girls and sexual minority girls. The results highlight the importance of considering gender and sexual orientation when designing sexual aggression prevention programs.

Avoiding Covid-19 risk information in the United States: The role of attitudes, norms, affect, social dominance orientations, and perceived trustworthiness of scientists

This study seeks guidance from the planned risk information avoidance model to explore drivers of risk information avoidance in the context of COVID-19. Data were collected early during the pandemic. Among our most notable results is that participants who are more oriented toward social dominance and are more skeptical of scientists' credibility have (1) more supportive attitudes toward risk information avoidance and (2) feel social pressure to avoid risk information. The findings of this study highlight how the role of skepticism in science and intergroup ideologies, such as social dominance, can have important implications for how people learn about health-related information, even in times of heightened crisis.

Sending of Unwanted Dick Pics as a Modality of Sexual Cyber-Violence: An Exploratory Study of Its Emotional Impact and Reactions in Women

The sending of sexually explicit images by men to women without prior request, a practice commonly referred to as sending or receiving a "dick pic," is a fairly common manifestation of sexual cyber-violence that has grown in recent times. As research on this type of sexual cyber-violence is limited, the current study analyzed the prevalence of this phenomenon in a sample of 347 Spanish women between 18 and 30 years of age, studying the factors that influence the emotional impact reported by women if they received an unsolicited dick pic (using a hypothetical scenario) and exploring the various coping strategies that women would use in that situation. Results showed a significant prevalence of this type of cyber-violence in the sample, as 48.1% of the participants had received an unsolicited dick pic from an unknown man at some point. Women with lower levels of hostile sexism-but not of benevolent sexism-reported a higher depressed and angry/annoyed emotional impact of the sexual cyber-violence scenario. This was also the case for women with a less conservative political ideology, with less religious beliefs, as well as those women who perceived that their female friends receive this type of images frequently (descriptive norm) and who perceived that their female friends are less accepting of these situations (injunctive norm). In addition, from the strategies presented to the participants to cope with this situation of sexual cyber-violence, it was observed that a significant percentage of women would choose strategies, such as talking about the incident with other people and blocking the sender's access. Yet, fewer women would employ effective strategies, such as reporting the perpetrator's profile to the managers or administrators of the social network or reporting the incident to the police. This study is one of the first studies in Spain that addresses this new form of sexual cyber-violence against women by unknown men and suggests that, in online social networks, women experience the same situations of abuse, harassment, and sexual objectification that they have faced offline in everyday life. Therefore, more work needs to be done to raise awareness and try to prevent these situations, while also providing more support to these women so that they can adopt effective coping strategies.

The relationships between perceived mental illness prevalence, mental illness stigma, and attitudes toward help-seeking

Previous research suggests that, despite the commonality of mental illness in the United States, the majority of U.S. individuals with mental illness do not seek treatment. One important factor that contributes to this lack of treatment utilization is mental illness stigma. Such stigma may result, in part, from many individuals in the U.S. underestimating the prevalence of mental illness. To test whether this is the case, 638 adults from across the U.S. completed measures related to perceived prevalence of mental illness, private stigma, perceived public stigma, and help-seeking. Findings indicated participants significantly underestimated the given-year prevalence rate of mental illness. The perceived given-year prevalence rate was significantly correlated with lower private stigma and more positive attitudes towards help-seeking. Personal stigma significantly predicted attitudes towards help-seeking. Findings also suggested that individuals who have received mental health services have a higher perceived prevalence rate of mental illness, as well as lower levels of personal stigma and more positive attitudes towards help-seeking. These findings support the notion that helping the general public recognize the true prevalence rate of mental illness could reduce personal mental illness stigma and facilitate help-seeking behaviors. However, future experimental studies are needed to test this hypothesis.

The Association of Adolescent Gender Performance and Adult Intimate Partner Violence

PURPOSE

A quarter of women and nearly 1 in 10 men in the United States have reported experiencing intimate partner violence (IPV) that had lasting negative impacts at least once during their lifetime. To prevent IPV over the lifecourse, adolescence has been identified as an ideal period for healthy relationship education that addresses the various IPV risk factors. One of those risk factors is believing in traditional gender roles, but the behavioral aspect of gender performance has been understudied. This study explores the relationship between adolescent gender performance and adult IPV perpetration and victimization/survival.

METHODS

We used logistic regression to estimate associations of adolescent gender performance and adult IPV perpetration and victimization/survival in a sample of 2,197 males and 2,587 females from The National Longitudinal Study of Adolescent to Adult Health (Add Health) between 1994 and 2008.

RESULTS

Male adolescent gender performance was associated with increased adult IPV perpetration (adjusted odds ratio [AOR] = 1.11; 95% confidence interval [CI], 1.05-1.18 per 10% increase in gender performance) and victimization/survival (AOR = 1.07; 95% CI, 1.03-1.11 per 10% increase in gender performance). Female adolescent gender performance was not associated with adult IPV perpetration or victimization/survival.

DISCUSSION

The more similarly adolescent males behave to their adolescent male peers, the more likely they are to perpetrate and experience IPV in adulthood. This study supports the implementation of gender transformative education during adolescence and the specific need to address how the behaviors associated with male gender performance are risk factors for adult IPV.

Social Norms Sustaining Intimate Partner Violence: A Systematic Review of Methodologies for Proxy Measures

In light of the many robust quantitative data sets that include information on attitudes and behaviors related to intimate partner violence (IPV), and in an effort to expand the evidence base around social norms and IPV, many researchers construct proxy measures of norms within and across groups embedded in the data. While this strategy has become increasingly popular, there is no standardized approach for assessing and constructing these norm proxies, and no review of these approaches has been undertaken to date. This study presents the results of a systematic review of methods used to construct quantitative proxy measures for social norms related to IPV. PubMed, Embase, Popline, and Scopus, and PsycINFO were searched using Boolean search techniques. Inclusion criteria comprised studies published since 2000 in English that either (i) examined a norm proxy related to gender or IPV or (ii) analyzed the relationship between a norm proxy and perpetration of, experiences of, or attitudes toward IPV. Studies that employed qualitative methods or that elicited direct measures of descriptive or injunctive norms were not included. Twenty-six studies were eligible for review. Evidence from this review highlights inconsistencies in how proxies are constructed, how they are assessed to ensure valid representation of norms, and how researchers acknowledge their respective method's limitations. Key processes and reflections employed by some of the studies are identified and recommended for future research inquiries.

Perceptions About Local ART Adherence Norms and Personal Adherence Behavior Among Adults Living with HIV in Rural Uganda

Although misperceived norms often drive personal health behaviors, we do not know about this phenomenon in the context of antiretroviral therapy (ART) adherence. We conducted a cross-sectional study including all persons living with HIV (PLWH) on ART across eight villages in one parish in a rural region of southwestern Uganda. We used surveys to measure personal reports of ART adherence (not missing any doses of ART in the past 7 days was considered optimal adherence whereas missing doses was considered suboptimal adherence) and perceived norms about the local ART adherence norm (whether or not each individual thought 'most other PLWH on ART in this parish' missed any doses in the past 7 days). Multivariable Poisson regression models were used to estimate the association between perceived norms and personal adherence. Among 159 PLWH on ART (95% response rate), 142 (89%) reported no missed doses. However, 119 (75%) thought most individuals in this population of PLWH on ART were sub-optimally adherent. This misperception about the local ART adherence norm was prevalent in every subgroup of PLWH. Misperceiving the local ART adherence norm to be sub-optimal adherence was associated with a reduced likelihood of optimal adherence among married PLWH (adjusted relative risk [aRR] = 0.83; 95% confidence interval [CI] 0.71-0.97). The association was similar but imprecisely estimated for all PLWH (aRR = 0.91; 95% CI 0.82-1.01). Interventions to correct misperceived ART adherence norms as a stand-alone intervention or as a complement to other adherence promotion programs may influence ART adherence behavior and perhaps reduce HIV-related stigma.

Development and Testing of a Community-Based Intervention to Address Intimate Partner Violence among Rohingya and Syrian Refugees: A Social Norms-Based Mental Health-Integrated Approach

Intimate partner violence (IPV) is the leading form of gender-based violence globally and increases during times of conflict and displacement. To reduce IPV and encourage help-seeking, a two-phase community-based intervention was co-designed with Rohingya in Malaysia and Syrians in Lebanon. Three day workshops, utilizing a social norms-based mental health-integrated approach, were implemented for women and men in each country (n = 148). Pre- to post-measures indicated reductions in beliefs about acceptability of violence and rigid gender norms, and improvements in mental health, functioning, coping, and self-efficacy for women and men following workshop participation. Workshop participation was also associated with increased help-seeking intent, for both mental health and IPV (victims and perpetrators). Workshops included community design of poster campaigns to address IPV, which were then tested in each setting using a randomized controlled trial in Malaysia (n = 240) and a matched cluster comparison in Lebanon (n = 260). Women in both settings found IPV less acceptable in the poster condition. Help-seeking preferences were also influenced by the poster for women and men in both countries. This participatory intervention research can provide a roadmap for use in other settings, emphasizing the value of community-generated solutions to IPV among displaced populations.

Engineering social change using social norms: lessons from the study of collective action

Behavioral interventions have embraced social norms as information that can be communicated in simple messages to motivate behavior change. This article argues for the value and necessity of recognizing that social-norm interventions are grounded in group processes. This approach has three major benefits that more than offset the costs of its greater theoretical and practical complexity. One, it improves the effectiveness of existing interventions, including those that target the normative beliefs of individuals. Two, it opens up new intervention strategies that broaden the range of mechanisms used to change behavior. Three, it connects research on social-norm interventions with theories and research on rallies, rebellions, riots, and other forms of collective action.

Norms and Attitudes about Being an Active Bystander: Support for Telling Adults about Seeing Knives or Guns at School among Greater London Youth

A detailed understanding of the factors associated with support among youth for reporting a knife or gun at school to an adult is essential to inform violence prevention initiatives. However, no studies have empirically assessed attitudes about support for reporting among secondary school students in Greater London nor perceived norms about such support among peers. Thus, this study explores whether students misperceive peer norms about support for telling adults about seeing weapons at school. Anonymous surveys were completed by 7401 youth (52% female; 43% White; mean age 11.8 years) in school years 4-11 in 45 school cohorts in a greater London borough between 2007 and 2012. Students reported both personal support about reporting weapons to several categories of adults and whether they perceived most other students at their school to support reporting weapons to adults in each category. Most students (64-78% on average) in most cohorts personally thought that students should report seeing a weapon at school to head teachers, police/security guard, teachers/counselors, and parent/other adult relatives. However, 34-44% of students erroneously thought that the majority of their peers did not support reporting to these adults. Perceived norms predicted personal support for reporting, adjusting for the prevalence of actual support at one's school and other factors. Pervasive norm misperceptions about reporting may contribute to a less safe environment.

Social norms, misperceptions, and mosquito net use: a population-based, cross-sectional study in rural Uganda

BACKGROUND

Mosquito net use is an essential part of malaria prevention. Although previous research has shown that many people sleep under a mosquito net in endemic areas, it is unknown whether people underestimate how common it is to sleep under a net every night. Furthermore, perceived social norms about whether most others sleep under a mosquito net every night may contribute to personally sleeping under a net, given decades of research showing that people often mimic others' behaviours.

METHODS

Population-based data were collected from 1669 adults across eight villages in one rural parish in southwestern Uganda. Individuals' perception about whether most adults in their community sleep under a mosquito net every night was compared with whether daily mosquito net use was the actual norm in their community to identify the extent of norm misperception. The association between whether an individual perceived daily mosquito net use to be the norm and personal mosquito net use was assessed while adjusting for the ratio of nets:people in the household and other factors.

RESULTS

Although the majority (65%) of participants reported sleeping under a mosquito net every night (and 75% did so among the 86% of people with at least one net), one-quarter of participants thought that most adults in their community did not sleep under a mosquito net every night. Another 8% were unsure how many nights per week most adults in their community sleep under a mosquito net. Participants who perceived that daily mosquito net use was the norm were 2.94 times more likely to report personally sleeping under a mosquito net every night (95% CI 2.09-4.14, p < 0.001) compared to participants who thought doing so was not normative, adjusting for other factors.

CONCLUSIONS

Results suggest an opportunity for anti-malarial interventions to reduce misperceptions about mosquito net use norms and emphasize the commonness of daily mosquito net use in malaria-endemic regions. If people correctly perceive most others to sleep under a net every night, then they may personally do so when possible and support others to do so too.