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All experiences reported during 12 months of follow-up were classified into one of five sexual victimization categories: completed rape, attempted rape, coercion, attempted coercion, or nonconsensual sexual contact. The primary outcome was completed rape; other outcomes were prespecified as tertiary. (Secondary outcomes were psychological variables that were expected to mediate the effects of the intervention and are not included here.) Completed rape (oral, vaginal, or anal penetration) and nonconsensual sexual contact (nonpenetrative) were defined as nonconsensual sexual acts in which the perpetrator used threats, force, or drug or alcohol incapacitation. Coercion was considered to have occurred when perpetrators used pressure or manipulation (e.g., “threatening to end the relationship” or “continually verbally pressuring me”) to induce compliance in nonconsensual penetrative sexual acts. Attempted rape and attempted coercion were occasions in which the perpetrator tried to engage in the behavior but was not successful. For completed and attempted rapes, participants recorded the dates of occurrence.

The Mental Health Effects of Sexual Assault and Abuse

For the crime of rape and attempted rape, 40% of reported cases were among survivors under the age of 18
Outcomes were assessed in the modified intention-to-treat population, which included all eligible participants who completed one or more postrandomization survey. The primary analysis compared the incidence (first occurrence) of completed rape between the control group and the resistance group with the use of Kaplan–Meier failure curves (indicating the cumulative percentage of completed rapes among women in the respective groups) and the log-rank test. To account for the correlation among observations within group sessions, variance estimates were appropriately inflated for within-session clustering with the use of estimates of the design effect. The benefit of the resistance program was described in terms of relative risk reductions and the number of women who would need to participate in the program to prevent one additional completed rape from occurring within 1 year after participation. Because researchers have speculated that rates of attempted rape might be increased by resistance training, the incidence of attempted rape was also assessed.

 

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A review is presented of medico-legal examinations performed on two series of rape and attempted rape in 1975 ..
The curves show the cumulative percentage of completed rapes (Panel A) and attempted rapes (Panel B) among women in the control group and those in the resistance group during 1 year of follow-up. The insets show the same data on an enlarged y axis. P values calculated with the adjusted log-rank test accounted for the correlation among observations within group sessions (i.e., within-session clustering).

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In contrast to the four other outcomes evaluated, the risk of sexual coercion was not significantly reduced in the resistance group. We did not collect information on the context in which attempted and completed coercion took place. Most attempted and completed rapes are committed by men who are in female students’ social environment (acquaintances and classmates), whereas sexual coercion occurs more frequently in longer-term sexual relationships. It is possible that the discrepant results are explained in part by differences in the relationships in question. The resistance program focused on male acquaintances and new or early intimate relationships, to reflect the limited relationship history of first-year students. Despite this, the risk of sexual coercion was high among this cohort, which suggests that adding more education related to resisting coercion in relationships may be valuable.


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A total of 451 women were assigned to the resistance group and 442 women to the control group. Of the women assigned to the resistance group, 91% attended at least three of the four units. The 1-year risk of completed rape was significantly lower in the resistance group than in the control group (5.2% vs. 9.8%; relative risk reduction, 46.3% [95% confidence interval, 6.8 to 69.1]; P=0.02). The 1-year risk of attempted rape was also significantly lower in the resistance group (3.4% vs. 9.3%, P

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The Enhanced Assess, Acknowledge, Act Sexual Assault Resistance program consisted of four 3-hour units that involved information-providing games, mini-lectures, facilitated discussion, and application and practice activities. The first author developed, revised, and pilot-tested the program between 2005 and 2011. The names (Assess, Acknowledge, and Act) and content of the first three units were based on recommendations by Rozee and Koss for a resistance program for women. These authors drew heavily on the work of Ullman regarding successful rape self-defense strategies and on Nurius and Norris’s “cognitive ecological” model, which provided a theoretical framework for the environmental and psychological factors that affect women’s responses to sexual assault. The fourth unit (Sexuality and Relationships) adapted content from the Our Whole Lives sexuality-education curricula. Participants assigned to the resistance group could choose to attend sessions for all the units in one weekend (two units each day) or for one unit per week for 4 weeks.

by Yehudit Barsky Middle East Quarterly December 1998, pp

The 1-year risk of completed rape was significantly lower in the resistance group than in the control group (5.2% vs. 9.8%; relative risk reduction, 46.3%; 95% confidence interval [CI], 6.8 to 69.1; P=0.02), indicating that only 22 women would need to take the program in order to prevent one additional rape from occurring within 1 year after participation (). The benefit of the resistance program occurred early, and its efficacy was sustained throughout the 1-year follow-up period (). The program also reduced the incidence of attempted rape (3.4% in the resistance group vs. 9.3% in the control group; relative risk reduction, 63.2%; P and ). Incidences of nonconsensual sexual contact and attempted coercion were lower in the resistance group than in the control group, but there was no significant reduction in coercion in the resistance group ().