Sexual assault resistance education for university women: study protocol for a randomized controlled trial (SARE trial)

A Successful Sexual Assault Resistance Program Also Reduced Intimate Partner Violence

Despite several parallels between intimate partner violence (IPV) and sexual assault (SA), programs designed to reduce either of these forms of violence against women rarely evaluate the impact on both IPV and SA. Accordingly, we investigated whether one such program (the Enhanced Assess, Acknowledge, Act (EAAA) Sexual Assault Resistance program), designed to help university-aged women resist SA, could also reduce subsequent IPV. Women university students who were enrolled in the Sexual Assault Resistance Education (SARE) randomized controlled trial examining the impact of the EAAA program on SA, were recruited immediately after completing the last survey in the SARE trial. From this trial, 153 women completed the IPV substudy, which included an additional survey. Occurrence of IPV was assessed using the Composite Abuse Scale. Of the 93 new relationships reported by 66 women in the control group, the 1-year risk of IPV was 26.8%. In contrast, of the 113 new relationships reported by 87 women in the EAAA program group, the 1-year risk of IPV was 12.2%. Effectively, the EAAA program significantly reduced the 1-year risk of IPV by 54.4% (p = .037, 95% CI [2.9%, 79.8%]). Our findings suggest that the EAAA program is effective in reducing the risk of IPV and highlights the generalizability of programming that targets the foundational underpinning of multiple forms of gender-based violence.

Testing the effectiveness of a sexual assault resistance programme in 'real-world' implementation

Background: In a multi-site randomized controlled trial (RCT), the EAAA programme designed for first year university women (17-24 years old) was shown to reduce the likelihood of any (attempted and completed) rape in the next year by 50% (Senn, C. Y., Eliasziw, M., Barata, P. C., Thurston, W. E., Newby-Clark, I. R., Radtke, H. L., & Hobden, K. L. (2015). Efficacy of a sexual assault resistance program for university women. New England Journal of Medicine, 372(24), 2326-2335). Through a non-profit organization, EAAA has been available to universities globally since 2016 using a Train-the-Trainer model. Observations of the 'real world' implementation suggested that universities often altered eligibility criteria (especially year of study and age) in their recruitment.Objective: The current study (2017-2021) evaluated whether EAAA was effective when implemented by universities in Canada outside of the constraints of an RCT.Method: Five universities participated. Women students who signed up to take the EAAA programme on their campuses were recruited for the research. Participants completed surveys at 1-week pre-program and 1-week and 6-months post-programme. Compared to the RCT, participant eligibility was broader, the sample was more diverse in terms of race and sexual identity and had a higher proportion of survivors. Programme fidelity was adequate.Results: Comparisons in this quasi-experimental design, between students who took the programme and students in the control group (i.e. those who signed up but did not attend the programme), confirmed the effectiveness of the EAAA programme. Reduction of any rape exceeded the a priori benchmark of 37.5%. Completed rape was significantly reduced by 57.3% at 6-months. Reduction in attempted rape of 32.9% was lower than in the RCT likely due to the somewhat older (average age 22 vs 18) sample. Positive changes to previously established mediators of the programme effects were all replicated.Conclusions: These findings suggest that the EAAA is highly effective when implemented by universities even when eligibility for students in terms of year of study and age is broadened.

A Web-Based Sexual Violence, Alcohol Misuse, and Bystander Intervention Program for College Women (RealConsent): Randomized Controlled Trial

BACKGROUND

Sexual violence (SV) incidence among college women has been invariant for the past 20 years. Innovative prevention strategies that are low resource and technology driven but demonstrate efficacy are greatly needed.

OBJECTIVE

The aim of this study was to determine the efficacy of a novel theoretically driven internet-based intervention for first-year college students who identify as women (RealConsent) in reducing their risk of exposure to SV and alcohol misuse as well as increasing alcohol protective and bystander behaviors.

METHODS

This randomized controlled trial involved first-year college students who identified as women (n=881) attending 1 of 3 universities in the southeastern United States. Participants aged 18 to 20 years were randomized to RealConsent (444/881, 50.4%) or to an attention-matched placebo control (437/881, 49.6%). RealConsent is fully automated and consists of four 45-minute modules that incorporate entertainment-education media and proven behavior change techniques. The primary outcome was exposure to SV; the secondary outcomes were alcohol protective behaviors, dating risk behaviors, alcohol misuse, and bystander behavior. Study outcomes were assessed at baseline and 6-month follow-up.

RESULTS

Among participants with some exposure to SV, those in the RealConsent group experienced less exposure to SV than the placebo group (adjusted incidence rate ratio 0.48, 95% CI 0.33-0.69; P=.002). Furthermore, participants in the RealConsent group engaged in more alcohol protective behaviors (adjusted odds ratio 1.17, 95% CI 0.12-2.22; P=.03) and were less likely to binge drink (adjusted incidence rate ratio 0.81, 95% CI 0.67-0.97; P=.003). Finally, participants in the RealConsent group who had 100% dosage were more likely to engage in bystander behavior than those with <100% dosage plus placebo group (adjusted odds ratio 1.72, 95% CI 1.17-2.55; P=.006).

CONCLUSIONS

A comprehensive exposure to SV, alcohol use, and bystander educational program was successful in decreasing the occurrence of exposure to SV among those most at risk and in increasing alcohol protective behaviors. Because of its web-based and mobile technologies, RealConsent can be easily disseminated and holds potential for reducing campus SV.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03726437; https://clinicaltrials.gov/ct2/show/NCT03726437.

Beyond Sexual Assault Prevention: Targeted Outcomes for Empowerment Self-Defense

Empowerment Self-Defense (ESD) has been shown to be effective in reducing risk of sexual assault victimization among women, but because research in this area is still in its infancy, less is known about additional intervention outcomes that may explain how and why the intervention is effective and about other ways that ESD affects students. The purpose of this study was to examine ESD instructor perspectives about intervention outcomes they perceive to be most important for their students. Using qualitative case-study methodology, interviews from 15 ESD instructors from the United States and Canada were conducted and analyzed using thematic analysis, which yielded six themes: Agency, boundaries, core beliefs, health and healing, somatic experiences, and gender and intersectionality, with each theme having two or more subthemes. Although some of these outcomes have been quantitatively evaluated in previous ESD studies, over half (n = 10) have not yet been empirically measured and are the focus of this article. These 10 outcomes include enactment, self-determination, nonverbal communication, relationship quality, self-worth, healing, physical strength and power, downregulation, support and solidarity, and societal-level changes. In addition to developing standardized tools to measure these outcomes, future research should quantitatively evaluate these outcomes across diverse student populations and explore their effect on producing the profound outcome associated with ESD, which is reduced risk for sexual assault victimization.

"I Felt Powerful and Confident": Women's Use of What They Learned in Feminist Sexual Assault Resistance Education

Research on women's response and resistance to sexual assault risk has informed the development of interventions to improve women's ability to effectively resist sexual assault. However, little is known about how women anticipate, navigate, and respond to risk following participation in sexual assault risk reduction/resistance education programs. In this study, we examined the information and skills used by university women who had recently completed the effective Enhanced Assess, Acknowledge, Act (EAAA) sexual assault resistance program. We analyzed responses from 445 women using descriptive statistics and content and thematic analysis. Just under half (42%) of women used at least one EAAA strategy in the following 2 years. Most women reported that their efforts were successful in stopping an attack. Women's responses included strategies both to preempt sexual assault threat (e.g., avoiding men who display danger cues, communicating assertively about wanted and unwanted sex) and to interrupt or avoid an imminent threat (e.g., yelling, hitting, and kicking). Women's use of resistance strategies worked to subvert gendered social norms and socialization. The results suggest that counter to criticisms that risk reduction/resistance programs blame women or make them responsible for stopping men's violence, women who took EAAA typically positioned themselves as agentic and empowered in their resistance.

The Role of Interpersonal Sexual Objectification in Heterosexual Intimate Partner Violence From Perspectives of Perceivers and Targets

Sexual objectification is a subtle manifestation of sexist discrimination and violence against women that involves seeing and treating women as sex objects of male sexual desire. The primary aim of this research was to connect sexual objectification experiences with heterosexual intimate partner violence. This set of studies examined the impact of sexual objectification on intimate partner violence for both the female victim (Study 1) and the male perpetrator (Study 2). Female (Study 1) and male (Study 2) participants were asked to rate the extent they are victims or perpetrators of sexual objectification experiences and intimate partner violence. Moreover, women's self-silencing and men's ascriptions of humanity and empathy (through empathic concern and perspective taking) toward their partner was assessed. The results of the first study (including 154 heterosexual women) showed that general sexual objectification victimization indirectly leads to higher psychological and physical violence through the internalization of self-silence schemas. The second study (including 165 heterosexual men) demonstrated a link between general sexual objectification perpetration and psychological and physical intimate partner violence. Moreover, the relation between men's perpetration of objectification and intimate partner violence was mediated by ascriptions of humanity and empathic concern toward their female partner (but not through perspective taking toward her). Results of both studies demonstrate the effect of sexual objectification (as target or perpetrator) on global intimate partner violence and explain the different psychological mechanisms through which it takes place depending on the gendered perspective. Theoretical implications and practical considerations for interventions on intimate partner violence are discussed.

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.

An Evaluation of Strategies Used to Maximize Intervention Fidelity in a Randomized Controlled Trial of a Sexual Assault Resistance Program for University Women

In this paper, we describe and evaluate the strategies used to maximize intervention fidelity in a randomized controlled trial to examine the efficacy of a sexual assault resistance intervention. The EAAA program was based on the best available theory and evidence on how women can successfully resist sexual coercion from male acquaintances. Extensive protocols for hiring, training, and supervising facilitators were established a priori. Detailed intervention manuals were developed that clearly described program goals, learning objectives, core elements, troubleshooting tips, sections that must be delivered verbatim, adaptations that could be made if necessary, and the ideal and minimum dose. Program sessions were audio-recorded, and a subsample of recordings were scored for adherence to the manuals using detailed Intervention Fidelity Checklists (IFC) developed specifically for this research. The Gearing et al. (2011) Comprehensive Intervention Fidelity Guide (CFIG) was employed retrospectively to provide objectivity to our analysis and help identify what we did well and what we could have done better. The SARE (Sexual Assault Resistance Education) Trial received high scores (38 out of 44 (86%) from each of the first two authors on the CFIG, suggesting a high level of intervention fidelity. Although a potential for bias on the part of the two raters was an obvious limitation, as was our neglection to include measures of implementation receipt, which Gearing et al. (2011) recommended, our analysis underscores the utility in employing methods recommended to enhance intervention fidelity when developing and evaluating evidence-based interventions.

Navigating Uncertainty, Employment, and Women's Safety During COVID-19: Reflections of Sexual Assault Resistance Educators

COVID‐19 affects women in ways unique to the impacts of structural inequalities related to gender, sexuality, disability, race and socioeconomic status. In this article, we reflect on our own experiences of the pandemic, as feminist students, workers and sexual assault resistance educators located in a Canadian post‐secondary setting. Situating ourselves within feminist responses to sexual violence prevention, as facilitators of the Enhanced Assess, Acknowledge, and Act (EAAA) sexual assault resistance education programme for university women, we reflect on the impacts of the COVID‐19 pandemic on our work as EAAA facilitators in our Canadian university. We explore the theoretical possibilities that critical disability theory and queer theory present to the EAAA programme, and argue that incorporating concepts from these frameworks will complement the goals of the EAAA programme and improve inclusivity of queer, trans and disabled participants. We conclude with a look into the future by anticipating the impacts of COVID‐19 on our future work.

It's Your Place: Development and Evaluation of an Evidence-Based Bystander Intervention Campaign

Preventing sexual assault on college campuses is a national priority. Bystander intervention offers a promising approach to change social norms and prevent sexual misconduct. This study presents the implementation and evaluation of a theory-based campaign to promote active bystander intervention. The theory of planned behavior (TPB) served as a conceptual framework throughout campaign development and evaluation. Formative research published elsewhere was used to develop campaign strategies, communication channels, and messages, including "It is your place to prevent sexual assault: You're not ruining a good time." The It's Your Place multi-media campaign fosters a culture of bystander intervention through peer-to-peer facilitation and training, as well as traditional and new media platforms. A cross-sectional post-test only web-based survey was designed to evaluate the campaign and test the TPB's ability to accurately predict intention to intervene. Survey data were collected from 1,505 currently enrolled students. The TPB model predicted intention to intervene. There was a significant effect of campaign exposure on attitude, subjective norms, and perceived behavioral intention. This theory-based communication campaign offers implications for promoting active bystander intervention and reducing sexual assault.

A cluster randomized controlled trial to assess the impact of SAFE on spousal violence against women and girls in slums of Dhaka, Bangladesh

Background

Bangladesh reports one of the highest rates of intimate partner violence (IPV) in the world. Despite wide recognition of IPV as an important public health and human rights issue, evidence for IPV prevention is still inadequate. Lack of guidance on effective IPV prevention in Bangladesh resulted in targeting only women in most of the programmes.

Methods

This paper assesses impact of SAFE, a 20-month intervention (March 2012 to October 2013) in slums of Dhaka on IPV and tests effectiveness of female only groups vs. no groups; and female + male groups vs. female only groups on IPV in the community using a three-arm cluster randomized controlled trial. SAFE’s core activities included interactive group sessions, community mobilisation, and services. The last two activities were common across arms.

Findings

Regression analyses (female survey: baseline n = 2,666; endline n = 2,670) showed no effect of SAFE on IPV against women aged 15–29. However, sub-group analyses demonstrated 21% risk reduction of physical IPV against adolescent girls aged 15–19 in the female + male group intervention arm. A consistent reduction in sexual violence was observed in both female and female + male arms for both groups of women, but the results were not statistically significant.

Interpretation

The findings emphasise the importance of combining male and female interventions for reducing physical IPV against adolescent girls. Implications for future research have been discussed.

It's Not My Place: Formative Evaluation Research to Design a Bystander Intervention Campaign

Sexual misconduct remains a problem on college campuses despite years of documentation and research, and program development and implementation. The purpose of this study was to conduct systematic theory-based formative audience research to understand how college women and men make meaning of sexual assault and bystander intervention. A total of 69 men and women aged 18 to 24 years participated in eight gender-specific focus group discussions. A grounded theory approach was used to identify patterns and themes across the data. Themes emerging from the data included the following: (a) female participants' experiences of sexism and misogyny, (b) the myth that rape is falsely reported, (c) complex understandings of consent and entitlement, (d) the reluctance to stop someone from having a "good time," (e) the role of alcohol as a moderating factor in sexual misconduct and bystander intervention, and (f) preference for direct and impactful messaging. This study informs researchers and practitioners about college students' perceptions of, and experiences with, bystander intervention and sexual assault. Practitioners can use this information to develop effective mixed media, campus-wide social marketing campaigns.

Secondary and 2-Year Outcomes of a Sexual Assault Resistance Program for University Women

We report the secondary outcomes and longevity of efficacy from a randomized controlled trial that evaluated a novel sexual assault resistance program designed for first-year women university students. Participants (N = 893) were randomly assigned to receive the Enhanced Assess, Acknowledge, Act (EAAA) program or a selection of brochures (control). Perception of personal risk, self-defense self-efficacy, and rape myth acceptance was assessed at baseline; 1-week postintervention; and 6-, 12-, 18-, and 24-month postrandomization. Risk detection was assessed at 1 week, 6 months, and 12 months. Sexual assault experience and knowledge of effective resistance strategies were assessed at all follow-ups. The EAAA program produced significant increases in women's perception of personal risk, self-defense self-efficacy, and knowledge of effective (forceful verbal and physical) resistance strategies; the program also produced decreases in general rape myth acceptance and woman blaming over the entire 24-month follow-up period. Risk detection was significantly improved for the intervention group at post-test. The program significantly reduced the risk of completed and attempted rape, attempted coercion, and nonconsensual sexual contact over the entire follow-up period, yielding reductions between 30% and 64% at 2 years. The EAAA program produces long-lasting changes in secondary outcomes and in the incidence of sexual assault experienced by women students. Universities can reduce the harm and the negative health consequences that young women experience as a result of campus sexual assault by implementing this program. Online slides for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/page/pwq/suppl/index.

Re-Evaluating Sexual Violence Prevention Through Bystander Education: A Latent Growth Curve Approach

Recently, there has been a call for more advanced analytic techniques in violence against women research, particularly in community interventions that use longitudinal designs. The current study re-evaluates experimental evaluation data from a sexual violence bystander intervention program. Using an exploratory latent growth curve approach, we were able to model the longitudinal growth trajectories of individual participants over the course of the entire study. Although the results largely confirm the original evaluation findings, the latent growth curve approach better fits the demands of "messy" data (e.g., missing data, varying number of time points per participant, and unequal time spacing within and between participants) that are frequently obtained during a community-based intervention. The benefits of modern statistical techniques to practitioners and researchers in the field of sexual violence prevention, and violence against women more generally, are further discussed.

Efficacy of a sexual assault resistance program for university women

BACKGROUND

Young women attending university are at substantial risk for being sexually assaulted, primarily by male acquaintances, but effective strategies to reduce this risk remain elusive.

METHODS

We randomly assigned first-year female students at three universities in Canada to the Enhanced Assess, Acknowledge, Act Sexual Assault Resistance program (resistance group) or to a session providing access to brochures on sexual assault, as was common university practice (control group). The resistance program consists of four 3-hour units in which information is provided and skills are taught and practiced, with the goal of being able to assess risk from acquaintances, overcome emotional barriers in acknowledging danger, and engage in effective verbal and physical self-defense. The primary outcome was completed rape, as measured by the Sexual Experiences Survey-Short Form Victimization, during 1 year of follow-up.

RESULTS

A total of 451 women were assigned to the resistance group and 442 women to the control group. Of the women assigned to the resistance group, 91% attended at least three of the four units. The 1-year risk of completed rape was significantly lower in the resistance group than in the control group (5.2% vs. 9.8%; relative risk reduction, 46.3% [95% confidence interval, 6.8 to 69.1]; P=0.02). The 1-year risk of attempted rape was also significantly lower in the resistance group (3.4% vs. 9.3%, P<0.001).

CONCLUSIONS

A rigorously designed and executed sexual assault resistance program was successful in decreasing the occurrence of rape, attempted rape, and other forms of victimization among first-year university women. (Funded by the Canadian Institutes of Health Research and the University of Windsor; SARE ClinicalTrials.gov number, NCT01338428.).

Sexual Coercion and Psychological Aggression Victimization: Unique Constructs and Predictors of Depression

Sexual coercion of women is a common problem in couples that is often conceptualized as a facet of sexual assault or as a form of psychological aggression. Because psychological aggression is consistently linked to depressive symptoms, the researchers evaluated the unique contribution of sexual coercion victimization in the prediction of depressive symptoms beyond the variance explained by psychological aggression victimization. Sample 1 consisted of women living with a partner for at least a year and parenting a young child, whereas Sample 2 consisted of undergraduate students in relationships of at least 6 months. Overall, 27.4% of the women in Sample 1 and 22.8% of the women in Sample 2 reported experiencing sexual coercion victimization. Across both samples, depressive symptoms and psychological aggression victimization were significantly greater in women who experienced sexual coercion victimization. In addition, sexual coercion victimization and psychological aggression victimization each contributed significantly and uniquely to the prediction of depressive symptoms. Thus, although related to psychological aggression victimization, sexual coercion in an intimate relationship is a distinct construct. Implications for assessment, prevention, and couple therapy are discussed.

Sexual violence in the lives of first-year university women in Canada: no improvements in the 21st century

BACKGROUND

Summarizes the frequency, type, and context of sexual assault in a large sample of first-year university women at three Canadian universities.

METHODS

As part of a randomized controlled trial assessing the efficacy of a sexual assault resistance education program, baseline data were collected from women between ages of 17 and 24 using computerized surveys. Participants' experience with sexual victimization since the age of 14 years was assessed using the Sexual Experiences Survey--Short Form Victimization (SES-SFV).

RESULTS

Among 899 first-year university women (mean age = 18.5 years), 58.7% (95% CI: 55.4%, 62.0%) had experienced one or more forms of victimization since the age of 14 years, 35.0% (95% CI: 31.9%, 38.3%) had experienced at least one completed or attempted rape, and 23.5% (95% CI: 20.7%, 26.4%) had been raped. Among the 211 rape victims, 46.4% (95% CI: 39.7%, 53.2%) had experienced more than one type of assault (oral, vaginal, anal) in a single incident or across multiple incidents. More than three-quarters (79.6%; 95% CI: 74.2%, 85.1%) of the rapes occurred while women were incapacitated by alcohol or drugs. One-third (33.3%) of women had previous self-defence training, but few (4.0%) had previous sexual assault education.

CONCLUSIONS

Findings from the first large Canadian study of university women since the 1990s indicate that a large proportion of women arrive on campuses with histories of sexual victimization, and they are generally unprepared for the perpetrators they may face during their academic years. There is an urgent need for effective rape prevention programs on university campuses.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01338428. Registered 13 April 2011.