Skip to main content
NCBI home page
European Journal of Psychotraumatology logoLink to European Journal of Psychotraumatology
. 2023 Dec 18;14(2):2290859. doi: 10.1080/20008066.2023.2290859

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

Probar la efectividad de la implementacion en el ‘mundo real’ de un programa de resistencia a la agresion sexual

测试’现实世界’实施中性侵犯抵抗计划的有效性

Charlene Y Senn a,CONTACT, Karen L Hobden b, Misha Eliasziw c, Paula C Barata d, H Lorraine Radtke e, Gail L McVey f, Wilfreda E Thurston e
PMCID: PMC10732193  PMID: 38109360

ABSTRACT

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.

KEYWORDS: Sexual assault prevention, sexual violence, sexual victimization, effectiveness trial, university students

HIGHLIGHTS

  • This study evaluates whether the EAAA programme is effective when implemented by university staff at five Canadian universities outside of the constraints of an RCT.

  • Women-identified students who attended the EAAA programme experienced a 57.3% reduction in completed rape and other benefits including increased confidence and reductions in rape myth beliefs when compared to a comparable group of students who signed up but didn’t attend the programme.

  • These reductions in sexual victimization in the ‘real-world’ implementation of the EAAA programme in a sample of diverse undergraduate and graduate students enhances our confidence in its ability to reduce the pervasive public health issue of sexual violence experienced by women in university.

Sexual assault is a gendered crime that disproportionately affects young women (Breiding et al., 2014; Cotter & Savage, 2019; Smith et al., 2018). Universities have become important sites of protest, survivor support, and prevention efforts (e.g. Bloom et al., 2022; Campbell et al., 2023; Lichty et al., 2008; Rentschler, 2018) because more than half the student population is comprised of women who are at relatively high risk for sexual violence. Leading scholars in the field of sexual violence have recommended a comprehensive prevention approach (e.g. Banyard & Potter, 2017; Orchowski et al., 2020), one component being sexual assault resistance education for women (sometimes referred to as empowerment self-defence or risk reduction) (Senn et al., 2018). Importantly, such programmes are the only ones with evidence of lasting reductions in students’ sexual assault victimization (Hollander, 2014; Senn et al., 2015; Senn et al., 2017).

The Enhanced Assess, Acknowledge, Act sexual assault resistance education programme (also known as EAAA and Flip the Script with EAAATM) has so far yielded the strongest evidence of efficacy, obtained through a multi-site randomized controlled trial (Senn et al., 2013). First year women university students who attended the programme, compared to those in the control group, experienced 50% fewer rapes (attempted and completed) across the next year (Senn et al., 2015). These effects lasted for at least two years (Senn et al., 2017). Two sources were particularly influential in EAAA’s development. First, Nurius and Norris’ (1996) cognitive ecological model explains the cognitive and emotional barriers women encounter when a male acquaintance attempts to sexually coerce or assault them. Second, building on this, Rozee and Koss (2001) reviewed existing theory and empirical evidence and recommended content for a sexual assault resistance education programme. These recommendations provided the foundation of the first three units of EAAA, Assess, Acknowledge, and Act (Rozee & Koss’ concept). An added positive sexuality frame nourishes young women’s own sexual desires and facilitates better integration of programme content within their lives (Senn et al., 2011). EAAA is designed to: reduce the time required to detect danger from acquaintances in social situations (Assess), reduce emotional obstacles to acknowledging the danger and taking action (Acknowledge), and increase the likelihood that women will trust their judgement (Acknowledge) and leave, and/or use the most effective strategies to defend themselves (forceful verbal and/or physical resistance; e.g. Tark and Kleck (2014); Ullman (1997)) (Act) if necessary. The theoretical basis for the EAAA programme was tested in a mediation analysis; all variables hypothesized to be (primary or secondary) mediators responsible for the decrease in sexual assaults reported were supported (Senn et al., 2021). Even prior to the publication of the mediation analysis, organizations with good reputations for evaluating social interventions (i.e. Arnold Ventures, Blueprints for Healthy Youth Development, National Institute of Justice Crime Solutions) favourably reviewed the program’s evidence base.

Lacking however has been evidence of EAAA effectiveness when implemented outside of the constraints of a RCT, a challenge shared with other evidence-based interventions (Gottfredson et al., 2015). This study fills that gap.

1.1. Overview of scale up

Publications from the successful RCT (Senn et al., 2015) and subsequent, extensive media coverage created considerable demand for the EAAA programme, necessitating scale up. The programme developer and primary researcher conducted an extensive review of the literature to create a scale up plan that followed best practices for training and support for implementing sites (e.g. Beidas et al., 2014; Durlak & DuPre, 2008; Elliott & Mihalic, 2004). High intervention fidelity was achieved in the RCT (Senn et al., 2015), but reviews of past research in a variety of settings (e.g. Durlak & DuPre, 2008) suggested that staff implementing the programme would pay less attention to this issue. The programme manuals (facilitation scripts) created for the RCT were revised and expanded with learning objectives, detailed instructions for leading activities, trouble-shooting tips, etc. and a content architect created a new page format to facilitate ease of use. An intensive training process (6-day intensive Train-the-Trainer workshop, webinars, technical support) was developed and, beginning in June 2016, was offered annually through the non-profit SARE Centre (sarecentre.org).

Funding for a large mixed-method multi-level implementation effectiveness study, of which the current study is one part, was obtained and recruitment of Canadian universities took place in 2017 and 2018. Adhering to the training model, local staff, Campus Trainers (CTs), on those campuses completed training and then hired, trained, and supervised local near-peer facilitators. EAAA Program Facilitators (PFs) delivered the programme to students on their own campus. Not including preparatory reading and review of facilitator manuals, the facilitator training was 10 days in length and included behavioural rehearsal (dress rehearsals with an audience with planted questions/participant behaviour; Beidas et al. (2014)) with constructive critique. As part of the larger study, we evaluated the transfer of training from the non-profit organization to CTs and from CTs to PFs and found the training process to be successful in achieving its goals and preparing staff for programme delivery (see Hobden et al., 2021 for more detail).

1.2. Expected variations in program delivery and recruitment from the original RCT

Scale ups of evidence-based programmes in the community often involve divergences from the ideal or recommended practices (i.e. much less than perfect implementation; Durlak & DuPre, 2008) and tension between the need for fidelity and adaptation to the local context (e.g. Carvalho et al., 2013; Elliott & Mihalic, 2004). Despite careful manualization of EAAA, we recognized that some variation would occur. However, we subscribed to Elliott and Mihalic’s (2004) conclusion that fidelity is tied to effectiveness and therefore strongly discouraged altering the scripts, content, or activities (through training and a User Licensing Agreement). As is best practice, users were encouraged to make small modifications to increase perceptions of local relevance (e.g. statistics from their university/city/ province or state/country, place names in application scenarios).

The SARE Centre commonly receives requests to expand the delivery of EAAA to women students in upper years and/or outside the age range for which the programme was developed. We inform potential implementers that the programme was developed for the youngest undergraduate women for whom the risk of sexual violence is highest, and that the language and all application activities was developed for relevance to their specific developmental stage. We further advise that, while study year may not be as important to effectiveness as age, opening the programme beyond the intended age demographic could be problematic. Nevertheless, we anticipated that implementers might include women older than 24 for practical reasons, and that our evaluation would (inadvertently) allow us to assess whether this intervention can be “translat[ed for] broader usage” (Gottfredson et al., 2015, p. 895).

1.3. Study design

We used a longitudinal design1 and took advantage of a natural non-randomized control group which predictably occurred when students who had consented to be part of the research and completed the baseline survey did not show up for their first programme session. We used the TREND Statement Checklist (Des Jarlais et al., 2004) to guide our presentation of study details.

1.4. Objectives and hypotheses

The primary objective of the present study was to evaluate the effectiveness of the EAAA programme as it was implemented across five campuses. Programme outcomes were ‘benchmarked’ (Wade et al., 1998) against the previous RCT’s 6-month reduction in attempted or completed rape (‘any rape’) of 62.8% (95% CI: 37.5% to 77.2%) and compared to the lower limit of the confidence interval in the RCT of 37.5%. Using this comparison, effectiveness was defined as an observed relative risk reduction of ‘any rape’ greater than 37.5%. The number of outcome measures in the surveys and the length of follow-up were reduced from the original trial to minimize participant burden as students’ primary interest was not in the research. However, given that measures tied to theoretical mediators were found to be excellent predictors of the programme effects on sexual victimization in the RCT, we included a subset of these measures and hypothesized that there would also be significant increases in perception of personal risk of acquaintance sexual assault and self-defence self-efficacy and decreases in problematic rape myth beliefs. Measuring the mediators also provided a means of understanding aspects of the programme needing revision in the event the programme failed to be effective. To ensure that the evaluation of programme effectiveness was roughly comparable to the RCT, and with the awareness that some sites did not restrict eligibility to first (or second) year students or to 17–24-year-olds, we excluded students who were over 40 years of age from analysis. This cutoff excluded those far beyond the programme audience’s intended developmental period while retaining most of the recruited students.

2. Methods

2.1. Intervention sites

Seven Canadian universities met eligibility criteria (i.e. champion in stable position, staff available to become CTs, commitment to implementing a minimum of 6 groups for one academic year) and agreed to participate in the study. Universities were provided with incentives of $500 annually, training and travel/accommodation costs for 1 or 2 staff to attend the Train-the-Trainer workshop, 2 programme kits (including manuals for 4 facilitators), 3-year license (renewable at no cost), a part-time research assistant on site, annual virtual meetings, and an end of study Summit for staff at the research site (travel expenses paid). CTs attended a 6-day in-person intensive Train-the-Trainer workshop plus webinars provided by the SARE Centre. Two universities subsequently decided not to implement or had to delay implementation and so withdrew from the study. The five remaining sites were involved in the research for between one and three years. Participating universities ranged from small (∼2000 mostly undergraduates), medium (∼16,000 comprehensive), and large(r) (∼30,000 students). Eleven CTs and 21 PFs were trained across these sites. Some CTs had dual roles, that is, they were also PFs.

2.2. Student participants

Nine hundred and nine students signed up to take EAAA on one of the five participating campuses and were invited to participate in the study; 70% (N = 633) consented. Of these, 535 women-identified students2 between the ages of 17 and 40 years (84% of those who volunteered) completed the baseline survey and at least one follow-up (see Figure 1). Of these, 200 participants did not attend the first programme session3 and were assigned to the control group. The remaining 335 attended the first session and were assigned to the EAAA group.

Figure 1.

Figure 1.

Open in a new tab

Screening, randomization, and follow-up in the EAAA implementation study.

Baseline characteristics of the sample participants are reported in Table 1. Compared to the RCT, the implementation sample was more diverse and had a higher proportion of sexual violence survivors. Women who did not attend the first session of the programme had marginally (p = .07) higher belief in rape myths at baseline than women who showed up for the programme (See Table 3).

Table 1.

Baseline Characteristics of the Participants.

Characteristic EAAA Implementation (N = 535) SARE Trial (N = 893)
Months and years of enrolment, range September 2017 to March 2020 September 2011 to February 2013
Age in years, mean (standard deviation) 21.7 (3.3) 18.5 (1.2)
Participants at each site, n (%)    
 Site A 237 (44.3) 390 (43.7)
 Site B 146 (27.3) 326 (36.5)
 Site C 66 (12.3) 177 (19.8)
 Site D 64 (12.0)  
 Site E 22 (4.1)  
Age category, n (%)    
 17–20 years 211 (39.4) 832 (93.2)
 21–24 years 239 (44.7) 61 (6.8)
 25–40 years 85 (15.9) 0 (0.0)
Year of education, n (%)    
 First 131 (24.5) 893 (100.0)
 Second 84 (15.7) 0 (0.0)
 Third or fourth 203 (37.9) 0 (0.0)
 Graduate or professional 117 (21.9) 0 (0.0)
Race/ethnicity, n (%)    
 White or European 266 (49.7) 651 (72.9)
 Black or African 49 (9.2) 63 (7.1)
 East Asian 52 (9.7) 68 (7.6)
 South Asian 78 (14.6) 40 (4.5)
 Middle Eastern 44 (8.2) 27 (3.0)
 Indigenous 19 (3.6) 21 (2.3)
 Hispanic or Latino 20 (3.7) 17 (1.9)
 Unknown 7 (1.3) 6 (0.7)
Sexual identity, n (%)    
 Heterosexual 381 (71.2) 819 (91.7)
 Lesbian/gay 12 (2.2) 11 (1.2)
 Bisexual 94 (17.6) 37 (4.2)
 Not specified 48 (9.0) 26 (2.9)
Living arrangements, n (%)    
 Private home/apartment 439 (82.1) 410 (45.9)
 University/college residence 96 (17.9) 483 (54.1)
Currently involved in romantic relationship, n (%) 249 (46.5) 400 (44.8)
Currently involved in sexual relationship, n (%) 256 (47.8) 404 (45.2)
Previous sexual assault education, n (%) 98 (18.3) 36 (4.0)
Previous self-defence training, n (%) 160 (29.9) 296 (33.2)
Completed rape from 14 years of age, n (%) 193 (36.1) 208 (23.3)
Attempted rape from 14 years of age, n (%) 150 (28.0) 245 (27.4)
Coercion from 14 years of age, n (%) 188 (35.1) 198 (22.2)
Attempted coercion from 14 years of age, n (%) 211 (39.4) 272 (30.5)
Nonconsensual sexual contact from 14 years of age, n (%) 322 (60.2) 450 (50.4)
Type of programme attended, n (%)    
 Weekday 111 (20.8) 577 (64.6)
 Weekend 424 (79.2) 316 (35.4)
Number of EAAA sessions attended, n (%)    
 One 10 (3.0) 26 (5.8)
 Two 50 (14.9) 16 (3.6)
 Three 13 (3.9) 66 (14.6)
 Four 262 (78.2) 343 (76.1)
Open in a new tab

Table 3.

Between-group comparisons of perceived risk of acquaintance rape, self-defence self-efficacy, rape myth acceptance, and belief in female precipitation of rape over time.

      EAAA Implementation SARE Trial
      Baseline Post-Test 6 Months Baseline Post-Test 6 Months
      (N = 159) (N = 143) (N = 132) (N = 435) (N = 421) (N = 418)
Measure Group   (N = 319) (N = 308) (N = 284) (N = 442) (N = 430) (N = 431)
Perceived risk of acquaintance rape Control Mean (SE) 2.59 (0.10) 2.81 (0.10) 2.77 (0.10) 1.81 (0.05) 2.52 (0.06) 2.38 (0.06)
EAAA Mean (SE) 2.68 (0.07) 3.43 (0.08) 3.30 (0.08) 1.84 (0.05) 3.45 (0.06) 3.07 (0.06)
  Difference −0.09 −0.62 −0.53 −0.03 −0.93 −0.69
  (95% CI) (−0.34–0.16) (−0.88–−0.37) (−0.78–−0.26) (−0.17–0.11) (−1.11–−0.76) (−0.87–−0.52)
  Cohen’s d −0.07 −0.50 −0.42 −0.03 −0.71 −0.53
  P-value .47 < .001 < .001 .66 < .001 < .001
Self-defence self-efficacy Control Mean (SE) 39.8 (0.7) 42.6 (0.8) 43.8 (0.8) 44.9 (0.4) 47.2 (0.4) 47.1 (0.4)
EAAA Mean (SE) 39.3 (0.5) 51.8 (0.5) 49.1 (0.5) 44.0 (0.4) 53.6 (0.4) 51.4 (0.4)
  Difference 0.5 −9.2 −5.3 0.9 −6.4 −4.3
  (95% CI) (−1.3–2.3) (−11.0–−7.3) (−7.2–−3.3) (−0.2–2.0) (−7.5–−5.3) (−5.4–−3.2)
  Cohen’s d 0.05 −0.99 −0.57 0.11 −0.80 −0.54
  P-value .58 < .001 < .001 .11 < .001 < .001
Rape myth acceptance Control Mean (SE) 23.8 (0.7) 22.9 (0.7) 23.8 (0.7) 31.9 (0.6) 32.2 (0.7) 32.0 (0.7)
EAAA Mean (SE) 22.2 (0.5) 19.9 (0.5) 20.2 (0.5) 32.1 (0.6) 23.7 (0.7) 25.4 (0.7)
  Difference 1.6 3.0 3.6 −0.2 8.5 6.6
  (95% CI) (−0.1–3.4) (1.3–4.8) (1.8–5.4) (−2.0–1.6) (6.6–10.4) (4.7–8.5)
  Cohen’s d 0.18 0.35 0.42 −0.02 0.60 0.47
  P-value .07 < .001 < .001 .82 < .001 < .001
Belief in female precipitation of rape* Control Mean (SE) 8.9 (0.5) 8.8 (0.5) 8.7 (0.5) 15.4 (0.4) 15.9 (0.4) 15.8 (0.4)
EAAA Mean (SE) 8.0 (0.4) 7.2 (0.4) 7.2 (0.4) 15.2 (0.4) 10.0 (0.4) 10.9 (0.4)
  Difference 0.9 1.6 1.5 0.2 5.9 4.9
  (95% CI) (−0.4–2.2) (0.2–2.8) (0.1–2.8) (−0.8–1.2) (4.8–6.9) (3.8–6.0)
  Cohen’s d 0.15 0.27 0.27 0.02 0.73 0.61
  P-value .18 .02 .03 .72 < .001 < .001
Open in a new tab

Note. * Sample sizes for belief in female precipitation of rape in EAAA Implementation: Baseline (N = 121, 224), Post-Test (N = 112, 216), 6 Months (N = 99, 199). SE = standard error. CI = confidence interval.

2.3. Intervention

The Enhanced Assess, Acknowledge, Act (EAAA) sexual assault resistance education programme, also known as the Flip the Script with EAAATM programme, is a 12-hr in-person interactive programme. It uses mini-lectures, games, small and large group activities, discussions, demonstrations, written scenarios and film and audio clips to provide information and opportunities to apply knowledge and skills. Each of the four units has a unique focus. The first three units target each of the components of Rozee and Koss’ (2001) Assess, Acknowledge, and Act framework. The final unit was adapted with permission from the Our Whole Lives Sexuality Education programme (Goldfarb & Casparian, 2000; Kimball & Frediani, 2000). The programme is inclusive of self-identified women of all sexual identities and physical abilities. More detail on the EAAA programme can be found in Senn et al. (2013). The four 3-hr units are facilitated in small groups by two highly trained near-peer (usually graduate student or staff) facilitators.

Programmes Delivered. Fifty-three programmes were delivered4 across the five sites (range 2–20 per site across 1–3 years). Groups sizes ranged from 2 to 18 with a mean of 9 (SD = 4).

Fidelity. All programmes were audio recorded to permit fidelity review. One quarter of the programme units at each site were selected randomly and scored for intervention fidelity using the same scoring method as in the original trial (Senn et al., 2015). Fidelity was generally high (M = 90.72%; SD = 5.85; range 78.3–100%) though lower than the RCT (F = 17.72, p < .001; Hobden et al. (2021).

Dose. Retention rates in the programme group were similar to the RCT, with the majority of women students (n = 262; 78%) attending all four sessions (See Table 1 for more detail).

2.4. Measures/Outcomes

Primary Outcome – Sexual Assault. The Sexual Experiences Survey – Short Form Victimization (SES-SFV; Koss et al., 2007) follows best practice by describing behaviours that meet legal and social standards for sexual coercion and assault but does not require that respondents label their experiences. At all time-points, participants completed a gender-specific (male perpetrator) version of the SES-SFV. The time frame at baseline covered the period from age 14 to the current day, at 1-week post-intervention the brief period since baseline, and at 6-months since the post-test survey. Completed rape was defined as at least one experience of sexual intercourse (oral, anal, or vaginal) that was threatened, forced, or drugged (completed, not attempted) in the time period. Attempted rape was indicated when women endorsed one experience of attempted oral, anal, or vaginal intercourse through the use of threats, force, or incapacitation. A follow-up question requested the (approximate) date of occurrence.

Secondary Outcomes.

A single item, “What are your chances of being raped by someone you know?” (adapted from Gray, Lesser, Quinn, & Brounds, 1990), measured perceived risk of acquaintance rape. Higher scores on a five-point scale (1 = very unlikely, 5 = very likely) indicated greater perceived risk of acquaintance rape.

All multiple-item scales had good internal consistency as measured by Cronbach’s Alpha. Self-defence self-efficacy was assessed using a nine-item adapted version of Ozer and Bandura’s (1990) scale (Marx et al., 2001; Senn et al., 2011). Participants reported their confidence in their ability to defend themselves from men in a variety of situations on a seven-point scale (1 = not at all, 7 = very). Two questions more explicitly measured confidence in active rape resistance against a stranger and an acquaintance. Higher scores indicated greater confidence.

The 20-item Illinois Rape Myth Acceptance Scale – Short Form (IRMA-SF) (Payne, Lonsway, & Fitzgerald, 1999) assessed respondents’ belief in global rape myths. Responses were on a seven-point scale (1 = not at all agree, 7 = very much agree) with 17 items scored (3 fillers). Higher scores indicated greater endorsement of rape myths. Specific woman-blaming rape myths were measured using the six item Female Precipitation subscale of the Perceived Causes of Rape Scale5 (Cowan & Campbell, 1995; full scale administered). Respondents were presented with the stem “Rape is caused by … ” and asked on a 7-point scale the extent to which they agreed with a list of causes. Higher scores indicated greater women blaming.

Demographics/Background. At baseline, participants answered questions about their age, gender, sexual orientation, ethnicity, year of study, relationship history, and alcohol use, as well as whether they had participated in other sexual assault education or self-defence training.

2.5. Procedures

The study received Research Ethics Board clearance at the primary [REB#17–162] and all participating campuses. A research assistant at each of the five study sites provided the names and email addresses of students who had signed up for the EAAA programme on their campus. One week prior to their scheduled programme, students were invited by email to participate in the study and the first online survey, which included demographic questions, the measure of sexual victimization, followed by the Illinois Rape Myth Acceptance Scale, Perceived Causes of Rape Scale, and the Self Defence Self-Efficacy Scale. Up to three reminders were provided (Dillman et al., 2009) and included the reminder that the survey had to be completed prior to the start of the first unit.

One week after the last unit of the scheduled programme, study participants were emailed again, this time with the post-intervention survey link. This survey included all measures except demographics. The SES-SFV time frame was changed to the time since the last survey. At the end of the survey, participants were redirected to an unlinked survey page where their contact information and secondary contacts (in case they moved or changed their email address) were updated. At 6-months post-baseline, another survey with the same measures (timeframe for the SES-SFV altered) was sent out by email. Up to 3 reminders at three-to-four-day intervals were sent to those who had not completed the follow-up surveys. At the end of each survey, participants were provided with a list of local (site and city), national, and online resources.

In the first year of recruitment, incentives were $10, 15, and $20 for each survey respectively. After one recruitment period, attrition was higher than observed in the RCT (14% at 6-month compared to 3%), so follow-up incentives were increased to $20, 25, and 30. The final response rate was 69.7%, lower than in the RCT (97.1%), however, retention to at least one follow-up was 91.9%. Only 7.4% of participants enrolled were lost to follow-up.

3. Results

Data were analyzed using a modified intention-to-treat approach, whereby participants were included in the analyses if they completed one or more post-baseline surveys.

3.1. Primary outcomes: completed rape, attempted rape, and any rape

The primary analyses compared the incidence (first occurrence) of completed rape between the control and programme groups using Kaplan-Meier failure curves and the log-rank test. To account for the correlation among observations within group sessions, variance estimates were appropriately inflated for within-session clustering using estimates of the design effect. The benefit of the EAAA programme is described in terms of relative risk reductions (with corresponding 95% confidence intervals) and the number of women who would need to take the programme to prevent one additional completed rape from occurring within 6 months. The groups were compared on incidence of attempted rape and any rape (completed or attempted) in a similar manner. The EAAA Implementation trial was benchmarked a priori against the SARE RCT’s 6-month relative risk reduction of any rape of 62.8% (95% CI: 37.5% to 77.2%), with successful implementation being defined as relative risk reduction of any rape exceeding the lower limit of 37.5%. All statistical analyses were conducted using SAS 9.4 (SAS Institute), and results with p values less than .05 were considered statistically significant.

See Table 2 for results and a comparison between the present study and the RCT. The success of the EAAA implementation was confirmed as the observed relative risk reduction of any rape was 41.8%. As seen in Figure 2, in line with the results of the RCT, completed rape was reduced by 57.3% across the subsequent six months for participants who had attended any of the EAAA programme sessions. Attempted rapes were also reduced but not statistically significant, at 32.9%, in contrast to the 71.8% reduction in the RCT.

Table 2.

Between-group comparisons of primary outcomes at six months.

      EAAA Implementation SARE Trial
      (N = 200) (N = 442)
Outcome Group   (N = 335) (N = 451)
Completed rape Control Risk, n (%) 13 (8.2) 28 (6.4)
EAAA Risk, n (%) 10 (3.5) 11 (2.5)
  Absolute Risk Reduction, % 4.7 3.9
  (95% CI) (0.1–9.5) (1.2–6.8)
  Relative Risk Reduction, % 57.3 60.9
  (95% CI) (2.4–80.8) (22.7–81.1)
  P-value .03 .005
    Number Needed to Educate 22 26
Attempted rape Control Risk, n (%) 12 (7.3) 31 (7.1)
EAAA Risk, n (%) 15 (4.9)  9 (2.0)
  Absolute Risk Reduction, % 2.4 5.1
  (95% CI) (−2.6–7.4) (2.4–7.9)
  Relative Risk Reduction, % 32.9 71.8
  (95% CI) (−49.0–69.5) (42.0–86.3)
    P-value .37 < .001
    Number Needed to Educate 42 20
Any rape Control Risk, n (%)  20 (12.2)  49 (11.3)
EAAA Risk, n (%) 21 (7.1) 19 (4.2)
  Absolute Risk Reduction, % 5.1 7.1
  (95% CI) (−1.0–11.2) (3.5–10.5)
  Relative Risk Reduction, % 41.8 62.8
  (95% CI) (−7.2–68.7) (37.5–77.2)
  P-value .09 < .001
  Number Needed to Educate 20 14
Open in a new tab

Note. Risk estimates, absolute and relative risk reductions were calculated from Kaplan-Meier failure curves. Number Needed to Educate was calculated as 1/Absolute Risk Reduction in decimal. The analyses counted the first of each type of outcome over the six-month follow-up period, and therefore women could have experienced multiple outcomes during a single encounter or different encounters. CI = confidence interval.

Figure 2.

Figure 2.

Open in a new tab

Kaplan-Meier failure curves for completed rape, attempted rape, and any rape in the EAAA implementation study and in the SARE trial.

Note: The curves show the cumulative percentage of completed rapes, attempted rapes, and any rapes among women in the control group and those in the EAAA group during 6 months of follow-up. P-values are from log-rank tests.

3.2. Secondary outcomes: known mediators of reductions in sexual assault

Linear mixed models were used to assess differences in perceived risk of acquaintance rape, self-defence self-efficacy, rape myth acceptance, belief in female precipitation of rape, and effective rape resistance strategies. A random intercept was included in the models to account for the 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. The models consisted of three terms: group (programme or control), time (post-test or 6 months), and the cross-product between group and time. Results are summarized with corresponding 95% confidence intervals about group differences at each time point. Cohen’s d is used to quantify the intervention effect sizes as ‘small, d = .2’; ‘medium, d = .5’; or ‘large, d = .8’ (Cohen, 1988).

A subset of primary and secondary mediators that predicted the reductions in completed rape outcomes in the RCT were assessed (see Table 3 and Figure 3 for results and comparisons to the RCT). The analyses showed that the benefits of the EAAA programme were present in this real-world implementation. Perceptions of the risk of acquaintance rape and self-defence self-efficacy increased immediately following the programme and were still present at 6-month follow-up. General rape myths and specific woman-blaming beliefs decreased significantly and stayed low. The implementation also demonstrated similar benefits to the RCT in participants’ knowledge of, and willingness to use the most effective types of resistance, that is, forceful verbal and physical resistance strategies and to generate more forceful verbal strategies in a hypothetical situation (see Table 4 for results). The number of different forceful physical strategies participants had knowledge of and were willing to use in the situation approached significance. As expected, effect sizes were similar or lower in the real-world implementation than in the RCT except for self-defence self-efficacy, where the effect size for the implementation study was higher.

Figure 3.

Figure 3.

Open in a new tab

Known mediators of reductions in sexual assault in the EAAA implementation study and in the SARE trial.

Note: Mean scores with 95% confidence intervals are plotted at baseline, at 1-week post-intervention, and at 6-months for both the control and EAAA groups.

Table 4.

Between-group comparisons of mentioned use of effective rape resistance strategies (forceful verbal and forceful physical) and number of effective rape resistance strategies suggested over time.

      EAAA Implementation SARE Trial
      Post-Test 6 Months Post-Test 6 Months
      (N = 143) (N = 132) (N = 421) (N = 418)
Measure Group   (N = 308) (N = 284) (N = 430) (N = 431)
Mentioned forceful verbal resistance Control Percentage (SE) 55.9 (4.1) 63.9 (4.1) 62.7 (2.4) 71.1 (2.2)
EAAA Percentage (SE) 76.1 (2.4) 74.0 (2.6) 80.5 (1.9) 79.4 (1.9)
  Difference −20.2 −10.1 −17.8 −8.3
  (95% CI) (−29.6–−10.8) (−19.7–−0.50) (−23.8–−11.9) (−14.1–−2.6)
  Cohen’s d −0.43 −0.22 −0.40 −0.19
  P-value < .001 .03 < .001 .005
Number of instances of forceful verbal resistance Control Mean (SE) 0.74 (0.08) 0.92 (0.08) 0.85 (0.05) 0.93 (0.05)
EAAA Mean (SE) 1.24 (0.05) 1.14 (0.05) 1.26 (0.05) 1.21 (0.05)
  Difference −0.50 −0.22 −0.41 −0.28
  (95% CI) (−0.70–−0.30) (−0.43–−0.02) (−0.55–−0.28) (−0.41–−0.14)
  Cohen’s d −0.52 −0.23 −0.42 −0.28
  P-value < .001 .03 < .001 < .001
Mentioned forceful physical resistance Control Percentage (SE) 45.4 (4.2) 38.3 (4.2) 44.4 (2.4) 49.1 (2.4)
EAAA Percentage (SE) 71.4 (2.6) 52.5 (3.0) 76.8 (2.0) 69.4 (2.2)
  Difference −26.0 −14.2 −32.4 −20.3
  (95% CI) (−35.5–−16.4) (−24.2–−4.0) (−38.6–−26.2) (−26.8–−13.8)
  Cohen’s d −0.54 −0.29 −0.70 −0.42
  P-value < .001 .008 < .001 < .001
Number of instances of forceful physical resistance Control Mean (SE) 0.67 (0.10) 0.56 (0.10) 0.60 (0.06) 0.70 (0.06)
EAAA Mean (SE) 1.12 (0.07) 0.79 (0.07) 1.27 (0.06) 1.16 (0.06)
  Difference −0.45 −0.23 −0.67 −0.46
  (95% CI) (−0.68–−0.21) (−0.47–0.02) (−0.84–−0.51) (−0.62–−0.29)
  Cohen’s d −0.38 −0.19 −0.55 −0.37
  P-value < .001 .07 < .001 < .001
Open in a new tab

Note. SE = standard error. CI = confidence interval.

4. Discussion

For at least a decade in North America, there has been a deep consensus that sexual violence prevention on university campuses is necessary (e.g. Orchowski et al., 2010) but many challenges to actual prevention practice continue to exist. Among these is the abundance of programmes that have not been evaluated. When studied, few have any or sustained positive effects, especially on the most important outcomes, sexual perpetration and victimization (Orchowski et al., 2020). The EAAA programme is an exception, as it has been shown in a RCT to reduce the risk of sexual violence young women-identified students experience for at least two years post-programme (Senn et al., 2015; Senn et al., 2017). Although the programme is now available to universities, the question of whether the programme could maintain its effectiveness when scaled up remained. As leaders in the implementation science field have concluded, effectiveness of a programme when scaled up cannot be presumed after a successful trial (Durlak & DuPre, 2008). Demonstrating effectiveness in real-world conditions is critical to ensure our limited prevention resources are allocated to efforts that actually reduce sexual victimization. Further, given that participating universities expanded programme eligibility criteria, this study also meets Gottfredson et al.’s (2015, p. 896) recommendation to test effectiveness outside the narrow eligibility conditions of most controlled trials. Compared to the RCT, the EAAA programme in these real-world contexts was effective, demonstrating substantial reductions in completed rape, as well as having many other benefits, for a diverse sample of young, and somewhat older (average age 22; < 40), women-identified students across the years of university including graduate and professional schools, who were also more diverse in terms of ethnic identity, sexual identity, and history of sexual assault.

4.1. Reductions in sexual violence experienced

Although our implementation study showed a successful reduction in ‘any rape’ (completed and attempted rape combined) of 41.8%, which exceeded our a priori benchmark, this was a lower benefit than in the original RCT (62.8%). Importantly, however, the reduction in completed rape in this implementation study (57.3%) was comparable to the reduction in completed rape in the original RCT (60.9%). Thus, the programme showed robust effects for completed rape in this quasi-experiment.

The reductions in attempted rape, by contrast, were less than half of those observed in the original trial. While further research is necessary to replicate and explain this difference, we think that the wider age demographic may be responsible. We have argued elsewhere that the large (and somewhat surprising) reduction in attempted rape resulting from women’s participation in the programme was due to better and faster risk detection in social situations with acquaintances (Radtke et al., 2020; Senn et al., 2015; Senn et al., 2017; Senn et al., 2018; Senn et al., 2021). The programme includes a wide range of scenarios, but there is a focus on situations that young university women (1st year) are likely to experience including the detection of risk based on men’s behaviour in early dating contexts. These contexts are likely to change as women move into their 20s and 30s. For example, the proportion of students who live on campus is dramatically different between the original RCT and the current study (18% vs 54%, respectively). Additionally, the majority (52.5%) of students in the RCT (mean age 18), were not in committed romantic or sexual relationships but that percentage masks a quite dramatic change from first year (45% were in an intimate relationship) to 2-years later (75% at 24-mos follow-up; Senn et al. (2015); Senn et al. (2017)). Furthermore, qualitative and quantitative analysis of the RCT data indicated that the young women were using their new risk detection knowledge to cut short or end their early interactions with men whose behaviour raised red flags for them, and they did not persist in starting or building these relationships (Crann et al., 2021). Although we did not ask about length of relationship in the current study, students in their 20s and 30s are developmentally more likely to be in established romantic and/or sexual relationships (Lantagne & Furman, 2017). While perception of risk remains important, in established relationships early warning signs are often in the past, and simply leaving or ending the social interaction or relationship becomes more complicated. In addition, social situations (e.g. bar-going, type of parties, number of contacts with young men) may be different for women in their 20s (and 30s) than for those who are 18 and 19. For this reason, the contact with young men (under 25) who pose the highest risk (through their attitudes or behaviour) may be altered or reduced (Ybarra & Thompson, 2018). Alcohol use in social settings may also change and could affect early risk detection and resistance; however, it is hard without further research to know whether this would lessen or increase the risks experienced by students in their 20s and 30s. Alcohol consumption is generally higher for older students than for younger ones (Foster et al., 2014) but the party culture of the early years of university is more intense (Flack et al., 2008). Thus, the relationship between alcohol and sexual assault for older students is likely to be complicated and requires further study. While our cell sizes were too small to do formal statistical testing of age differences in experiences of alcohol-involved sexual assault, proportionally fewer of the completed rapes (53% versus 90%) experienced by women 21 and over involved perpetrator tactics related to alcohol/drugs incapacity compared to younger women.6 For attempted rape, the two age groups were similar, with 78% of 17–20-year-olds’ experiences involving alcohol incapacity compared to 84% of those over 21.7 All of our conjectures related to the age of the sample require testing in future research, but we suggest at a minimum that additional (developmentally appropriate) scenarios should be added for application activities in the programme when older students are included. Given the robust reductions in completed rape, we have no concerns about programme effectiveness in reducing sexual violence for women in their 20s and 30s but want to note that the benefits related to reductions in attempted rape may primarily be experienced by younger women-identified students.

4.2. Other programme benefits

The current programme’s development was based on theory (e.g. Nurius & Norris, 1996) and prior evidence (e.g. Ullman, 2007) addressing the obstacles that women encounter when they are faced with coercion by men they know and perhaps like or love (Senn et al., 2011; Senn et al., 2013). As recommended by Durlak and DuPre (2008), we “carefully specif[ied] the theoretically components of the program” (p. 342) and established that measures of these theoretically derived components were responsible for 95% of the reductions in completed rape (76% of those in attempted rape) (Senn et al., 2021). A subset of these measures was included in the current study to verify impact on these outcomes and to allow us to assess areas of weaker impact if the implementation trial had not been successful. Our findings from this quasi-experiment replicated the results of the original trial despite the considerably more diverse sample and the apparent historical changes in some baseline attitudes and beliefs, and all effects were maintained to 6-months.

The program’s ability to increase perception of personal risk of acquaintance rape was replicated with a medium effect size, with scores moving from below to above the midpoint. This change is necessary to overcome optimism biases and recognize risk cues in situations as personally relevant and therefore detectable (Gidycz et al., 2006). The programme had a large effect on an established primary mediator, participants’ confidence that they could successfully defend themselves in an acquaintance sexual assault situation increased. Rape myth beliefs are secondary mediators that affect participants’ ability to detect risk in specific situations. Mean scores on baseline rape myth acceptance and woman-blaming beliefs were lower than was previously observed in the RCT, likely due to increased discussions related to #Metoo and other social changes, yet women who attended the programme had even lower scores. The smaller effect size is likely due to basement effects.

Forceful verbal and physical resistance are the most effective self-defence strategies against both acquaintance and stranger sexual assault perpetrators (e.g. Tark & Kleck, 2014), yet these are the strategies that are least likely to be used by women in acquaintance situations. Ensuring all participants leave with a toolbox of effective strategies that they would be willing to use against an acquaintance perpetrator is a key learning outcome of the Act unit in EAAA. The findings from the RCT on this outcome were replicated in the current study with small to medium effect sizes; women who took the programme were more likely to suggest using one or more forceful verbal or physical strategies against an acquaintance sexual violence perpetrator than women in the control group. A non-significant difference between the groups in the number of forceful strategies suggested at 6-months post-programme may indicate that for women in their 20s and 30s, a booster to enhance memory of possible physical strategies is advisable.

4.3. Observations of implementation in the real world

There was considerable variation in the size of the implementation (number of programmes offered, number of women-identified students recruited) across universities, in part due to differences in their campus size. Durlak and DuPre (2008), in their review of implementation issues, suggest that monitoring implementations to ensure that programmes are being delivered as intended can increase efficacy and effect sizes. We assessed fidelity for the study but did not provide reports to Campus Trainers until the end of the project as fidelity monitoring was not sustainable or desired by most campuses at the conclusion of the study. The non-profit SARE Centre (sarecentre.org) offered technical support and Campus Trainers were in contact periodically to discuss implementation or supervision challenges.

We were concerned by several issues, when informed that campuses had cancelled programmes mid-way through (due to PF illness or size of the group) or had opened the eligibility far beyond the program’s intended audience (e.g. women 40+). COVID influenced the final semester of the programmes being offered with additional cancellations. Our study evaluating our train-the-trainer model, reported elsewhere (Jeffrey et al., 2022), while generally successful, showed weaknesses in some campuses’ training and supervision of PFs. Yet despite these challenges, the majority of women-identified students who signed up, showed up, and of those students, most completed all programme units. Fidelity to the programme curriculum was also generally high (average across units 78%) suggesting our manualization and methods for training regarding the importance of fidelity work outside the RCT (Hobden et al., 2021). These findings, in combination with the study outcomes, suggest that the programme can be successfully scaled up at universities in a way that benefits undergraduate (and graduate) women-identified students.

4.4. Limitations and strengths

Implementation research is rare in the sexual violence field, with most studies focusing on programmes offered within a single university. In those that involve multiple universities, recruitment of students to the interventions and the delivery of the programme itself (including training of the facilitators) are typically under the control of the researchers and/or academic and practitioner partnerships. The current study is unique in taking the next step in implementation science to ask whether an evidence-based programme is effective when offered by campus staff. This approach is a critical strength of the study because we were able to monitor decision points but did not interfere in decision making.

Some of the campuses’ decisions, however, impacted the research. For example, we had originally intended to use a wait-list control design, which is stronger methodologically, than having a natural quasi-control group based on whether students showed up for the first unit. Unfortunately, the difficulty for campuses in recruiting sufficient numbers of women to facilitate a waitlist made this impossible. Luckily, no differences were identified between those who did and did not attend (the latter had marginally higher rape myth acceptance) suggesting that the self-selection of participants to the groups was not biased. It is possible, however, that the groups differed on some variable that was not measured, and this was not detected.

We reduced the number of measures included in the survey and restricted the follow-up period to 6-months to increase the rate of student participation in the study and to reduce participant burden (Short et al., 2022). The high proportion of students who agreed to participate (70%) in the research and our high retention for at least one follow-up period (92%) suggests that we were successful and strengthens our confidence in the study’s conclusions. However, we were not able to evaluate the program’s impact on all primary mediators (e.g. situational risk detection) or to delve into participants’ backgrounds (e.g. length of current relationships) in more detail.

A primary strength of the study is related to the naturally occurring diversity of the sample of women who chose to sign up for EAAA on their campus. This means that the benefits of the EAAA programme have now been established for a much wider group of women-identified students, including those in their 20s and 30s, and in graduate school. The primary analyses for the RCT and subsequent analyses (Senn et al., 2015; Senn et al., 2017; Senn et al., 2022) confirmed that the programme worked for rape survivors for whom the rates of sexual violence victimization are higher. The current sample included an even larger proportion of rape survivors than the RCT (36% vs 23%) and, therefore, confirms the benefits for students regardless of prior victimization status. This latter finding may be of particular importance to those who provide support to survivors and may have previously been reluctant to refer survivors to this type of intensive sexual assault prevention programme.

5. Conclusion

RCTs are often considered the gold standard in intervention research and provide indispensable cause-and-effect evidence; however, they cannot be the final step in intervention work. The same processes that make RCTs valuable also make them somewhat artificial, which necessitates the testing of promising programmes in real world conditions. Effectiveness trials are still relatively uncommon, and this is the first published study for a campus sexual assault prevention programme. The findings of reductions in sexual victimization under these conditions have implications for broadening the reach of effective ways to help reduce the pervasive public health issue of sexual violence experienced by young women in university. This is the kind of evidence that university administrators cannot in good conscience ignore.

Funding Statement

This work was supported by Canadian Institutes of Health Research: [Grant Number 48843].

Notes

1

A waitlist control was deemed impractical because sites reported insufficient recruitment for a waitlist.

2

This included gender non-binary feminine presenting students. The decision to include non-binary students was made by each site, sometimes in consultation with the first author.

3

Attendance at the first unit is mandatory for safety and theoretical reasons.

4

Five programmes were only partially delivered due to facilitator illness, COVID, or unexpected later session no-shows.

5

Due to a survey error, this measure was not included for all participants.

6

10 and 13 rapes reported by <21 and ≥21-year-old female-identified students, respectively.

7

15 and 13 attempted rapes reported by <21 and ≥21-year-old female-identified students, respectively.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are openly available in Open Science Framework at https://osf.io/nq3zb/?view_only = 709995f762dd43a5801fd663a25e3ca2.

References

  1. Banyard, V. L., & Potter, S. J. (2017). Envisioning comprehensive sexual assault prevention for college campuses. In Travis C. B. & White J. W. (Eds.), APA handbook of the psychology of women (Vol. 2). American Psychological Association. 10.1037/0000060-013. [DOI] [Google Scholar]
  2. Beidas, R. S., Cross, W., & Dorsey, S. (2014). Show me, don’t tell me: Behavioral rehearsal as a training and analogue fidelity tool. Cognitive and Behavioral Practice, 21(1), 1–11. 10.1016/j.cbpra.2013.04.002 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bloom, B. E., Park, E., Swendeman, D., Oaks, L., Sumstine, S., Amabile, C., Carey, S., & Wagman, J. A. (2022). Opening the “Black Box”: Student-generated solutions to improve sexual violence response and prevention efforts for undergraduates on college campuses. Violence Against Women, 28(14), 3554–3587. 10.1177/10778012211068063 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Breiding, M. J., Smith, S. G., Basile, K. C., Walters, M. L., Chen, K., & Merrick, M. T. (2014). Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization – national intimate partner and sexual violence survey, United States, 2011. Centers for Disease Control and Prevention. (CDC), U.S. Department of Health and Human Services. [PMC free article] [PubMed] [Google Scholar]
  5. Campbell, R., Markowitz, J., Fedewa, T., Shareef, S., Fenton, D., & Southard, K. (2023). Improving access to postassault healthcare for college students: Creating a campus-based sexual assault nurse examiner program. Journal of Forensic Nursing, 19(1), 50–59. 10.1097/jfn.0000000000000381 [DOI] [PubMed] [Google Scholar]
  6. Carvalho, M. L., Honeycutt, S., Escoffery, C., Glanz, K., Sabbs, D., & Kegler, M. C. (2013). Balancing fidelity and adaptation. Journal of Public Health Management and Practice, 19(4), 348–356. 10.1097/PHH.0b013e31826d80eb [DOI] [PubMed] [Google Scholar]
  7. Cotter, A., & Savage, L. (2019). Gender-based violence and unwanted sexual behaviour in Canada, 2018: Initial findings from the Survey of Safety in Public and Private Spaces. Statistics Canada. https://www150.statcan.gc.ca/n1/pub/85-002-x/2019001/article/00017-eng.htm.
  8. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum. [Google Scholar]
  9. Cowan, G., & Campbell, R. R. (1995). Rape causal attitudes among adolescents. Journal of Sex Research, 32(2), 145–153. 10.1080/00224499509551784 [DOI] [Google Scholar]
  10. Crann, S. E., Senn, C. Y., Radtke, H. L., & Hobden, K. L. (2021). “I Felt Powerful and Confident”: Women’s use of what they learned in feminist sexual assault resistance education. Psychology of Women Quarterly, 10.0361/6843211043948 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Des Jarlais, D. C., Lyles, C., Crepaz, N., & the Trend Group (2004). Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: The TREND statement. American Journal of Public Health, 94(3), 361–366. 10.2105/AJPH.94.3.361 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Dillman, D. A., Smyth, J. D., & Christian, L. M. (2009). Internet, mail, and mixed-mode surveys: The tailored design method. John Wiley & Sons, Inc. [Google Scholar]
  13. Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41(3–4), 327–350. doi: 10.1007/s10464-008-9165-0 [DOI] [PubMed] [Google Scholar]
  14. Elliott, D. S., & Mihalic, S. (2004). Issues in disseminating and replicating effective prevention programs. Prevention Science, 5(1), 47–53. doi: 10.1023/B:PREV.0000013981.28071.52 [DOI] [PubMed] [Google Scholar]
  15. Flack, W. F. J., Caron, M. L., Leinen, S. J., Breitenbach, K. G., Barber, A. M., Brown, E. N., Gilbert, C. T., Harchak, T. F., Hendricks, M. M., Rector, C. E., Schatten, H. T., & Stein, H.C. (2008). “The Red Zone”: Temporal risk for unwanted sex among college students. Journal of Interpersonal Violence, 23(9), 1177–1196. 10.1177/0886260508314308 [DOI] [PubMed] [Google Scholar]
  16. Foster, C., Caravelis, C., & Kopak, A. (2014). National college health assessment measuring negative alcohol-related consequences among college students. American Journal of Public Health Research, 2(1), 1–5. doi: 10.12691/ajphr-2-1-1 [DOI] [Google Scholar]
  17. Gidycz, C. A., McNamara, J. R., & Edwards, K. M. (2006). Women's risk perception and sexual victimization: A review of the literature. Aggression and Violent Behaviour, 11(5), 441–456. 10.1016/j.avb.2006.01.004 [DOI] [Google Scholar]
  18. Goldfarb, E. S., & Casparian, E. M. (2000). Our whole lives: Sexuality education for grades 10–12. Unitarian Universalist Association. [Google Scholar]
  19. Gottfredson, D. C., Cook, T. D., Gardner, F. E., Gorman-Smith, D., Howe, G. W., Sandler, I. N., & Zafft, K. M. (2015). Standards of evidence for efficacy, effectiveness, and scale-up research in prevention science: Next generation. Prevention Science, 16(7), 893–926. doi: 10.1007/s11121-015-0555-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Gray, M. D., Lesser, D., Quinn, E., & Brounds, C. (1990). The effectiveness of personalizing acquaintance rape prevention programs on perception of vulnerability and on reducing risk-taking behavior. Journal of College Student Development, 31, 217–220. [Google Scholar]
  21. Hobden, K. L., Thurston, B. E., McVey, G. L., & Senn, C. Y. (2021). Intervention fidelity in a randomized controlled trial of a sexual assault resistance program for university women. Prevention Science, 22(7), 960–970. https://www.ncbi.nlm.nih.gov/pubmed/33864584 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Hollander, J. A. (2014). Does self-defense training prevent sexual violence against women? Violence Against Women, 20(3), 252–269. 10.1177/1077801214526046 [DOI] [PubMed] [Google Scholar]
  23. Jeffrey, N. K., Senn, C. Y., Hobden, K. L., Barata, P. C., McVey, G. L., Radtke, H. L., & Eliasziw, M. (2022). Evaluation of the transfer of training for a sexual assault resistance program enhanced with sexuality education. Sexuality Research and Social Policy, 19(4), 2007–2023. 10.1007/s13178-022-00749-0 [DOI] [Google Scholar]
  24. Kimball, R. S., & Frediani, J. (2000). Our whole lives: Sexuality education for adults. Unitarian Universalist Association. [Google Scholar]
  25. Koss, M. P., Abbey, A., Campbell, R., Cook, S., Norris, J., Testa, M., Ullman, S. E., West, C., & White, J. (2007). Revising the SES: A collaborative process to improve assessment of sexual aggression and victimization. Psychology of Women Quarterly, 31(4), 357–370. 10.1111/j.1471-6402.2007.00385.x [DOI] [Google Scholar]
  26. Lantagne, A., & Furman, W. (2017). Romantic relationship development: The interplay between age and relationship length. Developmental Psychology, 53(9), 1738–1749. 10.1037/dev0000363 [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Lichty, L. F., Campbell, R., & Schuiteman, J. (2008). Developing a university-wide institutional response to sexual assault and relationship violence. Journal of Prevention & Intervention in the Community, 36(1/2), 5–22. 10.1080/10852350802022241 [DOI] [PubMed] [Google Scholar]
  28. Marx, B. P., Calhoun, K. S., Wilson, A. E., & Meyerson, L. A. (2001). Sexual revictimization prevention: An outcome evaluation. Journal of Consulting and Clinical Psychology, 69(1), 25–32. 10.1037//0022-006x.69.1.25 [DOI] [PubMed] [Google Scholar]
  29. Nurius, P. S., & Norris, J. (1996). A cognitive ecological model of women's response to male sexual coercion in dating. Journal of Psychology and Human Sexuality, 8(1), 117–139. 10.1300/J056v08n01_09 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Orchowski, L. M., Edwards, K. M., Hollander, J. A., Banyard, V. L., Senn, C. Y., & Gidycz, C. A. (2020). Integrating sexual assault resistance, bystander and men’s social norms strategies to prevent sexual violence on college campuses: A call to action. Journal of Trauma, Violence, & Abuse, 21(4), 811–827. 10.1177/1524838018789153 [DOI] [PubMed] [Google Scholar]
  31. Orchowski, L. M., Gidycz, C., & Murphy, M. (2010). Preventing campus-based sexual violence. In Kaufman K. L. (Ed.), The prevention of sexual violence: A practitioner’s sourcebook (pp. 415–448). NEARI Press. [Google Scholar]
  32. Ozer, E. M., & Bandura, A. (1990). Mechanisms governing improvement effects: A self-efficacy analysis. Journal of Personality and Social Psychology, 58(4), 472–486. 10.1037/0022-3514.58.3.472 [DOI] [PubMed] [Google Scholar]
  33. Payne, D. L., Lonsway, K. A., & Fitzgerald, L. F. (1999). Rape myth acceptance: Exploration of its structure and its measurement using the Illinois Rape Myth Acceptance Scale. Journal of Research in Personality, 33(1), 27–68. 10.1006/jrpe.1998.2238 [DOI] [Google Scholar]
  34. Radtke, H. L., Barata, P. C., Senn, C. Y., Thurston, W. E., Hobden, K. L., Newby-Clark, I., & Eliasziw, M. (2020). Countering rape culture with resistance education. In Crocker D., Minaker J., & Nelund A. (Eds.), Critical conversations about sexual violence on university campuses: New challenges, novel solutions (pp. 349–370). McGill-Queen’s University Press. [Google Scholar]
  35. Rentschler, C. A. (2018). #Metoo and student activism against sexual violence. Communication, Culture and Critique, 11(3), 503–507. 10.1093/ccc/tcy022 [DOI] [Google Scholar]
  36. Rozee, P. D., & Koss, M. P. (2001). Rape: A century of resistance. Psychology of Women Quarterly, 25(4), 295–311. 10.1111/1471-6402.00030 [DOI] [Google Scholar]
  37. Senn, C. Y., Barata, P., Eliasziw, M., Hobden, K., Radtke, H. L., Thurston, W. E., & Newby-Clark, I. R. (2022). Sexual assault resistance education’s benefits for survivors of attempted and completed rape. Women & Therapy, 45(1), 41–67. 10.1080/02703149.2021.1971425 [DOI] [Google Scholar]
  38. 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), 1–13. 10.1186/1472-6874-13-25 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. 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. http://www.nejm.org/doi/full/ 10.1056/NEJMsa1411131 [DOI] [PubMed] [Google Scholar]
  40. Senn, C. Y., Eliasziw, M., Hobden, K. L., Barata, P. C., Radtke, H. L., Thurston, W. E., & Newby-Clark, I. R. (2021). Testing a model of how a sexual assault resistance education program for women reduces sexual assaults. Psychology of Women Quarterly, 45(1), 20–36. 10.1177/0361684320962561 [DOI] [Google Scholar]
  41. Senn, C. Y., Eliasziw, M., Hobden, K. L., Newby-Clark, I. R., Barata, P. C., Radtke, H. L., & Thurston, W. (2017). Secondary and 2-year outcomes of a sexual assault resistance program for university women. Psychology of Women Quarterly, 41(2), 147–162. https://journals.sagepub.com/doi/abs/ 10.1177/0361684317690119 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Senn, C. Y., Gee, S., & Thake, J. (2011). Emancipatory sexuality education and sexual assault resistance: Does the former enhance the latter? Psychology of Women Quarterly, 35(1), 72–91. 10.1177/0361684310384101 [DOI] [Google Scholar]
  43. Senn, C. Y., Hollander, J. A., & Gidycz, C. A. (2018). What works? Critical components of effective sexual violence interventions for women on college and university campuses. In Orchowski L. & Gidycz C. A. (Eds.), Sexual assault risk reduction and resistance: Theory, research and practice (pp. 245–289). Academic Press. [Google Scholar]
  44. Short, C. E., Smit, E. S., & Crutzen, R. (2022). Measuring psychological constructs in computer-tailored interventions: novel possibilities to reduce participant burden and increase engagement. European Health Psychologist, 22(4), 801–815. [Google Scholar]
  45. Smith, S. G., Zhang, X., Basile, K. C., Merrick, M. T., Wang, J., Kresnow, M.-j., & Chen, J. (2018). The National Intimate Partner and Sexual Violence Survey: 2015 Data Brief - Updated Release. https://www.cdc.gov/violenceprevention/pdf/2015data-brief508.pdf.
  46. Tark, J., & Kleck, G. (2014). Resisting rape the effects of victim self-protection on rape completion and injury. Violence Against Women, 20(3), 270–292. 10.1177/1077801214526050 [DOI] [PubMed] [Google Scholar]
  47. Ullman, S. E. (1997). Review and critique of empirical studies of rape avoidance. Criminal Justice and Behavior, 24(2), 177–204. 10.1177/0093854897024002003 [DOI] [Google Scholar]
  48. Ullman, S. E. (2007). A 10-year update of “review and critique of empirical studies of rape avoidance”. Criminal Justice and Behavior, 34(3), 411–429. [Google Scholar]
  49. Wade, W. A., Treat, T. A., & Stuart, G. L. (1998). Transporting an empirically supported treatment for panic disorder to a service clinic setting: A benchmarking strategy. Journal of Consulting and Clinical Psychology, 66(2), 231–239. 10.1037/0022-006X.66.2.231 [DOI] [PubMed] [Google Scholar]
  50. Ybarra, M. L., & Thompson, R. E. (2018). Predicting the emergence of sexual violence in adolescence. Prevention Science, 19(4), 403–415. 10.1007/s11121-017-0810-4 [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are openly available in Open Science Framework at https://osf.io/nq3zb/?view_only = 709995f762dd43a5801fd663a25e3ca2.

Articles from European Journal of Psychotraumatology are provided here courtesy of Taylor & Francis

RESOURCES