and Andra Teten Tharp, PhD

Synthesizing
y
g Research on
Sexual Violence Perpetration:
Risk and Protective Factors
and Prevention Programs that Work
Sarah DeGue, Ph.D. & Andra Teten Tharp, PhD
Division off Violence Prevention
Centers for Disease Control and Prevention
The findings and conclusions of this report are those of the author and do not necessarily
represent the official position of the Centers for Disease Control and Prevention.
Overview
• Review of risk and protective factors for SV perpetration
– Examples of consistently significant factors
– Gaps in the research
• Review of primary prevention strategies for SV perpetration
–
–
–
–
What works?
Promising strategies
What doesn’t work?
Evidence-based prevention
• Resources for more information
SYSTEMATIC REVIEW:
RISK AND PROTECTIVE FACTORS
Why Risk and Protective Factors?
• Risk Factor
– Increases the risk of violence
• Protective Factor
– Decreases the risk of violence OR
– Buffers the effect of a risk factors
• Risk and Protective factors can help determine:
– Which individuals or groups you target with prevention
– The content of prevention programs
• 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,
(adjudicated/non adjudicated all ages),
ages)
except child sexual abuse
– Most work has focused on male-to-female SV in college samples
Goals of CDC’s
CDC s Review
• 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 p
prevention strategies
g
Social Ecological Model
Societal Community Family/Peer
Individual
• Risk and protective factors occur at each level
• Presentation
P
t ti off results
lt organized
i d by
b level
l
l off SEM
• Highlights need for comprehensive approaches
Examples of Individual and Relationship Level
Risk Factors for SV
Gender-Based Cognitions
– Rape myth acceptance
– Hostility towards women
Sexual Behaviors
– Multiple sexual partners
Violence-Related Cognitions
– Acceptance of violence
Interpersonal Factors
– Cue misinterpretation
Relationship-Level Factors
– Impersonal sex
– History of child maltreatment
– Past SV perpetration
– Violence in the home
– Sexually
S
ll explicit
li it media
di
– Peer
P
approvall ffor fforced
d sex
Aggressive Behavior
Alcohol Use
See Tharp et al. (2013)
and pressure to have sex
– Gang membership
– Relationship conflict
Examples of Individual and Relationship Level
Risk Factors for SV
Gender-Based Cognitions
– Rape myth acceptance
– Acceptance of violence
– Hostility towards women
Sexual Behaviors
– Multiple sexual partners •
– Impersonal sex
– Past SV perpetration
– Sexually
S
ll explicit
li it media
di
Aggressive Behavior
Alcohol Use
See Tharp et al. (2013)
Violence-Related Cognitions
•
Interpersonal Factors
– Cue misinterpretation
Prevention
has traditionallyFactors
Relationship-Level
focused on risk in the area of
– History
of child maltreatment
gender-based
cognitions
– Violence in the home
Other domains should also be
Pand
approval
l ffor
d sex
addressed
dd – dPeer
d may
result
in
i fforced
greater impact
and pressure to have sex
– Gang membership
– Relationship conflict
Gaps
p in Research

Very few community and societal-level factors have been
studied and only 1 had a significant association with SV (e.g.,
community homicide rate)
 Opportunities still exist to address SV using community-level
strategies that reflect individual/relationship-level risk behaviors
through:
• Policy
• Leadership
• Other strategies that change the environment and culture

Very few protective factors identified.
 Emotional
E ti
l health
h lth and
d connectedness
t d
 Empathy
Risk Factor Take
Take-Aways
Aways

There is no single cause of
violence and no single “profile”
profile of
a perpetrator

Violence is the result of multiple
risk factors interacting overtime
and across settings/relationships

Multiple domains of risk should
be addressed as part of a
comprehensive prevention plan
SYSTEMATIC REVIEW:
PREVENTION PROGRAMS THAT
WORK
CDC’s Review of
SV Prevention Research



Systematic review of 140 studies
Includes evaluation literature on primary
prevention programs for male SV perpetration
To identify:
 effective programs or strategies
 components/characteristics of programs that increase or decrease
effectiveness
 promising approaches that require further research
 gaps in the
h evaluation
l
lliterature

“Effectiveness” defined by rigorous research design
(e g RCT),
(e.g.,
RCT) SV behavioral outcomes,
outcomes and followup
beyond post-test
DeGue et al. (under review)
What Works?

Only two programs have demonstrated evidence
of effectiveness in reducing SV behavior using a
rigorous evaluation design:

Both are developed and evaluated for
middle/high school youth
 Safe Dates
 Shifting Boundaries (school-level only)
Safe Dates




Middle/high school; universal
10-session
10
session curriculum
Play and poster contest
Targets TDV norms and peer responses
to TDV

Reduced
R
d
d rates off SV perpetration
i
behavior against a dating partner in
treatment g
group
p at 4-year
y
followup
p

Available ($225/per kit) from:
www hazelden org/web/go/safedates
www.hazelden.org/web/go/safedates
See Foshee et al. (1998)
Shifting
g Boundaries
 Middle school; universal and selected
 5-session knowledge-based curriculum alone did not effect SV
behavior
 School-level intervention was effective and included:




Posters to raise awareness/knowledge of TDV
Counselor-based intervention for students involved in “boundary” disputes
Protection order policy at school
“Hot spots” monitoring by school staff
 Reduced rates of SV perpetration behavior against peers and
dating partners in treatment schools at ~5-month follow-up
Available (free) from:
www.ncdsv.org/images/ShiftingBoundariesLessonsRelationshipsStudents
InMiddleSchool_12-2010.pdf
See Stein, Taylor, et al., 2011
Promising
g Approaches
pp
for SV



Multi-session programs with high-school or college
students
t d t
Programs that utilize a bystander approach
Programs that address SV in the context of dating
violence
 These approaches have some evidence of
effects on risk factors for SV (but not behavior)

Other types of programs may also work but they
haven’t been tested yet.
yet
Selected Promising
g Programs
g
Positive effects on risk factors in rigorous evaluation
• Coaching Boys Into Men
• High school; + effects on bystander behavior, and dating
violence perpetration (including SV) at 1 year follow
follow-up
up
• Bringing in the Bystander
• College; + effects on attitudes and bystander
efficac /intentions
efficacy/intentions
• Military; Mixed effects on bystander behavior
• Green Dot
• College and high school; preliminary results are
promising for both samples, but not yet published
What Doesn
Doesn’tt Work?

One-session educational/awareness programs
 R
Reviewed
i
d 93 one-session
i programs ((most < 1 hr)
h)
• No studies found effects on behavioral outcomes
• Effects on attitudes/knowledge typically did not persist to
follow-up
 Why?
• IInsufficient
ffi i t “dose”
“d ” to
t compete
t with
ith other
th influences
i fl
and
d change
h
behavior
• Usually involved passive audience
o Skills-based components are needed to change behavior
• Do not address other, stronger risk factors
 Could p
potentiallyy be useful to engage
g g the communityy in more
intensive interventions or reinforce messages from a
comprehensive strategy, but not effective as a standalone
Lessons from the Evaluation Literature

One-session programs likely insufficient to change
b h
behavior

Programs with multiple sessions that focused on skillskill
building and active participation were more likely to have
effects that persisted

Bystander, dating violence, and social-emotional skillsbased programs look promising
 More research is needed
Evidence--Informed Prevention
Evidence
• In the absence of a broad arrayy of evidencebased interventions, decisions for prevention
y
planning should be guided by:
– Known risk and protective factors for SV
– Principles
p of p
prevention ((Nation et al.,, 2003))
– Best available research evidence
• CDC report on www.NotAlone.gov provides a
summary of these considerations and more
resources
Opportunities
pp
for Innovation
• Target risk factors for SV using effective
strategies from other areas of public health
• Most promising domains:
– Youth violence
– Sexual health
– Alcohol
Al h l policy
li
Build a Comprehensive
P
Prevention
ti Strategy
St t
• Comprehensive strategies:
– include multiple interventions and affect multiple
settings to address a wide range of risk and protective
factors in the target population
• Considerations
–
–
–
–
–
Build on best-available science
Identify key messages and weave throughout
Identify and build capacity of implementation system
Leverage partnerships for multi-sectoral engagement
Integrate evaluation into implementation planning
An Example of Comprehensive
Prevention
Resources
• www.cdc.gov/violenceprevention/sexualviolence/
• www.notalone.gov
• Handouts available with references to these studies
and cited programs
Questions?
Dr. Sarah DeGue
Dr
[email protected]
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected] Web: www.atsdr.cdc.gov

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