Abstract
To respond to the epidemic of sexual assault on college campuses, many postsecondary institutions have instituted campus climate surveys, strengthened sexual assault misconduct policies, and created sexual assault task forces to coordinate entities within the institutional setting. However, few colleges and universities have engaged with regional networks to exchange resources, research, and innovative practices across campuses. This exploratory study applies the theoretical framework of social exchange theory to examine the necessary infrastructure for a regional network to enhance campus policies and prevention programs related to sexual assault, and the efficacy of providing formal and informal opportunities for information sharing. Interviews were conducted with 10 staff and students from seven of the nine campuses in the network. The sample includes representatives from one large public university, two historically Black colleges, a community college, and three private universities, one of which is faith based. Results indicate that there are several benefits and a few challenges for college campuses that participate in a regional network. Primary benefits include resource and information exchange, as well as new opportunities for student leadership and collaboration across campuses. Some challenges include staff turnover and limited time to devote to the network, as well as distance between some campuses. Based on these findings, it is recommended that universities consider building informal or formal alliances with regional colleges for mutual benefit.
Campus sexual assault is an epidemic on college campuses, with an estimated one out of five female students experiencing sexual assault (Muehlenhard et al., 2017). The 2014 and 2017 “Not Alone” reports released by the Obama administration’s White House Task Force elevated colleges’ commitment to addressing the prevalence and impact of sexual assault within their communities (The White House Task Force, 2014, 2017). The reports call for colleges to regularly conduct campus climate surveys and form coordinated community response teams (CCRTs) to comprehensively address sexual assault. This increased attention to sexual assault by campuses has also led to increased attention by scholars on topics such as effectively using campus climate surveys (Krebs et al., 2016; Wood et al., 2016), strengthening campus sexual assault policy (Richards et al., 2017; Streng & Kamimura, 2015), and building stronger sexual assault task forces within college campuses (Finley & Levenson, 2018; Lichty et al., 2018). While scholars have begun filling in these and other research gaps, one gap thus far overlooked is the potential usefulness of external regional networks focused on sexual assault across campuses. Such a network might increase campuses’ capacity to address sexual assault through shared information about resources and events, through network webinars and trainings, and through shared research, innovations, and best practices.
A regional network focused on campus sexual assault policy and prevention initiated by Men Can Stop Rape (MCSR), a nonprofit organization located in Washington, DC, provides an opportunity to examine whether such a network might be beneficial. MCSR received a grant in 2016 from the U.S. Department of Health & Human Services, Office of Women’s Health, College Sexual Assault Policy and Prevention Initiative, to, in part, build a regional network of nine colleges and universities in Washington, DC; Maryland; and Virginia (DMV). This exploratory qualitative study relies on social exchange theory (SET) to frame the experiences, benefits, and challenges associated with participating in this regional network (Cook & Rice, 2006).
The research questions guiding this study are as follows: (1) To what extent has the initiative increased interactions among individuals addressing sexual assault on the different campuses? (2) What are the benefits and challenges to participating in the regional campus network created through the initiative? (3) How might SET help frame the benefits and challenges of a regional campus sexual assault network?
Coordinated Community Responses
For decades, individuals working to address violence against women in local communities have developed CCRTs and sexual assault response teams (SARTs; Carlson et al., 2018; Shepard & Pence, 1999). At a basic level, service providers realized that their ability to address these crimes were interdependent on the responses of multiple actors and organizations (Gray, 1985; Lichty et al., 2008). It became clear that the community response would be more effective if entities worked together on a multidisciplinary team to share information, promote community awareness, and develop response protocols that prioritize victim safety and offender accountability (Danis, 2006). Research demonstrates that CCRT/SART models are for the most part effective, but more empirical research is needed (Greeson & Campbell, 2012; Greeson et al., 2016; Shorey et al., 2014; Uekert, 2003).
Over time, the CCRT/SART models became more common on college campuses among individuals working to address violence (Danis, 2006; Holtfreter & Boyd, 2006). Campuses that receive funding from the U.S. Department of Justice’s Office on Violence Against Women campus grant program are required to have a CCRT (Carlson et al., 2018). In addition, the American College Health Association (2011) guidelines for preventing sexual violence include a recommendation that universities develop a multidisciplinary taskforce to address sexual violence prevention and response. Relative to community CCRTs, campus CCRTs tend to have broader goals and more members, due in part to their newness on college campuses and the various stakeholders in the campus response (i.e., residence life, dean’s office, Title IX personnel, athletics, Greek life, other student organizations, campus advocates, health services, public safety, faculty, students, and other administrative departments (Carlson et al., 2018; Lichty et al., 2008).
Less is known about whether regional networks, among campuses or communities, provide similar benefit in addressing sexual or other types of victimization. One possible comparison is the coalition model in the United States. Every state, the District of Columbia, and some U.S. territories have a sexual violence coalition, a domestic violence coalition, or a “dual” coalition that focuses on sexual violence and domestic violence (Brownwell & Roberts, 2002). State and national organizations serve as the coordinating bodies and mechanisms for policy advocacy, service coordination, technical assistance, and information and resource sharing across member programs (National Network to End Domestic Violence, 2017; National Sexual Violence Resource Center, 2018).
Social Exchange Theory
Cropanzano and Mitchell (2005) outlined three pillars of SET that are applicable to the regional network described herein: (1) rules of exchange, (2) resources of exchange, and (3) social exchange relationships. Cropanzano and Mitchell suggest that an important antecedent to social exchange relationships are resources, material and nonmaterial, such as information, money, goods, and services. These are the resources of exchange that individuals and organizations are motivated to obtain through social exchange. The rules of exchange that govern those interactions are negotiated within the interpersonal, interunit, or interorganizational relationship. The presence of and adherence to rules of exchange strengthen the relationships over time and build trust among the individuals involved (Cropanzano & Mitchell, 2005).
Organizational theories have been underutilized in research on violence against women response teams (Moylan et al., 2015). Literature on interorganizational network effectiveness indicates that becoming involved in a network, such as the one discussed in this article, is a strategic choice based on an assessment of whether the advantages of participating outweigh any costs that might be associated with participation (Provan & Milward, 1995).
Although SET has been typically applied to business settings, this study offers an opportunity to broaden its application at a time when sexual assault scholars are calling for moving away from focusing prevention efforts on the individual in favor of more integrated, community-based, and comprehensive approaches to sexual violence prevention (Banyard, 2013; Basile, 2015; Casey & Lindhorst, 2009). SET, then, might help us determine whether a “community” of campuses in a region finds value in exchanging resources and building relationships to address sexual assault, and if the benefits outweigh the costs (Provan & Milward, 1995).
The Regional Network
This regional sexual assault policy and prevention network has been led by MCSR in collaboration with Clery Center, Network for Victim Recovery of DC, and Alteristic. Together, these four organizations constitute the DMV Campus Project team. To form the network, MCSR invited nine campuses in the region that it had longstanding relationships with to participate in the project with the goal of increasing their capacity by supporting individual campus sexual assault task forces. The campuses are located within a 70-mile radius and include two large state universities, two private universities, two public historically Black universities (HBCUs), two private faith-based universities, and one large community college.
Each campus designated one to two key stakeholders from their institution as points of contact (POCs) who participated in network activities and shared information about network activities with their campus. Network activities include conference calls, events, email exchanges, in-person meetings, webinars, and trainings. Examples of meeting, webinar, and training topics are engaging faculty, staff, and administrators in prevention and engaging campus men through healthy masculinity. Examples of resources created for the network include a sexual assault policy checklist, newsletters, and a sexual assault prevention checklist.
Also, a technical advisory group (TAG) consisting of one student from each campus was formed. POCs at each institution recommended the student. The TAG students’ role was to inform the project team and campus staff about student awareness and understanding of sexual assault policy and prevention across campuses, as well as to suggest strategies to increase student knowledge and participation. The TAG students were paid for up to 8 hours per semester and participated in regular conference calls and in-person meetings. The students constituted their own regional network and would sometimes interact with the campus staff network.
Method
Sample
At the time of the interviews, the universities had participated in the regional network from July 2016 through December 2018. The research team invited nine POCs, the primary contact from each college, to participate in the study. POCs at one of the private faith-based campuses and one of the state universities declined to participate. The POCs held a wide range of positions related to preventing or responding to sexual assault on their campus, from assistant vice presidents to directors to trainers to coordinators. 1 Because of staff turnover, one interviewee had been at the institution for 3 months. In addition, we invited three TAG students who had participated for at least three semesters to participate in an interview. One TAG student attended a private faith-based university, the second attended one of the private universities, and the third attended the community college. Table 1 displays details about the interviewees while retaining their anonymity and specifies their length of time serving as POCs.
Campus Type and Study Participants.
Note. n/a = not applicable; HBCU = historically Black university.
Procedure
After institutional review board approval, MCSR staff, who had familiarity and rapport with the POCs and their institutions, conducted phone interviews with 10 key informants at seven of the nine institutions—seven staff and three students. A set of eight interview questions about the benefits and challenges of the regional network were developed by MCSR. Questions for staff and students were developed based on Cropanzano and Mitchell’s (2005) three pillars of SET. Questions for staff also focused on the level of interaction with personnel from other campuses, capacity considerations, and ongoing collaborations. Questions for TAG students focused on their reasons for joining TAG, whether TAG expanded their knowledge of sexual assault, and collaborative opportunities.
Prior to the interview, participants were provided with an informed consent document that they signed and emailed to the interviewer. The questions guided each semistructured phone interview, which lasted for 30 to 45 minutes. During the interviews, MCSR staff took notes and audio recordings.
Analysis
Following the interviews, the research team transcribed the audio recordings and conducted directed content analysis (Hsieh & Shannon, 2005) using a priori coding, or hypothesis coding (Saldaña, 2015), using SET as a preexisting theoretical framework to analyze the transcribed interviews. A codebook of specific descriptive codes representing the three SET principles—(1) rules and norms of exchange, (2) resources of exchange, and (3) social exchange relationships—was developed (Fereday & Muir-Cochrane, 2006; see Table 2). Three coders, working independently, applied the codes to the transcribed interviews, and then met to jointly to share their own thought processes for applying the codes, marking places of agreement and coming to consensus for disparate codes (Crabtree & Miller, 1999; MacQueen et al., 1998). The coding scheme allowed for systematic identification of patterns in the data to connect theoretically important concepts.
Coding Information.
Note. SET = social exchange theory; POC = point of contact; TAG = technical advisory group.
Results
Rules and Norms of Exchange
Memorandums of agreement (MOAs) between MCSR and each of the nine colleges specified responsibilities for collaboration on the part of the involved parties. The process of creating reciprocal rules and norms of exchange through MOAs, contracts, a logic model, a work plan, designated POCs, and a calendar of events also helped to establish the parameters and expectations for interaction. The POC at Campus A spoke about the MOA’s role in establishing norms and expectations: “I think, at the outset, it’s possible that [the MOA] maybe did foster a sense of commitment . . .” The MOA—the formal signing onto the initiative—serves as a negotiated rule, which tends to be an “explicit and quid pro quo” (Cropanzano & Mitchell, 2005, p. 878). In contrast to the negotiated rule formed by the MOA, TAG students signed a contract that specified the time commitment, the focus of the work, the tasks, and the stipend amount. The rules and norms of exchange were critical to establishing initial expectations for participation in the network and for creating an environment fostering the exchange of resources across the nine campuses.
Resources of Exchange
All the POCs emphasized the opportunities for the exchange of resources that was created by structured network interactions such as phone calls, the email list, and in-person meetings and trainings. The POC at Campus C said, “I know that I’ve had a lot of questions answered by some of the people on the other campuses if they’re on the calls or through email chains or something like that.” The POC at Campus E described the value of sharing information about their events: We have like a larger network to share information with as well for our programs and our meetings and our conferences. So, we have more attendees at these conferences and in-person meetings that we can share information with.
These two quotes together indicate that information sharing is bidirectional; campus staff have increased opportunities to both share their information and receive information from others about sexual assault.
Campuses sometimes found it helpful to connect with institutions similar to them (i.e., pairing contacts from HBCUs, faith-based, state universities or smaller private universities) to discuss shared experiences and challenges, and identify potential solutions. The POC from Campus D provides one example of this: You know the fact that [Campus G] . . . is also like a medium-sized private school, and they have a full-time therapist [for victims]—something that I think we should have and knowing that they have it makes it a little bit easier for me to bring that kind of idea up or advocate for that sort of thing.
This statement speaks to how the network can enable stakeholders to leverage the reputation and experience of other institutions to advocate for policy changes within universities.
The three TAG students identified multiple instances where information shared in-person or during a group phone call affected the sexual assault prevention programming or approach to prevention programming at their own universities. A TAG student at Campus H, for example, spoke about how during a TAG call a student at Campus A described an event she was organizing. The TAG student at Campus H said, “We kind of [used] that [event] and the first year it was really successful. We had a lot of people involved.” The TAG students also valued learning about engaging different populations in sexual assault prevention, communicated by the TAG student at Campus C: “For me it was interesting working with religious schools like [Campuses H & G] because we do have religious students on campus but it’s not a perspective that’s brought up a lot in conversation.” Hearing how other colleges engaged with a specific student population informed possible strategies for engaging that same population on their own campus.
Social Exchange Relationships
All staff and student interviewees reported that their interactions with the other campuses increased over time due to the network. The POC at Campus I, for example, reported that prior to the initiative, she only had one contact at one other university, which meant that her interactions with the other campuses increased “almost 100%.” The TAG students shared that they joined the initiative in part to learn from other campuses in the network. “I joined up because I thought it’d be a really interesting way to meet up with other people on different campuses [to determine] best practices,” the TAG student from Campus C stated.
Similarly, campus POCs expressed a desire early on in the project for more opportunities to learn from and engage with other. As a result, the project team organized a daylong in-person meeting for the campuses to engage in conversation with one another about challenges and successes related to sexual assault policy and prevention. POCs from all the campuses attended except one. At the end of the meeting, the 13 participants were given a brief self-report survey, which included the question, “What was the most valuable aspect of the workshop or event?” Answers bore out the desire they expressed: “Talking to administrators in other campuses,” “connection to other schools,” and “opportunity to network with colleagues from other universities.” In all, 12 of the 13 answers expressed most valuing the chance to connect with other campuses.
Those campus POC interviewees who participated regularly in the regional network described a sense of commitment to the network, speaking in ways that reflected social exchange relationships, which involve deep connections engendering commitment and trust, with obligations that are less clearly drawn than, for instance, in an MOA. For example, the POC at Campus I said, Well, I think it’s just the natural progression of familiarity, first of all, with each other, and so each of the times we come together, I think we benefit more because we’re more trusting of one another and so everybody can really say, you know, what we really want to say.
These deeper connections not only promoted openness among members, but also increased the possibility of strengthening campuses’ ability to better support survivors. The POC from Campus I spoke about their role as a feeder school for all the other colleges in the network: The fact that we’ve [network participants] actually worked together, sat together, learned together, has enhanced our ability to contact one another. . . . And so it’s really good to have names and numbers of people out there when our students decide who, you know, we’ve been involved with as victims but they decide to move [to one of the other campuses in the network].
This contact shared that it has been beneficial “to have a real person’s name, not just an office. To say [to a transferring student] that when you start at [Campus G], you know, go see this person, other than just call this number.” Similarly, the POC from Campus H also valued having relationships with individuals at the other universities in the network: “Each university is structured so differently, and so many people wear so many different hats and sometimes unless you personally have a colleague or know someone it can be hard to make that initial point of contact.”
Unlike campus staff, who met together as a group several times, TAG students only had one in-person meeting. Until the group gathering, they had been limited to speaking with one another over the phone on a monthly basis. According to one of the students from Campus H, It was great to put faces to names, but also, I think you just get more comfortable idea-sharing and opening up more about what you are doing when you’re in person, and I think a lot of good ideas came out of that day.
This value of students’ idea sharing even extended beyond the TAG. After consulting with MCSR, a staff member from Campus H invited one of her peer educators who was not a TAG student to attend a network training in her place. She said about his attendance: I really think that empowered a lot of members of [the peer education program] . . . to say, “Yes, we’re students, but we can be just as involved in these conversations as well; we have a valuable perspective to share.”
The interviewee at Campus A observed a similar effect from inviting peer prevention educators to participate in activities connected to the regional network: “I think that helps students to feel more positively about their own campus’ prevention initiatives.” These examples indicate that inviting students to participate in a professional regional network can deepen intergenerational relationships between students and staff and increase students’ sense of impact both on their campuses and beyond.
Challenges
While none of the POCs interviewed specified drawbacks to participating in the regional network, they acknowledged three challenges: time commitments, staff transitions, and distance. The Campus A contact spoke to the challenges of time and work responsibilities: “Time. Everybody’s busy . . . doing this work, having limited resources, or limited staff to devote to this work.” Several campuses faced challenges with staff turnover throughout the project. During the initiative, staff POCs changed seven times across four campuses. The contact at Campus E, spoke to this challenge, saying, “And just being consistent is another big [challenge], especially for us, I would say, because we have so much transition sometimes it’s hard for us . . .” As for the final challenge, distance, although all campuses involved in the initiative were within 70 miles of each other, some campuses were 5 or 10 miles apart and accessible by public transportation, which made in-person meetings more feasible. Campus C was 40 miles away from the regular site where all the campuses gathered for trainings and meetings—twice as far as any of the other eight campuses. Because of distance, Campus C only participated in one of the seven all-campus trainings and meetings. The POC from Campus D acknowledged that it is not “like we’re all down the street from each other. So that’s where something like a remote or online or telephone connection might be the best way [to keep us connected].” But, as the Campus H staff contact said, “As hard as it is to get campuses together for an in-person meeting, that’s really where the connections develop.”
Discussion
According to Uekert (2003), CCRTs require key stakeholders who are active participants that can come to consensus about the nature of the response to crimes against women. While many colleges recognize the value of an internal response team to effectively and comprehensively address sexual assault on their campuses, the results of this exploratory study suggest that a regional campus network focused on sexual assault policy and prevention may also be a valuable resource for staff and students. As recommended by Moylan et al. (2015), this study uses an organizational theory, SET, to examine macrolevel ways to improve services for victims. The benefits of a regional network can be explained in relation to the three SET categories: (1) rules and norms of exchange, (2) resources of exchange, and (3) social exchange relationships. The first principle of SET, rules and norms of exchange, defined through MOAs, contracts, and informal consistent interaction, created conditions for the advancement of the other two SET principles.
The second principle of SET, resources of exchange, provides a useful lens for understanding many of the benefits identified through this study, such as information sharing and comparison leveraging. Forms of information sharing included learning about infrastructure, policy, programming, events, and practices related to sexual assault at other campuses. Information about infrastructure at one college in the network could be used as leverage by another to induce administrators to establish a similar beneficial infrastructure. Campus contacts and students also indicated that information related to differences among the colleges could be valuable, such as informing how they address sexual assault with diverse populations on their own campuses.
There are also benefits represented in this study that are connected to the third principle of SET, social exchange relationships. Interviewees expressed that they now have more trusting and open relationships with other network members, a willingness to ask for help from colleagues at other campuses, the ability to more effectively offer sexual assault survivors services when they transfer from one college in the network to another, and more meaningful intergenerational interactions among campus staff and students. As for the challenges related to distance, it may be that technology such as video conferencing could be used to connect POCs virtually.
Some interviewees acknowledged challenges to participating in an external, regional campus network, especially connected to turnover on their campuses, time commitments related to work responsibilities, and distance. Research has found that 50% of victim advocates experience secondary traumatic stress (Benuto et al., 2018), and the current study shed light on the extent of turnover in a short time frame among university staff working to respond to sexual assault. A national study identified several barriers for university sexual assault program staff such as a lack of funding, insufficient staffing, and minimal administrator/community buy-in (McKinney, 2017), which are similar to challenges that are also reflected in community-based organizations working to address domestic violence and sexual assault (Macy et al., 2010), and are likely associated with high turnover in these environments.
Even campuses mentioning these challenges, though, were able to identify benefits that seemed to outweigh the costs of participation in the network (Provan & Milward, 1995). Yet, similar to the challenges of community CCRTs, there are challenges inherent in having a network with multiple members that represent different entities with diverse needs and capacities (Carlson et al., 2018). That is, some institutions were at early stages of developing policies and programs against sexual assault or had one or two dedicated staff members working on the issue. Other institutions were at the forefront of implementing and evaluating programs, had multiple fully staffed departments working on sexual assault, and may have had less benefit or different goals for participation than the institutions who were newer at implementing initiatives on their campuses.
The results of this study demonstrate that a regional sexual assault network has the potential to strengthen campuses’ ability to address sexual assault more comprehensively in a region through increased resources. Campuses can recognize the importance of establishing rules of exchange for the network, which in turn will foster the exchange of resources and information. Regular interaction among members creates relationships with sexual assault staff on other campuses who can serve as professional support for comprehensively addressing sexual assault on a campus and within a region.
Limitations
The results of this exploratory study and its application to other existing or potential regional networks to address sexual assault should be considered in the context of the study’s limitations. First, this regional network succeeded a preexisting, but defunct, network for colleges and universities, which meant that at least some of the contacts already knew one another. Second, this network does not include all colleges and universities in the region and additional challenges may exist if the network were larger. The sample size of the current study is small (n = 10) and two of the institutions did not participate in the interviews. The reasons for their nonparticipation seemed to be due to time and capacity constraints given that the interviews were conducted shortly before the end of the fall semester. Still, it is important to acknowledge that their involvement may have provided additional insights. Third, due to turnover, one of the interviewees had not served as a POC for the entire grant period so this person could not speak to the benefits over the life of the grant. Finally, the results may be affected by social desirability bias, given that the interviews were conducted by employees of MCSR, the network convener.
Another limitation that may affect the long-term impact of this type of network is that the project was grant funded, and it may be difficult for there to continue to be a centralized coordinating body, which has been found to be important to the effectiveness of networks (Provan & Milward, 1995) and relates to the first principle of SET. However, there is some literature that supports avoiding overly centralized control of networks and instead to favor “moderately centralized” networks (Moylan et al., 2015), a shared power model that could be possible in this regional context.
Future Research
There are questions this exploratory study evokes that could be pursued in future research. Given the small sample, it is important to conduct additional studies to expand on these findings, even within this study’s regional network. The geographical size of the network is also relatively small; it would be beneficial to learn more about how the size of a region affects the functionality of a sexual assault network. Future research should continue to assess risk and protective factors for secondary traumatic stress and how to prevent burnout in the sexual violence field. In addition, interviewees in this study indicated they benefited from learning from their counterparts at other types of universities, but also appreciated the opportunities for in-depth conversations with similarly situated universities (by type, such as HBCU or faith-based institutions, or by structure, i.e., universities with similar internal workings to address sexual assault). Future research could look further at the benefits of connecting diverse types of universities versus universities with more similarities.
Future research could also explore the benefits of convening two distinct regional networks: a student network and a professional network. Studies examining how a campus’ preexisting levels of sexual assault resources affect participation in a regional network would also be worthwhile. In addition, it will be important to examine how to establish a regional network without a devoted funding source, as well as sustaining a regional network after a funding source expires, especially in light of research that finds that formal structures and processes are correlated with more effective networks (Greeson et al., 2016).
Conclusion
This study demonstrates important steps to consider if university sexual assault personnel seek to create a regional campus network. This study found that it is helpful to have infrastructure (e.g., a coordinating body, a listserv, MOAs) and a variety of ways for the participants to connect (phone, email, and in-person), with a necessity for in-person ways to connect. The social exchange relationships of the regional network benefited from having resources and rules of exchange to be able to set the necessary conditions for the exchange of sexual assault information and resources across campuses, which in turn has enhanced each campus’s policies and programming to address sexual assault.
Footnotes
Appendix
Authors‘ Note
The study protocol was approved by the American University Institutional Review Board, Protocol #IRB-2019-179.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This article was produced through funding provided by the College Sexual Assault Policy and Prevention Initiative Grant No. 1 ASTWH160043-01-00 from the U.S. Department of Health and Human Services (HHS) Office on Women’s Health. The opinions, findings, and conclusions or recommendations expressed in this document are those of the contributors and do not necessarily represent the official position or policies of HHS.
Notes
Supplement Note
This article is part of the Health Education & Behavior supplement issue, “Campus Sexual Assault Policy and Prevention.” Thank you to the following organizations which have generously supported the open access publication of this special supplement: Johns Hopkins Bloomberg School of Public Health, Center for Injury Research and Policy; Johns Hopkins University School of Nursing; Futures Without Violence; NORC at the University of Chicago; Texas Woman’s University; University of Kansas Department of Women, Gender & Sexuality Studies; University of Kansas School of Social Welfare; University of Kansas School of Public Affairs & Administration; and University of New Hampshire’s Prevention Innovations Research Center (PIRC). The entire supplement is available open access at
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