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EAAA (Enhanced Assess, Acknowledge, Act) Sexual Assault Resistance Education

A four-unit program to help first-year college women resist acquaintance sexual assault by providing them with information and resistance training.

Program Outcomes

  • Sexual Violence
  • Violent Victimization

Program Type

  • Skills Training

Program Setting

  • School

Continuum of Intervention

  • Universal Prevention

Age

  • Early Adulthood (19-22)

Gender

  • Female

Race/Ethnicity

  • All

Endorsements

Blueprints: Promising

Program Information Contact

Karen Hobden
SARE Centre
University of Windsor
Windsor, Ontario, Canada N9B 3P4
info@sarecentre.org
sarecentre.org

Program Developer/Owner

Charlene Y. Senn
University of Windsor


Brief Description of the Program

The sexual assault resistance program is designed to help first-year university women resist acquaintance sexual assault. The program consists of four 3-hour units that involve information-providing games, mini-lectures, facilitated discussion, and application and practice activities. Participants can attend group sessions for all the units in one weekend (two units each day) or for one unit per week for 4 weeks.

Outcomes

Relative to the control group, the intervention group showed significantly lower risk of:

  • completed rapes (up to 12 months)
  • attempted rapes (up to 24 months)
  • attempted coercion (up to 24 months)
  • non-consensual sexual contact (up to 24 months)

Regarding secondary outcomes, participants in the intervention group showed significantly improved:

  • self-assessed risk of acquaintance rape (24 months)
  • risk assessment skills (24 months)
  • self-defense self-efficacy (24 months)
  • acceptance of rape myths (24 months)
  • acceptance of women-blaming beliefs (24 months)
  • various rape resistance strategies (24 months)

Brief Evaluation Methodology

The study recruited female students from three Canadian colleges and randomized 916 subjects to an intervention or control group. Subjects completed surveys at baseline, 1-week after program completion, 6 months after baseline, and 12 months after baseline in which they reported on completed rape, attempted rape, coercion, and non-consensual sexual contact. The analysis also examined the occurrence of each type of sexual event over a 24-month follow-up period. Secondary outcomes included self-assessed risk of acquaintance rape, risk assessment, belief in rape myths, self-defense self-efficacy, and women-blaming beliefs.

Study 1

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), 2326-35.


Risk Factors

Individual: Substance use

Peer: Romantic partner violence

Protective Factors

Individual: Problem solving skills, Prosocial behavior, Refusal skills


* Risk/Protective Factor was significantly impacted by the program

Gender Specific Findings
  • Female
Race/Ethnicity/Gender Details

The program focuses on women only. The evaluated sample was nearly three-quarters white. Based on subgroup analyses run specifically for Blueprints, there is no statistical evidence to conclude that the program is not effective in any specific racial and ethnic category and in any specific sexual identity category.

A train the trainer model is employed in the dissemination of the EAAA program. EAAA Facilitators are trained by Campus Trainers who have attended the EAAA Train the Trainer workshop.

Training of Campus Trainers

6 full days in-person training delivered by EAAA Lead Trainer. This training includes an in-depth exploration of the theory and research behind the design and content of EAAA; key elements of EAAA facilitator supervision and common issues that arise in each of the four sessions; interactive practice supervising EAAA facilitator dry runs; brainstorming and practice dealing with participant issues such as woman blaming, gender norms, etc.; advice on hiring, training and supervision; discussion of practical issues related to administering and implementing the EAAA program in your campus community; one full day of specialized Wen-Do self-defense instruction for EAAA Trainers, etc.

Training of Facilitators

Note: As few as two Program Facilitators and as many as 18-20 could be trained together using the training model and methodology presented in the Campus/Community Trainer Manual.

A consecutive 8 full days of Facilitator Training followed by a 5-6-hour dress rehearsal of ACT at least 2 weeks before the first EAAA group begins is recommended. We suggest holding the training in late August or early September before classes begin and after students' summer jobs wrap. The intensity of the training helps with team cohesion and promotes focused and deep reflection on the content of the EAAA. If this cannot be achieved, a few different models are possible and are suggested in the Campus Trainer Manual.

Overview of Facilitator Training

The eight-day curriculum includes:

  • An overview of the theoretical and empirical underpinnings of educational interventions, in general, and the EAAA program, in particular
  • Tips for dealing with the challenges of facilitating educational interventions, including problems specific to sexual assault interventions
  • Legal issues surrounding sexual assault
  • Practice with and feedback from delivering facilitating components of the EAAA program with mock participants (i.e., full dress rehearsals using slides and program equipment)
  • A 15-hour Basic Wen-Do Course delivered by a certified Wen-Do Instructor and one day of individualized instruction for teaching specific techniques

Source: Washington State Institute for Public Policy
All benefit-cost ratios are the most recent estimates published by The Washington State Institute for Public Policy for Blueprint programs implemented in Washington State. These ratios are based on a) meta-analysis estimates of effect size and b) monetized benefits and calculated costs for programs as delivered in the State of Washington. Caution is recommended in applying these estimates of the benefit-cost ratio to any other state or local area. They are provided as an illustration of the benefit-cost ratio found in one specific state. When feasible, local costs and monetized benefits should be used to calculate expected local benefit-cost ratios. The formula for this calculation can be found on the WSIPP website.

Start-Up Costs

Initial Training and Technical Assistance

All costs are in Canadian dollars (CAD).

There are two levels of initial training that must be completed before the EAAA/Flip the Script™ program can be implemented. First, Campus/Community Trainers must attend the EAAA Train the Trainer workshop offered by the SARE Centre. Once trained, the Campus/Community Trainers can recruit and train facilitators (with the annual help of an approved empowerment self-defense instructor) to deliver the education program to first-year university students on their campuses. More detail is provided below.

The fee for attending the EAAA Train the Trainer workshop is $3300 plus 13% sales tax per participant and includes:

  • Licensing for 3 years.
  • 6 days of in-person training (with optional 7th day available for $250 additional fee + tax).
  • Two 2.5 hour webinars (required to complete the training).
  • Technical support for one year.
  • 1 Campus Trainer Kit, including a Campus Trainer Manual, a Campus Trainer USB (with PowerPoint slides and other resources for training facilitators), and a set of 5 EAAA Facilitator Manuals and Appendices.
  • 1 EAAA Program Kit, including two sets of EAAA Facilitator Manuals and Appendices, an EAAA Program USB (containing PowerPoint slides, audio and video recordings, and participant handouts) and other peripherals (e.g., laminated scenario cards) needed to deliver the intervention.

Training costs do not include travel or transportation. For EAAA Train the Trainer workshops offered at the University of Windsor, campus accommodation (shared bathroom and kitchen) is available at $325 a week + 13% tax. Local hotel accommodation is available at the University rate of $129.95 a night +18% for room and sales taxes.

Graduates of the Train the Trainer workshops (Campus/Community Trainers) are qualified to train and supervise EAAA Facilitators who deliver the EAAA/Flip the Script™ program to young women on their campuses or in their communities. It is important to note, however, that Campus/Community Trainers are qualified to supervise but not to teach the facilitators the physical self-defense component of the EAAA/Flip the Script™ program. A Wen-Do self-defense basic 15-hr workshop and an additional day of individualized instruction with a certified self-defense instructor must be part of EAAA Facilitator training. Wen-Do is a women's self-defense education organization in Canada. Approved alternative empowerment self-defense instructors can be used for those outside Canada, if the cost of annual Wen-Do training would be prohibitive.

The cost of training facilitators will vary depending on their salaries and the travel costs associated with either sending the facilitators to take a Basic Wen-Do Course (15 hr.) and individualized training (4 hr. for 2-3 facilitators; 7 hr. for 4-10 facilitators) or bringing a certified Wen-Do instructor (or approved alternative self-defense instructor) to your campus. EAAA Facilitators must receive 9 days of training, which includes 6 days delivered by the Campus/Community Trainer, 3 days of self-defense instruction, plus 15-20 hours of pre-training readings. Facilitators must also complete approximately 18 hours of additional preparation and practice in semesters with no training.

Curriculum and Materials

Included in the initial training fee.

Licensing

Universities are required to sign a licensing and trademark agreement detailing the conditions they agree to abide by when hiring and training facilitators and delivering the EAAA program on campus. Licensing for three years is included in the initial training fee and is currently renewable at no cost, provided the conditions outlined in the licensing agreement are honoured.

Other Start-Up Costs

Other start-up costs include the cost of staff time while attending the Train the Trainer workshop. For facilitator training and EAAA/Flip the Script™ program delivery, the following additional equipment is needed: a laptop computer, data projector and screen, 2 presentation easels/free standing flip charts, 2 strike pads (can be purchased online from Amazon or from martial arts equipment suppliers), and a digital recorder (for optional intervention fidelity checks). Books and posters required for EAAA/Flip the Script™ program must be purchased from secondary sources.

Intervention Implementation Costs

Ongoing Curriculum and Materials

Ongoing material costs include:

  • Snacks and refreshments for participants.
  • Printing costs for recruitment posters, flyers to distribute around campus and handouts given out during EAAA/Flip the Script™ program delivery.
  • Stationery costs: e.g., refills for flipcharts, markers, white board pens, sticky notes for Relationships & Sexuality exercise, etc.
  • Costs for creating/compiling resource kits for each participant who takes the EAAA/Flip the Script™ program. Each resource kit should include a report cover/pocket folder, copies of handouts provided in the EAAA program kit and others from local sources deemed useful, a pen, bookmarks/coasters/stickers (promotional/educational materials available free from your local sexual assault centers, student health clinics, etc.), and blank paper. Estimated cost approximately $8/kit.
  • (Optional) "My Body, My Decision" white boards (with mounted pen) for the Acknowledge unit (or other appropriate gift to fit with content) can be purchased from the SARE Centre at cost ($2 each, plus tax and shipping).

Additional manuals can be purchased from the SARE Centre for an additional fee ($150 per set (including appendices) plus tax and shipping). Additional full program kits (including 2 sets of EAAA Facilitator Manuals and Appendices) can be purchased for $600 in/kit plus tax and shipping.

Staffing

Qualifications:  Women 18 and over who are employed by or affiliated with a postsecondary institution or community organization working with the postsecondary institution can participate in the training to become a Campus/Community Trainer if their institution is preparing to implement EAAA. Although one Trainer is sufficient for implementation, the SARE Centre recommends that two women be trained if possible so duties can be shared and to protect program sustainability from staff turnover. The EAAA/Flip the Script™ program must be delivered by pairs of highly skilled and trained facilitators who identify as women and are preferably under 30 years of age (to be perceived as "expert peers" by participants). The SARE Centre recommends that a minimum of three facilitators be trained if possible to ensure there is always a backup in case of illness. Graduate students, senior undergraduates, and young staff members have been trained successfully as EAAA Facilitators.

Ratios: Three part-time facilitators working 290 hours each year (including training) can deliver 8 EAAA/Flip the Script™ programs with approximately 20 participants in each (160 total participants per academic year).

Time to Deliver Intervention: The EAAA/Flip the Script™ program is typically delivered in a 12-hour, two-day workshop over a weekend or in 3-hour sessions delivered on four weeknights (e.g., four Tuesdays in row).

Implementing EAAA also requires some administrative support staff to design and print recruitment posters, produce and compile participant resource kits, book rooms, arrange food for workshops, etc.

Other Implementation Costs

A feminist therapist to support facilitators (if needed).

Implementation Support and Fidelity Monitoring Costs

Ongoing Training and Technical Assistance

  • Campus/Community Trainers must provide annual refresher training for facilitators even when facilitators are experienced.
  • EAAA Facilitators are required to retake the 15-hour Basic Wen-Do course or similar self-defense training (approved by the SARE Centre) annually to maintain self-defense skills and safety.
  • The SARE Centre provides implementation support by email, phone, or video conferencing on request. This technical assistance is provided free for a minimum of one year.
  • Campus/Community Trainers have access to a password-protected part of the SARE Centre's website where various resources can be downloaded including videos, PowerPoint slides, training materials, recruitment suggestions, updates to research literature for trainers, etc. Trainers also become part of an online EAAA Community of Practice.

Fidelity Monitoring and Evaluation

  • Normal supervision of facilitators, if following guidelines provided, requires some level of fidelity monitoring.
  • [Optional] EAAA Facilitators complete Fidelity Issues Forms after each session and discuss in weekly supervision.
  • [Optional] Sites conducting research may choose to record sessions and review 25% selected at random - requires staff to listen to audio recordings and use checklists to check for intervention fidelity. This requires approximately 1.5 times the time of the session in staff time. The SARE Centre can provide this analysis on a cost-recovery basis.

Ongoing License Fees

None.

Other Implementation Support and Fidelity Monitoring Costs

No information is available

Other Cost Considerations

Universities/colleges wishing to implement the EAAA/Flip the Script™ program could reduce expenses by partnering with other postsecondary institutions located nearby. Some strategies for cost savings include sharing Campus Trainers or EAAA Facilitators across institutions, lowering expenses on EAAA Facilitator training costs by training them together, reducing travel costs by hosting the EAAA Train the Trainer workshop in their communities (for minimum of 8 Trainers).

Year One Cost Example

The following example is for a postsecondary institution that sends one staff member to be trained as a Campus/Community Trainer who then trains three graduate-level facilitators who deliver 8 programs serving 160 students in an academic year. This example assumes that the Campus Trainer is an existing university staff member (e.g., from student services, health, or Title IX office) who performs the training and supervision as part of her regular duties, so there is no staffing cost included for the Campus Trainer.

NOTE: Cost estimates are in Canadian dollars (CAD) and will need to be converted to US dollars for those wishing to implement in the United States.

Initial Training Fee for Campus/Community Trainer $3,729.00
Travel and accommodations for 1 Campus Trainer to attend Train the Trainer workshop in Windsor, Ontario, Canada $2,500.00
Self-defense instructor assistance for facilitator training (instructor's fee and travel) $5,670.00
Facilitator hours during training ($30/hr x 92 hrs x 3 + 14% fringe benefits) $9,439.00
4 audience members for dry runs during facilitator training ($15/hr. x 24 hrs. x 4 + 14% fringe benefits) $1,642.00
Facilitator hours for program delivery - ($30/hr. X 24 hrs./program X 6 programs/facilitator X 3 facilitators + 14% fringe benefits) $14,775.00
Administrative support at .10 FTE $5,000.00
One-time equipment purchases (laptop, easels, flip charts, 2 strike pads) $1,600.00
Materials including 160 resource kits ($1280), participant handouts and recruitment posters ($400), and "My Body, My Decision" white boards ($425: optional) $2,105.00
EAAA Participant snacks and refreshments for 4 weekday programs at $750 each and 4 weekend programs at $1250 each. $8,000.00
Total One Year Cost $54,460.00

The first year implementation costs shown above is equivalent to approximately $37,190 in US dollars. With 160 students receiving the intervention, the cost per student in the first year would be $340 Canadian or $232 US. This cost would be slightly lower in subsequent years after the one-time equipment purchases have been made and initial facilitator training is complete.

Funding Overview

Sustaining EAAA over time generally requires a commitment on the part of the administration of postsecondary institutions to allocate resources for EAAA within their core budget. This can mean training existing health, student services, or counseling center staff to act as Campus/Community Trainers. Partnerships with Women's Centers on campus and nonprofit Rape Crisis Centers can also offer support. These organizations may have access to grant funding to support staffing and training.

Funding Strategies

Improving the Use of Existing Public Funds

The biggest ongoing cost of the program is staff time for coordinating and training facilitators and pay for facilitators' time for preparation and delivery of workshops. College counseling or health centers can train existing staff to act as Campus/Community Trainers and recruit seniors or graduate students to work as facilitators. Postsecondary institutions could potentially offer the facilitator positions as internships for graduate students in psychology, sociology, social work, social justice, or counseling which could defray the cost of paying facilitators.

Allocating State or Local General Funds

State funds, most typically from college budgets, can be allocated to purchase the initial training and curriculum, as well as to pay staff to administer and deliver the intervention.

Maximizing Federal Funds

Formula Grants: The STOP Violence Against Women and the Sexual Assault Services Formula Grant Program (SASP) both provide funding to states and local law enforcement to support community solutions to address violence against women and interventions for victims of sexual assault. These funding streams (particularly SASP) may be funding rape crisis centers who can partner to deliver the EAAA program. See: www.justice.gov/ovw/grant-programs#svaw

Discretionary Grants: There are relevant federal discretionary grants administered by the Department of Justice, Office of Violence against Women. This office administers the Grants to Reduce Sexual Assault, Domestic Violence, Dating Violence, and Stalking on Campus Program. This program funds prevention education programs as well as other campus responses.

Foundation Grants and Public-Private Partnerships

Foundation grants can be solicited to pay for initial training. Foundations focused on grants to prevent and end violence against women as well as foundations focused on postsecondary education might potentially support this program.

Program Developer/Owner

Charlene Y. SennUniversity of Windsor401 Sunset Ave.Windsor, Ontario N9B 3P4Canadacsenn@uwindsor.cainfo@sarecentre.org sarecentre.org

Program Outcomes

  • Sexual Violence
  • Violent Victimization

Program Specifics

Program Type

  • Skills Training

Program Setting

  • School

Continuum of Intervention

  • Universal Prevention

Program Goals

A four-unit program to help first-year college women resist acquaintance sexual assault by providing them with information and resistance training.

Population Demographics

The program is designed for first-year female college students (ages 17-24).

Target Population

Age

  • Early Adulthood (19-22)

Gender

  • Female

Gender Specific Findings

  • Female

Race/Ethnicity

  • All

Race/Ethnicity/Gender Details

The program focuses on women only. The evaluated sample was nearly three-quarters white. Based on subgroup analyses run specifically for Blueprints, there is no statistical evidence to conclude that the program is not effective in any specific racial and ethnic category and in any specific sexual identity category.

Other Risk and Protective Factors

The program aims to improve knowledge and resistance skills of potential victims.

Risk/Protective Factor Domain

  • Individual

Risk/Protective Factors

Risk Factors

Individual: Substance use

Peer: Romantic partner violence

Protective Factors

Individual: Problem solving skills, Prosocial behavior, Refusal skills


*Risk/Protective Factor was significantly impacted by the program

Brief Description of the Program

The sexual assault resistance program is designed to help first-year university women resist acquaintance sexual assault. The program consists of four 3-hour units that involve information-providing games, mini-lectures, facilitated discussion, and application and practice activities. Participants can attend group sessions for all the units in one weekend (two units each day) or for one unit per week for 4 weeks.

Description of the Program

The sexual assault resistance program is designed to help first-year university women resist acquaintance sexual assault. The program consists of four 3-hour units that involve information-providing games, mini-lectures, facilitated discussion, and application and practice activities. Participants can attend group sessions for all the units in one weekend (two units each day) or for one unit per week for 4 weeks.

Unit 1 (Assess) focuses on improving women's assessment of the risk of sexual assault by male acquaintances and developing problem-solving strategies to reduce perpetrator advantages. Unit 2 (Acknowledge) assists women to more quickly acknowledge the danger in situations that have turned coercive, explore ways to overcome emotional barriers to resisting the unwanted sexual behaviors of men who are known to them, and practice resisting verbal coercion. Unit 3 (Act) explores and provides opportunities to overcome personal obstacles to resisting known men and offers instruction about and practice of effective options for resistance, including 2 hours of self-defense training focused entirely on situations involving acquaintances. Unit 4 (Sexuality and Relationships) aims to integrate content from the previous units into participants' sexual lives by providing sexual information, including the slang and scientific terms for a wide range of possible sexual activities beyond intercourse and health and safer-sex practices, and a context to explore their sexual attitudes, values, and desires and to develop practices and strategies for sexual communication.

Theoretical Rationale

The program draws on the "cognitive ecological" model (Nurius & Noris, 1996), which provides a framework for the environmental and psychological factors that affect women's responses to acquaintance sexual assault and interfere with early acknowledgement of danger and self-protection. It also draws on social psychology theories of persuasion (e.g., Elaboration Likelihood Model) for the design of process/delivery and some content (e.g., personal relevance). The "Enhancement" (Relationships and Sexuality unit) is included based on the rationale that emancipatory sexuality education focusing on women's sexual desires and alternatives to intercourse is critical to women's increased ability to seek out sex they do want, and to reject and actively resist sex that they do not want.

Theoretical Orientation

  • Skill Oriented
  • Cognitive Behavioral

Brief Evaluation Methodology

The study recruited female students from three Canadian colleges and randomized 916 subjects to an intervention or control group. Subjects completed surveys at baseline, 1-week after program completion, 6 months after baseline, and 12 months after baseline in which they reported on completed rape, attempted rape, coercion, and non-consensual sexual contact. The analysis also examined the occurrence of each type of sexual event over a 24-month follow-up period. Secondary outcomes included self-assessed risk of acquaintance rape, risk assessment, belief in rape myths, self-defense self-efficacy, and women-blaming beliefs.

Outcomes (Brief, over all studies)

Relative to the control group, the intervention group showed significantly fewer completed rapes (5.2% versus 9.8%), attempted rapes, attempted coercion, and non-consensual sexual contact at posttest. A follow-up analysis indicated that the lowered risk was significant even 24 months after program completion, though results were stronger for attempted rape (4.9% vs. 13.5%; significant) than completed rape (8.1% vs. 11.8%; not significant). Significant positive effects on self-assessed risk of acquaintance rape, risk assessment, self-defense self-efficacy, belief in rape myths, and women-blaming beliefs were maintained through 24 months, as were self-reported use of rape resistance strategies such as forceful verbal and physical resistance.

Outcomes

Relative to the control group, the intervention group showed significantly lower risk of:

  • completed rapes (up to 12 months)
  • attempted rapes (up to 24 months)
  • attempted coercion (up to 24 months)
  • non-consensual sexual contact (up to 24 months)

Regarding secondary outcomes, participants in the intervention group showed significantly improved:

  • self-assessed risk of acquaintance rape (24 months)
  • risk assessment skills (24 months)
  • self-defense self-efficacy (24 months)
  • acceptance of rape myths (24 months)
  • acceptance of women-blaming beliefs (24 months)
  • various rape resistance strategies (24 months)

Mediating Effects

Not examined.

Effect Size

The study presented figures on relative risk reduction (ranging from 34.1% to 63.2%) and number needed to treat (ranging from 8 to 22). Cohen's d ranged from small (.19) to large (.80) for program effects on secondary outcomes at 24-month follow-up.

Generalizability

The sample is limited by its reliance on female volunteers from Canadian universities and a low consent rate.

Potential Limitations

  • One of 17 baseline comparisons differed significantly across conditions, with no control for this variable in the analysis

Endorsements

Blueprints: Promising

Program Information Contact

Karen Hobden
SARE Centre
University of Windsor
Windsor, Ontario, Canada N9B 3P4
info@sarecentre.org
sarecentre.org

References

Study 1

Senn, C. Y., Eliasziw, M., Barata, P. C., Thurston, W. E., Newby-Clark, I. R., Radtke, H. L., & Hobden, K. L. (2013). Sexual assault resistance education for university women: Study protocol for a randomized controlled trial (SARE trial). BMC Women's Health, 13, 25. doi:10.1186/1472-6874-13-25

Certified 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), 2326-35.

Senn, C. Y., Eliasziw, M., Barata, P. C., Thurston, W. E., Newby-Clark, I., Radtke, L., . . . SARE team. (2014). Sexual violence in the lives of first-year university women in Canada: No improvements in the 21st century. BMC Women's Health, 14(35), 1-8. doi:10.1186/s12905-014-0135-4

Senn, C. Y., Eliasziw, M., Hobden, K. L., Newby-Clark, I. R., Barata, P. C., Radtke, H. L., & Thurston, W. E. (2017). Secondary and 2-year outcomes of a sexual assault resistance program for university women. Psychology of Women Quarterly, 41(2), 147-162.

Study 1

Evaluation Methodology

Design:

Recruitment: The study enrolled first-year female students, 17 to 24 years of age, at one large university in western Canada and two midsized universities in central Canada, from September 2011 to February 2013. Participants were recruited through e-mail messages and telephone calls, posters or flyers around campus, e-mail messages forwarded by professors, and presentations in classes and at student events. Of the 3241 women assessed, 916 (28.3%) were deemed eligible (i.e., able to attend one of the scheduled intervention sets) and agreed to participate.

Assignment: At the baseline session, the 916 participants completed a computerized survey, underwent randomization, and immediately attended their first resistance session or control session. Randomization was performed in permuted blocks of two. Intervention subjects received the 4-session treatment, while control subjects were invited by a research assistant to take and read brochures on sexual assault and were offered the opportunity to have questions answered in the group session or privately.

Attrition: Participants completed computerized surveys at baseline, and 1 week after completion of the intervention (control participants were matched to the same interval). They also completed offsite web-based surveys at 6 months and 12 months. Of the 916 randomized, 23 (2.5%) withdrew or were found to not meet eligibility requirements and were not included in the analysis, while an additional 43 (4.7%) were lost to follow-up or withdrew but were included in the analysis sample of 893. At the 18-month follow-up there was an attrition rate of 10.2%, while only participants enrolled in the first year of the trial's recruitment period were invited to complete the 24-month survey (n=370).

Sample:

The sample of first-year female college students in Canada had a mean age of 18 years and were 73% white or of European descent. Most were sexually active and about 23% reported having been raped after age 14.

Measures:

All participants were assessed at 6, 12, and 18 months posttest, with half the sample completing an additional follow-up assessment at 24 months. The primary outcome of interest was sexual assault, classified into one of five sexual victimization categories: completed rape, attempted rape, coercion, attempted coercion, or non-consensual sexual contact, and measured using the self-report Sexual Experiences Survey-Short Form Victimization, a widely used behavioral measure that is reported to have high reliability and validity. The secondary outcomes measuring psychological variables were as follows:

Perceived risk of acquaintance rape, measured on a 5-point scale with higher scores indicating greater perceived risk.

Risk assessment, using different vignettes at posttest and follow-ups (α=.81). The second risk assessment tool was a scenario read line by line with respondents instructed to indicate at which line they began to feel uncomfortable and at which line they would leave.

Self-defense self-efficacy was assessed using seven questions on a 7-point scale regarding participants' confidence about their ability to defend themselves from men in a variety of situations (α =.82).

Knowledge of effective rape resistance strategies were assessed using two measures; the one used at posttest indicated the respondent's likelihood to engage in a number of effective resistance strategies after reading a vignette, and the one used at follow-up was more open-ended, with respondents scored on whether (1) or not (0) they mention using one of the effective resistance strategies.

Rape myth acceptance was assessed using the Illinois Rape Myth Acceptance Scale - Short Form, which consists of 17 seven-point items regarding beliefs in global rape myths (α =.93).

Female precipitation of rape was assessed using the 6-item Female Precipitation subscale of the Perceived causes of Rape Scale (α =86).

Analysis:

The primary analysis of the incidence (first occurrence) of completed and attempted rapes used Kaplan-Meier failure curves (indicating the cumulative percentage of completed rapes among women in the respective groups) and the log-rank test. To account for the correlation among observations within group sessions, variance estimates were inflated for within-session clustering with estimates of the design effect. Analysis of the other outcomes - the incidence of coercion, attempted coercion, and nonconsensual sexual contact - used discrete-time survival analyses with a complementary log-log regression model and variance estimates inflated for within-session clustering. Linear and generalized linear models were used to assess the secondary outcomes. A random intercept was included in the models to account for correlation among observations within group sessions and a first-order autoregressive covariance structure was used to characterize the interdependence of the repeated measures over time. By nature, these models adjust for baseline outcomes.

Intent-to-Treat: The study largely relied on a "modified intention-to-treat population, which included all eligible participants who completed one or more postrandomization surveys." It appears that 6 subjects who withdrew were not followed due to IRB protocols and 17 subjects discovered after randomization to not meet eligibility requirements were dropped, but they made up only a small part (2.5%) of the sample. Another 43 did not complete the 12-month follow-up but were apparently included in the analysis (perhaps as censored observations). The 18-month follow-up data also included all available data, but the 24-month follow-up used only data from participants enrolled in the program's first year of recruitment due to budget concerns, which likely represents a violation of intent-to-treat for that follow-up period.

Outcomes

Implementation Fidelity: One quarter of the recordings from both groups were randomly selected and scored for fidelity. The intervention fidelity averaged 94% and the control fidelity averaged 86%. Attendance in the resistance group was 91%. There were no crossovers between groups, and cross-contamination was low: 14.5% of the participants in the control group and 10.4% of the participants in the resistance group shared facts or skills learned in their group with participants in the other group.

Baseline Equivalence: Of 17 baseline sociodemographic, relationship, past victimization, study recruitment, and previous training measures, one showed a significant difference between conditions. Past non-consensual sexual contact was higher in the control group.

Differential Attrition: The 1-year follow-up analysis included 442 of 452 in the control group (97.8%) and 451 of 464 in the intervention group (97.2%). Although included in the 12-month analysis, 43 subjects did not complete the follow-up. No tests for differential attrition were presented, though attrition was minimal. At 18 months, attrition reached 11.5% (400 of 452 retained) in the control and 10.2% (417 of 464 retained) in the treatment group, with no analysis of differential attrition by outcomes or other baseline characteristics. Additionally, only half of the sample (n=370, 185 in each group) was used for the 24-month follow-up with no assessment of the comparability of the resulting groups.

Posttest: Relative to the control group, the intervention group showed significantly fewer completed rapes (5.2% versus 9.8%), attempted rapes, rapes of either type, attempted coercion, and non-consensual sexual contact. The most benefit came in the first 4 months, with the gains maintained afterward through the 12-month follow-up. Only 1 of the 6 outcomes, coercion, did not differ significantly across conditions.

Two prespecified tests for subgroup analyses examined whether the intervention effect differed by prior rape victimization or program timing (i.e., weekend vs. weekday sessions). Neither interaction reached statistical significance.

Long-Term:

Through the 24-month follow-up, compared to the control group, program participants showed significant and sustained improvements in self-assessed risk of acquaintance rape, general risk assessment, self-defense self-efficacy, and effective resistance strategies, though the effect sizes for some of these did decrease over time (while remaining significant). Program participants also showed significant reduction in rape myth beliefs and women-blaming beliefs at all time points, though effect sizes did diminish over time. Intervention women also improved use of 3 of 4 rape resistance strategies through 24-month follow-up.

The program effects on completed rape diminished and lost significance before the 18 and 24-month follow-ups, though results remained in favor of the treatment group (8.1% vs. 11.8%). The program did sustain significant reductions in the risk of attempted rape, however, over the full time period (4.9% vs. 13.5% at 24 months).

Contact

Blueprints for Healthy Youth Development
University of Colorado Boulder
Institute of Behavioral Science
UCB 483, Boulder, CO 80309

Email: blueprints@colorado.edu

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Blueprints for Healthy Youth Development is
currently funded by Arnold Ventures (formerly the Laura and John Arnold Foundation) and historically has received funding from the Annie E. Casey Foundation and the Office of Juvenile Justice and Delinquency Prevention.