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Bystander Program to Reduce Sexual Violence by Witnessing Parental Intimate Partner Violence Status

Open AccessPublished:March 09, 2022DOI:https://doi.org/10.1016/j.amepre.2021.12.022

      Introduction

      Youth who witness parental intimate partner violence are at increased risk for sexual violence. Existing data from a cluster RCT were used to determine the effectiveness of Green Dot bystander intervention to reduce sexual violence among high-school students who did and did not witness parental intimate partner violence.

      Study Design

      A secondary analysis was conducted in 2021 of extant data from a 5-year cluster RCT.

      Setting/Participants

      A total of 26 high schools in Kentucky were randomized to intervention or control condition in 2010. A total of 15,863 surveys were analyzed from baseline, 30,014 from partial intervention implementation (Years 1 and 2), and 25,907 from full implementation (Years 3 and 4). The sample was stratified to include students who witnessed or did not witness parental intimate partner violence.

      Intervention

      The bystander intervention program was delivered in 2 stages. During partial implementation, a persuasive speech describing rates, risk factors, and bystander-based approaches to violence prevention was provided to most students in schools randomized to the intervention. During full implementation, an in-depth 5-hour skill-based bystander training was provided to popular opinion leaders among the students in intervention schools (10%–15%).

      Main Outcome Measures

      The primary outcome was sexual assault measured as perpetration and victimization. Secondary outcomes included sexual harassment and stalking, measured as victimization and perpetration.

      Results

      During full implementation, among students who witnessed parental intimate partner violence, the intervention was associated with significant reductions in sexual assault perpetration (β= −0.21, p<0.01), sexual harassment perpetration (β= −0.29, p<0.001), sexual assault victimization (β= −0.25, p<0.01), and sexual harassment victimization (β= −0.45, p<0.001). For students who did not witness parental intimate partner violence, the intervention was only associated with reductions in sexual harassment (β= −0.19, p<0.001) and stalking (β= −0.09, p<0.01) victimization.

      Conclusions

      As implemented in the parent RCT, the bystander training was more effective at reducing violent outcomes among those who witnessed parental intimate partner violence than in those who did not witness parental intimate partner violence.

      Trial Registration

      This study is registered at www.ClinicalTrials.gov, under identifier NCT01878097.

      INTRODUCTION

      Sexual violence (SV) includes attempted or completed nonconsensual sex, unwanted sexual contact, and sexual harassment.
      • Basile K
      • Smith S
      • Breiding M
      • Black M
      • Mahendra R.
      Sexual violence surveillance: uniform definitions and recommended data elements, version 2.0.
      SV often co-occurs with other forms of violence such as stalking.
      • Wilkins N
      • Tsao B
      • Hertz M
      • Davis R
      • Klevens J.
      Connecting the Dots: an overview of the links among multiple forms of violence.
      Rates of sexual assault, stalking, and sexual harassment are quite high among high-school students,
      • Smith S
      • Zhang X
      • Basile K
      • et al.
      The National intimate partner and sexual violence survey: 2015 data brief - updated release.
      with elevated risk among youth who have witnessed parental intimate partner violence (IPV).
      Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention
      Preventing multiple forms of violence: a strategic vision for connecting the dots.
      ,
      • Finkelhor D
      • Turner H
      • Hamby S
      • Ormrod R.
      Polyvictimization: children’s exposure to multiple types of violence, crime, and abuse.
      Negative consequences of SV include depression, post-traumatic stress, anxiety, sleep and eating disorders, and substance use.
      • Smith S
      • Zhang X
      • Basile K
      • et al.
      The National intimate partner and sexual violence survey: 2015 data brief - updated release.
      One in 4 youth report witnessing parental IPV.
      • Hamby SL
      • Finkelhor D
      • Turner H
      • Ormrod R.
      Children’s exposure to intimate partner violence and other family violence.
      Witnessing parental IPV is considered an adverse childhood experience (ACE), which is highly correlated with other known ACEs.
      • Merrick MT
      • Ford DC
      • Ports KA
      • Guinn AS.
      Prevalence of adverse childhood experiences from the 2011-2014 Behavioral Risk Factor Surveillance System in 23 states [published correction appears in JAMA Pediatr. 2018;172(11):1104].
      Youth who witness IPV are at increased risk of using or experiencing SV themselves

      Sexual violence: risk and protective factors. Centers for Disease Control and Prevention. https://www.cdc.gov/ViolencePrevention/sexualviolence/riskprotectivefactors.html. Updated February 5, 2021. Accessed May 5, 2021.

      owing to a myriad of factors, including parentally modeled acceptance of IPV and SV,
      • Karlsson ME
      • Calvert M
      • Hernandez Rodriguez J
      • Weston R
      • Temple JR
      Changes in acceptance of dating violence and physical dating violence victimization in a longitudinal study with teens.
      ,
      • Kinsfogel KM
      • Grych JH.
      Interparental conflict and adolescent dating relationships: integrating cognitive, emotional, and peer influences.
      structural inequities, and carceral responses that create unsafe environments for youth.
      • Cannon C
      • Ferreira RJ
      • Buttell F.
      Critical race theory, parenting, and intimate partner violence: analyzing race and gender.
      Identifying best practices for preventing violence among this high-risk group is essential to ending the cycle of family violence.
      • Wilkins N
      • Tsao B
      • Hertz M
      • Davis R
      • Klevens J.
      Connecting the Dots: an overview of the links among multiple forms of violence.
      Bystander intervention programs have been universally implemented as primary prevention methods in high schools and colleges.
      • Kettrey HH
      • Marx RA
      • Tanner-Smith EE
      Effects of bystander programs on the prevention of sexual assault among adolescents and college students: a systematic review.
      One such program, Green Dot, has demonstrated positive outcomes on violent outcomes, including reductions in victimization and perpetration of SV, stalking, sexual harassment, and dating violence (DV) among high-school students using a cluster RCT design.
      • Coker AL
      • Bush HM
      • Cook-Craig PG
      • et al.
      RCT testing bystander effectiveness to reduce violence.
      These programs often aim to prevent SV, yet limited data establish program efficacy to reduce violence.
      • Kettrey HH
      • Marx RA
      • Tanner-Smith EE
      Effects of bystander programs on the prevention of sexual assault among adolescents and college students: a systematic review.
      Bystander intervention programs have not been evaluated for their effectiveness within the high-risk group of youth who witness parental IPV. Witnessing parental IPV is the strongest risk factor for adult IPV victimization
      • Park S
      • Kim SH.
      The power of family and community factors in predicting dating violence: a meta-analysis.
      and is also associated with SV victimization/perpetration later,

      Sexual violence: risk and protective factors. Centers for Disease Control and Prevention. https://www.cdc.gov/ViolencePrevention/sexualviolence/riskprotectivefactors.html. Updated February 5, 2021. Accessed May 5, 2021.

      underscoring the need to intervene early. Prior research indicates that bystander intervention programs are effective at reducing violence norms,
      • Kettrey HH
      • Marx RA
      • Tanner-Smith EE
      Effects of bystander programs on the prevention of sexual assault among adolescents and college students: a systematic review.
      ,
      • Coker AL
      • Bush HM
      • Brancato CJ
      • Huang Z
      • Clear ER
      • Follingstad DR.
      Longer term impact of bystander training to reduce violence acceptance and sexism.
      • Coker AL
      • Bush HM
      • Brancato CJ
      • Clear ER
      • Recktenwald EA.
      Bystander program effectiveness to reduce violence acceptance: RCT in high schools.
      • Edwards KM
      • Banyard VL
      • Sessarego SN
      • Waterman EA
      • Mitchell KJ
      • Chang H.
      Evaluation of a bystander-focused interpersonal violence prevention program with high school students.
      which in turn have been found to mediate the effectiveness of interventions at the school level.
      • Bush HM
      • Coker AL
      • DeGue S
      • Clear ER
      • Brancato CJ
      • Fisher BS.
      Do violence acceptance and bystander actions explain the effects of Green Dot on reducing violence perpetration in high schools?.
      This may be particularly important among youth who witness parental IPV as they have elevated rates of violence acceptance
      • Karlsson ME
      • Calvert M
      • Hernandez Rodriguez J
      • Weston R
      • Temple JR
      Changes in acceptance of dating violence and physical dating violence victimization in a longitudinal study with teens.
      ,
      • Kinsfogel KM
      • Grych JH.
      Interparental conflict and adolescent dating relationships: integrating cognitive, emotional, and peer influences.
      ; however, these relationships have not been explored at the individual level.
      This study examined whether the bystander intervention program reduces SV among high-school students who did and did not witness parental IPV and whether violence acceptance is a mediator of these relationships. Prior analyses using these data demonstrate that the intervention is effective at reducing violent outcomes.
      • Coker AL
      • Bush HM
      • Cook-Craig PG
      • et al.
      RCT testing bystander effectiveness to reduce violence.
      A multigroup path analysis approach (stratifying the sample based on witnessing parental IPV) tested the conceptual model (Figure 1). It was hypothesized that students in intervention schools would receive more training than students in control schools (Path A). The students who received more training would have lower levels of violence acceptance (Paths B and C). It was expected that there would be a positive association between violence acceptance and violent outcomes (Paths D–O), such that higher levels of violence acceptance are associated with greater frequencies of victimization and perpetration. It was expected that students from the intervention school would report lower frequencies of violent outcomes (Paths P–U). Direct paths from training received to violence outcomes were not estimated because the training focuses on increasing bystander behaviors at the school level to reduce violence and does not directly address individual-level risk- or perpetration-reduction techniques. Prior analyses using these data
      • Coker AL
      • Bush HM
      • Cook-Craig PG
      • et al.
      RCT testing bystander effectiveness to reduce violence.
      ,
      • Bush HM
      • Coker AL
      • DeGue S
      • Clear ER
      • Brancato CJ
      • Fisher BS.
      Do violence acceptance and bystander actions explain the effects of Green Dot on reducing violence perpetration in high schools?.
      have focused on school-level outcomes and have not investigated efficacy among the high-risk group of students who witnessed parental IPV. This investigation fills those gaps by stratifying the sample based on witnessing parental IPV status, using the individual as the unit of analysis, and examining the impact of amount of training received.
      Figure 1
      Figure 1Path model for Phase 1 and 2.
      DV, dating violence.

      METHODS

      Data for the secondary analysis came from a 5-year cluster RCT to evaluate the effectiveness of Green Dot.
      • Coker AL
      • Bush HM
      • Cook-Craig PG
      • et al.
      RCT testing bystander effectiveness to reduce violence.
      ,
      • Clear ER
      • Coker AL
      • Cook-Craig PG
      • et al.
      Sexual harassment victimization and perpetration among high school students.
      In the parent study, 26 Kentucky high schools were randomized to the intervention (13 schools) or waitlist control condition (13 schools; 1:1 allocation ratio) using simple randomization procedures (details in Coker et al.
      • Coker AL
      • Bush HM
      • Cook-Craig PG
      • et al.
      RCT testing bystander effectiveness to reduce violence.
      ). Baseline surveying was conducted in all schools in spring 2010 (Year 0 of the study). A parental passive consent protocol was approved. All the parents of students in the participating high schools received a letter describing the study, and they were asked to notify the research staff if they did not want their child to participate. Students whose parents refused were not contacted in schools. Assent was obtained directly from students. The same survey was administered by research staff each spring (2010–2014). Because data collection was anonymous, the school and not the individual was the unit of analysis for prior longitudinal analyses. The University of Kentucky IRB approved the study protocol for this parent study, and the current secondary analyses were determined to be not human subjects research by the IRB at the University of North Carolina at Charlotte.
      Rape Crisis Center Educators (Educators) received training to provide the intervention beginning fall 2010. Intervention training was implemented in 2 phases: persuasive speeches as Phase I and in-depth bystander training to popular opinion student leaders (POLs) as Phase II. Phase I began in fall 2010 (Year 1) and Phase II began as early as fall 2011. During partial implementation (Years 1 and 2), schools focused on implementing Phase I activities. More than 50% of students in the intervention schools received Phase I training: 50-minute persuasive speeches delivered by Educators. These speeches described rates, risk factors, and bystander-based approaches to violence prevention. These overview speeches were provided annually to students in the intervention schools. During full implementation (Years 3 and 4), schools focused on implementing Phase II activities. This included the in-depth 5-hour skill-based bystander training provided to POLs, representing 10%–15% of the student body. POLs were identified by staff at the intervention schools. All intervention schools successfully implemented Phase I and Phase II activities. Control schools continued programming as usual, with research staff ensuring that no bystander intervention program was implemented.

      Study Sample

      Participants were high-school students aged 14–18 years. Unlike previous analyses from the parent study,
      • Coker AL
      • Bush HM
      • Cook-Craig PG
      • et al.
      RCT testing bystander effectiveness to reduce violence.
      ,
      • Bush HM
      • Coker AL
      • DeGue S
      • Clear ER
      • Brancato CJ
      • Fisher BS.
      Do violence acceptance and bystander actions explain the effects of Green Dot on reducing violence perpetration in high schools?.
      this analyses focused on individuals as the unit of analysis within phase of implementation (baseline, partial implementation, and full implementation). Data from the parent study were limited to individuals who were not missing information on all demographic variables nor violence or intervention training items. In addition, surveys were excluded if they contained mischievous responses (additional details provided by Coker and colleagues
      • Coker AL
      • Bush HM
      • Cook-Craig PG
      • et al.
      RCT testing bystander effectiveness to reduce violence.
      ). This resulted in a data set containing 74,878 surveys. For this analysis, additional surveys were excluded if there was data missing on any of the variables of interest (n=3,094, 4.1%). An analysis comparing survey completers to noncompleters found that a greater proportion of survey noncompleters were in higher grades; received a free or reduced-priced meal; witnessed parental IPV; and were male, non-White, and not exclusively heterosexual compared with survey completers (p<0.001). Multiple imputation was not used to replace missing variables owing to the dubious accuracy of predicting scores on behavioral outcomes like violence victimization and perpetration and the relatively small amount of missingness. A total of 15,863 surveys were included from baseline, 30,014 surveys from partial intervention implementation years, and 25,907 surveys from full implementation years (Appendix Figure 1, available online, contains the CONSORT diagram). Sample size was determined a priori by the parent study based on the number of rape crisis centers in Kentucky.
      • Coker AL
      • Bush HM
      • Cook-Craig PG
      • et al.
      RCT testing bystander effectiveness to reduce violence.

      Measures

      Detailed information about the materials used, including psychometric properties, have been described elsewhere.
      • Cook-Craig PG
      • Coker AL
      • Clear ER
      • et al.
      Challenge and opportunity in evaluating a diffusion-based active bystanding prevention program: Green Dot in high schools.
      Exposure variables included being in an intervention or control school and the amount of training a student received (coded ordinally as 0=no training because they were in a control school, 1=no training from an intervention school, 2=received overview speech only, or 3=received 5-hour skill-based training).
      The primary outcome was victimization by and perpetration of sexual assault within the past 12 months. A total of 3 questions were used to learn about the frequency of sexual assault, including: Had sexual activities even though you didn't really want to because they threatened to end your friendship or romantic relationship if you didn't or because you felt pressured by the other person's constant arguments or begging; had sexual activity when you didn't want to because the other person threatened to use or used physical force (like twisting your arm, holding you down); and had sexual activity when you didn't want to because you were drunk or using drugs. These items were revised for high-school populations from the National Intimate Partner and Sexual Violence Survey.
      • Black M
      • Basile KC
      • Brieding M
      • et al.
      The National intimate partner and sexual violence survey (NISVS) 2010 summary report.
      Secondary outcomes included victimization by, and perpetration of, sexual harassment, and stalking within the last 12 months. A total of 3 questions asked about sexual harassment, including: Tell stories or jokes that made you uncomfortable; make gestures, rude remarks, or use sexual body language to embarrass or upset you; and keep asking you out on a date or asking you to hookup even though you said “no.” These items were revised from the Sexual Experiences Questionnaire.
      • Fitzgerald LF
      • Magley VJ
      • Drasgow F
      • Waldo CR.
      Measuring sexual harassment in the military: the sexual experiences questionnaire (SEQ-DoD).
      A total of 3 questions asked about stalking, including: You were followed, spied on, or monitored using computer software, cameras, listening tools, or GPS; someone showed up at your home, school, or work or waited for you when you did not want them to; and you received unwanted phone calls, gifts, e-mails, text messages, or notes/pictures posted on social networking sites for example, Facebook, MySpace, or Twitter. These items were revised based on the National Violence Against Women Survey.
      • Tjaden P
      • Thoennes N.
      Prevalence, incidence, and consequences of violence against women: findings from the National Violence Against Women Survey.
      Categorical frequency response options were provided for each question, which were summed. The possible range of each outcome variable was 0–18.
      Potential mediators included endorsement of rape myths and DV acceptance. Rape myths were assessed for using a modified version of the Illinois Rape Myth Scale.
      • Payne DL
      • Lonsway KA
      • Fitzgerald LF.
      Rape myth acceptance: exploration of its structure and its measurement using the Illinois Rape Myth Acceptance Scale.
      A confirmatory factor analysis was used to determine items for inclusion.
      • Mennicke A
      • Bush HM
      • Brancato CJ
      • Coker AL.
      Bystander intervention efficacy to reduce teen dating violence among high school youth who did and did not witness parental partner violence: a path analysis of a cluster RCT.
      The final score omitted the item, Girls lead a guy on and then they claim sexual assault, resulting in a 6-item scale. Possible scores on this summed measure ranged from 0 to 18, with higher scores indicating greater endorsement of rape myths. A total of 5 items taken from the Acceptance of General Dating Violence subscale of the Acceptance of Couple Violence scale
      • Foshee VA
      • Bauman KE
      • Arriaga XB
      • Helms RW
      • Koch GG
      • Linder GF.
      An evaluation of safe dates, an adolescent dating violence prevention program.
      were used to assess the student's DV acceptance. Possible scores on this summed measure ranged from 0 to 15, with higher scores indicating greater DV acceptance.
      The sample was stratified based on the student's report of witnessing parental IPV. This was assessed by asking participants to indicate if they saw or heard a parent or guardian being hit, slapped, punched, shoved, kicked, or otherwise physically hurt by their spouse or partner. Response options were dichotomized to 0=never or 1=ever. This simplistic measure of exposure to parental IPV was used because of space and timing considerations and has its limitations
      • Øverlien C
      • Holt S.
      European research on children, adolescents and domestic violence: impact, interventions and innovations.
      ; however, it is consistent with the measurement of ACEs.
      • Shonkoff JP.
      Capitalizing on advances in science to reduce the health consequences of early childhood adversity.
      Potential confounding variables included sex (male/female), sexual orientation (exclusively heterosexual/not exclusively heterosexual), receipt of a free or reduced-price meal (yes/no), race (White/student of color), and relationship status (yes, in the past year/not in the past year). These variables were included as potential confounders based on prior research finding associations between victimization/perpetration and these demographic characteristics.
      • Clear ER
      • Coker AL
      • Cook-Craig PG
      • et al.
      Sexual harassment victimization and perpetration among high school students.

      Statistical Analysis

      Data analysis was completed in 2021. Descriptive statistics (n, mean, SD, and %) were used to characterize study participants. Bivariate statistics (2-sample t-tests and chi-square tests) were used to identify differences between stratified groups and intervention conditions on demographic characteristics, mediators, and outcome variables.
      Multigroup path analyses were used to test the path model in Figure 1 using SPSS Amos, version 26 for partial implementation and full implementation stages. Because training was not implemented, direct paths from intervention group to rape myths and DV acceptance were examined to test for any preintervention differences in these variables, for baseline. A path analysis approach was used instead of a multilevel modeling accounting for school-level clustering because of the low observed intraclass correlation values (≤0.01) and the structure of the data. Within each stage, frequencies of victimization and perpetration were adjusted for using the following demographic variables: sex, sexual orientation, receipt of a free or reduced-price meal, race, and relationship status. To ensure there was no multicollinearity between independent variables, variance inflation factor statistics were examined, and no problems were identified.
      Multigroup path analyses (estimating model fit and paths for 2 groups at once) were used to examine how the intervention operates at the individual level between those who witnessed parental IPV and those who did not witness parental IPV. Because individuals are not linked over time (precluding the ability to use ANCOVAs accounting for baseline characteristics
      • Twisk J
      • Proper K.
      Evaluation of the results of a randomized controlled trial: how to define changes between baseline and follow-up.
      ), the path analyses were conducted separately for each phase. First, the path model was tested using the full group (including both students who did and did not witness parental IPV) within each implementation stage, then the models were tested using a multigroup approach (stratifying by witnessing parental IPV status). The multigroup model was retained if the chi-square difference indicated it was a better fit to the data (p<0.05). Models were considered a good fit to the data if the root mean square error of approximation (RMSEA) and standardized root mean squared residual (SRMR) were ≤0.1 and if the comparative fit index (CFI) was ≥0.90.
      • Kline R.
      Principles and Practices of Structural Equation Modeling.
      Ideally, in a path model the chi-square test should be not significant (p>0.05); however, this test is sensitive to sample size, and because the size of this sample was quite large, this criterion was not used for evaluation of model fit.

      RESULTS

      At baseline, 55% of students identified as female, students were approximately evenly distributed through Grades 9–11 with fewer in Grade 12, 84% were White, 43% received a free or reduced-price lunch, 87% indicated their sexual orientation as exclusively heterosexual, 25% witnessed parental IPV, and 81% indicated they had been in a relationship in the past 12 months (Appendix Table 1, available online). Randomization produced intervention conditions with similar demographic characteristics and scores on outcomes at baseline, with the exception of race. At baseline, frequency of each violent outcome was statistically equivalent for students assigned to intervention and control schools; however, scores on rape myths and DV acceptance were lower for students from control schools. With the exception of grade, there were significant differences on all demographic variables between witnessing parental IPV groups. At baseline, students who witnessed parental IPV had higher scores on rape myths, DV acceptance, and violent outcomes.
      Table 1Comparing Absolute Mean of Outcome Variables Within Stage Between Intervention Groups
      VariablesBaselinePartial implementation stageFull implementation stage
      Did not witness parental IPVDid witness parental IPVDid not witness parental IPVDid witness parental IPVDid not witness parental IPVDid witness parental IPV
      Control n=5,970,Int n=5,943,Control n=2,008,Int n=1,942,Control n=10,889,Int n=12,927,Control n=2,837,Int n=3,361,Control n=10,180,Int n=10,937,Control n=2,46,Int n=2,337,
      M (SD)M (SD)M (SD)M (SD)M (SD)M (SD)M (SD)M (SD)M (SD)M (SD)M (SD)M (SD)
      Rape myths4.56 (2.73)**4.70 (2.88)*4.91 (3.10)5.03 (3.24)4.14 (2.80)4.21 (2.94)4.95 (3.49)5.01 (3.70)3.92 (2.82)**3.75 (2.80)*5.02 (3.84)**4.65 (3.59)*
      DV acceptance2.96 (2.60)3.06 (2.64)3.52 (3.03)3.68 (3.02)2.42 (2.56)**2.52 (2.67)*3.39 (3.34)3.49 (3.44)2.39 (2.56)**2.24 (2.46)*3.57 (3.61)**3.27 (3.33)*
      Sexual assault perpetration0.20 (1.47)0.17 (1.43)0.77 (3.68)0.79 (3.65)0.19 (1.16)0.21 (1.36)0.49 (2.42)0.58 (2.52)0.18 (1.27)0.16 (1.10)0.77 (3.32)**0.49 (2.51)*
      Sexual assault victimization0.93 (2.19)1.00 (2.30)1.11 (2.93)1.17 (3.00)0.67 (2.03)**0.75 (2.19)*1.17 (2.89)1.26 (2.91)0.74 (2.21)0.70 (2.05)1.33 (3.18)1.16 (2.90)
      Sexual harassment perpetration0.79 (2.93)0.76 (2.72)1.40 (4.21)1.56 (4.50)0.16 (0.83)0.20 (1.05)0.60 (2.45)0.68 (2.56)0.15 (0.88)0.13 (0.87)0.83 (3.20)**0.59 (2.68)*
      Stalking perpetration0.05 (0.21)0.04 (0.20)0.10 (0.30)0.11 (0.32)0.17 (0.92)0.17 (0.92)0.38 (1.37)0.42 (1.41)0.14 (0.77)0.13 (0.75)0.42 (1.33)0.36 (1.27)
      Sexual harassment victimization2.10 (3.44)2.21 (3.53)3.78 (4.62)3.62 (4.40)0.50 (1.46)0.53 (1.53)1.28 (2.58)1.28 (2.52)0.49 (1.52)0.44 (1.40)1.42 (2.91)**1.20 (2.62)*
      Stalking victimization0.38 (1.40)0.38 (1.50)2.05 (3.60)2.12 (3.58)0.39 (1.22)0.41 (1.27)0.97 (2.18)1.02 (2.23)0.38 (1.19)0.35 (1.13)1.10 (2.57)**0.91 (2.12)*
      Note: Boldface indicates statistical significance (*p<0.05, **p<0.01).
      DV, dating violence; Int, intervention; IPV, intimate partner violence; M, mean.
      Among students who did not witness parental IPV, students in intervention schools had higher rape myth scores at baseline compared with students who did not witness parental IPV in control schools (Table 1). During partial implementation, students who did not witness parental IPV in intervention schools had higher levels of DV acceptance and reported being victimized by SV more frequently than students who did not witness parental IPV in control schools. During full implementation, students who did not witness parental IPV in intervention schools had lower rape myths and DV acceptance scores than students who did not witness parental IPV in control schools.
      Among students who did witness parental IPV, no differences were observed between students from control or intervention schools on any of the outcome variables during baseline or partial implementation (Table 1). During full implementation, students who witnessed parental IPV in intervention schools had lower rape myths scores, DV acceptance, sexual harassment and SV perpetration, and sexual harassment and stalking victimization.
      The models testing intervention status, amount of training received, and violence acceptance on violent outcomes were a good fit to the data at each implementation stage (baseline: RMSEA=0.06, SRMR=0.04, CFI=0.93; partial implementation: RMSEA=0.05, SRMR=0.04, CFI=0.96; full implementation: RMSEA=0.05, SRMR=0.04, CFI=0.96). For each implementation phase, the multigroup path analysis was a better fit to the data than the full group model (baseline: chi-square difference=80, df=25, p<0.001; partial implementation: chi-square difference=163, df=38, p<0.001; full implementation: chi-square difference=117, df=38, p<0.001).
      The models tested the strength, direction, and significance of paths from intervention assignment to violent outcomes, operating through amount of training received and violence acceptance (Table 2). As anticipated, violence acceptance (rape myths and DV acceptance) was positively associated with each violent outcome (perpetration and victimization) for both witnessing parental IPV groups across all implementation stages (p<0.001). The strength of the associations was higher for students who witnessed parental IPV compared with students who did not witness parental IPV across implementation stages, as indicated by the CIs for the unstandardized regression betas. Implementation stage did not alter the strength of association for those who did not witness parental IPV. However, for students who did witness parental IPV, the strength of the association was higher in the later stage of implementation.
      Table 2Unstandardized Beta Estimates (99% CI) of Path Model Predicting Violence Outcomes
      PathsBaseline Year 0Partial implementation Years 1 and 2Full implementation Years 3 and 4
      No witness n=7,885, β (99% CI)Yes witness n=7,978, β (99% CI)No witness n=16,288, β (99% CI)Yes witness n=13,726, β (99% CI)No witness n=13,274, β (99% CI)Yes witness n=12,633, β (99% CI)
      Intervention to…
       Training received1.66** (1.65, 1.68)1.61** (1.58, 1.64)1.59** (1.57, 1.61)1.56** (1.52, 1.59)
       SA perp−0.04 (−0.09, 0.01)−0.03 (−0.21, 0.15)0.01 (−0.03, 0.05)0.02 (−0.15, 0.19)−0.11 (−0.04, 0.02)−0.21* (−0.41, −0.01)
       SA vic−0.03 (−0.09, 0.04)0.03 (−0.19, 0.25)0.00 (−0.05, 0.05)−0.10 (−0.31, 0.10)−0.03 (−0.08, 0.01)−0.25* (−0.48, −0.02)
       SH perp−0.03 (−0.12, 0.06)0.06 (−0.16, 0.28)0.03 (−0.03, 0.09)0.10 (−0.23, 0.02)−0.05 (−0.10, 0.01)−0.29** (−0.47, −0.16)
       Stalking perp−0.05 (−0.11, 0.02)−0.01 (−0.21, 0.19)−0.01 (−0.05, 0.03)0.00 (−0.19, 0.05)−0.02 (−0.06, 0.01)−0.18 (−0.44, −0.15)
       SH vic0.07 (−0.09, 0.22)−0.16 (−0.51, 0.20)0.12* (0.00, 0.23)−0.17 (−0.47, 0.14)−0.19** (−0.31, −0.08)−0.45** (−0.80, −0.10)
       Stalking vic0.03 (−0.07, 0.14)0.04 (−0.23, 0.32)0.07 (−0.01, 0.14)0.03 (−0.21, 0.27)−0.09* (−0.16, −0.01)−0.23 (−0.50, 0.03)
      Training received to…
       Rape myths0.13** (−0.00, 0.27)0.12
      Reflects the path between intervention and violence acceptance score.
      (−0.15, 0.38)
      −0.08** (−0.13, −0.03)−0.10 (−0.23, 0.02)−0.17** (−0.22, −0.12)−0.31** (−0.47, −0.16)
       DV acceptance0.10
      Reflects the path between intervention and violence acceptance score.
      (−0.02, 0.22)
      0.15
      Reflects the path between intervention and violence acceptance score.
      (−0.10, 0.40)
      −0.05 (−0.09, 0.00)−0.07 (−0.19, 0.05)−0.15** (−0.20, −0.10)−0.29** (−0.44, −0.15)
      Rape myths to…
       SA perp0.06** (0.05, 0.07)0.23** (0.19, 0.27)0.07** (0.06, 0.08)0.34** (0.31, 0.37)0.05** (0.04, 0.06)0.34** (0.30, 0.38)
       SA vic0.07** (0.06, 0.09)0.25** (0.21, 0.30)0.07** (0.06, 0.08)0.28** (0.24, 0.31)0.05** (0.03, 0.06)0.30** (0.25, 0.34)
       SH perp0.10** (0.08, 0.12)0.24** (0.20, 0.29)0.09** (0.07, 0.10)0.21** (0.17, 0.24)0.06** (0.05, 0.07)0.31** (0.27, 0.35)
       Stalking perp0.05** (0.04, 0.07)0.24** (0.21, 0.28)0.06** (0.05, 0.07)0.30** (0.27, 0.34)0.04** (0.04, 0.05)0.29** (0.25, 0.33)
       SH vic0.07** (0.04, 0.11)0.19** (0.11, 0.26)0.06** (0.03, 0.09)0.18** (0.12, 0.24)0.03** (0.01, 0.06)0.18** (0.11, 0.24)
       Stalking vic0.07** (0.05, 0.10)0.23** (0.18, 0.29)0.08** (0.06, 0.09)0.28** (0.23, 0.33)0.05** (0.04, 0.07)0.25** (0.19, 0.30)
      DV acceptance to…
       SA perp0.02** (0.01, 0.03)0.19** (0.15, 0.23)0.04** (0.03, 0.05)0.21** (0.18, 0.25)0.03** (0.02, 0.03)0.24** (0.20, 0.28)
       SA vic0.03** (0.02, 0.05)0.17** (0.13, 0.22)0.05** (0.03, 0.07)0.22** (0.18, 0.26)0.03** (0.02, 0.04)0.24** (0.20, 0.29)
       SH perp0.06** (0.04, 0.08)0.19** (0.15, 0.24)0.06** (0.04, 0.08)0.23** (0.19, 0.27)0.06** (0.05, 0.07)0.26** (0.21, 0.30)
       Stalking perp0.05** (0.04, 0.06)0.17** (0.13, 0.21)0.05** (0.04, 0.06)0.21** (0.17, 0.24)0.03** (0.02, 0.04)0.26** (0.22, 0.30)
       SH vic0.04* (−0.00, 0.07)0.11** (0.04, 0.18)0.06** (0.04, 0.09)0.18** (0.12, 0.24)0.08** (0.05, 0.11)0.22** (0.15, 0.29)
       Stalking vic0.07** (0.04, 0.09)0.19** (0.13, 0.24)0.08** (0.06, 0.09)0.22** (0.17, 0.27)0.07** (0.05, 0.09)0.30** (0.25, 0.036)
      Note: Boldface indicates statistical significance path (*p≤0.01; **p≤0.001).
      Frequency of violence outcomes were adjusted for demographic controls by including direct paths from sex, sexual orientation, meal status, race, and relationship status to each violence outcome Figure 1. provides a visual representation of these paths.
      —, path not tested; DV, dating violence; IPV, intimate partner violence; No witness, did not witness parental IPV; perp, perpetration; SA, sexual assault; SH, sexual harassment; vic, victimization; Yes witness, did witness parental IPV.
      a Reflects the path between intervention and violence acceptance score.
      During partial implementation, there was a significant negative association (p<0.001) between amount of training received and rape myths for those who did not witness parental IPV. As hypothesized, during full implementation, amount of training received was negatively associated with rape myths and DV acceptance for both witnessing parental IPV groups (p<0.001), but these associations were stronger for the students who witnessed parental IPV than students who did not witness parental IPV.
      The only significant association between the intervention and violent outcomes during partial implementation was a positive association with sexual harassment victimization among those who did not witness parental IPV (p<0.01); there were higher reports of sexual harassment victimization from students who did not witness parental IPV in intervention schools than in students who did not witness parental IPV in control schools. The opposite association was observed during full implementation for those who did not witness parental IPV: students from intervention schools had significantly lower reports of sexual harassment victimization (p<0.001) and stalking victimization (p<0.01) than students from control schools who witnessed parental IPV. For students who witnessed parental IPV, the intervention when fully implemented was significantly negatively associated with reports of the main outcome variables of sexual assault perpetration (p<0.01) and sexual assault victimization (p<0.01) as well as secondary outcomes including sexual harassment perpetration (p<0.001) and sexual harassment victimization (p<0.001).
      Examination of the standardized direct, indirect, and total effects of the intervention on violent outcomes (Table 3) indicated that total effects were not significant until the intervention was fully implemented. During full implementation, among those who did not witness parental IPV, significant standardized total effects were observed for the primary outcome of sexual assault victimization (but not for sexual assault perpetration) and secondary outcomes of sexual harassment perpetration, stalking perpetration, sexual harassment victimization, and stalking victimization. During full implementation for those who did witness parental IPV, significant total effects were observed for all violent outcomes. In general, the magnitudes of these effects were small (< −0.08). Total effects were larger among individuals who witnessed parental IPV than those who did not witness parental IPV. The largest effect was observed for sexual harassment perpetration (−0.078) and sexual assault perpetration (−0.072) among those who witness parental IPV.
      Table 3Direct, Indirect, and Total Effects (Standardized) of Intervention on Violence Outcomes
      OutcomesBaseline Year 0Partial implementation Years 1 and 2Full implementation Years 3 and 4
      Did not witness Parental IPV (n=7,885)Did witness parental IPV (n=7,978)Did not witness parental IPV (n=16,288)Did witness parental IPV (n=13,726)Did not witness parental IPV (n=13,274)Did witness parental IPV (n=12,633)
      Sexual assault perpetration
       Direct−0.019−0.0060.0040.003−0.006−0.031
       Indirect0.0050.011−0.005−0.013−0.010−0.041
       Total effect−0.0140.005−0.001−0.010−0.016−0.072
      Sexual assault victimization
       Direct−0.0090.0040.000−0.015−0.012−0.034
       Indirect0.0040.009−0.004−0.010−0.008−0.035
       Total effect−0.0050.014−0.004−0.025−0.020−0.069
      Sexual harassment perpetration
       Direct−0.0080.0100.0070.015−0.014−0.040
       Indirect0.0050.010−0.004−0.011−0.009−0.037
       Total effect−0.0030.0200.0030.004−0.023−0.078
      Stalking perpetration
       Direct−0.017−0.001−0.0040.000−0.011−0.026
       Indirect0.0050.010−0.004−0.012−0.009−0.038
       Total effect−0.0120.009−0.008−0.011−0.020−0.065
      Sexual harassment victimization
       Direct0.009−0.0170.017−0.017−0.012−0.045
       Indirect0.0020.004−0.002−0.005−0.004−0.019
       Total effect0.011−0.0130.015−0.022−0.033−0.063
      Stalking victimization
       Direct0.0080.0060.0140.004−0.020−0.028
       Indirect0.0040.008−0.003−0.009−0.008−0.032
       Total effect0.0110.0140.011−0.005−0.028−0.060
      Note: Boldface indicates statistical significance (p≤0.01).
      IPV, intimate partner violence.

      DISCUSSION

      As implemented in the parent RCT, the bystander intervention program was associated with a reduction in multiple forms of SV, especially among students who witnessed parental IPV. Although this bystander intervention program was associated with reductions in victimization for those who did not witness parental IPV, reductions in perpetration were only observed for students who did witness parental IPV. Several programs that target DV reduction among youth who have witnessed parental IPV have positive results, including Expect Respect,
      • Reidy DE
      • Holland KM
      • Cortina K
      • Ball B
      • Rosenbluth B.
      Evaluation of the expect respect support group program: a violence prevention strategy for youth exposed to violence.
      Date SMART,
      • Rizzo CJ
      • Joppa M
      • Barker D
      • Collibee C
      • Zlotnick C
      • Brown LK.
      Project Date SMART: a dating violence (DV) and sexual risk prevention program for adolescent girls with prior DV exposure.
      and the Youth Relationship Project.
      • Wolfe DA
      • Wekerle C
      • Scott K
      • Straatman AL
      • Grasley C
      • Reitzel-Jaffe D.
      Dating violence prevention with at-risk youth: a controlled outcome evaluation.
      This study extends effectiveness evaluations to SV outcomes and assesses whether a universally implemented approach is effective, specifically among high-risk students who witnessed parental IPV. Bystander intervention programs are often designed to reduce SV outcomes,
      • Bell S
      • Coker AL
      • Clear ER.
      Bystander program effectiveness: a review of the evidence in educational settings (2007-2018).
      and our findings indicate that this was particularly effective among students who witnessed parental IPV. The intervention was not effective at reducing stalking victimization/perpetration among students who witnessed parental IPV—suggesting that future bystander intervention programs that want to reduce stalking should be tailored to the unique dynamics of those experiences.
      For both witnessing groups, intervention-associated reductions in violent outcomes were only observed when this intervention was fully implemented. During full implementation, 10%–15% of POLs receive intensive skill-based training on how to intervene when they notice a concerning situation. Although the intervention elements that occur during partial implementation (i.e., persuasive speeches) may be integral to setting the stage for a successful intervention, our findings suggest that the key mechanism of change are these intensive training sessions. This was particularly true to reduce SV outcomes among students who witnessed parental IPV. Youth who witness parental IPV are more likely to be victims/perpetrators of violence

      Sexual violence: risk and protective factors. Centers for Disease Control and Prevention. https://www.cdc.gov/ViolencePrevention/sexualviolence/riskprotectivefactors.html. Updated February 5, 2021. Accessed May 5, 2021.

      ,
      • Braga T
      • Cunha O
      • Maia Â.
      The enduring effect of maltreatment on antisocial behavior: a meta-analysis of longitudinal studies.
      ,
      • Stith SM
      • Rosen KH
      • Middleton KA
      • Busch AL
      • Lundeberg K
      • Carlton RP.
      The intergenerational transmission of spouse abuse: a meta-analysis.
      ; thus, these youth may benefit from having trained peers who disrupt potential violence. Alternatively, there may be content within the intensive training that challenges norms that contribute to violence perpetration directly, as was originally intended within some bystander programs.
      • Katz J.
      Bystander training as leadership training: notes on the origins, philosophy, and pedagogy of the Mentors in Violence Prevention model.
      Other important pathways were also identified by this research. Unsurprisingly, levels of violence acceptance were associated with victimization and perpetration, especially among students who witnessed parental IPV. The level of training a student received was associated with a reduction in endorsement of violence norms during full implementation, especially among students who witnessed parental IPV. Past research evaluating violence prevention programs among youth has highlighted the importance and effectiveness of targeting problematic social norms,
      • Kettrey HH
      • Marx RA.
      Does the gendered approach of bystander programs matter in the prevention of sexual assault among adolescents and college students? A systematic review and meta-analysis.
      ,
      • Mujal GN
      • Taylor ME
      • Fry JL
      • Gochez-Kerr TH
      • Weaver NL.
      A systematic review of bystander interventions for the prevention of sexual violence.
      including the Fourth-R,
      • Wolfe DA
      • Crooks C
      • Jaffe P
      • et al.
      A school-based program to prevent adolescent dating violence: a cluster randomized trial.
      Shifting Boundaries,
      • Taylor BG
      • Stein ND
      • Mumford EA
      • Woods D.
      Shifting Boundaries: an experimental evaluation of a dating violence prevention program in middle schools.
      and Dating Matters.
      • Niolon PH
      • Vivolo-Kantor AM
      • Tracy AJ
      • et al.
      An RCT of Dating Matters: effects on teen dating violence and relationship behaviors.
      Although there was a stronger relationship between violence norms and violent outcomes for the students who witnessed parental IPV, this group also benefited more from receiving the bystander training, as indicated by a larger reduction in violence norms.
      Although past research indicates that a key component of prevention programs is disrupting harmful attitudes and beliefs that are associated with violence victimization/perpetration,
      • Kettrey HH
      • Marx RA.
      Does the gendered approach of bystander programs matter in the prevention of sexual assault among adolescents and college students? A systematic review and meta-analysis.
      ,
      • Mujal GN
      • Taylor ME
      • Fry JL
      • Gochez-Kerr TH
      • Weaver NL.
      A systematic review of bystander interventions for the prevention of sexual violence.
      this study makes an important contribution by identifying that this is largely explained by the high-risk group of youth who witnessed parental IPV. Because witnessing parental IPV is an ACE that is highly correlated with other ACEs,
      • Merrick MT
      • Ford DC
      • Ports KA
      • Guinn AS.
      Prevalence of adverse childhood experiences from the 2011-2014 Behavioral Risk Factor Surveillance System in 23 states [published correction appears in JAMA Pediatr. 2018;172(11):1104].
      it is likely that this identifier also captured students who experience other structural inequalities or lack of safe environments and are generally at increased risk of violence victimization and perpetration. Future research should use more sophisticated measures of ACEs to examine this hypothesis, as students with multiple ACEs may benefit from this prevention approach. Because the strength of the paths between violence norms and violent outcomes were small for the students who did not witness parental IPV, it is likely that other factors contribute to victimization/perpetration. Future research should identify other predictors of victimization/perpetration for those who did not witness parental IPV, while continuing to target this pathway to reduce victimization/perpetration among youth who witness parental IPV. Future research should also identify other influential pathways to decrease SV among this high-risk group, to stop the cycle of violence.

      Limitations

      All data were self-reported and cannot be corroborated; however, disclosure of violence used or experienced cannot be collected using other approaches. Data to measure witnessing parental IPV was based on a single, closed-ended item with no option to elaborate on the experience. Therefore, it was not possible to characterize witnessing parental IPV in more detail on the basis of severity or time frames. Data were collected cross-sectionally, precluding the ability to make causal determinations, especially about the influence of violence acceptance on violence exposure (or vice versa). Because students in high schools receiving the intervention were aware of randomization, differences in violence rates could be attributed to knowledge of this assignment if the intervention goals were clearly articulated across the hypothesized theory of behavior change. This potential explanation of study findings is unlikely because the finding would not be limited to those who witnessed parental IPV and were in an intervention school. There is likely bias in the findings because of the decision to use casewise deletion instead of multiple imputation. Unknowable bias is introduced when imputing the values of victimization/perpetration. Results were interpreted in light of the known biases caused by these missing data over the unknown biases caused by imputing. Based on the findings that a greater proportion of survey noncompleters were in higher grades; received a free or reduced-priced meal; witnessed parental IPV; and were male, non-White, and not exclusively heterosexual, it is likely that these results do not generalize to the most marginalized high-school youth.

      CONCLUSIONS

      This bystander intervention approach appears to be effective at reducing SV victimization and perpetration among the high-risk group of high-school students who previously witnessed parental IPV. A possible driver of this reduction seems to be through reduction in violence norms, such as rape myths and DV acceptance. Bystander intervention programs should consider tailoring programming to this group to enhance effectiveness, but should be encouraged in knowing that this approach works particularly well among the high-risk group of students who have previously witnessed parental IPV.

      ACKNOWLEDGMENTS

      The findings and opinions expressed in this paper do not necessarily reflect the views of the Centers for Disease Control and Prevention. The University of Kentucky IRB approved the study protocol for this parent study (13-0680-F1V), and the current secondary analyses were determined to be not human subjects research by the IRB at the University of North Carolina at Charlotte (19-0413).
      The parent study was supported by the Centers for Disease Control and Prevention Cooperative Agreement 5U01CE001675. Support for the secondary data analysis research was supported by the Centers for Disease Control and Prevention Award 1K01CE003158-01-00.
      No financial disclosures were reported by the authors of this paper.

      CRediT AUTHOR STATEMENT

      Annelise M. Mennicke: Conceptualization, Formal analysis, Funding acquisition, Methodology, Software, Visualization, Writing – original Draft, Writing – review and Editing. Heather M. Bush: Conceptualization, Funding acquisition, Methodology, Project administration, Resources, Supervision, Writing – review and editing. Candace J. Brancato: Conceptualization, Data curation, Methodology, Software, Writing – review and editing. Ann L. Coker: Conceptualization, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Writing – review and editing.

      Appendix. SUPPLEMENTAL MATERIAL

      REFERENCES

        • Basile K
        • Smith S
        • Breiding M
        • Black M
        • Mahendra R.
        Sexual violence surveillance: uniform definitions and recommended data elements, version 2.0.
        National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA2014 (Accessed January 19, 2022)
        • Wilkins N
        • Tsao B
        • Hertz M
        • Davis R
        • Klevens J.
        Connecting the Dots: an overview of the links among multiple forms of violence.
        National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA2014 (Accessed January 19, 2022)
        • Smith S
        • Zhang X
        • Basile K
        • et al.
        The National intimate partner and sexual violence survey: 2015 data brief - updated release.
        National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA2018 (Accessed January 19, 2022)
        • Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention
        Preventing multiple forms of violence: a strategic vision for connecting the dots.
        Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA2016 (Accessed January 19, 2022)
        • Finkelhor D
        • Turner H
        • Hamby S
        • Ormrod R.
        Polyvictimization: children’s exposure to multiple types of violence, crime, and abuse.
        U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention, Washington, DC2011 (Accessed January 19, 2022)
        • Hamby SL
        • Finkelhor D
        • Turner H
        • Ormrod R.
        Children’s exposure to intimate partner violence and other family violence.
        U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention, Washington, DC2011 (Accessed January 19, 2022)
        • Merrick MT
        • Ford DC
        • Ports KA
        • Guinn AS.
        Prevalence of adverse childhood experiences from the 2011-2014 Behavioral Risk Factor Surveillance System in 23 states [published correction appears in JAMA Pediatr. 2018;172(11):1104].
        JAMA Pediatr. 2018; 172: 1038-1044https://doi.org/10.1001/jamapediatrics.2018.2537
      1. Sexual violence: risk and protective factors. Centers for Disease Control and Prevention. https://www.cdc.gov/ViolencePrevention/sexualviolence/riskprotectivefactors.html. Updated February 5, 2021. Accessed May 5, 2021.

        • Karlsson ME
        • Calvert M
        • Hernandez Rodriguez J
        • Weston R
        • Temple JR
        Changes in acceptance of dating violence and physical dating violence victimization in a longitudinal study with teens.
        Child Abuse Negl. 2018; 86: 123-135https://doi.org/10.1016/j.chiabu.2018.09.010
        • Kinsfogel KM
        • Grych JH.
        Interparental conflict and adolescent dating relationships: integrating cognitive, emotional, and peer influences.
        J Fam Psychol. 2004; 18: 505-515https://doi.org/10.1037/0893-3200.18.3.505
        • Cannon C
        • Ferreira RJ
        • Buttell F.
        Critical race theory, parenting, and intimate partner violence: analyzing race and gender.
        Res Soc Work Pract. 2019; 29: 590-602https://doi.org/10.1177/1049731518784181
        • Kettrey HH
        • Marx RA
        • Tanner-Smith EE
        Effects of bystander programs on the prevention of sexual assault among adolescents and college students: a systematic review.
        Campbell Syst Rev. 2019; 15: e1013https://doi.org/10.4073/csr.2019.1
        • Coker AL
        • Bush HM
        • Cook-Craig PG
        • et al.
        RCT testing bystander effectiveness to reduce violence.
        Am J Prev Med. 2017; 52: 566-578https://doi.org/10.1016/j.amepre.2017.01.020
        • Park S
        • Kim SH.
        The power of family and community factors in predicting dating violence: a meta-analysis.
        Aggress Violent Behav. 2018; 40: 19-28https://doi.org/10.1016/j.avb.2018.03.002
        • Coker AL
        • Bush HM
        • Brancato CJ
        • Huang Z
        • Clear ER
        • Follingstad DR.
        Longer term impact of bystander training to reduce violence acceptance and sexism.
        J Sch Violence. 2020; 19: 525-538https://doi.org/10.1080/15388220.2020.1760108
        • Coker AL
        • Bush HM
        • Brancato CJ
        • Clear ER
        • Recktenwald EA.
        Bystander program effectiveness to reduce violence acceptance: RCT in high schools.
        J Fam Violence. 2019; 34: 153-164https://doi.org/10.1007/s10896-018-9961-8
        • Edwards KM
        • Banyard VL
        • Sessarego SN
        • Waterman EA
        • Mitchell KJ
        • Chang H.
        Evaluation of a bystander-focused interpersonal violence prevention program with high school students.
        Prev Sci. 2019; 20: 488-498https://doi.org/10.1007/s11121-019-01000-w
        • Bush HM
        • Coker AL
        • DeGue S
        • Clear ER
        • Brancato CJ
        • Fisher BS.
        Do violence acceptance and bystander actions explain the effects of Green Dot on reducing violence perpetration in high schools?.
        J Interpers Violence. 2021; 36: 10753-10774https://doi.org/10.1177/0886260519888206
        • Clear ER
        • Coker AL
        • Cook-Craig PG
        • et al.
        Sexual harassment victimization and perpetration among high school students.
        Violence Against Women. 2014; 20: 1203-1219https://doi.org/10.1177/1077801214551287
        • Cook-Craig PG
        • Coker AL
        • Clear ER
        • et al.
        Challenge and opportunity in evaluating a diffusion-based active bystanding prevention program: Green Dot in high schools.
        Violence Against Women. 2014; 20: 1179-1202https://doi.org/10.1177/1077801214551288
        • Black M
        • Basile KC
        • Brieding M
        • et al.
        The National intimate partner and sexual violence survey (NISVS) 2010 summary report.
        National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA2011 (Accessed January 19, 2022)
        • Fitzgerald LF
        • Magley VJ
        • Drasgow F
        • Waldo CR.
        Measuring sexual harassment in the military: the sexual experiences questionnaire (SEQ-DoD).
        Mil Psychol. 1999; 11: 243-263https://doi.org/10.1207/s15327876mp1103_3
        • Tjaden P
        • Thoennes N.
        Prevalence, incidence, and consequences of violence against women: findings from the National Violence Against Women Survey.
        Office of Justice Programs, National Institute of Justice, Washington, DC: U.S. Department of Justice1998
        https://www.ojp.gov/pdffiles/172837.pdf
        Date accessed: January 19, 2022
        • Payne DL
        • Lonsway KA
        • Fitzgerald LF.
        Rape myth acceptance: exploration of its structure and its measurement using the Illinois Rape Myth Acceptance Scale.
        J Res Pers. 1999; 33: 27-68https://doi.org/10.1006/jrpe.1998.2238
        • Mennicke A
        • Bush HM
        • Brancato CJ
        • Coker AL.
        Bystander intervention efficacy to reduce teen dating violence among high school youth who did and did not witness parental partner violence: a path analysis of a cluster RCT.
        J Fam Violence. 2021; 36: 755-771https://doi.org/10.1007/s10896-021-00297-y
        • Foshee VA
        • Bauman KE
        • Arriaga XB
        • Helms RW
        • Koch GG
        • Linder GF.
        An evaluation of safe dates, an adolescent dating violence prevention program.
        Am J Public Health. 1998; 88: 45-50https://doi.org/10.2105/AJPH.88.1.45
        • Øverlien C
        • Holt S.
        European research on children, adolescents and domestic violence: impact, interventions and innovations.
        J Fam Violence. 2019; 34: 365-369https://doi.org/10.1007/s10896-019-00067-x
        • Shonkoff JP.
        Capitalizing on advances in science to reduce the health consequences of early childhood adversity.
        JAMA Pediatr. 2016; 170: 1003-1007https://doi.org/10.1001/jamapediatrics.2016.1559
        • Twisk J
        • Proper K.
        Evaluation of the results of a randomized controlled trial: how to define changes between baseline and follow-up.
        J Clin Epidemiol. 2004; 57: 223-228https://doi.org/10.1016/j.jclinepi.2003.07.009
        • Kline R.
        Principles and Practices of Structural Equation Modeling.
        3rd ed. Guilford Press, New York, NY2010
        • Reidy DE
        • Holland KM
        • Cortina K
        • Ball B
        • Rosenbluth B.
        Evaluation of the expect respect support group program: a violence prevention strategy for youth exposed to violence.
        Prev Med. 2017; 100: 235-242https://doi.org/10.1016/j.ypmed.2017.05.003
        • Rizzo CJ
        • Joppa M
        • Barker D
        • Collibee C
        • Zlotnick C
        • Brown LK.
        Project Date SMART: a dating violence (DV) and sexual risk prevention program for adolescent girls with prior DV exposure.
        Prev Sci. 2018; 19: 416-426https://doi.org/10.1007/s11121-018-0871-z
        • Wolfe DA
        • Wekerle C
        • Scott K
        • Straatman AL
        • Grasley C
        • Reitzel-Jaffe D.
        Dating violence prevention with at-risk youth: a controlled outcome evaluation.
        J Consult Clin Psychol. 2003; 71: 279-291https://doi.org/10.1037/0022-006X.71.2.279
        • Bell S
        • Coker AL
        • Clear ER.
        Bystander program effectiveness: a review of the evidence in educational settings (2007-2018).
        in: O’Donoue W Schewe P Handbook of Sexual Assault and Sexual Assault Prevention. Springer Nature, Cham, Switzerland2019: 433-450https://doi.org/10.1007/978-3-030-23645-8_26
        • Braga T
        • Cunha O
        • Maia Â.
        The enduring effect of maltreatment on antisocial behavior: a meta-analysis of longitudinal studies.
        Aggress Violent Behav. 2018; 40: 91-100https://doi.org/10.1016/j.avb.2018.04.003
        • Stith SM
        • Rosen KH
        • Middleton KA
        • Busch AL
        • Lundeberg K
        • Carlton RP.
        The intergenerational transmission of spouse abuse: a meta-analysis.
        J Marriage Fam. 2000; 62: 640-654https://doi.org/10.1111/j.1741-3737.2000.00640.x
        • Katz J.
        Bystander training as leadership training: notes on the origins, philosophy, and pedagogy of the Mentors in Violence Prevention model.
        Violence Against Women. 2018; 24: 1755-1776https://doi.org/10.1177/1077801217753322
        • Kettrey HH
        • Marx RA.
        Does the gendered approach of bystander programs matter in the prevention of sexual assault among adolescents and college students? A systematic review and meta-analysis.
        Arch Sex Behav. 2019; 48: 2037-2053https://doi.org/10.1007/s10508-019-01503-1
        • Mujal GN
        • Taylor ME
        • Fry JL
        • Gochez-Kerr TH
        • Weaver NL.
        A systematic review of bystander interventions for the prevention of sexual violence.
        Trauma Violence Abuse. 2021; 22: 381-396https://doi.org/10.1177/1524838019849587
        • Wolfe DA
        • Crooks C
        • Jaffe P
        • et al.
        A school-based program to prevent adolescent dating violence: a cluster randomized trial.
        Arch Pediatr Adolesc Med. 2009; 163: 692-699https://doi.org/10.1001/archpediatrics.2009.69
        • Taylor BG
        • Stein ND
        • Mumford EA
        • Woods D.
        Shifting Boundaries: an experimental evaluation of a dating violence prevention program in middle schools.
        Prev Sci. 2013; 14: 64-76https://doi.org/10.1007/s11121-012-0293-2
        • Niolon PH
        • Vivolo-Kantor AM
        • Tracy AJ
        • et al.
        An RCT of Dating Matters: effects on teen dating violence and relationship behaviors.
        Am J Prev Med. 2019; 57: 13-23https://doi.org/10.1016/j.amepre.2019.02.022