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Promising Program Seal

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

Blueprints Program Rating: Promising

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

  • Sexual Violence
  • Violent Victimization

    Program Type

    • Skills Training

    Program Setting

    • School

    Continuum of Intervention

    • Universal Prevention (Entire Population)

    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).

      Age

      • Early Adulthood (19-22)

      Gender

      • Female only

      Gender Specific Findings

      • Female

      Race/Ethnicity

      • All Race/Ethnicity

      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.

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

      • Individual
      Risk Factors
      • Individual: Substance use
      • Peer: Romantic partner violence
      Protective Factors
      • Individual: Problem solving skills, Prosocial behavior, Refusal skills

      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.

      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.

      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.

      • Cognitive Behavioral
      • Skill Oriented

      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.

      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.

      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)

      Not examined.

      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.

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

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

      • Blueprints: Promising

      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.

      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, 135, 1-8. doi:10.1186/s12905-014-0135-4.

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

      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), 2326-2335.

      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).