Eliminating sexual violence on college campuses and in communities requires a comprehensive approach to primary prevention based on the best available research evidence. The Centers for Disease Control and Prevention (CDC), in partnership with federal and local partners, is committed to advancing the science of sexual violence prevention to inform the development of more effective strategies. This presentation is from a webinar hosted by the National Center for Campus Public Safety and presented by Kathleen C. Basile, PhD, the Lead Behavioral Scientist of the Sexual Violence and Child Maltreatment Team in the Research and Evaluation Branch of the Division of Violence Prevention of the CDC’s National Center for Injury Prevention and Control. Kathleen provides an overview of the latest knowledge related to sexual violence, including risk and protective factors, evidence-based strategies, and the need for comprehensive, multi-level approaches that address the complexities of this problem.

1. Applying the Best Available Research
Evidence to Build Comprehensive
Strategies for Sexual Violence (SV)
PrevenAon
Kathleen C. Basile, PhD
Lead Behavioral Scien0st
October 20, 2016
Na0onal Center for Injury Preven0on and Control
Division of Violence Preven0on

2. Overview of this Presentation
• Definition and Prevalence of SV
• Risk and Protective Factors for SV
• Review of Prevention Research
• STOP SV Technical Package
• Importance of a Comprehensive, Multi-Level Prevention
Strategy
• Examples of Innovative Projects in the College Context
2

3. Definition
and
Prevalence
3

4. • Sexual violence (SV) includes a sexual act that is
committed or attempted by another person
without freely given consent of the victim or when
the victim is unable to consent or refuse.
Includes:
– Penetrative sexual acts that are forced or alcohol/drug facilitated
– Penetrative acts in which the victim is non-physically pressured or
intimidated
– Intentional sexual touching
– Non-contact acts of a sexual nature
– Can also occur when a perpetrator forces or coerces a victim to
engage in sexual acts with a third party.
Basile KC, Smith SG, Breiding MJ, Black MC, Mahendra RR. Sexual Violence Surveillance: Uniform Definitions and
Recommended Data Elements, Version 2.0. Atlanta (GA): National Center for Injury Prevention and Control, centers for
Disease Control and Prevention; 2014.
Defining Sexual Violence
4

5. National Intimate Partner and Sexual
Violence Survey (NISVS) - Prevalence
q Lifetime estimates, 2011:
§ 1 in 5 women (19.3%) and 1 in 59 men (1.7%) has experienced
an attempted or completed rape.
§ 1 in 15 men (6.7%) reported being made to penetrate
§ 1 in 8 women (12.5%) and 5.8% of men reported sexual
coercion
§ Over one-quarter of women (27.3%) and 1 in 9 men (10.8%)
reported unwanted sexual contact
§ Almost a third of women (32.1%) and 13.3% of men reported
non-contact unwanted sexual experiences
5

6. Age at First Completed Rape, Female Victims, NISVS
2010
12.3%
29.9%
37.4%
14.2%
4.5% 1.7%
10 & Under
11-17
18-24
25-34
35-44
45+
6

7. Risk and
Protective
Factors
for SV
Perpetration
7

8. CDC’s Review of Risk/Protective
Factors for SV Perpetration
• Goals:
– Identify empirically based risk and protective factors for sexual
violence perpetration
– Compare risk factors across samples and developmental
phases
– Inform development and evaluation of sexual violence
prevention strategies
• CDC reviewed 191 studies to identify factors at
each level of the social ecology that were
associated with SV
– All types of SV and SV perpetrators (adjudicated/non-
adjudicated, all ages), except child sexual abuse
– Most work has focused on male-to-female SV in college
samples 8

9. • Summary on CDC’s website:
http://www.cdc.gov/violenceprevention/
sexualviolence/riskprotectivefactors.html
9

10. Risk and Protective Factors at Different
Levels of the Social Ecological Model
SocietalCommunityFamily/PeerIndividual
10

11. Examples of Individual and Relationship Level
Risk Factors for SV
Gender-Based Cognitions
– Rape myth acceptance
– Hostility towards women
Sexual Behaviors
– Multiple sexual partners
– Impersonal sex
– Past SV perpetration
– Sexually explicit media
Aggressive Behavior
Alcohol Use
Violence-Related Cognitions
– Acceptance of violence
Interpersonal Factors
– Cue misinterpretation
Relationship-Level Factors
– History of child maltreatment
– Violence in the home
– Peer approval for forced sex
and pressure to have sex
– Gang membership
– Relationship conflictSee Tharp et al. (2013) 11

12. Examples of Individual and Relationship Level
Risk Factors for SV
Gender-Based Cognitions
– Rape myth acceptance
– Hostility towards women
Sexual Behaviors
– Multiple sexual partners
– Impersonal sex
– Past SV perpetration
– Sexually explicit media
Aggressive Behavior
Alcohol Use
Violence-Related Cognitions
– Acceptance of violence
Interpersonal Factors
– Cue misinterpretation
Relationship-Level Factors
– History of child maltreatment
– Violence in the home
– Peer approval for forced sex
and pressure to have sex
– Gang membership
– Relationship conflictSee Tharp et al. (2013)
• SV prevention has
traditionally focused on risk in
the area of gender-based
cognitions
• Other domains should also be
addressed and may result in
greater impact
12

13. Risk and Protective Factors for SV
q Community level factors
§ No consistently found community
level factors (huge gap in our
knowledge about SV perpetration)
q Protective Factors (some
examples)
§ Emotional health and connectedness
(high school boys)
§ Academic achievement (high school
girls)
§ Parents’ use of reasoning to solve
family conflicts
• See http://ajl.sagepub.com/content/5/5.toc for a SV article in a special issue on violence in American Jo of Lifestyle
Medicine.
• See also Tharp, et al. 2013. Trauma Violence Abuse vol. 14 no. 2 ,133-167 .
13

14. Review of Prevention
Research
14

15. CDC’s Review of SV
Prevention Research
q Systematic review of 140 studies
(1985-2012)
q Evaluation literature on primary prevention
programs for SV perpetration
q Goals:
§ What works? What doesn’t work?
§ What are the gaps?
DeGue, S., Valle, L. A., Holt, M., Massetti, G., Matjasko, J., & Tharp, A. T. (2014). A
systematic review of primary prevention strategies for sexual violence perpetration.
Aggression and Violent Behavior, 19(4), 346-362. 15

16. • Safe Dates
• Shifting Boundaries (building-level)
• RealConsent*
Effective
• Coaching Boys Into Men
• Bringing in the Bystander
• Second Step: Student Success Through Prevention*
• Green Dot (college)*
Promising
• Brief, one-session educational interventions to
change awareness, knowledge, or attitudes/beliefs
Not effective
* Published after systematic review period; preliminary determination of
effectiveness.
What works? What doesn’t?
16

17. What Doesn’t Work?
q One-session educational/awareness programs
§ Reviewed 93 one-session programs (most < 1 hr)
• No studies found + effects on behavioral outcomes
• Effects on attitudes/knowledge typically did not
persist to follow-up
§ Why?
• Insufficient “dose” to compete with other influences and change behavior
• Usually involved passive audience
o Skills-based components are needed to change behavior
• Does not address other, stronger risk factors
§ Could be useful to engage the community in more
intensive interventions or introduce/reinforce
messages from a comprehensive strategy, but not
effective as a standalone
17

18. STOP SV: A Technical Package
to Prevent Sexual Violence
…A select group of strategies
based on the best available
evidence to help communities
and states sharpen their focus
on priorities with the greatest
potential to reduce sexual
violence.
18

19. Benefit of the STOP SV Technical Package
q Technical packages are one of the six key components
for effec0ve public health program implementa0on
because they:
§ Sharpen and focus what otherwise might be vague
commitments to "ac0on" by encouraging
implementa0on of specific interven0ons known to
be effec0ve.
§ Avoid a scaQershot approach of using a large
number of interven0ons, many of which have only a
small impact.
Frieden, T. R. (2014). Six components necessary for effective public health program implementation.
American Journal of Public Health, 104(1), 17-22. doi: 10.2105/AJPH.2013.301608 19

20. Structure of the STOP SV Technical Package
q The Technical Package has these components:
§ Strategies – direc0on or ac0ons to achieve
the goal of preven0ng violence
§ Approaches – specific ways to advance the
strategy
§ Example programs, policies, or
pracAces
§ Evidence– impact on violence or its
associated risk factors
20

21. ConsideraAons for Inclusion of Examples
in the Technical Package
Example programs, policies, or pracAces were chosen based on
the best available evidence:
• Meta-analyses, systematic reviews or rigorous evaluation studies
showing impacts on perpetration behaviors or established risk/
protective factors for SV
• Empirical support or a strong theoretical rationale for changing one or
more forms of violence or the conditions that give rise to violence
• Likelihood of achieving beneficial effects on multiple forms of violence.
• Likelihood of similar outcomes with different populations and/or in
different settings.
• No evidence of harmful effects on specific outcomes or with particular
subgroups.
• Feasibility in a U.S. context if the program or policy has been
implemented in another country.
21

22. 2222
Strategy Approach
S – Promote social norms that protect
against violence
§ Bystander approaches
§ Mobilizing men and boys as allies
T – Teach skills to prevent SV
§ Social-emotional learning
§ Teaching healthy, safe dating and intimate relationship skills to
adolescents
§ Promoting healthy sexuality
§ Empowerment-based training
O – Provide opportunities to empower
and support girls and women
§ Strengthening economic supports for women and families
§ Strengthening leadership and opportunities for girls
P – Create protective environments
§ Improving safety and monitoring in schools
§ Establishing and consistently applying workplace policies
§ Addressing community-level risks through environmental
approaches
SV – Support victims/survivors to lessen
harms
§ Victim-centered services
§ Treatment for victims of SV
§ Treatment for at-risk children and families to prevent problem
behavior including sex offending
22

23. Importance of a Comprehensive, MulA-
Level PrevenAon Strategy
23

24. Sexual
Violence
Attitudes/
Beliefs
Behavior
Personality/
Characteristics
Experiences Relationships
Context/
Environment
Norms/ Culture
Structural/
Institutions
24

25. Comprehensive Prevention
is the Goal
• Comprehensive strategies include multiple
components and affect multiple settings to
address a wide range of risk and protective
factors across all levels of the social ecology
SocietalCommunityFamily/PeerIndividual
25

26. 26

27. 27

28. What’s
missing?
SocietalCommunityFamily/PeerIndividual
Safe Dates
Bringing in the Bystander
Coaching Boys into Men
Second Step
Shifting Boundaries:
Building-Level
Need more community- and
societal-level strategies with
known efficacy
Green Dot
RealConsent
28

29. On the Horizon: Examples of
InnovaAve Projects in the College
Context
29

30. Exploring Policy Approaches
to Sexual Violence Prevention
q CDC is working to identify promising policy
strategies to prevent SV
q Policies can:
§ Have broad impact with few resources
§ Modify behavior by changing the environment,
social norms, or expectations/outcomes (i.e.,
reward/punishment)
§ Complement change at individual and
relationship levels
30

31. Why Alcohol Policies?
Impact on other forms of violence
§ Delinquency
§ Physical assault
§ Homicide
Strong relationship between alcohol and sexual
violence perpetration
§ 34-74% of SV perpetrators used alcohol at time of the
assault
Alcohol is a risk factor– but not a cause, or an
excuse 31

32. Promising Alcohol Policy
Approaches
q Areas with encouraging evidence; may be
ripe for future evaluations:
§ Pricing strategies
§ Outlet density
q Areas with some evidence; more research
needed to understand SV prevention potential
§ College policies (e.g., substance-free dorms)
§ Sale time
§ Drinking environment/Responsible Beverage Service
§ Sexist alcohol marketing
Lippy, C. & DeGue, S. (2014). Exploring alcohol policy approaches to the prevention of sexual violence
perpetration. Trauma, Violence, & Abuse. Published online, November 16, 2014, doi:
10.1177/1524838014557291.
32

33. Bystander Program Adoption and Efficacy to
Reduce SV/IPV in College Communities
(McBEE [Multi-College Bystander Efficacy
Evaluation])
q PI: Ann Coker, PhD, Univ of Kentucky (Co-PI: Heather Bush, PhD)
q Evaluation of Campus Sexual Violence Elimination (SaVE) Act] that requires
all publicly-funded colleges/universities to implement bystander intervention
programs (BIPs)
q No specific requirements in the SaVE Act for BIPs, so some colleges may be
implementing the “bare minimum” - may not reduce SV on college
campuses.
q Project will compare the relative efficacy of components of bystander
interventions implemented at approximately 30 colleges/universities across
the U.S. to increase bystander behaviors and reduce sexual violence
q Has the potential to identify the most cost-effective method for increasing
bystander intervention and potentially inform federal policy around BIP
training for colleges/universities 33

34. Shi$ing Boundaries College AdaptaAon
§ A collabora0on of a highly experienced team of experts from
complementary organiza0ons and ins0tu0ons:
• To be administered by the Center for Effective Public Policy
(CEPP), in partnership with:
• California Coalition Against Sexual Assault (CALCASA),
• National Sexual Violence Resource Center (NSVRC),
• Applied Research Services (ARS),
• Holly Rider-Milkovich, University of Michigan, and
• Dr. Nan Stein, Wellesley College Center for Research on
Women
34

35. Shi$ing Boundaries College AdaptaAon
§ This project will develop and incorporate situaAonal prevenAon
intervenAons within exisAng sexual assault prevenAon programs on
demonstraAon college campuses
§ Primary ObjecAves:
• Environmental Scans with Campuses
• Campus Site Visits for Planning and Implementation
• Develop Shifting Boundaries: College Adaptation Interventions
o Will draw upon the evidence-based foundation of the original
constellation of interventions and take into account the differences
across college and university settings
• Pilot Shifting Boundaries: College Adaptations Interventions on
Demonstration Campuses
• Implement Monitoring and Evaluation Protocol
• Develop and Disseminate Innovative Resource(s) for the Field
35

36. Shi$ing Boundaries College AdaptaAon
Important to Note:
§ Preliminary informaAon - the project is at a very early stage
§ The situaAonal intervenAons will be tailored to each university based on
their respecAve needs and within the context of complemen4ng the
exisAng campus sexual assault prevenAon acAviAes at each of the
campuses, not to replace/supplant
§ This is a pilot and "lessons learned" iniAaAve
§ The group hopes to develop a fairly structured but flexible adapAon of
Shi$ing Boundaries
36

37. Questions?
Contact Information:
Kathleen C. Basile, PhD
Lead Behavioral Scientist, DVP, NCIPC, CDC
E-mail: kbasile@cdc.gov
The findings and conclusions in this presentation are those of the author and do
not necessarily represent the official position of the Centers for Disease Control
and Prevention.