Annotated bibliography

Research Article

Testing a Model of How a Sexual Assault Resistance Education Program for Women Reduces Sexual Assaults

Charlene Y. Senn 1,2

, Misha Eliasziw 3 , Karen L. Hobden

1 , Paula C. Barata

4 ,

H. Lorraine Radtke 5 , Wilfreda E. Thurston

6 , and Ian R. Newby-Clark

4

Abstract The Enhanced Assess, Acknowledge, Act (EAAA) program has been shown to reduce sexual assaults experienced by university students who identify as women. Prevention researchers emphasize testing theory-based mechanisms once positive outcomes related to effectiveness are established. We assessed the process by which EAAA’s positive outcomes are achieved in a sample of 857 first year university students. EAAA’s goals are to increase risk detection in social interactions, decrease obstacles to risk detection or resistance with known men, and increase women’s use of effective self-defense. We used chained multiple mediator modeling to assess the combined effects of the primary mediators (risk detection, direct resistance, and self-defense self-efficacy) while simultaneously assessing the interrelationships among the secondary mediators (perception of personal risk, belief in the myth of female precipitation, and general rape myth acceptance). The hypothesized multiple mediation model with three primary mediators met the criterion for full mediation of the intervention effects. Together, the mediators accounted for 95% and 76% of the reductions in completed and attempted rape, respectively, demonstrating full mediation. The hypothesized secondary mediators were important in achieving improvements in personal and situational risk detection. The findings strongly support the benefit of cognitive ecological theory and the Assess, Acknowledge, Act conceptualization underlying EAAA. This evidence can be used by administrators and staff responsible for prevention policy and practice on campuses to defend the implementation of theoretically grounded, evidence-based prevention programs. Online slides for instructors who want to use this article for teaching are available on PWQ’s website at http://journals.sagepub.com/doi/suppl/10.1177/0361684320962561

Keywords sexual assault, sexual violence, prevention, resistance, women

For at least 40 years, people and communities affiliated with

feminist, health, and educational organizations and institu-

tions have been working to prevent sexual assault (e.g.,

Morrison et al., 2004; Women Against Rape, 1980), and since

the early 2000s, there has been increased interest in

evidence-based program development and evaluation to rig-

orously assess interventions’ successes and failures. Much of

this work has been accomplished on university campuses.

A number of qualitative and quantitative review articles and

meta-analyses have summarized the state of the field and

made recommendations for promising directions for aca-

demics and practitioners (Basile et al., 2016; DeGue et al.,

2012; DeGue et al., 2014; Ellsberg et al., 2015; Gidycz et al.,

2002; Lonsway et al., 2009; Schewe, 2002). As well, promi-

nent researchers have called for resources to be focused on

evidence-based, theory-driven, effective programs within a

comprehensive approach to sexual violence prevention

(e.g., Banyard, 2013; Banyard & Potter, 2017; Orchowski

et al., 2010; Orchowski et al., 2018). This approach includes,

and extends beyond, student programming to changing entire

campuses and communities. Included in current recommen-

dations by a consortium of independent sexual violence pre-

vention researchers and the Centers for Disease Control are

bystander-based interventions for students of all genders,

resistance education for female students, and continued

development of programming for male students related to a

1 Department of Psychology, University of Windsor, Ontario, Canada 2 Women’s and Gender Studies Program, University of Windsor, Ontario,

Canada 3 Department of Public Health and Community Medicine, Tufts University,

Boston, MA, USA 4 Department of Psychology, University of Guelph, Ontario, Canada 5 Department of Psychology, University of Calgary, Alberta, Canada

6 Department of Community Health Sciences, University of Calgary, Alberta,

Canada

Corresponding Author:

Charlene Y. Senn, Department of Psychology, University of Windsor,

401 Sunset Avenue, Windsor, Ontario, Canada N9B 3P4.

Email: [email protected]

Psychology of Women Quarterly 2021, Vol. 45(1) 20–36 ª The Author(s) 2020

Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0361684320962561 journals.sagepub.com/home/pwq

bystander and social norms education (Basile et al., 2016;

Orchowski et al., 2018).

These opinions are strongly supported by the prevention

science literature (e.g., Nation et al., 2003), where it has long

been recommended that all prevention work be comprehen-

sive in having multiple interventions targeted for different

audiences within a system and use prevention best practices

(e.g., include opportunities for active interaction and appli-

cation of skills). Researchers in academia and public health

have also recommended improvements to evaluation research

in order to answer more precise questions about what

works and why (Banyard et al., 2014; DeGue et al., 2014;

Orchowski et al., 2018). Published standards for reporting

randomized and nonrandomized evaluation trials (Des Jarlais

et al., 2004; Schulz et al., 2010) and calls for better reporting

of interventions so that they can be understood and imple-

mented with findings replicated and improved upon by others

(e.g., Hoffmann et al., 2014; Pinnock et al., 2017) have also

emerged. Specifically, within the sexual violence prevention

field, researchers have argued for more rigorous studies that

would allow the testing of theory-based mechanisms once

positive outcomes related to their effectiveness are estab-

lished (e.g., Norris et al., 2018).

Salazar et al.’s (2019) recent analysis of the mechanisms

for change in the RealConsent program for university men is

a good example of such an analysis. While high attrition in

the follow-up period and the short duration of the positive

outcomes make the authors’ conclusions tentative, it is an

important first attempt to understand how a theory-based

sexual assault program works. To our knowledge, no studies

of sexual assault resistance education programs for university

women have assessed the process by which positive out-

comes are achieved (Senn et al., 2018), despite increasing

calls for such analyses (Hollander, 2018; Norris et al.,

2018). This is our goal.

The current article focuses on the first author’s

Enhanced Assess, Acknowledge, Act (EAAA) sexual

assault resistance education program, which is also known

as the Flip the Script TM

program. EAAA is the only pro-

gram that in a randomized controlled trial (RCT) has been

shown to substantially reduce the sexual assaults that

women university students experienced over the subsequent

year (i.e., 50% reduction in attempted and completed rape as well as reductions in other forms of sexual assault;

Senn et al., 2015). In fact, positive outcomes occur for at

least 2 years (Senn et al., 2017). A few empowerment

self-defense or risk reduction programs for women have

also demonstrated positive sexual assault outcomes. Specif-

ically, assessment of a 30-hour empowerment self-defense

program using a quasi-experimental design indicated signif-

icant reductions in sexual victimization for college women

for at least 1 year after participating in the program

(Hollander, 2014). A shorter, 7.5-hour risk reduction pro-

gram, evaluated using an experimental design, also led to

significant reductions in sexual victimization for subsets of

college women who participated in the program for a few

months (e.g., Gidycz et al., 2006; for a review of theory and

evidence for the type of program more generally, see

Orchowski & Gidycz, 2018). Thus, the benefits of under-

standing how these types of programs work extend beyond

a single program.

We were ideally situated to provide answers to this ques-

tion for many reasons. EAAA was evaluated in a multi-site

RCT with a large sample of 893 women students. There were

prospective data for women who did and did not take the

program, which included information about their back-

grounds and baseline scores on key variables. Further, we

followed them with assessments across more than a year with

high retention. Data collection included measurement of

potential mediators (mechanisms) 1-week post-intervention

and sexual assaults in the 12 months following that assess-

ment, which allowed for prospective temporal conclusions

regarding the mediators’ influence on post-program sexual

assault outcomes. As such, we were able to go beyond the

goal of finding out whether a program works to decrease

sexual victimization to how and why the program works. This

article describes a chained multiple mediation analysis,

which allowed us to assess the joint processes that produced

treatment outcomes. Through this analysis, we tested the

model of theoretically postulated mechanisms that drove the

development of the sexual assault resistance education pro-

gram. This is important for scientific and practical reasons

and has not previously been reported.

Theoretical and Empirical Foundation of EAAA

The EAAA program’s name acknowledges that it is based in

large part on the recommendations of Rozee and Koss (2001),

who synthesized decades of theory and rape research to sug-

gest a theoretically driven, evidence-based approach for sex-

ual violence prevention programming for young women. 1

They named this conceptualization “Assess, Acknowledge,

Act (AAA).” AAA was conceived on a bedrock of theory and

feminist research, particularly the cognitive ecological theory

proposed by Norris and Nurius (e.g., Norris et al., 1996;

Nurius & Norris, 1996) and the evidence of effective sexual

assault resistance strategies provided by Ullman (1997, 1998)

as well as a long tradition of feminist grassroots activism,

advocacy, theory, and self-defense practice (e.g., Bateman,

1978; Rozee et al., 1991; Wen-Do Women’s Self Defence,

n.d.; Women Against Rape, 1980). These underpinnings are

described in more detail elsewhere (Rozee et al., 1991; Rozee

& Koss, 2001; Senn et al., 2015; Senn et al., 2017). Rozee and

Koss’s proposed approach challenged past practices that were

not theory- or evidence-based, tended to focus primarily on

stranger sexual assault, and were largely ineffective (see

Morrison et al., 2004, for review of research evaluations of

programs conducted prior to this period). They argued that,

given the continuing alarming rates of sexual violence expe-

rienced by young women, the complete lack of success in

Senn et al. 21

reducing perpetration, and the substantial evidence base

available, providing women with knowledge and skills to

prepare them to detect risk, overcome emotional obstacles

to acknowledging the danger, and to resist sexual coercion

or sexual assault by men they know was imperative.

In response to this call, the first author designed a resis-

tance program curriculum to bring the conceptualized pro-

gram into reality. The term “resistance” is used in its broadest

sense to represent any attitudes women hold or actions they

take to refuse to accept or comply with social norms or expec-

tations that (a) support woman-blaming explanations for sex-

ual violence, (b) undergird societal tolerance of rape culture,

and/or (c) undermine women’s sexual autonomy. Resistance

includes defensive actions women take to protect their

boundaries, their body, and sexual integrity in interactions

with others. For survivors, resistance also includes the refusal

to accept sexual violence perpetrators’ views of them and

what occurred. EAAA reduces the sexual victimization

women experience while holding perpetrators entirely

responsible for their actions (Senn et al., 2015; Senn et al.,

2017) and interrupts messages often perpetuated in a rape

culture (Radtke et al., 2020). The program has a gendered

framing, focusing on sexual assaults perpetrated by men who

are known to young women (i.e., it uses a broad definition of

acquaintances that includes family members, intimate part-

ners, classmates, neighbors, and other men they know).

EAAA is designed and implemented to recognize the diver-

sity of experiences of participants who self-identify as

women in terms of prior sexual victimization history (i.e.,

that there will always be survivors in the room), demo-

graphics (e.g., race, class, religion), abilities (e.g., physical

ability, ability to be loud), sexual identity (i.e., explicitly

acknowledges heterosexual, bisexual, lesbian, and asexual

identities), and relationship and sexual experience.

The goals of the program are to (a) increase the likelihood

that empirically supported risk cues in social contexts (e.g.,

isolation, alcohol) and revealed in men’s behavior (e.g., per-

sistence, sexual entitlement) will be detected by women as

early as possible in social interactions, (b) decrease women’s

emotional or cognitive obstacles to risk detection or resistance

in situations involving known men, and (c) increase the like-

lihood that women will use defensive actions (e.g., leaving

when possible, forceful verbal and physical self defense) that

are most likely to lead to better outcomes (i.e., reduced severity

of the sexual assault, interruption of rape; Tark & Kleck, 2014;

Ullman, 1997) when threats are detected.

To accomplish these goals, the curriculum has four 3-hour

units. Unit 1, Assess, is designed to help women identify

situations and behaviors that signal a higher risk for sexual

violence. Unit 2, Acknowledge, was created to assist women

to overcome emotional barriers to acknowledging the threat

from men they know and provides practice in identifying and

resisting verbal coercion. Unit 3, Act, provides empowerment

verbal and physical self-defense training (based on Wen-Do

Women’s Self Defence) focused on effective strategies for

resisting common acquaintance tactics. Unit 4, Relationships

and Sexuality, adapted from the Our Whole Lives curriculum

(Goldfarb & Casparian, 2000; Kimball & Frediani, 2000),

offers high quality sexual information and a context for

exploring and talking about their own sexual desires and

relationship values. In other words, EAAA gives women

evidence-based information, skills, and practice within a pos-

itive sexuality framework to empower them to more quickly

identify a sexually coercive situation involving a male

acquaintance as dangerous and get out or use forceful resis-

tance if necessary. More detail on the program content is

provided elsewhere (Radtke et al., 2020; Senn et al., 2013).

The key findings for the registered, multisite (three uni-

versities), RCT (SARE Trial) evaluating EAAA have been

published elsewhere (Senn et al., 2015; Senn et al., 2017) but

are briefly summarized here. The reductions in sexual vio-

lence for young women who were assigned to the EAAA

program (Senn et al., 2015) were accompanied by positive

program effects on a number of other important outcomes

(Senn et al., 2017) measured 1 week after participation and,

for most, at 6 and 12 months (and up to 24 months). We

measured these additional outcomes because they were

hypothesized mediators; that is, they encompassed most of

the theoretical mechanisms targeted by the AAA approach to

increase women’s safety without limiting their freedom. In

this study, we go beyond our previous analysis of the pro-

gram’s positive effects on these outcomes to test whether,

together, they are mediators of the reductions in the sexual

assault across time. In other words, do improved scores on

these outcomes at post-test (1-week after participation) com-

bine to account for the reductions in sexual assault experi-

enced from that point until the 12-month follow-up?

In the following section, we explain the hypothesized mul-

tiple mediation model (Figure 1) and, specifically, the theory

behind our expectations that the possible mediators would

combine to lead to reductions in sexual assault. Given that

the model was built based on the best evidence available,

there are no competing theoretical models to be tested; rather,

we are assessing whether the model works as a whole and

whether the relationships for any hypothesized elements are

not supported. Any variable that is hypothesized to explain a

portion of the EAAA program’s effect on sexual assault vic-

timization through a direct link to the outcome, we refer to as

a “primary mediator.” These are the primary elements of the

AAA model. Any variable that is hypothesized to have an

indirect link to the outcome through its influence on a pri-

mary mediator, we refer to as a “secondary mediator.”

Mediators of Reductions in Sexual Assault

Risk detection is a key element of the primary appraisal pro-

cess outlined in Nurius and Norris’s (1996) cognitive ecolo-

gical model and hence also the theoretical underpinning of

the first unit (Assess). The program is designed to undermine

socialization processes about “stranger risk” that direct

22 Psychology of Women Quarterly 45(1)

women to use a wide range of precautionary strategies

involving restrictions on their freedom without protecting

them from sexual violence (e.g., not walking alone at night;

Gordon & Riger, 1989; Stanko, 1990). The curriculum pro-

vides information and practice in identifying empirically sup-

ported risk factors for acquaintance sexual assault and

encourages women to trust their own instincts and judgments

when they identify risk cues in social situations. Based on

past research (e.g., Marx et al., 2001) and theory, better risk

detection (i.e., more accurate, earlier) at post-test, which was

a positive outcome of participation in EAAA (Senn et al., 2017),

should be directly linked to reductions in sexual victimization

in the subsequent 12 months and hence a primary mediator.

The EAAA program also addresses obstacles women

encounter at secondary appraisal stages (i.e., after risk has

been detected and when they are making “determinations of

coping resources, options, and outcomes”; Nurius & Norris,

1996, p. 130) in interactions with coercive men. Content and

activities in the second unit of the EAAA program focus on

strengthening women’s belief in their own sexual and rela-

tionship rights and undermine the belief that relationships

must be preserved at all costs. Young women are provided

with a context in which they can practice asserting their needs

and confronting common verbal and physical acquaintance

perpetrator tactics. In the third unit, facilitators present

evidence that direct forceful verbal and physical resistance

strategies and leaving lead to better outcomes in sexual

assault situations. In any given situation, participants are then

able to select their own toolbox of effective strategies from

among the many techniques taught. Nurius and Norris (1996)

summarize the goal of intervention to improve the situation

for women as follows:

Thus, the extent to which a woman is prepared to see assertive

behavior as a reasonable resistance stance and is assisted to gain

assertiveness skills and habits may have an indirect effect

mediated through a woman’s cognitive structures operating at

the time of the coercion. (p. 122, emphasis added)

Thus, both increases in self-defense self-efficacy, that is,

confidence that she could assert and defend herself across a

range of situations, and the ability and willingness to use more

direct resistance strategies in a hypothetical situation should be

related to one another and be primary mediators of the EAAA

program’s effects on sexual assault. Notably, in our previously

published analysis, we found both variables to be positively

impacted by program participation (Senn et al., 2017).

Based on the research evidence (e.g., Vitek et al., 2018),

risk detection was a primary mediator expected to be influ-

enced by secondary mediators (i.e., other specific attitudes

Figure 1. Hypothesized Multiple Mediation Model.

Note. Primary mediators are variables that are hypothesized to explain a portion of the Enhanced Assess, Acknowledge, Act program’s (Group) effect on sexual assault victimization and have a direct link to the outcome (Sexual Assault). Secondary mediators are variables that are hypothesized not to have a direct link to the outcome themselves but rather are expected to influence the primary mediators. OwnRisk ¼ perceived risk of acquaintance rape; FPrecip ¼ belief in female precipitation of rape; RapeMyth ¼ rape myth acceptance; RiskDet ¼ risk detection; DResist ¼ direct resistance; SDSE ¼ self-defense self-efficacy.

Senn et al. 23

and beliefs directly affected by the EAAA program). Three

hypothesized secondary mediators that were included in the

RCT were (a) women’s perceptions of their own general risk

of sexual assault, (b) acceptance of rape myths, and (c) the

belief that women play a causal role in sexual assault. All

were affected in the desired direction by program participa-

tion at the post-test, and these effects were maintained for at

least 2 years (Senn et al., 2017). These attitudes and behaviors

were not expected to have direct effects on sexual victimiza-

tion (i.e., changes in attitudes and beliefs alone have never

been sufficient to reduce the incidence of sexual assault;

Morrison et al., 2004). Instead, they were included in the trial

precisely because any improvements in these attitudes and

beliefs were hypothesized to facilitate risk detection. Thus,

we hypothesized that in combination these three factors

would be related to each other and would lead to better out-

comes in sexual assault through their relationships with risk

detection. Each is described in more detail below.

An optimism bias, which is the belief that while others are

at risk of experiencing a particular negative outcome, we are

not ourselves at risk, can in some circumstances be protective

(e.g., against depression; Conversano et al., 2010). However,

“unrealistic optimism” (Nurius & Norris, 1996) is an obstacle

to detecting acquaintance sexual assault risk (Norris et al.,

1996). Unsurprisingly, an optimism bias is present in women’s

estimates of their sexual assault risk (Gidycz et al., 2006). The

problematic piece of this perception is not the judgment of risk

for other women who are similar to us—this tends to be rela-

tively accurate (i.e., there is a possibility the bad event could

occur)—but rather judgment for one’s self (i.e., it is unlikely to

occur to me). The RCT analyses showed that the EAAA pro-

gram increased women’s perceptions of their own general risk

of sexual assault (Senn et al., 2017). 2

We hypothesized that this

should be related to women’s risk detection in specific situa-

tions by making “danger cues” relevant and worthy of attention

as they arose in those situations.

Similarly and relatedly, commonly held myths about the

characteristics of rape, rape perpetrators, and rape victims

(e.g., that rape is most likely to be perpetrated by strangers)

may be psychologically self-protective (e.g., “only women

who do X, wear Y, or go to Z are raped and I would never

do those things”) but may also have negative consequences,

such as impairing perceptions of one’s own risk of sexual

assault (e.g., Bohner et al., 2009; Yeater et al., 2010).

Victim-blaming beliefs are thought to be particularly perni-

cious in this regard. We therefore hypothesized that the pro-

gram’s positive effects in reducing rape myths in general and

the specific incorrect belief that women cause rape by their

own actions (Senn et al., 2017) would be related to improved

risk perception. Further, we expected that reducing the belief

that women cause rape by their own actions, a belief that

when applied to the self can give one false sense of security

(e.g., If I don’t go there or do that, then it can’t happen to me),

would be related to increases in women’s perceptions of their

own personal risk because reducing these beliefs makes sali-

ent that any woman is potentially at risk.

The theory and evidence upon which EAAA was built

emerges from many different, primarily correlational studies

often focused on a single domain (e.g., risk perception or

self-defense strategies) that were related to positive outcomes

(Norris et al., 2018; Tark & Kleck, 2014; Vitek et al., 2018).

Although changes in individual domains can occur and can be

important in their own right (e.g., more high-quality informa-

tion about a phenomenon or more skill is usually better than

less), our focus is on how the combined domains of the whole

model are implicated in achieving the reductions in attempted

and completed rape 3

affected through participation in the

EAAA program.

We focused on the 1-year data from the SARE Trial RCT,

because a drop in effect sizes after 1 year and a decrease in

the sample size across 2 years reduced our ability to test these

relationships beyond this period. 4

We assessed mediation

prospectively using participants’ scores on the hypothesized

primary and secondary mediators that were measured 1-week

post-program and their experience of sexual assault in the

subsequent 12 months after the post-test. Given our large

sample size, we were able to test the mediation effects for

completed and attempted rape separately. It should be noted

that rape is broadly and behaviorally defined to include oral,

vaginal, and anal penetration by a man without the woman’s

consent through a range of perpetrator tactics including

threats, force, and taking advantage of or inducing women’s

incapacitation from drugs or alcohol (Koss et al., 2007).

Method

Participants

Eight hundred and ninety-three first-year undergraduate stu-

dents who identified as women were recruited at three uni-

versities and enrolled in the SARE RCT. The full trial

protocol has been published (Senn et al., 2013), as have the

1- and 2-year primary and secondary outcomes (Senn et al.,

2015; Senn et al., 2017). The prospective analysis in the

present study required valid responses on potential mediators

measured post-intervention at a 1-week post-test and sexual

assault outcomes measured beyond that point. A total of 871

(97.5%) women completed the 1-week post-program survey. Among these, 857 (98.4%) completed one or both of the 6- and 12-month follow-up surveys (i.e., not lost to

follow-up) and were included in this study. The 36 partici-

pants who were excluded were not characteristically different

from the 857 who were retained in the present study (all ps

ns). The average age of the included women was approxi-

mately 19 years, almost all were heterosexual or bisexual,

one-quarter were women of color, one-half lived in a univer-

sity residence, one-third had previous self-defense training,

and approximately one-quarter had experienced the previous

victimization (see Table 1).

24 Psychology of Women Quarterly 45(1)

Intervention

EAAA. This small group (�20 participants) intervention was led by pairs of highly trained, slightly older peer (<30 years)

women facilitators. Women attended an average of 3.62 (SD

¼ 0.82) of four sessions, with most (91%) attending three or four sessions. Curriculum fidelity was high (average 94%) as measured by the assessment of randomly selected audio

recordings.

Control. To match the standard of care common to all univer- sity campuses at the time, brochures on sexual assault were

available for participants to take and read, with a friendly and

knowledgeable person available to answer any questions that

arose about sexual assault or available resources from the

group of participants. Brochures chosen were specific to the

campuses but had common elements, including the provision

of general sexual assault information, date rape drug facts,

legal and medical information for survivors, and local

resources.

Procedure

The detailed RCT protocol and procedures are published else-

where (Senn et al., 2013), but we provide a brief overview

here. Participants were recruited through a variety of means,

including posters, emails, tabling, and advertising in research

participant pools. Interested students made contact by phone or

email, were screened by a research assistant and given a

detailed explanation of the purpose of the study, the longitu-

dinal survey process and timing, and the randomization pro-

cedure. They then chose the timing of the baseline and EAAA

intervention sessions that matched their schedule without yet

knowing to which condition they would be randomly assigned.

All participants attended a baseline session to complete sur-

veys in a computer lab, were randomized (using Randomize.

net), and then directed to their intervention room. A meal was

provided, the randomization outcome was revealed, and the

session facilitated. Depending on their chosen schedule, those

students randomized to the EAAA program completed the

other units during the same weekend as the baseline session,

with two program units delivered each day, or across the next 3

weeks, with one program unit delivered immediately and the

other three in subsequent weeks. Control participants attended

their brief group brochure session and then did not return until

the post-test survey session. Both control and program parti-

cipants completed in-person, post-test surveys. For the pro-

gram participants, these occurred 1 week after the final

program session. Control participants completed these surveys

at the same time as the program participants with whom they

attended the baseline and randomization session. Thereafter,

all participants completed follow-up online surveys at 6

months, 12 months, 18 months, and for those enrolled in the

first year of the trial 24 months, after the baseline session. The

CONSORT flowchart is published elsewhere (Senn et al.,

2015; Senn et al., 2017).

In the original published article on the efficacy of the

program in improving sexual assault outcomes (Senn et al.,

2015), an intention-to-treat analysis was used. This required

that any sexual assaults occurring between the baseline and

the post-test be included in the assessment of efficacy even

though participants in the program condition had not yet

received the full dose of the intervention. This affected pro-

gram participants who chose the weekday format more since

there was more time between their baseline and post-test

survey sessions (average of 28 days) compared to those

choosing the weekend format (average of 8 days). For the

current prospective analysis, sexual assaults needed to have

occurred after completion of the post-test sessions where

potential mediators were measured. Therefore, while other

aspects of intention-to-treat were still used, we scored sexual

assaults occurring after the post-test as the first occurrence of

this outcome. As randomization was effective in ensuring

equality between groups on all potential mediators measured

at baseline (Senn et al., 2015) and two mediators were

assessed using single-use measures only at post-test, the cur-

rent analysis used only mediator data obtained at the post-test

survey.

Measures

Sexual assault was measured using the Sexual Experiences

Survey–Short Form Victimization (SES-SFV; Koss et al.,

Table 1. Between-Group Comparisons of Participant Characteristics at the Time of Randomization.

Participant Characteristic EAAA

(n ¼ 434) Control

(n ¼ 423) p

Age in years, M (SD) 18.5 (1.2) 18.5 (1.2) .90 White race, n (%) 316 (72.8) 313 (74.0) .69 Heterosexual identity, n (%) 399 (91.9) 390 (92.2) .89 Living in a university residence, n (%) 235 (54.1) 230 (54.4) .95 Sexually active, n (%) 268 (61.7) 259 (61.2) .87 Currently involved in a romantic

relationship, n (%) 197 (45.4) 189 (44.7) .83

Currently involved in a sexual relationship, n (%)

191 (44.0) 196 (46.3) .49

Previous sexual assault education, n (%)

16 (3.7) 18 (4.3) .67

Previous self-defense training, n (%) 147 (33.9) 140 (33.1) .81 Sexual victimization since the age

of 14 years, n (%) Completed rape 95 (21.9) 98 (23.2) .65 Attempted rape 107 (24.6) 120 (28.4) .22

Perceived risk of acquaintance rape, M (SD)

1.83 (1.03) 1.80 (0.99) .71

Belief in female precipitation of rape, M (SD)

15.0 (7.5) 15.3 (7.2) .56

Rape myth acceptance, M (SD) 31.8 (12.0) 31.8 (11.6) .92 Self-defense self-efficacy, M (SD) 43.9 (7.8) 44.9 (8.3) .09

Note. EAAA ¼ Enhanced Assess, Acknowledge, Act.

Senn et al. 25

2007). The SES-SFV provides participants with seven items

consisting of a stem that describes a sexually coercive or

assaultive act or attempted act (e.g., “A man put his penis

into my vagina or [someone] inserted fingers or objects with-

out my consent by . . . ”), followed by five descriptions of perpetrator tactics or strategies (e.g., “using force, for exam-

ple, holding me down with their body weight, pinning my

arms, or having a weapon”). The tactics range from verbal

pressure to physical force. Given the gender-specific focus of

the program, we removed the gender-neutral reference to

“someone” to ensure reports were victimization by men only.

Participants responded to each stem and tactic based on the

frequency of occurrence (a) since the age of 14, (b) since the

baseline (1-week post-program), and (c) since the last survey

for 6- to 24-month follow-ups. When participants reported an

attempted or completed rape, they were prompted to use a

pop-up calendar to pick the (approximate if necessary) month

and the day the incident happened. As such, the outcome/

dependent variable in the mediation model is analyzed as

time-to-event. Victimization by attempted or completed rape

between the 1-week post-program survey and 12-months of

follow-up is the focus of the current analysis and randomiza-

tion to the EAAA program or control group is the causal

variable.

Mediators. Figure 1 illustrates the hypothesized chained mul- tiple mediation model. Primary mediators are those variables

hypothesized to have a direct link to the outcome. Secondary

mediators are hypothesized to influence primary mediators

without direct relationships to the outcome. Responses to

these measures at a 1-week post-test are the focus of the

current analysis. All measures demonstrated good internal

consistency in the current sample (Senn et al., 2017).

Primary Mediators. These included situational risk detec- tion, direct resistance, and self-defense self-efficacy. Situa-

tional risk detection was assessed using Testa et al.’s (2006)

measure that provides a hypothetical acquaintance dating

scenario with escalating coercion revealed at two time points

(collapsed data used here) and asks the question, “How likely

is it that the situation just described will result in . . . ” fol- lowed by 10 positive (e.g., “an evening that ends pleasantly”)

and negative (e.g., “You being upset by Michael’s behavior”)

outcomes. Participants rated the likelihood of each on a

7-point scale. The 6 item Direct Resistance subscale (Testa

et al., 2006, built on items from Norris et al., 1999, and Davis

et al., 2004) was used to measure willingness to use effective

self-defense strategies (e.g., “Forcefully push him away”) in a

hypothetical situation. It was administered following the

coercive dating scenario described above on the same

7-point likelihood Response Scale with the data collapsed

across the two time points. Self-defense self-efficacy was

measured by responses on a 7-point Confidence Scale to

11 items adapted by (Senn et al., 2017) of Marx et al.’s

(2001) adaptation of Ozer and Bandura’s (1990) scale (e.g.,

“If a situation develops in which you feel you could be in

danger of sexual assault, how confident are you that you

could successfully think up ways to get out of that situation

and then execute your plan?”).

Secondary Mediators. These include (a) a single-item mea- sure of perception of one’s own general risk of acquaintance

rape, Perceived Risk of Acquaintance Rape (“What are your

chances of being raped by someone you know?”), rated on a

5-point scale from “very likely” to “very unlikely” (adapted

from Gray et al., 1990); (b) a specific measure of victim

blaming, the 6-item Female Precipitation subscale of the Per-

ceived Causes of Rape Scale (Cowan & Campbell, 1995; e.g.,

“Rape is caused by women allowing the situation to get out of

control”); and (c) a general measure of rape myth beliefs, the

Illinois Rape Myth Acceptance Scale–Short Form (Payne

et al., 1999; e.g., “Men from nice middle-class homes almost

never rape”).

Statistical Analyses

Path analyses were used to fit the chained multiple mediator

models. Weibull proportional hazards regression models

were used because the outcomes were time-to-first completed

rape and time-to-first attempted rape and as such yielded

hazard ratios which can be interpreted as relative risks (i.e.,

risk ratios). The proportional hazards assumption was

assessed by plotting log(�log[survival]) versus the log of survival time and by testing the time dependent covariate in

the regression models.

The total effect of the EAAA program was estimated by

calculating unadjusted hazard ratios (HR) from Weibull propor-

tional hazards regression models that included the intervention

variable as the only predictor in the models. The direct effect

was estimated by calculating adjusted hazard ratios from regres-

sion models that consisted of the intervention variable and the

mediators. The percentage of the mediated intervention effect

was calculated from the respective intervention regression coef-

ficients in the total effect and direct effect models as follows:

100 � btotal effect � bdirect effectð Þ=btotal effect½ � (MacKinnon et al., 2007). The interpretation of the model findings was aided by

converting the resulting pathway unstandardized regression

coefficients (b) to hazard ratios for the primary mediators and

semipartial Pearson correlation coefficients for the secondary

mediators.

We tested the primary mediators jointly using a likelihood

ratio test to establish whether they are the process through

which the effects of the program are realized. Full mediation,

defined as a non-significant direct effect, would suggest that

the mediators explain the impact of EAAA, whereas partial

mediation (a significant direct effect) would suggest that the

mediators are important to the EAAA outcomes but not suf-

ficient to explain the outcome. Given that both the EAAA

program and control were conducted in group sessions, all

regression models accounted for clustering of outcomes

within group sessions by using the generalized Huber/

26 Psychology of Women Quarterly 45(1)

White/sandwich estimator of the variances. The extent of

clustering was characterized by design effects. All analyses

were conducted using Stata Version 16 (StataCorp LLC, Col-

lege Station, TX, USA) and SAS Version 9.4 (SAS Institute

Inc., Cary, NC, USA), and results with p values less than .05

were considered statistically significant.

Results

As shown in Table 1, the randomization of a relatively large

number of women into the trial yielded two similar groups

with regard to demographics, sexual experience, and poten-

tial mediators (those assessed pre-randomization), and

therefore no adjustment for baseline covariates was neces-

sary in the analyses. Among the 857 women included in the

present study, 52 (6.1%) experienced a completed rape and

43 (5.0%) experienced an attempted rape between the time of completing the post-test survey and 12 months of

follow-up, and only 2.1% (9 of 434) in the EAAA program and 2.6% (11 of 423) in control were lost to follow-up. As both the outcome event rates and lost to follow-up rates

observed in the present study were low, it is permissible

to calculate the percentage of the mediated intervention

effect from the respective intervention regression coeffi-

cients without concern of bias (Burgos Ochoa et al.,

2020). With regard to model proportionality assumptions,

the plots of log(�log[survival]) versus the log of survival time yielded relatively parallel lines and the test of the time

dependent covariate in the regression models yielded

non-significant p values (.36 and .14 for completed and

attempted rape, respectively). As the EAAA program and

control sessions were conducted in 93 groups (clusters),

Figure 2. Total Effect Models and Final Chained Multiple Mediator Models for Completed Rape and Attempted Rape.

Note. (Panel A) The total effect, relating intervention group to completed rape without mediators, in terms of a hazard ratio was .55 (b ¼ �.601, relative risk reduction ¼ 45%, p ¼ .037). After accounting for clustering the p value was .055. The total effect, relating intervention group to attempted rape without mediators, in terms of a hazard ratio was .41 (b ¼�.893, relative risk reduction ¼ 59%, p ¼ .011). (Panel B) The direct effect, relating intervention group to completed rape with mediators, in terms of a hazard ratio was .97 (b ¼�.029, relative risk reduction ¼ 3%, p ¼ .933); the percentage of the mediated intervention effect was 95.2% (p < .001). The direct effect, relating intervention group to attempted rape with mediators, in terms of a hazard ratio was .80 (b ¼�.217, relative risk reduction ¼ 20%, p ¼ .595); the percentage of the mediated intervention effect was 75.7% (p < .001). Solid lines represent significant paths and dashed lines represent nonsignificant but hypothesized paths. CpltRape ¼ completed rape; AttmRape ¼ attempted rape; OwnRisk ¼ perceived risk of acquaintance rape; FPrecip ¼ belief in female precipitation of rape; RapeMyth ¼ rape myth acceptance; RiskDet ¼ risk detection; DResist ¼ direct resistance; SDSE ¼ self-defense self-efficacy.

Senn et al. 27

with an average of 9.2 participants in each group, the

within-group clustering resulted in design effects of 1.19 for

completed rape and 1.11 for attempted rape.

For this sample of 857 women, the total effect of the

EAAA program was a 45.0% reduction in the risk of com- pleted rape (HR ¼ 0.55, p ¼ .037: ignoring clustering, p ¼ .055: accounting for clustering; Figure 2, Panel A). For attempted rape, the total effect of the EAAA program was a

59.0% reduction (p ¼ .011). Results from the final chained multiple mediation analyses are displayed in the path diagram

(Figure 2, Panel B) and numerically summarized in Table 2.

The three primary mediators in the hypothesized model,

when tested jointly, were responsible for a significant reduc-

tion in the sexual assault outcomes (likelihood ratio test, p <

.001). Some of the relationships (hazard ratios) between the

primary mediators and the outcomes were nonsignificant

because of the interrelationships among the mediators. All

are critical to the overall mediation model as evidenced by

the significant likelihood ratio test. The hypothesized

secondary mediators related to each other as predicted, rape

myth acceptance and belief in female precipitation partially

mediated the intervention’s effect on the perceptions of one’s

own general risk, and perception of personal risk and rape

myth acceptance mediated the intervention’s effect on risk

detection. One hypothesized path was not supported; belief in

female precipitation did not have a significant path directly to

risk detection.

The model fully mediated the intervention effects for both

completed rape and attempted rape by yielding direct effects

of 3% (p ¼ .93) and 20% (p ¼ .59) reductions in risk, respec- tively. Specifically, the model mediated 95.2% (p < .001) of the intervention effect for completed rape and mediated

75.7% (p < .001) for attempted rape. In our theoretical model, we assumed that secondary med-

iators work solely through a primary mediator, so we also

examined a model with paths from these secondary mediators

to the outcome to test this presumption. The percentage of

mediation did not increase. In addition, we evaluated whether

Table 2. Regression Coefficients for the Primary and Secondary Mediators in the Final Path Diagram With Respective Hazard Ratios and Correlation Coefficients for Completed and Attempted Rape.

Completed Rape Attempted Rape

Global Primary a Likelihood Ratio Test p Likelihood Ratio Test p

RiskDet! DResist!Outcome LR3df ¼ 31.92 <.001 LR3df ¼ 20.50 <.001 SDSE!

Primary mediators b

bAdjusted HRAdjusted p bAdjusted HRAdjusted p

RiskDet ! Outcome �0.060 0.94 .016 �0.025 0.97 .281 DResist ! Outcome �0.042 0.96 .032 �0.039 0.96 .033 SDSE ! Outcome �0.035 0.96 .121 �0.059 0.94 .006 Group ! Outcome �0.029 0.97 .933 �0.217 0.80 .595

Completed and Attempted Rape

Secondary mediators b bAdjusted rSemipartial p

Group ! OwnRisk 0.679 .24 <.001 FPrecip ! OwnRisk �0.018 �.07 .026 RapeMyth ! OwnRisk �0.013 �.08 .017 Group ! FPrecip �5.845 �.39 <.001 Group ! RapeMyth �1.868 �.07 .009 FPrecip ! RapeMyth 1.125 .64 <.001 OwnRisk ! RiskDet 0.446 .07 .027 FPrecip ! RiskDet 0.075 .05 .114 RapeMyth ! RiskDet �0.211 �.23 <.001 Group ! DResist 1.128 .06 .023 RiskAsmt ! DResist 0.523 .50 <.001 SDSE ! DResist 0.243 .20 <.001 Group ! SDSE 6.572 .46 <.001

Note. RiskDet ¼ risk detection; DResist ¼ direct resistance; SDSE ¼ self-defense self-efficacy; OwnRisk ¼ perceived risk of acquaintance rape; FPrecip ¼ belief in female precipitation of rape; RapeMyth ¼ rape myth acceptance; HR ¼ hazard ratio. a Likelihood ratio test assessing the joint (global) significance of the three primary mediators. b Each row indicates each mediator’s contribution to the model beyond their interrelations with other mediators; estimated from the final chained multiple mediator models that adjusted for all primary and secondary mediators and clustering.

28 Psychology of Women Quarterly 45(1)

an all-paths model would improve mediation of the outcome

over our theoretical model. Again, the percentage of media-

tion did not increase.

Discussion

In sexual violence prevention practice, we generally have

presumed that effective programs work to achieve their out-

comes in the ways that we theorized; however, we cannot

move our theory and practice forward unless we test these

models or mechanisms directly. Until recently, sexual vio-

lence prevention programs have not been sufficiently effec-

tive to warrant this type of exploration nor have the

evaluation studies been sophisticated enough in design, sam-

ple sizes, quality of measured outcomes, and so on, to allow

it. The current findings contribute to the sexual violence pre-

vention field by advancing our understanding of how a sexual

assault resistance program for university women works to

reduce the sexual victimization that women experience.

Although mediation analyses often focus on one media-

tor at a time (Baron & Kenny, 1986; Preacher & Hayes,

2004), we used a chained multiple mediation analysis,

which accounts for the relationships among the mediators.

This analysis confirmed that the theoretical model we tested

fully mediates the program’s effects on sexual assault. In

other words, the direct program effect is no longer statisti-

cally significant when the mediators are included in the

model. More important, and surprising perhaps, the theore-

tical model tested accounts for 95% of the reduction in completed rape and 76% of the reduction in attempted rape. This is an unusually large mediation effect and provides

strong support for EAAA’s theoretical and evidentiary

underpinnings (Nurius & Norris, 1996; Rozee & Koss,

2001). The theory works extremely well to explain the pos-

itive outcomes of sexual assault resistance education for

women students in the early stages of their university

studies.

Primary Mediators of Program Reductions in Sexual Assault

Based on theory and prior evidence, we hypothesized that the

EAAA program would reduce completed and attempted rapes

through changes in three key mechanisms—risk detection,

self-defense self-efficacy, and direct resistance. As expected,

the three primary mediators worked together in producing the

program’s effects on sexual assault.

We explicitly included two of the hypothesized primary

mediators, risk detection and self-defense efficacy, because

they were key aspects of Nurius and Norris’s cognitive eco-

logical model, the theory upon which the AAA approach

and the EAAA program are built. Risk detection is involved

in the primary appraisal of a social situation involving an

acquaintance as dangerous and, therefore, in need of a

response. Self-defense self-efficacy is involved in the

secondary appraisal of a coercive sexual situation as some-

thing that can be overcome by, or coped with, using

women’s own resources. Improving risk detection is gener-

ally viewed as a necessary goal of an intervention but not

sufficient to lead to better outcomes (Vitek et al., 2018).

After all, one could see danger and not know what to do,

say, or the options available to take actions, leading to pas-

sivity or non-response (Macy et al., 2006; Nurius et al., 2004).

Self-efficacy is critical to people being able to implement

changes in their lives (Bandura, 1977), and past research has

shown that confidence is related to an increased likelihood of

women responding assertively in sexual assault situations

(Vitek et al., 2018).

However, knowing more about one’s options and effective

responses and being willing to use them are also important to

action. Because expanding these available resources (i.e.,

women’s knowledge and capabilities) is theorized to reduce

barriers to resistance (Rozee & Koss, 2001), we also included

women’s selection of, and willingness to use, the resistance

strategies known to be the most effective in an acquaintance

sexual assault situation, namely, direct, forceful verbal and

physical strategies (e.g., Tark & Kleck, 2014).

This model supports the necessity of designing resistance

programming to influence all three primary mediator com-

ponents of the AAA model (Rozee & Koss, 2001). The

multiple mediation analysis shows how risk detection,

self-defense self-efficacy, and direct resistance strategies

operate when they are considered together. Risk detection

and direct resistance are correlated. After all, if danger is

not detected, assertive or forceful actions will not be taken,

and vice versa. Self-defense self-efficacy and direct resis-

tance are also correlated. This makes sense for exactly the

reason that we, and other researchers (Hollander, 2016,

2018; Rozee & Koss, 2001), argue for their inclusion in the

model. Specifically, they are both necessary for resistance

to be undertaken. A woman who lacks the general confi-

dence in her ability to take action to stand up for or defend

herself is unlikely to report that she would use defensive

actions in a specific situation. Similarly, high confidence

that she could problem-solve and defend herself in an

acquaintance situation could be misplaced, if she is unable

to detect risk in the early stages of the situation, when more

defensive options are available compared to later stages, or

if she lacks knowledge of likely effective strategies.

Altogether, these findings support Rozee and Koss’s

(2001) AAA conceptualization and claims that women

would benefit substantially from increased ability to assess

danger in acquaintance situations, overcome emotional

obstacles to acknowledge risk and feel prepared and confi-

dent knowing that resistance is possible, and then to take

action using their own judgment and the best strategies

available to them. Even though we measured risk detection

and direct resistance in response to hypothetical situations,

these factors together with self-defense self-efficacy

explained the lower levels of completed and attempted rape

Senn et al. 29

reported by the women across the year following program

participation. Therefore, the content and activities within

EAAA, which increased knowledge of sexual assault risk

cues in men’s behavior and in social situations, increased

theoretical and practical knowledge of effective resistance

strategies in acquaintance situations, and enhanced

women’s confidence in their own judgment and abilities

(Senn et al., 2017) all play important roles in reducing sex-

ual victimization.

Secondary Mediators of Program Reductions in Sexual Assault

Detection of danger is extremely difficult in acquaintance

social situations where building friendships or intimate rela-

tionships, studying, partying, or otherwise having fun are the

focus of the interactions, and coercive and controlling strate-

gies usually start slowly and escalate (Norris et al., 1996;

Norris et al., 1999; Nurius, 2000; Nurius & Norris, 1996).

Based on the research literature, we added three potential

secondary mediators affected by the EAAA program to the

theoretical model: women’s perceptions of their own general

risk of sexual assault, belief in rape myths, and the pernicious

myths that hold rape victims responsible. The analysis

strongly supported the indirect role of all three in achieving

program improvements in sexual victimization through

enhancing women’s ability to detect risk, one of the primary

mediators. However, unlike our test of mediation for the

sexual assault outcomes, which is based on prospective data,

our test of the mediation of the primary mediators was

cross-sectional, disallowing conclusions of causality. Never-

theless, these findings provide evidence of how improve-

ments in one of the primary mediators, risk detection,

might be accomplished by the program’s content and process.

We used only a single item measure of perception of own

general risk of sexual assault, which made underestimation of

effects more likely (e.g., Beal & Dawson, 2007). Despite this,

increasing women’s perceptions of their own general risk of

acquaintance sexual assault was an important link in the

chain to better risk detection in a specific situation. Vitek

et al. (2018) have suggested that the optimism bias may be

related to all three stages of the AAA model, not just risk

detection. In our test of the full (all paths) model, which failed

to improve mediation, paths from perception of general risk

to the other primary mediators, self-defense self-efficacy and

direct resistance (representing the final two stages of the

AAA conceptualization and secondary appraisal and coping

in the cognitive ecological model), were not supported.

Although a test of Vitek et al.’s hypothesis with a more

nuanced and robust measure should be attempted in the

future, our analysis suggests that the model works extremely

well when the benefits of increasing perception of one’s own

general risk modestly are presumed to act through increasing

risk detection.

As expected, the secondary mediators were inter-related.

Reducing women’s already low general rape myths, which

include but extend beyond victim-blaming attitudes, may

allow them to appreciate the gendered social reality and see

themselves as potentially vulnerable to acquaintance sexual

assault. In the analysis, lowered general rape myth accep-

tance was directly related to higher perception of one’s own

general risk, and then through that perception of personal risk

contributed to improvements in risk detection. We suspect

that undermining the general rape myths that focus on exclud-

ing known men from being considered as perpetrators could

be responsible for this contribution to risk detection. EAAA’s

ability to reduce woman-blaming beliefs specifically was also

important. It was indirectly related to increased risk detection

through women’s higher acknowledgment of their personal

risk of acquaintance sexual assault. Both the content and

philosophy of EAAA as well as the rigorous training process

for facilitators aim to ensure that woman-blaming is inter-

rupted and undermined as it arises during the group interven-

tion. This program feature proves to be very important in

improving participants’ risk detection through lower general

and specific rape myths.

To be clear, we are not calling for a return to the proble-

matic past practice of entirely, or primarily, focusing sexual

assault prevention on undermining rape myths (Morrison

et al., 2004). Unsurprisingly, given the complicated nature

of the cultural discourses about sexual assault and women’s

varied experiences, as well as the tenuous link between atti-

tudes and behavior (Fishbein & Ajzen, 2011), reducing neg-

ative attitudes about rape alone does not reliably increase

bystander behaviors or reduce victimization or perpetration

(DeGue et al., 2014; Fenton et al., 2016). This was confirmed

in our analysis as direct pathways from attitudes to the sexual

assault outcomes were not supported. Nevertheless, we have

shown that even though women hold relatively low levels of

belief in rape myths and victim-blaming and there is no direct

link to reduced sexual assault, reducing belief in rape myths

appears to have specific benefits for women’s resistance to

sexual assault. It is related to improved risk detection in

acquaintance situations. Faster and more accurate detection

of danger is necessary for the benefits of any resistance, risk

reduction, or self-defense program to be fully realized.

Attempted Versus Completed Rape

Our analyses were focused on two categories of sexual

assault. First, we applied the model to the completed (oral,

anal, and vaginal) rape outcome, which is central to most

studies of sexual assault prevention. The mediation model

explains the EAAA program’s effects across the diverse per-

petrator tactics assessed by the SES. Similar to other studies

of university students’ experiences, a large proportion of

these rape experiences involved alcohol (Abbey, 2011; Klein

et al., 2018; Krebs et al., 2009). Nonetheless, because past

research has demonstrated that alcohol consumption impairs

30 Psychology of Women Quarterly 45(1)

risk detection (e.g., Parks et al., 2016) and response/resis-

tance (e.g., Davis et al., 2004; Stoner et al., 2007) to sexual

coercion, future research could explore the specific ways in

which EAAA resistance education contributes to, and might

be limited in, reducing alcohol-involved sexual assaults

specifically.

Second, we tested the same theoretical model for

attempted rape. However, the model tested was based on

theory and evidence primarily derived from research on com-

pleted rape. Despite this, the same mediation model predicted

a large proportion of the program-produced reduction in

attempted rape. This suggests there is substantial overlap in

the mechanisms that explain EAAA’s positive effects in

reducing both completed and attempted rapes. A somewhat

lower percentage of mediated effect was found for attempted

rape (76% vs. 95%), which suggests that there may be room for other mediators to be added to the model when consider-

ing attempted rape. We provide some possible explanations

for the results involving attempted rape based on the current

study and past research to guide future research.

Women cannot control whether men in their social envir-

onments will be coercive, so reductions in attempted rape

victimization mean that some men who were coercive were

not able to execute their plans or increase their level of intru-

sion. Reductions in attempted rape may have been accom-

plished by women detecting early warning signs from verbal

indications of men’s attitudes (e.g., sexual entitlement) or

behavior (e.g., attempts to socially isolate them) and leaving

the situation before the men became coercive. This requires

trusting their instincts or perceptions at earlier stages, some-

thing that we did not directly measure. Further, they may

have used forceful verbal or physical strategies that inter-

rupted the trajectory of coercion (e.g., “you are crowding

me, MOVE AWAY” or a wrist-release to make him let go

as he grabbed her wrist to try to move her to a more isolated

location). Women tend to match their force to the force being

used against them (Tark & Kleck, 2014), so detailed study of

the forms of direct resistance corresponding with particular

instances of attempted rape may offer some clues to what

works some or most of the time. Alternatively, or in addition,

women may have engaged in other strategies to undermine

risk factors that enhance perpetrators’ advantages (e.g., iso-

lation) that are not included in the direct resistance measure

(e.g., called a friend to join them at the party when a guy who

was in attendance made them feel uncomfortable; Anderson

et al., 2016). Thus, our findings for attempted rape can be

explained (at least in part) by components of the AAA model.

However, because some (24%) of the program effect for attempted rape was not explained by the model, we likely

need to look beyond the AAA model to explain the program’s

success in reducing attempted rape. A combination of quan-

titative and qualitative research with women who have taken

resistance programs may be needed for further theory

development.

Directly measuring the benefits of the fourth unit’s posi-

tive sexuality enhancement of the AAA model could also

improve our understanding of how EAAA works to reduce

attempted rape. This unit contributes to resistance education

by challenging societal messages that women’s sexual desires

are of lesser importance than are those of men. It addresses

the absence of high-quality sexual education and discussion

of women’s sexual desires in society at large (Fine, 1988;

Fine & McClelland, 2006) and how normative (hetero)sexual

practices put men’s (presumed) sexual needs ahead of

women’s (Hollway, 1984). This latter discourse, in particular,

has been implicated in acquaintance sexual assault (Gavey,

2005). Due to participant burden, we did not measure

women’s awareness of their own desires and values or their

confidence in asserting these in various situations, although

earlier work has shown benefits (Senn et al., 2011). For het-

erosexual and bisexual women, who constituted the majority

of the sample, increases in sexual knowledge and confidence

would be expected to contribute to faster risk detection, par-

ticularly identification of sexual pressure and other coercive

tactics.

In general, it may be wise for future researchers to do what

we did not, that is, to think through the theoretical model for

attempted rape specifically from the start. In this way, addi-

tional constructs could be identified and measured. We

encourage researchers to include analysis of attempted rape

experiences and avoid treating them as “non-events”

(Cermele, 2010) or as less important (Hollander & Rodgers,

2014) when evaluating prevention programs and testing the-

oretical models so that we hone our broader sexual assault

prevention knowledge and skills.

Strengths and Limitations

Our study’s prospective design provided many benefits and

allowed us to test the influence of mediators at one point in

time (post-test) on subsequent sexual victimization. As a

result, we could infer causality for that outcome. However,

we could only do a cross-sectional analysis of the relationship

of the secondary mediators with the primary mediator, risk

assessment. Although risk detection was related to the atti-

tudes and beliefs serving as secondary mediators and these

attitudes and beliefs improved after participation in the pro-

gram, we cannot conclude that the improvements in risk

detection were produced by the changes in attitudes and

beliefs. Further research is needed.

Our sample size was large, our retention was high (>97%), and our conclusions are based on the responses of women

with and without rape experiences prior to their participation

in the research. Despite these strengths, our sample was not

large enough to reliably evaluate the model separately for

women with and without prior sexual victimization experi-

ence (i.e., to test whether victimization moderates the media-

tion model). We explore similarities and differences in

EAAA’s program effects for individual outcomes by prior

Senn et al. 31

victimization elsewhere (Senn et al., in press), but await

future research with larger samples for this more complex

analysis.

Our test of the theoretical model was applied to a large and

diverse sample of university students who identify as women.

We are working now to expand the populations who may

benefit from resistance programming of this type and would

then be able to test whether the same or similar mediation

model applies. We are currently adapting EAAA for younger

girls and will be evaluating the adapted version in an RCT.

We are also working with other scholars to lay the ground-

work for an adaptation of the EAAA model specifically for

trans-identified students, if it is appropriate.

The field has many good measures but needs more in the

domains key to women’s resistance to sexual violence and

several measures, which we used as the best available, have

limitations. Perception of personal risk is clearly important to

women’s ability to detect risk as we were able to conclude

this even with an imperfect single-item measure. Still, there is

a need for a multi-item measure of perception of sexual

assault risk (and the related optimism bias) with good psy-

chometric properties. We join other researchers (e.g., Vitek

et al., 2018) in also calling for improved measurement of risk

detection. Testa et al. (2006), building on the work of others

(Davis et al., 2004; Norris et al., 1999), developed the strong

measures of risk detection and direct resistance used in our

research. However, participants are responding to a specific

two-part scenario of a dating interaction with a coercive man.

Scenarios for acquaintance situations that are relevant for

women who do not date men, due to their sexual identity or

cultural/religious/political background, are needed. More-

over, an ability to measure and then collapse across responses

to multiple situations and contexts would strengthen the mea-

surement of the constructs. Other available risk perception

measures (Messman-Moore & Brown, 2006) could also be

improved with more scenario options. Currently, once these

measures have been used in a longitudinal study, they cannot

be presented again because the “end of the story” is now

known. This is a limitation for understanding how program

effects are mediated for the longer term.

Our analysis was also limited by our failure to include

measures of implied mediators. For example, we presumed

that if women improved their risk detection and used more

direct, forceful resistance strategies, they had overcome at

least some of the known obstacles to assessing, acknowled-

ging, and acting to resist acquaintance sexual assault. Our

analyses would have been improved by measuring changes

in women’s endorsement of known obstacles and assessing

whether this process variable acts as a primary or secondary

mediator. We also did not measure what is variously

described as relationship investment or motivation to main-

tain relationships with men, yet this is the hypothesized origin

of one specific psychological barrier to acknowledging dan-

ger and/or resisting men they know, particularly for hetero-

sexual women (Macy et al., 2007; Norris et al., 2018; Nurius

et al., 2004). EAAA explicitly acknowledges this motivation

(and its positive roots) and uses various approaches to under-

mine its application in circumstances where risk cues have

been detected. Explicit measurement of this barrier for

acquaintance rape resistance may have improved the model.

Some researchers have suggested that the experience of

learning physical and verbal self-defense changes how

women experience their bodies, including their sense of inha-

biting and having ownership of them (i.e., embodiment; see

Piran, 2016) and that this can lead to increased demands that

boundaries be respected and resistance when boundaries are

violated (Hollander, 2004; Hollander, 2014). Inclusion of

measures of embodiment and of experiences setting and pro-

tecting boundaries might both be fruitful additions for future

research. Qualitative research with young women who have

experienced the program could also potentially expand our

knowledge of other ways in which this type of education

affects them.

Practice Implications

The current study builds on our previously published research

in offering important insights for practitioners of empower-

ment self-defense. Previous analysis showed that a relatively

small number of hours (3 of 12) of instruction focused on

verbal and physical self-defense in acquaintance situations is

sufficient to increase confidence and willingness to use

the strategies that research has shown are most likely to be

effective. Current findings show that these two benefits also

contribute to reductions in attempted and completed rape.

Detecting risk in social situations and men’s behavior is nei-

ther obvious nor easy because of the emotional obstacles to

seeing danger when it is present in acquaintance situations.

Our findings show, however, that significant attention must

be paid to this kind of risk detection to achieve these dramatic

benefits. Finally, our findings demonstrate the importance of

creating a self-defense learning environment that directly

contradicts woman-blaming and rape myths.

In recent years, sexual violence prevention researchers

have come together in calling for universities to develop

comprehensive sexual violence prevention plans, including

both targeted and universal (bystander) prevention program-

ming to achieve meaningful change (e.g., Bonar et al., 2020;

Orchowski et al., 2018). By contrast, in the current political

climate with burgeoning roles and responsibilities and limited

resources, university administrators who are responsible for

developing prevention policies and staff in prevention roles

may feel pressured to offer a single, one-size fits all, online or

in person prevention program for students. The current study

provides compelling evidence to defend the implementation

of theoretically grounded, evidence-based prevention prac-

tices. The findings show the specific mechanisms by which

resistance education on campus works to empower women

and reduce the likelihood that they will experience sexual

violence. Specifically, offering sexual assault knowledge and

32 Psychology of Women Quarterly 45(1)

challenges to rape myths and perceptions that sexual violence

can only occur to others and not oneself lays the foundation

for effective education. However, this is not enough. Achiev-

ing large reductions in attempted and completed rape requires

that program content and practices build on this foundation

by improving risk detection in social interactions with

acquaintances, providing a context within which women can

safely identify and reduce emotional obstacles to risk detec-

tion and resistance, and increasing women’s repertoire of

effective strategies and confidence to interrupt and resist sex-

ual coercion and sexual assault attempts. Providing even

more benefit than we demonstrated may be possible through

enhanced programming; providing less is not defensible.

Conclusion

The chained multiple mediation analysis showed that the

hypothetical model underlying the EAAA program explains

the dramatic reductions in sexual violence experienced by

program participants. Sexual assault is not inevitable

(Bevacqua, 2000; Radtke et al., 2020). Empowering students

who identify as women with knowledge and skills and

providing a place and time for application and practice can

make a profound difference in their lives. Although we await

cultural change and interventions that can prevent sexual

violence perpetration reliably and substantially, resistance

education for women should be one critical piece of all com-

prehensive sexual assault prevention plans.

Authors’ Note

This study was registered with ClinicalTrials.gov (Identifier

NCT01338428). This article is based on data published in Senn

et al. (2015) and Senn et al. (2017). The trial protocol was published

in Senn et al. (2013).

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) disclosed receipt of the following financial support for

the research, authorship, and/or publication of this article: The study

was supported by an Operating Grant from the Canadian Institutes

of Health Research (FRN 110976) and by the University of

Windsor.

ORCID iD

Charlene Y. Senn https://orcid.org/0000-0002-3463-5704

Notes

1. Rozee and Koss (2001) also suggested a new direction for pre-

vention for young men which has not been taken up to our

knowledge.

2. This represents the important half of the two parts of the opti-

mism bias, the gap between own and other estimates (optimism

bias). This gap is being narrowed for women in the program

group only (p < .001) by the improvement in women’s own

perception of risk (unpublished analysis). As such, it is appropri-

ate to connect this change to the optimism bias.

3. Reduction in other forms of sexual assault was also observed.

Due to space limitations, we focus on attempted and completed

oral, vaginal, and anal rape due to their greater impacts on

women’s mental and physical health.

4. There was no evidence of sleeper effects.

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