Translating sexual assault prevention from a college campus to a United States military installation: piloting the know-your-power bystander social marketing campaign

Short-Term Outcomes of a Healthy Relationship Intervention for the Prevention of Sexual Harassment and Sexual Assault in the US Military: Pilot Pretest-Postest Study

BACKGROUND

Sexual harassment (SH) and sexual assault (SA) are serious public health problems among US service members. Few SH and SA prevention interventions have been developed exclusively for the military. Code of Respect (X-CoRe) is an innovative web-based, multilevel, SA and SH intervention designed exclusively for the active-duty Air Force. The program's goal is to increase Airmen's knowledge and skills to build and maintain respectful relationships, ultimately reducing SH and SA and enhancing Airmen's overall well-being and mission readiness.

OBJECTIVE

This pilot study aimed to assess the short-term psychosocial impact (eg, knowledge, attitudes, and self-efficacy) of the web-based component of X-CoRe on a sample of junior enlisted and midlevel Airmen.

METHODS

Airmen from a military installation located in the Northeastern United States were recruited to complete the 10 web-based modules in X-CoRe (9/15, 60% male; 7/15, 54% aged 30-35 years). Participants were given pretests and posttests to measure short-term psychosocial outcomes associated with SH and SA. Descriptive statistics and paired 2-tailed t tests were conducted to assess differences from preintervention to postintervention time points.

RESULTS

After completing X-CoRe, participants had a significantly greater understanding of active consent (P=.04), confidence in their healthy relationship skills (P=.045), and confidence to intervene as bystanders (P=.01). Although not statistically significant (P>.05), mean scores in attitudes about SH, couple violence, and cyberbullying; perceptions of sexual misconduct as part of military life; and relationship skills self-efficacy with a romantic partner and friend also improved.

CONCLUSIONS

The findings from this study demonstrate X-CoRe's effectiveness in improving critical determinants of SH and SA, making it a promising intervention for SH and SA prevention. More rigorous research is needed to determine X-CoRe's impact on SH and SA victimization and the long-term impact on associated psychosocial determinants.

The Impact of a Public Health Campaign to Deter Viewing of Child Sexual Abuse Images Online: A Case Study of the UK Stop It Now! Campaign

Public campaigns offer an opportunity to prevent child sexual abuse by raising awareness and promoting help available to bystanders, victims, and those at risk of perpetrating the abuse. This paper explores the impact of The Lucy Faithfull Foundation's 'Stop It Now!' campaign in the UK (2015-2018) on help-seeking. Helpline calls (11,190 unique callers), website analytics (109,432 new website visitors) and three website-hosted surveys (N = 252) provided data on help-seeking, awareness, and self-reported behavior. Results indicated that there were more visitors to the help website during active campaigning periods, and helpline callers and website visitors were more likely to seek help after viewing campaign materials during active than non-active campaign periods. Help-seekers were predominantly men concerned about their own behavior. Survey 2 respondents concerned about their own behavior (n = 53) indicated that their awareness of the law (75.5%), and legal and personal consequences (67.9%) had changed after hearing about the campaign, and 66% reported a change in behavior. Public health campaigns may be an effective way to promote help-seeking and prevent abuse.

Qualitative Analysis of Bystander Intervention Among Young Adult Male Soldiers Who Engage in At-Risk Drinking

Bystander intervention-when someone intervenes to help in situations that pose a risk for harm-is a promising strategy for sexual violence prevention. In the current study, a sample of U.S. Army male soldiers (N = 10; ages 18-24) who engaged in at-risk drinking completed a 90-min individual semi-structured interview to understand the ways in which soldiers intervene to address risk for sexual violence. Two independent raters coded soldier responses using thematic analysis and identified eight main themes: (a) recognizing risk for sexual violence; (b) labeling situations as problematic and taking responsibility; (c) facilitators of intervention; (d) barriers to intervention; (e) intervention strategies; (f) reactions and consequences to intervention; (g) alcohol's influence on intervention; and (h) using bystander intervention to shift cultural norms. As soldiers reported noticing more extreme risks for violence, prevention interventions may help service members identify situations earlier in the continuum of harm. Soldiers anticipated intervening in a way that was physical and aggressive, which could facilitate physical altercation and result in collateral misconduct. Results from the present study reveal ways that bystander intervention programs for civilians can be tailored to address the unique individual, situational, and contextual factors relevant to the military. These findings also highlight the importance of teaching soldiers indirect and nonaggressive strategies for intervention.

A public health approach to preventing hazing on a university campus

Objective: The present report describes a comprehensive, public health approach to hazing prevention on a university campus and evaluates its impact over time. Participants: Two different surveys (PULSE and MASCOT) were administered to college undergraduate students, in April 2013 (PULSE n = 6,190; MASCOT n = 3,117) and March 2015 (PULSE n = 4,892; MASCOT n = 2,259). Methods: A public health model of hazing prevention was implemented between 2011-2015. The MASCOT Survey assessed experiences of hazing and non-hazing behaviors, and the PULSE Survey measured beliefs and perceptions of social norms related to hazing. Results: Survey results showed lower levels of hazing experiences reported by students in 2011-2015 compared to 2009-2013 and increased endorsement of a positive normative belief about hazing from 2013 to 2015. Conclusions: The findings represent the first measurable decrease in hazing associated with prevention efforts in the literature, though design limitations preclude clear causal inferences. The results suggest that the university's strategies may have been effective at reducing hazing, and therefore serve as an important step forward in the field of hazing prevention research.

An Application of the Confluence Model of Sexual Aggression Among Young Adult Male Soldiers

Sexual violence in the U.S. military is a serious concern. Whereas numerous studies document the prevalence of sexual violence among service members, far less research has examined etiological risk factors for sexual aggression perpetration among service members. The present study sought to evaluate the applicability of the Confluence Model of Sexual Aggression among a sample of young adult men engaged in active-duty military service within the U.S. Army. Anonymous surveys were completed by 326 male soldiers between the ages of 18 and 24 at a large military installation in the Southeastern region of the United tStates. Men's likelihood to engage in sexual aggression was operationalized as men's perceived likelihood to persist with sexual activity despite a partner's resistance. Aligning with the Confluence Model of Sexual Aggression, two composite variables reflecting hostile masculinity and tendency toward impersonal sex were created. A linear regression indicated that the main effects of hostile masculinity and impersonal sex were significantly associated with greater perceived likelihood of sexual aggression perpetration. Results also revealed that while the interaction term between hostile masculinity and impersonal sex was significant, the direction of the relationship suggests that the effect of impersonal sex is weaker at higher levels of hostile masculinity. These findings lend evidence to help identify those at elevated risk for perpetrating sexual aggression, as well as informing programmatic efforts to prevent sexual assault within the military.

Resources and Support for Sexual Assault Survivors Receiving Services From the U.S. Air Force: What Survivors Say They Need for Recovery

Sexual assault (SA) is a serious challenge faced by the U.S. military. Participants in this study included men and women who volunteered in response to a call for survivors of SA. Participants included active duty and reserve U.S. Air Force (USAF) members, spouses of service members, or civilian employees for the USAF (beneficiaries). The primary research question was, "if you could design the perfect response system to support survivors, what would be included in this system?" The research team conducted in-depth interviews with nine survivors. Next, 82 survivors completed a survey agreeing or disagreeing with strategies identified by interview participants to improve services for survivors and offered additional suggestions. Analysis revealed survivor recommendations to improve SA services.

Correlates of Bystander Intervention Attitudes and Intentions Among Young Adult Active Duty Male Soldiers

Sexual assault is a significant problem within the United States military. Bystander intervention skills training is recognized as a promising strategy for sexual assault prevention within both civilian and military populations. Sexual assault prevention programs which include training in bystander intervention teach individuals to notice situations that may pose a risk for harm and safely act to positively influence the outcome. This study examines correlates of bystander intervention attitudes and intentions among young adult active duty male soldiers (N = 282) between the ages of 18 and 24. Positive bystander intervention attitudes and intentions were associated with lower levels of rape myth acceptance, greater discomfort with sexism, lower likelihood of continuing an unwanted sexual advance after verbal resistance from a partner, greater likelihood of gaining verbal consent from a partner, and greater perceived peer approval for bystander intervention. In a multiple regression, perceived peer approval for bystander intervention and self-reported lower likelihood of continuing a sexual advance after verbal resistance from a partner emerged as significant predictors of positive bystander intervention attitudes and intentions (R² = .41). Given that perceptions of peer norms are modifiable, these findings highlight the importance of addressing peer norms in bystander intervention training programs for military personnel.

Promoting Compassionate Responses to Disclosures of Sexual Violence in University Settings: Exploring the Impact of a Social Marketing Campaign

This study explores a social marketing campaign aimed to promote compassionate responses to disclosures of sexual violence from peers and raise awareness of university-based formal support services. Findings from a survey ( n  =  189) and follow-up focus groups ( n  =  11) conducted with university students in Australia indicated that exposure to the campaign may support students’ self-perceived confidence in responding compassionately to disclosures of sexual violence and raise awareness of university-based formal support services. These findings suggest social marketing may be a useful tool to form part of universities’ sexual violence response and prevention strategies. These findings may help inform future university campaigns.

The Perceptions of Sexual Assault Prevention According to Military Spouses

Military spouses are at an increased vulnerability with regard to the potential of being sexually victimized. They are twice as likely as their civilian counterparts to experience sexual victimization. Despite the increased probability of sexual assault, not all military spouses perceive sexual assault and its prevention through the same lens. Recognizing that reality is subjective, the theoretical framework for this study was a constructivist paradigm. A qualitative case study was executed for the purpose of querying the perceptions of military spouses as it relates to sexual assault, its prevalence, and its prevention. The study employed the use of a web-based questionnaire consisting of 11 open-ended questions that included two scenario-based questions designed to explore perceptions of sexual assault, the need for a military spouse prevention program, and the catalyst for bystander intervention. Questionnaire results from 29 anonymous military wives whose husbands were affiliated with four out of the five branches of service were analyzed to gauge their perceptions specific to sexual assault and its prevention. The analysis of their responses resulted in the emergence of five themes related to sexual assault prevention that include the notion that military spouses view themselves as a vulnerable population for sexual victimization and its prevalence although little discussion is given to the topic. Results also indicated that a military spouse-targeted sexual assault prevention program is needed to familiarize military spouses with definitions of sexual assault and consent, reporting options, and victims' rights. The study also found that the majority of military spouses are not familiar with the resources and services available to victims of sexual assault. The overarching implication is that a prevention program for military spouses is needed to familiarize them with reporting options and services as well as mitigate occurrences of sexual assault through training and education.

Utilizing a Professionalism Mentor to Address Sexual Harassment in Academic Ophthalmology

Objective This study assesses a new departmental role—a professionalism mentor—who receives sexual harassment reporting, liaisons with campus resources, and organizes educational sessions.

Study Design Multicenter randomized controlled survey study.

Methods Academic ophthalmology departments in the United States were randomized to a professionalism mentor group (n = 9) and a control group (n = 7). Among both pre- and postsurveys, 605 faculty and trainee responses were received and 546 were complete. The intervention group was assigned a professionalism mentor with educational session for a 6- to 10-month period. Sexual harassment and reporting rate change over time were compared between the two groups.

Results Among 546 anonymous responses, 16% experienced workplace sexual harassment during the prior 10 months. Location in the South or Midwest was a risk factor (p < 0.001). Victims were mostly women (76%), including residents/fellows (46%) and academic attendings (49%); perpetrators included patients (35%) and academic attendings (35%). Departments with and without a professionalism mentor had stable harassment from pre- to postsurvey (p = 0.95 comparing change). The professionalism mentor group had an increase in reporting to an authority from pre- to postsurvey (7–23%), whereas the control group had a decrease (27–12%; p = 0.07 comparing change). Most faculty and trainees in the interventional arm of this study recommended instituting a professionalism mentor with educational session (66% presurvey and 68% postsurvey), compared with educational session alone (25% presurvey and 23% postsurvey), or neither (9% presurvey and 9% postsurvey). Residency program directors in the professionalism mentor group even more strongly supported instituting both a professionalism mentor and educational program (100% presurvey and 100% postsurvey) as opposed to educational program alone (0% presurvey and 0% postsurvey) or neither (0% presurvey and 0% postsurvey).

Conclusion This study identified a high sexual harassment rate in academic ophthalmology departments over a brief period. The presence of a professionalism mentor was viewed favorably and may lead to increased reporting.

Interventions to Improve Sexual and Reproductive Health in US Active Duty Military Service Members: A Systematic Review

OBJECTIVE

To identify and describe behavioral interventions to promote sexual and reproductive health among US active duty military service members.

DATA SOURCES

Systematic searches of PubMed, CINAHL, and PsychINFO (N = 1609 records).

INCLUSION CRITERIA

English-language articles published between 1991 and 2018 and retrieved using search terms related to military service, interventions, and sexual and reproductive health.

EXCLUSION CRITERIA

Articles excluded if not empirically based, not published in peer-reviewed journals, did not sample active duty US military personnel, and did not examine the effectiveness of specified preventive sexual or reproductive health intervention(s).

DATA EXTRACTION

Teams of paired authors extracted study rationale; aims; design; setting; description of the intervention; measures; sample demographics; clinical, behavioral, and psychosocial outcomes; and conclusions.

DATA SYNTHESIS

Given the heterogeneity of studies, narrative synthesis was performed.

RESULTS

Fifteen articles met inclusion criteria: 10 focused on sexually transmitted infection (STI) acquisition and/or unintended pregnancy and 5 on sexual assault. Studies that assessed clinical outcomes found that interventions were associated with lower rates of STIs and/or unintended pregnancy. Significant effects were found on knowledge-related outcomes, while mixed effects were found on attitudes, intentions, and behaviors.

CONCLUSIONS

Current evidence on the effectiveness of sexual and reproductive health interventions in the US military is limited in quality and scope. Promoting sexual and reproductive health in this population is critical to maintaining well-being among servicemembers, their families, and the communities surrounding military installations.

Sexual violence victimization among community college students

Objective: To assess the prevalence of sexual violence victimization among a community college student population. Participants: In March 2017, students (800) from seven community colleges in a northeastern state participated in an online campus climate survey using the ARC3 Survey Instrument. Methods: We analyze demographic differences between participants who were victimized and those who were not, and we examine the relationship between participant victimization and well-being. Results: Participants who identified as female, younger than 26, not heterosexual, or a race other than Caucasian were significantly more likely to report victimization. Participants who reported victimization were significantly more likely to score negatively on well-being scales than those who did not. Conclusions: Sexual violence prevalence rates among community college students are similar to reported prevalence rates among traditional 4-year undergraduate students. Results suggest a need for increased research on sexual violence among the understudied community college student population.

Bystander Response to Sexual Assault Disclosures in the U.S. Military: Encouraging Survivors to use Formal Resources

Experiencing military sexual assault (MSA) results in serious mental health consequences. Sexual assault survivors often disclose to informal sources of support, and how these individuals respond can have a significant effect on survivors' wellbeing. Bystander intervention is one mechanism through which institutions, such as the U.S. Military, aim to teach informal support providers to respond positively and effectively to sexual assaults. One bystander response that survivors may find helpful is the discussion of formal resources (e.g., counseling options, reporting options). The current study examined factors associated with U.S. Service members' intentions to encourage sexual assault survivors to report and seek mental health counseling, including individual characteristics (rank, gender, personal experience of MSA) and perceptions of military sexual assault response efforts (exposure to sexual assault training, leader response to sexual assault, service barriers). The study also examined contextual factors (branch) and interactions between individual and contextual predictors. We analyzed survey data from 27,505 active duty Service members collected by the U.S. Department of Defense. As expected, rank, gender, experience of MSA, training exposure, leader response, and service barriers were associated with Service members' intentions to encourage MSA survivors to report and seek-help. Bystander responses to disclosures can have a significant effect on survivors' response to the assault, and these findings can help in identifying why bystanders may or may not encourage the use of formal resources after receiving a sexual assault disclosure.

Bystander Intervention to Prevent Sexual Violence: The Overlooked Role of Bystander Alcohol Intoxication

OBJECTIVES

Bystander training is a promising form of sexual violence (SV) prevention that has proliferated in recent years. Though alcohol commonly accompanies SV, there has been little consideration of the potential impact of bystander alcohol intoxication on SV prevention. The aims of this commentary are to provide an integrative framework for understanding the proximal effect of alcohol on SV intervention, provide recommendations to spark novel research, and guide the application of research to bystander programming efforts.

METHOD

This commentary begins with a review of existing bystander training programs and the need to target alcohol use and misuse in these programming efforts. Next, pertinent alcohol and bystander theories and research are drawn from to develop a framework for the proximal effect of alcohol on SV intervention.

RESULTS

The well-established decision-making model of bystander behavior (Latané & Darley, 1970) and Alcohol Myopia Theory (Josephs & Steele, 1990) are used to identify potential barriers to SV intervention that may be created or exacerbated by alcohol use. Additionally, the ways in which alcohol may facilitate intervention are discussed.

CONCLUSIONS

Specific recommendations are made for elucidating the relationship between alcohol and bystander behavior and testing the impact of alcohol at each level of the presented framework. Methodological and analytic concerns are discussed, including the need for more multi-method studies. Recommendations to guide the application of the present framework to SV prevention programming efforts are provided and consider how the proximal effects of alcohol impact intervention.

Evaluations of Sexual Assault Prevention Programs in Military Settings: A Synthesis of the Research Literature

The prevention of sexual assault (SA) in the U.S. military is a significant priority. This study applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to a literature search that identified research evaluating SA prevention programs conducted within military settings. Only six studies published between 2005 and 2016 met criteria for inclusion in the review. Studies demonstrated high heterogeneity in the: (1) conceptual framework of the prevention approach; (2) target population and timing of administration; (3) study recruitment methods; (4) methodological design; (5) method of delivery, program dosage and theory of change; and (6) outcome administration and efficacy. Scientific rigor according to the Oxford Center for Evidence-based Medicine was also variable. Several gaps in the research base were identified. Specifically, research evaluating SA prevention programs have only been conducted among U.S. Army and U.S. Navy samples. Most studies did not examine whether program participation was associated with reductions in rates of sexual violence. Studies also lacked utilization of a long-term follow-up period. Additionally, studies did not reflect the types of SA prevention programs currently being implemented in military settings. Taken together, further research is needed to enhance the evidence base for SA prevention in the military, and to evaluate the effectiveness of the approaches currently being conducted with service members.

Sexual Assault Prevention Efforts in the U.S. Air Force: A Systematic Review and Content Analysis

The issue of sexual assault in the U.S. military is problematic and prevalent. All military branches have undertaken an effort to develop and implement sexual assault prevention programs (SAPPs), yet these programs lack a rigorous and independent evaluation process, limiting an understanding of effectiveness. We examined the four official SAPPs that have been used within the U.S. Air Force (USAF) over the past decade by comparing their content and process with best practice suggestions for SAPPs. Content of the four USAF SAPPs was evaluated on 47 different criteria grouped into the following program elements: content, process, and outcome. Independent ratings of the criteria were reliable, and results indicated strengths and opportunities for improvement. Most notably, evidence of an objective program evaluation system is lacking. Recommendations for improving SAPPs are offered.

See Something, Do Something: Predicting Sexual Assault Bystander Intentions in the U.S. Military

Sexual assault is a pervasive problem in the U.S. military, especially against women. Bystander intervention is increasingly promoted as important for reducing sexual violence, and it may be particularly helpful in contexts with high rates of sexual violence. Bystander training encourages and enables people to intervene safely and stop sexual violence. In this study, we drew from an ecological model to investigate intrapersonal, microsystem, and exosystem factors that predicted Service members' assumption of personal responsibility to intervene in an alcohol-involved sexual assault. Moreover, we examined how these predictors played a role in decisions about how to intervene: confronting the perpetrator, assisting the victim, or finding someone to help. We analyzed data from 24,610 active duty personnel collected by the Department of Defense. Several factors significantly related to Service members' bystander intentions: gender, rank, morale, attitudes about sexual assault, training, and trust in the military sexual assault system predicted the likelihood and method of bystander intervention. These findings help identify how and why people intervene (or fail to intervene) when they witness situations that could develop into sexual violence.

Challenges of Bystander Intervention in Male-Dominated Professional Sport

Programs aimed at preventing violence against women have increasingly adopted bystander approaches, yet large gaps remain in our knowledge about what drives bystanders to act or not, particularly in settings where there is an increased risk of violence against women occurring. This article contributes to this gap by examining data from research with professional male athletes from the Australian Football League. Drawing from a mixed methods approach, including a survey and interviews with football players, we outline some of the challenges to bystander intervention faced by professional athletes and discuss some of the possible similarities and differences between these and other groups of men.

Men Faculty Gender-Equity Advocates

As part of a National Science Foundation (NSF) ADVANCE grant, North Dakota State University (NDSU) created a program of men faculty Advocates to engage in gender-equity/climate improvement efforts. Sixteen men Advocates spent 4 years reading materials, attending NDSU ADVANCE FORWARD programming, and creating training sessions for male faculty gender-equity Allies. The current investigation reviews core aspects of effective Ally preparation programs, and then compares this Advocates program with elements of successful men’s profeminist gender-equity advocacy work. We discovered that the NDSU Advocates used 12 of Berkowitz’s 19 elements, with 4 additional elements present. Implications for this men’s gender-equity advocates program, similar programs at other colleges and universities, and other Ally/advocates programs are discussed.

Improving college campus-based prevention of violence against women: a strategic plan for research built on multipronged practices and policies

Growing awareness of the scope of violence against women (VAW) on college campuses has led to innovations in intervention and prevention These efforts have often followed best practices in prevention, have targeted different campus populations, and used varied tools. Prevention evaluation on campuses is increasing. This review briefly summarizes what we have learned about preventing VAW on campus from evaluation research and then describes a roadmap for where research needs to go. To date, most work focuses almost exclusively on sexual violence, concentrates on single programs on one campus, focuses on attitude outcomes, and most research explores main effects of program utility. More complex prevention and research models are needed including the use of multipronged prevention approaches and researching their synergistic effects; investigation of more specific program effects to better unpack what essential elements of different prevention tools are driving changes; and more complex analyses of outcomes including exploration of moderating variables. This research agenda has implications for new programs, policies, and research designs including the importance of partnerships between practitioners and researchers to actualize these goals.

Evaluation of the Green Dot Bystander Intervention to Reduce Interpersonal Violence Among College Students Across Three Campuses

Evidence suggests that interventions to engage bystanders in violence prevention increase bystander intentions and efficacy to intervene, yet the impact of such programs on violence remains unknown. This study compared rates of violence by type among undergraduate students attending a college campus with the Green Dot bystander intervention (n = 2,768) with students at two colleges without bystander programs (n = 4,258). Violent victimization rates were significantly (p < .01) lower among students attending the campus with Green Dot relative to the two comparison campuses. Violence perpetration rates were lower among males attending the intervention campus. Implications of these results for research and practice are discussed.

Addressing sexual and relationship violence in the LGBT community using a bystander framework

Sexual and relationship violence are two major public health issues that affect an alarming number of undergraduate students. As a result, many colleges and universities have protocols to serve victims of these forms of violence. Despite federal legislation stating that all students should have equitable experiences, current protocols and programs focus primarily on heterosexual students. College student victims of sexual and relationship violence who identify as lesbian, gay, bisexual, or transgender can face particular challenges, including disclosure of their sexual and gender orientations, and revictimization when seeking services. In recent years an increasing number of campuses have adopted bystander prevention strategies to address sexual and relationship violence. These strategies seek to engage community members in the prevention of sexual and relationship violence by training them to identify and safely intervene in situations where sexual or relationship violence is about to occur, is occurring, or has occurred. In this article we review published bystander prevention strategies that focus on preventing sexual and relationship violence in the campus community, and discuss how bystander strategies are addressing or can address relationship and sexual violence in the LGBT community.