Novel Program Cuts Sexual Assault Rates on College Campuses

Megan Brooks

June 11, 2015

A sexual assault resistance program for female freshman college students proved highly effective in a controlled trial conducted on three university campuses in Canada. During a period of 1 year, the program led to a decrease in completed and attempted rape and other forms of victimization.

"The program has a strong foundation of psychological theory and is based on research evidence," Charlene Y. Senn, PhD, Department of Psychology, University of Windsor, in Canada, told Medscape Medical News.

"There are many barriers to recognizing danger in situations where threat is not expected, such as social situations or interactions with known men. The program is designed to give women the information, skills, and practice they need so that they can more quickly identify a situation as dangerous and get out or use forceful resistance if necessary," she noted.

The study was published online June 11 in the New England Journal of Medicine.

Clear, Sustained Effect

Young women attending university are at substantial risk of being sexually assaulted, primarily by young men they know. Universities face heightened pressure to educate students about sexual assault, but effective strategies to reduce the risk "remain elusive," the authors note.

They studied the efficacy of a sexual assault resistance program, as compared with access to brochures on sexual assault (control), in 893 first-year female students at the universities of Windsor, Guelph, and Calgary.

The resistance program consists of four 3-hour units in which information is provided and skills are taught and practiced, with the goal of being able to assess risk from acquaintances, overcome emotional barriers in acknowledging danger, and engage in effective verbal and physical self-defense.

There were 451 women in the resistance group and 442 in the control group. Of the women assigned to the resistance group, 91% attended at least three of the four units.

The researchers report that the 1-year risk for completed rape was significantly lower in the resistance group than in the control group (5.2% vs 9.8%; relative risk reduction, 46.3%; 95% confidence interval [CI], 6.8 - 69.1; P = .02). They calculate that for every 22 women enrolled, the intervention would prevent one additional rape from occurring within 1 year after participation.

"The benefit of the resistance program occurred early, and its efficacy was sustained throughout the 1-year follow-up period," they note. "The program also reduced the incidence of attempted rape (3.4% in the resistance group vs 9.3% in the control group; relative risk reduction, 63.2%; P < .001)." Incidents involving nonconsensual sexual contact and attempted coercion were also lower in the resistance group than in the control group, but there was no significant reduction in coercion in the resistance group.

In subgroup analysis, the 1-year risk for completed rape in the control group was nearly four times as high among previously victimized women as among women with no history of victimization (22.8% vs 5.8%). Despite the elevated risk among previously victimized women, the resistance group had a lower 1-year risk for completed rape than the control group (relative risk reduction, 25.1%).

"Few health-behavior prevention programs show a clear and sustained effect, and when they do, booster sessions are usually required," Dr Senn and colleagues note in their article. "In the current trial, efficacy was shown and sustained to 1 year without booster sessions. This is important, because the risk of sexual assault is highest in the early years of university. Follow-up of trial participants is continuing to evaluate whether the benefit persists beyond 1 year."

"The program requires well-trained and knowledgeable facilitators who can deliver the workshop in pairs to small groups of 20 women. By next year, we'll have developed a train-the-trainer session so universities and colleges can participate and then deliver their own workshops," said Dr Senn.

"Our research will continue by assessing the effectiveness of the program when it is delivered at other universities under less controlled conditions," Dr Senn said.

Partial Solution

Kathleen C. Basile, PhD, of the Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, comments on the study in a linked editorial.

She notes that sexual violence is a "preventable public health problem," but there are "no easy solutions to this problem. Quick, single-session sexual violence interventions are not effective and may actually be harmful."

Dr Basile says this study has "numerous strengths consistent with principles of effective prevention, including a rigorous design, assessment of several types of sexual violence, and an intervention informed by theory and administered in multiple sessions with the use of varied teaching methods."

The study's primary weakness, according to Dr Basile, is that it places the onus for prevention on potential victims, "possibly obscuring the responsibility of perpetrators and others. With a public health approach, the most efficient way to have a population-level effect on violence is through a focus on primary prevention with potential perpetrators as part of a comprehensive, multilevel approach."

She also believes it would be wrong to focus all attention on the college-age group for prevention efforts. "We must start younger," she writes.

The study was supported by a grant from the Canadian Institutes of Health Research and by the University of Windsor. The authors' financial disclosures are listed in the original article.

N Engl J Med. Published online June 11, 2015. Full text, Editorial

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