Prevention of Sexual Violence in sport: A Socioecological Review

Abstract

Sexual violence in sport is prevalent and represents a serious public health concern. The social-ecological model for health promotion has been used successfully as a framework to identify individual-to-policy level factors aimed at health promotion or disease prevention. The purpose of this review was to examine both published and non-published (publicly available) SVP efforts conducted within the context of sport and make recommendations for future practice. Grey literature search methods were utilized to conduct a review of publicly available documents. This included (a) a comprehensive Google search using unique search terms that would identify SVP efforts within sport settings and (b) a review of the publicly accessible websites identified in the previous step. Following the grey literature search, and using the SVP practices identified in step one, we conducted a supplementary literature search using scientific publication search engines to identify whether the SVP practices identified in step one had associated peer-reviewed publications. Finally, we assessed various characteristics of each SVP practice including the target population, age range of intended participants, and whether the SVP had associated peer review publications. This led to the identification of 35 unique SVP practices: 25 (71%) SVP practices were assigned to the Intrapersonal level, 6 (17%) were assigned to the Interpersonal level, 9 (26%) were assigned to the Organizational level, 3 (9%) were assigned to the Community, and 2 (6%) were assigned to the Policy level. This review uncovered several important findings including a lack of multi-level SVP practices within sport, a lack of SVP practices that target children, minimal programming aimed at specifically preventing perpetration, the need to elevate policy level action, and a lack of peer-reviewed literature. Ultimately findings suggest that sport organizations ought to prioritize sexual violence prevention using national organizations for guidance.

Keywords

prevention intervention anything related to sexual assaultregon

Introduction

Sport is a powerful sector in American society and culture. More than half of Americans describe themselves as sport fans (Jones, 2015) and almost 72% of children participate in sport (Aspen Institute, 2019). There are well established physical (Oja et al., 2015), psychological, and psychosocial benefits of sport participation (Eime et al., 2013). Many of these benefits are linked specifically to the social nature of sport, that is, positive interactions with peers and supportive adults (Oosterhoff et al., 2017). There are also broad level community benefits of sport in society like elevating community strengths beyond that of the sport networks themselves, including improved community capacity (Edwards, 2015), social connectedness (Hoye et al., 2015), social cohesion (Meir & Fletcher, 2019), and community involvement (Levermore, 2008; Nicholson et al., 2014). Further, sport has been linked to the sustainment of community development activities such as community members connecting through leisure activities (Schulenkorf, 2012). Lastly, sport has led to community development in socially and economically disadvantaged areas such as sport programming and social activities aimed at traditionally disadvantaged communities (Levermore, 2008).

Despite the positive outcomes of sport, it has been linked to less desirable outcomes such as sexual violence. A 2020 study of middle and high school students found sport-involved youth were more likely to be involved (both victimized and a perpetrator) in sexual violence than peers not involved in sport (Cheever & Eisenberg, 2020). Evidence also indicates that both male (21%) and female (31%) athletes experience sexual abuse (Brackenridge et al., 2008; Leahy et al., 2002). Sexual violence perpetration patterns vary within sport; some studies indicate teammates or other athletes as perpetrators (Basile et al., 2020; Cheever & Eisenberg, 2020) while other studies indicate coaches, teachers, or instructors as perpetrators (Brackenridge et al., 2008).

While sport is a central component of American society and contributes to the pervasiveness of sexual violence, it can also serve as a platform for prevention (Raj et al., 2017; Cheever & Eisenberg, 2020). Traditional peer-reviewed literature includes a variety of published studies on sexual violence prevention efforts within the sport. For example, some target important psychosocial factors within the athlete (e.g., Mentors In Violence 2021; Katz, 1995), some use bystander intervention strategies (e.g., Green Dot, 2021; Coker et al., 2015), and others target important relationships between players and coaches (e.g., Coaching Boys Into Men; Miller et al., 2012). To establish a more complete representation of SVP practices within sport, looking outside peer-reviewed literature is necessary. For example, while several interventions and system-level toolkits as well as other technical assistance resources have been developed in recent years, a thorough understanding of such SVP practices within the sport context is limited. To include the full landscape of SVP practices in sport, the purpose of this review was to examine both published and non-published (publicly available) SVP efforts conducted within the context of sport and make recommendations for future practice.

There are various models and frameworks used by health promotion and disease prevention specialists to aid in the conceptualization and explanation of why communities, and individuals within communities, behave the way they do. One such framework that has guided many comprehensive investigations into human behavior is the socioecological model for health promotion (SEMHP; McLeroy et al., 1988). This model has been successfully used to analyze a variety of public health areas (Golden & Earp, 2012) including physical activity/sedentariness (Lindsay et al., 2017; Mullane et al., 2017), alcohol use (Sudhinaraset et al., 2016), HIV prevention (Baral et al., 2013), suicide prevention (Cramer & Kapusta, 2017), sexual violence in non-sport settings (Campbell et al., 2009; Register, 2018; Willis & Jozkowski, 2018), and sexual violence within sport settings (Scarduzio el.al., 2021). Generally, the SEMHP suggests that human behavior can be influenced at multiple levels (McLeroy et al., 1988). The SEMHP includes five levels (Table 1): (1) intrapersonal factors, (2) interpersonal processes, (3) institutional or organizational factors, (4) community factors, and (5) public policy. The SEMHP can also be used to assist in the planning of prevention programming to ensure that a comprehensive approach is used. The SEMHP is a similar ecological framework as developed by Bronfenbrenner (Bronfenbrenner, 1977) and the four level Social Ecological Model used by CDC for violence prevention (Centers for Disease Control & Prevention, 2021a; Dahlberg & Krug, 2002). For this review, levels of the SEMHP were used to organize SVP practices.

Table 1.

Description of Each Level of the SEMHP.

Level	Description
Intrapersonal	Individual cognitions (e.g., knowledge, attitudes, normative perceptions, and beliefs)
Interpersonal	Social networks (e.g., family, friends, teammates, and coaches)
Organizational	Formal and informal rules and regulations (e.g., organizational, league, association, or team)
Community	Relationships among organizations, institutions, and informal networks within defined boundaries
Policy	Policies and laws designed to protect the health of a community; (e.g., policies for health protection including regulations for healthy actions)

Methods

Data Collection, Selection Criteria, and Analysis

The purpose of this review was to conduct a broad grey literature search to examine SVP practices within sport and make recommendations for future practice. A grey literature review includes data or information that is external to traditional academic publications and includes but is not limited to public reports, policy literature, white papers, organizational websites, and government documents. It is possible that conducting a traditional search of only peer-reviewed publications could have resulted in the omittance of relevant SVP practices. Furthermore, because many sport organizations do not publish their SVP practices in peer-reviewed publications (e.g., scientific journals), we purposefully chose a grey literature review. It was our intent that using a grey literature review would help increase the likelihood of including a greater number of SVP practices within sport. Lastly, since sport reaches a broad range of audiences (children, adolescents, young adults, and adults), we use the term sexual violence prevention to include a range of types of sexual violence prevention such as child sexual abuse prevention for children, teen dating violence prevention for adolescents, and other sexual violence prevention effort for young adults and adults.

Our first step was to conduct a grey literature review which included (a) a comprehensive Google search using unique search terms that would identify SVP efforts within sport settings and (b) a review of the publicly accessible websites identified in the previous step. We used a variety of search term combinations using the following key words: sexual violence prevention, sport, interpersonal violence, sexual assault, sexual misconduct, and sexual abuse. For example, specific search term combinations included but were not limited to “sport and sexual violence,” “sexual assault and sport,” “sexual abuse and athletes,” and “interpersonal violence and sport.” We used three criteria to select SVP practices for review. SVP practices were included if: (a) the SVP practice targeted individuals involved in sport (e.g., athlete, coach, parent of athlete, and athletic administrator); (b) sufficient details of the SVP efforts were provided; and (c) the SVP practice(s) were implemented in the United States. In an effort to create an inclusive review and to elevate the importance of diversity we included SVP practices for analyses regardless of who the prevention effort was aimed at (e.g., gender, race, and age). Following the grey literature search, and using the SVP practices identified in step one, we conducted a supplementary literature search using scientific publication search engines (e.g., EBSCO and PsychINFO) to identify whether the SVP practices identified in step one had associated peer-reviewed publications. The purpose of step two was to identify the number of SVP practices that had at least one peer-reviewed publication, not to evaluate the scientific rigor of the studies or indicate demonstrated impact via evaluation.

Once the grey literature and supplementary peer-reviewed search was concluded, SVP efforts were assigned to one or more of the SEMHP levels based on SVP practice implementation. For example, if an SVP practice targeted intrapersonal level cognitions as well as aimed to promote social networks for the prevention of sexual violence, then it was included as both an Intrapersonal and Interpersonal level practice. Finally, we assessed various characteristics of each SVP practice including the target population (e.g., youth athletes, coaches, and collegiate athletes), age range of intended participants, and whether the SVP had associated peer review publications.

Results

The grey literature search which was conducted in 2020 uncovered 38 SVP practices. After further review, three were excluded; one was a student thesis paper, one was relevant to sport but upon deeper review was not related to sexual violence, and the third was a sexual violence training that could be used with youth sport organizations but included no evidence to suggest that it actually had been implemented. Ultimately, a total of 35 SVP practices were included in this review. All five levels of the SEMHP were represented by at least one SVP practice. Some SVP practices were assigned to more than one level of the SEMHP. Table 2 provides the name of each SVP practice or organization who implemented the SVP practice and a brief description.

Table 2.

Brief Description of the SVP Practice.

SVP Practice Name	Brief Description
It’s On Us (NCAA)	A campaign that encourages college athletes to make a commitment to denounce support of sexual violence
White Ribbon	A campaign that encouraged coaches to sign a pledge supporting healthy relationships and gender equality in sport
NCAA SV Toolkit	An educational document for NCAA member institutions that provides sexual violence information
U.S. Center for SafeSport Toolkit	An educational document for parents that provides sexual violence information
Gameplan	A web and mobile based program with an SVP course for athletes
myPlaybook SVP	A web-based program for collegiate athletes with an SVP course
Step Up!	A bystander intervention for college athletes
Mentors in Violence Prevention	A face-to-face program that educates college athletes on sexism, prevention, leadership, and bystander intervention
Fair Play	A face-to-face program that educates college athletes about healthy sexuality, sexual violence, and bystander engagement
Green Dot	A bystander education program that has been used with college athletes
Alpha Point (athlete program)	A 45-minute video-based education program that addresses bullying, hazing, relationship, harassment, and healthy relationships
Certification of Responsible Relationship	A face-to-face workshop specialized for female and non-binary college athletes
SCREAM theatre for athletes	A face-to-face or video-based education program for college athletes
EVERFI Sexual Assault Prevention (Everfi, 2021)	A web-based program providing college teams information about sexual violence
Real Consent (Real Consent, 2021)	A web-based sexual assault prevention that has been used with college athletes
Major League Baseball SVP	Educational materials that provide sexual violence education to its players
National Football League (2016a) SVP	Educational materials that provide sexual violence education to its players
National Hockey Leagu (2016b) SVP	Educational materials that provide sexual violence education to its players
APPLE Training Institute	A face-to-face training college athletes and athletics personnel that includes goals related to SVP.
10 Ways to Distinguish Consent	A guide for students and advisors related to consent
Live Respect	Downloadable materials to help mentors educate and encourage middle and high school boys
Adaptive Sports Abuse Prevention	A face-to-face curriculum for coaches, trainers, and volunteers serving athletes with disabilities
Monique Burr Foundation (2021) Athlete Safety Matters	A face-to-face program focused on empowering youth athletes (Monique Burr Foundation, ND)
Protecting Students from Abuse	An NFSHS Safe Sport Course for high school coaches
Coaching Boys Into Men	A face-to-face program for coaches
One Love Foundation (2021)	Web-based resource that builds networks of athletes to prevent relationship violence
Athletes As Leaders (2021)	Downloadable materials to empower for high school athletes on girls’ teams
NCAA (2010 institutionalization of SVP)	Organizational policy: NCAA board of governors institutionalization of SVP educational and prevention strategies
NCAA (2018 attestation policy)	Organizational policy: NCAA Board of Governors requires NCAA schools attest to SVP programming
The Center (MAAPP, 2019)	Organizational policy: Requiring national governing bodies to limit one-on-one interactions between adults who have regular contact with or authority over minor athletes
The Center (mandatory SVP)	Organizational policy: Safeguarding approaches, including mandatory education and training to address one-on-one interactions which create different opportunities for misconduct
The Center (Code of conduct)	Organizational policy: Addresses misconduct, investigations, and audit requirements for compliance with Center policies and provides a universal standard for the more than 50 Olympic and Paralympic sport organizations in the United States
Team Up Washington, 2020	Community organizing that links several sexual assault organizations with professional athletic teams and sports media sponsors and supporters to expand Coaching Boys Into Men and Athletes as Leaders into SVP programming and coach trainings across the state of Washington
Protecting Young Victims from Sexual Abuse and Safe Sport Authorization Act of 2017	Federal policy: On February 14, 2018, a federal law went into effect, requiring individual-level and organizational-level prevention strategies to address sexual abuse within sports. Requires five major organizational requirements for applicable amateur sports organizations (ASO)
Empowering Olympic and Amateur Athletes Act of 2019	Federal policy: July 2019, the Empowering Olympic and Amateur Athletes Act of 2019 was introduced. This bill increases accountability regarding the governance of institutions and requires increased athlete representation within governance of those institutions, enhances protections to prohibit retaliation and protect whistleblowers, and requires The Center to develop training materials for specific audiences

Table 3 includes the SVP practice’s assigned ecological level(s), the SVP practices target population, the age range of targeted community, and whether the SVP practice had any associated peer-reviewed publications for each SVP practice or organization who implemented the SVP practice. In sum, 25 (71%) SVP practices were assigned to the Intrapersonal level, 6 (17%) were assigned to the Interpersonal level, 9 (26%) were assigned to the Organizational level, 3 (9%) were assigned to the Community, and 2 (6%) were assigned to the Policy level.

Table 3.

Sexual Violence Prevention Practice Details.

SVP Practice Name	Ecological Level	Target Population	Age	Publication
It’s On Us (NCAA, 2021)	Intrapersonal, interpersonal	College	18–22	No
White Ribbon Dean College (2018)	Intrapersonal	“Men and boys”	Unspecified	No
NCAA SV Toolkit	Intrapersonal	College	18–22	No
U.S. Center for Safe Sport Toolkit	Intrapersonal	Youth & adult	Unspecified	No
Gameplan (2021)	Intrapersonal	High school, college, professional	Unspecified	No
myPlaybook, (2021) SVP	Intrapersonal	College	18–22	No
Step Up!(2021)	Intrapersonal	College	18–22	Yes
Mentors in Violence Prevention	Intrapersonal, interpersonal	Non-specific	Unspecified	Yes
Fair Play (2021)	Intrapersonal, interpersonal	College	18–22	No
Green Dot	Intrapersonal	College, faculty/staff	18+	Yes
AlphaPoint.me Resilience Program	Intrapersonal	College	18–22	No
Certification of Responsible Relationship	Intrapersonal	College	18–22	No
SCREAM theatre	Intrapersonal	College	18–22	No
EVERFI Sexual Assault Prevention (Everfi, 2021)	Intrapersonal	College	18–22	Yes
Real Consent (Real Consent, 2021)	Intrapersonal	College	18–22	Yes
MLB SVP Hagen (2015)	Intrapersonal, organizational	Professional	Unspecified	No
NFL SVP	Intrapersonal, organizational	Professional	Unspecified	No
NHL SVP	Intrapersonal, organizational	Professional	Unspecified	No
APPLE Training Institute APPLE (2021)	Intrapersonal	College	18–22	No
10 Ways to Distinguish Consent National Center for Student Life (2021)	Intrapersonal	Middle/high school/college	12–22	No
Live Respect A Call To Men (2021)	Intrapersonal	Middle/high school boys	13–18	No
Adaptive Sports Abuse Prevention IMPACT Boston (2021)	Intrapersonal	Coaches, trainer, volunteers	Unspecified	No
MBF Athlete Safety Matters (MBF, 2021)	Intrapersonal	Youth	5–17	No
Protecting Students from Abuse (NFSHS, 2021)	Intrapersonal, organizational	High school coaches	Unspecified	No
Coaching Boys Into Men	Intrapersonal, interpersonal, community	Coaches and youth	15–18	Yes
One Love Foundation	Interpersonal	Unspecified	Unspecified	No
Athletes As Leaders	Interpersonal, community	High school girls	15–18	No
NCAA (2010 SVP institutionalization)	Organizational	Collegiate	18–22	No
NCAA (2018 attestation policy)	Organizational	Collegiate	18–22	No
The Center MAAPP (2021)	Organizational	Youth	<18	No
The Center (Mandatory SVP)	Organizational	Unspecified	Unspecified	No
The Center (Code of Conduct)	Organizational	Unspecified	Unspecified	No
Team Up Washington, 2020	Community	Coaches/mentors/youth	Unspecified	No
Protecting Young Victims from Sexual Abuse and Safe Sport Authorization Act of 2017	Policy	Sport organizations	Unspecified	No
Empowering Olympic and Amateur Athletes Act of 2019	Policy	All amateur	Unspecified	No

Of the 25 (71%) SVP practices assigned to the Intrapersonal level, the target population varied between youth, college, and professional athletes. Half (12) of the SVP practices were designed for 18–22-year-old athletes and 8 SVP practices did not specify an age range. Lastly, 5 (20%) of the intrapersonal level SVP practices had at least one associated peer reviewed publications. They include Step Up! (Orsini et al., 2019), Mentors In Violence Prevention (Katz, 1995), Green Dot (Coker et al., 2015), EVERFI’s Sexual Assault Program for athletes (Zapp et al., 2021), Real Consent (Salazar et al., 2018), and Coaching Boys Into Men (Miller et al., 2012). See Tables 2 and 3.

Next, this review uncovered 6 (17%) SVP practices that were assigned to the Interpersonal level. The target population varied between youth and college athletes and coaches. Three of the Interpersonal SVP practices were designed for 18–22-year-old athletes, 2 were designed for 15–18-year old athletes and their coaches, and 2 did not specify an age range. Lastly, 2 interpersonal level SVP practices had at least one associated peer-reviewed publications; Coaching Boys Into Men (Miller et al., 2012) and Mentors In Violence (Katz, 1995). See Tables 2 and 3.

This review did not intend on reviewing all localized Organizational SVP practices (e.g., local youth, high school, or professional leagues) that are implemented nationally. Instead, this review focused on national organizations’ SVP practices. Nine (26%) Organizational SVP practices were identified in this review. Three of the practices were led by professional sport leagues (NHL, MLB, NFL), one was led by and intended for high school athletes, two were led by the NCAA and were intended for collegiate student athletes, and three were led by the U.S. Center for SafeSport (The Center) (2018). Each organization has established misconduct and reporting policies and procedures. None of the SVP practices assigned to the Organizational level had associated peer review publications. See Tables 2 and 3.

This review uncovered 3 (9%) SVP practices that were assigned to the Community level. The target population for each of the Community level SVP practices was aimed at youth athletes. One specified that it was also for youth coaches (Coaching Boys Into Men, 2021), while another specified that it was for high school girls (Athletes as Leaders, 2021). Lastly, one of the community level SVP practices had at least one associated peer-reviewed publications; Coaching Boys Into Men (Miller et al., 2012). See Tables 2 and 3.

A state-by-state policy analysis was not conducted; however, the grey literature search uncovered 2 (5%) federal laws aimed at preventing sexual violence in sport. One of the federal laws targets SVP practices of sport organizations (United States Congress S.534, 2017) and the other federal policy aims to increase increases accountability (United States Congress S.2330, 2020) regarding the governance of institutions, including the USOPC and the National Governing Bodies and require The Center to provide education to coaches, trainers, doctors, young children, adolescents, adults, and individuals with disabilities (United States Congress S.2330, 2020). See Tables 2 and 3.

Discussion

Sexual violence research has grown over the last decade. Media attention about sexual violence has driven organizational rules for professional, collegiate, high school, and youth sport organizations. Such national attention has contributed to increases in federal funding for SVP, such as CDC’s Rape Prevention and Education Program that funded hundreds of SVP programs throughout the country, including those within sport, and led to policy changes at the National Collegiate Athletic Association (2021a; 2021b) and The Center (i.e., mandated SVP programming). Many of these advancements do not make it into traditional scientific journals; therefore, this grey literature review revealed a broader scope of SVP practice within sport.

This review uncovered a variety of important findings including a lack of multi-level SVP practices within sport, a lack of SVP practices that target children, minimal programming aimed at specifically preventing perpetration, the need to elevate policy level action, and a lack of peer-reviewed literature specifically outlining SVP measures within sport. The following discussion section will further explore these findings.

Multi-Level Approaches

Prevention efforts should simultaneously target multiple levels of the social-ecological model (Centers for Disease Control & Prevention, 2021a). This review uncovered that few SVP practices act across multiple levels of the SEMHP. Our findings suggest that most SVP practices within sport are occurring at the individual (i.e., intrapersonal or interpersonal) level. As noted by the CDC, targeting multiple levels of the socioecological model can increase the comprehensiveness of programming as well as increase potential for impact (Centers for Disease Control & Prevention, 2021a). Successfully conducting SVP across multiple levels of the SEMHP requires the establishment of partnerships between program developers, sport organizations, and policy makers to develop comprehensive approaches to SVP. Athlete-serving organizations should consider purposefully engaging in local and national partnerships to develop communities of practice (RALIANCE, 2021b). Communities of practice include formal or informal partnerships between the sport community and sexual violence experts. As with organizational prevention efforts, these partnerships should engage diverse groups (e.g., SVP advocates, sport organization administrators, coaches, athletes, parents, community leaders, law enforcement, and schools) as a means of enhancing community awareness and strengthening SVP practices. Furthermore, professional sport organizations can serve as key partners (RALIANCE, 2021b). Through such partnerships, sport organizations can develop a coordinated community response that engages multi-layered action, cooperation, and solidarity around SVP. Team Up Washington is a prime example of community driven efforts aimed at linking sexual assault organizations with professional athletic teams and sports media sponsors and supporters to expand Coaching Boys Into Men and Athletes as Leaders across the state of Washington. This multi-level approach exemplifies how partnerships between program developers, sport organizations, and state leadership can be used to establish a culture of caring that supports survivors and values safety and prevention within sport. Future SVP efforts within sport should attempt to go beyond individual-level efforts and attempt to establish community partnerships to implement efforts across multiple levels of the SEMHP.

Aiming SVP Efforts Toward Younger Athletes

Many sport organizations provide sport programming for young athletes; some as young as 5 years old. However, this review identified only three SVP practices within sport that implement efforts for athletes under the age of 15. Approximately half of the SVP practices identified in this review were intended for athletes 18 years or older (e.g., college athletes) and many others did not specify the intended audience age of their SVP programming; thus greater efforts are needed to deliver SVP practices that are intended for child athletes (i.e., ages 5–15). It is possible that SVP efforts for younger athletes are embedded within programs more broadly targeting social and emotional learning (SEL) outcomes; however, evidence of this is extremely limited and examples specifically for young athletes was not uncovered during our review. Importantly, SVP practices for young children do exist. Although not within the sport context, the Second Step Child Protection Unit has resulted in positive effects related to improved knowledge about child sexual abuse among elementary school aged children (i.e., ages 5–10). This program also aims to promote healthy relationships between students and teachers (Nickerson et al., 2019). Whereas the Second Step Child Protection Unit is teacher led and not intended to be delivered through sport, it could serve as a guide for developing sport specific SVP practices for young athletes. Additionally, the Centers for Disease Control and Prevention’s Preventing Child Sexual Abuse Within Youth-serving Organizations: Getting Started on Policies and Procedures (Saul & Audage, 2007) provides an overview of components of child sexual abuse prevention policies that youth-serving organizations can institutionalize. Efforts are currently underway to update the publication and provide new resources. The components in the 2007 resource span from screening adults and monitoring behavior to responding to child sexual abuse to prevention trainings and ensuring safe environments (Centers for Disease Control & Prevention, 2021b). Whereas these guidelines are not specifically for sport organizations, many of the organizational policy recommendations are adaptable to a sport environment, as many sport organizations are also youth-serving organizations. Additionally, through meaningful partnerships and communities of practice, sport organizations can collaborate with SVP experts to develop programming tailored for younger athletes or adapt current programming that would be more suitable for younger audiences. When doing so, it is critical that program developers pay close attention to the developmental stages of youth athletes they target so that educational content and materials are best understood and internalized by the young athletes. For example, when developing educational materials for young athletes, developers should tailor the educational content, imagery, language, reading level, and use of audio visual technologies to the young athlete’s cognitive and emotional level.

Efforts Specifically Targeting Perpetration

Sexual violence perpetration is a critical issue within sport (Cheever & Eisenberg, 2020). Whereas it was not a primary objective of this review, it appeared as though most SVP practices included in this review include practices to prevent victimization rather than specifically prevent perpetration. However, it is noteworthy that one SVP practice included in this review (Coaching Boys Into Men) has evidence of reducing likelihood of perpetration among program participants and has been found to be effective in reducing dating abuse at a 1 year follow-up among middle school male-identified athletes (ages 11–14) (Miller et al., 2013). Coaching Boys Into Men provides athlete mentors with skills to foster healthy masculinity in young male athletes; in turn serving as a strategy to prevent likelihood of future perpetration. For most other SVP practices included in this review it was difficult to discern whether the practice specifically targeted victimization, perpetration, or both. This may be the result of three critical issues, (a) sport organizations who are implementing perpetration prevention efforts may not be disseminating their practices or related findings publicly, (b) it may be the case that, in fact, there are few SVP practices within sport that are specifically attempting to prevent perpetration or target perpetrators, and/or (c) many sport organizations may not have the resources to conduct studies that include multiple measurement points as well as long-term follow-up measures of perpetration. Not only is it difficult to measure perpetration, but it is also challenging to measure perpetration within short-term periods (e.g., 6-month to 1-year follow up periods). Collectively this elevates the critical need for organizational partnerships between sport organizations and SVP experts both locally and nationally. Sport organizations need to be supported with through finances (e.g., money earmarked for SVP, including staffing), time (e.g., specific times throughout the year to directly discuss SVP), or other assets (e.g., connect to other community SVP prevention efforts) to prevent perpetration. Lastly, yet equally important, additional research is necessary to better understanding effective prevention of perpetration within the sport context.

Elevating Policy Level Action

As noted previously, much of the focus of SVP within sport is on the intra and interpersonal levels of the SEMHP. This review was done to provide a review of SVP practices at all levels of the SEMHP. Whereas a state-by-state policy review was not conducted, this review identified two federal laws related to SVP in sport. Safeguarding policies in sport must be a critical part of prevention. Policies and protocols to respond to sexual violence in sport are necessary, including responding to and investigating reports of sexual violence, supporting victims, and holding people accountable who support or commit acts of violence. Policies and practices to prevent sexual violence, including reinforcing bystander and champion behaviors, setting up mechanisms to reinforce values of respect, healthy relationships, and character are equally essential. Sport organizations should align policies and procedures that codify policies and practices to establish a connected enforcement mechanism for responding to and preventing sexual violence. Policies must be developed and informed by practice, and in turn, policies must also be translated into practice for those who are impacted by policy. For example, The Center convened an external advisory group to update the Minor Athlete Abuse Prevention Policies. The advisory group included survivors, parents, athletes, child sexual abuse prevention experts, public health experts, sport national governing bodies, and other interested constituents. Additionally, the Center’s audit and compliance team conducts regular and random audits to ensure that sport national governing bodies are implementing required policies. This level of accountability is necessary to ensure compliance with policies to both safeguard youth as well as other participants from abuse and hold organizations accountable when policies are not being followed (Johnson et al., 2020). Additionally, there are a lack of policies focusing specifically on proactive prevention within sport environments. Such prevention-focused policies should include codifying ongoing education and training requirements for athletes and coaches, establishing and enforcing codes of conduct that specifically target risk and protective factors for sexual violence, and creating accountability structures for coaches and athletes who have potentially committed an offense or broken a conduct code related to respect/equity.

Wide Dissemination of SVP Practices

This review uncovered few SVP practices with associated peer review publications; however, of those, several had multiple peer review publications (e.g., Green Dot, Coaching Boys Into Men, and Mentors in Violence Prevention). Whereas peer review publications of SVP practices are important, it is also critical for sport organizations to implement SVP practices, measure SVP impact, and disseminate the results of their work. Critically, SVP initiatives should have a development trajectory that helps move the initiative from newly established to empirically supported. Available findings, both peer reviewed and in the grey literature, allow for improvement of SVP practices over time. As SVP practices within sport grow, it will require ongoing research and evaluation efforts. There is very limited evidence of effectiveness of organizational, community, and policy-level efforts. Of the SVP practices with associated peer-reviewed publications, all but one was intrapersonal or interpersonal level practices. Coaching Boys Into Men, assigned to the intrapersonal, interpersonal, and community level, had multiple associated peer-reviewed publications. Dissemination of findings, measuring and disseminating impact serves as a collective benefit and should be done across all levels of the SEMHP. Specifically, greater efforts are needed to evaluate and disseminate the findings of community-, organizational-, and policy-level SVP strategies.

Diversity and Inclusion in SVP Practice

As with all SVP approaches, the intersecting identities of those participating must be carefully considered and included in the overall design of SVP strategies as well as during implementation and evaluation. As such, while conducting this review, we paid particularly close attention to whether the identified SVP practices used methods and/or strategies that either integrated or emphasized diversity and inclusion. Ultimately, this review did not identify culturally specific practices being currently used in SVP in sport. Current and future practices should consider the inclusion of tailored SVP practices based on social and cultural contexts (Basile et al., 2016). For example, if an SVP practice addresses erroneous social norms related to sexual violence, it would be beneficial to present back to participants tailored normative data that are relevant to the participant’s self-identified community. Additionally, careful consideration should be given to the setting of the SVP initiative and population of interest (Basile et al., 2016), including but not limited to gender, race, age, sport type (contact and non-contact; individual and team), ability (adaptive and able-bodied), sport level, community setting, and audience (coach, athlete, administrator, and parent).

Limitations

Whereas a grey literature search plan was purposefully selected to minimize the risk of omitting relevant and current SVP practices, we acknowledge the limitations of this methodology. First, it is possible that SVP practices were missed during this review because many organizations and program implementers do not publish their SVP practices in the peer-reviewed literature or publish on a web site. However, the sample of SVP practices included in this review reflects a representative range across all levels of the social ecology. Second, many local grassroots organizations, including rape crisis centers and others funded through Rape Prevention Education grants across the U.S., that have developed SVP practices in sport may not be publicly available. Third, this review did not evaluate every SVP program across each level of the SEMHP. For example, in this review SVP organizational practices were limited to policies from two large national sport organizations. The review only included national policies and did not examine state-level policies. Lastly, whereas this review did search peer-reviewed studies, this review did not assess the effectiveness of each SVP effort.

Conclusion

Sexual violence in sport remains a critically important public health issue (Alexander et al., 2011). Evidence from this review suggests that there is a lack of multi-level approaches to SVP within sport, a lack of SVP practices that target children, minimal programming aimed at specifically preventing perpetration, the need to elevate policy level action, and a lack of peer-reviewed literature specifically outlining SVP measures within sport. Sport organizations can prioritize sexual violence prevention using national organizations such as RALIANCE (RALIANCE, 2021a) which considers the important implications of the sport context and the CDC for guidance.

Footnotes

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) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Jeffrey J. Milroy

Anita Raj

Kathryn M. Barker

Miranda Sitney

Alyssa Maryn

Author Biographies

Jeffrey J. Milroy, MPH, Dr.PH, is an Associate Professor in Public Health Education and Director of the Center for Athlete Well-being at the University of North Carolina Greensboro. Dr. Milroy studies the individual, environmental, and socioecological factors that impact the well-being of athletes.

Katie Hanna is the Chief Programs Officer for the U.S. Center for SafeSport, a national non-profit organization focused on ending all forms of abuse in sport. Katie has over 14 years of experience working with youth and adults to prevent sexual assault at the local, state and national level.

Tori VandeLinde is the Training & Technical Assistance Specialist for RALIANCE and the California Coalition Against Sexual Assault. Tori has a commitment to sexual violence prevention and community health that has stemmed from her Master’s of Public Health program Oregon State University, where she also worked on sexual health and healthy sexuality promotion programs.

David S. Lee, MPH, is the Research and Evaluation Director at RALIANCE, a national partnership dedicated to empowering industries, and sectors to create organizational cultures free from sexual harassment, misconduct, and abuse. Mr. Lee is also the Deputy Director at ValorUS (formerly CALCASA). Mr. Lee has been involved in the movement to end sexual assault and domestic violence since 1982.

Keith L. Kaufman, PhD, is trained as a Clinical/Community Psychologist and is a Professor of Psychology at Portland State University in Portland, Oregon. He has edited/co-authored three books, a host of book chapters and peer reviewed articles on organizational safety, prevention of sexual violence, and juveniles who have sexually offended. He has provided national safety consultation to a broad range of organizations and recently led the development of the Sport Situational Prevention Approach, designed to enhance athlete safety.

Anita Raj, PhD, is a Tata Chancellor Professor of Society and Health. She is a Professor in both the Departments of Medicine and Education Studies and the Director of the Center on Gender Equity and Health (GEH). Her research, including both epidemiologic and intervention studies, focuses on sexual and reproductive health, maternal and child health, women's economic empowerment, and gender inequalities including gender-based violence and child, early and forced marriage.

Kathryn M. Barker is a social epidemiologist with expertise in adolescent sexual and reproductive health, social and gender norms, multi-level modeling, and qualitative inquiry. She holds a Doctor of Science from Harvard University and a Master of Public Health from UNC/Chapel Hill. Dr. Barker has worked in global reproductive health at USAID and non-profit international research organizations.

Miranda Sitney, PhD, is a graduate of Portland State’s community psychology doctoral program. Her dissertation work focused on the role of fathers in the development of juvenile sexual offending behavior. She is currently a Senior Research and Evaluation analyst with Multnomah County’s Department of Community Justice.

Aliza Lipman, BA, is a graduate student in the Portland State University Applied Psychology Program Community Track. Her research focuses on childhood trauma and sexual abuse prevention as well as prevention and intervention at a systemic level. Aliza holds positions on the ATSA Prevention Committee and at the Oregon Program Evaluators Network.

Alyssa Glace, PhD, is a postdoctoral associate at the University of Calgary. She researches gender-based violence prevention, sexual consent, and the stigma faced by sexual violence survivors. She also examines online and social media discussions of gender-based violence and masculinities, including a focus on Incels.

Jason Z. Kyler-Yano, PhD, is an applied community psychology researcher, program evaluator, and mixed methods data analyst. His doctoral research at Portland State University examined the intersections among masculinity, culture, and intimate partner violence perpetration for Asian American men. Currently, his applied work focuses on evaluating programs addressing housing insecurity, homelessness, and financial instability across Oregon.

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