Student-Athletes’, Coaches’, and Administrators’ Perspectives of Sexual Violence Prevention on Three Campuses with National Collegiate Athletic Association Division I and II Athletic Programs

Abstract

Research has found associations between intercollegiate athletics and risk for sexual violence, and that sexual violence is more pervasive at colleges and universities with National Collegiate Athletic Association (NCAA) Division I athletic programs, relative to NCAA Division II, NCAA Division III and no athletic programs. Simultaneously, sports involvement is linked with prosocial values and there are documented developmental benefits of sports participation. College athletic programs hold promise for fostering sexual violence prevention but there is limited knowledge about how student-athletes conceptualize sexual violence and how athletes, coaches, and administrators perceive available prevention and response programs. We conducted seven Focus Group Discussions (FGDs) and 21 In-Depth Interviews (IDIs) with student-athletes, athletic directors, and coaches from public university Division I (n = 2) and Division II (n = 1) campuses. We assessed perceptions of sexual violence, knowledge and opinions of available prevention and response programs, and sought input on how to bridge gaps in campus sexual violence policies. Student-athletes associated sexual violence with alcohol in their relationships with peers and asymmetrical power dynamics in relationships with coaches and faculty. Athletes felt strong connections with teammates and sports programs but isolated from the larger campus. This created barriers to students’ use of services and the likelihood of reporting sexual violence. Athletes felt the mandatory sexual violence prevention training, including additional NCAA components, were ineffective and offered to protect the university and its athletic programs from legal complications or cultural ridicule. Athletic staff were aware of policies and programs for reporting and referring sexual violence cases but their knowledge on how these served students was limited. Student-athletes were uncomfortable disclosing information regarding relationships and sexual violence to coaches and preferred peer–led prevention approaches.

Introduction

In 2020, sexual violence remains a critical issue on U.S. college and university campuses, despite the federal Clery Act, mandatory sexual assault prevention education at some schools, and targeted campus violence prevention programs (Gash & Harding, 2018) in the #MeToo era. Sexual violence is an all-encompassing, non-legal term that refers to any sexual act, comment, or advance against a person’s sexuality using coercion, by any person regardless of their relationship to a victim that includes, but is not limited to, sexual assault (including rape) and sexual harassment (WHO, 2002).

Estimates suggest one third of all female and one tenth of all male undergraduates in the U.S. experience sexual violence at some point during their time at college or university (Fedina et al., 2018). Additionally, female undergraduates report significantly more incidents than male undergraduates (Banyard et al., 2007). Research also suggests other groups have heightened vulnerability for experiencing campus sexual violence, including gay versus heterosexual men; bisexual versus heterosexual people, and black transgender versus white transgender people (Fedina et al., 2018). Identifying those at highest risk for violence on campuses is essential for designing effective prevention and treatment approaches. Likewise, perpetrators must be identified, held accountable, offered their own treatment and involved in prevention programming.

Several of the most well-publicized cases of sexual violence to emerge during the #MeToo era, so far, have involved key figures in intercollegiate athletics. Perpetrators have included student-athletes (e.g., Baylor University Bears football players were convicted for sexual assault between 2012 and 2016), coaches (e.g., Ohio State University diving coach, William Bohonyi, who was found guilty of sexually abusing a 16 year-old female athlete), and athletic staff (e.g., Larry Nassar, former physician at Michigan State University convicted of sexually abusing hundreds of female athletes). College sports systems represent a unique population including 45,0000 student-athletes for understanding the problem of campus violence and for developing solutions. This is particularly the case given research indicating that, compared to non-athletes, male college student-athletes are more likely to use sexual violence against both female and male undergraduates (Bonomi et al., 2018; Schaaf et al., 2019) and to be serial perpetrators (Foubert, Clark-Taylor, & Wall, 2020; Seabrook et al., 2018).

The National Collegiate Athletic Association (NCAA) is the organization that regulates and administers intercollegiate athletics at 4 year colleges in the U.S. NCAA member institutions are divided into three divisions: Division I, Division II, and Division III. There are 351 colleges and universities in Division I and these schools have the largest student bodies, athletics budgets, and athletic scholarships. There are 308 and 443 colleges and universities in Divisions II and III, respectively, and smaller schools generally compete in these two divisions (“NCAA Recruiting Facts,” 2016). In 2015, the NCAA formed a Sexual Assault Task Force to help athletic departments engage in education, collaboration and compliance surrounding sexual violence (National Collegiate Athletic Association, 2016). To guide understanding of sexual violence, as it occurs on a continuum, the NCAA provides the following definitions of sexual assault, rape and sexual harassment. Sexual assault refers to sexual contact or behavior that occurs without explicit consent and includes forcible and non-forcible rape and sexual battery. Rape is one form of sexual assault that is uniformly defined as “penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.” Sexual harassment includes unwelcome sexual advances, requests for sexual favors, and other verbal or physical harassment of a sexual nature that prohibits a person’s ability to participate in, or benefit from, a school’s education program or workplace, including conditioning the granting of an educational benefit based on submission of sexual conduct (National Collegiate Athletic Association & Sport Science Institute, 2016).

In 2017, the NCAA Board of Governors adopted a policy on campus sexual violence that requires campus leaders, including university chancellors or presidents, directors of athletics and Title IX coordinators at each NCAA member institution to certify that athletes, coaches and administrators have been educated on sexual violence, that athletic departments are knowledgeable and compliant with school policies on sexual violence, and that institutional sexual violence policies and processes and the Title IX coordinator’s contact information is available to everyone in the department of athletics (National Collegiate Athletic Association & Sport Science Institute, 2016). These are important actions given research suggesting higher rates of sexual assault occur on NCAA campuses, relative to non-member campuses (Wiersma-Mosley et al., 2017) and significantly more violence against women occurs on Division I campuses versus Division II, III schools and universities with no athletic programs (Wiersma-Mosley & Jozkowski, 2019).

Individual colleges and universities have also developed policies and procedures to address violence and make campuses safer for students, including focused programs for student-athletes, many of which aim to develop positive player/coach relationships by capitalizing on coaches’ positions of authority and influence over athletes. Some institutions provide coaches with tools to help student-athletes develop leadership and non-violent conflict resolution skills (Kimble et al., 2010). While few of these programs have been evaluated, some evidence suggests coach-led interventions can effectively reduce college student-athletes’ alcohol use (Foubert et al., 2020), increase awareness of campus resources for sexual violence and shift attitudes about the acceptability of interpersonal violence (Tredinnick & McMahon, 2019). Bystander prevention is another commonly used approach with student-athletes that is promoted by the NCAA (National Collegiate Athletic Association & Sport Science Institute, 2016). A study with Division I football players found those trained by their coach to recognize signs, symptoms, and consequences of sexual violence and unhealthy relationships were more likely to positively intervene as bystanders in risky situations (Kroshus et al., 2018).

Important gaps remain in our understanding of sexual violence prevention among intercollegiate athletes. For instance, although higher rates of sexual assault have been recorded on Division I campuses versus campuses with Division II or III or no athletic programs, we do not know how NCAA student-athletes conceptualize sexual violence, in or out of the context of sports. We are also unaware of how they perceive current sexual violence policies and programs at their college/university or within their athletic program, or how athletic directors and coaches feel about their role. Further, despite many colleges and the NCAA promoting coach-led interventions and peer-to-peer bystander training, the acceptability of these programs has not been widely assessed. The current study aimed to fill these gaps by talking with intercollegiate student-athletes, coaches, and administrators at three NCAA Division I and II university campuses about sexual violence prevention and response in their athletic programs, and seeking their thoughts on how to foster partnerships between academic and athletic departments to create a climate and culture that promotes safe relationships and prevents sexual violence on campus.

Methods

Research Setting

The University of California is a public university system with 10 undergraduate campuses, eight of which are part of the NCAA. Six are Division I, one is Division II, and one is Division III. The current study took place at two of the Division I UC campuses (Los Angeles [UCLA] and Santa Barbara [UCSB]) and one Division II UC campus (San Diego [UCSD]). UCLA is part of the Pac-12 Conference and the Mountain Pacific Sports Federation (MPSF). Because UCLA has a football program, it is further classified as one of the NCAA Division I Football Bowl Subdivision (FBS) campuses, placing it in the top level of college football in the United States and among the largest and most competitive schools in the NCAA. Neither UCSB nor UCSD have football programs on their campus. As a Division I school, UCSB is considered a Non-football, Multi-sport campus. It is part of the Big West Conference, with the exception of men’s water polo and volleyball teams, and men’s and women’s swimming, which are in the MPSF. UCSD is currently Division II but in 2017 accepted an invitation to join the Big West Conference and transition over a period of 6 years to NCAA Division I. Men’s volleyball and women’s water polo have already started their Big West participation and a full Big West competitive slate will take place in the current, 2020–21 academic year.

Research for this study was led by faculty investigators at each campus, and a team of 16 undergraduate (n = 10) and graduate (n = 6) student research interns at UCLA (5 students), UCSB (5 students), and UCSD (6 students). Project coordinators supervised and oversaw all student study activities on each campus. All research staff received comprehensive training in research ethics and compliance, qualitative research methods, and trauma-informed care.

Participants and Procedures

Participants were recruited from each campus and included student-athletes, coaches (both assistant and head coaches), and athletic directors (including overall director, associate director, deputy director, etc.). Eligibility criteria for all participants were: (1) age of 18 years or older; (2) currently attending or working at UCLA, UCSB, or UCSD; (3) having a way of being contacted either by phone or email; (4) consenting to be involved in the study; and (5) English-speaking. Students were eligible if they played on a Division I or II team. NCAA athletes were prioritized for recruitment. However, we had difficulty in reaching our target number of student-athlete participants so ended up allowing club-level sports athletes to participate as well, if they expressed interest in enrollment. Coaches and administrators were only eligible if they had been working at the campus for at least 6 months.

Recruitment involved a combination of targeted and snowball sampling. Email messages were sent to all NCAA Division I and II student-athletes, coaches, and athletic directors (ADs), recruitment flyers were posted near each campus’ athletic department and a snowball sample was also used. All interested individuals were asked to complete a short online survey to screen for eligibility. Eligible participants were connected, via email or cell phone, to a student researcher to schedule a date, time and location for an in-depth interview (IDI) or focus group discussion (FGD). All data collection was done on campus, at an accessible and convenient location like campus library study room and athletic department office where privacy could be ensured. All participants provided written informed consent to participate in the study and to have their data collection session audio recorded. All participants received a US$ 25 Visa gift card in compensation for their time. The study protocol was approved by the UCSD Human Research Protection Program, with reliance approval from the institutional review boards (IRB) at UCLA and UCSB.

In-Depth Interviews (IDIs) were conducted with student-athletes, coaches, and athletic directors. IDIs with students aimed to explore their attitudes about relationships and sex, their definitions of sexual violence, sexual harassment and healthy relationships, and their awareness of available services, prevention programs, and/or policies addressing sexual violence at the university and in their athletic department. We sought students’ opinions on how they can become more involved in making the campus an environment that does not tolerate sexual or gender-based violence. IDIs with coaches and athletic directors aimed to elucidate department procedures, services, and protocols for sexual violence response and prevention. FGDs were conducted with student-athletes only and aimed to understand group norms surrounding the sports environment and how athletics were felt to impact campus safety, healthy socializing and acceptance/rejection of relationship violence. We explored students’ definitions of healthy versus unhealthy relationships and sex as well as sexual assault and sexual harassment. Each discussion was facilitated by a moderator and a note-taker. The goal of each FGD was to learn how students feel about balancing life as athletes and college students during the #MeToo era. FGD topics included perceptions of whether sexual violence was a problem on campus, opinions on how the UC and each athletic department handles and responds to sexual violence against students. Participants were asked to provide details on the types and quantity of information they received at college about sexual violence and if they had heard faculty, staff, or administration address sexual assault or harassment.

Qualitative Data Analysis

IDIs and FGDs were audio-recorded and transcribed verbatim. Transcripts were redacted to remove personal identifying information and uploaded to Dedoose version 4.5.91. A grounded theory inductive approach was used to code the data and identify emergent themes and subthemes (Miles & Huberman, 1994; Ryan & Bernard, 2003). Analysis was done collaboratively by the authors of this paper who developed a coding tree to create an analytic blueprint of the relationship between the major themes, topics, ideas, concepts, and terms that emerged during the review of transcripts. During the process of reading transcripts, the research team discussed the codes that emerged and agreed on categories for organizing them, including groups of broad conceptual codes that were further refined into sub-codes. At least two reviewers coded each transcript. The research team participated in continuous meetings to iteratively revise the codes. The principal investigator (PI) reviewed and signed off on all themes and helped solved discrepant codes that the team was unable to reach consensus on to ensure inter-rater reliability. Codes and corresponding excerpts were retained for analysis upon agreement between the coding team and PI. The first broad code theme was campus culture, with sub-codes: alcohol use, and sports. Under the sports code, following five sub codes were developed: coach/player relationship, hierarchy, identity, mentorship, and role as athletes. The second broad code theme was services, with sub-codes: prevention, online training, and NCAA requirements. The third broad code theme was knowledge and awareness. The fourth was reasons for not reporting. The fifth broad code theme was values, attitudes and beliefs.

Results

We conducted 21 IDIs with student-athletes (n = 12) and athletic directors and coaches (n = 9), and seven FGDs with male (n = 4) and female (n = 3) student-athletes. Sixty individuals participated from the three campuses, including 51 student-athletes and nine athletic department staff members, including head and assistant coaches and athletic directors including deputy directors, associate directors, etc. To maintain confidentiality of staff members, we collectively refer to all coaches and directors as “athletic staff.” Most student=athletes (39%) and athletic staff (45%) were from UCSD. Among the student-athletes, 32 (63%) were female and 19 (27%) were male. Athletes were from 11 NCAA sports teams and three student-run sports clubs (see Table 1 for details).

Table 1.

Participant Characteristics of 51 Student-Athlete and Nine Staff Member Participants From UCLA, UCSB, and UCSD.

		Campus	Number	Percentage (%)
Student-athletes by campus (n=51)		UCLA	13	26
		UCSB	18	35
		UCSD	20	39
Athletic staff members by campus (n=9)		UCLA	3	33
		UCSB	2	22
		UCSD	4	45
Number of NCAA (n=47) and club (n=4) athletes by type of sport (n=13)
Sport	NCAA men	NCAA women	Club athletes	% Of sample by sport
Soccer	3	8	0	22
Volleyball	3	7	0	20
Water polo	1	6	0	14
Basketball	2	4	0	12
Swimming	0	3	2	10
Rowing	0	3	0	6
Fencing	2	0	0	4
Baseball	1	0	0	2
Tennis	0	2	0	4
Softball	0	1	0	2
Track and field	0	1	0	2
Rugby	0	0	1	2
Sailing	0	0	1	2

Note. UCLA = University of California Los Angeles; UCSB = University of California Santa Barbara; UCSD = University of California San Diego.

Defining Sexual Assault and Sexual Harassment

To understand how participants conceptualized the language of sexual violence, we asked them to define “sexual assault” and “sexual harassment” with their own words. All struggled to distinguish between the two. This lack of clarity was felt to be a barrier to violence prevention.

“I think one of the biggest proponents of sexual assault is the lack of recognizing what is sexual assault and what is not (sexual assault).” - Male Athlete, FGD participant

Students explained that although they hear the vocabulary of sexual violence repeatedly, they don’t regularly give much thought to what each distinct experience or term encompasses.

“I hear about sexual assault all the time, like in the media and throughout the (college) orientation programs, but it’s never really been drilled into my head - like what it is and how to deal with it.” - Female Athlete, FGD participant

Students said it was further difficult to quantify the magnitude of sexual violence on their campus because of “gray areas” around consent make it hard to seek services when negative sexual experiences cause discomfort or feelings of harm/violation but do not fall under a legal definition of sexual assault.

“Let’s say people are making out and that’s okay. And then it seems like it’s okay to go further, but one person hesitates. They don’t want to continue. But in the moment it’s a gray area. Is it sexual assault? If it was consensual in the beginning and then leads to something else that - you know - may or may not have been consensual…Is that sexual assault? Even though two people were like, “we’re okay with it” when starting…that’s where I don’t know. Where would you draw the line?” - Female Athlete, FGD participant

Although anyone can experience sexual violence, participants primarily conceptualized sexual assault and harassment as violence against women, perpetrated by men. The context in which men used violence was consistently categorized in two main groups: violence in situations defined by asymmetrical power dynamics and alcohol and drug-related violence. Two of the most influential relationships in the lives of student-athletes are those with their coaches and professors. All participants recognized that coaches and professors can positively influence the lives of college athletes. At the same time, their power was also noted as a tool they could use to manipulate students into abusive relationships and out of reporting it to anyone.

“I have very strong feelings about the lack of major influence the university has on faculty involved in inappropriate behavior within the college environment. And obviously, we have those relationships too, potentially, in athletics - the relationships with a coach…a male coach, coaching female athletes, for example. As an athletic administrator - I’m just going to be candid - I think there needs to be some real emphasis on the role of these adults when it comes to sexual assault and relationships.” - Athletic Staff, IDI participant.

Relationships with faculty were not addressed much in interviews, but student-athletes narrated feelings of limited negotiating power in their relationships with coaches. They said it was always important for them to please their coaches and project strength and ability. Bringing things up to their coach about sexual violence triggered fears of seeming vulnerable, weak, or like a non-team player, and as a result losing playing time or a spot on the starting lineup. One female student said she and other women athletes are reluctant to address abuse in the sports system because they want to be recognized for their strength, and don’t “want to come out about it and look all prudish or lame.” A male student-athlete said he and his peers kept quiet out of “an inherent fear of authority” and “social anxiety mixed with not wanting to go through a legal system.” Students felt unprotected (from authority figures) by the university’s policies or prevention approaches.

“Part of the problem is you can educate people for the better, but when you have individuals in power, like coaches, they can set the culture back and really do a lot of damage to the way these issues, like sexual violence, are approached and talked about.” - Male Athlete, FGD participant

Alcohol Use and Sexual Violence among Athletes

From the perspective of student-athletes, peer-to-peer sexual violence (i.e., assault perpetrated by one student against another) was thought to mostly involve alcohol or substance use. There was consensus, including among staff, that drugs and alcohol were readily available on campuses.

“These kids are coming to college and there’s alcohol everywhere, right?…Well we’ve noticed it’s becoming a bigger problem, you know - they are even using Oxycontin and mixing those kinds of drugs and alcohol and it can have a real negative effect.” - Athletic Staff, IDI participant

Students perceived drinking as a ritual of college life and heavy episodic drinking (or “binge drinking”) was normalized. Student-athletes “partied” a lot together and, often isolated from non-athlete students. Participants also felt that student athletes were more likely to “binge drink” than non-athlete students, and the most severe, negative consequences were believed to be experienced by female students/athletes.

“At every party I’ve been to here, the guys are kind of drunk and having a good time but the girls are blacked out.” - Male Athlete, IDI participant

Participants theorized that athletes “binge” on alcohol more frequently than their non-athlete counterparts because practices of their full athletic-academic schedules, leaving short periods of time to socialize, where they need to compensate by cramming all their downtime activities and social events, including drinking into limited windows of free time.

“Because of their seasons and their practice and game structure - binge drinking happens. Because the student can’t drink and then suddenly they CAN for one night. You know when you tie all that to the issues that occur when both men and women are together and have been drinking, um, that that’s where we end up - with athletes having more problems than the average student. I think those are things we can continue to address in multiple ways. It’s not just, ‘Oh, these are athletes so they’re more likely to be rapists,’ which is what the misconception is. It’s more of how they end up in situations and how we can educate them not to.” - Athletic Staff, IDI participant

As illustrated in the above quote, participants linked alcohol use with increased risk for sexual assault by complicating someone’s ability to negotiate sexual consent.

“With drinking…I think that hinders the ability to recognize sexual assault even worse. I think wholeheartedly that alcohol does contribute to sexual assault.” - Male Athlete, FGD participant

With a better sense of participants’ understanding of sexual violence, we asked them about their involvement on campus and within the sports system and how it influenced their feelings of connectedness to school and their perceived risk for sexual violence.

Athletic Identity and Campus Involvement

Membership to NCAA athletic program was a great source of pride as well as stress for student-athletes. It is important to understand the identity as a student-athlete when designing sexual violence prevention programs and services. Student-athletes repeatedly narrated pride surrounding their membership—as an elite athlete—in the large, nationally recognized University of California athletic system.

“I am proud…we’ve moved up in the rankings nationally from public institution and stuff. So it’s really become more of a, like, prestigious university. It’s really cool to be at a place that has that much respect, national respect.” - Female Athlete, FGD participant

Many felt honored to serve as NCAA athletic representatives of their campus. Participation in sports contributed to a strong and positive identity among athletes, making them feel like unique members of campus who were not only students, but serving as the face of university.

“I think my personal pride comes from being in athletics and that makes me feel rooted with teammates, and other people are looking out for me. And then that’s what I value most - I’m an athlete not just a student.” - Female Athlete, FGD participant

Athletes also recognized the benefit of being part of an organized team, including learning the importance of cooperation, building on each other’s strengths while accepting each other’s weaknesses, providing physical and emotional support to others, and developing respect for self and teammates. These attributes carried a powerful sense of commitment to “having your teammates’ backs” - both on and off the field.

“I think for a fact if I was ever at a party and my teammates were there and I got into any sort of altercation with someone else, I know every single person on my team that was there that saw it would instantly jump in.” - Male Athlete, FGD participant

For some, particularly male athletes, the ongoing sense of alliance and loyalty among teammates created a strong sense of belonging on campus.

“I think athletics definitely has a stronger sense of belonging just because we are here to support each other in athletics.” - Male Athlete, FGD participant

Some of the club-level female-athletes felt the closeness of teammates increased their safety.

“You need a group of people looking out for you all the time. I usually go out with my friends from rugby. We are a lot more aggressive than your typical women. So we see something, we do something.” - Female Athlete, IDI participant

Overwhelmingly, however, most student-athletes felt a substantial divide between the academic and athletic sides of their own campus lives. Students narrated limited feelings of connection with the larger campus community and, sometimes, even beyond their own team.

“I’m more connected with my team than the Triton community as a whole, just because we spend so much time together and also have the same schedule so we hang out, outside of practice a lot, but, as a whole community, it’s not like we do a lot. There’s not a whole lot of community in general at UCSD.” - Male Athlete, FGD participant

A consistent message was that student-athletes face great pressure to balance two equally demanding endeavors—a sports career and full-time enrollment at an academically competitive university. Students struggled to “do it all” and athletic staff also recognized athletes’ ongoing challenges with anxiety over sports and academic performance, pressure to maintain athletic scholarships, and fear of disappointing parents or coaches, among other stressors.

“…dealing with some of the pressures and some of the common things that student athletes say they deal with, as it relates to social media, and failure, and feeling anxiety, and home sick, depression...some of those things. I definitely think students face so many unique stressors and then with athletics on top, plus many other responsibilities.”-Athletic Staff, IDI participant

Athletic departments respond with attempts to mitigate stresses and offer resources and services for student-athletes, particularly in the area of academic support.

“They have help - tutors and mentors and study groups. They really have a lot of resources for them to use.” - Athletic Staff, IDI participant

Despite these resources, students said they felt pressed to do everything well, and additional anxiety from always needing to act like leaders of their campus and the UC system. While—as noted—this ambassador-type identity sometimes created pride for students, it also commonly added to what seemed like a stretched, sometimes unattainable, list of responsibilities.

“…student conduct has come up a lot, because they drill it into our mindset. We’re representing the university and all that. We’re playing other teams and other schools so we have to really be model citizens, model students.” - Male Athlete, IDI participant

Associations between Intercollegiate Athletics, Mental Health and Sexual Violence

In addition to enriching their lives, participants narrated how playing competitive sports took away from time for other activities, interests, and relationships. Division I and II athletes said dedication to their sport came at the expense of taking part in activities most students look forward to in college, such as time with friends, parties and social events. Many club-level athletes specifically decided against NCAA-level play in order to have more rounded college experience, where they were not limited by their sport schedule.

“You can miss out on a lot of things with practices and games from travel and stuff. So I feel like if we were just regular students, we would be able to do more.” - Female Athlete, IDI participant

The pressures felt by many NCAA athletes gave them a sense of social isolation and limited social support, both of which are associated with adverse health outcomes (Leigh-Hunt et al., 2017) and were referenced in our study. Interviews with students, coaches, and directors revealed rising numbers of student-athletes are living with anxiety and depression.

“I’ve worked at [named 3 private colleges] and I’d say this (UC campus) is probably the hardest to do well in, academically. The stress and pressure here…I think it probably adds up and gets to the kids. A lot of those kids - maybe half of them - don’t have a great network of friends or the social skills or time to make those friends. I think that can be internalized and turned into anxieties and depression.” - Athletic Staff, IDI participant

Stigma was noted a main reason given for student-athletes choosing to not seek assistance for mental health issues or sexual violence. Athletes feared disclosing mental health symptoms like depression or reporting sexual assault or harassment would make them seem weak or problematic, potentially impacting their athletic career and future chances of professional play.

“There is stigma around being the victim in any situation, whether it’s sexual assault or anything else. I think this is especially so, being an athlete. You don’t necessarily want to be portrayed as being weak. There’s talk of mental strength and the mental part of being an athlete. I think that’s a huge part of what is encouraged of us, or voiced to us. So I think it’s like, ‘oh this [referring to being a victim of sexual assault] is just another way for me to NOT be mentally stronger.’ I think it kind of also plays into the mental illness stigma and how you’re kind of looked down upon… if you come out as being vulnerable and weak, as an athlete.” - Female Athlete, FGD participant

Some female NCAA athletes felt the high-profile image of being a Division I or II player and the tight-knit nature of the athletic department reduced their ability to self-protect from harm and discrimination, particularly in light of new Title IX rules on college campuses, allowing accused perpetrators to cross-examine the victim during a live hearing. Some women interpreted this policy change, precluding a victim’s ability to remain anonymous, as a major gap in support for survivors on college campuses—particularly student-athlete survivors who are assaulted by another student-athlete, in a system where players are shaped to feel obligated to protect fellow athletes and the interests of the athletic department, even if it compromises their own welfare.

“This past month, someone on our team was assaulted by another athlete and she’s not reporting it, since he’s a part of the athletic department. If we say his name, then Title IX - because the rule just changed - would, instead of putting it under Title IX as his case, it would go under her name. She (the assault victim) sent out a text to make sure it was in his name. Because if it gets out that she reported him, he will be notified through the athletic department and there would be charges - so he’d know which team it came from. They would know who it was and it would be really scary for her - that they would know who specifically she was. It would harm her more than it would harm him.” - Female Athlete, FGD participant

Male athletes also felt a strong sense of loyalty to their team and to up-holding its reputation, leading some to feel pressured to protect their teammates, even in a case of sexual violence.

“I’ve heard that a lot of time, players won’t say anything - if they know about a sexual assault - because they don’t want to get him (their teammate) in trouble. They also don’t want to get in trouble, themselves. They don’t want to have their name in the news.” -Male Athlete, IDI participant

Some female athletes found it hard to acknowledge sexual assault as sexual assault when they knew the perpetrator, and sometimes empathized with the person who attacked them, trying to see the incident from his point of view. The quote below illustrates how one participant justified the assaulter’s behavior and expressed concern about causing him harm.

“It kinda hurt my life, but do I need to ruin yours because of it? Cause I know you, and I think there’s sympathy - probably especially with people they know. ‘They didn’t mean to and they’re my friend, and they misunderstood.” Giving sympathy to their assaulter happens by the victim ‘cause they know them.” Female Athlete, IDI participant

Perceptions of NCAA Programming for Campus Sexual Violence Response and Prevention

To address and respond to sexual violence in NCAA sports programs, the Sport Science Institute of the NCAA developed the “Athletics Tool Kit for a Healthy and Safe Culture” (National Collegiate Athletic Association & Sport Science Institute, 2016)for implementation on all NCAA member campuses, including UCLA, UCSB and UCSD. In the 2018–2019 academic year, all three campuses attested to following the requirements of the NCAA Policy on Campus Sexual Violence. We asked participants to share their feelings on how well their campus did in demonstrating their commitments to engaging college leadership in sexual violence prevention and offering evidence-based educational programming. We did not investigate similar programming for club-level sports programs on the UC campuses.

NCAA’s commitment to engaging college leadership in sexual violence prevention.

The NCAA’s first core commitment area to preventing sexual violence in intercollegiate sports is leadership and making violence prevention a priority for college presidents/chancellors, athletics directors, coaches, sports medicine personnel and other athletics stakeholders (National Collegiate Athletic Association & Sport Science Institute, 2016). Staff members, coaches in particular, were keenly aware of their important role as active promoters of prosocial individual and culture change—on campus and within the lives of student-athletes.

“It’s my job – to help them become responsible adults. I mean, look, there’s only so much basketball we can teach…and the teaching part means you teach them about life. How to be a good person, how to be responsible, how to be a man of your word, how to be on time, how to compete, how to be a great teammate. You know, how to have empathy for others who aren’t as fortunate as you. You’re an elite athlete. We’re less than 1% of the population, right? If they don’t learn these things and they’re around us for four years, what are we doing? I shouldn’t be coaching. Right?” - Athletic Staff, IDI participant

Student-athletes in leadership positions, such as team captain, are also required per NCAA guidelines to participate in formal training. Compared to the rest of the players, student leaders said they were exposed to more of what is going on among campus and athletic leadership, with regard to education and prevention. In theory, they are to pass these lessons along to their team.

“As a team captain, before the season we watch a video with the EDI (Equity, Diversity and Inclusion) Director and our coaches. It’s an anti-hazing video but also encompasses anti-sexual assault and anti-sexual harassment and anti-harassment. I think in my position, where I’ve put myself as a leader in the program, I’ve seen a lot more of the preventative tactics that the school is putting forward.” - Female Athlete, IDI participant

A noted gap in university leadership was a lack of evaluation of violence prevention efforts on campus. The National College Health Assessment (NCHA) is an NCAA-recommended research survey on student health habits, behaviors, and perceptions. Some participants had completed it during the prior year but none were aware of the results, demonstrating a missed opportunity for prevention education. Students and staff unanimously felt more should be done by the UC to develop and assess campus climate regarding sexual violence, overall and as it relates to athletics. When discussing why more research has not been done on the UC campuses, and how some leaders have expressed concerns about studies on violence, one participant said:

“Quite frankly I don’t understand why (some are concerned about research). Well I can’t understand it, but personally I don’t understand what the concerns would be because sexual violence is a problem that needs to be addressed.... and the reason it’s a problem that needs to be addressed is because we don’t do things like research, which allows things to continue as is. To me, it’s almost like research on racism, you know? A lot of people don’t want to talk about those things and that’s why we continue to have the issues we have - because we don’t have that collection of information about some ideas to work on it and so forth.” -Athletic Staff, IDI participant

NCAA’s commitment to educational programming to change behaviors and cultures.

The NCAA requires its member campuses to provide evidence-based educational programming, tailored to meet the needs of student-athletes and provided to all who directly influence student-athletes’ decision making and behaviors (e.g., coaches, athletics administrators, sports medicine staff, academic support personnel, faculty, family of student-athletes). Student-athletes recalled educational programming during orientation, team meetings and specially arranged sessions focused on distinct topics like substance abuse or the relationship between sexual violence and alcohol. Many indicated that they valued the positive intent of the UC education programming but felt it was devalued by athletes who saw it as one more obligation to take care of in their already limited time.

“I feel there is really good information and the intent is there but people don’t take it seriously - just because it’s another thing we have to do.” Female Athlete, FGD participant

Most emphasis in the athletic programs was said to be placed on having students complete brief, one-off trainings on how to understand consensual sex before a sexual encounter and on bystander intervention methodology. Athletes expressed authentic interest in learning more about relationship dynamics and sexual health and thought the NCAA training programs were a real start, but most felt the offerings availed to them were prescribed and inadequate.

“I think (the training) was as helpful as a 6 minute video could be, but the idea of it is more like the NCAA is mandating that everybody gets this training. So it was like, ‘okay, let’s meet the requirement and check the box,’ but it wasn’t sufficient.” - Male Athlete, FGD participant

Student-athletes, especially women, felt the NCAA education on negative language choices and their adverse impact on team culture was ineffective, or was not provided at all as some participants were unaware of this programming. Many female athletes noted there was ongoing use of misogynistic and demeaning language in the sports system.

“Their entire team (referring to one of the NCAA men’s teams), as a whole, makes sexist comments. They’re not perfect little boys. They are college men and they cross the line in other ways too.” -Female Athlete, IDI participant

Staff also recognized a need for prevention education to be more comprehensive and revised to be more survivor-centered. Current approaches—particularly those offered as brief training modules, followed by comprehension quizzes—were thought by many to be lacking in their ability to cultivate a true understanding, compassion and empathy.

“Do the tests make you understand how the victim feels or anything close to it? Absolutely not. Of course not. I’m a man. Do most men understand what it’s like to walk in a woman’s shoes to feel that fear and all that? No. That’s like saying, do most men understand what it’s like to have a baby. No. Can there be a lot better understanding? Absolutely. I know guys that have daughters are a little more sensitive to it, and also if they have wives. Sometimes they could be [more understanding] but taking a test will not change anything.” -Athletic Staff, IDI participant

Most staff only recalled completing the NCAA’s online training program which was available for student-athletes as well. Student-athletes felt these sessions lacked authenticity and meaning and could be completed rapidly, without actually learning anything.

“People would scroll through (the online program) and be like, ‘whoa!’ Like it was a joke. ...it was just very cringy kind of… I think it was well intended, but it wasn’t the best way to convey it. And no one did it and then we got to the last day and our coaches were like, ‘This is a list of everyone who hasn’t checked off that they’ve watched the video. Please do it by the end of the day.’” -Female Athlete, FGD participant

A common reflection on the education provided through the athletic department—including both in-person and online offerings—was it reflected little thought from leadership and likely only served to achieve compliance with NCAA’s requirements. This was narrated by both students…

“Every single thing I see [about violence prevention] looks like they’re being forced to do it. It all looks like this is some kind of legal requirement from some other thing, like the government or the NCAA. Just nothing that looks like its actually, like there’s any real investment in it, other than a liability dodge.” -Male Athlete, FGD participant...and athletic department staff members:

“They did this out of CYA, which means ‘cover your ass.’ All University of California campuses have to take this online training about sexual assault and about these types of things. It’s about an hour. It’s taken online and you know that’s what everybody has to do. That’s what I call a CYA fix.” Athletic Staff 2, IDI participant

Students said they thought the education was supposed to promote prevention of sexual violence but felt that most measures used by the UC were “reactionary,” not preventative. One-off trainings, lack of participatory approaches that offer iterative platforms for learning, and the provision of basic contact information for campus sexual assault centers (referred to as CARE offices at the UC) and the school-wide Counseling and Psychological Services (CAPS) were perceived as “bandaid” approaches to claim compliance with the Department of Education and maintain NCAA membership status.

“I think the UC’s entire preventative measures can be summed up as ‘too little, too late’ because they DO have CAPS and CARE and stuff like that, but it’s like - we don’t even know what they do. So like, having these [measures] is too little, and it’s only after the fact.” -Male Athlete, FGD participant

College Athletic Programs as a Platform for Sexual Violence Prevention

Intercollegiate athletics are one of the most well established systems on many college and university campuses and hold promise for serving as a platform to prevent sexual violence among athletes and the larger campus community. Coach-led interventions are widely promoted and implemented to work toward these goals but participants expressed strong reservations about the acceptability and effectiveness of student-athletes turning to their coaches for guidance on healthy sexual experiences and intimate relationships. Both athletes and coaches were fully comfortable with an approach of working together on developing positive team relationships and athletic and academic competency. On the contrary, the head coach-athlete relationship was seen as unacceptable for addressing personal issues, unless absolutely necessary. Coaches recognized and understood that their student-athletes almost always only wanted them to see their best side.

“I oftentimes am the decision-maker of their playing time, which can skew the relationship a little bit. They tend to get a little closer to the assistant coaches. For instance, when we drive the vans at the airport, it’s a mad dash to get into the one with the assistant coach. The last couple of stragglers get into my van. There is a separation there and I think there needs to be. And there’s more of a separation during the fall season because that’s kind of when the results really are the emphasis of what we do…. I’ve always thought that I’m a fairly approachable guy, but much more so out of season than in season. In season is hard. My one assistant especially, is the most approachable guy, in season.” -Athletic Staff, IDI participant

Almost all student-athletes felt wary of sharing non-sports information about their lives with their coaches. It felt uncomfortable and inappropriate and students believed it was also awkward for the coaches—thinking they, too, would rather avoid knowing about student problems.

“I feel like most coaches would be scared for their athletes to come out and admit something out of fear that could either ruin the face of the athletic department and they wouldn’t want any scandals, so I feel like they’d usually rather sweep it under the rug, just to avoid any problems.” -Male Athlete, FGD participant

Athletes said they would not feel comfortable confiding in their coaches about sexual violence.

“If I were [sexually assaulted]....I probably wouldn’t go to my coaches, not because they’re not supportive but I just wouldn’t feel as comfortable talking about that personal of a topic with them.” -Female Athlete, FGD participant

Assistant coaches were felt to be better placed than head coaches to help student-athletes handle or avoid relationship-level problems in their lives. Instead, students unanimously stated a preference for peer-to-peer mentorship frameworks. Athletes felt more comfortable interacting with their peers, overall, and particularly when it came to addressing intimate details about their lives, let alone a potentially traumatizing event such as sexual violence. Student-athletes said they prefer receiving guidance from other student-athletes, because their shared generational and athletic experiences cultivate stronger feelings of comfort and safety—to disclose information, ask questions, and receive meaningful feedback.

“In my experiences with our coaches, they haven’t given us any strong guidance in terms of matters that really pertain to our lives and have really serious implications, aside from the scope of “Hey, study” and “Don’t do stupid shit!” With a situation like sexual assault, it would be very meaningful to have members, like for example, within the scope of athletics, members of a team, for example, speaking out on this type of stuff.” -Male Athlete, FGD participant

Student-Athlete Mentor (SAMs) programs were seen as a successful way to provide help and support to other athletes—through education, raising awareness, and promoting healthy lifestyles. The SAM approach was implemented for first year players on one of the study campuses and both the athletes and staff members felt strongly about its positive impact.

“We have a [peer] mentoring program just for our freshmen. So we require our freshmen to be in it because it’s a transitional thing plus it’s a way for us to monitor their academic performance, as well. So they meet with their mentors once a week… we think it’s a resource we really have to take advantage of.” -Athletic Staff, IDI participant

Some student-athletes said peer mentors might be preferred over formal services on campus.

“We had a girl on our team who had been sexually assaulted in high school. She told our team openly about it and I think our coaches know about it too. I think she went to CAPS and said she’s getting help but I feel like if someone on our team were to experience sexual assault and they know she has already been through, she would definitely be a person our team members would approach… I feel like it’s better going to someone who is your same age and plays the same sport. There are so many similarities. I feel like that would make me more comfortable.” -Female Athlete, FGD participant

Team captains, in particular, were thought to be ideal mentors for raising awareness, modeling prosocial behaviors and offering guidance on how to have healthy relationships.

“I’m pretty sure if the team captain said something like ‘sexual assault is a problem and we need to make sure we all have the same mentality towards this type of issue, particularly if we’re going to be partying or if people want to pursue avenues of sexual interactions with other people’ that would help. It’s nice when it comes from somebody you have an intimate relationship with, telling you about these types of things. It needs to come from somebody there’s a form of respect with. I feel like if a captain said a few words about that, that would be a good thing to do, a good way to educate people about these types of things.” -Male Athlete, FGD participant

Discussion

Our research yields three main findings. First, student-athletes and athletic department staff members associated college sports participation with increased risk for sexual violence but felt the prevention education and response programs available to them through either the university or the NCAA failed to effectively address key issues at the root of this synergistic relationship. The second main finding is that NCAA athletes felt academically and socially isolated from the larger campus community. This sense of a disconnection was perceived to contribute to increased rates of mental health problems among student-athletes, and decreased likelihood of their use of important campus resources (e.g., psychosocial and counseling services) and of reporting sexual violence. Lastly, despite widespread promotion and implementation of coach-led “character education” training for college athletes—on topics including bystander intervention, and relationship violence—student-athletes expressed discomfort with disclosing information to their coaches about their intimate sexual relationships.

Corroborating prior findings that sexual assault and harassment are often misunderstood by student-athletes and intercollegiate athletic department staff (Rahimi & Liston, 2009), our participants struggled to define these concepts. Athletes said that, apart from completing mandatory university and NCAA sexual violence prevention education training, they had never spent time assessing their understanding of the continuum of sexual violence, let alone what could be done to stop it. Participants referred to a previously coined “Checkbox Culture” in athletic departments that is limited to what is necessary to meet requirements set by their university, Title IX or the NCAA. Athletic departments provided referrals or resources when necessary without overtly supporting survivors (McCray, Sutherland, & Pastore, 2018). Building on previous studies(Long, Rahimi, & Liston, 2015; McCray et al., 2018), our findings imply a need for more nuanced sexual assault education that is tailored to meet the distinct needs of different genders and sports teams, and account for other key social determinants.

We suggest moving away from top-down decision-making and program implementation, and toward student-led approaches that encourage critical thought, opportunities for open-discussion and emergent problem solving techniques. Student-athletes should not only be participants, but leaders in all efforts to design, implement and refine programs and policies related to sexual violence prevention and response on campus and in athletic departments. Including student voices in research, as we have done in our study, is informative but it is not enough. We argue that university administrators and athletic/academic leaders also need to begin radically listening to student-athletes and responding to their suggestions on their own education and outreach needs. Students consistently reported that sporadic, one-off trainings that provide general awareness-raising or one-way instructional messaging on consensual sexual encounters do not succeed in educating athletes on consent, survivors’ services, or intervention approaches. It is time for university and college leadership to listen to and really hear what student-athletes are saying, and respond with meaningful change.

We would benefit from borrowing lessons from the global field of violence against women prevention programming and research. Decades of experience reveals that effective transformation requires focusing on violence more broadly (i.e., not only as it relates to sports), and coordinating systems to promote insightful reflection on sexual assault and harassment as public health problems and to ensure critical connections are made (i.e., between athletes and the overarching campus community) (Michau, Horn, Bank, Dutt, & Zimmerman, 2015). NCAA athletes described their lives as so narrowly focused on their sport that they felt disconnected from the campus community around them. This isolation was often compounded by a strong pull from athletic departments for athletes to turn to internal resources of support (e.g., student-athlete tutors) and to their coaches for guidance on personal problems. Student-athletes expressed discomfort, however, with the idea of sharing details about their sexual experiences and intimate relationships with coaches. Athletes were loosely aware of sexual violence and mental health resources on the broader campus with female student-athletes demonstrating significantly more knowledge than males. Most student-athletes in our study showed reluctance to use available resources because of limited time, and concerns that seeking assistance outside of the athletic department would cause more problems than benefit. To understand prevalence and risk factors for sexual violence victimization and perpetration, as well as barriers and facilitators to service utilization among student-athletes, we recommend representative, quantitative research for measuring these estimates. Our qualitative research does suggest, however, that strong loyalty to the sports system served as a barrier to athletes’ willingness to seek assistance for services and, for female athletes, to report perpetrators of violence, particularly if the abuser was also within the athletic system.

Student-athletes provided other important recommendations for improving sexual violence education programs and resources on campus. Participants from both men’s and women’s teams felt stronger connections with their teammates and team captains than with any of their coaches. Athletes requested that programming be redesigned so other athletes are able to lead systems change efforts focused on understanding and preventing sexual violence and addressing its intersections with salient issues such as alcohol related concerns. A small liberal arts college study recently found exposure to bystander training that addressed heavy drinking increased athlete’s prosocial bystander behaviors and decreased high-risk alcohol use (Morean et al., 2018). This type of approach warrants pilot-testing for feasibility and impact on large campuses like those in our study. Students and staff alike felt the university should put more resources into increasing staffing in the counseling and sexual violence service offices, and efforts should be placed on better coordinating targeted programming for student-athletes so they feel more connected.

While our study informs gaps in current sexual violence prevention efforts through in-depth analysis of student-athletes’, coaches’ and administrators’ perspectives, there are limitations worth noting. First, our findings are likely not generalizable to all NCAA sports and the student-athletes who play them—both on our three study campuses and across the UC system and beyond. This is because our sample was small and lacked representation from athletes and staff from all of the NCAA sports teams at UCLA, UCSD, and UCSB. Most notably missing from our pool of participants were football players, the athletes most commonly accused of perpetrating sexual assault on college and university campuses (Wiersma–Mosley & Jozkowski, 2019). Further, while two men’s basketball players participated in a focus group, we largely lacked representation from male student-athletes who played other than football and basketball contact, team-sports where aggression is common including hockey, lacrosse, wrestling, etc. Research has found that boys and men who play these heavy-contact sports are significantly more likely to perpetrate sexual assault, physical violence and psychological aggression, relative to players of non-contact, individual sports such as cross country (Forbes et al., 2006; Trebon, 2007). Despite extensive efforts to engage male student-athletes and their coaches in our study, we were commonly met with non-response and/or declined participation. Receiving endorsement of our study from NCAA leadership and university athletic directors facilitated enrollment of participants, but these endorsements and their benefits were limited. Some athletic leaders seemed reluctant to participate or have their staff and students get involved in our research due to concerns about how the information they shared with us would be portrayed or disseminated to the public. These worries seemed amplified as a result of both high profile scandals and negative local news stories in the media over the past few years, involving NCAA players, coaches and directors. We tried to mitigate these concerns by providing detailed information on how our public health research aimed to minimize bias that can occur in data collection, analysis and reporting. Nonetheless, it took an extensive amount of effort and time to involve participants from the athletic departments and we were unsuccessful in recruiting more players and staff from the most popular and highest revenue-generating sports at UCLA (football), UCSD (men’s basketball) and UCSB (men’s basketball). These shortcomings limit our ability to make between- or within-group inferences from our findings, and to speak to the perspectives of the most highly valued and prestigious and possibly most violent student-athletes on our campuses. An ideal future research design would use stratified sampling methods to ensure equal representation of student-athletes from men’s and women’s teams and non-contact individual and contact team-level sports. Also important would be ensuring participation of athletes from the most popular and highest revenue-earning sports.

Because our research was conducted on three, large public university system campuses, our findings should be interpreted with caution when considering their applicability to the culture at smaller schools and/or private institutions. Further, this assessment was a sub-study of a larger project focused on overarching perspectives on sexual and intimate relationships and campus environment related to relationship health. As such, the IDI and FGD guides we used were developed for broader discussion and were not created specifically for examination of violence within sports culture. Thus, sports specific probing was not uniformly enforced or outlined, potentially missing important nuances and findings. Lastly, some participants did not feel comfortable providing us with their complete demographic information in the pre-interview / pre-focus group survey. This resulted in an incomplete dataset on participants’ identifying characteristics, such as age, race and ethnicity, gender, and sexual identity and orientation. This precludes our ability to understand potentially important differences between participants and examine how student-athletes from historically marginalized populations experience and perceive sexual violence. We believe, however, that ensuring confidentiality and offering the option of anonymity are critical when conducting research on highly sensitive topics, such as sexual violence, in such a close community.

Despite the small scale of this study, we feel the findings are important and actionable, providing insights into some changes that can be made immediately, such as bringing student-athletes to the forefront of program and policy reform. This study highlights student-athletes’ needs, concerns, and reasons for not seeking care which could inform student engagement and participation efforts. We intend to use what we have learned from this study to guide next steps in research on the UC campuses and hope our results might help others think through future prevention and response efforts on their own campuses.

Biographies

Author Biographies

David Stoddard Carey, BA, is was a consultant with the Center for Gender Equity and Health in the Division of Infectious Diseases and Global Public Health at the UCSD School of Medicine. He is currently a Clinical Research Coordinator for the Department of Orthopaedic Surgery at Stanford University. His research interests include harm reduction, holistic pain management, and peer led violence prevention.

Stephanie Sumstine, MPH, is a Project Director at the UCLA Center for Community Health and the Center Coordinator for the University of California Global Health Institute (UCGHI) Women’s Health, Gender and Empowerment Center of Expertise (WHGE COE). Her research interests include substance use, sexual health, and addressing health disparities in historically marginalized communities.

Claire Amabile, BA, is a Master student in a dual degree program, pursuing Master of Public Health and Master of Social Welfare degrees at the University of California Los Angeles. Her research interests include sexual violence prevention and intervention, global perceptions of sexual violence, and the intersection of abuse against animals and intimate partner violence.

Heather S. Helvink, BA, is a Research Assistant at the Center for Gender Equity and Health in the Division of Infectious Diseases and Global Public Health at the UCSD School of Medicine. Her work involves assisting with projects that address reproductive rights, sexual violence, and health outcomes of women and girls locally and globally.

Cierra Raine Sorin, MA, is a Doctoral Candidate in Sociology with a Feminist Studies emphasis at the University of California, Santa Barbara. Her research interests include masculinity, gender, sexuality, and sexual violence. Cierra’s dissertation is a study of consent education, practices, and enactment, and anti-violence efforts in BDSM communities in the United States.

Dallas Swendeman, PhD, MPH, is an Associate Professor in the Department of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at the University of California Los Angeles (UCLA). He Co–Directs the University of California Global Health Institute’s Women’s Health, Gender and Empowerment Center of Expertise, and Co–Directs the Development Core of the Center for HIV Identification, Prevention and Treatment Services (CHIPTS) at UCLA.

Eunhee Park, MPH, is a doctoral student in the Department of Community Health Sciences at the University of California Los Angeles Fielding School of Public Health. Her primary research interests include reducing violence against women, advancing sexual and reproductive health, and reducing environmental threats to maternal and child health.

Jennifer A. Wagman, PhD, MHS, is an Associate Professor in the Department of Community Health Sciences at the University of California Los Angeles Fielding School of Public Health. She is the Director of Violence Prevention Research for the University of California Global Health Institute Women’s Health, Gender and Empowerment Center of Expertise.