Preventing Interpersonal Violence on College Campuses

Abstract

Sexual assault, stalking, dating violence, and intimate partner violence, herein collectively termed interpersonal violence (IV), are public health problems affecting 20% to 25% of female college students. Currently, One Act is one of the few IV prevention training programs at universities that teach students bystander skills to intervene in low- and high-risk IV situations. The objectives of this study were 1) to evaluate One Act’s effects on date rape attitudes and behaviors, and bystanders’ confidence, willingness to help, and behavior, and 2) to compare the effects on bystander skills between One Act and Helping Advocates for Violence Ending Now (HAVEN), an IV response training program with similar participants. Data were collected over 2 years, before and after One Act and HAVEN trainings. We measured outcomes with four scales: College Date Rape Attitudes and Behaviors, Bystander Confidence, Willingness to Help, and Bystander Behavior. The analysis compared within- and between-group mean differences in scale scores pre- and post-trainings using linear mixed models. One Act showed improvements for date rape attitudes and behaviors (p < .001), bystander’s confidence (p < .001), and willingness to help (p < .001). One Act participants’ bystander confidence improved more (p = .006), on average, than HAVEN’s. The differences in the two trainings’ effects on bystander willingness to help and behavior had similar patterns but were not statistically significant. We found a larger positive impact on bystander confidence among students who participated in the bystander prevention training compared with the response training. Further research is needed to improve the measures for bystander behavior and measure the bystander trainings’ larger impact on the community.

Keywords

sexual violence prevention bystander intervention interpersonal violence college

Introduction

Sexual assault, stalking, dating violence, and intimate partner violence, herein collectively termed interpersonal violence (IV), are serious public health problems that affect many college women (Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2013; Fisher, Cullen, & Turner, 2000; White & Smith, 2004). Approximately 20% to 25% of women experience sexual assault while enrolled at a college or university (Krebs, Lindquist, Warner, Fisher, & Martin, 2009; White House Task Force to Protect Students From Sexual Assault, 2014). A 2014 report from the U.S. Senate shows that many colleges and universities are “failing to comply with the law and best practices in how they handle sexual violence among students” (U.S. Senate Subcommittee on Financial & Contracting Oversight—Majority Staff, 2014). This 2014 report, which presented results of surveys conducted with 440 four-year institutions of higher education, found that more than 20% of campuses do not provide any sexual assault report training for faculty and staff; more than 40% of schools have not conducted a single investigation of sexual violence in the past 5 years; and more than 20% of institutions give the athletic department oversight of sexual violence cases involving student athletes.

Women are at the highest risk when they first enter college, and most assaults are perpetrated by serial offenders (Lisak & Miller, 2002; White & Smith, 2004). Compared with women who have not been victimized, IV victims experience more short- and long-term physical and mental health consequences, including chronic pain, migraines/headaches, sexually transmitted infections, disability, depressive and anxiety symptoms, post-traumatic stress disorder, and suicidal thoughts (Coker, Smith, Bethea, King, & McKeown, 2000; Pico-Alfonso et al., 2006). Although the vast majority of research focuses on women, men (Davies, 2002) and transgender individuals (National Coalition of Anti-Violence Programs, 2013) also experience IV. Due to its prevalence and devastating effects, IV prevention is a public health priority on campuses and in larger communities (Basile, 2004; Campbell, 2002; National Intimate Partner and Sexual Violence Survey, 2010).

Since the 1990s, the Student Right-to-Know and Campus Security Act (later renamed the Clery Act) has required colleges and universities that receive federal funding to regularly report violent crimes, including sexual assault on and nearby campus, and to make information available to students about how to report such crimes. The U.S. Department of Education has also charged universities with both responding appropriately to instances of IV and acting to prevent them (U.S. Department of Education, 2011). Until recently, sexual assault prevention programming in higher education has focused on one-time workshops presented to single-gender groups, which have been shown to be effective in changing individuals’ attitudes toward rape and rape myth acceptance (Lonsway et al., 2009; Vladutiu, Martin, & Macy, 2011). However, changing individuals’ attitudes does not necessarily change behavior and/or prevent violence. In addition, prevention programs for college students vary in the constructs they are trying to change, such as “behavioral intentions, self-reported behaviors, directly observed behaviors, self-reported sexual victimization, and self-reported sexual aggression” (Breitenbecher, 2000, p. 24). Some colleges have had success in teaching subpopulations such as sorority women on how to avoid victimization (Brecklin & Ullman, 2005; Gidycz, Rich, Orchowski, King, & Miller, 2006; Rothman & Silverman, 2007).

A more promising community-based approach to reducing IV is addressing the bystander effect, which occurs when individuals witness a high-risk or emergency situation (e.g., IV), but fail to help victims or potential victims because the presence of other bystanders diffuses responsibility (Darley & Latane, 1968). Empowering bystanders to intervene emerged from social-psychology research and has been applied to IV since the 1990s, when educators began teaching intervention skills to college students (Branch, Richards, & Dretsch, 2013; Coker et al., 2011). Bystander education programs on college campuses attempt to teach community members (potential bystanders) safe and effective strategies for intervening “in a positive way before, during or after a situation or event in which they see or hear behaviors that promote sexual violence” (National Sexual Violence Resource Center, 2013).

The bystander intervention approach offers colleges and universities practical strategies to address and change social norms that create gender inequality and violence (Banyard, Plante, & Moynihan, 2004). This community-based emphasis removes the need to treat women as potential victims and men as potential perpetrators, and includes students who identify outside the male/female binary, such as transgender students. In addition, a bystander approach to IV prevention has the potential to encourage both behavioral and attitudinal change in individuals, challenging violence-supportive social norms, and encouraging community responsibility (Banyard et al., 2004; Casey & Lindhorst, 2009; Moynihan et al., 2010; Moynihan, Banyard, Arnold, Eckstein, & Stapleton, 2011).

Recent research on bystander education in college populations has had promising, though limited, results. Banyard, Moynihan, and Plante (2007) demonstrated positive improvements in program participants’ sexual assault knowledge, sexual assault attitudes, and bystander behaviors through their Bringing in the Bystander program. Likewise, Coker and colleagues (2011) found that students who received the Green Dot bystander training program reported more active bystander behaviors relative to students who received no training. Although these programs vary in specific content and delivery, all are informed by the bystander prevention philosophy described above.

Researchers have explored factors that influence bystanders’ actions, such as the nature of the problem and the bystander’s power relationship to the people involved (Nicksa, 2014). These factors are critical to tailor curricula to specific subpopulations. For example, bystander intervention programs targeting fraternities and athletes have significantly improved knowledge about sexual assault, helping attitudes, and bystander confidence (National Sexual Violence Resource Center, 2013). Unique formats of presenting information, such as Theatre of the Oppressed, demonstrated success in increasing self-reported likelihood of intervening in future situations (Ahrens, Rich, & Ullman, 2011). These limited studies comprise an encouraging evidence base for bystander prevention programming efforts.

The focus on bystander interventions is timely. The 2014 U.S. Senate Sexual Violence on Campus Report shows a lack of institutional compliance with laws and best practices. The 2013 Campus SaVE Act, passed by Congress within the renewal of the Violence Against Women Act, requires campuses to implement bystander education for new students to prevent violence. However, the Act specifies neither effective program components nor metrics for success (112th Congress, 2011; White House Task Force to Protect Students From Sexual Assault, 2014). Research to date has been limited by small sample sizes, cross-sectional designs, and lack of comparison groups (Banyard, 2008; Moynihan et al., 2011). Moreover, there is tremendous variability in the targeted outcomes (e.g., attitudes, skills, and behaviors), specific measures, and duration of follow-up (i.e., 2, 3, or 6 months; Ahrens et al., 2011; McMahon et al., 2014). We conducted this study to evaluate the effects of one particular bystander education program on date rape attitudes and behaviors, bystanders’ confidence, willingness to help, and behavior, and to compare the effects on bystander skills between this program (One Act) and another IV program, not directly targeting bystander intervention for prevention of violence (Helping Advocates for Violence Ending Now [HAVEN]).

Method

IV Prevention Programs

A large Southeastern U.S. university developed two complementary skills-based training programs to address IV among students. HAVEN was developed in 2006 to teach faculty, staff, and students how to appropriately respond to students who disclose having experienced IV. HAVEN training content includes discussion of qualities of healthy, unhealthy, and abusive relationships as well as in-depth coverage of resources for helping someone who has experienced sexual assault, stalking, dating violence, and/or intimate partner violence. The expected outcomes for participants who attend HAVEN training are decreased acceptance of violence, rape myths, and victim-blaming, and increased knowledge of resources, active listening skills, and self-reports of supporting survivors (Table 1).

Table 1.

Comparison of One Act and HAVEN Training Programs.

Characteristics	One Act	HAVEN
Main objective	IV prevention	IV response
Total number of trained students (2011-2013 academic years)	765	722
Length of training	4 hr	4 hr
Facilitators	1 staff or graduate assistant and 2-3 undergraduate peer educators	1 staff or graduate assistant and 2-3 undergraduate peer educators
Outcomes desired	Decreased acceptance of violence, rape myths, and rape-supportive languageIncreased personal investment, confidence, and willingness to actIncreased self-reported acts of pro-social bystander behavior	Decreased acceptance of violence, rape myths, and victim-blamingIncreased knowledge of resources and active listening skillsIncreased self-reported acts of supporting survivors
Curriculum content	Empathy building exerciseDefinitions of termsWarning signsBystander intervention theoryScope of violencePeer examples of interventionScenarios and role-play	Empathy building exerciseDefinitions of termsCycle of violenceActive listeningRole of a friendResources and referralsScenarios and role-play
Total number of trainings (2011-2013 academic years)	49 throughout the fall and spring semesters	40 throughout the fall and spring semesters
Types of participants	Approximately equally distributed between participants who sign up as individuals and as part of a group to which they belong (i.e., living learning community or student club)	More participants sign up as individuals than as groups

Note. HAVEN = Helping Advocates for Violence Ending Now; IV = interpersonal violence.

Although the community reported positive experiences via process evaluations and increased interest in the program, HAVEN was not designed to prevent IV. In 2010, One Act training was developed by student leaders in collaboration with full-time staff and faculty to train students on prevention of sexual assault, stalking, dating violence, and intimate partner violence by interrupting the bystander effect and taking action. One Act training reviews warning signs of potential violence and seeks to motivate participants to evaluate situations for their own safety as well as other people involved. The expected outcomes for participants who attend One Act training are decreased acceptance of violence, rape myths, and rape-supportive language; increased personal investment, confidence, and willingness to act; and increased self-reported acts of pro-social bystander behavior to prevent sexual violence, stalking, and relationship violence (Table 1).

Using scenarios written by students to ground the discussion in real-life scenarios, One Act training provides a structure for positive bystander action through the following steps: observe, assess, act, and follow-up. These steps include being able to recognize warning signs by observing the problem and assessing how to intervene safely using strategies such as asking for help, creating a distraction, or talking directly. Finally, participants learn to follow-up to ensure the situation is over and no other action is needed. During the pilot year of One Act, student participants were asked to complete a process evaluation at the end of the training, including what participants liked most about the program and which scenarios seemed realistic. These data were used to adapt the program to the context and specific needs of the campus community and student body.

Starting in its second year, an outcome evaluation was implemented for One Act and for HAVEN to compare participants’ attitudes and behaviors before and after trainings because participants in the two trainings were likely to be similarly motivated. The two trainings shared curricula content (addressing date rape attitudes and behaviors through reviewing definitions and an empathy building exercise) and selected desired outcomes (decreased acceptance of violence and rape myths; however, each training also had distinct objectives and curriculum content; Table 1). Of note, only One Act focuses on improving bystanders’ confidence, willingness to help, and behavior through a bystander intervention theory and peer role modeling of intervention.

Study Participants and Procedures

Data were collected from One Act and HAVEN training participants—undergraduate students—who completed surveys before and after trainings during the 2011-2012 and 2012-2013 academic years. Participants in both trainings were recruited on campus through outreach to student organizations and advertisements via social media, paper and electronic fliers, and websites. Trainings were scheduled throughout the academic year, and students could sign up to attend at their chosen day and time. Some students chose to attend only One Act, others only HAVEN, and some attended both trainings. Data from students who attended both trainings in the study’s time frame were not included in the analysis. The 49 One Act and 28 HAVEN trainings each had between 8 and 38 participants; both trainings had similar proportions of small and large group sizes.

Before each training, facilitators explained the purpose of the surveys, and participants were invited to voluntarily complete the paper- or web-based survey before the training (T1). After training, participants were invited by email to complete surveys 1 week (T2) and 2 months after training (T3). If a student attended both HAVEN and One Act, only data from the first training they attended were included in our analysis. As incentives, participants received a t-shirt for completing the T2 survey; they could opt to enter a drawing for a gift card or an iPad after completing the T3 survey. Researchers did not have access to information that would disclose participants’ identities, and data files were kept in locked computers and offices. The research project received University Institutional Review Board approval.

Measures

We compared One Act and HAVEN using four outcomes that were derived from previously validated scales. These scales were adapted to our specific program evaluation (adaptations are described below, and the appendix contains the adapted scales). First, rape attitudes and behaviors were measured with the College Date Rape Attitude and Behaviors Scale (CDRABS). The CDRABS is based on theories of the causes and risk factors of date rape and contains 27 items (Lanier & Elliott, 1997). Each item in the CDRABS used a 5-point Likert-type scale (strongly disagree to strongly agree) to react to statements such as “The degree of a woman’s resistance should be a major factor in determining if rape has occurred.” Composite scores were created by summing responses across the questions, with some questions reverse coded.

The other three scales—Bystander Confidence Scale, Willingness to Help Scale, and Bystander Behavior Scale—were also adapted from previous studies (Banyard & LaPlant, 2002; Banyard, Plante, Cohn, et al., 2005; Banyard, Plante, & Moynihan, 2005) to measure content specific to One Act and to minimize survey response fatigue. We reviewed content of the trainings and removed questions that were not directly connected to the training. Then, based on piloting the survey with students, we excluded a few questions based on their feedback regarding contextual relevance and time required for survey completion.

The Bystander Confidence Scale asked participants to report their degree of confidence to perform 15 bystander behaviors on a scale of 0 (can’t do) to 100 (very certain can do), and the mean of these 15 items was calculated. An example of a bystander behavior is “Do something if I see a woman who looks very uncomfortable surrounded by a group of men at a party.” For the Willingness to Help Scale, participants were asked how willing or likely they were to engage in 9 bystander behaviors (e.g., Express disagreement with a friend who says forcing someone to have sex is okay.) using a 5-point Likert-type scale. Composite scores were computed by summing responses across the questions.

The Bystander Behavior Scale asked respondents to indicate which of 19 behaviors they had actually done in the past 2 months (no data collected at T2); they could choose “not applicable” if they did not have the opportunity to engage in behaviors such as “Walked a friend home from a party who had too much to drink.” We summed the number of behaviors they reported doing, with “not applicable” set to missing. For all scales, higher scores reflected desirable behaviors. Missing responses on scale items were imputed by filling in the mean of non-missing responses for each participant, provided that no more than 50% of the responses were missing. We estimated Cronbach’s alpha for each scale as follows: CDRABS = .83, Bystander Confidence = .88, Willingness to Help = .79, Bystander Behavior = .84. Value of α > .70 is considered to have acceptable reliability (Nunnally, 1978).

Analysis

Similar characteristics between the One Act and HAVEN trainings provided a basis to evaluate the effectiveness of One Act as a bystander training program by itself in a within-group analysis and to compare it with HAVEN in a between-group analysis. The analysis examined (a) over-time changes in date rape attitudes and behaviors, and bystanders’ confidence, willingness to help, and behavior among One Act participants, and (b) a comparison between One Act and HAVEN participants on changes in bystander skills. For the former, we conducted within-group, pre−post comparisons of One Act participants. For the latter, we examined between-group differences (One Act vs. HAVEN) in scale scores over time (before and after training). To make both types of comparisons, we applied appropriate contrasts in linear mixed effect regression models using all available data for all the participants who had at least 50% complete responses for each scale. Data were also excluded for duplicate entries, students without T1 data, and if students did not indicate which training(s) they had participated in prior to each survey. Data from the T1, T2, and T3 surveys were analyzed using Stata, version 11.2 (StataCorp, College Station, TX).

We used linear mixed models to compare changes in mean response scores, accounting for correlation between repeated longitudinal responses (Holden, Kelley, & Agarwal, 2008). In our models, fixed effects included the type of training attended, time of survey (T1, T2, and T3), interaction terms for the previous two variables, and control variables, including previously attended similar trainings, age, gender, length of time at the University of North Carolina at Chapel Hill (UNC), residency status (in/out-of-state), housing (on/off-campus), race/ethnicity, sexual orientation, association with the Greek system, and participation in athletic programs. The models also included random participant effects to account for correlation between responses from the same participant. For between-group comparisons on the two scales that were measured at three time points (CDRABS and Willingness to Help), we first compared the groups using an overall test for any differential mean change from T1; if this test was significant, we then compared the groups for mean change from T1 with each of T2 and T3. To explore potential bias due to attrition, One Act participants who completed all three surveys were compared with those who only completed the T1 survey. All tests were conducted using two-sided tests at the .05 level, with no adjustments for multiple comparisons.

Results

Participants

A total of 1,487 students were trained during the 2 academic years. The final analytical data set had 1,681 observations from 930 participants (One Act = 594 and HAVEN = 336). The average response rates for T2 and T3 measures for One Act were 60% and 30%, respectively, and 48% and 28%, respectively, for HAVEN (Table 2). Compared with participants who completed T1 only, those who completed follow-up surveys (T2 and T3) were more likely to be younger, heterosexual, and not Black/African American. Participant characteristics and the comparison between One Act and HAVEN at T1 are summarized in Table 2. Apart from age and gender, there were no statistically significant differences between the two groups.

Table 2.

Participants’ Characteristics and Differences Between One Act and HAVEN.

Characteristic	One Act (n = 594)	HAVEN (n = 336)	One Act vs. HAVEN, Difference
Age, M (SD)	19.6 (1.1)	19.8 (1.3)	0.2*
Gender
Female	70.3%	77.1%	6.8*
Male	28.6%	21.7%	−6.8
Other	1.2%	1.2%	0.0
Race/ethnicity
Asian/Pacific Islander	11.3%	11.3%	0.1
Black/African American	17.0%	12.5%	−4.5
Latino/Hispanic	8.1%	4.8%	−3.3
White/Caucasian	63.0%	65.2%	2.2
Other	7.6%	8.0%	0.5
Sexual orientation
Heterosexual	84.9%	90.2%	5.3
Gay	2.9%	3.1%	0.1
Bisexual	3.4%	2.1%	−1.3
Other	8.8%	4.6%	−4.3*
Time at University (years), M (SD)	2.2 (0.9)	2.3 (1.0)	0.1
Enrollment status: In-state	76.2%	77.4%	1.2
Living situation: On-campus	78.6%	74.9%	−3.7
Greek member/pledging	20.1%	15.8%	−4.3
Athletic team member	4.2%	5.9%	1.7
Transfer student	5.1%	4.7%	−0.3
Response rates
T2	60%	48%
T3	30%	28%

Note. HAVEN = Helping Advocates for Violence Ending Now.

p < .05.

Program Effectiveness

For the within-group analysis of One Act, we observed an increase, on average, between T1 and T3 on the CDRABS (M difference = 0.14; p < .001; 95% confidence interval [CI] = [0.07, 0.21]), as shown in Table 3. Similarly, the Bystander Confidence Scale (M difference = 9.08; p < .001; 95% CI = [6.66, 11.49]), and the Willingness to Help Scale (M difference = 0.28; p < .001; 95% CI = [0.21, 0.34]) also increased, on average. For the Bystander Behavior Scale, the observed effect was positive but not statistically significant (M difference = .02; p = .51; 95% CI = [−0.03, 0.06]). The CDRABS and the Willingness to Help Scale also had data from T2. Between T2 and T3, there was no evidence of change (M difference = .02; p = .59; 95% CI = [−0.05, 0.09]) in the CDRABS, whereas the Willingness to Help Scale declined, on average, for the same period of time (−0.09; 95% CI = [−0.16, −0.01]; p = .02).

Table 3.

Model-Estimated Means and Mean Differences for Comparisons of Interest.

		One Act		HAVEN		Between-Group Comparison (One Act–HAVEN)
Mean/Differences to Be Estimated	Scale	Estimate	95% CI	Estimate	95% CI	Estimate	95% CI
Date Rape Attitudes and Behavior	T1	—	—	—	—	−0.07**	[−0.12, −0.02]
	T2	—	—	—	—	−0.04	[−0.10, 0.02]
	T3	—	—	—	—	−0.01	[−0.13, 0.12]
	T2 − T1	0.12***	[0.09, 0.15]	0.09***	[0.05, 0.13]	0.03	[−0.02, 0.08]
	T3 − T1	0.14***	[0.07, 0.21]	0.07	[−0.02, 0.17]	0.06	[−0.06, 0.18]
	T3 − T2	0.02	[−0.05, 0.09]	−0.02	[−0.12, 0.09]	0.03	[−0.09, 0.16]
Bystander Confidence	T1	—	—	—	—	−3.17***	[−5.02, −1.33]
	T3	—	—	—	—	2.84	[−1.53, 7.21]
	T3 − T1	9.08***	[6.66, 11.5]	3.06	[−0.48, 6.61]	6.01**	[1.72, 10.3]
Willingness to Help	T1	—	—	—	—	−0.06	[−0.13, 0.01]
	T2	—	—	—	—	−0.03	[−0.11, 0.05]
	T3	—	—	—	—	0.10	[−0.04, 0.24]
	T2 − T1	0.37***	[0.32, 0.42]	0.34***	[0.28, 0.41]	0.03	[−0.05, 0.11]
	T3 − T1	0.28***	[0.21, 0.36]	0.12*	[0.01, 0.24]	0.16*	[0.02, 0.30]
	T3 − T2	−0.09*	[−0.16, −0.01]	−0.22***	[−0.33, −0.11]	0.13	[0.00, 0.27]
Bystander Behavior	T1	—	—	—	—	−0.02	[−0.05, 0.01]
	T3	—	—	—	—	0.01	[−0.07, 0.09]
	T3 − T1	0.02	[−0.03, 0.06]	−0.02	[−0.08, 0.05]	0.03	[−0.05, 0.11]

Note. T1 = pre-test; T2 = 1 week post-test; T3 = 2 month post-test; HAVEN = Helping Advocates for Violence Ending Now; CI = confidence interval.

p < .05. **p < .01. ***p < .001.

Time trends of the composite scale score means for the between-group analysis of One Act and HAVEN are graphed in Figure 1, and the model-estimated means and mean differences can be found in Table 3. Comparing One Act with HAVEN, the overall test for the CDRABS (p = .320) and the Willingness to Help Scale (p = .070) were not statistically significant. Although the overall result for the Willingness to Help Scale was not significant, in a post hoc comparison, One Act participants improved their scores, on average, by 0.16 points more than HAVEN participants between T1 and T3 (p = .022; 95% CI = [0.02, 0.30]). Scores for the Bystander Confidence Scale at T1 were 3.17 points higher, on average, for HAVEN than One Act (p = .001; 95% CI = [1.33, 5.02]). One Act group participants improved their Bystander Confidence Scale scores, on average, by 6.01 points more than HAVEN’s between T1 and T3 (p = .006; 95% CI = [1.72, 10.31]). For the Bystander Behavior Scale, average scores did not differ significantly between HAVEN and One Act participants at T1 (difference = −0.20 p = .245; 95% CI = [−0.53, 0.13]). The difference in average score changes over time between the two groups was also not significant (difference = 0.04; p = .372; 95% CI = [−0.04, 0.12]).

Figure 1.

Participants’ mean scale scores for One Act and HAVEN programs over time (academic school years 2011-2012 and 2012-2013).

Discussion

IV is prevalent on college campuses, and often results in serious physical, mental, and emotional health problems and threatens students’ academic achievement. Many college campuses still fail to comply with laws and best practices in how they handle sexual violence among students (U.S. Senate Subcommittee on Financial & Contracting Oversight—Majority Staff, 2014). The One Act training program is designed to provide students with the knowledge and skills to be effective bystanders and prevent IV in high-risk situations, therefore, also preventing negative health and academic outcomes. As such, it is responsive to the Campus SaVE Act passed by Congress in 2013. We compared One Act with HAVEN, which focuses on IV response and does not address the bystander effect. Because One Act and HAVEN participants were generally similar (likely due to shared interest in, and higher sensitivity to, IV-related issues), we extend previous knowledge about IV prevention programs by (a) including a comparison group in our study, (b) following participants over time, and (c) having a large sample size.

Our findings suggest that One Act training significantly improved bystanders’ date rape attitudes and behaviors, as well as their confidence and willingness to help as bystanders in high-risk IV situations. These findings are similar to previous evaluations of violence prevention programs (Coker et al., 2011; McMahon et al., 2014; Moynihan et al., 2011). One Act (prevention) and HAVEN (response) share the objective to positively affect date rape attitudes and behaviors among college students. As expected, both trainings achieved these objectives and the two approaches had similar effects over time. However, the bystander prevention is unique to One Act only. The significantly larger positive effect of One Act compared with HAVEN on bystander confidence suggests that the bystander component of One Act may ultimately increase IV prevention by increasing bystander confidence more than programs that omit bystander training, although our results do not necessarily provide evidence that this is the case.

As with other recent studies evaluating bystander trainings, this study suggests that teaching students bystander skills for high-risk IV situations increases awareness that may prevent IV among college students (Coker et al., 2011; McMahon et al., 2014; Moynihan et al., 2011). The IV response training (HAVEN), which did not include this bystander component, had no significantly positive effect on bystander confidence or behavior, both of which are essential to prevent IV on college campuses. Although increasing bystander behavior is a goal of the One Act training, results showed no significant difference in bystander behavior scores within the One Act group before and after the training, in these first 2 years of the program’s implementation. From our results, training a large number of students on bystander prevention appears to increase their willingness to help and confidence in taking action, when they observe a high-risk IV situation. This action not only could counter the bystander effect, but also could serve as an example for others to take action in the future and contribute to a culture of acceptance of bystander behaviors.

Bystander behavior may also be influenced by changing policies and norms on campus. After the first 2 years of collecting this data, a task force was convened to develop a new sexual assault policy which was released in August 2014. As for norms, between fall 2011 and fall 2013, there was a 4.9% increase in students who reported “talk[ing] with friends about watching each other’s drinks [at parties],” a 4.2% increase in “speak[ing] up to friends to help avoid a risky situation or problem with alcohol,” and a 1.5% increase in “persuad[ing] a friend that they’d had enough to drink.” Outcome indicators for these bystander behaviors across the university’s community have been obtained through questions added to the biannual American College Health Association—National College Health Assessment II Survey (ACHA-NCHA; www.acha-ncha.org). As observed in the above data, we anticipate that these norms will change in a positive way over time, increasing the number of self-reports of bystander behavior compared with what we found in our study.

As more students become One Act trained, a shift in participants’ demographics has also been observed. During the 2 years of training included in this analysis, 82% of One Act participants reported knowing someone who has been affected by IV, and almost 30% reported being personally affected by IV. Although the percentage of participants who know someone affected by IV has remained relatively constant over the academic years, the percentage of personally affected participants has decreased from 39% during the 2010-2011 academic year, to 27% during the 2012-2013 academic year. This shows an increase in One Act participation by people who do not identify as IV survivors over time; a trend we may continue to observe as One Act expands to train groups such as the Greek community, athletic teams, university staff, and the general student body.

Limitations

One limitation is that although we selected reliable outcome measures, they have not been tested for validity. However, these were the best available and most widely used measures. Second, the low-response rate, especially at T3, introduces the potential for self-selection bias. One Act had higher response rates for T2 and T3 than HAVEN that we could not explain with the available data. Although retention may drop for longer periods of time, following students for only 2 months also limited our ability to measure behavior over time. Students were not randomized to a training group, which means that differential responses could be the result of uncontrolled confounding; however, the two groups are generally comparable with respect to measured characteristics. Finally, attitudes, confidence, and willingness to help are necessary for behavior change to take place, but not guarantors of action.

Conclusion

The 2013 Campus SaVE Act requires college campuses to implement bystander education for new students. However, there are few scientifically rigorous evaluations of IV prevention programs. This evaluation builds on earlier research, demonstrating that bystander education has great potential to prevent IV in college campuses, and thus, reduce negative health and academic outcomes. In addition, the larger positive impact on bystander confidence among students who participated in the bystander prevention education program compared with the response education program on the same campus encourages a continued focus on bystander education for IV prevention. Future research should focus on improving the measures for bystander behavior, and consider the inclusion of factors related to policy and norm changes in college campuses, and the evaluation of the effects of programs like One Act on the larger community. After decades of silence, today the public is increasingly more aware of IV-related incidents and their negative effects on public health. Riding on this momentum, it is time to invest in strengthening prevention training programs, social marketing, and policy changes to reverse this epidemic of violence.

Footnotes

Appendix

Acknowledgements

We are grateful for the work of Mariana Garrettson, MPH, from the Injury Prevention Research Center, University of North Carolina at Chapel Hill; Rebecca Macy, PhD, from the School of Social Work, University of North Carolina at Chapel Hill; and Sandra L. Martin, PhD, from the Gillings School of Global Public Health, University of North Carolina at Chapel Hill, who were part of the study design process.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported with funding from the North Carolina Department of Health and Human Services, North Carolina Translational and Clinical Sciences Institute, and the Injury Prevention Research Center.

Author Biographies

Kei Alegría-Flores has an MPH from The George Washington University and is a PhD student in the health policy and management department at University of North Carolina (UNC)−Chapel Hill. She is a Global Health Corp Fellow and Fogarty Global Health Fellow. She has worked and volunteered to end interpersonal violence for over a decade.

Kelli Raker has an MA in higher education and student affairs from The Ohio State University, and has been awarded the University Award for the Advancement of Women in 2013. She serves on the North Carolina Sexual Violence Prevention Team. She collaborates with student leaders on a bystander intervention skills program at UNC–Chapel Hill to prevent violence.

Robert K. Pleasants is the interpersonal violence prevention coordinator and an adjunct assistant professor in Health Behavior and Women’s and Gender Studies at UNC–Chapel Hill. He has been involved in violence prevention in North Carolina since 2001. He serves on the North Carolina Sexual Violence Prevention Team and has facilitated anti-sexist men’s groups.

Mark A. Weaver, an assistant professor of medicine and biostatistics, has actively contributed to the design and analysis of many randomized and observational studies with clinical, behavioral, and health services research outcomes. His areas of statistical expertise include analysis of longitudinal data, and data from complex sampling designs, among others.

Morris Weinberger is the Vergil N. Slee distinguished professor of health care quality management, Department of Health Policy and Management at UNC–Chapel Hill, and The Durham Center for Health Services Research and Development in Primary Care (HSR&D) senior research career scientist with the Durham Veterans Affairs Medical Center (VAMC) Centers of Excellence. He specializes on improving health care services for vulnerable patients with chronic diseases.

References

Ahrens

C. E.

Rich

M. D.

Ullman

J. B.

(2011). Rehearsing for real life: The impact of the InterACT Sexual Assault Prevention Program on self-report likelihood of engaging in bystander interventions. Violence Against Women, 17, 760-776.

Banyard

V. L.

(2008). Measurement and correlates of prosocial bystander behavior: The case of interpersonal violence. Violence and Victims, 23, 83-97. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18396583

Banyard

V. L.

LaPlant

L. E.

(2002). Exploring links between childhood maltreatment and empowerment. Journal of Community Psychology, 30, 687-707. doi:10.1002/jcop.10026

Banyard

V. L.

Moynihan

M. M.

Plante

E. G.

(2007). Sexual violence prevention through bystander education: An experimental evaluation. Journal of Community Psychology, 35, 463-481. doi:10.1002/jcop.20159

Banyard

V. L.

Plante

E. G.

Cohn

E. S.

Moorhead

Ward

Walsh

(2005). Revisiting unwanted sexual experiences on campus: A 12-year follow-up. Violence Against Women, 11, 426-446. doi:10.1177/1077801204274388

Banyard

V. L.

Plante

E. G.

Moynihan

M. M.

(2004). Bystander education: Bringing a broader community perspective to sexual violence prevention. Journal of Community Psychology, 32, 61-79. doi:10.1002/jcop.10078

Banyard

V. L.

Plante

E. G.

Moynihan

M. M.

(2005). Rape prevention through bystander education: Bringing a broader community perspective to sexual violence prevention (Publication No. NCJ 208701). Washington, DC: U.S. Department of Justice, National Institute of Justice. Retrieved from https://www.ncjrs.gov/pdffiles1/nij/grants/208701.pdf

Basile

K. C.

(2004). The differential association of intimate partner physical, sexual, psychological, and stalking violence and posttraumatic stress symptoms in a nationally representative sample of women. Journal of Traumatic Stress, 17, 413-421. doi:10.1023/B:JOTS.0000048954.50232.d8

Branch

K. A.

Richards

T. N.

Dretsch

E. C.

(2013). An exploratory analysis of college students’ response and reporting behavior regarding intimate partner violence victimization and perpetration among their friends. Journal of Interpersonal Violence, 28, 3386-3399. doi:10.1177/0886260513504494

10.

Brecklin

L. R.

Ullman

S. E.

(2005). Self-defense or assertiveness training and women’s responses to sexual attacks. Journal of Interpersonal Violence, 20(6), 738-762 doi:10.1177/0886260504272894

11.

Breitenbecher

K. H.

(2000). Sexual assault on college campuses: Is an ounce of prevention enough? Applied & Preventive Psychology, 9, 23-52. doi:10.1016/S0962-1849(05)80036-8

12.

Campbell

(2002). Intimate partner violence and physical health consequences. Archives of Intern Medicine, 162, 1157-1163. doi:10.1001/archinte.162.10.1157

13.

Casey

E. A.

Lindhorst

T. P.

(2009). Toward a multi-level, ecological approach to the primary prevention of sexual violence: Prevention in peer and community contexts. Trauma, Violence and Abuse, 10, 91-114. doi: 10.1177/1524838009334129

14.

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2013). Intimate partner violence. Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/ViolencePrevention/intimatepartnerviolence/index.html

15.

Coker

A. L.

Cook-Craig

P. G.

Williams

C. M.

Fisher

B. S.

Clear

E. R.

Garcia

L. S.

Hegge

L. M.

(2011). Evaluation of green dot: An active bystander intervention to reduce sexual violence on college campuses. Violence Against Women, 17, 777-796. doi:10.1177/1077801211410264

16.

Coker

A. L.

Smith

P. S.

Bethea

King

M. R.

McKeown

R. E.

(2000). Physical health consequences of physical and psychological intimate partner violence. Archives of Family Medicine, 9, 451-457. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10810951

17.

Darley

J. M.

Latane

(1968). Bystander intervention in emergencies: Diffusion of responsibility. Journal of Personality and Social Psychology, 8, 377-383. doi:10.1037/h0025589

18.

Davies

(2002). Male sexual assault victims: A selective review of the literature and implications for support services. Aggression and Violent Behavior, 7, 203-214. doi:10.1016/S1359-1789(00)00043-4

19.

Fisher

B. S.

Cullen

F. T.

Turner

M. G.

(2000). The sexual victimization of college women (Publication No. NCJ 182369). Washington, DC: U.S. Department of Justice, National Institute of Justice. Retrieved from https://www.ncjrs.gov/pdffiles1/nij/182369.pdf

20.

Gidycz

C. A.

Rich

C. L.

Orchowski

King

Miller

A. K.

(2006). The evaluation of a sexual assault self-defense and risk-reduction program for college women: A prospective study. Psychology of Women Quarterly, 30, 173-186. doi:10.1111/j.1471-6402.2006.00280.x

21.

Holden

J. E.

Kelley

Agarwal

(2008). Analyzing change: A primer on multilevel models with applications to nephrology. American Journal of Nephrology, 28, 792-801. doi:10.1159/000131102

22.

Krebs

C. P.

Lindquist

C. H.

Warner

T. D.

Fisher

B. S.

Martin

S. L.

(2009). College women’s experiences with physically forced, alcohol- or other drug-enabled, and drug-facilitated sexual assault before and since entering college. Journal of American College Health, 57, 639-649. doi:10.3200/JACH.57.6.639-649

23.

Lanier

C. A.

Elliott

M. N.

(1997). A new instrument for the evaluation of a date rape prevention program. Journal of College Student Development, 38, 673-675.

24.

Lisak

Miller

(2002). Repeat rape and multiple offending among undetected rapists. Violence and Victims, 17, 73-84. doi:10.1891/vivi.17.1.73.33638

25.

Lonsway

K. A.

Banyard

V. L.

Berkowitz

A. D.

Gidycz

C. A.

Katz

J. T.

Koss

M. P.

. . .Ullman

S. E.

(2009). Rape prevention and risk reduction: Review of the research literature for practitioners. Harrisburg, PA: National Online Resource Center on Violence Against Women.

26.

McMahon

Allen

Postmus

J. L.

McMahon

S. M.

Peterson

N. A.

Hoffman

M. L.

(2014). Measuring bystander attitudes and behavior to prevent sexual violence. Journal of American College Health, 61, 58-66.

27.

Moynihan

M. M.

Banyard

V. L.

Arnold

J. S.

Eckstein

R. P.

Stapleton

J. G.

(2010). Engaging intercollegiate athletes in preventing and intervening in sexual and intimate partner violence. Journal of American College Health, 59, 197-204.

28.

Moynihan

M. M.

Banyard

V. L.

Arnold

J. S.

Eckstein

R. P.

Stapleton

J. G.

(2011). Sisterhood may be powerful for reducing sexual and intimate partner violence: An evaluation of the Bringing in the Bystander in-person program with sorority members. Violence Against Women, 17, 703-719. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21628337

29.

National Coalition of Anti-Violence Programs. (2013). Lesbian, gay, bisexual, transgender, queer, and HIV-affected intimate partner violence in 2012. Retrieved from http://avp.org/storage/documents/ncavp_2012_ipvreport.final.pdf

30.

National Intimate Partner and Sexual Violence Survey. (2010). NSIVS: An overview of 2010 findings on victimization by sexual orientation. National Center for Injury Prevention and Control. Retrieved from http://www.cdc.gov/violenceprevention/pdf/cdc_nisvs_victimization_final-a.pdf

31.

National Sexual Violence Resource Center. (2013). Engaging bystanders to prevent sexual violence: A guide for preventionists. Retrieved from http://www.nsvrc.org/publications/nsvrc-publications-guides/engaging-bystanders-prevent-sexual-violence-guide

32.

Nicksa

S. C.

(2014). Bystander’s willingness to report theft, physical assault, and sexual assault: The impact of gender, anonymity, and relationship with the offender. Journal of Interpersonal Violence, 29, 217-236.

33.

Nunnally

J. C.

(1978). Psychometric theory (2nd ed.). New York, NY: McGraw-Hill.

34.

112th Congress. (2001). Text of H.R. 2016 (112th): Campus SaVE Act (Introduced Version)—GovTrack.us. GovTrack.us. Retrieved from http://www.govtrack.us/congress/bills/112/hr2016/text#

35.

Pico-Alfonso

M. A.

Garcia-Linares

M. I.

Celda-Navarro

Blasco-Ros

Echeburúa

Martinez

(2006). The impact of physical, psychological, and sexual intimate male partner violence on women’s mental health: Depressive symptoms, posttraumatic stress disorder, state anxiety, and suicide. Journal of Women’s Health, 15, 599-611. doi:10.1089/jwh.2006.15.599

36.

Rothman

Silverman

(2007). The effect of a college sexual assault prevention program on first-year students’ victimization rates. Journal of American College Health, 55, 283-290.

37.

U.S. Department of Education. (2011). Dear Colleague Letter from Assistant Secretary for Civil Rights Russlynn Ali. Retrieved from http://www2.ed.gov/about/offices/list/ocr/letters/colleague-201104.html

38.

U.S. Senate Subcommittee on Financial & Contracting Oversight—Majority Staff. (2014). Sexual violence on campus: How too many institutions of higher education are failing to protect students. Washington, DC: U.S. Senate. Retrieved from http://www.mccaskill.senate.gov/SurveyReportwithAppendix.pdf

39.

Vladutiu

C. J.

Martin

S. J.

Macy

R. J.

(2011). College- or university-based sexual assault prevention programs: A review of program outcomes, characteristics, and recommendations. Trauma, Violence, & Abuse, 12, 67-86.

40.

White House Task Force to Protect Students From Sexual Assault. (2014). Not alone: The first report of the white house task force to protect students from sexual assault. Retrieved from https://www.notalone.gov/assets/report.pdf

41.

White

J. W.

Smith

P. H.

(2004). A longitudinal perspective on physical and sexual intimate partner violence against women (Publication No. NCJ 199708). Washington, DC: National Institute of Justice. Retrieved from https://www.ncjrs.gov/pdffiles1/nij/199708.pdf