Primary Prevention of Sexual Violence in Indiana

1. Primary Prevention of Sexual Violence in Indiana A Progressive Move Forward Towards Eradication Emily K. Lynch ISDH Office of Women’s Health Intern 3rd Year IU MPH Graduate Student Tuesday, August 19th, 2008

2. The American Medical Association refers to sexual violence as a “silent and violent epidemic.” Indiana State Sexual Assault Plan: The Plan for 2003-2008, Indiana Coalition Against Sexual Assault

3. My Goals as the Intern • Perform a Literature Review of actions taken in other states • Rationale & Methodology of other states’ surveys • Results of other states’ surveys • Evaluate and Analyze IN’s Survey

4. Some Prevention Basics • Primary Prevention • Keeping Sexual Violence from ever happening • Taking actions to prevent the actual process from starting • E.g. Changing attitudes and beliefs that perpetuate Sexual Violence • Secondary Prevention • Do not prevent occurrence, but detect early warning signs • E.g. Detecting lower-level types of abuse that many times lead to sexual violence…..looking for Warning Signs • Tertiary Prevention • Treating the aftermath…..victim treatment and advocacy • E.g. Centers for Hope, SARTs, Criminal Justice Agencies, Offender Rehabilitation Programs Disease Screening, PowerPoint, April 2008, Dr. Gregory Steele, IU Dept. of Public Health

5. Quick Peak at History • Pre-1986 • Small, grassroots, response organizations for victims • 26 programs to serve 92 counties in IN • Post-1986 • The development of the Indiana Coalition Against Sexual Assault • Provided networking, training, and technical assistance to victim assistance programs • 1994 – 1st State Plan and Directory • 1996 – Incorporation of Child Victim Advocacy • Growth, Growth, Growth across the state! Indiana State Sexual Assault Plan: The Plan for 2003-2008, Indiana Coalition Against Sexual Assault

6. Funding History • Pre – 2000 • No funding from the state of IN • Mostly Federal Funding • Preventive Health and Health Services Block Grant from the federal Family and Social Services sector – Sexual Assault Services $ • 1994 - Victims of Crime Act (VOCA) &Violence Against Women Act (VAWA) passed • 1996 – CDC introduced Rape Prevention and Education funding • Awarded to Purdue Dept. of Agriculture, 4-H Youth Program establishing CARe Indiana State Sexual Assault Plan: The Plan for 2003-2008, Indiana Coalition Against Sexual Assault

7. Prevalence before Survey • Uniform Crime Report • Voluntary Reporting • 88 IN Law Enforcement Agencies report – about 1/3 • Nationally, 93,934 estimated rapes in 2005 • 1,856 IN rapes in 2005 • National Crime Victimization Survey • 200,780 rapes per year in 2004 and 2005 • 2x the national estimate of the UCR • Cannot be used to generate state data • National Violence Against Women Survey • 302,000 rapes in 1995-1996 • 3x the national estimate of the UCR • Cannot be extrapolated to State Data The State of Rape Data Collection in Indiana, Perkins, W., Fisher, B., & Paxton, M., date unknown

8. Rape Data Collection in Indiana • INCASA survey of Sheriff Departments, Victim Service Providers, & Victim Assistance Programs in Indiana • Inconsistencies in the definition of rape • Inconsistent types of information collected between agencies • Low levels of information sharing between agencies The State of Rape Data Collection in Indiana, Perkins, W., Fisher, B., & Paxton, M., date unknown

9. Overview of Indiana’s Survey

10. General Format • Question pertaining to occurrence of crime of interest • Questions pertaining to when occurrence happened – either month or year recorded • Question pertaining to reporting to Legal Authorities Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

11. Survey Goals • Assess the prevalence of incidents/crimes against women over the age of 18 in the state of Indiana • Assess the reporting of incidents/crime to legal authorities Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

12. Methodology • Done by the Survey Research Center at IUPUI, sponsored by INCASA • Random digit-dialing telephone survey • Voluntary and confidential • Average interview was 6.88 minutes • Data collected between Oct. 2007 through Dec. 2007 • Completed Surveys = 913 • Response Rate = 31.8% • Sample Size = 2,871 • Sampling Error did not exceed ± 3% Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

13. Questions • Has anyone ever taken anything from you by force? • Have you ever been a victim of stalking? • Has anyone ever threatened to cause you bodily harm, either with or without the use of a weapon? • Has anyone ever physically assaulted you, either with or without the use of a weapon, causing injury? • Have you ever been subjected to inappropriate and degrading comments or behavior just because you are female? 6. Have you ever been sexually harassed in the workplace? Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

14. Questions Cont. 7. Has anyone exposed you to unwanted sexual situations that did not involve physical touching? 8. Have you ever personally experienced any of the forms of sexual assault I just mentioned? • Verbal in nature? • Unwanted Sexual Contact? • Relation to perpetrator? 9. Has anyone ever attempted to have sex with you after you said or showed that you didn't want them to? • Relation to perpetrator? 10. Has anyone ever in your life HAD SEX with you after you said or showed that you didn't want to? • Relation to perpetrator? Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

15. Demographics • Employment • Age • Marital Status • Racial or Ethnic Background • Religious Preference • Religiosity • Education • Income Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

16. Limitation • Geographic Location

17. Results of Survey

18. Demographics • Age – 32.7% where 55 years old or older – 1/3 29.8% where 18-34 years of age – 3/10 • Marital Status – 66.1% were married – 2/3 • Race – 90.8% were White/Caucasian • Religious Preference – 66.7% were Protestant – 2/3 • Religiosity – 51.5% attended church weekly or nearly weekly • Education – 31.2% were high school graduates or had their GEDs – 3/10 21.9% Some technical/trade school or college – 1/5 • Income – 26.5% earned $20-$40 thousand per year – 1/4 20.7% earned $40-$60 thousand per year – 1/5 Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

19. Theft by Force Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

20. Stalking Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

21. Threats Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

22. Physical Assault Causing Injury Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

23. Gender-based Inappropriate/degrading comments or behavior Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

24. Workplace Sexual Harassment Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

25. Unwanted Non-physical sexual situations Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

26. Sexual Assault all forms Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

27. Attempted Rape Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

28. Rape Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

29. Conclusion Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

30. Conclusion Cont. Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

31. Conclusion Cont. Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

32. More Statistics in Report • For every incident/crime, prevalence in percent is presented for each demographic variable. • For every incident/crime, proportion of women reporting to authorities are presented for each demographic variable. Female Victimization in Indiana – 2008: Summary of Methods and Findings, Survey Research Center at IUPUI

33. Other States’ Surveys

34. Oklahoma • Random Telephone Survey • Attitudes and Beliefs surrounding Sexual Violence • Knowledge of and Likelihood of reaching out for help if victimized • Victims asked to paint a picture of the sequence of events of their sexual assault or rape Injury Update: A Report to Oklahoma Injury Surveillance Participants, Brown, S., 2006

35. Iowa & Massachusetts • Only BRFSS Data gathered • Around 2-4 questions asked on topic • Very brief 2005 & 2006 BRFSS Module on Sexual Violence, IAsdh & MAsdh respectively

36. New Hampshire • Random Telephone Survey • Modeled after the National Violence Against Women Survey • Some questions taken from the Secondary Victimization Behaviors Scale – a psychological scale • Some questions originally authored • 9 sets of questions ranging from: • Attitudes and Beliefs towards the topic of Sexual Assault overall • Types of Sexual Assault/Rape experienced • Attitudes on how incident was handled • Barriers to getting Victim Care & Advocacy • Physical Assault experienced 2006 NH Statewide Sexual Assault Survey, NH Coalition Against Domestic/Sexual Violence, NH State Dept. of Health, University of New Hampshire, et al.

37. Virginia • Random Telephone Survey • Men andWomen interviewed • Magnitude of Sexual Assault • Characteristics of Assault Experience • Reporting Rates • Service Needs • Access & Barrier Issues • Extrapolated to estimate child sexual assault victimization Prevalence of Sexual Assault in Virginia, 2003, Masho, S. & Odor, R. K.

38. Theory-building Data Analysis

39. Non-Parametric Spearman’s Correlation • CrossTabs of Questions 1 to 10 • The Spearman’s Correlation Coefficient indicates the direction and strength of relationship between two variables. It is a non-parametric test of significance of correlation. The closer to 1 or -1 the coefficient is, the stronger the correlation or relation is between the two variables. Dr. Jay Arekere, IU School of Medicine, Dept. of Public Health, advisor Emily K. Lynch, IU School of Medicine, Dept. of Public Health, student

40. Example #1 • Variables Q1 (Question 1) and Q2 (Question 2): Are these two variables correlated with each other? • CoEff = 0.132 P-value = < 0.001 which is less than 0.10 (set value) • Thus, responses to Q1 and Q2 are positively and significantly correlated. • Therefore, any woman who admits to something being taken from her by force (Q1) is also significantly more likely to respond to being a victim of stalking (Q2) as well and vice versa. Dr. Jay Arekere, IU School of Medicine, Dept. of Public Health, advisor Emily K. Lynch, IU School of Medicine, Dept. of Public Health, student

41. Logistic Regression •  Logistic Regression is a multivariate regression analysis examining the relationship between a binary dependent variable (Y) and a set of independent variables (X). • Because the dependent variable is binary (for instance, [0,1] or [Yes, No]), the regression analysis yields the odds, in probabilistic terms, of change in the dependent variable as a result of the independent variable. • In such cases, where the dependent variable is binary, linear regression does not work since the odds or probability is bounded by zero and one. • Thus, the regression Odds Ratios are interpreted as follows: if the OR is > 1, then X is more likely to affect the Y-variable; if the OR is < 1, then X is less likely to affect the y-variable; if the OR = 1, then there is no effect on the Y-variable; and if 1 is within the Confidence Interval, then the X variable DOES NOT have a statistically significant effect. Dr. Jay Arekere, IU School of Medicine, Dept. of Public Health, advisor Emily K. Lynch, IU School of Medicine, Dept. of Public Health, student

42. Example #1 for Question #5 • “Have you ever been subjected to inappropriate and degrading comments or behavior just because you are a female?” Dr. Jay Arekere, IU School of Medicine, Dept. of Public Health, advisor Emily K. Lynch, IU School of Medicine, Dept. of Public Health, student

43. interpretation • Therefore, the X-variables “Less than High School,” “Married,” and “High Religiosity” are all more likely to significantly affect the Y-variable (Q5 stated above). • In other words, a woman with less than a high school education is more likely to admit to being subjected to inappropriate or degrading comments or behavior just because she was female as compared to those with higher education (i.e. more than Bachelors). • Similarly, women who are married and those who are highly religious (go to church every week) are more likely to report being subjected to inappropriate or degrading comments or behavior as compared to divorced women and women who are less religious (i.e. go to church rarely or do not go to church at all) respectively. Dr. Jay Arekere, IU School of Medicine, Dept. of Public Health, advisor Emily K. Lynch, IU School of Medicine, Dept. of Public Health, student

44. Limitations • Geographic Location data not gathered • Consistency of Sample • 91% were White/Caucasian • All women over 18….nobody younger, no men • No questions that specifically or directly ask about childhood incidents • Rape question does not include women who were incapacitated to say no by alcohol, drugs, fear, mental capacity, etc. • Other Biases inherent of a study

45. Questions???