College Health Center-based Alcohol and Sexual Violence Intervention

描述(申请人提供)：这是一项利益相关者参与的纵向研究，通过双臂整群随机对照试验，测试一种简短的减少伤害干预措施，以降低接受大学生健康服务机构护理的18-24岁男性和女性与酒精相关的性暴力的风险(K=20所大学；基线N=2200)。性暴力(SV)(包括性胁迫、非自愿的性接触和强奸)在女大学生中很常见，超过四分之三的被性侵犯的女性报告说，第一次这样的经历发生在25岁之前。尤其是与酒精有关的性侵犯在大学校园中非常普遍，大约一半的性侵犯案件发生在受害者和/或犯罪者醉酒的背景下。酒精和性暴力之间的这种联系涉及多种途径，关于酒精消费的社会规范和对性暴力的期望促进了此类暴力的发生和漏报。大学生健康中心仍然是一个未开发的环境，可以接触到年轻人，进行SV预防和干预。这项研究借鉴了调查团队的几项干预研究，整合了每项研究的成功成分：1)旁观者方法，即向个人传授作为SV预防的积极干预者的技能，而不是以冷漠或宽容的方式回应，是在社会背景下促进变化的有效策略；2)关于SV的普及教育，无论临床环境中是否披露，都可以导致对SV的认识和对相关服务的使用；以及3)临床医生引入的减少伤害策略可以增加使用策略帮助自己和朋友的意图 提高安全性。简短的咨询干预使用一张手掌大小的安全卡，上面有关于SV和减少伤害的信息，在临床会面期间给予所有患者。GIFTS(为创伤支持和安全提供信息)提供(A)关于SV的患者教育和评估；(B)讨论减少伤害行为以降低自己和同龄人与酒精相关的SV的风险(包括旁观者干预)；以及(C)支持转诊至受害者服务机构。需要有效的干预措施，接触到更多目睹或经历与酒精相关的SV的大学年龄青年。10个大学生健康中心将随机接受培训，接受整合到常规大学健康访问中的短暂干预。与对照组相比，接受礼品干预的男性和女性受试者应更好地认识到酒精相关SV的构成、制定减少伤害策略的知识和自我效能、干预意图以及使用SV相关服务的知识和自我效能(目标1)。在目睹了同伴性暴力的青少年中，接受礼物的青少年更有可能报告干预措施，以中断同伴的有害行为(目标2)。与对照客户相比，有SV受害历史的客户在他们的诊所就诊期间更有可能披露SV，报告更多地使用SV相关服务，并且在随访时报告较少的SV受害(目标3)。

DESCRIPTION (provided by applicant): This is a stakeholder-engaged longitudinal study to test, via a 2-armed cluster randomized controlled trial, a brief harm reduction intervention to reduce risk for alcohol-related sexual violence among male and female youth ages 18-24 receiving care from college student health services (K = 20 colleges; baseline N = 2200). Sexual violence (SV) (including sexual coercion, non-consensual sexual contact, and rape) is common among college women, and over three quarters of women who have been sexually assaulted report that the first of such experiences occurred before the age of 25. Alcohol-related SV, in particular, is highly prevalent on college campuses, with about half of sexual assault cases occurring in the context of victim and/or perpetrator intoxication. Multiple pathways have been implicated in this association between alcohol and SV, with social norms regarding alcohol consumption and expectations for SV facilitating both the occurrence and underreporting of such violence. College student health centers remain an untapped setting to reach youth for both SV prevention and intervention. This study draws on several intervention studies by the investigative team, integrating successful components from each: 1) the bystander approach in which individuals are taught skills as active interveners in SV prevention rather than responding with apathy or tolerance is an effective strategy for promoting change within social contexts; 2) universal education about SV regardless of disclosure in the clinical setting can result in increased recognition of SV and use of relevant services; and 3) harm reduction strategies introduced by clinicians can increase intentions to use strategies to help oneself and friends that increase safety. The brief counseling intervention uses a palm-size safety card with information about SV and harm reduction given to all patients during clinical encounters. GIFTS (Giving Information for Trauma Support and Safety) provides (a) patient education and assessment regarding SV; (b) discussion of harm reduction behaviors to reduce risk of alcohol-related SV for self and peers (including bystander intervention); and (c) supported referrals to victim services. Interventions effective in reaching more college-age youth who either witness or experience alcohol-related SV are needed. Ten college student health centers will be randomized to receive training in the brief intervention integrated into routine college health visits. Compared to controls, male and female clients receiving the GIFTS intervention are expected to have greater recognition of what constitutes alcohol-related SV, knowledge of and self-efficacy to enact harm reduction strategies, intentions to intervene, and knowledge of and self-efficacy to use SV-related services (Aim 1). Among youth who have witnessed peer SV, youth receiving GIFTS will be more likely to report interventions to interrupt peer's harmful behaviors (Aim 2). Clients with SV victimization history who receive GIFTS are expected to be more likely to disclose SV during their clinic visit, report greater use of SV-related services, and report less recent SV victimization at follow up compared to control clients (Aim 3).