a research paper on sexual assault

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Campus Sexual Assault: A Systematic Review of Prevalence Research From 2000 to 2015

Affiliations.

1 1 National Institute of Justice, Washington, DC, USA.
2 2 School of Social Work, University of Maryland, Baltimore, MD, USA.
3 3 College of Criminology and Criminal Justice, Florida State University, Tallahassee, FL, USA.
PMID: 26906086
DOI: 10.1177/1524838016631129

Sexual assault is a pervasive problem on university and college campuses in the United States that has garnered growing national attention, particularly in the past year. This is the first study to systematically review and synthesize prevalence findings from studies on campus sexual assault (CSA) published since 2000 ( n = 34). The range of prevalence findings for specific forms of sexual victimization on college campuses (i.e., forcible rape, unwanted sexual contact, incapacitated rape, sexual coercion, and studies' broad definitions of CSA/rape) is provided, and methodological strengths and limitations in the empirical body of research on CSA are discussed. Prevalence findings, research design, methodology, sampling techniques, and measures, including the forms of sexual victimization measured, are presented and evaluated across studies. Findings suggest that unwanted sexual contact appears to be most prevalent on college campuses, including sexual coercion, followed by incapacitated rape, and completed or attempted forcible rape. Additionally, several studies measured broad constructs of sexual assault that typically include combined forms of college-based sexual victimization (i.e., forcible completed or attempted rape, unwanted sexual contact, and/or sexual coercion). Extensive variability exists within findings for each type of sexual victimization measured, including those that broadly measure sexual assault, which is largely explained by differences in sampling strategies and overall study designs as well as measures of sexual assault used in studies. Implications for findings and recommendations for future research on the prevalence of college-based sexual victimization are provided.

Keywords: campus sexual assault; college students; prevalence; rape; sexual victimization; unwanted sexual contact.

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Research article
Open access
Published: 27 December 2018

Exploring the relationships between sexual violence, mental health and perpetrator identity: a cross-sectional Australian primary care study

Laura Tarzia ORCID: orcid.org/0000-0002-0220-4985 1 , 2 ,
Sharmala Thuraisingam 1 ,
Kitty Novy 1 ,
Jodie Valpied 1 ,
Rebecca Quake 1 &
Kelsey Hegarty 1 , 2

BMC Public Health volume 18 , Article number: 1410 ( 2018 ) Cite this article

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Research supports the association between adult sexual violence (SV) and poor mental health. However, most studies focus on rape and physical sexual assault. Little is known about how more subtle forms of SV affect women’s well-being. Furthermore, evidence for the impact of the perpetrator’s identity is mixed. There is also little data from clinical populations to help health practitioners identify SV. This paper addresses these gaps by exploring the associations between different types of adult SV, perpetrator identity, and women’s mental health in the Australian primary care setting.

We conducted a descriptive, cross-sectional study in general practice clinics. Adult women completed an anonymous survey while waiting for the doctor. Measures included PHQ-9 (depression), GAD-7 (anxiety) and PCL-C (post-traumatic stress disorder). SV was measured using items from the National Intimate Partner and Sexual Violence Survey and categorised into three groups (rape/sexual assault; coercive behaviours and/or reproductive control; and unwanted sexual contact).

We found significant associations between rape/sexual assault and poor mental health, and between coercion and/or reproductive control and higher PTSD and anxiety scores, compared to women with no SV experiences. SV perpetrated by an intimate partner was associated with significantly higher mean PTSD scores than SV perpetrated by a stranger, and significantly higher depression scores than SV perpetrated by another known person.

Findings suggest that associations between SV and mental health are mediated by type of SV and perpetrator identity. Health practitioners should enquire about different types of SV beyond stranger rape as a cause of poor mental health, and about perpetrator identity to inform them about the likelihood of ongoing symptoms.

Peer Review reports

Sexual violence against women (SV) is globally prevalent [ 1 ]. In Australia, approximately one in five women have experienced some form of SV since the age of 15 years [ 2 ]. Research consistently shows strong associations between adult SV victimisation and poor mental health [ 3 , 4 , 5 ], including anxiety, depression, and post-traumatic stress disorder (PTSD) [ 5 ]. However, there is inconsistency around what behaviours are included in the definition of ‘sexual violence’ [ 6 ]. The majority of SV literature focuses only on rape or physically violent sexual assault [ 7 ], yet SV also encompasses other behaviours such as coercion, reproductive control, unwanted sexual contact, and forced consumption of pornography [ 4 ]. With the exception of a few studies examining the mental health impacts of coercion as an aspect of intimate partner violence [ 8 , 9 ], and one study from the Cote d’Ivoire on reproductive control [ 10 ], little is known about the health effects of these more subtle types of SV, despite their prevalence [ 11 ].

In an earlier study [ 6 ] we found that poor mental health in women attending Australian general practices was associated with SV, even when a broader definition was used. Women most commonly reported experiencing public harassment or flashing, unwanted groping, and being coerced into having sex. Despite the more subtle nature of these incidents compared to rape or violent sexual assault, women who had experienced SV in our sample were significantly more likely than those who had not to experience higher levels of anxiety and depression, although the association with depression disappeared after controlling for childhood sexual abuse. In the present study, we sought to unpack this finding further by exploring the relationship between poor mental health and specific types of SV.

Another poorly understood relationship is that between the identity of a perpetrator of SV and women’s mental health. Studies consistently suggest that women are most likely to be sexually assaulted by a known perpetrator in their own home [ 12 ], yet community understandings of sexual violence typically focus on stranger rapes in dark alleyways. This is highly problematic, since compared to SV perpetrated by a stranger, SV at the hands of an intimate partner is associated with a higher risk of death or serious injury [ 13 ], exposure to multiple and repeated attacks [ 14 ], greater risk of sexually transmitted infection [ 15 ] and increased feelings of shame [ 16 ], all of which are likely to contribute to poor mental health outcomes. Despite this, findings around mental health and perpetrator identity have been mixed [ 17 , 18 , 19 , 20 ]. For instance, Ullman et al. [ 19 ] found no significant differences in mental health outcomes between women raped by a stranger and those raped by an intimate partner. On the other hand, Abrahams et al. [ 17 ] found higher rates of depression in women raped by a known perpetrator rather than a stranger, although they did not distinguish between an intimate partner and another known person. Several other studies also found worse mental health outcomes associated with SV perpetrated by a partner, including PTSD, stress and dissociation [ 18 ], and hyperarousal [ 20 ]. The majority of these studies, however, focus on rape or violent sexual assault, and several include only women who had already disclosed, or who were seeking help for SV.

As well as a paucity of knowledge around the circumstances of SV experiences and how these impact on women’s mental health, there is a lack of SV data from the primary care setting [ 6 , 21 , 22 ]. This is problematic given that the World Health Organization has recommended primary care as a key part of an effective early intervention and response [ 1 ]. The findings from our previous study suggest that almost half of women presenting to general practice clinics have experienced some form of SV [ 6 ], yet, health practitioners have little data from their own clinical population to guide practice.

The current paper aims to address these key gaps in the literature by reporting data from a cross-sectional study conducted in Australian general practice clinics. Our objectives are threefold: to explore the relationships between different types of sexual violence and mental health outcomes; to understand the relationship between perpetrator identity and mental health outcomes; and to provide data from a primary care sample to help guide practice. We argue that due to the complex relationship between women’s mental health and SV victimisation, general practitioners (GPs) and other health professionals ought to consider a range of circumstances and situations beyond those of stranger rape when seeing female patients with mental health symptoms.

The present study built on previous work exploring the associations between women’s mental health and SV described elsewhere [ 6 ]. We used a short (10–15 min) anonymous survey with women aged over 18 years delivered via iPad or on paper in the waiting room of participating GP clinics.

Practice recruitment

Information packs were posted to 101 private GP clinics in Victoria, Australia who had participated in a previous study on intimate partner violence [ 23 ]. A research assistant then telephoned the clinics a week later to follow up. The lead researcher attended interested clinics in person to speak with staff about the study. It was not a requirement that all doctors at a clinic agree participate in order for the clinic to be eligible.

Participants

Eligible participants were adult women (> 18) waiting to see a participating doctor, who were able to provide informed consent, and had sufficient English comprehension to complete a survey. We needed a sample size of 336 women to have sufficient power to detect one third of a standard deviation in mental health scores between those who had experienced SV and those who had not. Based on our previous study [ 6 ], we assumed similar proportions in each group.

SV experiences were determined using questions about ‘Sexual Violence Victimisation’ and ‘Control of Reproductive and Sexual Health’ taken from the US National Intimate partner and Sexual Violence Survey [ 11 ]. The items cover a broad range of behaviours including reproductive coercion, sex under the influence of alcohol or substances, rape and sexual assault, and unwanted kissing or touching. The identity of the perpetrator was asked using a single item developed for this study: ‘What was the relationship of the perpetrator to you?’. The answer options were: stranger, boy/girlfriend, a date, a partner living with you now, a partner you were living with at the time (now ex-partner), an ex-partner that you were not living with at the time, a family member, a friend, any other acquaintance. Severity of current depressive symptoms was measured using the PHQ-9 [ 24 ], a well-validated tool which has shown very good psychometric properties in primary care settings [ 24 ]. Respondents were asked to indicate on a 4-point scale how often they had experienced each of the 9 items in the previous 2 weeks. Scores range from 0 to 27, with a range of 5 to 9 suggesting mild depression, 10 to 14 moderate depression, 15 to 19 moderately severe depression and 20–27 severe depression. Anxiety severity was measured using the generalised anxiety scale (GAD-7) [ 25 ], a well-validated and widely-used tool. The GAD-7 has shown excellent psychometric properties in prior research [ 26 ]. Respondents were asked to indicate how often they had experienced each of the 7 items in the last 4 weeks: 0 = Not at all; 1 = Several days; 2 = More than half the days. Scores could therefore range from 0 to 14. Scores of 8 or above suggest possible presence of an anxiety disorder, when using the GAD-7 diagnostic algorithm for anxiety disorder, and scores of 5 or above suggest at least a mild level of anxiety. PTSD was measured using the PCL-C (civilian version) [ 27 ], a self-report tool with excellent test-retest reliability and high internal consistency. Scores for this measure range from 17 to 85. Although the PCL-C is not strictly a diagnostic tool, studies have suggested that a score of 30 is a good predictor of PTSD diagnosis in a primary care sample [ 28 ], and could therefore be considered ‘clinically meaningful’.

Data collection

Data were collected between March and August 2016. Research assistants were placed in the clinic waiting rooms. All patients were informed that a research project was in progress. Female patients arriving for their appointment were asked by the practice manager or receptionist whether they would mind being approached whilst waiting for the doctor. If the woman declined, this was recorded along with her date of birth and postcode (with permission and for comparison purposes only). The research assistants were then notified so that they did not disturb the patient. Practice managers also alerted the researchers to any patients who would not be able to consent due to ill health/disability or lack of English comprehension. For safety reasons, any female patient closely attended by a male partner was not approached. Eligible female patients who agreed to be approached were provided with an information sheet outlining the study. The research assistants answered any questions or concerns in person. Women were then given an iPad or paper survey to complete. Written consent via a tick box was built into the survey on the initial screen of the iPad or first page of the paper version.

Survey responses collected on the iPad were saved to the Cloud as soon as the participant submitted the survey. Data collected using paper surveys were manually entered by a member of the research team. Ten percent of the paper survey data was cross-checked by a second researcher.

A number of strategies were put into place to maximise the safety and well-being of participants. These included: providing all women with resource cards on completion of their survey; ensuring that doctors were provided with information on responding to disclosures of SV and child abuse; ensuring that all team members were trained to respond sensitively to participant distress; and providing private spaces in which to speak with women if needed.

Data analysis

STATA version 13.1 [ 29 ] was used for all analyses. Descriptive statistics were used to summarise participant demographics. SV items were categorised into three groups for analysis: 1. rape or sexual assault; 2. coercive behaviours and/or reproductive control without rape or sexual assault; 3. unwanted sexual contact only (see Table 1 ). Coercive behaviours and reproductive control were combined due to the similarities between the constructs. Perpetrator identities were collapsed into three categories: intimate partner, family member or other known person, and stranger. Linear mixed-effects models using restricted maximum likelihood estimation and random intercepts at the clinic level were used to estimate the mean difference in mental health score between those who had experienced a form of SV and those who had not. Outcome measures were adjusted by clinic (cluster) and experience of childhood sexual abuse, given that both these variables could potentially influence both adult SV victimisation [ 30 , 31 ] and mental health [ 32 , 33 , 34 ]. Any participant characteristics that differed between those who experienced sexual violence and those who did not (see Table 2 ) were treated as potential confounders. These variables were tested in separate univariate models with the outcome variable, form of sexual violence and perpetrator identity. Only those variables found to be associated with both the outcome and independent variable were included as confounders in the adjusted model. Transformations for skewed continuous measures were considered. The distributions of residuals for each outcome were used to check the goodness of fit of the models and the influence of potential outliers on the regression models assessed. Under the linear mixed-effects regression model, missing data were assumed to be missing at random. Intra-clinic correlations for mental health outcomes were calculated using one-way analysis of variance.

Sensitivity analyses using pattern-mixture models were carried out to test the robustness of the missing at random assumption. For data that is missing at random, the difference between the mean of the missing data and the mean of the observed data δ , is zero. The sensitivity analysis carried out in this study considers various plausible values for δ other than zero to simulate scenarios in which the missing data may not be missing at random. Positive values of δ indicate that participants with missing data have on average higher outcome scores than observed participants. Negative values of δ indicate that participants with missing data have on average lower outcome scores. In the sensitivity analyses, the regression analyses take into account the plausible values of δ . These regression results were compared with those from the main analysis to determine whether study conclusions changed if the missing data was not missing at random.

Seven Victorian GP clinics were recruited, however, two dropped out due to lack of interest from doctors and one due to logistical issues. Four practices remained; two located in metropolitan Melbourne, one in an outer north-east suburb, and one in a coastal town in the Greater Geelong area. Thirty-two doctors were available across these clinics; 14 agreed to take part in the study. A total of 684/785 (87%) women were approached and asked to participate (see Fig. 1 ). Overall, 325/428 (76%) eligible women completed the survey, with between 7 and 125 women from each clinic (mean number of eligible participants per clinic = 81.3, SD = 53.5; intraclass correlations for PTSD = 0.01; depression =0.009; and anxiety = 0.01). Reasons for non-participation included: the woman being too unwell; needing to attend to children; discomfort with the topic, or having insufficient time to complete the survey.

Recruitment of sample

Table 2 shows the demographics of the sample by experiences of SV. Twenty women did not provide data for the sexual violence items, leaving a total of 305 women included in our analyses. The majority of women were born in Australia, had at least completed high school and were employed.

Approximately 41% ( n = 126/305) of participants had experienced some form of SV since the age of 15 years, and 11% ( n = 34/305) had experienced it in the past 12 months. Sixteen percent ( n = 48/305) had ever experienced rape or sexual assault. Overall, 17.5% ( n = 53/305) had ever been coerced into having sex or experienced reproductive control. Seven percent ( n = 22/305) had experienced coercion and/or reproductive control without also having experienced rape or sexual assault. Eighteen percent (56/305) of women had experienced only unwanted sexual contact such as groping, harassment, flashing or touching.

Type of sexual violence experiences and mental health

All outcomes, PCL-C, PHQ-9 and GAD-7, demonstrated good internal consistency and reliability (Cronbach’s alpha 0.94, 0.88 and 0.76 respectively). There was a strong relationship between women’s experiences of rape or sexual assault and poor mental health (see Table 3 ). Women who had been raped or sexually assaulted had on average significantly higher PTSD scores (mean difference = 10.5, 95% CI =6.8 to 14.2) than women who had not experienced SV. These women also experienced significantly higher levels of anxiety (mean difference = 2.3, 95% CI = 1.1 to 3.5) and depressive symptoms (mean difference = 2.7, 95% CI = 0.9 to 4.4) compared to women with no SV experiences.

For women who had experienced coercive behaviour and/or reproductive control without rape or sexual assault, mean PTSD scores and mean anxiety scores were significantly higher compared to women who had not experienced SV (PTSD mean difference = 8.8, 95% CI = 3.9 to 13.7; anxiety mean difference = 2.7, 95% CI = 1.2 to 4.2). There was no statistical difference in mental health scores between those who experienced unwanted sexual contact alone and those who had not experienced sexual violence.

Relationship between perpetrator identity and mental health

Seventy-eight of the 126 women who had experienced SV responded to the perpetrator identity question. For those who responded to this item, SV perpetrated by an intimate partner (see Table 4 ) was associated with significantly higher mean PTSD scores than SV perpetrated by a stranger (mean difference = 8.0, 95% CI = 0.8 to 15.2). Intimate partner sexual violence was also associated with significantly higher mean depression scores than women assaulted by another known person (mean difference = 2.8, 95% CI = 0.2 to 5.4). There was little difference in anxiety scores between perpetrator types. Despite approximately 37% missing data for perpetrator type, sensitivity analyses testing the robustness of the missing at random data assumption revealed no change in conclusions (see Additional file 1 ).

This cross-sectional study contributes to the knowledge base around women’s experiences of adult SV and provides a more nuanced view of the associations between different types of SV and mental health. It also highlights the long-lasting impacts of SV, which are present even when past childhood sexual abuse is taken into account. The study also provides data from a clinical population; there is a lack of such information currently available [ 21 , 22 ] to guide practice and shape an effective response from health professionals.

Consistent with the existing literature [ 3 , 5 ], women who had ever experienced rape or sexual assault had higher mean levels of PTSD, anxiety and depression compared to women who had not experienced SV. Furthermore, the mean PTSD score for women who had been raped or sexually assaulted was above the suggested threshold of 30 for screening in a primary care setting [ 28 ], and mean depression and anxiety scores for these women fell within the symptomatic range (mild to moderate symptoms). Whilst this was an expected finding, it is nonetheless important information for GPs and other primary care providers; as it highlights that historical SV may still contribute to current mental health symptoms in their clinical population.

A key finding of this study was that women who had experienced coercive behaviours or reproductive control (without also having experienced rape or sexual assault) had significantly higher PTSD and anxiety scores than women who had experienced no SV. Mean anxiety scores for these women were very similar to those of women who had been raped or sexually assaulted, and again, the mean PTSD score was above the suggested diagnostic threshold for a primary care sample. Given the small numbers of women in each group, reaching statistical significance suggests that the relationship between these behaviours and poor mental health is strong. This is a critical finding that has important implications for practice. General practitioners and other health professionals responding to women should explore past experiences of coercion or reproductive control – in addition to rape and sexual assault – as a possible factor in otherwise unexplained mental health symptoms, particularly PTSD and anxiety.

Our study also sheds light on the relationship between women’s mental health and the identity of the perpetrator. For those who responded to the perpetrator identify question, women assaulted by an intimate partner had significantly higher mean PTSD scores than women assaulted by a stranger and significantly higher mean depression scores than women assaulted by another known person such as a family member or friend. This supports the theory that SV perpetrated by an intimate partner has particularly serious impacts on women’s mental health. This may be due to the increased level of fear for personal safety that many women experience when living with a perpetrator of violence [ 12 ], as well as the often ongoing and frequent nature of the abuse. It is also likely that the breach of trust and sense of humiliation women may experience [ 35 , 36 ] after intimate partner sexual violence may contribute to poor mental health outcomes. Despite this, intimate partner sexual violence is often neglected or assumed to be less serious than assaults perpetrated by a stranger. Clinicians ought to enquire about the identity of the perpetrator in order to inform themselves about the likelihood of ongoing mental health problems in the future.

Limitations of the study

In the interests of keeping the survey brief, we were unable to capture data concerning the frequency of SV experiences, as well as other non-sexual traumas. Consequently, we have reported only associations rather than a causal relationship between SV and women’s mental health, which could only be achieved through a longitudinal study. Furthermore, the response rate from recruiting general practice clinics, although consistent with other studies [ 23 ], was low, and this may have affected the generalisability of the findings. Lastly, our sample size was not powered for three categories of SV, which led to low numbers in some of the groups. Many women also chose to skip the perpetrator question in the survey. This may account for the lack of statistical significance on some of the outcome measures, although for those where significance was reached it suggests a strong relationship.

Conclusions

Our study found significant associations between women’s experiences of being coerced into having sex or having their reproductive autonomy taken away, and poor mental health outcomes. While the associations between rape/physical sexual assault and poor mental health have previously been identified within the literature, little was known about how more subtle forms of SV might impact on women’s well-being. The study also supports the theory that SV perpetrated by an intimate partner is particularly traumatic for women when compared to SV perpetrated by a stranger or another known person. These are important findings for health practitioners responding to women who present with otherwise unexplained mental health symptoms. This study represents an important first step in gaining a clearer picture of how SV impacts on women’s mental health; more research with a larger population group is recommended in order to explore these relationships further.

Abbreviations

Generalized Anxiety Disorder 7 item scale

General practitioner (family doctor)

Post-traumatic stress disorder checklist, civilian version

Patient Health Questionnaire 9 item depression scale

Post-traumatic stress disorder

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Acknowledgements

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This study was funded by an Early Career Researcher Grant from The University of Melbourne. The funding body played no part in the study design, data collection, analysis, or in preparation of this manuscript.

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The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Laura Tarzia, Sharmala Thuraisingam, Kitty Novy, Jodie Valpied, Rebecca Quake & Kelsey Hegarty

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Contributions

LT, JV, KH and RQ designed and conceptualised the study, each making substantial intellectual contributions. ST and JV developed and conducted statistical analyses. ST, JV, LT and KH interpreted the findings and their implications for practice. KN collected the data and managed study recruitment. LT and ST drafted the manuscript. All authors (LT, JV, KN, RQ, KH and ST) contributed to editing and critically revising the manuscript and all authors read and approved the final version. All authors agree to be accountable for all aspects of the work.

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Ethics approval was received for the study from the Human Research Ethics Committee at The University of Melbourne (#1543699.1). Participants provided written consent to take part in the study via a tick box embedded in the first page of the survey.

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Additional file

Additional file 1:.

Sensitivity analysis results. Results of sensitivity analyses using pattern-mixture models to test the robustness of the missing at random assumption. (DOCX 33 kb)

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Tarzia, L., Thuraisingam, S., Novy, K. et al. Exploring the relationships between sexual violence, mental health and perpetrator identity: a cross-sectional Australian primary care study. BMC Public Health 18 , 1410 (2018). https://doi.org/10.1186/s12889-018-6303-y

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Research Article

Sexual assault incidents among college undergraduates: Prevalence and factors associated with risk

Contributed equally to this work with: Claude A. Mellins, Kate Walsh, Aaron L. Sarvet, Melanie Wall, Leigh Reardon, Jennifer S. Hirsch

Roles Conceptualization, Funding acquisition, Investigation, Methodology, Project administration, Supervision, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Division of Gender, Sexuality and Health, Departments of Psychiatry and Sociomedical Sciences, New York State Psychiatric Institute and Columbia University Medical Center, New York, New York, United States of America

Roles Conceptualization, Writing – original draft, Writing – review & editing

Affiliations Ferkauf Graduate School of Psychology, Yeshiva University, New York, New York, United States of America, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America

Roles Conceptualization, Formal analysis, Investigation, Visualization, Writing – review & editing

Affiliation Division of Biostatistics, Department of Psychiatry, New York State Psychiatric Institute and Columbia University Medical Center, New York, New York, United States of America

Roles Conceptualization, Formal analysis, Investigation, Methodology, Visualization, Writing – review & editing

Affiliations Division of Biostatistics, Department of Psychiatry, New York State Psychiatric Institute and Columbia University Medical Center, New York, New York, United States of America, Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States of America

Roles Conceptualization, Investigation, Methodology, Writing – original draft, Writing – review & editing

¶ ‡ These authors also contributed equally to this work.

Affiliation Social Intervention Group, School of Social Work, Columbia University, New York, New York, United States of America

Roles Conceptualization, Investigation, Methodology, Writing – review & editing

Affiliation Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, United States of America

Roles Methodology, Writing – review & editing

Affiliation Department of Youth, Family, and Community Studies, Clemson University, Clemson, South Carolina, United States of America

Roles Investigation, Methodology, Writing – review & editing

Affiliation Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States of America

Roles Conceptualization, Writing – review & editing

Affiliation Department of Sociology, Columbia University, New York, New York, United States of America

Roles Data curation, Investigation, Methodology, Writing – review & editing

Roles Data curation, Investigation, Methodology

Roles Writing – original draft, Writing – review & editing

Roles Conceptualization, Data curation, Investigation, Methodology, Project administration, Writing – review & editing

Roles Conceptualization, Funding acquisition, Investigation, Methodology, Writing – review & editing

Claude A. Mellins,
Kate Walsh,
Aaron L. Sarvet,
Melanie Wall,
Louisa Gilbert,
John S. Santelli,
Martie Thompson,
Patrick A. Wilson,
Shamus Khan,

Published: November 8, 2017
https://doi.org/10.1371/journal.pone.0186471
Reader Comments

25 Jan 2018: The PLOS ONE Staff (2018) Correction: Sexual assault incidents among college undergraduates: Prevalence and factors associated with risk. PLOS ONE 13(1): e0192129. https://doi.org/10.1371/journal.pone.0192129 View correction

Sexual assault on college campuses is a public health issue. However varying research methodologies (e.g., different sexual assault definitions, measures, assessment timeframes) and low response rates hamper efforts to define the scope of the problem. To illuminate the complexity of campus sexual assault, we collected survey data from a large population-based random sample of undergraduate students from Columbia University and Barnard College in New York City, using evidence based methods to maximize response rates and sample representativeness, and behaviorally specific measures of sexual assault to accurately capture victimization rates. This paper focuses on student experiences of different types of sexual assault victimization, as well as sociodemographic, social, and risk environment correlates. Descriptive statistics, chi-square tests, and logistic regression were used to estimate prevalences and test associations. Since college entry, 22% of students reported experiencing at least one incident of sexual assault (defined as sexualized touching, attempted penetration [oral, anal, vaginal, other], or completed penetration). Women and gender nonconforming students reported the highest rates (28% and 38%, respectively), although men also reported sexual assault (12.5%). Across types of assault and gender groups, incapacitation due to alcohol and drug use and/or other factors was the perpetration method reported most frequently (> 50%); physical force (particularly for completed penetration in women) and verbal coercion were also commonly reported. Factors associated with increased risk for sexual assault included non-heterosexual identity, difficulty paying for basic necessities, fraternity/sorority membership, participation in more casual sexual encounters (“hook ups”) vs. exclusive/monogamous or no sexual relationships, binge drinking, and experiencing sexual assault before college. High rates of re-victimization during college were reported across gender groups. Our study is consistent with prevalence findings previously reported. Variation in types of assault and methods of perpetration experienced across gender groups highlight the need to develop prevention strategies tailored to specific risk groups.

Citation: Mellins CA, Walsh K, Sarvet AL, Wall M, Gilbert L, Santelli JS, et al. (2017) Sexual assault incidents among college undergraduates: Prevalence and factors associated with risk. PLoS ONE 12(11): e0186471. https://doi.org/10.1371/journal.pone.0186471

Editor: Hafiz T. A. Khan, University of West London, UNITED KINGDOM

Received: July 28, 2017; Accepted: October 2, 2017; Published: November 8, 2017

Copyright: © 2017 Mellins et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data underlying the study cannot be made available, beyond the aggregated data that are included in the paper, because of concerns related to participant confidentiality. Sharing the individual-level survey data would violate the terms of our agreement with research participants, and the Columbia University Medical Center IRB has confirmed that the potential for deductive identification and the risk of loss of confidentiality is too great to share the data, even if de-identified.

Funding: This research was funded by Columbia University through a donation from the Levine Family. The funder (Levine Family) had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Recent estimates of sexual assault victimization among college students in the United States (US) are as high as 20–25% [ 1 – 3 ], prompting universities to enhance or develop policies and programs to prevent sexual assault. However, a 2016 review [ 4 ] highlights the variation in sexual assault prevalence estimates (1.8% to 34%) which likely can be attributed to methodological differences across studies, including varying sexual assault definitions, sampling methods, assessment timeframes, and target populations [ 4 ]. Such differences can hamper efforts to understand the scope of the problem. Moreover, while accurate estimates of prevalence are crucial for calling attention to the population-health burden of sexual assault, knowing more about risk factors is critical for determining resource allocation and developing effective programs and policies for prevention.

Reasons for the variation in prevalence estimates include different definitions of sexual assault and assessment methods. Under the rubric of sexual assault, researchers have investigated experiences ranging from sexual harassment at school or work, to unwanted touching, including fondling on the street or dance floor, to either unwanted/non-consensual attempts at oral, anal or vaginal sexual intercourse (attempted penetrative sex), or completed penetrative sex [ 3 , 5 – 7 ]. Some studies have focused on a composite variable of multiple forms of unwanted/non-consensual sexual contact [ 8 , 9 ] while others focus on a single behavior, such as completed rape [ 10 ]. Some studies focus on acts perpetrated by a single method (e.g. incapacitation due to alcohol and drug use or other factors) [ 11 ], while others include a range of methods (e.g., physical force, verbal coercion, and incapacitation) [ 12 – 15 ]. In general, studies that ask about a wide range of acts and use behaviorally specific questions about types of sexual assault and methods of perpetration have yielded more accurate estimates [ 16 ]. Behavioral specificity avoids the pitfall of participants using their own sexual assault definitions and does not require the respondent to identify as a victim or survivor, which may lead to underreporting [ 10 , 17 – 19 ].

Although an increasing number of studies have used behaviorally specific methods and examined prevalence and predictors of sexual assault [ 20 , 21 ], they typically have used convenience samples. Only a few published studies have used population-based surveys and achieved response rates sufficient to mitigate some of the concerns of sample response bias [ 4 ]. US federal agencies have urged universities to implement standardized “campus climate surveys” to assess the prevalence and reporting of sexual violence [ 22 ]. Although these surveys have emphasized behavioral specificity, many have yielded low response rates (e.g., 25%) [ 23 ], particularly among men [ 24 ], creating potential for response bias in the obtained data. Population-based probability samples with behavioral specificity, good response rates, sufficiently large samples to examine risk for specific subgroups (e.g., sexual minority students), and detailed information on personal, social, or contextual risk factors (e.g., alcohol use) [ 22 , 23 ] are needed to more accurately define prevalence and inform evidence-based sexual assault prevention programs.

Existing evidence suggests that most sexual assault incidents are perpetrated against women [ 25 ]; however, few studies have examined college men as survivors of assault [ 26 – 28 ]. Furthermore, our understanding of how sexual orientation and gender identity relate to risk for sexual assault is limited, despite indications that lesbian, gay, bisexual (LGB), and gender non-conforming (GNC) students are at high risk [ 29 – 31 ]. It is unclear if these groups are at higher risk for all types of sexual assault or if prevention programming should be tailored to address particular types of assault within these groups. Also, although women appear to be at highest risk for assault during freshman year [ 32 , 33 ], the dearth of studies with men or GNC students have limited conclusions about whether freshman year is also a risky period for them.

Additional factors associated with experiencing sexual assault in college students include being a racial/ethnic minority student (although there are mixed findings on race/ethnicity) [ 34 , 35 ], low financial status, and prior history of sexual assault [ 3 , 33 , 36 ]. Other risk factors include variables related to student social life, including being a freshman [ 24 ], participating in fraternities and sororities [ 19 , 37 , 38 ], binge drinking [ 1 , 39 ] and participating in “hook-up” culture [ 40 – 42 ]. Whether sexual assault is happening in the context of more casual, typically non-committal sexual relationships (“hook-ups”) [ 40 ] vs. steady intimate or monogamous relationships has important implications for prevention efforts.

To fill some of these knowledge gaps, we examined survey data collected from a large population-based random sample of undergraduate women, men, and GNC students at Columbia University (CU) and Barnard College (BC). The aims of this paper are to:

Estimate the prevalence of types of sexual assault incidents involving a) sexualized touching, b) attempted penetrative (oral, anal or vaginal) sex, and c) completed penetrative sex since starting at CU/BC;
Describe the methods of perpetration (e.g., incapacitation, physical force, verbal coercion) used; and
Examine associations between key sociodemographic, social and romantic/sexual relationship factors and different types of sexual assault victimization, and how these associations differ by gender.

Materials and methods

This study used data from a population-representative survey that formed one component of the Sexual Health Initiative to Foster Transformation (SHIFT) study. SHIFT used mixed methods to examine risk and protective factors affecting sexual health and sexual violence among college undergraduates from two inter-related institutions, CU’s undergraduate schools (co-educational) and BC (women only), both located in New York City. SHIFT featured ethnographic research, the survey, and a daily diary study. Additionally, SHIFT focused on internal policy-translation work to inform institutionally-appropriate, multi-level approaches to prevention.

Participants

Survey participants were selected via stratified random sampling from the March 2016 population of 9,616 CU/BC undergraduate students ages 18–29 years. We utilized evidence-based methods to enhance response rates and sample representativeness [ 22 , 43 ]. Using administrative records of enrolled students, 2,500 students (2,000 from CU and 500 from BC) were invited via email to participate in a web-based survey. Of these 2,500 students, 1,671 (67%) consented to participate (see Procedures). Among those who consented to participate, 80.5% were from CU and 19.5% were from BC (see Table 1 below for demographic data on the CU/BC student population, the random sample of students contacted, the survey responders, and the current analytic sample).

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https://doi.org/10.1371/journal.pone.0186471.t001

SHIFT employed multiple procedures to assure protection of students involved in our study; these procedures also improve scientific rigor. The study was approved by the Columbia University Medical Center Institutional Review Board and we obtained a federal Certificate of Confidentiality to legally protect our data from subpoena. SHIFT also obtained a University waiver from reporting on individual sexual assaults, as reporting would obviate student privacy and willingness to participate. Students were offered information about referrals to health and mental health resources during the consent process and at the end of the survey, and such information was available from SHIFT via other communication channels. Finally, in reporting data we suppressed data from tables where there were less than 3 subjects in any cell to avoid the possibility of deductive identification of an individual student [ 44 ].

SHIFT used principles of Community Based Participatory Research regarding ongoing dialogue with University stakeholders on study development and implementation to maximize the quality of data and impact of research findings [ 45 ]. This included weekly meetings between SHIFT investigators and an Undergraduate Advisory Board, consisting of 13–18 students, reflecting the undergraduate student body’s diversity in terms of gender, race/ethnicity, sexual orientation, year in school, and activities (e.g., fraternity/sorority membership). It also included regular meetings with an Institutional Advisory Board comprised of senior administrators, including CU’s Office of General Counsel, facilities, sexual violence response, student conduct, officials involved in gender-based misconduct concerns, athletics, a chaplain, mental health and counseling, residential life, student health, and student life.

Following both the Undergraduate Advisory Board’s recommendations and Dillman’s Tailored Design Method for maximizing survey response rates [ 43 ], multiple methods were used to advertise and recruit students. These included: a) email messages, both to generate interest and remind students who had been selected to participate, crafted to resonate with diverse student motives for participation (e.g., interest in sexual assault, compensation, community spirit, and achieving higher response rates than surveys at peer institutions), b) posting flyers, c) holding “study breaks,” in which students were given snacks and drinks, and d) tabling in public areas on campus.

Participants used a unique link to access the survey either at our on-campus research office where computers and snacks were provided (16% of participants) or at a location of their choosing (84% of participants) from March-May, 2016. Before beginning the survey, participants were asked to provide informed consent on an electronic form describing the study, confidentiality, compensation for time and effort, data handling procedures, and the right to refuse to answer any question. Students who completed the survey received $40 in compensation, given in cash to those who completed the survey in our on-campus research office or as an electronic gift card if completed elsewhere. Students were also entered into a lottery to win additional $200 electronic gift cards. This compensation was established based on feedback from student and institutional advisors and reviewed by our Institutional Review Board. It was judged to be sufficient to promote participation, and help ensure that we captured a representative sample, including students who might otherwise have to choose between paid opportunities and participating in our survey, but not great enough to feel coercive for low resource students. This amount of compensation is in line with other similar studies [ 46 ]. On average, the survey took 35–40 minutes to complete.

The SHIFT survey included behaviorally-specific measures of different types of sexual assault, perpetrated by different methods, as well as measures of key sociodemographic, social and sexual relationship factors, and risk environment characteristics. The majority of instruments had been validated previously with college- age students. The survey was administered in English using Qualtrics ( www.qualtrics.com ), providing a secure platform for online data collection.

Sexual assault.

Sexual assault was assessed with a slightly modified version of the revised Sexual Experiences Survey [ 16 ], the most widely used measure of sexual assault victimization with very good psychometric properties including internal consistency and validity previously published [ 17 , 47 ]. The Sexual Experiences Survey employs behaviorally specific questions to improve accuracy [ 18 ]. The scale includes questions on type of assault, including sexualized touching without penetration (touching, kissing, fondling, grabbing in a sexual way), attempted but not completed penetrative assault (oral, vaginal, anal or other type of penetration; herein referred to as attempted penetrative assault) and completed penetrative assault (herein referred to as penetrative assault). We used most of the Sexual Experiences Survey as is. However, with strong urging from our Undergraduate Advisory Board, we made a modification, combining the questions about different types of penetration (oral, vaginal, etc.) rather than asking about each kind separately. In the Sexual Experiences Survey, for each type of assault there are six methods of perpetration. Two of the types reflect verbal coercion: 1) “Telling lies, threatening to end the relationship, threatening to spread rumors about me, making promises I knew were untrue, or continually verbally pressuring me after I said I didn’t want to” (herein referred to as “lying/threats”), and 2) “Showing displeasure, criticizing my sexuality or attractiveness, getting angry but not using physical force, after I said I didn’t want to” (herein referred to as “criticism”). The remaining types included use of physical force, threats of physical harm, or incapacitation (“Taking advantage when I couldn’t say no because I was either too drunk, passed out, asleep or otherwise incapacitated”), and other. For each incident of sexual assault, participants could endorse multiple methods of perpetration. Participants were also asked to report whether these experiences occurred: a) during the current academic year (this was a second modification to the Sexual Experiences Survey) and/or b) since enrollment but prior to the current academic year. For this paper, data for the two time periods were combined, reflecting the entire period since starting CU/BC. See Fig 1 for a replica of the questionnaire.

https://doi.org/10.1371/journal.pone.0186471.g001

Demographics.

Demographics included gender identity (male, female, trans-male/trans-female, gender queer/gender-non-conforming, other) [ 48 ], year in school (e.g., freshman, sophomore, junior, senior), age, US born (yes/no), lived in US less than five years (yes/no; proxy for recent international student status), transfer student (yes/no), low socioeconomic status (receipt of Pell grant-yes/no [need-based grants for low-income students, with eligibility dependent on family income]); how often participant has trouble paying for basic necessities (never, rarely, sometimes, often, all of the time), and race/ethnicity (non-Hispanic white, non-Hispanic-Asian, non-Hispanic black, Hispanic/Latin-x, other [other included: American Indian or Alaska Native, Native Hawaiian or Pacific Islander, More than one Race/Ethnicity, Other]). Gender was categorized as follows: female, male and GNC (students who responded to gender identity question as anything other than male or female).

Fraternity/Sorority.

Fraternity/sorority membership (ever participated) was assessed with one question from a school activities checklist (yes/no). We report on Greek life participation here to engage with the substantial attention this has received as a risk factor.

Problematic drinking.

Problematic drinking during the last year was assessed with the Alcohol Use Disorders Identification Test (AUDIT) [ 49 ], a widely used, well-validated standardized 10-item screening tool developed by the World Health Organization. Psychometrics have been established in numerous studies [ 50 – 52 ]. The AUDIT assesses alcohol consumption, drinking behaviors, and alcohol-related problems. Participants rate each question on a 5-point scale from 0 (never) to 4 (daily or almost daily) for possible scores ranging from 0 to 40. The range of AUDIT scores represents varying levels of risk: 0–7 (low), 8–15 (risky or hazardous), 16–19 (high-risk or harmful), and 20 or greater (high-risk). We also examined one AUDIT item on binge drinking, defined as having 6+ drinks on one occasion at least monthly [ 49 ].

Sexual orientation.

Sexual orientation was assessed with one question with the following response options (students could select all that applied): asexual, pansexual, bisexual, queer, heterosexual and homosexual, as well as other [ 53 , 54 ]. Students were categorized into four mutually exclusive groups for analyses: heterosexual, bisexual, homosexual, and other which included asexual, pansexual, queer, or another identity not listed. Non-heterosexual students who indicated more than one orientation were assigned hierarchically to bisexual, homosexual, then other.

Romantic/sexual relationships.

Romantic/sexual relationships since enrollment at CU/BC were assessed with one question. Response choices included: none, steady or serious relationship, exclusive or monogamous relationship, hook-up-one time, and ongoing hook-up or friends with benefits. Students defined “hookup” for themselves. Students could check all that applied. This variable was trichotomized: at least one hook-up, only steady or exclusive/monogamous relationships, and no romantic/sexual relationships.

Pre-college sexual assault.

Students also were asked one yes/no question on whether they had experienced any unwanted sexual contact prior to enrolling at CU/BC.

Data analysis

To assess the representativeness of the sample, the distribution of demographic variables based on administrative records from CU and BC for the total University undergraduate population were compared to the random sample of students contacted, the survey responders, and the current analytic sample, which consists of students that responded to the questions about sexual assault. Demographics for survey responders are based on self-report from the survey. Cramer’s V effect size was used to assess the magnitude of the differences in demographic distributions between the CU/BC population and respondent sample where smaller values (i.e. Cramer’s V <0.10) indicate strong similarity [ 55 ].

Analyses were performed on each type of sexual assault as well as a combined “Any type of sexual assault” variable: yes/no experienced sexualized touching, attempted penetrative assault, and/or penetrative assault since CU/BC. Prevalence of each type of sexual assault was calculated by gender and year in school, with chi-square tests of difference used to compare prevalence between genders across each year in school versus freshman year. The total number of incidents of assault and the mean, median and standard deviation for number of incidents of assault per person reporting at least one assault were summarized. Among individuals who experienced any type of sexual assault, the proportions that experienced a particular method of perpetration (e.g. incapacitation, physical force) were calculated by type of sexual assault. Chi-square tests compared proportions between males and females for each perpetration method. The associations of each key correlate with the odds of experiencing any sexual assault were calculated and tested using logistic regression stratified by male/female gender. In addition, a multinomial regression with hierarchical categories (no assault, sexualized touching only, attempted penetrative assault [not completed], and penetrative assault [completed]) as the outcome was performed to examine if associations differed by type of sexual assault. To adjust for the fact that the sample comes from a finite population (i.e. CU/BC N = 5,765 women; N = 3,851 men), a standard finite population correction was implemented for standard error estimation using SAS Proc Surveylogistic. Given the low sample size of GNC students, they were excluded from some analyses. All analyses were conducted using SAS (v. 9.4).

Descriptive statistics

Table 1 presents demographic data on the full University, the randomly selected sample, the respondents and the analytic sample for this paper. Among students who consented to the survey (n = 1,671), 46 stopped the survey before the sexual assault questions and 33 refused to answer them resulting in an analytic sample of n = 1,592 (95% completion among responders). Demographic characteristics (i.e. gender [male, female], age, race/ethnicity, year in school, international status, and economic need [Pell grant status]) of the respondent sample were very similar (Cramer’s V effect size differences all <0.10 [ 55 ]) to the full CU/BC population ( Table 1 ) indicating that the responder and final analytic samples were representative of the student body population.

The analytic sample included 58% women, 40% men, and 2% GNC students (4 students refused to identify their gender) and was distributed evenly by year in school with most (92%) between18-23 years of age. Self-reported race/ethnicity was 43% white non-Hispanic, 23% Asian, 15% Hispanic/Latino, and 8% black non-Hispanic; 13% were transfer students, and the majority of the sample was born in the US (76%). Twenty-three percent of participants received Pell grants and 51% of students acknowledged at least sometimes having difficulty paying for basic necessities.

The majority of women (79%) and men (85%) identified as heterosexual. In terms of romantic/sexual relationships since starting CU/BC, 30.0% of women and 21.6% of men reported no relationships, 21.0% of women and 22.6% of men reported only steady/exclusive relationships with no hookups, and 49.0% of women and 55.7% of men reported at least one hook-up. Finally, 25.5% of women, 9.4% of men, and 47.0% of GNC students reported pre-college sexual assault.

Aim 1: Prevalence of sexual assault victimization at CU/BC

Overall rates by gender and school year..

Since starting CU/BC, 22.0% (350/1,592) of students reported experiencing at least one incident of any sexual assault across the three types (sexualized touching, attempted penetrative assault, and penetrative assault). Table 2 presents data on types of assault by gender and year in school. Women were over twice as likely as men to report any sexual assault (28.1% vs 12.5%). There was evidence of cumulative risk for experiencing sexual assault among women over four years of college, so that by junior and senior year, respectively, 29.7% and 36.4% of women reported experiencing any sexual assault, compared to 21.0% of freshman women who had only one year of possible exposure (p < .05). However, one-fifth (21.0%) of women who took the survey as freshman had experienced unwanted sexual contact, compared to 36.4% over 3+ years (seniors), suggesting that as others have found, the risk of assault is highest in freshman year.

https://doi.org/10.1371/journal.pone.0186471.t002

Among men, one in eight indicated that they had been sexually assaulted since starting CU. Similar to women, the risk for sexual assault among men accumulated over the four years of college, with 15.6% of seniors vs 9.9% of freshman reporting a sexual assault since entering CU, although this difference was not statistically significant.

Although the numbers were small, GNC students reported the highest prevalence of sexual assault since starting CU/BC (38.5%; 10/26). Numbers were too small (n<3) to present stratified by year in school (see Table 2 ).

Types of sexual assault by gender ( Table 2 ).

The most prevalent form of sexual assault was sexualized touching; rates for women (23.6%) and GNC students (38.5%) were significantly higher than rates for men (11.0%; p < .05). Prevalence of attempted penetrative assault and penetrative assault were about half that of sexualized touching. Compared to men, women were three times as likely to report attempted penetrative assault (11.1% vs 3.8%) and over twice as likely to experience penetrative assault (13.6% vs 5.2%). Among GNC students, the majority reporting sexualized touching, with rates of the other two types too small to report.

Experiencing multiple sexual assaults ( Fig 2 ; S1 Table ).

Students could report multiple types of sexual assault incidents (i.e. sexualized touching, attempted penetrative, and penetrative assault) as well as multiple incidents experienced of each type. Overall, students reported a total of 1,007 incidents of sexual assault experienced since starting CU/BC. For the 350 students who indicated any sexual assault, the median number of incidents experienced was 3.

https://doi.org/10.1371/journal.pone.0186471.g002

Among the 350 students reporting any sexual assault, Fig 2 presents different combinations of sexual assault experienced by students since CU/BC. Most prevalent, 38.0% reported experiencing only sexualized touching; 19.0% reported both sexualized touching and penetrative assault incidents; 17.0% experienced all three types of assault; and 12.0% sexualized touching and attempted penetrative assault.

Aim 2: Methods of perpetration (lying/threats, criticism, incapacitation, physical force, threats of harm, and other) by gender ( Table 3 )

Across types of assault, incapacitation was the method of perpetration reported most frequently (> 50%) in both men and women. For both women and men, approximately two-thirds of all penetrative assaults and about half of sexualized touching and attempted penetrative assaults involved incapacitation.

https://doi.org/10.1371/journal.pone.0186471.t003

Physical force was reported significantly more frequently by women than men (34.6% vs 12.7%) for any sexual assault. More specifically, compared to men, women were three times more likely to experience sexualized touching via physical force (32.1% vs. 10.0%), and six times more likely to experience penetrative assaults via physical force (33.3% vs 6.1%).

Lastly, a sizeable number of respondents reported verbal coercion (ranging from 21.0% to over 40.0% depending on type of assault). Criticism was cited by women at rates similar to physical force for both sexualized touching and penetrative assaults. Among men, both verbal coercion methods were cited most frequently after incapacitation for all three types of assault.

For GNC students, we examined rates of each perpetration method for only the composite variable any sexual assault (due to small numbers in any specific type of assault). Among those who experienced an assault, incapacitation was the most frequently mentioned method (50.0%), followed by criticism (40.0%).

Aim 3: Identify factors associated with sexual assault experiences

We examined the association between sexual assault (both any sexual assault [ Table 4 ] and each type of sexual assault [ Table 5 ]) and key demographic, sexual history and social activity factors. Results are stratified by gender (women/men).

https://doi.org/10.1371/journal.pone.0186471.t004

https://doi.org/10.1371/journal.pone.0186471.t005

Race/Ethnicity.

For both women and men, the prevalence of any sexual assault was similar for all race/ethnicity groups compared to non-Hispanic White students with one exception. Asian students (women and men) were less likely to experience any sexual assault than non-Hispanic White students. For women only, differences emerged by type of assault. Asian women compared to non-Hispanic White women were less likely to experience penetrative assault (OR = 0.35, CI: 0.19–0.62), but not attempted penetrative assault (OR = 0.56, CI: 0.25–1.26), nor sexualized touching only (OR = 1.00, CI: 0.59–1.69). Black women were found to have increased odds of touching only incidents compared to non-Hispanic White women (OR = 1.99, CI: 1.05–3.74). There were no other significant racial or ethnic differences.

Economic precarity.

Women who often or always had difficulty paying for basic necessities had increased odds of any sexual assault; for men the trend was similar but it did not reach statistical significance. Considering penetrative assault specifically, both men and women who often or always had difficulty paying for basic necessities had increased risk (women OR = 2.24, CI: 1.23–4.09; men OR = 3.07, CI: 1.04–9.07) compared to those who never had difficulty.

Transfer student.

Women transfer students were less likely to experience any sexual assault than non-transfer students. Closer inspection of type of assault revealed that this protective effect was seen for sexualized touching only (OR = 0.34, CI: 0.15–0.80), but not for penetrative (OR = 0.60, CI: 0.34–1.08), nor attempted penetrative (OR = 1.03, CI: 0.48–2.21) assault. There were no significant differences between men who were transfer students and those who were not.

For women, those who identified as bisexual and those who identified as some other sexual identity besides heterosexual, homosexual, or bisexual (includes people endorsing exclusively one or a combination of: Asexual, Pansexual, Queer, or a sexual orientation not listed), were more likely to experience any sexual assault than heterosexual students. For penetrative assault specifically, this increased risk was only present for individuals with some other sexual identity (OR = 2.11, CI: 1.20–3.73). For men, those who identified as homosexual were more likely to experience any sexual assault than heterosexual male students. For penetrative assault specifically, those who identified as homosexual, bisexual, or some other sexual identity all had substantially increased risk compared to those with a heterosexual identity (OR = 4.74, CI: 2.10–10.71; OR = 3.39, CI: 1.03–11.16; OR = 4.74, CI:1.10–20.48, respectively).

Information about the gender of the perpetrator for different gender and sexual orientation groups was available for a subset of incidents (336/997). Among these events, 98.4% (3/184) of the heterosexual women indicated the perpetrator was a man, while 97.1% (33/34) of the bisexual women, 75% (3/4) of the homosexual women, and 88.9% (24/27) of the other sexual identity women indicated it was a man. For men who were assaulted, 84.9% (45/53) of the heterosexual men reported the perpetrator was a woman, while 0 of the homosexual men said the perpetrator was a woman. Numbers for bisexual men and other sexual identity men were too small to report separately, but combined showed that 5/8 (63.0%) of bisexual and other sexual identity men said the perpetrator was a woman. Of the GNC students reporting on a most-significant event, 77.8% (7/9) reported that they were assaulted by a male perpetrator (the numbers are too small to further examine by sexual orientation).

Lived in US less than 5 years.

There was no association found between living in the US for less than 5 years and any sexual assault, nor any specific type of sexual assault.

Relationship status.

Among both women and men, students who had at least one hook-up were more likely to have experienced any sexual assault than students who were in only steady/exclusive relationships since starting college. Among women who had engaged in at least one hook-up, this increased risk held for each type of sexual assault (penetrative: OR = 5.03, CI = 2.91–8.68, attempted penetrative: OR = 4.43, CI = 1.83–10.8, sexualized touching only: OR = 3.26, CI = 1.74–6.09), while among men the increased risk was found for sexualized touching only (OR = 13.33, CI = 2.09–85.08), but could not be estimated (due to small numbers) for completed penetrative assault. Women who did not have any romantic or sexual relationship since CU/BC were found to be less likely to experience penetrative assault than women who had a steady/exclusive relationships only (OR = 0.05, CI: 0.01–0.31).

Fraternity/Sorority membership.

Although a relative minority of students participated in fraternities (24.1%) or sororities (18.2%), for both men and women, those who participated were more likely to experience any sexual assault than those who did not. Examination of type of assault revealed that the effect is driven primarily by sexualized touching only which is significant in both women (OR = 1.63, CI: 1.00–2.67) and men (OR = 2.40, CI: 1.25–4.63) and not significantly increased for penetrative nor attempted penetrative assault.

Risky or hazardous drinking.

For both men and women, individuals who met criteria on the AUDIT for risky or hazardous drinking were more likely to experience any sexual assault than those who did not. When examining each type of assault separately, for men this increased risk was only significant for penetrative assault (OR = 4.07, CI: 2.01–8.21). For women, the increased risk of assault held for each type of assault—penetrative (OR = 6.04, CI: 4.10–8.90), attempted (OR = 3.38, CI: 1.84–6.19) and touching (OR = 2.33, CI: 1.42–3.81). We also looked at one AUDIT item specifically on binge drinking (6 or more drinks on a single occasion). Individuals who reported binge drinking at least monthly were more likely to experience any sexual assault than those who did not. When examining each type of assault separately, for men this increased risk was only significant for penetrative assault (OR = 2.15, CI: 1.12–4.15). For women, this increased risk was significant for penetrative assault (OR = 3.12, CI: 2.09–4.65), attempted assault (OR = 2.28, CI: 1.20–4.33), and touching (OR = 2.42, CI:1.50–3.91).

Pre-college assault ( Table 5 ).

Among both women and men, those who experienced pre-college assault were more likely to experience any sexual assault while at CU/BC. The increased risk held for penetrative assault in both women (OR = 3.01, CI: 2.07–4.37) and men (OR = 2.44, CI: 1.03–5.76). In women, the increased risk also held for attempted penetrative, but not touching only, whereas in men, the increased risk held for touching only, but not attempted penetrative sex.

The SHIFT survey, with a population-representative sample, good response rate and behaviorally-specific questions, found that 22.0% of students reported a sexual assault since starting college, which confirms previous studies of 1 in 4 or 1 in 5 prevalence estimates with national samples and a range of types of schools [ 23 , 24 ]. However, a key finding is that focusing only on the “1 in 4/ 1 in 5” rate of any sexual assault obscures much of the nuance concerning types of sexual assault as well as the differential group risk, as prevalence rates were unevenly distributed across gender and several other social and demographic factors.

Similar to other studies [ 4 , 24 ], women had much higher rates of experiencing any type of sexual assault compared to men (28.0% vs 12.0%). Moreover, our data suggest a cumulative risk for sexual assault experiences over four years of college with over one in three women experiencing an assault by senior year. However, our data also suggest that freshman year, particularly for women, is when the greatest percentage experience an assault. This supports other work on freshman year as a particularly critical time for prevention efforts, otherwise known as the “red zone” effect for women [ 32 ].

Importantly, our study confirms that GNC students are at heightened risk for sexual assault [ 23 ]. They had the highest proportion of sexual assaults, with 38.0% reporting at least one incident, the majority of which involved unwanted/non-consensual sexualized touching. These data should be interpreted very cautiously given the small number of GNC students. However, increasingly studies suggest that transgender and other GNC students have sexual health needs that may not be targeted by traditional programming [ 57 ]; thus, a better understanding of pathways to vulnerability among these students is of high importance.

Similarly, students who identified as a sexual orientation other than heterosexual were at increased risk for experiencing any sexual assault, with bisexual women or women who identified as “other” and men who identified as any non-heterosexual category at increased risk. Similar to GNC students, understanding the specific social and sexual health needs of LGB students, particularly as it relates to reducing sexual assault risk is critical to prevention efforts [ 58 ]. Factors such as stigma and discrimination, lack of communication, substance use, as well as a potential lack of tailored prevention programs may play a role. To our knowledge, there are no evidence-based college sexual assault prevention programs targeting LGB and GNC students. Our data suggest that the LGB and GNC experiences are not uniform; more research should be done within each of these groups to understand the mechanisms behind their potentially unique risk factors.

Our data also suggest that the 20–25% rate of any sexual assault obscures variation in assault experiences. Sexualized touching accounted for the highest percentage of acts across gender groups, with over one-third of participants reporting only sexualized touching incidents. Rates of attempted and completed penetrative sexual assault were about half the rate of sexualized touching. This finding does not minimize the importance of addressing unacceptably high rates of attempted penetrative and penetrative assault (14%-15%), but it does suggest the importance of specificity in prevention efforts. For GNC students, for example, the risk of assault was primarily for sexualized touching with very few reporting attempted penetrative assault or penetrative assault during their time at CU/BC. These elevated rates of unwanted sexual touching may be a combination of GNC students’ focus on their gendered sexual boundaries–and thus potentially greater awareness of when advances are unwanted–at a developmental moment when they are building non-traditional gender identities, as well as these students’ social vulnerability. Further investigation is warranted.

Moreover, there was variation in methods of perpetration reported by survivors of sexual assault. Incapacitation was the most common method reported across all gender groups for each type of assault, and female and male students who reported risky or hazardous drinking were at increased risk for experiencing any sexual assault, particularly penetrative assault. Across campuses in the US, hazardous drinking is a national problem with substantive negative health outcomes, risk for sexual assault being one of them [ 2 , 39 , 59 ]. Our data underline the potential of programs and policies to reduce substance use and limit its harms as one element of comprehensive sexual assault prevention; we found few evidence-based interventions that address both binge drinking and sexual assault prevention. Of course, any work addressing substance use as a driver of vulnerability must do so in a way that does not replicate victim-blaming.

However, similar to other studies with broad foci, incapacitation was not the only method of perpetration reported. For women, physical force, particularly for penetrative sex, was the second most frequently endorsed method. Verbal coercion, including criticism, lying and threats to end the relationship or spread rumors, was also employed at rates similar to physical force for women, and was the second most frequently endorsed category for men and GNC students. Prevention programs, such as the bystander interventions which are the focus of efforts on many campuses [ 60 ], often focus on incapacitation or physical force. These interventions tend to highlight situations where survivors (typically women) are vulnerable because they are under the influence of substances. In SHIFT, verbal coercion is also shown to be a powerful driver of assault; however, it typically does not receive as much attention as rape, which is legally defined as penetration due to physical force or incapacitation. If a survivor is verbally coerced into providing affirmative consent, the incident could be considered within consent guidelines of “yes means yes” but it may have been unwanted by the survivor [ 61 , 62 ]. Assertiveness interventions and those that focus on verbal consent practices may be useful for addressing this form of assault.

We also found high rates of re-victimization. As others have found, pre-college sexual assault was a key predictor for experiencing assault at CU/BC [ 33 , 36 ]. However, we also found high rates of repeat victimization since starting at CU/BC with a median of 3 incidents per person reporting any sexual assault since starting CU/BC, and the highest risk of repeat victimization in women and GNC students. These data underline the importance of prevention efforts that include care for survivors to reduce the enhanced vulnerability that has been shown in other populations of assault survivors [ 36 ]. Future studies should also seek to disaggregate the relationship between type of victimization (sexualized touching, attempted penetrative assault, penetrative assault) and repeat victimization.

This study also identified a number of variables associated with sexual assault, some similar to previous studies and others different. As noted, gender was a key correlate. While prevention efforts should respond to the population-level burden by focusing on the needs of women and GNC students, it is important to note that men were also at risk of sexual assault. In our study, nearly 1 in 8 men reported a sexual assault experience, a rate also found in the Online College Social Life survey [ 56 ], but higher than other studies [ 63 , 64 ]. Few programs target men, and issues around masculinity and gender roles may make it difficult for men to consider or report what has happened to them as sexual assault. Importantly, this study found that men who were members of fraternities were at higher risk for experiencing assault (specifically unwanted/nonconsensual sexualized touching) than those who were not members. This is consistent with previous findings, including the Online College Social Life survey [ 56 ], but is of particular note because research has identified men in fraternities as more likely to be perpetrators [ 64 ], but few, if any, studies have looked at fraternity members’ vulnerability to sexual assault. Our data suggest a need for further examination of the cultural and organizational dimensions of Greek life that produce this heightened risk of being assaulted for both men and women. However, it is important to note that we did not examine a range of other social and extracurricular groups which may have produced risk as well and thus a more full examination of student undergraduate life is needed.

One other key factor associated with assault was participation in “hook ups”. Both male and female students who reported hooking up were more likely to report experiencing sexual assault, compared to students who only had exclusive or monogamous relationships and those who had no sexual relationships. The role of hooking up on college campuses has received much attention in the popular press and in a number of books [ 65 , 66 ], but little has been written about its connection to sexual assault, although several recent studies are in line with ours about its role as a risk factor for experiencing sexual assault on college campuses [ 40 , 41 ]. Multiple mechanisms may be at work: students who participate in hookups may be having sex with more people, and thus face greater risk of assault due to greater exposure to sex with a potential perpetrator, but students who participate in hookups may also face increased vulnerability because many hookups involve “drunk” sex, or because hookups by definition involve sexual interactions between people who are not in a long-term intimate relationship, and thus whose bodies and social cues maybe unfamiliar to each other. Alternatively some aspects of hook-ups may be more or less risky than others and therefore continued study of different dimensions of these more casual relationships that can refer to a wide-range of behaviors is necessary.

Several demographic characteristics were not for the most part associated with sexual assault. We did not find racial or ethnic differences in sexual assault risk with primarily one exception, Asian male and female students were at less risk overall compared to white students. We also did not find transfer students to be at greater risk; female transfer students were actually at lower risk, potentially due to less exposure time, particularly during freshman year. International student status as indicated by having been in the US<5 years was also not associated with increased risk. However, this study highlights the role of economic factors that have received limited attention in the literature. Little is known about how economic insecurity may drive vulnerability, but issues of power, privilege, and control of alcohol and space all require further examination.

There are several limitations to this study. Participants came from only two private schools that are interconnected in one city, and thus findings may not generalize to the rest of the US. There is a continued need for more national studies with different types of colleges and universities in urban and rural environments with more varied economic backgrounds in order to fully understand institutional and contextual differences. Although we had a response rate that was higher than many prior studies and our rates of sexual assault are consistent with prior studies [ 4 ], we cannot assess the extent to which selection bias may have occurred and therefore, our rates could be an underrepresentation or overrepresentation depending on who chose to participate. Although this concern is somewhat mitigated by findings that basic demographic data between respondents and the total population of students at two colleges suggest no significant differences, there may be some bias in factors we did not consider. Our present analysis has focused only on bivariate associations between risk factors and assault. While this analysis provides a valuable description of which groups are at elevated risk or not, future work will consider how combinations of risk factors at different levels may interact to increase risk. Critically, the analysis presented here reflects a focus on those who experience being assaulted, but in other work we look at the characteristics of perpetrators, both from those who reported perpetrating and from a subset of incidents that survey respondents described in depth, which provided more information about the perpetrator. A greater understanding of the characteristics and contexts of perpetration is without question vital for effective prevention. Finally, our data are cross sectional. Longitudinal studies with a comprehensive range of predictors are critical for identifying pathways of causality and targets for interventions.

Despite these limitations, this study confirms the unacceptably high rates of sexual assault and suggests diversity in experiences and methods of perpetration. A key conclusion is that a”one size fits all” approach that characterizes the extant literature on evidence-based prevention programs [ 67 ] may need to be altered to more effectively prevent sexual assault in college. Clearly different groups had differential risk for assault and may require much more targeted prevention efforts. Bystander interventions have shown promise in addressing risk in social situations, including fraternity parties and other settings with high alcohol use [ 68 , 69 ]. However, bystander interventions may not be sufficient for incidents occurring in non-party contexts where verbal coercion methods or physical force may be used without others around.

Creating effective and sustainable changes to campus culture requires engaging with a broad range of institutional stakeholders. SHIFT investigators are in the process of sharing selected findings with both student and institutional advisory boards, and an intensive collaborative process allows us to explore the implications of our results for a broad range of policies and programs, including both elements commonly considered as sexual assault prevention (consent education, bystander trainings), more general topics related to sexual orientation and verbal discussions of sex, and aspects of the institutional context across diverse domains including alcohol policy, mental health services, residential life policies, orientation planning, and the allocation of space across campus.

Overall, our findings argue for the potential of a systems-based [ 70 ] public health approach–one that recognizes the multiple interrelated factors that produce adverse outcomes, and perhaps particularly emphasizes gender and economic disparities and resulting power dynamics, widespread use of alcohol, attitudes about sexuality, and conversations about sex–to make inroads on an issue that stubbornly persists.

Supporting information

S1 table. number of incidents of sexual assault since enrolling at cu/bc, among individuals with at least one incident..

https://doi.org/10.1371/journal.pone.0186471.s001

Acknowledgments

The authors thank our research participants; the Undergraduate Advisory Board; Columbia University’s Office of the President and Office of University Life, and the entire SHIFT team who contributed to the development and implementation of this ambitious effort.

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Published: 18 July 2013

Lessons learned from child sexual abuse research: prevalence, outcomes, and preventive strategies

Delphine Collin-Vézina 1 ,
Isabelle Daigneault 2 &
Martine Hébert 3

Child and Adolescent Psychiatry and Mental Health volume 7 , Article number: 22 ( 2013 ) Cite this article

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Although child sexual abuse (CSA) is recognized as a serious violation of human well-being and of the law, no community has yet developed mechanisms that ensure that none of their youth will be sexually abused. CSA is, sadly, an international problem of great magnitude that can affect children of all ages, sexes, races, ethnicities, and socioeconomic classes. Upon invitation, this current publication aims at providing a brief overview of a few lessons we have learned from CSA scholarly research as to heighten awareness of mental health professionals on this utmost important and widespread social problem. This overview will focus on the prevalence of CSA, the associated mental health outcomes, and the preventive strategies to prevent CSA from happening in the first place.

Although only recently acknowledged as a concerning social problem, child sexual abuse (CSA) is, in our day, at the forefront of worldwide social policies and practices. Four decades of research has certainly contributed to better our knowledge on the experiences of victims of CSA. With more than 20,000 research papers on CSA listed under the most renowned research databases, child and adolescent mental health practitioners, researchers and decision-makers may find it challenging to keep up with this rapidly increasing literature. In response to this need, the aim of the current paper is to provide a brief overview on CSA to heighten awareness of practitioners on this utmost important and widespread social problem. The content of this paper was first presented at the annual symposium of the Centre for Child Protection , headed by the Institute of Psychology at the Pontifical Gregorian University and scholars of the University of Ulm, to a group of religious leaders responding to the sexual abuse of minors around the world, including Argentina, Ecuador, Germany, Ghana, India, Indonesia, Italy and Kenya. Upon invitation, this current publication is a unique opportunity to highlight a few of the main lessons we have learned from the scholarly literature on CSA, with a focus on its prevalence, mental health outcomes and preventive strategies.

Magnitude: how prevalent is CSA?

Until recently, there was much disagreement as to what should be included in the definition of CSA [ 1 ]. In some definitions, only contact abuse was included, such as penetration, fondling, kissing, and touching [ 2 ]. Non-contact sexual abuse, such as exhibitionism and voyeurism, were not always considered abusive. Nowadays, the field is evolving towards a more inclusive understanding of CSA that is broadly defined as any sexual activity perpetrated against a minor by threat, force, intimidation, or manipulation. The array of sexual activities thus includes fondling, inviting a child to touch or be touched sexually, intercourse, rape, incest, sodomy, exhibitionism, involving a child in prostitution or pornography, or online child luring by cyberpredators [ 3 , 4 ]. CSA experiences vary greatly over multiple dimensions including, but not limited to: duration, frequency, intrusiveness of acts perpetrated, and relationship with perpetrator. Although sexual activity between children has long been thought to be harmless, child on child CSA experiences, such as those involving siblings, is increasingly being recognized as detrimental for the emotional well-being of children as adult on child CSA [ 5 – 7 ]. While adult-to-child interactions in which the purpose is sexual gratification are considered abusive, sexual behaviours between children are less clear-cut as there is no universal definition of sexual abuse that differentiates it from normal sex play and exploration [ 8 ]. Although a 2 to 5-year age difference between children was first suggested as necessary to consider sexual behaviours between siblings to be incest [ 9 ], this criterion is being questioned as studies have shown this age difference to be much lower in many substantiated cases of child-to-child abuse [ 10 ]. This formulation of CSA is in keeping with the recommendations from the 1999 World Health Organization Consultation on Child Abuse Prevention, where CSA is defined as any activity of a sexual nature ‘between a child and an adult or another child who by age or development is in a relationship of responsibility, trust or power, the activity being intended to gratify or satisfy the needs of the other person’. That said, some definitional issues have not yet been resolved in the field. First, much disparity exists regarding age for sexual consent, or age for sexual maturity, which has an influence on the extent to which statutory sex offenses are considered CSA. Sexual activities that involve a person below a statutorily designated age fall under the large umbrella of CSA; however, the age of consent varies greatly across countries, from as young as 12 or 13 (e.g. Tonga, Spain) to 17 or 18 years of age (e.g. some states in the US, Australia). In virtually all European jurisdictions, sexual relations are legal from age 16 onwards, but some countries have set the age for sexual consent at 14 or 15 [ 11 ]. In other words, when no coercion or force is used, cases that involve sexual activities between an adult and, for example, a 14-year-old teenager, will be either perceived as a consensual sexual relationship or criminalized and defined as sexual abuse, depending on the legal statutorily designated age of the country where the event occurred. In Canada, a bill was recently adopted to change the age of consent from 14 to 16, a premiere in Canada’s history, which emphasizes the impact governmental decisions can have on definitional issues of CSA in societies over time [ 12 ]. Second, although coerced sexual activities that occur in dating or romantic relationships is recognized as a form of sexual violence by the World Health Association (see for example a WHO multi-country study from Garcia-Moreno and colleagues [ 13 ]), the extent to which this form of interpersonal violence is socially recognized and acknowledged in different legislations around the world is unclear.

In that vein, the exact extent of the problem of CSA is difficult to approximate given the lack of consensus on the definition used in research inquiries, as well as the differences in the data collection systems across areas [ 14 ]. For example, in their review of the current rates of CSA across 55 studies from 24 countries, Barth and colleagues [ 15 ] found much heterogeneity in studies they reviewed and concluded that rates of CSA for females ranged from 8 to 31% and from 3 to 17% for males. Though, despite these methodological challenges, recent systematic reviews and meta-analyses that included studies conducted worldwide across hundreds of different age-cohort samples have consistently shown an alarming rate of CSA, with averages of 18-20% for females and of 8-10% for males [ 16 ], with the lowest rates for both girls (11.3%) and boys (4.1%) found in Asia, and highest rates found for girls in Australia (21.5%) and for boys in Africa (19.3%) [ 17 ]. Research findings do, however, clearly demonstrate a major lack of congruence between the low number of official reports of CSA to authorities, and the high rates of CSA that youth and adults self-report retrospectively. Indeed, the recent comprehensive meta-analysis conducted by Stoltenborgh and colleagues [ 17 ] that combined estimations of CSA in 217 studies published between 1980 and 2008, showed the rates of CSA to be more than 30 times greater in studies relying on self-reports (127 by 1000) than in official-report inquiries, such as those based on data from child protection services and the police (4/1000). In other words, while 1 out of 8 people report having experienced CSA, official incidence estimates center around only 1 per 250 children.

This discrepancy can be explained by the different steps that CSA cases go through before they are substantiated, and thus counted in official-report inquiries. First, victims of CSA or their confidants have to disclose their suspicions to the authorities. Many reports of child abuse are never passed on. In fact, the majority of studies highlight the fact that many victims continue to be unrecognized [ 3 ]. A review of CSA studies by Finkelhor [ 2 ] found that across all studies, only about half of victims had disclosed the abuse to anyone. This problem is often referred to as the phenomenon of the “tip of the iceberg” [ 18 ], where only a fraction of CSA situations are visible and a much higher proportion remain undetected. Disclosure is a delicate and sensitive process that is influenced by several factors, including implicit or explicit pressure for secrecy, feelings of responsibility or blame, feelings of shame or embarrassment, or fear of negative consequences [ 2 , 19 , 20 ]. Ethnic and religious cultures may also influence the way by which the process of disclosure is experienced and can act as either facilitators or barriers to the telling and reporting of CSA [ 21 ], which may explain variations of CSA rates across geographical areas [ 17 ]. Moreover, mandatory reporting regulations that have been adopted over the past decades in several countries, which imply that professionals are obliged to bring their suspicions of CSA to the attention of the authorities, can also impact the official counts of CSA in different countries [ 22 ]. In jurisdictions that have chosen not to enact mandatory reporting, including New Zealand, the United Kingdom, and Germany, a large discrepancy between adult self-reports of CSA and official data is to be expected as more cases may not be divulged to the authorities than in countries where reporting is mandatory. Second, based upon the initial disclosure or reporting, cases are screened in or out for further investigation by child protection workers or the police. Not all sexual abuse cases are considered to fall under the jurisdiction of child protection services, such as those that were assessed to involve no imminent risk to the child with regards to his/her security and development. For instance, cases where the alleged perpetrator is not the child’s caregiver may be less likely to be retained for investigation as it may not be under child welfare responsibilities to investigate these cases [ 23 ]. Finally, in light of evidence gathered in the course of the investigation process, cases are deemed substantiated or not by child protection workers and the police. When the child’s testimony is deemed unreliable or when the proof is perceived as questionable, cases may be considered unfounded and will, as a result, not be counted towards official data. Indeed, there is some evidence that police are less likely to charge sexual offenses than any other type of violent crime [ 24 ]. Other factors, such as the victim’s gender, may also influence substantiation decisions as demonstrated in a recent American study that showed, using the National Survey of Child and Adolescent Well-Being, that workers were less likely to substantiate cases involving male victims [ 25 ]. As improper interviewing techniques may hamper the capacity of victims to report accurately the abusive experience they were subjected to, promoting and sustaining best-practice interviewer techniques, notably among police officers, should be prioritized [ 26 ]. Considering the impact that all these different layers of influence have on cutting down the number of CSA cases that are known to and substantiated by the authorities, victims identified in official-report inquiries are therefore believed to represent only a small fraction of the true occurrence. For all these reasons, relying on official-reports to determine the magnitude of CSA is a method that carries a constant error of underestimation. In other words, children that are identified are only those that were able to disclose, were believed, reported to, and followed up by proper authorities, and those cases that presented enough evidence to be substantiated as CSA.

In terms of risk factors, being female is considered a major risk factor for CSA as girls are about two times more likely to be victims than males [ 16 , 17 ]. Several authors do, however, point out that there is a strong likelihood that boys are more frequently abused than the ratio of reported cases would suggest given their probable reluctance to report the abuse [ 27 ]. A recent Canadian population-based study confirmed this assumption by showing that among CSA survivors, 16% of female victims had never disclosed the abuse, whereas this proportion rose to 30% for male victims [ 28 ]. With respect to age, children who are most vulnerable to CSA are in the school-aged and adolescent stages of development, though about a quarter of CSA survivors report they were first abused before the age of 6 [ 3 ]. In addition, girls are considered to be at high risk for CSA starting at an earlier age and lasting longer, while boys’ victimisation peaks later and for a briefer period of time. The presence of disability is also considered a risk factor for CSA and other forms of maltreatment as the impairments may heighten the vulnerability of the child [ 29 ]. Aside, the absence of one or both parents or the presence of a stepfather, parental conflicts, family adversity, substance abuse and social isolation have also been linked to a higher risk for CSA [ 30 ]. In terms of the presupposed impact of socioeconomic status and ethnic background, the existing literature has many weaknesses and obvious contradictions. Overall, while low family or neighborhood socioeconomic status is a great risk factor for physical abuse and neglect [ 31 , 32 ], its impact on CSA is not as proven. On one hand, CSA could appear to occur more frequently among underprivileged families because of the disproportionate number of CSA cases reported to child protective services that come from lower socioeconomic classes [ 3 ]. In that vein, some populations of children have been overrepresented in research that focuses on vulnerable populations, such as Black American children from low socioeconomic status families, which may create an erroneous belief that race and ethnicity are risk factors for CSA [ 33 ]. On the other hand, some recent population-based studies are showing that, amongst other factors, living in poverty is a predictive factor for children to be subjected to both physical and sexual abusive experiences [ 34 , 35 ].

Mental health outcomes: what are the effects of CSA?

Several models have been developed in an attempt to explain the adverse negative impact of CSA [ 36 ]. Among the most established conceptual frameworks on the impact of CSA is the Four-Factor Traumagenics Model [ 37 ]. This model suggests that CSA alters a child’s cognitive and emotional orientation to the world and causes trauma by distorting their self-concept and affective capacities. This model underscores the issues of trust and intimacy that are particularly pronounced among victims of CSA. The unique nature of CSA as a form of maltreatment is highlighted by the four trauma-causing factors that victims may experience, which are traumatic sexualization, betrayal, powerlessness, and stigmatization. Traumatic sexualization refers to the sexuality of the victims that is shaped and distorted by the sexual abuse. Betrayal is the loss of trust in the perpetrator who shattered the relationship and in other adults who are perceived as not having protected the child from being abused in the first place, or having not supported her upon disclosure. Powerlessness is experienced through power issues at play in CSA, where victims are unable to alter the situation despite feeling the threat of harm and the violation of their personal space. Stigmatization is the incorporation of perceptions, reinforced by the perpetrator’s manipulative discourse or by dominant social negative attitudes towards victims, of being bad or deserving and responsible for the abuse.

Several reviews and meta-analyses published in the 90s and early years of 2000 suggested that a wide range of psychological and behavioral disturbances were associated with the experience of CSA, which led experts in the field to conclude that CSA was a substantial risk factor in the development of a host of negative consequences in both childhood, adolescence and adulthood [ 38 – 41 ]. More recently, systematic reviews have confirmed that, given the vast array of etiological factors that interact in predicting mental health outcomes, CSA is considered a significant, though general and nonspecific, risk factor for psychopathology in children and adolescents [ 42 – 44 ].

Among the wealth of psychopathologies that have been studied among CSA victims, post-traumatic stress and dissociation symptoms have received great attention. Overall, victims have been shown to present significantly more of these symptoms than non-abused children, or than victims of other forms of trauma. In one of our studies that compared 67 sexually abused school-aged girls with a matched group, CSA was found to significantly increase the odds of presenting with a clinical level of dissociation and PTSD symptoms, respectively, by eightfold and fourfold [ 45 ]. These results have echoed previous research conducted among cohorts of sexually abused school-aged children and teenagers where about a third to a half of all victims showed clinical levels of post-traumatic stress symptoms [ 46 – 50 ]. Only a few studies have been conducted with younger cohorts of children, yet high levels of dissociation were documented among sexually abused preschoolers [ 51 , 52 ]. In that vein, results from one of our recent inquiries revealed higher frequencies of dissociative symptoms among a group of 76 sexually abused children aged 4 to 6 than children of the comparison group [ 53 ]. These symptoms were found to persist over a period of a year following disclosure [ 54 ]. In contrast to children who have experienced other forms of trauma, it was also found that CSA victims are more likely to present post-traumatic stress symptoms [ 55 ]. Using a prospective method in which sexually abused children were followed over 36 months, Maikovich, Koenen, and Jaffe [ 25 ] demonstrated that boys were as likely as girls to exhibit post-traumatic stress symptoms.

Aside from post-traumatic stress and dissociation symptoms, a significant number of other mental health and behavioral disturbances have been linked to CSA. High levels of mood disorders, such as major depressive episodes, are found in cohorts of children and teenagers who have been sexually abused [ 56 , 57 ]. Sexually abused children are more likely than their non-abused counterparts to present behavior problems, such as inappropriate sexualized behaviors [ 58 ]. In the teenage years, they are found to more often exhibit conduct problems [ 59 ] and engage in at-risk sexual behaviors [ 60 , 61 ]. Victims are more prone to abusing substances, to engaging in self-harm behaviors, and to attempting or committing suicide [ 62 – 65 ]. Adolescents sexually abused in childhood are five times more likely to report non-clinical psychotic experiences such as delusions and hallucinations than their non-abused counterparts [ 66 ].

The mental health outcomes of CSA victims are likely to continue into adulthood as the link of CSA to lifetime psychopathology has been demonstrated [ 67 – 72 ]. Even more worrisome is the fact that CSA victims are more at risk than non-CSA youth to experience violence in their early romantic relationships [ 73 , 74 ] and that they are 2–5 times more at risk of being sexually revictimized in adulthood than women not sexually abused in childhood [ 75 – 77 ]. In adulthood, CSA survivors are more likely to experience difficulties in their psychosexual functioning [ 78 , 79 ]. A 23-year longitudinal study of the impact of intrafamilial sexual abuse on female development confirmed the deleterious impact of CSA across stages of life, including all of the mental health issues mentioned above, but also hypothalamic–pituitary–adrenal attenuation in victims, as well as asymmetrical stress responses, high rates of obesity, and healthcare utilization [ 80 ]. The impact of CSA as a predictor of major illnesses is garnering increasing attention, including gastrointestinal disorders, gynecologic or reproductive health problems, pain, cardiopulmonary symptoms, and diabetes [ 81 – 83 ]. In all cases, early assessment and intervention to offset the exacerbation and continuation of negative outcomes is highlighted, according to several studies [ 84 ], as symptoms can develop at a later age [ 3 ] or may not be apparent at first [ 85 ].

Indeed, despite overwhelming evidence of deleterious outcomes of CSA, it is commonly agreed that the impact of CSA is highly variable and that a significant portion of victims do not exhibit clinical levels of symptoms [ 86 ]. Some authors have suggested that about a third of victims may not manifest any clinical symptoms at the time the abuse is disclosed [ 87 ]. This can be explained, in part, by the extremely diverse characteristics of CSA which lead to a wide range of potential outcomes [ 86 ]. Other common reasons thought to account for asymptomatic survivors of sexual abuse include: (1) insufficient severity of abuse, (2) the fact that symptoms may not be detected by practitioners, (3) development of avoidant coping styles that mask victims’ distress, (4) or that asymptomatic survivors may be more resilient than the survivors who show symptoms [ 88 ]. Related to this latter explanation, among an array of variables potentially influencing the resilience capacities of CSA victims, children who receive support from their non-offending parents [ 89 ] and those who have not experienced prior abuse [ 90 ] seem to fare better in spite of the sexual abuse adversity. Among other personal and relational factors that promote resilience in victims are: less reliance on avoidant coping strategies to deal with the traumatic event [ 91 – 93 ], higher emotional self-control [ 94 ], interpersonal trust and feelings of empowerment [ 85 ], less personal attributions of blame and of stigmatization [ 95 , 96 ], and high family functioning and secure attachment relationships [ 97 , 98 ]. This scholarship points to the importance of using a broad ecological framework when researching and intervening on the factors that promote resilience in victims of CSA [ 88 ].

Three promising lines of research have recently emerged that shed new light on the relationships between CSA and psychopathology. First, results from the growing field of polyvictimization, which is the study of the impact of multiple types of victimization (from peers, family, crime, community violence, physical assaults, and sexual assaults), call for a de-compartmentalization of violence research by pointing out that cumulative experiences of victimizations are more detrimental to the child’s well-being than are any single experiences, including those of a sexual nature [ 99 ]. This suggests that measuring the impact of all forms of victimization alongside CSA is warranted in order to fully capture the influence of violence and abuse on the development of children and youth mental health outcomes. Second, recognizing the great diversity of symptom presentations in sexually abused cohorts, several scholars have attempted to identify the different profiles or sub-categories of victims. For example, Trickett and colleagues [ 100 ] found distinct profiles in their sample of girls sexually abused by family members, including victims of multiple perpetrators, characterized by significantly higher levels of dissociation, and victims of father-daughter incest who presented higher levels of disturbances across domains, including internalized (e.g. depression) and externalized (e.g. delinquency) behaviors. Hébert and colleagues [ 101 ] further contributed to this scholarship by identifying four different profiles among a sample of sexually abused children: (1) the chronically abused children displaying anxiety symptoms, (2) the severely abused children presenting a host of both internalized and externalized problems, (3) the less severely abused children displaying fewer symptoms, (4) and the less severely impaired children despite severe experiences of CSA, which the authors referred to as the resilient group. As a whole, these studies call for a better tailoring of the services offered to sexually abused children, so that services can well match the mental health needs of victims [ 102 ]. Third, drawing from epigenetics [ 103 ], cutting-edge inquiries are developing in CSA research on the interaction of CSA with other environmental factors and with genetic factors to predict mental health and behavioral outcomes, for example, violent behavior [ 104 ], or suicidal gesture [ 105 ]. These inquiries confirm the relevance of studying the psychobiology of child maltreatment [ 106 ] as a promising route to better our understanding of the unique contribution of CSA to mental health disturbances, relative to other factors, as well as of the complex nature of the interactions at play. This knowledge could eventually benefit the elaboration of effective intervention programs.

Preventive strategies: how can we prevent CSA from happening in the first place?

In light of the high prevalence of CSA and the wealth of deleterious outcomes associated with this abusive experience, it stands to reason that research attention must turn toward preventing CSA. Two widespread forms of sexual assault prevention efforts have been extensively studied and disseminated, namely, offender “management” and educational programs delivered, for the most part, in school settings. Offender management is the approach that aims to control known offenders, for example, registries, background employment checks, longer prison sentences and various intervention programs. It is a tertiary prevention initiative that acts mostly in the individual sphere and, as such, presents certain inherent limitations in regards to preventing CSA from happening in the first place [ 107 ]. Indeed, although the public generally approves of so-called punitive legal practices, such as longer sentences, they are based on a misconception of sexual abusers as pedophiles, “guileful strangers” who prey on children in public places, when in actual fact the child sex offender population is more varied, includes individuals known to the victim and is comprised of juveniles in almost a third of cases [ 107 ].

The second most frequent approach, primary prevention, involves universal educational programs generally delivered in schools and aimed at potential victims. In the majority of cases, these universal programs also intervene in the individual preventive sphere and more infrequently in the family or societal sphere. Regarding children attending elementary school, meta-analyses by Zwi and colleagues [ 108 ], covering 15 studies, and by Davis and Gydicz [ 109 ], covering 27 studies, revealed that programs are effective at building children’s knowledge about sexual abuse and their preventive skills. The second of those two meta-analyses further demonstrated that programs are more effective if they are longer in duration (four sessions or more), if they repeat important concepts, if they provide children with multiple opportunities to actively practice the taught notions and skills, and if they are based on concrete concepts (what is forbidden) rather than abstract notions (rights or feelings). Some programs have proven effective for building knowledge and skills among children in an average socio-economic environment [ 110 ], but presented mitigated results in a multi-ethnic and underprivileged urban environment, indicating that the program may need to be adapted in order to optimize its effects with specific clientele [ 111 ]. As per adolescents or young adults attending high school or college, a meta-analysis of 69 studies involving close to 20,000 participants revealed that programs are effective for improving participants’ knowledge and attitudes [ 112 ]. However, changes in terms of behaviours or intentions to act were too low to be clinically significant. Also, factors related to the clientele, the facilitator, the setting and the format of the program have all been shown to impact the effectiveness of sexual violence prevention programs in college or university settings [ 113 ]. For some of the above programs, data are available to suggest that they are associated with a reduction of the incidence of child sexual assault [ 114 ] and sexual victimization in teenage romantic relationships [ 115 ]. However, too few studies are available to draw a firm conclusion as to the efficacy of prevention efforts, introduced since the 1970s, to reduce the true incidence of CSA observed by authorities in some countries, most notably the US [ 116 – 119 ].

The advantages of the universal approach are numerous: these programs can be offered at low cost, they are fairly easy to implement widely, and they allow to reach a maximum number of children while avoiding the stigmatization of a particular population. Yet, this approach has also been criticized since it places the responsibility of prevention in the hands of children. Consequently, this approach should not be considered as the only answer to a social problem as complex as CSA. A multi-factorial approach may indeed constitute a more promising solution to solve the problem of sexual abuse. A multi-factorial conceptualization of sexual assault suggests that only the development of global preventive approaches, targeting personal, family as well as societal norms that influence the risk of assault, may substantially reduce incidence and prevalence rates [ 119 , 120 ]. Those actions may take a variety of forms, such as awareness campaigns, efforts to provide the proper training to all persons who may work with children and adolescents, including sexual abuse and trauma themes in academic programs of future practitioners, or even the development of up to date and comprehensive kits to help the media provide information free of sexism, prejudices and sensationalism when reporting on sexual assault cases. In addition, parents’ participation is a fundamental element for a successful prevention initiative as this may increase the acquisition of preventive abilities in children [ 110 ], thus, future endeavors will need to tackle the challenges to foster a greater participation of parents. While most prevention initiatives have favoured a universal approach, targeting at-risk groups may also ensure optimal efficacy of prevention efforts. Integrating new technologies and using social medias (web site, applications for cell phones, online interactive games) may be particularly relevant for prevention efforts targeting teenagers. If such approaches were implemented and coordinated on a broad scale, they may have a greater impact on the number of sexual assault victims.

The sexual abuse of children is a form of maltreatment that provokes reactions of indignation and incomprehensibility in all cultures. Yet, CSA is, unfortunately, a widespread problem that affects more than 1 out of 5 women and one out of 10 men worldwide. This alarming rate clearly calls for extensive and powerful policy and practice efforts. While the effects of CSA may not always be initially visible, survivors of CSA still carry the threat to their well-being. The traumatic experience of CSA is one major risk factor in the development of mental health problems affecting both the current and future well-being of victims. Considering that many victims continue to be undetected, the roots of these mental health problems may also be unrecognized. In an effort to provide effective services to all victims, we should prioritize the development of strategies to address the barriers to disclosure and reporting. Although the taboo of CSA might not be as prominent as a few decades ago when CSA was rarely spoken of, veiled issues may still prevent victims from reaching out to authorities to reveal the abuse they suffer. To effectively prevent CSA, global preventive approaches, targeting personal, family and societal conditions, need to be explored and validated so to protect the next generations of children and youth from sexual victimization.

Author’s information

Prof. Dr. Delphine Collin-Vézina is the Tier II Canada Research Chair in Child Welfare. She is a clinical psychologist by profession and a researcher in the area of child sexual abuse. She is an Associate Professor at the McGill University School of Social Work (Canada). Her proposed research program aims at promoting societal recognition of sexual abuse, and at implementing and evaluating promising practices to help victims of abuse heal from their trauma.

Prof. Dr. Isabelle Daigneault is a clinical psychologist and an Associate Professor in the Department of Psychology at the Université de Montréal (Canada). She has a particular interest in the areas of resilience and mental health of young sexual assault victims, as well as in the processes influencing the life trajectories of young victims. Her projects also relate to the efficacy of treatments offered to victims and sexual assault prevention programs.

Prof. Dr. Martine Hébert has training in child development and child clinical psychology. She is Full Professor at the Department of Sexology at the Université du Québec à Montréal (Canada) and director of the Research Team on interpersonal trauma. Her research interests focus on the diversity of profiles in sexually abused victims and factors related to resilience trajectories. Current projects also center on the evaluation of prevention and intervention programs.

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Collin-Vézina, D., Daigneault, I. & Hébert, M. Lessons learned from child sexual abuse research: prevalence, outcomes, and preventive strategies. Child Adolesc Psychiatry Ment Health 7 , 22 (2013). https://doi.org/10.1186/1753-2000-7-22

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Sexual assault: women’s voices on the health impacts of not being believed by police

Karen McQueen ORCID: orcid.org/0000-0001-9246-343X 1 ,
Jodie Murphy-Oikonen 2 ,
Ainsley Miller 1 &
Lori Chambers 3

BMC Women's Health volume 21 , Article number: 217 ( 2021 ) Cite this article

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A Correction to this article was published on 03 June 2021

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Sexual assault is a prevalent crime against women globally with known negative effects on health. Recent media reports in Canada indicate that many sexual assault reports are not believed by police. Negative reporting experiences of sexual assault have been associated with secondary victimization and trauma among survivors. However, little is known about the impact that being sexually assaulted and not believed by police has on a survivor’s health and well-being. The purpose of this study was to explore women’s experiences of not being believed by police after sexual assault and their perceived impact on health.

We conducted open-ended and semi-structured interviews with 23 sexual assault survivors who were sexually assaulted and not believed by police. The interviews explored the self-reported health impacts of not being believed by police and were conducted from April to July, 2019. All interviews were audio-recorded, transcribed, and entered into NVIVO for analysis. Data were analyzed using Colaizzi’s analytic method.

Analysis revealed three salient themes regarding the health and social impact of not being believed by police on survivors of sexual assault: (1) Broken Expectations which resulted in loss of trust and secondary victimization, (2) Loss of Self, and (3) Cumulative Health and Social Effects. The findings showed that not being believed by police resulted in additional mental and social burdens beyond that of the sexual assault. Many survivors felt further victimized by police at a time when they needed support, leading to the use taking of alcohol and/or drugs as a coping strategy.

Reporting a sexual assault and not being believed by police has negative health outcomes for survivors. Improving the disclosure experience is needed to mitigate the negative health and social impacts and promote healing. This is important for police, health, and social service providers who receive sexual assault disclosures and may be able to positively influence the reporting experience and overall health effects.

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The high rate of sexual violence against women is a concerning public health issue as approximately one in three women in North America experience sexual assault in their lifetime [ 1 , 2 ]. While sexual assault is a pervasive social issue that does not discriminate against age, gender, ability or status, research indicates that certain groups are at greater risk [ 1 , 3 , 4 ]. This includes women who are of colour [ 1 ], Indigenous, [ 3 , 5 , 6 ], employed in the military, living and working in underprivileged environments [ 3 ], have a disability [ 7 ], and student populations [ 3 , 8 ].

Sexual assault, defined as any type of forced or coerced sexual contact or behavior that happens without consent [ 9 ], violates the sexual integrity of individuals and exposes them to a variety of negative health outcomes [ 10 ]. These may include, but are not limited to social, psychological [ 10 , 11 , 12 , 13 ], sexual [ 12 , 13 , 14 ], and physical health outcomes [ 15 , 16 , 17 ] that may have lifelong deleterious effects on survivors.

In North America, police response to sexual assault has been highly criticized based on a culture of victim blaming and stereotyping which result in disbelief of sexual assault reports [ 18 , 19 ]. Rape myths also perpetuate the belief that many women lie about assault [ 4 , 20 ] and that rape only occurs to women who choose to live risky or chaotic lifestyles [ 21 ]. Recent Canadian media reports indicate that these societal myths are abundant in law enforcement, as a high number of sexual assault reports are not validated, and many sexual assault cases have been classified as “unfounded” [ 22 ]. According to the criminal code of Canada, when a case is classified as “unfounded” by the police, it is determined that a crime neither occurred nor was it attempted in the first place [ 23 ]. This contrasts with sexual assaults classified as unsubstantiated, as this classification is reserved for cases in which evidence is lacking and validation of the crime cannot be determined [ 23 ]. As such, the code “unfounded” is indicative of the victim not being believed and interpreted as lying. However, a meta-analysis of 7 studies found that the actual rate of false reporting (e.g., lying) about sexual assaults was low (approximately 5%) and typically reflected mental health concerns, misunderstanding of what constitutes sexual assault, and altered memory due to drug and alcohol use [ 24 ]. The findings from the meta-analysis suggest that many cases are inappropriately labelled as unfounded or not believed by police. A positive step was recently taken to minimize the use of the term "unfounded" through expanded Canadian crime reporting options; however, the change in codes does not automatically translate into increased belief of women’s sexual assault reports to the police. While the term unfounded is specific to Canadian reporting, evidence exists that not being believed by police is a widespread issue and not unique to Canada [ 25 , 26 ].

The experience of sexual assault and not being believed by police has not been explored from women’s first-hand accounts. Research has identified that many sexual assault survivors have had negative reporting experiences with police that can negatively impact well-being [ 27 ]. Other studies report that negative experiences may lead to secondary victimization [ 28 ] or trauma [ 29 , 30 ]. Given the known negative health effects that sexual assault has on survivors, coupled with the potential detrimental effects of a negative reporting experience, there is a need for a better understanding of how not being believed by police impacts women’s health. This is important for police, health, and social service providers who work with women who have been sexually assaulted, as a multidisciplinary response [ 31 ] to sexual assault is needed across the health, social, and legal sectors. The guiding principles of a multi-disciplinary approach are to ensure the survivors are safe, that their voices are heard, and that they have the autonomy to decide what they need for healing [ 32 ]. Thus, the purpose of this study was to understand the health impacts for women who were sexually assaulted and not believed by the police. For our study, health was broadly defined as a state of physical, mental and social well-being [ 33 ].

Study design

The study involved qualitative research and explored the lived experience of women who were sexually assaulted and not believed by the police [ 34 ]. It particularly explored the self-reported health impacts of study participants. It used a phenomenological approach to capture the lived experiences of participants [ 35 ]. The consolidated criteria for reporting qualitative research (COREQ) guided the conduct of this study [ 36 ].

Sampling and recruitment of participants

Purposive sampling was used to recruit a sample of participants from a large geographic area in northwestern Ontario, Canada, between April 13th and July 21st, 2019. Recruitment strategies included social media advertising (e.g., Facebook, Twitter, and Instagram) and through word of mouth from social service providers who had been informed of the research. Individuals wishing to learn more about the research study were invited to contact a member of the research team via cellular telephone or email. During the initial contact, the research process was explained and potential participants were invited to ask questions.

The eligibility criteria to participate in the study included: (a) being an English-speaking female 16 years of age or older, having experienced a sexual assault, which was reported to police, (b) self-report that the sexual assault was not believed by the police, and (c) ability to provide consent and participate in interviews within the designated study region. Participants were excluded from the research if: (a) the police laid charges and/or the perpetrator was taken to court, (b) the survivor of the sexual assault did not wish to pursue charges, or (c) the survivor self-identified that they were unsure whether a sexual assault occurred (unclear events or memories). A research assistant screened prospective participants by telephone to ensure they met the inclusion criteria for the research. The Principal Investigator or Co-Investigator provided a full explanation of the study, re-assessed eligibility and obtained informed consent before commencing the interview. Written consent was obtained for all in-person interviews. Two participants who were interviewed through telephone provided verbal consent. The informed consent process included providing information on the purpose of the research, risks and benefits of participation, anticipated outcomes and dissemination of the information gathered through the research. All participants were informed of their rights including not answering questions, asking for clarification, requesting a break and/or ending the interview at any time. All participants who provided written consent were provided with a copy. The consent process (written and verbal) was approved by the research ethics board.

Thirty-seven women expressed interest in the research. Twenty-three women met the inclusion criteria of having experienced a sexual assault, reported the assault to the police, and perceived that they were not believed by police. Participant’s perceptions of police disbelief were determined by various factors such as the short duration of police report with little or no note taking, location of the reporting (not at the police station), no incident numbers provided, blaming questions, lack of a thorough investigation, no follow-up on case outcomes from the police, no charges laid, and/or no return phone calls from the police. Some participants indicated that police explicitly stated that they did not believe the woman’s report. One participant provided a copy of the police report, which confirmed that the police did not believe her report. There were no individuals who refused to participate in the study; however, the researchers excluded thirteen transcripts from the analyses based on the exclusion criteria. Despite reviewing inclusion and exclusion criteria prior to the interview, it emerged during some interviews that the women were believed by police. In three cases police laid charges and the perpetrators went to court and in six cases the women chose not to pursue charges. Two of the sexual assault cases were not reported to the police and two self-identified that they suspected but were not certain a sexual assault had occurred (e.g., they stated that “something didn’t feel right”, but had no recollection of a sexual assault). One participant was excluded as she was unable to provide consent due to being intoxicated.

Data collection

Data collection was conducted by an all-female research team and included one to two semi-structured face-to-face (n = 21) or telephone interviews (n = 2) based on participant preference. Second interviews were conducted with two participants based on their request to provide additional information. Interviews were conducted in the University campus and led primarily by the principal investigator or lead author with expertise in interviewing and qualitative methods. A second member of the research team was present to collect demographic data, take field notes and support the interview process. There were no other individuals present during the interview. Prior to commencement of the interview, introductions were made and the purpose and rationale for the research were outlined for the participant, allowing an opportunity for questions to be addressed.

The interviews were open-ended and followed a semi-structured interview guide developed for this study. The interview guide was informed by the literature and researcher expertise in relation to the purpose of the study (see Additional file 1 ). To isolate the impact of not being believed from that of the sexual assault, women were asked to describe the impact on health (if any) when their sexual assault report was not believed by the police and how that differed from the impact of the sexual assault on their health and well-being. In addition to the interviews, a demographic questionnaire was completed by participants after the interviews. The average length of the interviews was 53 min. A second interview occurred on two occasions when participants called back to report information that they felt was important and not included in the first interview. The research team discussed termination of conducting further interviews based on saturation of the data. A few additional interviews were conducted and included in the analysis once saturation had been achieved since they had been previously scheduled.

Following each interview, participants were provided with an honorarium as a token of appreciation for their time. In addition, all participants were provided with a list of support services available in the community if they felt they required additional support. The university institutional research ethics board (ref # 1466856) approved all study related materials (e.g., consent, recruitment advertisement, and interview guide).

Data analysis

To aid in the analysis, all interviews were audio recorded and transcribed verbatim. All interviews were conducted in English, which was the language of the participants, hence no translation of the transcripts was required. Transcripts were entered into NVIVO version 11. Colaizzi's [ 37 ] analytic method was used as a means of organizing and analyzing the data. This approach included extensive reading of transcribed data, extraction of significant phrases, a constant comparative method, and a comprehensive thematic description of the accounts of participants by three study team members (JM-O, KM, AM). A fourth study team member (LC) reviewed all themes and data collected within each theme to verify the findings. Discussion occurred between all (n = 4) research team members to ensure the interpretation of findings was accurate; no changes to the original thematic analysis were deemed necessary. All participants were invited through email to validate themes. Five participants requested to review the thematic findings. These findings were discussed via telephone with the principal investigator. The five participants confirmed the findings and did not add any further information.

Participant characteristics

Of the twenty-three women who participated in the study, approximately half self-identified as Caucasian (n = 12; 52%) or Indigenous (n = 11; 48%). The average age of women at the time of the study was 37 years (range 22 to 57 years). Most women reported being single (n = 15; 65%), unemployed (n = 13; 56%), and earning an annual income less than $19,999 (n = 16; 69%). Participants had various levels of education, including partial high school (n = 6; 26%), high school completion (n = 1; 4%), college (n = 9; 39%), and university (n = 5; 22%), while two did not report their levels of education.

The circumstances of the sexual assault were mixed. More than half of the women (n = 15; 65%) reported knowing the perpetrators (intimate partner [n = 1], family member [n = 3], acquaintance/friend [n = 11]), while eight (35%) of the perpetrators were strangers. Likewise, the response to the sexual assault varied, with nine (39%) reporting that they physically and/or verbally resisted the attacker (n = 11; 48%). Drugs and alcohol were a factor in many of the sexual assaults, with 57% (n = 13) of perpetrators having consumed alcohol, nine of whom, had also used drugs. For the assaults by strangers, women were unsure whether the perpetrator had used drugs or alcohol. Among survivors, half reported (n = 12; 52.2%) using substances prior to the assault. Of these, the majority used alcohol only (n = 8), alcohol and drugs (n = 3) or drugs only (n = 1). Three additional participants reported that they were forcibly given alcohol and/or drugs prior to the assault. Five participants (21.7%) suspected that they were drugged by the perpetrator prior to being sexually assaulted.

Analysis of the interview transcripts revealed three salient themes related to the health and social impact of not being believed by the police. These included: (a) Broken Expectations, (b) Loss of Self, and (c) Cumulative Health and Social Effects . Within the theme of Broken Expectations, two subthemes emerged including Loss of Trust and Secondary Victimization .

Broken expectations

Overall, most participants noted that the purpose of the police was to protect the public. They disclosed that this sense of safety and protection contributed to their sense of well-being and was disrupted during their report of sexual assault. Accordingly, when the women made their sexual assault reports to police, they believed that the police would assist and investigate their complaints. However, the participants explained that there was incongruence between what they believed would happen when they reported and what actually occurred. They described feelings of disappointment, being let down, having an additional pain, or that their sexual assault reports fell on “ deaf ears ” (033). “ They are supposed to be there to help you and keep you safe, and I didn’t think they were doing it at all ” (010) . An Indigenous participant who reported her sexual assault to the police and waited more than 24 h for a police response, described how she thought making a report would be the first step of the healing process after the sexual assault, but believed that her experience with the police made it [sexual assault experience] all worse:

You think that they [police] are going to protect you, right, and that they are going to do justice. What happened had happened [sexual assault] and that couldn’t be undone. I don’t know how to explain it, like kind of a step towards healing, if that makes sense. Like that would have been my first step, instead it just kind of made a new pain to have to deal with. (009)

Participants’ expectations were broken when the police did not act and investigate their complaints. Before reporting, participants believed that the police would take their complaints seriously. Participants reported that they expected “ I would get called back ” (008), “ that the assault would be investigated ” (001) or “ they would take my report ” (022). However, many said that they never heard back from police and that their concerns were never followed up. These broken expectations led to adverse social and health outcomes for participants when they perceived they were not being believed. This included loss of trust in the police and secondary victimization by the police.

Loss of trust

Many participants reported experiencing loss of trust in the police and the justice system after not being believed and/or their report not being followed-up. Much of the discussion regarding loss of trust was based on participants’ perceptions that the police did not care about them as individuals or that the police had too many other things to deal with. This loss of trust led women to feel that there was no point in seeking assistance from the police in other situations. A young woman who was sexually assaulted while sitting alone in a secluded area, reported the assault to the police, and recalled that the police laughed at her when she disclosed that she was assaulted by a stranger. Their response precipitated her lack of trust; “ We will take care of each other, because they [police] don’t care about us and…you know, they don’t believe you anyways, so don’t even bother. We will deal with our own stuff ” (012) . Another participant who was sexually assaulted and reported the assault to the police following a medical examination at the hospital, described feeling interrogated by the police, with the police officer’s initial question being “ Did you just do it and regret it ” (017)? This experience led to her lack of trust and subsequent protective instincts with her two young children, “ I always tell my kids police are safe to go to, but there is still hesitation with that…I wouldn’t discourage them from it, but I would rather have them come to me and then I’ll help them if something ever happened ” (017) .

The loss of trust in police impacted some women who experienced further violence or sexual assaults and did not make subsequent reports out of fear of not being believed by the police. An Indigenous participant who reported feeling immense shame when the police did not believe that her sexual assault had occurred, described the impact of the police response on her subsequent experience with violence, “ When I first got into my domestic (i.e. intimate partner abuse) , the relationship was violent, like I never called [the police] , I never called anytime that I got hit. I never felt like they would believe me anyway ” (009) . Similarly, despite being drugged during her sexual assault, and left “hogtied” (i.e. hands and feet tied together) on a street, a participant who perceived her involvement in the sex trade contributed to not being believed by the police, described the impact of the disbelief on her well-being, “ Well, I was in a relationship where I was beat, beat very badly, and it took me 2 years before I reported it…because they wouldn’t believe me ” (029) . Participants’ prior experience with police greatly impacted their subsequent physical and mental health, as several indicated enduring subsequent abuse instead of reporting to the police.

Secondary victimization

Women had various motivations to report their experiences of sexual assaults to the police. Many of the women wanted to report their experiences to the police in order to have the perpetrator charged, or to prevent others from being assaulted. Some indicated that they felt nervous to report to the police and only did so with encouragement from family, friends or healthcare/service providers. When the women did report, and were not believed, some felt being further victimized by the reporting experience and the questions they were asked. A young woman who was sexually assaulted after a social outing with friends on a University campus, described her interaction with the police, thus:

His [police officer] demeanour, like a bit of everything; his tone. I remember his tone because he was like well did you do this? Even the way he asked it was like, what were you wearing? … That’s the one thing I can really remember, and I said those questions shouldn’t stick with me for the rest of my life, but they do. I feel like sometimes that was worse than the actual incident (017).

Similarly, another participant who was involved in sex work, commented that the police response to her report was “ well you work the streets, you bring it on yourself ” . Furthermore, the police officer stated, “ serves you right for being out there on the corners and out at night, you women ask for it. I will never forget that; you women ask for it ” (029)! The experience of being let down by the professional who is supposed to protect you was perceived as emotionally damaging well beyond the trauma of the sexual assault. It is this disbelief from the police that left women feeling defeated, unsafe and unworthy of protection and support.

Loss of self

All participants reported that not being believed by police impacted them at a personal level. Many indicated that the disbelief by police impacted their well-being and made them feel as if a part of them had been lost or taken away. The women described feelings of loss regarding their self-worth, self-esteem, self-image, and/or self-confidence after not being believed. A woman who was drugged by her perpetrator, had a rape kit done at the hospital, reported the assault to the police and felt dismissed by them, discussed the impact of disbelief from the police on her sense of self, thus:

It took away from who I was as a person before that, and it chipped away at my self-esteem. It made me think ok, well if these people think that I am not worthy of investigation and not worthy of fighting for, then why should I fight for myself? Why should I fight for my life (022)?

Similarly, another participant who was sexually assaulted repeatedly by her step-brother, explained the impact that the disbelief from the police had on her self-worth, stating, “ You feel like if the police don’t care what happens to you, why should I, right ” (033)? The internalization of the police response was further articulated as, “ I do the same thing that they did to me, I sweep me under the carpet ” (i.e. ignore my own needs) (033) . The narratives by participants show that many of the women felt that the lack of investigation and validation of their report was synonymous with not being worthy or important enough. The lack of validation made one woman view herself as “ a lying, drunk piece of shit really ” (018) .

Women also reported that not being believed impacted how they perceived themselves or how they were perceived by others. They indicated that they felt “ guilty ”, “ like a liar ”, “ like I did something wrong ” , “ dismissed ” , “ shame ” and “ angry ” after not being believed. Some women reported that they blamed themselves or felt guilty like it was their fault for going to the bar the night they were assaulted or that they willingly went with the individual who later assaulted them. Despite being the victims of crime, the interaction that women had with the police prompted an internalization of shame and personal responsibility for something outside of their control.

Cumulative health and social effects

Participants reported that the sexual assault negatively impacted their health. All (n = 23, 100%) women self-reported negative effects on their mental health including Post Traumatic Stress Disorder (PTSD), depression, and escalation or initiation of alcohol or drug abuse. Thirteen (57%) had physical injuries (e.g., bruises, cuts, head injury) and many reported negative social effects including subsequent homelessness (n = 10, 31%) and/or future unreported assaults (sexual or physical) (n = 17, 74%). At times, it was difficult for the women to specifically separate out the effects of the sexual assault from those of not being believed by police on their health and well-being. However, participants reported that not being believed by police exacerbated or resulted in additional negative effects on their overall health and well-being. Many indicated that the experience of being sexually assaulted and then not being believed had a cumulative effect, which made the impact worse. One participant who was sexually assaulted in high school stated that,

I became very angry at the world that I had to go through that and nobody else did and or no one else even cared or believed me. It was a very dark place in my life. I tried to commit suicide after that too at one point. I had a lot of mental health issues (033).

Women used various descriptors in their narratives to explain how not being believed by police had both significant and long-lasting health and social effects. In terms of the magnitude of the impact, a woman who was sexually assaulted by a relative reported that not being believed “ probably affected me the worst ” (009). Another indicated that “ it did have an effect on me emotionally, very strongly ” (001) and “ you know I felt like that [emotional effects] for a very long time ” (022). Not being believed by police also meant that there would never be closure of the cases and this left women to wonder what could have been, or how their lives might have been different. A woman who experienced sexual assault from a distant family member explained the impact of the lack of closure of her case, “ who would I be if these things never happened to me? Or maybe if the police believed me and there was closure to the case, would that make a big difference to me or would it not? I don’t know ” (033). Similarly, a participant who found the courage to report a sexual assault away from her home environment in another community, had her file transferred numerous times without any police officer taking full responsibility. She explained that not being believed added to the sexual assault, “ I think it’s the whole thing, the big picture, the whole experience. You know, like why me? What did I do to deserve this? (033)” .

This study explored the impact that being sexually assaulted and not believed by the police had on women’s health. Overall, women reported that not being believed by police had a negative impact on their mental (e.g., low self-esteem, loss of self-worth, secondary victimization) and social health (e.g., loss of trust, experiencing and not reporting further assaults) beyond the impact of the sexual assault (e.g., PTSD, substance use, physical injuries etc.). This indicates that not being believed by police resulted in additional mental and social burdens during an already traumatic period. For many of the women, they perceived the impact to be both significant and long-lasting. These findings suggest that women who were not believed by police felt further victimized and may have suffered additional trauma.

Our findings are consistent with the general sexual assault literature that suggests that women often experience secondary victimization from lack of investigation, insensitivity, and perceived judgment from police officers, as well as low rates of arrests and sentencing of the perpetrator(s) [ 38 ]. Unexpected negative reactions, including blame, judgment, disbelief, and lack of empathy may negatively influence well-being and recovery [ 39 , 40 ]. Negative social reactions to sexual assault disclosures may amplify feelings of powerlessness, grief, loss, and disenfranchisement [ 13 ], shame [ 41 , 42 ], increased severity and duration of PTSD [ 43 ] and other mental health concerns [ 44 ]. When the sense of self (i.e. self-worth) is negative, there are often greater risk-taking behaviours as survivors may not feel that they are worthy of protection or deserving of safety and wellness [ 43 ]. The women in our study, who had negative reporting experiences, lost trust in police, and reported experiencing further assaults and victimization. Additionally, as women were not believed by police, they were often not referred for support or treatment, leaving survivors to either attempt to heal from within, or turn to health and social service providers for support on their own. Without treatment, women felt that the negative effects of the sexual assault and not being believed were cumulative, severe and long lasting. Furthermore, many had poor mental health (e.g., PTSD, depression, anxiety) and reported escalation of substance use as a coping mechanism.

Women’s first-hand accounts of their reporting experiences from our study highlight the associated trauma that presents when women’s reports are not believed by police. When women’s sexual assault disclosures are responded to with empathy and validation, they experience less adverse health outcomes [ 45 ]. In addition to improved health, women who have positive experiences are also likely to utilize adaptive coping strategies such as cognitive restructuring, expressing emotion and meditation [ 46 ] and are likely to approach formal assistance networks (e.g., mental health or primary care provider) [ 47 ]. Given the deleterious effects of not being believed by the police on the health and well-being of survivors, and the known benefits of an empathic response, health and social service professionals may be well positioned to assist women in rebuilding their lives, promoting positive coping strategies, and ensuring that women’s voices matter.

Health and social service professionals can reduce the impact of secondary victimization [ 48 ] and the negative effect on health and well-being of survivors by believing survivors’ accounts. Health and social service providers should determine the experiences women had with police in order to ensure that survivors are provided with a safe environment and their dignity is maintained. Person-centered care is central to assisting survivors of sexual assault heal from their experiences. Thus, providing compassionate care and preserving the dignity and well-being of the survivor [ 49 ] is essential for mitigating the impact of the assault and the experience of disbelief from the institutions designated to protect them. Comprehensive care for survivors is needed for immediate and long-term health benefits [ 50 ]. Professionals are also well-equipped to fulfill an advocacy role with sexual assault survivors [ 32 ] which may assist in re-visiting the sexual assault report, safety planning, achieving justice through law enforcement, and subsequently assisting in closure of cases for survivors.

Our research has demonstrated that sexual assault survivors fear reporting subsequent victimization to the police due to a lack of trust in them. Fear of reporting is problematic as access to positive formal support may mitigate the severity of trauma reaction among survivors [ 39 ]. Health and social service providers trained in trauma informed care can increase sexual assault reporting by supporting survivors and advocating for sensitive treatment from the police. While numerous factors may impact women’s recovery from the trauma of sexual assault [ 51 ], enhancing the disclosure experience is one strategy that may be beneficial for attaining long-term health and wellbeing of survivors, given that sexual assault is already one of the most under-reported crimes [ 52 ].

The lack of reporting of sexual assault is problematic for several reasons. First, underreporting of sexual assault underestimates the severity of the problem and results in under-estimation of the number of individuals affected. Having an accurate recording of the extent of sexual violence is necessary for the allocation of resources for preventive and treatment services [ 53 ]. Safety is also of concern, as recidivism of sexual perpetration is a risk for both the survivor and/or other individual(s). Furthermore, if women do not disclose the sexual assault, they are likely to suffer in silence and are at risk of missing out on supportive services. Given that survivors of trauma often feel betrayed and may have difficulty trusting others [ 54 ], their reluctance to report is not surprising. The findings of this study support the need to provide a safe space for survivors to disclose sexual violence without being further victimized [ 54 ].

Implications for policy and practice

The women in our study articulated the negative impact that not being believed by police had on their well-being beyond the sexual assault. Their voices (e.g., research themes) need to be highlighted to provide a better understanding of women’s experiences, which may lead to increased sexual assault reporting and improved response from law enforcement.

The large number of Indigenous women in our sample requires further exploration. Rates of sexual violence against Indigenous women are three times greater compared to other groups [ 3 ], and historical patterns of maltreatment and being dismissed by police still persist [ 55 , 56 , 57 ]. Their experiences may be unique and require targeted interventions (i.e. focus on cultural safety) to meet their needs.

Sensitization regarding women’s experiences and how to respond positively to survivors is required for community service providers, police, and healthcare professionals who receive sexual assault reports [ 26 , 44 , 58 ]. Sensitivity training for police officers that incorporates women’s voices and experiences can also serve to reduce bias, and improve belief of survivors. This may be particularly important in small communities where there are no specialized units to investigate sexual assaults. Strategies that survivors feel are helpful include providing time to talk about their experiences (i.e. listening), expressing belief in their experiences, telling them it is not their fault, and promoting agency [ 44 ]. Avoiding blame, offering support, validating their experiences, providing support and follow-up [ 43 ] and safety planning are also important for survivors’ health and well-being [ 44 ]. Furthermore, incorporating trauma-informed principles such as establishing safety, respect, choice, collaboration, and empowerment are additional strategies that could facilitate a positive disclosure experience and minimize the possibility of re-traumatization [ 59 ]. Using this type of approach recognizes the impact violence has on individuals and minimizes secondary victimization [ 59 ]. Information, education and communication campaigns are also needed to challenge the normalization of rape culture myths, so that victims feel safe to report and/or seek services for sexual assault [ 60 ].

Limitations

Participation is the study was voluntary and limited to women who self-disclosed that their sexual assault report to police was not believed. We were unable to determine whether the cases were classified as unfounded by police. This study presents only the perspective of those who perceived that they were not believed and did not include those who reported sexual assault and had positive experiences. Although participants included a diverse sample of women (i.e. by ethnicity, education, and socio-economic status) the study design precluded comparison within the sample. The participants in this study were primarily women from low socio-economic background with limited education residing in one geographic area and the findings may not be generalizable to all women.

Conclusions

Sexual assault has long been associated with adverse outcomes for survivors. Not being believed by police after reporting a sexual assault has an additional negative impact on survivors beyond that of the assault. The findings of this study suggest that efforts are needed to improve the support for sexual assault disclosures for women so that they can report sexual assault without experiencing further victimization, thereby increasing their safety and potentially mitigating secondary victimization. The women’s voices from our study may provide police and health and social service providers with a better understanding of the experiences of sexual assault survivors thereby improving police response.

Availability of data and materials

Data used in this paper are not publicly available due to the sensitive nature of the topic and the risk of breaching confidentiality. The data are available on reasonable request from the lead author.

Change history

03 june 2021.

A Correction to this paper has been published: https://doi.org/10.1186/s12905-021-01380-8

Abbreviations

Consolidated criteria for reporting qualitative research

Post-traumatic stress disorder

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Acknowledgements

The authors acknowledge all the survivors who shared their stories, as well as Alexa Hiebert for her assistance with recruitment and interviewing.

This research was funded by SSHRC Insight Development Grant #1466362. The funder played no role in the design and implementation of the study, data analysis, drafting the manuscript or the decision to submit the manuscript for publication.

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J.M-O provided oversight on all aspects of the study from conception through to implementation. All authors participated in the interviewing of participants and reviewed all transcripts. KM, J.M-O and AM had overall responsibility for the data analysis with LC providing feedback on themes. All authors participated in the writing of the manuscript and reviewed the final submission. All authors read and approved the final manuscript.

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McQueen, K., Murphy-Oikonen, J., Miller, A. et al. Sexual assault: women’s voices on the health impacts of not being believed by police. BMC Women's Health 21 , 217 (2021). https://doi.org/10.1186/s12905-021-01358-6

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DOI : https://doi.org/10.1186/s12905-021-01358-6

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Rape-Related Pregnancies in the 14 US States With Total Abortion Bans

1 Planned Parenthood of Montana, Billings, Montana
2 Resound Research for Reproductive Health, Austin, Texas
3 Hunter College, City University of New York, New York
4 Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
5 Department of Medicine, University of California, San Francisco
Editor's Note Access to Safe Abortion for Survivors of Rape Deborah Grady, MD, MPH; Sharon K. Inouye, MD, MPH; Mitchell H. Katz, MD JAMA Internal Medicine
Medical News in Brief 65 000 Rape-Related Pregnancies Took Place in US States With Abortion Bans Emily Harris JAMA
Correction Error in Methods, Results, and Table 2 JAMA Internal Medicine

Many US women report experiencing sexual violence, and many seek abortion for rape-related pregnancies. 1 Following the US Supreme Court’s 2022 Dobbs v Jackson Women’s Health Organization ( Dobbs ) decision overturning Roe v Wade , 14 states have outlawed abortion at any gestational duration. 2 Although 5 of these states allow exceptions for rape-related pregnancies, stringent gestational duration limits apply, and survivors must report the rape to law enforcement, a requirement likely to disqualify most survivors of rape, of whom only 21% report their rape to police. 3

Editor's Note Access to Safe Abortion for Survivors of Rape JAMA Internal Medicine

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U.S. military sexual assault rates 2 to 4 times higher than govt estimates, study says

Image: Pentagon Commences Sexual Assault Awareness And Prevention Month

The number of sexual assaults in the U.S. military is likely two to four times higher than government estimates, according to a new study out of Brown University.

The study, completed by the Costs of War Project at Brown University’s Watson Institute, compared Defense Department data on sexual assaults with data that was not from the DOD to estimate sexual assault figures in the military since 2001.

“During and beyond the 20 years of the post-9/11 wars, independent data suggest that actual sexual assault prevalence is two to four times higher than DoD estimations — 75,569 cases in 2021 and 73,695 cases in 2023,” the authors wrote in the report , which was released Wednesday.

Defense Department figures estimate that there were approximately 35,900 cases in 2021 and around 29,000 military personnel assaulted in 2023, the study said.

The Brown report said that independent studies show higher estimates of the number of active-duty service members experiencing sexual assault, and it compared those studies with Defense Department numbers.

“This report highlights a middle range — two to four times higher than DoD estimates — as likely providing the most accurate numbers,” it said.

A Defense Department spokesperson said it would "be inappropriate to comment on the methodology of studies not conducted by the Department."

"The department continues our sustained progress to build strong command climates and prevent sexual assault, assist sexual assault survivors with recovery, and hold alleged offenders appropriately accountable," the spokesperson added. "Sexual violence will not be tolerated, condoned, or ignored within our ranks. Everything we are doing in this space is focused on helping us make lasting, meaningful change."

Among those mentioned in the report is Vanessa Guillén, a soldier at Fort Hood (now Fort Cavazos), Texas, who had reported sexual harassment at the base and who officials say was later killed by another soldier, Spc. Aaron Robinson.

Guillén’s April 2020 killing sparked calls for military reform and, in 2022, Congress passed the “I Am Vanessa Guillén Act” that changed the way the military handles sexual abuse-related investigations and allegations.

Another soldier at Fort Hood, Elder Fernandes, died by suicide in 2020 after experiencing what the Army said was "abusive sexual contact."

The Costs of War Project report comes a year after a Pentagon report found that reports of sexual assault at the nation’s three military academies rose more than 18% from 2021 to 2022, hitting a new high.

A 2021 Congressional Research Service report said there was some evidence that a majority of sexual offenses in the military are not being reported.

The I am Vanessa Guillén Act removed military commanders from the equation when it comes to sexual assault investigations and puts the investigation in the hands of independent prosecutors.

The Costs of War Project report calls that change "the largest change to the UCMJ since the military created its own legal system in 1950," referring to the Uniform Code of Military Justice.

The report faults the U.S. wars in Iraq and Afghanistan following the terrorist attacks of Sept. 11, 2001, as putting the long-standing issue of sexual assault, racism and other discrimination secondary to force readiness.

"In the Secretary of the Army’s own words, going to war has prevented the military from institutionally reckoning with its shameful longstanding epidemic of sexual assault," the authors wrote.

Phil Helsel is a reporter for NBC News.

Courtney Kube is a correspondent covering national security and the military for the NBC News Investigative Unit.

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National sexual violence prevention project

La Trobe University researchers will lead a new project to identify the most effective sexual violence prevention programs, following $7.45 million Federal Government funding.

PHOTO: The ReGEN team at La Trobe Dr Jess Ison, Associate Professor Kirsty Forsdike, Felicity Young and Professor Leesa Hooker.

Minister for Social Services Amanda Rishworth said to create real change and end sexual violence in Australia, we need to take action based on evidence.

Organisations that run sexual violence interventions can each apply for up to $600,000 in funding to work with La Trobe researchers. Twelve organisations will be selected to develop their projects over a six-month period and up to 10 of these will then be selected for full implementation and evaluation.

Known as the ‘ Partners in Prevention of Sexual Violence Project ’, the scheme is designed to strengthen evidence for sexual violence prevention in Australia.

Professor Leesa Hooker, a Principal Research Fellow and Director of the Reducing Gender-Based Violence Research Group (ReGEN) at La Trobe Rural Health School, said the funding would help bridge an existing gap.

“At the moment, we don’t really have any evidence-based interventions to prevent sexual violence,” Professor Hooker said.

“Once this work is carried out, we will have a better evidence base about what works in relation to preventing sexual violence. This knowledge can then be used to inform the development of future interventions to reduce rates of sexual violence across Australia.”

Organisations can apply through La Trobe University to be a part of the project, which is expected to last around three years.

“ReGEN at La Trobe University is proud to lead this research, and we are delighted the Federal Government is investing in improving sexual violence prevention,” Professor Hooker said.

“We expect that the outcomes of this project will be able to be used to change community attitudes and behaviours on an issue that has a devastating impact on far too many people.”

According to the Australian Bureau of Statistics, more than one in five women and around one in 16 men have experienced sexual violence since the age of 15. LGBTQ+ people also face significant rates of sexual violence.

The ReGEN Research Group, led by Professor Hooker, will work alongside RMIT, the Centre for Alcohol Policy Research, the Australian Research Centre in Sex, Health and Society, and community partners for the project.

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A systematic review of primary prevention strategies for sexual violence perpetration ☆

Associated data.

This systematic review examined 140 outcome evaluations of primary prevention strategies for sexual violence perpetration. The review had two goals: 1) to describe and assess the breadth, quality, and evolution of evaluation research in this area; and 2) to summarize the best available research evidence for sexual violence prevention practitioners by categorizing programs with regard to their evidence of effectiveness on sexual violence behavioral outcomes in a rigorous evaluation. The majority of sexual violence prevention strategies in the evaluation literature are brief, psycho-educational programs focused on increasing knowledge or changing attitudes, none of which have shown evidence of effectiveness on sexually violent behavior using a rigorous evaluation design. Based on evaluation studies included in the current review, only three primary prevention strategies have demonstrated significant effects on sexually violent behavior in a rigorous outcome evaluation: Safe Dates ( Foshee et al., 2004 ); Shifting Boundaries (building-level intervention only, Taylor, Stein, Woods, Mumford, & Forum, 2011 ); and funding associated with the 1994 U.S. Violence Against Women Act (VAWA; Boba & Lilley, 2009 ). The dearth of effective prevention strategies available to date may reflect a lack of fit between the design of many of the existing programs and the principles of effective prevention identified by Nation et al. (2003) .

1. Introduction

Sexual violence 2 is a significant public health problem affecting millions of individuals in the United States and around the world ( Black et al., 2011 ; Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002 ; World Health Organization/London School of Hygiene & Tropical Medicine, 2010 ). Efforts to prevent sexual violence before it occurs (i.e., primary prevention) are increasingly recognized as a critical and necessary complement to strategies aimed at preventing re-victimization or recidivism and ameliorating the adverse effects of sexual violence on victims (e.g., Black et al., 2011 ; Centers for Disease Control & Prevention, 2004 ; DeGue, Simon, et al., 2012 ; Krug et al., 2002 ). Successful primary prevention efforts, however, require an understanding of what works to prevent sexual violence and implementing effective strategies. Currently, there are no comprehensive, systematic reviews of evaluation research on primary prevention strategies for sexual violence perpetration. Such a review is needed to inform prevention practice and guide additional research to build the evidence base. To address this gap, the current paper provides a systematic review and summary of the existing literature and identifies gaps and future directions for research and practice in the prevention of sexual violence perpetration.

Primary prevention strategies, as defined here, include universal interventions directed at the general population as well as selected interventions aimed at those who may be at increased risk for sexual violence perpetration ( Centers for Disease Control & Prevention, 2004 ). To capture the breadth of possible sexual violence prevention efforts, we defined primary prevention strategies to include any primary prevention efforts, including policies and programs (similar to Saul, Wandersman, et al., 2008 ). Consistent with the public health approach to sexual violence prevention ( Cox, Ortega, Cook-Craig, & Conway, 2010 ; DeGue, Simon, et al., 2012 ; McMahon, 2000 ), strategies to prevent violence perpetration, rather than victimization, are the focus of this review. Although risk reduction approaches that aim to prevent victimization can be important and valuable pieces of the prevention puzzle 3 , a decrease in the number of actual and potential perpetrators in the population is necessary to achieve measurable reductions in the prevalence of sexual violence ( DeGue, Simon, et al., 2012 ).

1.1. Goals of the current review

1.1.1. describing the state of the field in sexual violence prevention.

The first goal of this review is to describe the broad field of sexual violence prevention research and identify patterns of results associated with evaluation methodology or programmatic elements. Although a number of qualitative reviews, meta-analyses, and one meta-review (e.g., Anderson & Whiston, 2005 ; Breitenbecher, 2000 ; Carmody & Carrington, 2000 ; Vladutiu, Martin, & Macy, 2011 ) have been conducted over the past two decades, no reviews examine methodological and programmatic elements and sexual violence outcomes across the broad spectrum of sexual violence primary prevention efforts. Several existing reviews focus solely on describing approaches being implemented in the field and the use of underlying theory ( Carmody & Carrington, 2000 ; Fischhoff, Furby, & Morgan, 1987 ; Paul & Gray, 2011 ). Two non-systematic reviews identified methodological and programmatic issues associated with sexual violence prevention efforts with college students ( Breitenbecher, 2000 ; Schewe & O’Donohue, 1993 ) and called attention to the need to measure behavioral outcomes (in addition to changes in attitudes and behavioral intentions) to demonstrate an impact on sexual violence. These reviews also pointed out that the small statistically significant effects reported on the, primarily attitudinal, measures in existing studies may not be truly meaningful (i.e., clinically significant). These existing reviews focused solely on college-based strategies, limiting the generalizability of these findings to community-based and younger audiences.

Three meta-analyses examined the effectiveness of educational prevention programming with college students ( Anderson & Whiston, 2005 ; Brecklin & Forde, 2001 ; Flores & Hartlaub, 1998 ), but two of these focused only on attitudinal outcomes (i.e., Brecklin & Forde, 2001 ; Flores & Hartlaub, 1998 ). All three reported small to moderate mean effects on attitudes ranging from 0.06 to 0.35 (e.g., rape myth acceptance) and noted that the magnitude of effects decreased as the interval between strategy implementation and data collection increased. In addition, Anderson and Whiston (2005) reported a moderate mean effect size for knowledge (0.57), but reported small mean effect sizes for behavioral intentions (0.14), incidence of sexual violence (0.12), and attitudes considered more distal to sexual violence (0.10; e.g., adversarial sexual beliefs, hostile attitudes toward women), suggesting that the changes may have little clinical significance. Mean effect sizes for rape empathy and indicators of greater rape awareness (e.g., willingness to volunteer at rape crisis centers) were not significantly different from zero. The results from these meta-analyses suggest that knowledge and attitudes are assessed most frequently in prevention programming with college students, with attitudinal measures showing the largest effect sizes in evaluations of those programs. Although attitudes and behaviors are related, attitudes typically account for a relatively small proportion of the variance in behavior (e.g., Glasman & Albarracín, 2006 ; Kraus, 1995 ), suggesting that achieving attitude change may not be enough to impact sexual violence behaviors.

The one meta-review ( Vladutiu et al., 2011 ) also focused on reviews of college-based programs. Vladutiu and colleagues noted that reviews often made inconsistent recommendations, primarily due to differences in program context and content and the outcomes examined in the studies. For example, Vladutiu et al. (2011) concluded that longer programs were generally associated with greater effectiveness, but some shorter programs were able to document change when rape myth acceptance was the only outcome of interest. Single-gender audience approaches were generally considered more effective, but primarily when the program focused on attitudes, empathy, and knowledge outcomes related to sexual violence. The meta-review also identified a wide range of content and delivery components that were associated with changes on different outcomes. Finally, Vladutiu et al. (2011) noted that of the reviews included in their meta-review, only one had been published in the last decade (i.e., Anderson & Whiston, 2005 ). As indicated previously, there are no comprehensive reviews of the sexual violence prevention evaluation literature, and the only systematic reviews have dealt solely with college-based strategies. Relatively few patterns have been identified or recommendations made with respect to improving primary prevention of sexual violence or the rigor of evaluations conducted in the field. An updated, systematic, and comprehensive review of the literature on sexual violence primary prevention programs is warranted.

1.1.2. Summarizing “what works” in sexual violence prevention

The second goal of this review is to identify and summarize the best available evidence on specific sexual violence primary prevention strategies. Prevention practitioners are increasingly being asked to select and implement evidence-based practices and to devote resources toward strategies most likely to have an impact on health outcomes, but guidance and information on navigating this process are lacking ( Saul, Duffy, et al., 2008 ; Tseng, 2012 ). In particular, we wish to identify effective strategies for preventing sexual violence perpetration behaviors, as that is the ultimate goal of sexual violence prevention efforts. Although targeting risk and protective factors such as attitudes and knowledge are common prevention approaches, the most critical objective is to prevent sexual violence perpetration behaviors and their adverse effects ( Centers for Disease Control & Prevention, 2004 ; World Health Organization/London School of Hygiene & Tropical Medicine, 2010 ). Evidence regarding change in sexual violence perpetration behavior, however, is generally absent from the literature ( Schewe & O’Donohue, 1993 ; Vladutiu et al., 2011 ; World Health Organization/London School of Hygiene & Tropical Medicine, 2010 ). By summarizing the evidence on strategies that have been rigorously evaluated for sexually violent behavior, we can identify and categorize programs that currently appear to have evidence of effectiveness, those that are ineffective, and others that are potentially harmful strategies to assist practitioner efforts at better selecting and implementing sexual violence prevention strategies.

2.1. Search strategy

To identify studies meeting selection criteria for this review, we first conducted searches of the following online databases between May and August of 2009 and repeated these searches in March and April of 2010 and May of 2012: PsycNet, PsycExtra, PubMed, ERIC, Sociological Abstracts, MEDLINE, Web of Knowledge, Dissertation Abstracts International, and GoogleScholar. Search terms included combinations of the following: (intervention, prevent*, program, effectiveness, efficacy or evaluation) and (perpetration, rape, rapist, sex*, coercion, violence, aggression, assault, offender, or abuse). Second, manual reviews of issues from relevant journals (i.e., Aggression and Violent Behavior , Journal of Adolescent Health , Journal of Interpersonal Violence , Journal of Women’s Health , Prevention Science , Psychology of Violence , Sexual Abuse: Journal of Research and Treatment , Trauma , Violence , & Abuse , Violence Against Women , Violence & Victims ) published between January 2008 and May 2012 were also conducted to identify recent work in this area that may not have been cataloged yet in searchable databases. Third, to identify unpublished evaluation reports, solicitations were sent to relevant email lists and e-newsletters, including Prevent Connect, VAWnet, and the Sexual Violence Research Initiative. Fourth, for each article or report identified, we scanned the reference list to identify and retrieve additional reports that might meet inclusion criteria. During each of these iterative search steps, we were over-inclusive to ensure that all abstracts with the potential for inclusion were identified. The initial searches identified more than 10,600 reports, from which 330 were retained for full-text retrieval because they appeared to describe an outcome evaluation of a sexual violence prevention strategy.

2.2. Study selection criteria

Studies were eligible for inclusion if they examined the effectiveness of primary prevention strategies for sexual violence perpetration and were published in print or online between January 1985 4 and May 2012. Journal articles, book chapters, and reports from government agencies or other institutions were included. Efforts were made to gather unpublished manuscripts, conference presentations, theses, and dissertations (see above). Because the focus on this review is to summarize the evidence base for the primary prevention of sexual violence perpetration, this review did not include studies that exclusively examined secondary and tertiary prevention approaches (e.g., treatment or recidivism prevention), strategies targeting victimization prevention (i.e., risk reduction), or etiological research. In order to avoid double-counting studies, existing reviews and meta-analyses of interventions for sexual violence prevention were excluded.

Only studies that compared one intervention condition to a no-treatment or waitlist control group (i.e., experimental and quasi-experimental designs) or that utilized a single-group pre–post design were included in this review, as the goal was to ascertain changes or differences in the outcomes following exposure to a specific treatment program. Thus, we excluded studies in which data from two different intervention groups were combined and compared to a control group as it was not possible to determine which intervention was responsible for any observed changes on the outcome measures. In addition, we excluded studies in which the intervention and the comparison conditions received different sexual violence prevention programs, because these studies examine the relative benefits of one program compared to another program as opposed to an individual program’s overall effectiveness relative to no intervention. Similarly, studies in which the comparison condition included a combined sample of control participants and participants who received a different sexual violence preventative intervention were also excluded. Because our focus was to examine the effectiveness of strategies to prevent sexual violence, studies that did not measure outcomes relevant to sexual violence perpetration were excluded (see below for a description of the outcomes included).

Of the 330 full-text reports retrieved, 226 reports were excluded. Reports were excluded because they did not describe an outcome evaluation study (45%; n = 101; e.g., review or meta-analysis, program description, theoretical paper, etiological research), did not measure sexual violence-related outcomes (11%; n = 25), evaluated a victimization prevention strategy only (10%; n = 23), did not evaluate a primary prevention strategy (8%; n = 18; e.g., sex offender treatment or recidivism prevention), did not utilize a research design with a comparison group or pre–post measurement (7.5%; n = 17), or met other exclusion criteria (8.1%; n = 27; e.g., non-English language). In addition, we identified several reports that described outcomes from the same study (e.g., a dissertation and a peer-reviewed journal article). In these cases, the peer-reviewed journal article was coded as the primary source and other reports were excluded as a duplicate report (3%; n = 7). In some cases, the excluded reports (e.g., dissertations) were used to provide supplemental information about the sexual violence prevention program or the evaluation design during the coding process. Numerous attempts were made to retrieve all reports identified in the initial searches, including contacting the first author directly and utilizing inter-library loan resources to obtain print copies. However, another eight reports (3.5%) identified through database searches could not be retrieved and were excluded as unavailable. These missing reports were nearly all dissertations and most were published more than 15 years ago; thus, this review may underrepresent these older dissertations.

2.3. Data extraction

2.3.1. coding process.

The review team developed a structured coding sheet 5 to extract, quantify, and summarize information from studies. A detailed coding manual was developed to ensure consistency across coders. Before coding began, the review team completed several reviews in order to refine the coding sheet and manual and to increase reliability. The review team consisted of six doctoral-level researchers with expertise in violence prevention. Two reviewers independently coded each of the 104 reports meeting inclusion criteria for this study between November of 2009 and December of 2012. Coding dyads were randomized such that no two coders coded more than one-sixth of the studies together. After each study was coded independently by two reviewers, coding sheets were compared and discrepancies were discussed. Initial agreement by independent coders was acceptable, with reviewers initially agreeing on 75.6% of codes. The coding dyad discussed any items on which there was disagreement until consensus was reached on the best possible response for each item, and the final consensus code was used in analyses.

2.3.2. Study variables and outcomes coded

The variables coded included the report type, study design, sample, nature of the prevention strategy (i.e., setting, delivery, dose, stated program goals, program content), and relevant program outcomes. Study outcomes relevant to sexual violence were coded within eight key categories: sexually violent behavior 6 including rates or reports of perpetration or victimization; rape proclivity or self-reported likelihood of future sexual perpetration; attitudes about gender roles, sexual violence, sexual behavior, or bystander intervention; knowledge about sexual violence rates, definitions, and laws; bystanding behavior related to sexual violence, such as intervening in a risky situation or speaking up about violence; bystanding intentions or self-reported likelihood of intervening in a hypothetical scenario; relevant skills related to communication, relationships, or bystanding behavior, and affect / arousal to violence including victim-related empathy and sexual attraction to violence.

The patterns of intervention effects within each study were summarized within and across outcome categories. Intervention effects were considered positive if significant effects were reported on all relevant outcomes in the hypothesized direction at all measurement time points. Study effects were categorized as null if all findings on relevant outcomes were non-significant. Effects were mixed if findings were a combination of positive and null. Studies that had at least one significant finding on any relevant outcome in a negative direction, suggesting potentially harmful effects of the intervention, were categorized as having negative effects. Given the diversity of study designs, outcome measures, and follow-up periods examined, it was necessary to collapse findings from multiple measures and measurement periods within each study to characterize the overall patterns of effectiveness. For example, findings from multiple attitudinal measures relevant to sexual violence were collapsed into a composite “attitudes” category. For some analyses, these findings were further collapsed across outcome types (e.g., attitudes, knowledge) to obtain a summary of the overall effects. Similarly, intervention effects observed at different time points (i.e., post-test, follow-up) were combined into one code to represent the overall pattern of outcomes for that study.

2.3.3. Study sample

Of the 104 reports coded, 73 described a single study in which one prevention strategy was evaluated using a comparison group or pre–post design. The remaining 31 reports described findings from more than one evaluation study. The majority of these reports ( n = 25) compared two or more prevention strategies to a single control group, resulting in non-independent data across the various studies. Four reports described two or more separate studies in which samples were distinct and data were independent. Two reports included one study with independent data and two with non-independent data in the same report. To examine outcome data for each separate preventative program or strategy evaluated, we coded information about the study design, program characteristics and content, and outcome data for each of these studies separately. This approach is consistent with the process for systematic reviews recommended by the Task Force on Community Preventive Services ( Briss et al., 2000 ). Thus, the review team identified and coded 140 separate evaluation studies from the 104 reports meeting inclusion criteria. References for all studies included in this review are available in an online supplemental archive (see supplemental materials ); studies mentioned in the text are also referenced below.

2.4. Criteria for defining rigorous evaluation designs

Studies were classified as having either a rigorous or non-rigorous evaluation design. Rigorous evaluation designs included experimental studies with random assignment to an intervention or control condition (e.g., randomized controlled trial [RCT], cluster RCT) or rigorous quasi-experimental designs, such as interrupted time series or regression-discontinuity, for strategies where random assignment is not possible due to implementation restrictions (e.g., evaluation of policy). Other quasi-experimental designs (e.g., comparison groups without randomization to condition, including matched groups) and pre–post designs were considered non - rigorous evaluation designs , for the purposes of examining effectiveness in this review, consistent with standards of prevention science and evaluation research (e.g., Eccles, Grimshaw, Campbell, & Ramsay, 2003 ; Flay et al., 2005 ; Shadish, Cook, & Campbell, 2002 ).

In addition to design considerations, studies meeting criteria for a rigorous evaluation design were required to have at least one follow - up assessment beyond an immediate post-test assessment. Prior research has established the presence of a rebound effect on attitudinal and knowledge outcomes for sexual violence prevention programs wherein effects are seen immediately after the program but are not evident at longer-term follow-up ( Anderson & Whiston, 2005 ; Brecklin & Forde, 2001 ; Carmody & Carrington, 2000 ). In addition, studies without a follow-up assessment often conducted the pre-test and the post-test measurement and the intervention all within the same session, increasing the potential influence of demand characteristics and test–retest effects. Thus, studies that did not include at least one follow-up measurement beyond immediate post-test, regardless of the research design, were also considered to be non-rigorous.

2.5. Criteria for evaluating evidence of effectiveness for preventing sexual violence

To identify prevention strategies with rigorous evidence of effectiveness, we developed criteria to classify specific interventions based on the strength of evidence of effectiveness for preventing sexually violent behavior. These criteria, illustrated in Fig. 1 , emphasize sexual violence behavioral outcomes and rigorous experimental research designs that permit inferences about causality. Based on these criteria, interventions were placed into one of five categories: Effective for Sexual Violence Behavioral Outcomes includes those interventions with evidence of any positive impact on sexual violence victimization or perpetration in at least one rigorous evaluation. Interventions categorized as Not Effective for Sexual Violence Behavioral Outcomes were evaluated on sexual violence outcomes using a rigorous evaluation design and had consistently null effects on those measures. Interventions categorized as Potentially Harmful for Sexual Violence Behavioral Outcomes include those with at least one negative effect on sexually violent behavior in a rigorous evaluation. Interventions categorized as More Research Needed included those with evidence of positive effects on sexual violence behavior in a non-rigorous evaluation or positive effects on sexual violence risk factors or related outcomes in a rigorous evaluation. Interventions were considered to have Insufficient Evidence if they were not published in a peer-reviewed journal or formal government report, if they measured outcomes at immediate post-test only without a longer follow-up period, if they found null effects on sexual violence behavioral outcomes using a non-rigorous design; and/or if they only examined risk factors or other related outcomes using a non-rigorous design (regardless of the type of effect).

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Decision tree for evaluating evidence of effectiveness on sexual violence behavioral outcomes in rigorous evaluation.

We attempted to identify and combine findings from multiple studies or reports examining the same intervention based on the program name or description and used outcomes from the most rigorous evaluation(s) available to categorize the program’s effects. In some cases, researchers may have evaluated modified versions of the same program over time; findings from these evaluations were considered together if the program name did not change and there were no indications that modifications to the structure or content of the program model over time substantially altered the core content or strategy.

3.1. Study and intervention characteristics

Evaluation of sexual violence perpetration prevention programs peaked in the late 1990s and again in 2010 and 2011 (see Fig. 2 ). Table 1 describes characteristics of the 140 studies and interventions, including the research design, study population, intervention length, setting, participant and presenter sex, and mode of delivery. Notably, almost two-thirds ( n = 84; 60%) of the included studies examined one-session interventions with college populations; these programs had an average length of 68 min. The majority of studies utilizing pre–post designs measured outcomes at immediate post-test only ( n = 13, 56.5%). Studies with quasi-experimental designs measured outcomes most often at post-test ( n = 12, 34.3%) or with a follow-up period of one month or less ( n = 10, 28.6%). In contrast, evaluations using experimental designs had the lowest proportion of studies with post-test only outcomes ( n = 19, 23.2%) and the highest proportion with follow-ups at 5 months or longer ( n = 17, 20.7%).

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Number of studies meeting inclusion criteria by publication year (Jan 1985–May 2012).

Study and intervention characteristics.

Study characteristics ( = 140 studies )	( )	Range		%
Publication type
Peer-reviewed journal article			96	68.6
Dissertation			37	26.4
Government report			3	2.1
Unpublished study			4	2.9
Study design
Experimental			82	58.6
Quasi-experimental			35	25
Pre–post			23	16.4
Time to last follow-up
Immediate post-test			44	32.4
1 month or less			37	27.2
2–4 months			32	23.5
5+ months			23	16.9
Study population race/ethnicity
>60% White			84	60
>60% Black, Asian/Pacific Islander, or Hispanic/Latino			5	3.5
Diverse (no group more than 60%)			19	13.7
Not reported			32	22.8
Study population age	18.4 (3.9)	10–47.5
Study sample size	385.4 (560.2)	22–2643
Intervention characteristics	( )	Range		%

Number of sessions	2.6 (3.9)	1–8
One session only			93	72.7
2+ sessions			35	27.3
Session length (in min.)	75.6 (61.8)	10–450
Total exposure (sessions × length; in hrs)	3.7 (7.6)	.2–42
1 h or less			49	49.5
More than 1 h			50	50.5
Study setting
College campus			98	70
High school			20	14.3
Middle school			10	7.1
Elementary school			3	2.1
Community			4	2.9
Other/mixed settings			5	3.6
Participant sex
Mixed-sex groups			82	58.6
Single-sex group, males only			40	28.6
Single-sex groups, males and females			8	5.7
Other/not applicable			10	7.1
Presenter sex
Male and female co-presenters			35	25
Male only			28	20.6
Female only			18	13.2
Other/mixed			13	9.6
Unknown/not applicable			42	30.9
Presenter type
Professional in related field			35	25
Peer facilitator			27	19.3
Teacher/school staff			19	13.6
Advanced student facilitator			10	7.1
Other/unknown/not applicable			49	35
Program content
Attitudes			117	83.6
Knowledge			113	80.7
Relevant skills			62	44.3
Victim empathy			34	24.3
Substance use			29	20.7
Sexual violence behavior			19	13.6
Peer attitudes			13	9.3
Social norms related to sexual violence			11	7.9
Organizational climate			5	3.6
Policy/sanctions			6	4.3
Consensual sexual behavior			4	2.9
Gender equality			4	2.9
Content targeted to specific audience
College fraternities			7	5.0
Athletic teams			6	4.3
Specific racial/ethnic groups			3	2.1
Intervention mode(s) of delivery
Interactive presentation (e.g., with discussion)			76	54.3
Didactic-only lectures			65	46.4
Film/media presentation			61	43.6
Active participation (e.g., role plays, skills practice)			50	35.7
Live theater/dramatic performance			16	8.1
Written materials			7	5
Posters/social norms campaign			6	4.3
Community activities/policy development			3	2.1

To examine changes in evaluation methodology over time, we compared studies published in 1999 or earlier ( n = 73; 52.1%) to those published in 2000 or later ( n = 67; 47.9%). Before 2000, 63% ( n = 46) of published studies were RCTs, 30.1% ( n = 22) used quasi-experimental designs, and 6.8% ( n = 5) used pre–post designs; 28.8% ( n = 21) assessed outcomes at immediate post-test only and only 6.8% ( n = 5) followed participants for 5 months or longer. Since 2000, 53.7% ( n = 36) of published studies were RCTs, 19.4% ( n = 13) were quasi-experimental, and 26.9% ( n = 18) were pre–post designs; 34.3% ( n = 23) of these studies measured outcomes at immediate post-test only, but another 26.9% ( n = 18) of studies assessed outcomes after at least 5 months.

3.2. Intervention effects by study characteristics and outcome type

Table 2 summarizes patterns of intervention effects by study characteristic and outcome types. Studies with mixed effects across outcome types and follow-up periods were most common (41.4%; n = 58). More than one-quarter of studies (27.9; n = 39) reported only positive effects and another 21.4% ( n = 30) reported only null findings. Nine studies (6.4%) had at least one negative finding suggesting that the intervention was associated with increased reporting of sexually violent behavior ( Potter & Moynihan, 2011 ; Stephens & George, 2009 ), rape proclivity ( Duggan, 1998 ; Hillenbrand-Gunn, Heppner, Mauch, & Park, 2010 ), or attitudes toward sexual violence ( Echols, 1998 ; McLeod, 1997 ; Murphy, 1997 ). Peer-reviewed studies and government reports tended to have positive or mixed findings more often than dissertations and unpublished manuscripts. Examination of outcomes by study design suggested that evaluations employing more rigorous methodologies (i.e., experimental or quasi-experimental designs with comparison groups) were less likely to identify consistently positive effects than studies using a pre–post design. Similarly, studies that examined outcomes at immediate post-test only were more likely to identify positive effects than studies with a longer follow-up period.

Patterns of intervention effects by study characteristics and outcome type.

Subset of studies ( )	Type of intervention effect (%)

	Positive	Negative	Mixed	Null
All evaluations (136)	27.9	6.4	41.4	21.4
Publication type
Published (95)	35.8	4.2	45.3	14.7
Unpublished (41)	12.2	12.2	36.6	39
Study design
Experimental design (80)	23.8	6.3	48.8	21.3
Quasi-experimental (35)	29.4	5.9	35.3	29.4
Pre–post design (21)	42.9	–	42.9	14.3
Time to last follow-up
Immediate post-test (43)	46.5	–	39.5	14
1 month or less (37)	21.6	16.2	35.1	27
2–4 months	(31)	19.4	3.2	48.4
5+ months (21)	19	–	61.9	19
Outcome type
Sexually violent behavior (21)	4.8	14.3	33.3	47.6
Rape proclivity (18)	16.7	11.1	22.2	50
Attitudes (115)	33	3.5	33	30.4
Knowledge (34)	61.8	–	17.6	20.6
Bystanding behavior (10)	50	–	30	20
Bystanding intentions (14)	57.1	–	14.3	28.6
Relevant skills (8)	62.5	–	25	12.5
Affect/arousal to violence (9)	33.3	–	33.3	33.3

Note . Of the 140 studies reviewed, 136 conducted sufficient outcome analyses to determine the effects of the intervention on relevant measures; the remaining four studies from three reports ( Feltey, Ainslie, & Geib, 1991 ; Heppner, Humphrey, Hillenbrand-Gunn, & DeBord, 1995 ; Wright, 2000 ) are not included in these analyses.

Looking at the pattern of intervention effects by outcome type, results suggest that null effects were more common and positive effects less common on sexually violent behavior and rape proclivity outcomes than on other outcome types. Specifically, about half of all studies measuring sexually violent behavior or rape proclivity found only null effects (47.6%; n = 10); very few studies (4.8%; n = 4) reported only significant, positive effects on these main outcomes of interest. In contrast, the majority of studies measuring knowledge, bystanding behavior or intentions or skills found consistently significant positive effects on these outcomes. No clear pattern was evident for studies assessing attitudinal or affective/arousal outcomes.

To examine the potential impact of intervention length, we estimated the average intervention exposure (i.e., sessions × length) for studies with positive, mixed, negative, and null effects. Findings indicate that interventions with consistently positive effects were about 2 to 3 times longer, with an average length of 6 h ( SD = 11.4), than interventions with mixed ( M = 3.2 h; SD = 6.6), negative ( M = 2.2 h; SD = .9), or null ( M = 2.8 h; SD = 4.3) effects.

3.3. Evidence of effectiveness for preventing sexual violence perpetration

As shown in Table 3 , only three interventions (based on 3 studies; 2.1%) were categorized as effective for sexual violence behavioral outcomes: Safe Dates (e.g., Foshee et al., 2004 , 2005 ), Shifting Boundaries building-level intervention ( Taylor, Stein, Mumford, & Woods, 2013 ; Taylor et al., 2011 ), and funding associated with the 1994 U.S. Violence Against Women Act ( Boba & Lilley, 2009 ). Five interventions (based on 11 studies; 6.4%) were found to be not effective for sexual violence behavioral outcomes and three interventions (based on 2 studies; 2.1%) reported evidence suggesting that they were potentially harmful. Another ten interventions (based on 17 studies; 12.1%) were categorized as needing more research in order to understand their effects. Findings within each of these categories are discussed below. The majority of studies reviewed ( n = 108; 77.1%) provided insufficient evidence to adequately evaluate the effectiveness of the intervention for preventing sexual violence; these studies were unpublished manuscripts or dissertations which had not been subjected to independent peer review ( n = 53; 38%), measured outcomes at immediate post-test only ( n = 57; 41%), and/or examined only risk factors or related outcomes for sexual violence using a non-rigorous design ( n = 71; 51%). Interventions with insufficient evidence are not included in Table 3 due to the large number of studies in this category and the lack of practical value for this information when the findings are inconclusive.

Summary of the best available evidence for the primary prevention of sexual violence (SV) perpetration.

Intervention name/citation	Intervention type	Evaluation design/ sample size	Longest follow-up period assessed	Study population	Study notes/limitations	Key outcomes

						SV perpetration/victimization	Risk factors/related outcomes

Safe Dates ( , , , )	10-session curriculum focused on consequences of dating violence, gender stereotyping, conflict management skills, and attributions for violence; student theater production and poster contest; increased services for dating violence victims in community	RCT/14 schools	4 years	8th and 9th graders; rural NC county		Reductions in sexual dating violence perpetration and victimization at 4 years later; significant effects found on sexual dating violence perpetration and marginal effects ( = .07) on SV victimization at all four follow-up periods in regression modeling ( )
Shifting Boundaries, building- level Intervention ( , )	Temporary building-based restraining orders, poster campaign to increase awareness of dating violence, “hotspot” mapping and school staff monitoring over 6–10 week period	RCT/117 classrooms	6 months	6th and 7th graders		Reductions in perpetration and victimization of sexual harassment and peer sexual violence; reductions in dating sexual violence victimization but not perpetration
1994 Violence Against Women Act funding ( )	VAWA funding distributed by U.S. Department of Justice through formula grants and discretionary grant programs to improve criminal enforcement, victim advocacy, and state and local capacity from 1997–2002	Fixed-effects panel data regression modeling, controlling for crime trends and other related grant funding/10,371 jurisdictions	1997–2002	Reports from police jurisdictions		Reduction in annual rape rates (using data from the FBI’s Uniform Crime Reports)

Shifting Boundaries, Classroom- Based Intervention ( , )	6-session curriculum based on combined content from the Law and Justice and Interaction-Based Treatments evaluated in and ; focuses on knowledge, relationship boundaries, and bystander intervention	RCT/117 classrooms	6 months	6th and 7th graders		No effects on SV perpetration or victimization against peers or partners
The Men’s Program ( ; ; ; ; ; )	One hour peer educator-led, victim empathy-based presentation with interactive discussion; some evaluations have assessed variants of the core program with modules focused on specific topics (e.g., consent, bystanding, alcohol) (1 h total)	Multiple designs, including RCT and quasi-experimental	7 months	Male college students and fraternity members	Although mixed effects on SV behavior were found across studies, effects were consistently null in the most rigorous evaluation using random assignment and analyses by assigned condition ( ; )	Null effect on SV behavior in an RCT at 7 months follow-up ( ; ); positive effects on SV perpetration in a Solomon 4-group experimental design for a subsample of fraternity men with no outcomes reported for non-fraternity men ( )
Acquaintance Rape Prevention Program ( ; )	Awareness and education-based program, one-hour session	RCT/1108	9 weeks	Male and female college students		Null effects on SV perpetration or victimization
Coordinated Community Response (CCR) for intimate partner violence ( )	Federal funding allocated to communities to coordinate prevention and response activities for intimate partner violence (IPV), including: victim services; policy, training, and outreach; efforts to improve enforcement; and primary prevention activities	Controlled QE/12,039			Challenges in evaluating CCR activities may have limited ability to detect effects; lower rates of any IPV victimization (including SV) in the last year were found in communities with 6-year CCRs vs. 3-year CCRs	Null effects on SV victimization by an intimate partner in CCR vs. control communities
The Men’s Project ( )	1.5 hour workshop and 1 hour booster for men focused on social norms and bystander intervention	RCT/635	7 months	College men		Positive short-term (4 month) effects on self-reported SV perpetration were found but these effects were no longer significant at 7 months follow-up

Law and Justice Curriculum ( , )	Knowledge-based, 5-session curriculum [precursor of Shifting Boundaries Classroom-Based Intervention; ]	RCT/123 classrooms	6 months	6th and 7th grade students; Cleveland	Authors suggest that iatrogenic findings could be due to increased awareness and reporting in the intervention group	SV perpetration against dating partners at 6 month follow-up
Interaction-based Treatment ( , )	5-session curriculum on setting and communicating relationship boundaries, wanted/unwanted behaviors, bystander intervention [precursor of Shifting Boundaries Classroom-Based Intervention; ]	RCT/123 classrooms	6 months	6th and 7th grade students; Cleveland	Authors suggest that iatrogenic findings could be due to increased awareness and reporting in the intervention group	Decreased peer SV victimization at 6 months; SV perpetration against dating partner at post-test
Videos targeting empathy, attitudes, and education ( )	50-minute video including the NOMORE Men’s Program ( ) discussing ways for men to help rape victim and including a description of a male police officer’s rape, and a videotaped interview with Jackson Katz regarding the negative intersection of alcohol and rape on college campuses, with introductory preambles by facilitator	RCT/83	5 weeks	College men		Marginally significant ( = .053) in SV behavior at follow-up for intervention group; significant in SV behavior at follow-up for high-risk men in intervention group compared to high-risk men in control group


Coaching Boys Into Men ( )	Coach-delivered, norms-based dating violence prevention program, 11 brief discussions (10–15 min each)	RCT/16 schools	3 months	Male high school student athletes	1-year follow-up data [not included in this review; ( )] showed positive effects on dating violence perpetration (combined measure; not SV-specific)	Not measured	Mixed effects on attitudes at 3 months; null effects on dating violence perpetration at 3 months (combined measure of physical, sexual and psychological abuse)
Expect Respect — Elementary Version ( ; )	Bullying and sexual harassment- focused intervention involving a 12-session classroom curriculum (adapted from Bullyproof), staff training, policy development, parent education, and support services	RCT/12 schools (>600 students)	One school year	5th grade students and school staff	Measurement limitations; focused on bullying outcomes; intervention students and teachers reported witnessing more bullying	Not measured	Improvements in student and staff knowledge of sexual harassment definitions
Bringing in the Bystander ( ; ; )	Bystander education and training program administered as one 90-minute session, three 90-minute sessions, or a 4.5 hour session	Multiple designs, including RCT and quasi-experimental (QE)	4.5 months	Male and female college students, college athletes, or military personnel		Not measured	(1 or 390 min. sessions; RCT design): Positive effects on knowledge, bystander self-efficacy, and bystander intentions; mixed effects on attitudes. (one 4.5 hour session; RCT design): Null effects on attitudes and bystander behaviors; positive effects on bystander efficacy and intentions. (one 4.5 hour session; QE design): Mixed effects on bystander behaviors


Feminist Rape Education Workshop ( )	One 25-minute workshop addressing knowledge and rape myths; presented live or on video	RCT/480	3 weeks	Male and female college students		Not measured	Positive effects on attitudes
Brief educational video to dissociate sex from violence ( )	14-minute educational “briefing” video intended to dissociate violence from sexuality viewed prior to exposure to a violent, sexually explicit film	RCT/105	2 weeks	College men	Random assignment was used, but groups were not equivalent at pre- test on key outcomes; participants were debriefed about the purpose of the study to the follow-up assessment	Not measured	Positive effects on attitudes
Campus Rape video ( )	22-minute video featuring interviews with female rape survivors plus educational pamphlet	RCT/151	2 weeks	College men	has been evaluated in several additional studies, all with null effects or mixed effects using a non-rigorous design; the preponderance of evidence suggests that this program is likely not effective in changing attitudes over a longer follow-up period (611, 349,449,408,407)	Not measured	Positive effects on one attitudinal measure in one experimental study at 2 week follow-up
SHARRP Consent 101 ( )	One 10–15 minute session addressing sexual consent	RCT/127 students	2 weeks	Male and female college students	Small sample size	Not measured	Mixed effects on knowledge and attitudes
Acquaintance Rape Education Program ( )	Two one-hour sessions with activities addressing communication and relationship skills, attitudes, and knowledge	RCT/154	5 months	Male and female high school students	More than 50% attrition at 5 month follow-up; = 75 at follow-up	Not measured	Mixed effects on attitudes
Rape Supportive Cognitions (RSC)/Victim Empathy (VE) Videos ( )	50-minute video addressing either knowledge/attitudes or victim empathy; plus brief thought exercise involving a hypothetical rape scenario	RCT/74	2 weeks	College men	Small sample size	Not measured	Both video conditions had positive effects on self- reported attraction to sexual aggression; RSC video had positive effects on attitudes; VE video had mixed effects on attitudes
Date Rape Education Intervention ( )	50-minute presentation including knowledge-based lecture, video, and a personal experience with date rape with being disclosed by one of the presenters	RCT/821	1 month	College men and women	Null effects on three out of four attitudinal measures; no significant changes in attitude scores were observed for male participants	Not measured	Mixed effects on attitudes

4. Conclusions and discussion

The current systematic review sought to address two key objectives in an effort to inform and advance the research and practice fields of sexual violence primary prevention. First, by examining evaluation research on the primary prevention of sexual violence perpetration over nearly 30 years, we aimed to describe and assess the breadth, quality, and evolution of evaluation research and prevention programming in order to identify gaps for future development, implementation, and evaluation work. Second, we categorized sexual violence prevention programs on their evidence of effectiveness in an effort to inform decision-making in the practice field based on the best available research evidence.

4.1. State of the field: research on the primary prevention of sexual violence perpetration

In the last three decades, a sizable literature has emerged examining the effectiveness of strategies to prevent sexual violence perpetration with more than 100 evaluation reports identified since 1985. The number of studies published in the last two years of this review increased notably, suggesting a possible resurgence of research interest in this area. However, our results suggest that the sexual violence prevention evaluation literature has not seen a steady increase in publications over time to mirror the large increases in other types of sexual violence research. A bibliometric analysis of sexual violence research found that publications with the keywords “rape,” “sexual assault,” or “sexual violence” increased over 250% between 1990 and 2010, from approximately 5990 citations in 1990 to about 15,400 citations in 2010 ( Centers for Disease Control & Prevention, 2012 ). Despite this marked increase in general research attention to sexual violence, the current review suggests that the prevention evaluation literature has remained relatively stagnant both in terms of quantity and quality. In part, this trend may reflect the relatively limited resources available during this period for development and rigorous evaluation of sexual violence primary prevention approaches ( Jordan, 2009 ; Koss, 2005 ). Fortunately, funding for sexual violence evaluation research has increased over the last decade. For example, CDC funded 27 research projects with a focus on sexual violence between 2000 and 2010, resulting in the increased availability of more than $19 million in federal funding for the field; more than half of these projects involved prevention evaluation research ( Centers for Disease Control & Prevention, 2012 ; DeGue, Simon, et al., 2012 ). Although this funding represents a large proportional increase in federal dollars available for sexual violence research, the total research funding available remains low compared to other forms of violence and other areas of public health ( Backes, 2013 ; DeGue, Massetti, et al., 2012 ).

In addition to limiting the quantity of evaluation research studies, fiscal constraints may have also resulted in less rigorous research designs, as large randomized controlled trials of prevention strategies are generally considered costly to implement. Indeed, this review found two-thirds of the evaluation studies conducted over nearly 30 years examined brief, one-session interventions with college populations, approaches that are relatively inexpensive to implement and evaluate. In terms of measurement, few of these studies ( n = 11) measured sexually violent behavior, and none found consistently positive effects on these key behavioral outcomes. Of course, the predominance of brief awareness and education strategies in the literature not only reflects resource limitations for research but also implementation challenges in the field. Many colleges may limit access to students to only one class period or have policies requiring only 1 h of relevant training—spurring the development of programs to fit this need. Nevertheless, future research is needed that rigorously evaluates a more diverse and comprehensive set of prevention approaches with various populations.

Although the vast majority of preventative interventions evaluated to date have failed to demonstrate sufficient evidence of impact on sexual violence perpetration behaviors, progress is being made. Findings from several large, federally-funded 7 effectiveness trials of comprehensive, multi-component primary prevention strategies have been published more recently, with interventions targeting a broader, and younger, segment of the population (e.g., Foshee et al., 2004 , 2012 ; Miller et al., 2012b ; Taylor et al., 2013 ) with additional evaluations underway (e.g., Cook-Craig et al., in press ; Espelage, Low, Polanin, & Brown, 2013 ; Tharp, Burton, et al., 2011 ). This new research is providing the primary prevention practice field with additional evidence on which to base decisions about resource allocation and implementation in order to prevent sexual violence. However, as we discuss below, more rigorous evaluation research on various prevention approaches is needed before we can expect to see measurable reductions in sexual violence at the population level.

4.1.1. Evaluation methodology

A movement toward evidence-based policymaking has been gaining traction in the US. In 2012, the U.S. Office of Management and Budget directed federal agencies to prioritize rigorous research evidence in budget, management, and policy decisions in order to improve effectiveness and reduce costs ( Office of Management & Budget, 2012 ). These shifting federal priorities reflect a growing push in the field by researchers and advocacy organizations such as the Coalition for Evidence-Based Policy ( www.coalition4evidence.org ) for increased investment in evaluation research and the implementation of evidence-based programs. Evaluation guidelines provided by these various stakeholders emphasize the value of well-conducted, rigorous evaluations with an emphasis on randomized controlled trials to permit the strongest possible conclusions regarding causality (e.g., Flay et al., 2005 ; Office of Management & Budget, 2012 ).

A small majority (58.6%) of the studies in this review utilized an experimental design with randomization, and about three-quarters of these collected follow-up data beyond an immediate post-test. Thus, fewer than half (45%; n = 63) of the included studies met our minimum criteria for a rigorous evaluation. Further, only 17 of the rigorous evaluations included measures of sexually violent behavior, the intended public health outcome of the programs. In summary, after nearly 30 years of research, the field has produced very few evaluation studies using a research design that, if well-conducted, would permit conclusions regarding the effectiveness of the intervention for preventing sexually violent behavior. This shortage of rigorous research accounts, in large part, for the lack of evidence-based interventions available to practitioners to date.

The use of less rigorous methodologies, such as single-group or quasi-experimental designs, is often necessary and cost-effective for the purposes of program development, improvement, and to establish initial empirical support for an intervention ( Tharp, DeGue, et al., 2011 ). However, there is an implicit expectation that the rigor of evaluation research will continue to increase over time, both for individual interventions with promising initial outcomes and for the literature as a whole ( Tharp, DeGue, et al., 2011 ). However, this review did not find evidence of a general shift toward more rigorous evaluation methodology in the field over time. A comparison of studies published before and after 2000 found that evaluations completed from 2000 to 2012 were actually less likely to utilize an experimental design with randomization (53.7% vs. 63%) and more likely to utilize a pre–post design (26.9% vs. 6.8%) than studies from 1985 to 1999. Further, most of the identified interventions were the subject of a single evaluation rather than an evolving program of research, regardless of the initial study quality or findings. Progress in the field is dependent on systematic research initiatives that build off of the existing evidence base and move toward the ultimate goal of identifying “what works”.

4.1.2. Prevention approach

Much has been learned from the prevention science and public health fields about the characteristics of effective prevention strategies. For example, Nation et al. (2003) identified nine “principles of prevention” that were strongly associated with positive effects across multiple literatures and found that effective interventions had the following characteristics: (a) comprehensive, (b) appropriately timed, (c) utilized varied teaching methods, (d) had sufficient dosage, (e) were administered by well-trained staff, (f) provided opportunities for positive relationships, (g) were socio-culturally relevant, (h) were theory-driven, and (i) included outcome evaluation. Similar sets of “best practices” for prevention have been articulated elsewhere (e.g., Small, Cooney, & O’Connor, 2009 ). With the exception of outcome evaluation which we addressed above, we consider how well the sexual violence literature to date aligns with each of these principles.

4.1.2.1. Comprehensive

Comprehensive strategies should include multiple intervention components and affect multiple settings to address a range of risk and protective factors for sexual violence ( Nation et al., 2003 ). However, the vast majority of interventions evaluated for sexual violence prevention have been fairly one-dimensional — implemented in a single setting, typically a school or college, and often utilizing a narrow set of strategies to address individual attitudes and knowledge related to sexual violence. A minority of programs included content to address individual-level risk factors other than attitudes and knowledge (e.g., relevant skills and behaviors). Fewer than 10% included content to address factors beyond the individual level, such as peer attitudes, social norms, or organizational climate and policies, despite evidence that relationship and contextual factors are also important in shaping risk for sexual violence perpetration ( Casey & Lindhorst, 2009 ; Tharp et al., 2013 ). Several relatively recent studies have evaluated interventions that utilize a more comprehensive approach by combining educational or skills-building curricula with social norms campaigns, policy changes, community interventions, and/or environmental changes (e.g., Ball et al., 2012 ; Foshee et al., 2004 ; Taylor et al., 2011 ); however, comprehensive interventions remain the exception and not the norm. In order to potentially reduce and prevent sexual violence, program developers should build off of this work and develop a range of comprehensive strategies geared toward multiple populations.

4.1.2.2. Appropriately-timed

More than two-thirds of sexual violence prevention strategies evaluated thus far have targeted college samples. There is consensus that college men and women are at a particularly high risk for sexual violence perpetration and victimization, making this a key population for intervention. However, because many college men have already engaged in sexual violence before arriving on campus or will shortly thereafter ( Abbey & McAuslan, 2004 ), prevention initiatives that address this age group may miss the window of opportunity to prevent sexual violence before it starts. Primary prevention efforts may be best targeted at younger populations—before college. Sexually violent behavior is often initiated in adolescence ( Abbey & McAuslan, 2004 ), and more than 40% of victims will experience their first completed rape before age 17 ( Black et al., 2011 ). Only about one-quarter of the studies reviewed here evaluated interventions in high schools, middle schools, or elementary schools. However, younger populations are getting increased attention from program developers and evaluators in recent years. One-third of the evaluations involving school-aged youth in this review were published in 2010 or later, and several randomized trials of school-based strategies are underway in the field ( Cook-Craig et al., in press ; Espelage et al., 2013 ; Tharp, Burton, et al., 2011 ). It is notable that the only strategies with evidence of effectiveness on sexually violent behavior, to date, target adolescents. This is consistent with findings from a recent review of intimate partner violence prevention strategies ( Whitaker, Murphy, Eckhardt, Hodges, & Cowart, 2013 ), suggesting that adolescence may represent a critical window to intervene on these related behaviors. Better targeting our prevention strategies to adolescents and evaluating these efforts into the college years will aid in our understanding about the preventative effects of these interventions.

4.1.2.3. Varied teaching methods

Research indicates that preventative interventions are most successful when they include interactive instruction and opportunities for active, skills-based learning ( Nation et al., 2003 ). Prior reviews of sexual violence prevention programs also suggest that engaging participants in multiple ways (e.g., writing exercises, role plays) and with greater participation may be associated with more positive outcomes ( Paul & Gray, 2011 ). In the current review, nearly one-third of interventions utilized a single mode of intervention delivery (or teaching method) and another 40% utilized two modes of instruction. The most common modes of intervention delivery involved interactive presentations (i.e., presentations with opportunities for questions or discussion), didactic-only lectures, and/or videos. Only about one-third of the programs involved active participation in the form of role playing, skills practice, or other group activities. The effectiveness of program development efforts may be increased by focusing on integrating more active learning methods in order to increase the likelihood that participants acquire and retain skills and knowledge.

4.1.2.4. Sufficient dose

Prevention approaches must provide a sufficient “dose” of the intervention, as measured by total exposure to program content or contact hours, to have an effect on the behavior of participants ( Small et al., 2009 ). The intensity needed to be effective will vary by the type of approach, the needs and risk level of participants, and the nature of the targeted behavior, but longer programs may be more likely to achieve lasting results ( Nation et al., 2003 ). Our findings suggest that the dose received by participants is often small. Three-quarters of interventions had only one session, and half of all studies involved a total exposure of 1 h or less. While it may be possible to impact some behaviors with a brief, one-session strategy, it is likely that behaviors as complex as sexual violence will require a higher dosage to change behavior and have lasting effects. Indeed, we found that interventions with consistently positive effects in this review tended to be 2 to 3 times longer, on average, than interventions with null, negative, or mixed effects. Of course, there are practical limitations on the time and resources available to implement prevention strategies in most settings. The most efficient interventions would balance the necessity of providing a sufficient dose to achieve intended outcomes with the need for long-term sustainability and scalability. But, outcomes are critical: No matter how brief or low-cost an intervention may be, if it does not impact the outcomes of interest, implementation will not be an efficient or effective use of resources.

4.1.2.5. Fosters positive relationships

Strategies that foster positive relationships between participants and their parents, peers, or other adults have been associated with better outcomes in past prevention research ( Nation et al., 2003 ). Although the short length and didactic nature of most interventions reviewed here do not lend themselves well to relationship-building, strategies that work to nurture or capitalize on positive relationships are beginning to gain traction in the field. For example, programs that engage youth in facilitated peer support groups (e.g., Expect Respect; Ball et al., 2012 ) can leverage positive peer influences to reduce violent behavior. Further, strategies that train and empower youth to serve as active bystanders (e.g., Bringing in the Bystander; Banyard, Moynihan, & Plante, 2007 ; or, Green Dot; Cook-Craig et al., in press ) utilize existing peer networks to diffuse positive social norms and messages about dating and sexual violence. In addition, recent work to involve parents in dating violence prevention is a promising new direction (see for example, Families for Safe Dates ; Fo et al., 2012). Although these particular interventions have not yet demonstrated effects on sexual violence perpetration in a rigorous evaluation, research is ongoing, and the attention to the role of relationships in behavior modification and risk may prove fruitful.

4.1.2.6. Sociocultural relevance

Prevention programs that are sensitive to and reflective of community norms and cultural beliefs may be more successful in recruitment, retention, and achieving outcomes ( Nation et al., 2003 ; Small et al., 2009 ). Only three interventions were identified that included content designed for specific racial/ethnic groups, including Asian-Pacific Islander ( Stephens, 2008 ), African-American ( Weisz & Black, 2001 ) and Latino/a ( Nelson et al., 2010 ) populations. Fourteen studies (10% of the total) evaluated programs targeting fraternity men, male athletes, or members of the military. No studies evaluated programs targeting sexual minority populations. Overall, about two-thirds of the interventions reviewed were implemented with majority-White samples. Nation et al. (2003) note that involving members of the target population in the development and implementation of prevention strategies may improve the programs’ perceived relevance to the community’s needs. Future program development and evaluation research efforts should gauge the extent to which interventions with culturally specific approaches result in increased cultural relevance, recruitment, retention, and impact on preventing sexual violence.

4.1.2.7. Well-trained staff

Effective programs tend to have staff or implementers that are stable, committed, competent, and can connect effectively with participants ( Mihalic, Irwin, Fagan, Ballard, & Elliott, 2004 ). Sufficient “buy-in” to the program model is also important to credibly deliver and reinforce program messages ( Nation et al., 2003 ). Although researchers are increasingly recognizing the importance of measuring and describing characteristics of implementers and training procedures, few reports included this information. Reports were typically limited to a basic description of the type of implementer (e.g., peer, school staff, professional). About one-quarter of the interventions were implemented by professionals with expertise related to sexual violence prevention and extensive knowledge of the program model (e.g., program developers, sexual violence prevention practitioners). The majority of programs were implemented by peer facilitators, advanced students, or school/agency staff who may not have specific expertise in the topic. The sexual violence prevention field would benefit from more extensive descriptions of program staff and training and implementation research to determine characteristics of program staff that may enhance the preventative effects of our programs.

4.1.2.8. Theory-driven

A recent review by Paul and Gray (2011) concluded that sexual violence prevention strategies often lack a strong theoretical framework and fail to utilize established social psychological and behavior change research to inform program development. Etiological theories that identify modifiable points for intervention in the development of health risk behaviors are extremely valuable as a basis for prevention development ( Nation et al., 2003 ), especially when supported by evidence that the factors identified represent causal influences in a theoretical model. Although we did not systematically examine the theoretical underpinnings of interventions, attention to etiological theory (e.g., risk and protective factors and processes; Nation et al., 2003 ) was implicit in many studies with a focus on changing presumed sexual violence risk factors. The most common risk factors addressed were knowledge and attitudes about rape, women, and sex. There is limited empirical evidence linking legal or sexual knowledge to sexual violence perpetration ( Tharp, DeGue, et al., 2011 ) and virtually no theoretical reason to believe that rape is caused by a lack of awareness about laws prohibiting it. However, education about rape laws and statistics remains a frequent component of sexual violence prevention strategies. Attitudes are similarly attractive targets for intervention because they are relatively easy to measure and assess for change in the short-term. However, more empirical and theoretical work is needed to establish these factors as functional pieces in violence development rather than merely correlates or indicators and to provide well-developed, integrative theories to explain the role of attitudes and their potential value as primary prevention targets. On the other hand, cognitive factors, including hostility toward women, traditional gender role adherence, and hypermasculinity, have shown consistent links to sexual violence perpetration ( Tharp et al., 2013 ) but are rarely addressed directly in prevention programs. Strategies that involve working with young men to shape and support healthy views of masculinity and relationships, such as Men Can Stop Rape ( www.mencanstoprape.org ) or Coaching Boys into Men ( Miller et al., 2012b ), are promising exceptions, but more evaluation research is needed in order to ascertain whether these programs have an impact on sexual violence.

4.2. What works (and what doesn’t) to prevent sexual violence perpetration?

Emphasizing rigorous evaluation and behavioral outcomes, we developed and applied a set of criteria to identify specific interventions with more or less evidence of effectiveness for the primary prevention of sexual violence perpetration in order to serve as a guide for decision-making. Communities and organizations are increasingly interested in and required to implement evidence-based interventions with an expectation of achieving reductions in sexual violence. Table 3 is intended to serve as a resource and tool for this purpose. Although we believe that this approach has many practical advantages, it has notable limitations as well. Most importantly, it is limited by the ever-growing and evolving nature of the evaluation research literature. Over time, additional effective interventions will be identified, some will be found to be ineffective, and others will find that their effects can be replicated—or not—in different populations. The current review provides only a snapshot of knowledge regarding “what works” currently to prevent sexual violence. Practitioners are encouraged to consider this information in the context of the needs, goals, and resources of their organization and to supplement this summary with additional information about the strategy and new research findings as they become available. This summary may also be useful in identifying promising strategies in need of further research or when developing new comprehensive strategies that combine the strengths of multiple evidence-based approaches. Future research investments should reflect the best available science and theory, and move beyond approaches that have proven ineffective or insufficient.

4.2.1. What works (so far)?

Only three strategies, to date, have evidence of at least one positive effect on sexual violence perpetration behavior using a rigorous, controlled evaluation design. The best available evidence suggests that these strategies, if well-implemented with an appropriate population, may be effective in preventing sexually violent behavior. Notably, none of these evaluations have been replicated and it is not known whether their effects will generalize to other populations, age groups, or to forms of sexual violence that were not assessed. In addition, it is likely that none of these approaches, in isolation, will be sufficient to reduce rates of sexual violence at the population-level, even if brought “to scale” ( Dodge, 2009 ). Instead such approaches should be viewed as potential components of an evidence-based, comprehensive, multi-level strategy to combat sexual violence.

Safe Dates is a universal dating violence prevention program for middle- and high-school students involving a 10-session curriculum addressing attitudes, social norms, and healthy relationship skills, a 45-minute student play about dating violence, and a poster contest. Results from one rigorous evaluation using an RCT design showed that four years after receiving the program, students in the intervention group were significantly less likely to be victims or perpetrators of self-reported sexual violence involving a dating partner relative to students in the control group ( Foshee et al., 2004 ).

Shifting Boundaries is a universal, school-based dating violence prevention program for middle school students with two components: a 6-session classroom-based curriculum and a building-level intervention addressing policy and safety concerns in schools. Results from one rigorous evaluation indicated that the building-level intervention, but not the curriculum alone, was effective in reducing self-reported perpetration and victimization of sexual harassment and peer sexual violence, as well as sexual violence victimization (but not perpetration) by a dating partner ( Taylor et al., 2011 , 2013 ).

The U.S. Violence Against Women Act of 1994 (VAWA) aimed to increase the prosecution and penalties associated with sexual assault, stalking, intimate partner violence and other forms of violence against women, as well as to fund research, education and awareness programs, prevention activities, and victim services ( Boba & Lilley, 2009 ). Results of a rigorous, controlled quasi-experimental evaluation suggest that VAWA-related grant funding through the U.S. Department of Justice for criminal justice-related activities was associated with a .066% annual reduction in rapes reported to the police, as well as reductions in aggravated assault. Given the deficit of policy, environmental, or community-level change strategies with empirical, or even theoretical, evidence in this field ( DeGue, Holt, et al., 2012 ), communities and researchers may be able to learn from the programs and strategies funded by VAWA to inform development or implementation of similar approaches to prevent sexual violence.

4.2.2. What (probably) doesn’t work, or might be harmful?

This review identified five interventions with evidence of null effects on sexually violent behavior in at least one rigorous evaluation. It is notable that most of these programs have shown positive effects on other related outcomes, including potential risk factors or moderators. In some cases, positive effects on behavioral outcomes were identified using non-rigorous evaluation designs. Additional research that evaluates these strategies with different measures of sexual violence perpetration, stronger implementation, different populations, longer follow-up periods, or larger sample sizes may possibly reveal positive effects on behavior. However, the most rigorous evidence currently available suggests that these strategies have so far not been effective in changing rates of sexual violence perpetration after a reasonable follow-up period.

Three interventions were identified as having potentially harmful effects on sexual violence behavioral outcomes in at least one rigorous evaluation. Interestingly, all three interventions included content utilized in other programs that were classified as not effective in this review (i.e., The Men’s Program, Foubert, 2000 ; Shifting Boundaries classroom-based curriculum, Taylor et al., 2011 ). It is possible that these negative outcomes reflect increased awareness and enhanced reporting in the intervention group, as suggested by some authors (e.g., Taylor et al., 2011 ). Alternatively, the findings might indicate that respondents had an adverse reaction to the content. More research is needed to understand why these interventions are not working as intended with their target populations. In the absence of additional research, practitioners may wish to select other strategies without evidence of potentially iatrogenic effects.

Importantly, based on the criteria applied here, interventions could only be identified as effective, ineffective, or potentially harmful when they were subjected to rigorous evaluation measuring sexually violent behavior. However, the vast majority of interventions evaluated in the last three decades did not utilize rigorous designs with behavioral outcome measures. It is possible that many, if not most, of the interventions identified as having insufficient evidence or being in need of more research would not prove effective if rigorously evaluated. Most of the programs reviewed were brief, one-session psycho-educational programs conducted with college students. The development and implementation of brief education and awareness programs has served as an important stepping stone for the field — arguably increasing administrators’ and students’ awareness and knowledge of sexual violence and sexual violence prevention. However, none of these programs have provided consistent evidence of impact on sexual violence outcomes, and most have not shown evidence of lasting impact on the risk factors or related outcomes that were measured. Thus, we join others in the field (e.g., Casey & Lindhorst, 2009 ) in calling for a paradigm shift in sexual violence prevention that moves us away from low-dose educational programming in adulthood and toward investment in the development and rigorous evaluation of more comprehensive, multi-level strategies (e.g., those that include individuals, parents, and peers) that target younger populations and seek to modify community and contextual supports for violence.

4.2.3. What else might work to prevent sexual violence?

Ten interventions had positive or mixed effects on risk factors for sexual violence or related outcomes in a rigorous evaluation. Although these initial findings are positive and promising, we do not know whether change in these risk characteristics will result in actual reductions in sexual violence perpetration behavior; additional rigorous evaluation on sexual violence behavioral outcomes would be needed to examine those effects. Studies that found consistently positive effects on sexual violence outcomes in a non-rigorous evaluation also met criteria for consideration in this category—but none were identified.

When determining whether strategies in this category should be considered for implementation in communities or further research investments, the prevention principles outlined above may serve as a useful guide. Researchers and practitioners should consider whether a strategy’s content, delivery method, dose, target audience, and theoretical base are consistent with lessons learned from the sexual violence and general prevention literatures. Based on their prevention approach and initial evidence from large RCTs with longer follow-up periods, Coaching Boys Into Men ( Miller et al., 2012b ) and Bringing in the Bystander ( Banyard et al., 2007 ), for example, stand out as two strategies with substantial potential for impacting sexually violent behavior if subjected to rigorous evaluation on these outcomes. Coaching Boys Into Men is based on social norms theory and utilizes high school coaches to engage male athletes in 11 brief, structured discussions about dating violence through the sports season. At one-year follow-up the program showed positive effects on a general measure of dating violence perpetration, but effects on sexual violence specifically were not measured ( Miller et al., 2012b ). Bringing in the Bystander is a bystander education and training program that aims to engage participants as potential witnesses to violence (rather than as perpetrators or victims) and provides them with skills to help when they see behavior that puts others at risk, including speaking out against rape myths and sexist language, supporting victims, and intervening in potentially violent situations. Some positive effects were found across studies on risk factors for sexual violence; sexual violence behavioral outcomes have not yet been examined ( Banyard et al., 2007 ). Although more research is needed, the bystander approach to prevention is already gaining traction in the field. Other programs using a bystander engagement approach, such as Green Dot ( Cook-Craig et al., in press ), are also being evaluated but the findings have not yet been published.

4.3. Moving forward: gaps and priorities for progress

There have been substantial gains in the field of sexual violence prevention over the last 30 years with regard to public education and awareness, legal protections for victims, federal funding and infrastructure for prevention work, community mobilization, and research on the prevalence, etiology, and prevention of sexual violence. But important gaps remain, hindering progress toward the ultimate goal of reducing sexual violence at the population level. Rates of sexual violence remain alarmingly high, and we still know very little about how to prevent it.

The field’s ability to identify effective strategies for sexual violence perpetration is severely constrained by the quality of the available research. Without more rigorous research designs that examine the primary behavioral outcomes of interest, it is not possible to determine with sufficient confidence whether a strategy is likely to have the desired outcomes or be cost-effective. Evaluation research need not always involve an RCT; other rigorous quasi-experimental designs, such as regression discontinuity or interrupted time series, may be the most practical options for evaluating policy or environmental strategies, for example. In contrast, less rigorous designs, such as pre–post studies, may be the best approach for formative research to develop and refine strategies. Likewise, measurement of risk characteristics provides important information about potential mediators and moderators of effectiveness, but without identification of true causal risk factors, these outcomes cannot tell us whether or not a program “works.” Thus, measurement of key behavioral outcomes, including perpetration behavior, is a critical component of rigorous effectiveness research. Of course, the use of RCTs and behavioral measures represent only the minimum criteria necessary to allow for causal inferences from the data; these design features alone do not ensure that a study is well-conducted or reliable. Additional factors, such as sample size and retention, measurement validity, group equivalence, and appropriate data analysis, are also important in determining whether study findings represent valid evidence of effectiveness ( Coalition for Evidence-Based Policy, 2010 ). Thus, a critical priority for the field to ensure the growing availability of effective, evidence-based prevention strategies for sexual violence involves improving study rigor. The limited available resources for prevention should be directed toward methodologies most likely to advance practical knowledge of what works.

There is also a need in the field to consider not only statistical significance, but also the magnitude or clinical significance of any effects identified. If a strategy is widely implemented, even a small effect on perpetration behavior may have a large impact. However, a small effect on an attitudinal or knowledge outcome, for example, may not have any practical value. One limitation of this review is that we examined this field as it is — categorizing outcomes by the direction of effect rather than by the size of the effect. The broad scope of the current review and the wide variability in the quality and design of included studies made meta-analytic techniques impractical. However, prior meta-analyses conducted with smaller subsets of the literature have found relatively small effects, especially on the most direct or proximal outcomes ( Anderson & Whiston, 2005 ; Brecklin & Forde, 2001 ; Flores & Hartlaub, 1998 ). As noted by these prior reviews ( Breitenbecher, 2000 ; Schewe & O’Donohue, 1993 ), more attention to issues of clinical significance is needed within the sexual violence evaluation literature to better understand the value and potential impact of specific strategies when applied at the population-level.

The lack of effective prevention strategies for sexual violence is due not only to a lack of rigorous evaluation to identify those effects but also to the nature and quality of the approaches being developed and evaluated. A key conclusion from this review is that a large portion of research (and, presumably, programmatic) resources, to date, have been invested in brief psycho-educational strategies that are not consistent with the principles of prevention and have not demonstrated effectiveness despite numerous evaluations. Prevention strategies based in a coherent theory of change with a plausible likelihood for impact on sexual violence perpetration and addressing a broader range of risk and protective factors for sexual violence may be more likely to be effective. With most of the attention in existing programs focused on knowledge and attitudes, many sexual violence risk factors—well-grounded in theory—have been ignored. For example, childhood exposure to violence, general delinquency and aggression, and early sexual behavior have consistent empirical support across numerous studies and are included in the Confluence Model, a well-supported theoretical model of sexual violence perpetration, but they are rarely addressed in sexual violence prevention efforts ( Tharp et al., 2013 ). Explicit attention to an expanded range of risk factors in intervention development and a broader set of behavior change theories, such as those identified by Paul and Gray (2011) , may result in more integrative and effective models of prevention.

The lack of community- and societal-level prevention approaches for sexual violence perpetration also remains a critical gap in this field. The social–ecological model ( Bronfenbrenner, 1977 ) conceptualizes violence as a product of multiple, interacting levels of influence at the individual, relationship, community, and societal levels of the social ecology. Most prevention strategies evaluated thus far have focused solely or primarily on creating change at the individual level, with a few also addressing peer influences or small-scale social norms change through bystander intervention or school poster campaigns. Individual-and relationship-based approaches are likely key pieces of the prevention puzzle given the plethora of risk correlates identified at these levels. But, achieving long-term behavior change with such programs is unlikely when they are delivered in a social, cultural, or physical environment that counteracts those messages and discourages safe, healthy behaviors or rewards violent behavior ( DeGue, Holt, et al., 2012 ). This would necessitate drawing on theory and lessons learned in other areas of public health to identify innovative policy, environmental, and structural approaches that support and encourage healthy behavior, positive social norms, and non-violence. Such strategies would target modifiable risk and protective factors that are characteristic of communities and that are empirically or theoretically associated with sexual violence (e.g., neighborhood disorganization, availability of alcohol; Casey & Lindhorst, 2009 ; DeGue, Massetti, et al., 2012 ; Tharp et al., 2013 ). In late 2013, CDC released a funding opportunity announcement to encourage innovation in this area by providing potential funding for the rigorous evaluation of such an approach (See RFA-CE-14-005 on www.grants.gov ). More work is needed to develop and identify community-level measures, indicators, or proxies of sexual violence beyond law enforcement record data for use in evaluating these outer-level approaches ( DeGue, Holt, et al., 2012 ).

Continued progress is needed toward the development and rigorous evaluation of effective, comprehensive, theory-based primary prevention strategies for sexual violence perpetration that address risk and protective factors at multiple levels of the social ecology. This progress is dependent on the innovation and methodological expertise of sexual violence researchers and program developers, well-directed research funding, and support from prevention professionals implementing these strategies in the field. Sexual violence is a complex problem with social, structural, cultural, and individual roots. By designing prevention efforts that are equally complex, multifaceted, and embedded within our lives and environments we can enhance their effectiveness. With increasing pressure to demonstrate effectiveness and economic efficiency, stronger evidence of impact will be required to justify investments in evidence-based primary prevention strategies. Thus, further investment in rigorous evaluation research is critical to ensuring sustained movement toward the identification of evidence-based strategies for the prevention of sexually violent behavior. Such research should focus on comprehensive, theory-based strategies across levels of the social ecology and build on the best available research evidence to identify a complement of effective approaches for implementation and move us closer to ending sexual violence in communities.

Supplementary Material

Supplemental materials: appendix a, appendix a. supplementary materials.

Supplementary data to this article can be found online at http://dx.doi.org/10.1016/j.avb.2014.05.004 .

2 Sexual violence is defined as any nonconsensual sexual act committed or attempted against someone, including forced or alcohol/drug facilitated penetration of a victim; or used to facilitate making the victim penetrate a perpetrator or someone else; nonphysically pressured unwanted penetration; intentional sexual touching and non-contact sexual acts ( Basile, Smith, Breiding, Black, & Mahendra, in press ).

3 A recent Special Issue of Violence Against Women (March 2014, Vol 20) addressed current research and theory related to self-defense approaches to sexual violence victimization prevention: http://vaw.sagepub.com/content/20/3.toc .

4 The start date of 1985 was chosen to capture the 25-year period prior to the initial intended end date of 2010. The review was later extended through May 2012 to capture the most recent evaluation studies at that time.

5 A copy of the coding sheet is available from the first author upon request.

6 Studies were coded as measuring sexual violence behavioral outcomes if they utilized: a) rates of sexual violence victimization or perpetration based on official records (e.g., police or hospital data), or b) self-reported sexual violence victimization or perpetration assessed via survey, including the range of abusive contact and non-contact behaviors falling within the CDC’s definition of sexual violence ( Basile et al., in press ).

7 Four of the five clinical trials cited here were funded by CDC’s Division of Violence Prevention. The evaluation of Shifting Boundaries (cite) was funded by the National Institutes of Justice.

☆ The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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IMAGES

⇉Sexual Assault Research Paper Essay Example
(PDF) AFRICAN AMERICAN WOMEN AND SEXUAL ASSAULT: INCIDENCE, HEALTH
(PDF) The National Problem of Untested Sexual Assault Kits (SAKs
(PDF) A Compendium of Sexual Assault Research
Understanding Sexual Assault Free Essay Example
⇉Sexual Assault: Causes and Consequences Essay Example

COMMENTS

Sexual assault victimization and psychopathology: A review and meta
Abstract. Sexual assault (SA) is a common and deleterious form of trauma. Over 40 years of research on its impact has suggested that SA has particularly severe effects on a variety of forms of psychopathology, and has highlighted unique aspects of SA as a form of trauma that contribute to these outcomes. The goal of this meta-analytic review ...
The Global Prevalence of Sexual Assault: A Systematic Review of
The aim of this paper was to offer an updated review of English-language studies published since 2010 that examined the prevalence of adolescent and/or adult sexual assault in countries other than the US and Canada. Knowledge about the worldwide scale of sexual aggression is scarce compared to the broad research literature that has built up in ...
Sexual assault: women's voices on the health impacts of not being
The women in our study articulated the negative impact that not being believed by police had on their well-being beyond the sexual assault. Their voices (e.g., research themes) need to be highlighted to provide a better understanding of women's experiences, which may lead to increased sexual assault reporting and improved response from law ...
Mental and sexual health outcomes following sexual assault in
This paper examines the characteristics of adolescents presenting to sexual assault services and mental and sexual health outcomes after an assault. Methods This was a prospective cohort study in adolescents aged 13-17 years attending the Sexual Assault Referral Centres serving Greater London, UK, over 2 years.
PDF A Review of the Literature on Sexual Assault Perpetrator
Additional Research Examining the Characteristics and Behaviors of Sexual Assault Perpetrators in the Air Force Is Needed. This literature review focused mainly on the plethora of existing studies examining characteristics and behaviors of sexual assault perpetrators within the general population.
Preventing Sexual Violence: A Behavioral Problem Without a Behaviorally
This article presents an intellectual history and quantitative meta-analysis of primary prevention efforts to reduce sexual violence. Sexual violence is a major public-health problem in the United States and across the globe (Basile et al., 2022; Center for Disease Control, 2022).Accordingly, significant efforts and resources are aimed at primary prevention strategies, which are intended to ...
Sexual Abuse: Sage Journals
Sexual Abuse. Impact Factor: 2.1 5-Year Impact Factor: 2.7. Sexual Abuse provides a forum for the latest original research and scholarly reviews on both clinical and theoretical aspects regarding the perpetration of sexual abuse. It is the only publication to focus exclusively on this field, thoroughly … | View full journal description.
The Global Prevalence of Sexual Assault: A Systematic Review ...
Abstract. Objective: We present a review of peer-reviewed English-language studies conducted outside the United States and Canada on the prevalence of sexual assault victimization in adolescence and adulthood published since 2010. Method: A systematic literature search yielded 32 articles reporting on 45 studies from 29 countries.
Long-term outcomes of childhood sexual abuse: an umbrella review
For outcomes with high quality scores, we examined absolute rates reported in primary studies. Specifically, longitudinal cohort studies reported that among individuals who experienced childhood sexual abuse, 503 (28%) of 1809 developed substance misuse. 56. and 36 (38%) of 96 developed post-traumatic stress disorder.
Sexual Assault as a Contributor to Academic Outcomes in University: A
Sexual assault is a prevalent and consequential issue affecting millions of people globally (Benoit et al., 2015; Walters et al., 2013).The effects of experiencing a sexual assault are profound because the effects can last for an extended period of time, contribute to lower mental health, can result in lower psychosocial functioning (e.g., Dworkin, 2020; Dworkin et al., 2017; Rothman et al ...
Sexual assault victims face a penalty for adjacent consent
Across 11 experimental studies (n = 12,257), we show that female victims of sexual assault are blamed more and seen as less morally virtuous if their assault follows voluntary sexual intimacy, a factor we term "adjacent consent".Moreover, we illuminate a psychological mechanism contributing to this penalty: When a woman who provided no consent whatsoever is assaulted, people tend to see ...
Campus Sexual Assault: A Systematic Review of Prevalence Research From
Abstract. Sexual assault is a pervasive problem on university and college campuses in the United States that has garnered growing national attention, particularly in the past year. This is the first study to systematically review and synthesize prevalence findings from studies on campus sexual assault (CSA) published since 2000 (n 1⁄4 34).
Campus Sexual Assault: Future Directions for Research
Abstract. Campus sexual assault (CSA) has received unprecedented attention over recent years, resulting in an abundance of federal guidance and mandates. In response, efforts to address and prevent CSA at Institutions of Higher Education (IHE) across the country have grown quickly, including the development and implementation of programs and ...
Campus Sexual Assault: A Systematic Review of Prevalence Research From
Abstract. Sexual assault is a pervasive problem on university and college campuses in the United States that has garnered growing national attention, particularly in the past year. This is the first study to systematically review and synthesize prevalence findings from studies on campus sexual assault (CSA) published since 2000 ( n = 34).
Exploring the relationships between sexual violence, mental health and
Research supports the association between adult sexual violence (SV) and poor mental health. However, most studies focus on rape and physical sexual assault. Little is known about how more subtle forms of SV affect women's well-being. Furthermore, evidence for the impact of the perpetrator's identity is mixed. There is also little data from clinical populations to help health practitioners ...
Male Victims of Sexual Assault: A Review of the Literature
3. Prevalence of AMSVo. In Western nations, such as the UK, the US, and the Nordic countries, the prevalence of male-on-male rape or sexual assault is believed to be between 5 and 10% of all sexual assaults each year [35,36,37,38].According to the Home Office crime statistics for England and Wales, there were 9901 rapes of victims aged 16 and older in total during the 2010-2011 financial ...
Sexual assault incidents among college undergraduates ...
Sexual assault on college campuses is a public health issue. However varying research methodologies (e.g., different sexual assault definitions, measures, assessment timeframes) and low response rates hamper efforts to define the scope of the problem. To illuminate the complexity of campus sexual assault, we collected survey data from a large population-based random sample of undergraduate ...
Lessons learned from child sexual abuse research: prevalence, outcomes
With more than 20,000 research papers on CSA listed under the most renowned research databases, child and adolescent mental health practitioners, researchers and decision-makers may find it challenging to keep up with this rapidly increasing literature. ... Two widespread forms of sexual assault prevention efforts have been extensively studied ...
Sexual assault: women's voices on the health impacts of not being
The high rate of sexual violence against women is a concerning public health issue as approximately one in three women in North America experience sexual assault in their lifetime [1, 2].While sexual assault is a pervasive social issue that does not discriminate against age, gender, ability or status, research indicates that certain groups are at greater risk [1, 3, 4].
PDF The Campus Sexual Assault (CSA) Study
least one completed sexual assault since entering college: 4.7% were victims of physically forced sexual assault; 7.8% of women were sexually assaulted when they were incapacitated after voluntarily consuming drugs and/or alcohol (i.e., they were victims of alcohol and/or other drug- [AOD] enabled sexual assault); 0.6% were sexually assaulted
Deserted: The U.S. Military's Sexual Assault Crisis as a Cost of War
This author of this report found that sexual assault prevalence in the military is likely two to four times higher than official government estimations. Based on a comparison of available data collected by the U.S. Department of Defense to independent data, the research estimates there were 75,569 cases of sexual assault in 2021 and 73,695 ...
Correction: Sexual and dating violence prevention programs for male
Sexual and dating violence (SDV) by male youth (≤ 25 years)—including sexual harassment, emotional partner violence, and rape—is a worldwide problem. ... such as explicit attention to victimization and masculinity and discuss best practices for evaluation research, including assessments of program integrity, and examining relevant ...
PDF Deserted: The U.S. Military's Sexual Assault Crisis as a Cost of War
of sexual assault faced fear of retaliation given that "military service members who reported sexual assault were 12 times more likely to suffer retaliation for doing so than to see their offender, if a service member, convicted for a sex offense."63 Human Rights Watch warned that any gains in reporting would be lost if victims who report their
Rape-Related Pregnancies in the 14 US States With Total Abortion Bans
Many US women report experiencing sexual violence, and many seek abortion for rape-related pregnancies. 1 Following the US Supreme Court's 2022 Dobbs v Jackson Women's Health Organization (Dobbs) decision overturning Roe v Wade, 14 states have outlawed abortion at any gestational duration. 2 Although 5 of these states allow exceptions for rape-related pregnancies, stringent gestational ...
"A Rape Is a Rape, Regardless of What the Victim Was Doing at the Time
Research finds that "problematic" victim behaviors—for example, alcohol consumption—influence sexual assault case outcomes. ... she received the Academy of Criminal Justice Sciences William L. Simon/Routledge Outstanding Paper Award for her research examining the effects of individual- and national-level factors on attitudes toward ...
U.S. military sexual assault rates 2 to 4 times higher than govt
"During and beyond the 20 years of the post-9/11 wars, independent data suggest that actual sexual assault prevalence is two to four times higher than DoD estimations — 75,569 cases in 2021 ...
Waiting to Tell: Factors Associated with Delays in Reporting Sexual
Research has examined sexual violence in the context of reporting to a medical professional and the collection of forensic physical evidence (i.e., a sexual assault medical ... Ultimately, the central thesis of this paper is to improve survivor access to treatment, law enforcement, and other services in order to increase likelihood of recovery ...
National sexual violence prevention project
Known as the 'Partners in Prevention of Sexual Violence Project', the scheme is designed to strengthen evidence for sexual violence prevention in Australia. Professor Leesa Hooker, a Principal Research Fellow and Director of the Reducing Gender-Based Violence Research Group (ReGEN) at La Trobe Rural Health School, said the funding would ...
US military sex assault cases much higher than official estimates
The Department of Defense estimated approximately 35,900 sexual assault cases in 2021 and 29,000 in 2023, but the study's author said a synthesis of independent data yielded estimates of 75,569 ...
A systematic review of primary prevention strategies for sexual
This systematic review examined 140 outcome evaluations of primary prevention strategies for sexual violence perpetration. The review had two goals: 1) to describe and assess the breadth, quality, and evolution of evaluation research in this area; and 2) to summarize the best available research evidence for sexual violence prevention practitioners by categorizing programs with regard to their ...

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Campus Sexual Assault: A Systematic Review of Prevalence Research From 2000 to 2015

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Exploring the relationships between sexual violence, mental health and perpetrator identity: a cross-sectional Australian primary care study

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BMC Public Health

Sexual assault incidents among college undergraduates: Prevalence and factors associated with risk

Introduction

Materials and methods

Participants

Sexual assault.

Demographics.

Fraternity/Sorority.

Problematic drinking.

Sexual orientation.

Romantic/sexual relationships.

Pre-college sexual assault.

Data analysis

Descriptive statistics

Aim 1: Prevalence of sexual assault victimization at CU/BC

Types of sexual assault by gender ( Table 2 ).

Experiencing multiple sexual assaults ( Fig 2 ; S1 Table ).

Aim 2: Methods of perpetration (lying/threats, criticism, incapacitation, physical force, threats of harm, and other) by gender ( Table 3 )

Aim 3: Identify factors associated with sexual assault experiences

Race/Ethnicity.

Economic precarity.

Transfer student.

Lived in US less than 5 years.

Relationship status.

Fraternity/Sorority membership.

Risky or hazardous drinking.

Pre-college assault ( Table 5 ).

Supporting information

Acknowledgments

Lessons learned from child sexual abuse research: prevalence, outcomes, and preventive strategies

Magnitude: how prevalent is CSA?

Mental health outcomes: what are the effects of CSA?

Preventive strategies: how can we prevent CSA from happening in the first place?

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Child and Adolescent Psychiatry and Mental Health

Sexual assault: women’s voices on the health impacts of not being believed by police

Study design

Sampling and recruitment of participants

Data collection

Data analysis

Participant characteristics

Broken expectations