Developments in Sexual Assault Resistance Education: Combining Risk Reduction and Primary Prevention

Abstract

Most sexual assault prevention focuses exclusively on primary prevention programs. Risk reduction strategies, however, have an equally important role to play in prevention efforts. By way of illustration, we provide efficacy data on a sexual assault protection program that incorporates both primary prevention and risk reduction within a single seminar. These data, which replicate previous program evaluations while adding two new cohorts of program and control group students, indicate that program participants exhibit long-term attitude change and have significantly reduced rates of assault relative to the control group. Implications for campus programming are discussed.

Keywords

program evaluation sexuality victimization prevention

Although public attention on sexual assault prevention has been high since the creation of the White House task force to protect students from sexual assault (Obama 2014) that attention has generally been one-sided. Federal mandates, funding pools, and policy changes have been oriented exclusively toward primary prevention efforts, especially those associated with bystander intervention training (American College Health Association [ACHA] 2008; Centers for Disease Control and Prevention [CDC] 2004; McCaughey and Cermele 2017; The White House 2014). Primary prevention approaches seek to prevent initial perpetration by promoting healthy relationships, respectful sexual environments, realistic understandings of consent, and awareness of situational cues that indicate possible dangers. One of the principal goals of these programs is to alter social norms that support sexual assault and change bystander cultures that are complicit in acts of sexual violence.

One important consequence of this singular focus on primary prevention is that the benefits of risk reduction programs—many of which include self-defense training—have been ignored. Risk reduction programs teach potential victims how to effectively avoid and/or thwart an assault attempt. Their primary focus is on helping potential victims learn to use verbal and/or physical self-protection strategies. Although empirical evidence has consistently shown that self-defense training benefits participants via increased self-efficacy, enhanced perceived situational control, improved self-esteem, fewer completed assaults, and, in some instances, a lower overall risk of sexual assault (Brecklin 2007; Brecklin and Ullman 2005; Hollander 2014; Lonsway 2009; Menning and Holtzman 2015; Senn et al. 2015; Ullman 2007), these kinds of programs have generally been excluded from federal-level policy recommendations (Gidycz and Dardis 2014; McCaughey and Cermele 2017; The White House 2014) and they have been maligned in the national dialogue about these issues (Kerby 2014; Marcotte 2014). This is true, in part, because such programs are often thought to promote victim blaming and to unfairly constrain women’s behavior by focusing on what they can do to avoid assault rather than focusing on deterrents to perpetrator behavior.

Proponents of risk reduction, however, have begun to call attention to these exclusionary practices and limited perspectives on self-defense. Blog posts (Kamienski, N.d.; Taylor and Wanamaker 2014), op-ed pieces (Criado-Perez 2014), and scholarly journal articles (Gidycz and Dardis 2014; Hollander 2014; McCaughey and Cermele 2017; Thompson 2014) highlight the many benefits of risk reduction training and draw attention to the empirical data on the efficacy of these programs. Most importantly, rather than continuing the practice of elevating one type of approach above the other, many scholars are advocating that federal agencies, policy makers, and college campuses embrace both primary prevention and risk reduction approaches simultaneously (Gidycz and Dardis 2014; Holtzman and Menning 2015c; McCaughey and Cermele 2017). These scholars assert that by leveraging the strengths of primary prevention and risk reduction strategies, prevention experts, practitioners, and college campuses will be more likely to achieve the outcomes they seek—long-term attitude changes among students, shifts in the social norms that uphold rape culture, and, ultimately, reductions in assault risk. To continue excluding risk reduction programs, they note, is to “[miss] a critical opportunity” to protect young women (and men) from sexual assault (McCaughey and Cermele 2017:4).

Although these arguments have received some notice by advocates and policy makers in recent years (ACHA 2016; Stahl 2016), large-scale shifts in the kinds of policy recommendations being suggested at the federal level are still needed. Scholars, therefore, must not only continue to advocate for the benefits of self-defense, but they must further explore the gains associated with comprehensive programming—those programs that combine primary prevention and risk reduction strategies simultaneously. This article contributes to these efforts by using evaluation data from a sexual assault protection program called Elemental to explore the benefits of a comprehensive approach.

The Tension between Primary Prevention and Risk Reduction

Campus sexual assault achieved prominence as a social issue in the 1980s, and as a consequence, programming that focused on preventing assault and research that assessed the efficacy of prevention programs proliferated (Bart and O’Brien 1981; Johnson and Russ 1989; Koss, Gidycz, and Wisniewski 1987). Much of this early programming emphasized risk reduction—that is, it sought to teach potential victims (typically defined as women) how to assertively make their wishes known and reduce assault risk by engaging in protective behaviors, including using physical self-defense techniques against aggressors (Pizone-Glover, Gidycz, and Jacobs 1998; Vladutiu, Martin, and Macy 2011). Early evaluation data on these programs, however, produced mixed results. Although research suggested that risk reduction and self-defense training had individual-level benefits for women, including improved self-esteem and fewer completed assaults (Brecklin 2007; Brecklin and Ullman 2005; Clay-Warner 2002; Ullman 1997, 1998, 2007), these studies also suggested that programs produced short term, rather than long-term, attitude changes in students and had little impact on the overall risk of sexual violence because they did not reduce rates of attempted assault (Breitenbecher and Gidycz 1998; Gidycz, Layman, et al. 2001; Gidycz, Lynn, et al. 2001; Heppner et al. 1995; Pizone-Glover et al. 1998; Vladutiu et al. 2011).

Moreover, these programs faced criticism on two fronts. First, research suggested that self-defense training often failed to account for the situational differences associated with stranger versus acquaintance assaults (Norris, Nurius, and Dimeff 1996; Nurius 2000; Nurius et al. 2000). Because standard self-defense training does not always appropriately address the psychological barriers associated with using violent self-protection measures against a known assailant, critics argued that the utility of self-defense training was diminished (Breitenbecher and Scarce 2001). Second, and relatedly, these programs were criticized as a form of victim blaming. Because risk reductions programs appear to put the responsibility for self-protection and rape avoidance on women rather than holding men accountable for their actions, critics complained that the focus on risk reduction and self-defense was not only inappropriate but also dangerous because it did not address the underlying social causes of assault and thus could not fully rid society of sexual violence (Cermele 2004; Hollander 2009).

This growing concern with risk reduction ultimately prompted a pendulum swing in the field, such that risk reduction approaches fell nearly completely out of favor and primary prevention approaches became the programming choice of federal agencies, prevention practitioners, and college campuses (McCaughey and Cermele 2017). For instance, both the CDC and the ACHA published white papers suggesting that prevention efforts should focus on averting initial perpetration by trying to change the social norms and campus environments that promote sexual violence (ACHA 2008; CDC 2004). In the years that followed the release of these reports, scholars and practitioners developed a number of approaches focused on culture change, including bystander intervention programs (Banyard, Plante, and Moynihan 2004; Moynihan and Banyard 2009), social norming campaigns (Berkowitz 2003), social marketing campaigns (Potter 2012; Potter and Stapleton 2013), and awareness-raising programs, especially for potential perpetrators (Berkowitz 2002; Foubert 2000). Campuses across the United States followed suit by creating their own bystander programs and launching localized social marketing campaigns, practitioners and direct service providers began to elevate primary prevention above risk reduction approaches, and federal agencies started channeling research dollars toward primary prevention evaluation efforts (Gidycz and Dardis 2014; McCaughey and Cermele 2017).

These evaluation efforts, however, have produced mixed results. Studies have found that bystander intervention training and social marketing campaigns have significant, positive effects on students’ attitudes and intended behaviors in the short term (Banyard, Moynihan, and Plante 2007; Foubert 2000; Moynihan et al. 2010), but the long-term efficacy of these programs, especially with respect to changes in actual rather than intended behaviors, has been inconsistent. Although some recent studies have demonstrated long-term attitude changes among students (Moynihan et al. 2015), most research has found such effects to be temporary (DeGue et al. 2014; Heppner et al. 1995; Lonsway and Kothari 2000; Mabry and Turner 2016; McMahon, Postmus, and Koenick 2011; Potter and Stapleton 2012; Vladutiu et al. 2011). Similarly, research has only rarely demonstrated a link between these attitudinal shifts and actual rates of assault (Coker et al. 2016; Coker et al. 2015; Salazar et al. 2014).

Thus, we arrive at the current state of affairs in the field of sexual assault prevention—risk reduction programs are largely excluded from campus programming efforts and from national-level discussions of sexual assault, while primary prevention programs are embraced on both fronts despite inconsistent empirical evidence linking these programs to long-term attitude change and reduced assault risk. The reality is that both types of programs have merit and both have shortfalls—although primary prevention programs do not always directly impact assault rates, they are part of the larger cultural effort to change social norms regarding sexual assault and that is an important goal. And although early evaluations of risk reduction programs produced mixed results, more recent work suggests that self-defense training, if designed appropriately, can account for both stranger and acquaintance assaults, can empower rather than blame women, and can lower rates of assault (Gidycz and Dardis 2014; Hollander 2014; Holtzman and Menning 2015a; McCaughey and Cermele 2017; Menning and Holtzman 2015; Rosenblum and Taska 2014; Senn et al. 2015; Tark and Kleck 2014; Thompson 2014).

Given that both kinds of programs have contributions to make to effective prevention efforts, the continued preference for bystander intervention and social marketing campaigns over risk reduction training causes a certain amount of tension in the field (McCaughey and Cermele 2014). This tension is, however, unproductive and could be avoided. Sexual violence is a complex, multifaceted problem; no single solution will adequately address the issue. Risk reduction proponents, therefore, argue that although current emphases “artificially simplify” prevention efforts (McCaughey and Cermele 2017:10), the field could—and should—integrate primary prevention and risk reduction as synergistic strategies (Gidycz and Dardis 2014; Holtzman and Menning 2015c; Menning and Holtzman 2015, in press). McCaughey and Cermele (2017) even go so far as to argue that self-defense training is a form of primary prevention because it operates to stop an assault from happening or escalating in much the same way bystander intervention does. Ultimately, though, whether or not one agrees with the assertion that the divide between primary prevention and risk reduction is a false dichotomy, the larger point is that effective sexual assault prevention likely needs to include both kinds of approaches as valid programming options. To do otherwise, scholars argue, is to deny students access to important preventive measures, and that only serves to further hinder prevention effort (Gidycz and Dardis 2014; McCaughey and Cermele 2017; Menning and Holtzman in press).

This study, thus, seeks to examine the benefits of combining primary prevention and risk reduction strategies by examining the efficacy of a sexual assault protection program that incorporates both of these approaches within a single seminar. Such an effort allows us to further explore whether a comprehensive, rather than bifurcated, approach to prevention programming can significantly contribute to the field.

Elemental

Elemental is a six hour, face-to-face program that uses videos, expert instruction, simulations, group discussion, and guided practice to educate students about sexual assault prevention. The primary prevention components of the seminar focus on alcohol awareness, giving and getting consent, party culture, party safety, cultural factors associated with assault, including gender and sexual orientation, and some discussions of bystander intervention. The risk reduction features of the program focus on strengthening students’ abilities to recognize situational cues that indicate potential dangers while also providing them with a variety of flexible, nuanced response options that can be utilized as situations unfold. Students learn both verbal and physical and violent and nonviolent responses for situations ranging from a stranger assault to those involving a long-term friend, a significant other, and a casual acquaintance. This focus on varied response options and the inclusion of verbal defenses, in addition to physical techniques, helps combat common psychological barriers to resistance by teaching students how to tailor responses to fit their own circumstances and feelings.

Importantly, the program was designed to align with best practices in prevention (Gidycz and Dardis 2014; Nation et al. 2003; Menning and Holtzman 2015; Rozee and Koss 2001; Thompson 2014). Elemental, therefore, addresses the social realities of assault, including how gendered ideas about heterosexual and same-sex sexual encounters heighten assault risk. It also empowers rather than blames victims, addresses the gender socialization dynamics that increase the risk of assault for women and sexual minorities, discusses psychological principles, such as consistency and reciprocity, that promote “giving in” in situations involving sexual coercion, and offers participants a toolbox of response options that can be either forceful or nonforceful, verbal or physical.

More specifically, Elemental was designed to reflect the realities of college sexual assault. We worked alongside an interdisciplinary team of 15 undergraduate students from a midsized, Midwestern university to examine the published research on sexual assault prevention and field three original surveys on student party culture, common sexual assault situations, and victim responses to sexual threats (Holtzman and Menning 2015b). This information was used in consultation with several prevention experts to design a program that is grounded in science, accounts for student voices and perspectives, and addresses relevant cultural factors associated with assault, including gender, sexual orientation, alcohol, acquaintance versus stranger assaults, and college hook-up culture.

Second, the program empowers participants by emphasizing that there is no single correct way to respond to an assault; instead, responses must be tailored to specific individuals’ feelings and circumstances. Thus, instructors use a combination of lecture, guided discussions, videos, role-playing, and skill-building exercises with other participants, with trained, padded assistants, and with realistic props, including beds and couches, to familiarize students with a range of response options and then offer them a number of different opportunities to enact and practice them. Following the seminar, students are provided with a comprehensive set of online video review materials that promote regular practice over the course of the following year.

Third, Elemental devotes a substantial amount of time to addressing both the psychological barriers associated with responding to a known assailant and the various ways that gender socialization contributes to assault. Seminar discussions, videos, and role-playing exercises address gendered expectations for sex, sexual coercion and verbal pressure to “give in,” and the various ways that alcohol and party environments contribute to assault risk. Students discuss and practice various techniques for overcoming these artifacts of gender socialization.

Finally, the program’s curriculum incorporates a variety of simple and effective verbal and physical strategies that are based upon research in social psychology, linguistics, and martial arts. Specifically, students are shown four different responses for each threat discussed during the seminar. These responses vary in intensity and level of violence and thus provide participants with a toolbox from which they can draw as they tailor responses to their particular needs.

In these ways, then, Elemental reflects many of the best practices associated with both women’s self-defense (Gidycz and Dardis 2014; Rozee and Koss 2001; Thompson 2014) and general standards of prevention programming (Nation et al. 2003; Menning and Holtzman 2015). However, Elemental departs from women’s self-defense programs in one important way—in an effort to be as inclusive as possible and to reflect the realities of assault, men are allowed to attend the seminar. The seminar deals explicitly with the fact that men can be victims of assault, although at significantly lower rates than women, and it addresses the reality that gay men, lesbians, and bisexual individuals, regardless of biological sex, are at significantly increased risk of assault (Balsam, Beauchaine, and Rothblum 2005; Martin et al. 2011; Walters, Chen, and Breiding 2013). Seminar content includes discussions of sexual violence among sexual minorities, a video scenario involving a heterosexual male victim, and two video scenarios involving victims who are either lesbian or gay. To date, only a small number of male students, most of whom have self-identified as gay or bisexual, have participated in the seminar, but it is important to recognize that Elemental does differ from most prevention programs in this way.

Initial studies of the efficacy of Elemental have suggested it not only impacts students’ attitudes toward assault for at least six months but it also lowers incidences of assault among program participants relative to control group students (Holtzman and Menning 2015a). But replication of these findings is needed to be sure that effects are consistent. Moreover, because of the limited number of comprehensive programs in the field and because Elemental is comprehensive in design, a follow-up efficacy study of the program are warranted. Here, then, we expand on our initial studies by including two additional cohorts of program participants and two additional cohorts of control group students. This provides us with our strongest test to date of not only the program’s efficacy but of the benefits of a comprehensive programming strategy.

Data and Methods

Sample

We use longitudinal data collected from those who participated in the program, and compare this with control group assessment data to measure the effectiveness of Elemental. Study recruitment and instrument procedures vary according to group. All procedures were approved by the institution’s institutional review board (IRB), and a tailored-design approach (Dillman, Smyth, and Christian 2014) was used to increase response rates and minimize other forms of error in all phases of data collection. The tailored-design approach is comprehensive in scope and adaptable to multimodal and longitudinal administration of survey instruments. As such, the methodologies and modes chosen reflect numerous choices designed to reduce total survey error within the constraints of available resources, and tailored to the needs of the population being studied. Special attention was directed toward the need for data confidentiality and the reduction of error in the collection of sensitive data.

Program group

During each of four Fall semesters (2012–2015), students were invited to participate in the program via a series of e-mails and other announcements that were circulated to all incoming freshmen that year. We focused on recruiting freshmen because prior research shows that students are more likely to experience sexual assaults early in their college careers (Humphrey and White 2000). Program participants were recruited to take part in the research study at the beginning of each seminar by a member of the research team who was not involved in the instruction of the seminar. Those who agreed completed a pretest and a posttest on paper and then a series of longitudinal follow-up surveys that were administered online using Qualtrics and that included measures to protect data confidentiality (e.g., Secure Socket Layer [SSL] encryption, coded survey links); participants recruited in a given Fall semester comprise a cohort. Almost 90 percent of program participants from 2012 through 2015 elected to participate in the study (N = 322). Members of all cohorts were invited to participate in follow-up surveys at six months using a four-contact e-mail strategy (including a prenotice e-mail) and incentivized with a chance to win one of three $50 prizes. Cohort members from 2013 onward were also invited to participate in a six-week follow-up survey. The overall response rate for those answering either the six-week or six-month (or both) follow-up surveys for the program group is 56 percent. Supplementary regression analyses (not shown here, available upon request) were conducted to check for response bias; no evidence was found that respondents differed significantly from nonrespondents on the basis of academic year, assault history, ethnicity, or Sexual Assault Protection Scale (SAPS) index scores (described below), which suggests that data are missing at random. Moreover, no significant differences were detected in these traits across cohorts of program participants.

Control group

Control group participants came from two different groups. First, a one-time survey was administered on paper in two large introductory sociology classes in the Spring of 2013 and 2015 (N = 262) to coincide with the six-month follow-up data collection taken from program participants recruited in Fall 2012 and Fall 2014. Second, a longitudinal control group was recruited two additional introductory sociology classes at the beginning of the Fall semesters of 2013 and 2014 (N = 295); students were given a paper questionnaire to coincide with the administration of the program and collection of program-group pretest-posttest data. Six-week and six-month follow-up surveys were administered for this group using methods identical to those used for program participants.

Both of these groups were recruited via identical methodology: The principal investigator (PI) asked instructors of introductory courses if they could attend a class to collect data from their students; if approved, then the PI or an IRB-approved representative visited the class to administer the survey. All students who attended were invited to participate via a standardized recruitment script and received course credit for the activity by turning in a separate credit sheet. Course instructors were not present, and all students who submitted credit sheets received credit for the activity, regardless of whether they completed the survey. These steps were taken to avoid pressuring students to participate. Those who had participated in Elemental were asked via the standardized recruitment script to read the survey for content and to return it blank.

Response rates to longitudinal control data collection efforts were poor (between 10 percent and 20 percent). For program analysis purposes, this prompted us to rely on comparisons of program participants to control group data taken from the in-class control samples (i.e., at the beginning of the semester and at six months) alone for most analyses. Except in instances where questions are program-specific, items on the control-group survey are identical to those used in the instruments administered to the program group.

The proportion of the program group that is non-Hispanic white (80 percent) is similar to the proportion of those in the control group (83 percent) and for campus overall (81 percent). Similarly, the average class standing and age of those in the program group are similar to those in the control group (i.e., between freshman and sophomore year, and 19 years old). However, as would be expected given the targeting of the program and the introductory nature of the control-group classes, the average class standing and age of those groups are lower than that of undergraduate students on campus overall (i.e., between sophomore and junior year, and about 21 years old). In short, the program and control samples mirror each other in important ways, as well as reflect the make-up of students early in their college careers.

Variables

Program

A binary variable measuring program participation (1 = program participant, 0 = control group) is included in models measuring the effects of program participation.

SAPS index

The pretest, posttest, six-week follow-up, six-month follow-up (starting in Spring 2014), and control surveys ask participants attitudinal questions about sexual assault, sexual consent, personal confidence, contextual awareness, boundary setting, and other measures that are commonly related to the pedagogical goals of both primary prevention and risk reduction programs, and are hypothesized to be related to assault risk (see the appendix). Students responded to each statement by indicating their level of agreement or disagreement (1 = strongly disagree, 7 = strongly agree) with the statement. In previous work, we used exploratory factor analyses to determine if subfactors that could be created from these measures would be independently useful for predicting later assault, but concluded that none of the subfactors could predict actual assault or assault-related outcomes by themselves with any consistency; instead, a single scale, called the SAPS index, comprised of 25 of these items, was a significant predictor of assault outcomes (Menning and Holtzman in press). Here we use an extended 41-item version of the SAPS scale because the inclusion of the additional items has been shown to increase internal validity (Menning and Holtzman in press).

The scale is constructed by standardizing each of the 41 items to have a mean of 0 and a standard deviation of 1, multiplying these standardized observations by a regression coefficient derived from a factor analysis with a single factor, and summing those results. The resulting sums are then standardized into an index, with a standard deviation of 10. The index is then set to have a mean of 100 for the nonprogram group. This allows us to track changes in the program group relative to their peers in the nonprogram group in a way that is easily interpretable at pretest, posttest, six weeks postprogram, and six months postprogram. Higher scores indicate greater preparation to address situations that may lead to sexual assault; internal consistency for the scale is excellent (Cronbach’s α = .95). Supplementary regression analyses (not shown here, available upon request) indicate several significant predictors of scale scores. For example, males score 8 points higher, heterosexuals score 3 point higher, whites score 2.5 points lower, and those who have experienced a previous sexual assault score 3 points lower on the index, controlling for other influences.

Because the 41-item battery was not included in the six-month follow-up survey for the first cohort of students who participated in the program in Fall of 2012, we use an adjusted version of the posttest index score that accounts for observed attenuation in other cohorts through six months when performing regressions for six-month outcomes.

Sexual assault

Sexual assault has been measured in many ways; however, underreports are common for a variety of reasons, including the hesitance of respondents to frame the activity that they experienced as a crime and the narrowness of the definitions provided in the instrument (Koss 1996). Sexual violence encapsulates a range of unwanted sexual activities that include physically forced intercourse, verbally coerced sex, and unwanted groping, fondling, and so forth (Black et al. 2011). As such, we take a broad approach to measuring sexual violence by asking respondents if they experienced any unwanted sexual contact or activity (1 = yes, 0 = no) since starting college (control group) or since taking Elemental (program group at six-week or six-month follow-ups).

Control variables

For regression analyses, measures were included for sex (1 = male, 0 = otherwise; recoded from a measure that included a nonbinary option), sexual orientation (1 = exclusively or predominantly heterosexual and only incidentally homosexual, 0 = otherwise; recoded from a 6-point Kinsey scale), ethnic minority status (1 = non-Hispanic white, 0 = otherwise; derived from a measure that included options for white, Black/African American, Latinx, Asian, Native American, and “other”), academic year (1 = freshman, 2 = sophomore, 3 = junior, 4 = senior, 5 = graduate student), and previous sexual assault (1 = yes, 0 = no).

The size of the sample used in the analyses varies depending on survey and item response rates and the waves at which specific measures were taken. Descriptive statistics for all variables can be found in Table 1.

Table 1.

Descriptive Statistics.

Variable	M	SD	Minimum	Maximum	n
Program SAPS index
Pretest	90.99	9.64	65.84	112.63	311
Posttest	107.82	7.60	73.93	118.79	255
Six weeks	103.69	9.90	72.83	120.92	91
Six months	103.77	10.48	79.98	120.30	71
Control SAPS index
Beginning of Fall	100.00	10.45	67.33	118.28	284
Six months/Spring	99.84	11.00	55.00	118.21	257
Combined program and control sample for regression, six months/Spring
Assaulted	0.15	0.36	0	1	375
Male	0.22	0.42	0	1	375
Heterosexual	0.90	0.30	0	1	375
White	0.80	0.40	0	1	375
Academic year	1.54	0.86	1	5	375
Previous assault	0.33	0.47	0	1	375
SAPS index^a	101.12	10.17	55.00	118.21	375
Program	0.33	0.47	0	1	375

Note. SAPS = Sexual Assault Protection Scale.

Adjusted posttest scores for program group to account for expected six-month attenuation.

Results

We use a combination of paired sample t tests, two-sample t tests with unequal variances, single-sample t tests, ordinary least square (OLS) regression, and binary logistic regression, as appropriate for each specific analysis. All analyses were conducted using Stata 14.1.

A series of two-sample t tests allows us to replicate earlier tests of program participation with the expanded sample and scale: Pretest SAPS index scores for program participants are about 9 points lower than those of their nonprogram peers at the beginning of college, t(589) = 12.37, p < .001. Restricting the sample to freshman women and repeating the test yields similar results although the difference is slightly reduced, t(318) = 7.99, p < .001. Supplementary regression analyses (not shown here, available upon request) show that the difference persists, albeit with a slightly reduced magnitude, after controlling for gender, sexual orientation, and academic year. In short, program participants enter the program about three-quarters to one standard deviation below their peers on the SAPS index.

By posttest, however, their SAPS scores are about 8 points higher than those of their peers, t(515) = −10.00, p < .001. Again, this difference persists (but is a bit larger) when the sample is restricted to freshman women. Likewise, supplementary regression analyses (not shown here, available upon request) that use all available data and account for the effects of gender, sexual orientation, and academic year continue to show significantly higher posttest scores among program participants relative to control group students. Program participants thus leave the program about three-quarters to one standard deviation above their peers on the SAPS index.

But what happens to SAPS scores over time? As might be expected, there is some attenuation. Paired-sample t tests show that scores drop by about 4 points from posttest to the six-week mark, t(75) = −5.50, p < .001, but they then remain stable through the six-month mark, t(53) = −0.55, p = .58 (see Figure 1). Moreover, the level of program participants’ SAPS scores remains higher than both their pretest scores, t(84) = 12.35, p < .001, and the baseline nonprogram score of 100, t(70) = 3.03, p < .01. Consistent with initial tests of this program (Holtzman and Menning 2015a), this suggests that Elemental has a significant, long-term impact on students’ attitudes and beliefs with respect to sexual assault.

Figure 1.

SAPS index: Program participants through six months.

In fact, the average SAPS score of the Spring control group is indistinguishable from that of the Fall group, even though the same numerical adjustments to the mean and standard deviation are made to this group as to the Fall control group. And, as our supplementary OLS regression analyses show, additional years in college have no significant effect on SAPS scores, net of other effects, b = .003, t(404) = .01, p = .994. This suggests that programming—far more than informal social experiences in college—is effective in moving SAPS scores.

We next examine whether scores on the SAPS index predict assault risk. A binary logistic regression analysis predicting assault six months after the beginning of the semester and controlling for various background factors indicates that higher scores on the scale are related to reduced assault risk, b = −.06, z(367) = −.388, p < .001 (see Table 2). As Figure 2 illustrates, translation of the regression coefficients into a set of predicted probabilities over the range of two standard deviations above and below the control group mean while holding all other effects to their averages indicates that the reduction in risk is substantive. Again consistent with previous findings (Holtzman and Menning 2015a; Menning and Holtzman 2015), Elemental impacts students’ assault risk through the attitudinal changes that it promotes.

Table 2.

Effects of SAPS Index and Other Variables on Assault.

Variable	Coefficient
Variable	(SE)
Male	0.897
Male	(1.039)
Heterosexual	0.078
Heterosexual	(0.508)
Male × Heterosexual	−1.031
Male × Heterosexual	(1.130)
White	−0.528
White	(0.360)
Academic year	0.325*
Academic year	(0.160)
Previous assault	0.944**
Previous assault	(0.314)
SAPS index	−0.056***
SAPS index	(0.015)
Intercept	3.289*
Intercept	(1.541)

Note. Observations = 375. Logistic regression coefficients with standard errors in parentheses below. SAPS = Sexual Assault Protection Scale.

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

Figure 2.

Predicted probabilities of sexual assault over range of SAPS scores (six months postprogram/into academic year).

Given this mediated effect of program participation, we also assess if Elemental has direct effects on assault risk. That is, we examine whether it has effects beyond those that are being measured by the SAPS index. As Table 3 indicates, a binary logistic regression that includes both the SAPS index and program participation as independent variables predicting assault at six months suggests not only that the SAPS predicts later assault risk but that program participation also has a direct effect on assault risk, independent of SAPS score, b = −.85, z(366) = −2.13, p < .05. Again, translation of the regression coefficients into sets of predicted probabilities over the range of two standard deviations above and below the control group mean while holding all other effects to their averages indicates that the reduction in risk is substantive (see Figure 3). If we compare the predicted risk of assault at six months for the nonprogram group at the group’s average SAPS score of 100 and the program group’s risk at its average score of 104 at six months, we find that the nonprogram group’s predicted rate of assault is 16 percent, whereas the program group’s expected rate is 6 percent, all other effects being average. This constitutes a reduction of nearly two-thirds in the expected rate of assault.

Table 3.

Effects of SAPS Index, Program Participation, and Other Variables on Assault.

Variable	Coefficient
Variable	(SE)
Male	0.727
Male	(1.046)
Heterosexual	−0.045
Heterosexual	(0.518)
Male × Heterosexual	−1.156
Male × Heterosexual	(1.134)
White	−0.408
White	(0.367)
Academic year	0.323*
Academic year	(0.164)
Previous assault	1.108***
Previous assault	(0.325)
SAPS index	−0.046**
SAPS index	(0.015)
Program	−0.847*
Program	(0.398)
Intercept	2.464
Intercept	(1.582)

Note. Observations = 375. Logistic regression coefficients with standard errors in parentheses below. SAPS = Sexual Assault Protection Scale.

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

Figure 3.

Predicted probabilities of sexual assault over range of SAPS scores (six months postprogram/into academic year).

These data are consistent with initial tests of Elemental and suggest that program participation produces long-term changes in students’ attitudes and beliefs about sexual assault that offer protective outcomes over time. In addition to this mediated effect on assault risk, program participation has a direct impact on risk as well.

Discussion

Previous evaluation data with two cohorts of Elemental participants suggested that the program was effective at impacting students’ attitudes, thereby lowering their risk of assault (Holtzman and Menning 2015a). This study adds two additional cohorts of both program and control group students in an effort to test the robustness of previous findings. As was true in prior program evaluations, results indicate that Elemental has both mediated and direct effects on assault risk. The program promotes important changes in students’ attitudes and beliefs regarding sexual assault, those changes are maintained over time, and they bestow protective benefits to students by reducing their risk of assault over a six-month period. Importantly, the risk of assault for Elemental students drops nearly two-thirds to 6 percent, compared with the apparent 16 percent for the nonprogram students. These data thus provide the strongest test to date of the efficacy of Elemental.

There are, however, limitations to this study. First, it is not a randomized trial (DeGue et al. 2014), and the students who self-selected into the program exhibited lower SAPS index scores at the beginning of the semester than their peers. We believe that this is telling, as it highlights a real-world, rational-choice process in enrollment in college programs wherein those who may feel that they are underprepared to face the challenges presented by college life are more likely to seek opportunities to develop relevant skills. Although we have controlled statistically for other background factors, it is possible that an unmeasured feature is disproportionately present among program participants that is responsible for the patterns observed herein. It is possible, for example, that those who choose to enroll in such programs are more prone to contemplate issues of gender-based violence, whereas their peers may tend to be precontemplative of such issues. However, the low scores at program entry suggest that, if anything, program participants enter with a relative disadvantage (rather than an advantage) to their peers. To some degree, then, this serves to strengthen the importance of the effects found here.

Second, as mentioned earlier, the control data are not truly longitudinal, and it is possible that the cohorts of students in the six-month control sample constitute, for reasons unknown to us, a particularly vulnerable group. Third, the data presented here only explore outcomes six months postprogram. Although this covers the most vulnerable period for most freshmen, a more long-term study would be informative regarding outcomes later in college and would be particularly instructive when formulating suggestions for the frequency with which the program might be repeated (e.g., taken annually). Fourth, as indicated by the continuing significance of program participation in our models, the mechanisms whereby the program reduces assault remain incompletely specified. We suspect that the inclusion of more measures of attitudes, beliefs, and behaviors commonly associated with primary prevention may be helpful in additional evaluations (Menning and Holtzman in press), as well as expanding the investigation to include other validated scales in the research literature, including those measuring rape myth acceptance, consent awareness, assertiveness, and gender norms. Finally, although Elemental is open to both men and women, the number of men who have attended thus far has been too low to allow for statistical tests of program effects for men. For now, then, we cannot say with certainty that the findings presented here can be extended beyond female college students. Overall, then, although the findings are strongly suggestive that the program demonstrates long-term effectiveness, we both urge caution due to the limitations posed by constraints on data and methodology and suggest that future work should rectify these and other shortcomings via collection of more comprehensive data and randomized longitudinal experiments.

What, then, do these findings mean for the field of sexual assault prevention more generally? We suggest that the data on Elemental further illustrate the benefits of comprehensive programming. Not only does the program combine primary prevention and risk reduction strategies within a single seminar, results consistently suggest that it positively impacts students’ attitudes and lowers incidences of assault over time (Holtzman and Menning 2015a; Menning and Holtzman 2015). These results stand in sharp contrast to the many evaluation studies that have found only short term (e.g., nine weeks or less) attitude changes among students and few reductions in assault risk (Breitenbecher and Gidycz 1998; Coker et al. 2016; Coker et al. 2015; DeGue et al. 2014; Gidycz, Layman, et al. 2001; Gidycz, Lynn, et al. 2001; Heppner et al. 1995; Vladutiu et al. 2011). We argue that the comprehensive nature of the program is what produces these outcomes, precisely because it leverages the strengths of both primary prevention and risk reduction approaches (Menning and Holtzman 2015, in press).

This suggests that the current focus on primary prevention by practitioners, college campuses, and federal agencies may be misplaced. The results presented here, when considered in tandem with recent studies by Hollander (2014), Senn (2013) and Senn et al. (2015) which demonstrate positive effects of women’s self-defense programs, highlight the significant impact that risk reduction training can have on rates of assault. Moreover, what is noteworthy about the self-defense programs tested by Hollander (2014), Senn (2013) and Senn et al. (2015) is that both include detailed classroom curriculums that cover issues of gender socialization, dating norms, healthy sexuality, and so forth. Many of these same themes are incorporated into primary prevention programs, including social marketing campaigns and bystander intervention training. Thus, although neither Hollander (2014) nor Senn (2013) and Senn et al. (2015) have explicitly described their programs as including primary prevention elements, it appears that they, in fact, do just that. To the extent that is true, we suggest that the efficacy of these programs and others like Elemental may derive from the way risk reduction training and contextualizing information on gender, party culture, consent, alcohol, and so forth interact with one another. Such findings are reinforced by our own prior work in validating the SAPS, which suggested that no one subscale within the instrument is consistently and independently predictive of assault (Menning and Holtzman in press). We urge both further empirical exploration of the efficacy of approaches that combine primary prevention with risk reduction, as well as a revisiting of the preference in policy that so heavily favors a dichotomized approach with far more resources dedicated to primary prevention than to risk reduction.

Ultimately, what seems clear is that primary prevention and risk reduction both have a role to play in prevention efforts, and early signs of policy change do exist. For instance, the ACHA recently revisited its guidelines on sexual violence prevention (originally published in 2008) and released a report that not only explicitly advocates for the inclusion of risk reduction training on college campuses, but calls for an integrated approach whereby risk reduction and primary prevention programs are delivered in coordinated ways (ACHA 2016). This is likely a step in the right direction, but as more evidence accumulates in support of a combined approach, more change will be needed. Pending additional empirical support, these data suggest that federal agencies, university administrators, Title IX officers, and other student affairs professionals should consider embracing comprehensive programming. This is true even given the recent changes in prevention programming that have been ushered in by the Trump Administration. Although the U.S. Department of Education has rescinded some Obama-era policies and replaced them with interim guidelines (U.S. Department of Education 2017), these changes do not impact the core requirements of the Campus SaVE Act (Violence against Women Reauthorization Act 2013); thus, all institutions of higher education that receive any federal dollars (including student financial aid) must provide ongoing sexual violence prevention programming to all students.

Thus, campuses should continue to explore and adopt a variety of prevention programs, including those that combine primary prevention and risk reduction. Doing so will help ensure that college students have access to a range of empirically demonstrated programs, and that is the best way to promote meaningful change in rates of sexual assault.

Footnotes

Appendix

Appendix.

Attitude and Belief Variables (41 Items).

Variable	Questionnaire items (7-point Likert-type scales)
Please indicate how strongly you agree or disagree with the following statements.
Comfortable	I am comfortable saying, “no” when I do not want something.
Stand up	I stand up for myself.
Protect space	I protect my personal space effectively.
Set boundary	I am comfortable setting boundaries.
Freeze	If someone tried to hurt me, I would freeze.
Others happy	It is important to make others happy even if it makes me unhappy.
Stranger danger	Strangers are always more dangerous than people I know.
Assertive	I am assertive.
Pressure	I am good at keeping people from pressuring or manipulating me into doing things that I do not want to do.
Obligated	I do things because I feel obligated to do them, even if is not good for me personally.
Alcohol	Alcohol can be dangerous in social situations.
Consent	When it comes to sexual issues, I understand what consent is.
Communicate	When it comes to sex, I am confident in my ability to communicate what I want.
Aware	I am aware of what happens around me.
Watching out	I am good at watching out for myself.
Risk look	I know what to look for to tell if a situation puts me at risk of sexual assault.
Risk do	I know what to do when a situation puts me at risk of sexual assault.
Please indicate how safe or unsafe you feel in the following circumstances.
Safe public	When in public (on campus, at work, etc.)
Safe social	At social events (parties, get-togethers)
Safe alone	When alone with someone else
Please indicate how confident you feel that you know what to look for to tell if a situation is dangerous in the following circumstances.
Danger public	When in public (on campus, at work, etc.)
Danger social	At social events (parties, get-togethers)
Danger alone	When alone with someone else
Please indicate how confident you feel in your ability to protect yourself from sexual assault in the following circumstances:
Protect public	When in public (on campus, at work, etc.)
Protect social	At social events (parties, get-togethers)
Protect alone	When alone with someone else
Please indicate how much you agree or disagree with the following statements.
Imagine that you are faced with a challenging, awkward, sexually charged situation involving a stranger.
Stranger say	You would know what to say.
Stranger do	You would know what to do.
Stranger effective	Your response would be effective.
Stranger control	You would control the situation if it became an emergency.
Stranger physical force	If the situation became an emergency, you could use physical force effectively to protect yourself.
Imagine that you are faced with a challenging, awkward, sexually charged situation involving a friend or acquaintance.
Friend say	You would know what to say.
Friend do	You would know what to do.
Friend effective	Your response would be effective.
Friend control	You would control the situation if it became an emergency.
Friend physical force	If the situation became an emergency, you could use physical force effectively to protect yourself.
Imagine that you are faced with a challenging, awkward, sexually charged situation involving an intimate partner.
Partner say	You would know what to say.
Partner do	You would know what to do.
Partner effective	Your response would be effective.
Partner control	You would control the situation if it became an emergency.
Partner physical force	If the situation became an emergency, you could use physical force effectively to protect yourself.

Authors’ Note

An earlier version of this paper was presented at the 2016 American Psychological Association Meetings in Denver, Colorado.

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.

Related Resources

1. In addition to the American College Health Association (ACHA) reports cited in the reference section, readers may also find the ACHA’s most recently released toolkit, “Addressing Sexual and Relationship Violence: A Trauma Informed Approach,” to be informative. It can be found at https://www.acha.org/ACHA/Resources/Addressing_Sexual_and_Relationship_Violence_A_Trauma_Informed_Approach.aspx.

2. In 2014, Violence against Women released a special issue on risk reduction in sexual assault prevention. See volume 20, issue 3.

3. Additional information about Elemental can be accessed at www.elementalprotection.org.

4. For further discussion of the importance of flexibility and nonviolent response options in sexual assault prevention, see Mellisa Holtzman’s TEDx talk titled “What If Sexual Assault Self-Protection Could be Nonviolent?” at http://youtu.be/u-7VAFBGWqc.

Author Biographies

Mellisa Holtzman is professor of sociology at Ball State University. Her research interests are centered on sex, gender, and sexual assault prevention. Her published work includes articles in Journal of Interpersonal Violence, Perspectives on Sexual and Reproductive Health, Journal of American College Health, Law and Social Inquiry, Sociological Focus, and Teaching Sociology. She is the cocreator and current director of Elemental, a sexual assault protection program that utilizes both primary prevention and risk reduction training for students.

Chadwick L. Menning is professor and chair of sociology at Ball State University. His research currently focuses on sexual assault prevention and related applications of sociological research. He has published his works in journals such as Journal of American College Health, College Teaching, Journal of Health and Social Behavior, Perspectives on Sexual and Reproductive Health, and Journal of Interpersonal Violence. He is the cocreator of Elemental, a sexual assault protection program.

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. 2013. The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Findings on Victimization by Sexual Orientation. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.