Prevention of sexual violence among college students: Current
challenges and future directions
Erin E. Bonar
a,b
, Sarah DeGue
c
, Antonia Abbey
d
, Ann L. Coker
e
, Christine H. Lindquist
f
,
Heather L. McCauley
g
, Elizabeth Miller
h
, Charlene Y. Senn
i
, Martie P. Thompson
j
, Quyen M.
Ngo
b,k
, Rebecca M. Cunningham
b,k,l
, Maureen A Walton
a,b
a
Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
b
Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
c
Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for
Disease Control and Prevention, Atlanta, GA, USA
d
Department of Psychology, Wayne State University, Detroit, MI, USA
e
Department of Obstetrics & Gynecology, School of Medicine, University of Kentucky, Lexington,
KY, USA
f
Division for Applied Justice Research, RTI International, Research Triangle Park, NC, USA
g
School of Social Work, Michigan State University, East Lansing, MI, USA
h
Division of Adolescent and Young Adult Medicine, University of Pittsburgh Medical Center
Children’s Hospital of Pittsburgh & Department of Pediatrics, University of Pittsburgh School of
Medicine, Pittsburgh, PA, USA
i
Department of Psychology and Women’s & Gender Studies Program, University of Windsor,
Windsor, Ontario, Canada
j
Department of Psychology, Clemson University, Clemson, SC, USA
k
Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
l
School of Public Health, University of Michigan, Ann Arbor, MI, USA
Abstract
Objective: Preventing sexual violence among college students is a public health priority. This
paper was catalyzed by a summit convened in 2018 to review the state of the science on campus
sexual violence prevention. We summarize key risk and vulnerability factors and campus-based
interventions, and provide directions for future research pertaining to campus sexual violence.
Results and Conclusions: Although studies have identified risk factors for campus sexual
violence, longitudinal research is needed to examine time-varying risk factors across social
ecological levels (individual, relationship, campus context/broader community and culture) and
data are particularly needed to identify protective factors. In terms of prevention, promising
Declaration of Interest:
The authors have no conflicts of interest to report.
HHS Public Access
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Published in final edited form as:
J Am Coll Health
. 2022 ; 70(2): 575–588. doi:10.1080/07448481.2020.1757681.
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individual and relational level interventions exist, including active bystander, resistance, and
gender transformative approaches; however, further evidence-based interventions are needed,
particularly at the community-level, with attention to vulnerability factors and inclusion for
marginalized students.
Keywords
campus sexual violence; risk factors; prevention; marginalized students
Introduction
Sexual violence remains a critical public health concern for students attending colleges and
universities. The Centers for Disease Control and Prevention (CDC) defines sexual violence
as “a sexual act that is committed or attempted by another person without freely given
consent of the victim or against someone who is unable to consent or refuse.”
1(p.11)
Such
acts range from non-contact unwanted experiences (e.g., verbal sexual harassment) to forced
penetration. The current paper generally focuses on contact-related behaviors. Unwanted
sexual touching is the most prevalent form of campus sexual violence experienced by
college students, followed by incapacitated (i.e., due to drugs/alcohol) rape, and attempted
forced rape.
2
A clear understanding of the scope of this problem is hindered by: 1) use of
official statistics to estimate its magnitude, as there is underreporting of sexual violence to
campus authorities, 2) variation in definitions and measures of sexual violence in self-report
surveys
3–7
, and 3) missing data on surveys.
8
Nonetheless, a recent review suggested that
prevalence of sexual violence victimization on college campuses is approximately 5% for
men and 25% for women.
8
These rates remain comparable to what has been found since
researchers began systematically measuring college women’s self-reported victimization in
the 1980s.
9
College students are an important focus for sexual violence prevention as 18 to 24 year-old
females have the highest rate of sexual violence victimization compared to females of
other ages
10
and 81.3% of female victims experience a first rape before age 25.
11
The
college context positions students to be at risk through decreased parental monitoring,
increased alcohol use, increased sexual activity, and exposure to peer norms about sexual
violence.
12,13
Thus, sexual violence affects many college students, takes place in a high
risk context of increasing independence and risk behaviors, and can result in many negative
sequelae (e.g., psychiatric distress, academic problems).
14–16
It is critical to provide appropriate support for survivors
6
while also engaging in upstream
prevention approaches to eliminate sexual violence. In 2018 the University of Michigan
Injury Prevention Center hosted a day-long event titled, the “Summit on the Prevention of
Campus Sexual Assault.” The purpose of this summit was to better understand the state of
campus sexual violence prevention science and to identify next steps for prevention under
a public health model. Leaders in the field presented research data pertaining to sexual
violence prevention for college students across levels of the social ecology.
17
Presentations
focused on the public health framework for prevention, risk factors for campus sexual
violence based on experimental and survey research, special considerations for marginalized
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students (i.e., sexual and gender minorities, racial/ethnic minorities), and evidence-based
prevention programs delivered on campuses and in college communities. Interactions
occurring during this summit catalyzed this subsequent summary paper, which included
summaries provided by speaker authors, supplemented by additional literature. Key video
excerpts are available on the University of Michigan Injury Prevention Center’s website:
https://injurycenter.umich.edu/event/summit-on-the-prevention-of-campus-sexual-assault/.
Several recent reviews summarize the sexual violence literature, many including college
students, focusing on: prevention programs,
18–22
violence against women,
23
risk factors for
victimization and perpetration in college and general populations,
24–27
and, specifically,
male-targeted sexual violence programs.
28
Reviews specific to campus sexual violence
prevention have focused on topics such as campus response/policy
29
or more narrowly on
prevalence,
2,5
or bystander programs,
19,20
with a notable exception addressing prevalence,
prevention, response, and policy, broadly.
30
In light of these prior reviews and given the
Summit’s focus, this paper broadly highlights key research findings to inform current
campus sexual violence prevention efforts under a social ecological framework while
recognizing that factors at a given level of the social ecology may also exert influence across
levels. First, we summarize risk factors at the individual, relationship, and community levels,
with particular attention to vulnerability among marginalized students (i.e., racial/ethnic
minority students, LGBTQ students). Second, we describe key interventions across these
levels. Finally, we provide directions for next steps in sexual violence prevention research
and practice for colleges and universities, highlighting key technical packages.
31–33
Understanding risk factors for perpetration and victimization
To prevent sexual violence among college students, it is important to understand risk
factors for perpetration and victimization identified in studies using survey and experimental
research designs, across individual, relationship, and community levels. Note that although
individual behaviors contribute to victimization risk when a perpetrator is present, sexual
violence is never the fault of the victim as it cannot occur without a perpetrator.
Individual level risk factors—Individual level risk factors described here are
summarized in Table 1. Data suggest that men are more likely to perpetrate sexual violence
with research lacking on risk factors for female perpetration, likely given the low rates of
this behavior.
34,35
For men, risk factors for sexual violence perpetration with strong support
include prior perpetration, sexual behaviors (e.g., multiple sexual partners, impersonal sex,
motivation for sex, exposure to sexual media), and sexual- and violence-related cognitions
(e.g., hostility toward women, hypermasculinity, rape myth acceptance).
24
Consistent with
a prior review,
24
one recent study found that 19% of men reported sexual violence
perpetration before college, with risk factors including sexual media consumption, alcohol
misuse, and hypermasculinity.
36
Longitudinal research of sexual violence perpetration is
infrequent, yet existing literature suggests that risk factors for perpetration, such as hostile
masculinity, rape supportive beliefs, and pornography exposure, can change over the college
years, and that these changes are associated with changes in the likelihood of sexual
violence.
37–39
Studies also suggest protective factors that buffer against sexual violence
perpetration. For example, empathy, an individual level construct, may be protective via
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moderating the relationship between some risk factors (e.g., perceived peer approval of
forced sex, high risk drinking) and sexual violence perpetration.
40
Another study found that
college men who felt they learned from committing prior sexual violence and felt remorse
were less likely to perpetrate again within one year. In contrast, men who spoke about
women in callous ways were more likely to perpetrate over time.
41
In addition to female sex, research suggests several individual risk factors for sexual
violence victimization including indicators of lower socio-economic status (e.g., difficulty
paying for basic needs).
15,35
Further, one study of college women found that over half
of sexual violence cases occur in the context of victim and/or perpetrator intoxication
42
supporting acute intoxication as a risk factor.
24
Emerging research also suggests that
sexual violence victimization in the year before college entry relates to increased hazardous
drinking during the first year of college
43
which can further increase risk.
Consistent with these surveys, experimental studies provide clues about risk factors for
perpetration.
44,45
Given the extensive literature linking alcohol consumption with sexual
violence perpetration,
46
alcohol is the most frequently manipulated variable in laboratory
studies.
27
Typically, men are randomly assigned to consume non-alcoholic or alcoholic
beverages and are asked to read, listen to, or watch a sexual violence scenario before
answering questions about how they would think, feel, and act in that situation. Compared
to sober men, intoxicated men often have higher scores on measures of the woman’s sexual
arousal and their own sexual arousal, anger, belief that the woman “owed them” sex,
perceptions that the man in the scenario acted appropriately, and willingness to act similarly
in that situation.
47–51
Men higher in hostility and sexual dominance are the most likely to
respond in a sexually aggressive manner when intoxicated.
52,53
Thus, the effects of alcohol
on cognitive processing appear to increase the likelihood that a man who is predisposed to
be sexually aggressive will act in such a manner when intoxicated.
Beyond these general risk factors, marginalized students may differ in their experience of
sexual violence vulnerability; thus, we highlight key topics of race and ethnicity and gender
and sexual diversity below.
Racial and Ethnic Minority Students.: The association between race/ethnicity and risk
of sexual violence victimization is complex given that the socio-historical context of race
in the United States has had a long-standing impact on the economic, social, and health
consequences experienced by marginalized communities. Racial categories intersect and are
influenced by other variables across levels of social ecology (e.g., socioeconomic status,
campus environments, cultural norms, alcohol consumption), the unique effects of which
are difficult to isolate. Measurement differences across studies increase this complexity.
Although small numbers make precise estimates difficult, American Indian/Alaska Native
students appear to experience higher rates of sexual violence than other students.
54
Asian
and Pacific Islander students appear to be at lowest risk.
55,56
One study found that Latino
students (the largest minority group enrolled in U.S. post-secondary institutions
57
) had
lower rates of victimization than White students.
55
However, another study found generally
comparable rates for Hispanic (12.2%) and non-Hispanic (11.6%) students,
56
making it
difficult to discern a consistent pattern.
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Regarding Black students (the second largest minority group in U.S. post-secondary
institutions
57
) results are mixed. One study found that they had higher odds of past-year
sexual violence compared to White students,
55
another found comparable rates for White
and Black students,
56
and others have reported lower rates for Black students compared to
White students.
9
Data from the Campus Sexual Assault study (conducted at two traditionally
White public universities), and a similar study at four Historically Black Colleges and
Universities (HBCU), suggest that racial differences in alcohol consumption and the extent
to which survey questions account for alcohol-related incapacitation may clarify these
inconsistencies. HBCU undergraduate women, versus those at non-HBCUs, had lower
rates of incapacitated sexual violence (and overall sexual violence) yet comparable rates
of physically forced sexual violence since entering college.
58
This difference appeared to
be due to lower alcohol consumption among Black women (not unique factors of HBCUs),
because no differences in sexual violence were found between Black women attending
HBCUs and non-HBCUs and alcohol consumption was lower for Black women across
school type.
58
Therefore, measurement nuances, particularly whether surveys query sexual
violence when incapacitated due to substances, are important when attempting to understand
racial/ethnic differences. Survey questions that do not assess sexual violence when
incapacitated due to substances may undercount such experiences, producing estimates that
primarily reflect physically-forced incidents.
Sexual and Gender Minority Students.: Sexual and gender minority college students are
at elevated risk for sexual violence victimization prior to
59,60
and during college,
12,56,60,61
compared with heterosexual and cisgender students. Bisexual students experience
disproportionate risk, with more than a quarter reporting sexual violence victimization,
compared to 14% of gay and lesbian students and 11% of heterosexual students.
56
Students
with multiple marginalized identities experience elevated victimization risk. A recent
National College Health Assessment study found that Black transgender students had the
highest predicted probability of sexual violence (58%) compared to the Latino (27%) and
White (14%) transgender students.
55
Numerous social and contextual factors shape vulnerability to sexual violence among sexual
and gender minority students. They often experience discrimination related to these aspects
of their identities,
62–64
which fuels violence perpetration against them,
65
fosters feelings
of internalized homonegativity
66–68
and hinders disclosure of victimization.
69
Social norms
and attitudes also shape these students’ vulnerability to sexual violence. For example,
bisexual students confront sexual objectification,
70
pressure to “prove” their sexuality,
71
and cultural narratives of hypersexuality.
70
These experiences are compounded by potential
exclusion from both heterosexual and queer communities,
70,72
which makes care-seeking
difficult. Male-identified survivors of sexual violence may be silenced by hypermasculinity
norms that are incongruent with narratives of survivors as feminine and defenseless.
69,73,74
Such barriers are compounded for gay and bisexual male survivors, who face pressures to
conform to hegemonic masculine norms.
75
Relationship level risk factors—Relationship level risk factors described here are
summarized in Table 2. Risk factors for sexual violence perpetration at the relationship
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level include all male peer affiliation.
24
A meta-analysis suggested that males’ athletic
and fraternity involvement increases risk for sexual violence supportive attitudes and
perpetration.
76
As influenced via peer relationships, perceptions of peer attitudes and
behaviors (e.g., peer approval of forced sex, peer sexual aggression, peer pressure for
sex) are also associated with perpetration.
24,36,38,39,77
Longitudinal research shows that as
perceptions of peer approval of forced sex and sexual coercion increase, so does likelihood
of perpetration, whereas decreases in rape supportive peer norms are associated with a
declining trajectory of perpetration.
38,39
Peer norms have also been manipulated in lab-based
experiments, in which men are asked to select a film clip (sexually aggressive or not) to
show to a confederate woman whom they believe is another study participant. Men are more
likely to choose the sexually aggressive film when they are randomly assigned to first watch
another man (a confederate) choose the film clip.
78
In simulated bystander situations, men
randomly assigned to hear male confederates objectifying women are less likely to stop
a female confederate’s exposure to a sexual video, as compared to men assigned to hear
neutral statements about women.
79
Being in a casual or committed relationship (vs. single)
is associated with more sexually aggressive behaviors among college men, particularly for
those using alcohol prior to sex.
80
At the family relationship-level, pre-college factors such
as child abuse and exposure to parental violence are risk factors for perpetration.
24
Social situations involving drinking peers are important risk factors for perpetration
and victimization. In lab studies
81,82
, intoxication can reduce bystanders’ recognition of
dangerous situations. In surveys, alcohol consumption is associated with lower likelihood
of bystander intervention.
83,84
Regarding victimization risk, being in a dating relationship
confers risk as a large portion of sexual violence occurs with dating partners. For example,
a recent study of 361 students found that 35% had experienced sexual violence from a
dating partner
85
and that exposure to deviant peers (e.g., involved in crime) was associated
with attempted rapes. Recent research has also identified meeting potential partners via
dating apps and having “hook-up” type relationships as risk factors for victimization,
15,86
with more research needed to understand what factors drive these associations (e.g., are
individuals who use dating apps also more likely to perpetrate sexual violence?). Prior
victimization is a risk factor for future victimization as well.
15,35
Related to re-victimization,
positive peer norms about hook-ups are associated with re-victimization among college
women with prior sexual violence victimization.
87
Fraternity/sorority involvement is also a
relationship-level risk factor for victimization.
15
Community, contextual, and institutional level risk factors—Given that sexual
violence reporting rates vary across institutions,
56
an emerging focus in prevention-related
research involves identifying risk factors at the campus and/or community level.
24,88,89
Such
risk factors are typically measured via locations/policies related to alcohol consumption
(e.g., drinking settings) that increase risk for sexual violence, individual perceptions of
campus climate (e.g., inclusivity), and institutional characteristics (e.g., public vs. private).
Research using these proxy-measures for community level factors provide direction for
community-level interventions to address risk for sexual violence via policy, environmental
changes, or institution-wide practices to change the culture of the campus and/or students’
broader community. To begin, although data from the National Crime Victimization
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Survey indicate that most incidents of female sexual violence victimization among college
students occur at or near their home (38%) or the home of someone they know (29%),
10
campus environments that facilitate high-risk drinking are associated with increased risk.
Longitudinal research shows that college men’s attendance in high risk drinking settings
(bars/parties) is associated with perpetration.
90
A recent study from two New York campuses
found that in cases of incapacitated sexual violence victimization, about half of women had
just been at a party with the perpetrator before the event (versus 15.8% for non-incapacitated
victimization), and nearly half (46.5%) said the incident occurred in a dorm (fraternity
house: 10.5%; off-campus party/bar: 14.9%; other location: 28.9%).
86
Next, while athletic
and Greek life involvement are identified as relationship-level risk factors, particularly
because they are associated with attitudes that predict sexual violence perpetration (e.g.,
hypermasculinity, rape myth acceptance
76
), more research is needed to clarify which types
of events and/or features of the environment of these communities (e.g., parties, formal
events) affect risk.
89
Second, while research documents elevated risk among sexual and gender minority
students,
12,56,60,61,91
studies examining community-level factors, such as how campus
climates may drive these disparities, are lacking. Studies using proxy-measures of campus
inclusivity, namely sexual and gender minority students’ perceptions, provide clues to
inform campus-level prevention interventions. For example, among students from 478 higher
education institutions, perceived inclusivity of sexual and gender minority people on campus
was associated with significantly lower odds of sexual violence for these individuals.
92
Inclusive climates may operate by reducing perpetration against sexual and gender minority
students, increasing bystander intervention, or empowering students to use harm reduction
strategies.
92
Finally, several studies examined institutional characteristics in order to infer community-
level factors. One study found that institutional characteristics (public/private, 2-/4-year;
metro/non-metro location) were not significantly associated with perpetration rates,
34
whereas another found significant differences with a relatively small magnitude (e.g.,
higher victimization rates at small vs. large, and private vs. public institutions).
56
Another
study found that geographic region is associated with increased risk in some cases
(e.g., Midwestern and Southern vs. Northeastern campuses), as was campus size (10,000–
20,000 students versus <2,500), while research institutions had lower rates than bachelor’s
institutions.
93
This study also identified several student body features associated with
campus sexual violence rates, including higher campus-wide binge drinking rates, lower
proportions of heterosexual students and higher proportions of younger students and
females, higher number of sexual partners, and greater proportions reporting discrimination.
As most studies examine traditional universities, research is needed to examine community
college characteristics (e.g., frequent evening classes, commuter factors such as walking
to parking lots). Recent data from seven northeastern U.S. community colleges (N=800
students) suggest concerning rates of sexual violence victimization since enrollment (11%
victimized via unwanted sexual contact, coercion, attempted and completed rape; 48% when
including sexual harassment, relationship violence, stalking, etc.).
94
Students who were
female, sexual and racial minorities, and under age 26 were more likely to report any
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victimization.
94
These data highlight unique characteristics of community colleges, which
may reflect physical environments and/or differences in programs or policies related to
sexual violence requiring further study.
Future directions—Table 3 summarizes future directions for research in regarding risk
factors for campus sexual violence based on gaps in the above literature. These include:
(1) conducting additional longitudinal studies including time-varying risk factors and
evaluating victimization and perpetration trajectories for students of all genders; (2) using
a developmental lens to examine malleable risk factors (e.g., alcohol consumption, peer
norms), that can change during college; and (3) focusing on understudied risk factors at
the community and contextual levels (e.g., physical and social/contextual environment),
including in community colleges. Understanding community-level factors could inform
implementation of effective prevention strategies across levels of the social ecology,
particularly for marginalized students. Further, given variations in risk across sexual, gender,
and racial/ethnic minority sub-groups, more research is needed to better understand how
sexual violence manifests in these marginalized groups to inform prevention. We note that
specific racial/ethnic groups should not be presumed to be at higher or lower risk without
more consistent evidence. Further, students with disabilities comprise another marginalized
population warranting future attention, given research suggesting that individuals with
disabilities experience increased risk for sexual violence.
95,96
Finally, regarding experimental work, researchers are developing virtual reality paradigms
which may allow for more nuanced and realistic responses.
97,98
The peer studies above
demonstrate how constructs under consideration for interventions could be piloted in
experimental studies. Some researchers find unexpected, harmful effects with high-risk
individuals, hardening their attitudes when presented with messages intended to challenge
beliefs about women or masculinity.
99,100
Thus, using experimental paradigms with
updated technology to pilot potential prevention interventions may help identify and avoid
unintended negative consequences.
Efficacious and Promising Prevention Programs
A remaining gap in campus sexual violence prevention work involves needing to expand
and implement efficacious prevention approaches addressing risk for perpetration and
victimization across genders and levels of the social ecology. Few approaches have
been rigorously evaluated in college populations (i.e., with well-controlled designs, such
as randomized controlled trials [RCTs]) and shown to reduce sexual victimization or
perpetration or sexual violence risk factors.
18,19,22
We highlight key programs below
targeting different levels of the social ecology (although some inherently address multiple
levels).
Individual level—Few prevention programs focusing on sexual violence by potential
perpetrators in college populations have strong evidence of effectiveness in reducing men’s
perpetration behavior, with two promising exceptions.
101,102
RealConsent is an interactive,
web-based program designed for college-age men to increase prosocial intervening
behaviors, change attitudes and normative beliefs about sex, rape, and masculine gender
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roles, and increasing knowledge of consent. An RCT found that RealConsent was effective
in decreasing sexual violence perpetration and increasing positive bystander behavior over 6
months. Similarly, the group-based Sexual Assault Prevention Program (1.5 hour program, 1
hour booster) which seeks to increase men’s empathy about sexual violence, decrease rape
myth acceptance, increase consent knowledge, promote bystander intervention, and reduce
normative misperceptions holds promise.
103
In addition to demonstrating efficacy on several
risk factors (e.g., exposure to sexual media), relative to a control group, program recipients
were less likely to perpetrate sexual violence over 4-months.
Other interventions focus on changing individual-level attitudes and behaviors to reduce
the victimization risk
18
by teaching women how to recognize threat and bolstering self-
efficacy to use self-defense strategies.
104–110
Few individual-focused programs demonstrate
sustained behavioral outcomes. The Enhanced Assess, Acknowledge, Act (EAAA) Sexual
Assault Resistance program
105
is a notable exception that also includes curricula on positive
sexuality. Designed for women of all sexual identities, based on feminist and social
psychological theory
111,112
and prior research,
113–115
EAAA includes four group sessions
delivered by female facilitators to: 1) decrease the time needed to assess a situation as
dangerous and take action, 2) reduce emotional obstacles to taking the action necessary
to get away, and 3) maximize use of verbal and physical self-defense tactics most likely
to be effective. The program script asserts that perpetrators are entirely responsible for
their behavior. After pilot studies showed promise,
116–118
a multi-site RCT
106
showed
that EAAA increased women’s perception of their risk of acquaintance rape, knowledge,
self-efficacy, and willingness to use self-defense strategies in hypothetical situations. EAAA
also reduced the relative risk of attempted and completed rape (non-consensual oral, vaginal,
or anal penetration) by 50% in the year following participation, as well as non-penetrative
sexual violence. Program benefits persisted at least two years later.
107
Despite concern
that programs for women may inadvertently increase perceptions of women’s responsibility
for sexual violence,
119
participation in EAAA led to sustained decreases in rape myth
acceptance and beliefs in female provocation or responsibility for rape.
107
The program
worked both for rape survivors and women with no prior rape experience, and decreased
self-blame if women were raped after EAAA.
120
A multi-site implementation study of
EAAA is underway in Canada.
As called for in a recent review,
16
comprehensive prevention strategies should target
multiple settings and risk factors,
121
with campus healthcare settings being important
locations (e.g., health centers, counseling centers, Emergency Departments), potentially due
to the medical and mental health consequences of sexual violence.
14–16,122,123
Therefore,
we highlight ongoing work using a cluster RCT testing a brief trauma-informed, harm
reduction intervention to reduce risk for alcohol-related sexual violence among male and
female students receiving care from 28 college health centers.
124
The Giving Information
for Trauma Support and Safety (GIFTS) intervention is being compared to a brief alcohol
risk reduction counseling intervention. GIFTS uses a palm-size safety card with information
about sexual violence and provides: (a) education and assessment regarding sexual violence
(regardless of disclosure); (b) discussion of harm reduction behaviors to reduce risk of
alcohol-related sexual violence for self and peers (including bystander intervention); and
(c) supported referrals to survivor services. GIFTS builds on a growing evidence-base
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demonstrating effectiveness of survivor-centered clinic-based interventions in increasing
recognition of abusive behaviors, knowledge of resources, and self-efficacy to enact
harm reduction strategies, and among specific populations, reducing physical, sexual, and
cyber relationship abuse victimization and reproductive coercion.
125–127
Although primarily
targeted at the individual level as primary prevention, GIFTS is also intended to amplify
campus prevention efforts by encouraging students who have witnessed sexual violence, to
be more likely to intervene to interrupt a peer’s harmful behaviors and to provide support to
peers who have been harmed. As secondary prevention, students with prior sexual violence
exposure receiving GIFTS are expected to be more likely to disclose sexual violence during
their clinic visit and report greater use of sexual violence-related services.
124
Relationship level—Bystander training addresses the relationship level of the social
ecology by training individuals to intervene with others when they witness sexual violence
or behaviors that increase sexual violence risk, such as use of sexist or objectifying
language, endorsement of violence-supportive attitudes, or violence risk behaviors (e.g.,
heavy alcohol use). Engaged bystander programs seek to decrease sexual violence
acceptance and build skills to increase bystander actions that can reduce sexual violence.
As such, when well-implemented across a community (i.e., college campus), bystander
programs can change perceived social norms around violence and encourage both men
and women to take action to prevent it. The Campus SaVE legislation required training
on college campuses that teaches “safe and positive bystander intervention that may
be carried out by an individual to prevent harm or intervene” when there is a risk of
violence.
128
A number of bystander programs have focused on men and women (e.g.,
Green Dot,
129–131
Bringing in the Bystander,
132–134
Know Your Power
135
), while others
use sex-specific training [e.g., the Men’s Program
136–138
and Women’s Program
139,140
].
21
Rigorously evaluated and effective bystander programs for colleges include Bringing in the
Bystander
132,134,141
and Green Dot
129–131
; we specifically highlight Green Dot below, as it
was presented in our prevention Summit.
The Green Dot program for colleges and high schools includes two phases: 1) a 50-minute
motivational speech including definitions of sexual violence, its frequency, risk factors,
and opportunities for prevention and intervention, designed for delivery to all students at
a campus; and, 2) an intensive, interactive skill development bystander training, ideally
delivered in groups of 20–25 over 4–6 hours using a Peer Opinion Leaders strategy
(e.g., training by those whom others emulate or respect). For college students, Green Dot
significantly reduced sexual violence acceptance and increased active bystander behaviors
relative to those who did not receive Green Dot.
129
One college campus using Green Dot,
relative to two with no bystander program, had significantly lower rates of sexual violence
accounted for by a reduction in alcohol- or drug-facilitated sexual violence.
131
Similarly,
over 4 years, rates of sexual violence were 25% lower in the Green Dot campus versus the
two with no bystander program
131
; this was primarily accounted for by reduced alcohol- and
drug-facilitated sexual violence. This program also reduced sexual harassment, stalking, and
psychological dating violence victimization and perpetration.
130,131
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Community level—To date, no community-level interventions for campus sexual violence
have been rigorously tested. A review
18
of over 140 sexual violence prevention programs
(not restricted to college campuses) found that very few (<10%) addressed campus climate
or policies. A study
142
of 24 four-year colleges in Georgia, found that only 14% had
policies and practices that met compliance criteria for the Clery Act in 2014. Policies
varied widely across institutions, despite increased public attention and federal guidance
surrounding campus sexual violence after a 2011 Dear Colleague letter from the Department
of Education.
Future Directions—Table 3 summarizes future directions for research on prevention
interventions, based on gaps in the literature above. More research is needed to continue
identifying effective primary prevention programming for campus sexual violence. Although
bystander programs are effective at changing bystander attitudes and behaviors,
129,132,134
bystanders are present in few situations where sexual violence directly occurs (no more than
17%).
143
Combining bystander programs with programs helping students build knowledge
and skills to intervene on their own behalf is warranted.
144–147
Similarly, programs targeting
high-risk groups that address norms related to masculinity and sexual aggression in addition
to bystander training may be suitable for college settings. For example, the coach-delivered
Coaching Boys Into Men program for male athletes, was efficacious among middle school
students in increasing bystander behaviors and decreasing relationship violence among
those with a history of dating. In addition to potentially adapting such programs for
college campus delivery, there is a need to examine whether the effects of this and
other early prevention programs persist into the college years.
148
Next, implementation
research that seeks to implement and identify essential elements of efficacious programs
(e.g., using dismantling designs
149
) and optimal program dose, across specific settings
(e.g., dorms, online, classroom; community colleges, commuter or residential schools) and
populations, would be an important contribution. Conducting cost-effectiveness analyses of
efficacious programs can help ensure that prevention resources are well-utilized, and can
assist communities in making informed implementation decisions. Collecting cost-related
data during an evaluation can permit such analyses with limited need for additional
resources. Finally, research identifying optimal implementation and dissemination strategies
for efficacious programs is needed. Although a challenging task, evaluating comprehensive
prevention strategies that include combining evidenced-based programming with broader
initiatives to improve campus climate for marginalized students (e.g., programs that enhance
inclusivity for sexual and gender minorities such as those targeting micro-aggressions,
tailored prevention services for minority students at higher risk), could move the field
forward.
As a limitation of the field, prior interventions often focused on men’s perpetration of sexual
violence toward (presumably heterosexual) women, with future studies needed to enhance
prevention for gender and sexual minorities. Moreover, research is needed regarding male
victims of sexual violence who often have few resources and potentially more stigma
(e.g. rape myths around male victims), and female perpetrators of sexual violence who
are rarely studied (e.g., risk factors, motivations).
35,150–152
This gap could be addressed
by qualitative work to better understand and broaden our understanding of gendered risk
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factors. Programming that better accounts for gendered risk factors is also needed, as
gender-neutral programs may not sufficiently address well-established risk factors associated
with traditional masculinity.
24,36
Further, given the variation in risk for sexual violence
victimization for marginalized students, existing data can be used for sub-group analyses to
inform tailoring programs for specific student populations. Few existing interventions are
designed for marginalized populations specifically,
18
yet programs may be more effective
when tailored to cultural beliefs and norms.
153,154
Finally, prior prevention programs generally fall within inner levels of the social ecology—
addressing individual and relationship risk factors—with little known about what works
at the community level. Individual-level efforts must be accompanied by universal, campus-
wide efforts in partnership with the local community to make the college experience safer
for all students, including vulnerable populations by addressing institutional and structural
factors (e.g., racism, homophobia) that enhance risk. Alcohol policies on and off-campus
can help mitigate sexual violence for students.
31,155
Engaging alcohol outlets by providing
bystander training for bar staff has improved their positive bystander intentions and could
benefit from research examining long-term outcomes.
156
Campus efforts to support equity
across genders and marginalized identities via increasing representation amongst faculty
and leadership can promote an inclusive campus culture.
31
Investing in programs (e.g.
SafeZone
157
) for sexual and gender minority students, and bolstering campus enforcement
of sexual violence and anti-discrimination policies to be responsive to the lived experiences
of sexual and gender minority students and other marginalized students, could be an
important part of community-level interventions. Finally, it is noteworthy that an efficacious
building-level program for middle school students that involved hot-spot mapping and
intervention, Shifting Boundaries,
158
is currently being adapted for college campuses and
could yield promising results.
Summary and Directions for Future Research
There is broad agreement that a comprehensive approach is necessary to prevent campus
sexual violence.
31,121,159,160
Such an approach should address multiple goals including:
changing societal attitudes regarding the continuum of behaviors that comprise sexual
violence,
161,162
developing programs, policies, or other prevention approaches to stop
perpetration and hold perpetrators accountable,
18
empowering potential victims with
knowledge and skills to act on their own behalf to defend their sexual rights,
105,107
and
facilitating the empowerment of bystanders to disrupt harmful social norms, intervene on
others’ behalf, and support survivors.
130,132,134
Existing efforts have not fully mitigated
the problem
163,164
with consistent rates of sexual violence for decades
9,165
and recent data
documenting the high economic cost of sexual violence (over $122,000 lifetime cost per
rape victim; $3.1 for all victims
166
).
To build a comprehensive, efficacious approach, key gaps must be addressed with support
for additional research. First, although substantial progress has been made to identify risk
factors for sexual violence perpetration and victimization,
18,24
data on protective factors
are generally lacking.
24
Protective factors include characteristics of the individual, their
experiences, their relationships, or their environment that can reduce violence or buffer
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the effects of risk factors. Research identifying modifiable characteristics of the campus
culture, environment, policies, or practices that are associated with lower levels of sexual
violence is needed, and would improve the ability of colleges and universities to create
environments that buffer risk, supporting the development of comprehensive strategies that
address external spheres of the social ecology. Although we focus on college campus
interventions, it is important to note that risk and protective factors are often established
prior to college, and prevention efforts are needed before college entry across levels (e.g.,
schools, cultural norms, policy) and for the general community.
Second, few studies have examined risk factors or interventions that cut across levels
social ecology, with examination of community-level factors and prevention approaches
being particularly needed. For example, a CDC systematic review of sexual violence
perpetration risk factors in the general population
24
identified 42 individual-level risk
factors, 23 relationship-level factors, and only 2 societal/community-level factors. In a
parallel manner, few studies have tested the efficacy of multi-component interventions
across levels, with additional research needed.
18,167
The social ecological framework can
be helpful in conceptualizing the problem of sexual violence and targeting prevention,
while also considering that factors can interact across levels. Further, programs for both
perpetration and victimization prevention that work across levels of the social ecology
can be tailored to cultural considerations that may affect one’s risk of perpetrating sexual
violence or being a victim, while also considering the different contexts in which sexual
violence occurs (e.g., partnered relationships, among acquaintances, in and out of the party
scene). Consistent with White House Task Force recommendations,
168
the CDC’s STOP SV:
A Technical Package to Prevent Sexual Violence
31
supported primary prevention programs
that address different levels of social ecology by fostering healthy relationship skills, social
norms that protect against violence, and protective environments as recommended best
practices. STOP SV supports the idea that practitioners and communities may work together
to identify the approaches best suited for local contexts.
Next, the majority of research focused on campus sexual violence focuses on the context
of a male perpetrator and a female survivor, likely due to its high frequency. Conceptual
models of perpetration and victimization may need to be expanded to fully incorporate the
range of perpetrator-victim relationships. Additional support is needed for future research to
increase representation of diverse students in efforts to inform adaptations of evidence-based
programs that will be effective for reducing victimization among higher risk marginalized
groups (e.g., sexual and gender minorities, students with disabilities, Black, Hispanic/
Latino Students, and American Indian/Alaska Native students) with potential use of hybrid
implementation-effectiveness designs
169
to more rapidly impact sexual violence rates.
Although research findings are mixed regarding the impact of institutional characteristics
on perpetration and victimization rates,
34
understudied institutional features or norms may
differentially connote risk, particularly for marginalized individuals and men and women
separately, and based on type of college setting, with community and commuter colleges
being particularly under-represented.
In summary, we assert that comprehensive prevention from a public health perspective
involves a set of coordinated multi-component strategies that address risk and protective
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factors across the social ecology, that complement and reinforce each other with consistent
messaging from multiple sources across multiple contexts, including addressing the diverse
student population (e.g., racial/ethnic, sexual and gender minorities, those with disabilities,
those at community colleges and/or commuter schools).
18,88
Such strategies address risk
characteristics of the individual and their relationships — which is typical in campus
prevention efforts
19
— but also include community-level programs and structural/societal-
level policies (e.g., Campus SaVE Act
128
) that attempt to modify students’ physical and
social environment. To build multi-level strategies aimed at transforming the current campus
climate, we need a strong evidence base of risk and protective factors and effective strategies
at all levels. In addition to the framework provided by the CDC technical package STOP
SV: A Technical Package to Prevent Sexual Violence,
31
the CDC guide Sexual Violence
on Campus: Strategies for Prevention
32
and the National Collegiate Athletic Association
toolkit
33
may be helpful to colleges and universities working to improve campus sexual
violence prevention efforts.
Acknowledgements:
Meredith L. Philyaw-Kotov, Jessica S. Roche, & Bethany Pollock
Funding: This work was supported by a grant to the University of Michigan Injury Prevention Center by the
Centers for Disease Control & Prevention Award Number R49-CE-002099. Dr. Coker was supported by funding
from the Centers for Disease Control and Prevention under Grant #U01CE15003; and by the Eunice Kennedy
Shriver National Institute of Child Health and Human #R01HD075783. Dr. Ngo was also supported by funding
from the National Institute for Child Health and Human Development under Grant #R03HD087520; and by the
National Institute on Alcohol Abuse and Alcoholism under Grant #K23AA022641. Dr. Senn was supported by
the Canadian Institutes of Health Research through a Tier 1 Canada Research Chair in Sexual Violence and
Project grants. Dr. Thompson was supported by the Eunice Kennedy Shriver National Institute of Child Health and
Human Development, NIH under Grant #R15HD065568 and #R03HD053444-01A1. Drs. Miller and McCauley
were supported by the National Institute on Alcohol Abuse and Alcoholism under Grant #R01AA023260.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the
funders, the Centers for Disease Control & Prevention, or the Department of Health and Human Services.
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Table 1.
Summary of individual-level risk factors for sexual violence perpetration and victimization discussed
Risk Factors for Perpetration Risk Factors for Victimization
•Male sex •Female sex
•History of perpetration •Sexual/gender minority status
•Risky sexual behaviors (e.g., multiple sexual partners, impersonal sex), motivation for
sex, and exposure to sexual media
•Multiple marginalized identities
•Sexual/violence-related cognitions (e.g., hypermasculinity, hostile beliefs about women,
rape myth acceptance, rape supportive beliefs, perceived peer approval of forced sex,
need for sexual dominance)
•Lower socioeconomic status
•Excessive alcohol use and other substance misuse •American Indian/Alaskan Native background
(other race/ethnicity data are mixed/nuanced)
•Alcohol intoxication
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Table 2.
Summary of relationship-level risk factors for sexual violence perpetration and victimization discussed
Risk Factors for Perpetration Risk Factors for Victimization
•Experience of child abuse •History of victimization
•Exposure to parental violence •Being in a dating relationship
•All male peer affiliation (i.e., athletics, fraternity involvement) •“Hook-up” relationship factors (e.g., alcohol
intoxication)
•Perceptions of rape supportive peer attitudes/behaviors (e.g., approval of forced sex and
sexual coercion, sexual aggression, peer pressure for sex)
•Meeting partners on dating websites
•Being in a relationship (casual or committed) as opposed to single, for men and
particularly those using alcohol prior to sex
•Association with deviant peers
•Alcohol consumption/intoxication by bystanders •Fraternity/sorority involvement
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Table 3.
Summary of next steps for future research pertaining to risk factors and interventions
Risk Factors Interventions
•Greater representation of all genders, sexual minority
students, racial and ethnic minority students, and
students with disabilities
•Target malleable risk factors that may change during college (e.g., alcohol
consumption, peer norms) and tailor for sub-group differences
•Longitudinal studies to evaluate trajectories of
victimization and perpetration, including time-varying
risk factors
•Account for gender-related nuances
•Greater focus on risk factors at the campus,
community, and contextual level, including
understanding institutional characteristics
•Identify essential elements of efficacious programs, optimal dose, timing, etc. and
examine whether early interventions in the life course alter sexual violence outcomes
in college.
•Use of virtual reality paradigms to enhance validity in
experimental research
•Combine efficacious or promising programs that target different aspects of risk (e.g.,
bystander training, individual self-defense and awareness training) with climate and
community-based approaches to potentially enhance impact
•More comprehensive study of protective factors
across levels of social ecology
•Identify best implementation and dissemination strategies to encourage adoption and
maintenance of efficacious programs
•Examine community and campus policies and partnerships aimed at improving
climate and reducing risks (e.g., alcohol policies, inclusivity initiatives,
environmental modifications)
•Conduct analyses of implementation costs and cost-effectiveness
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