Empowerment Self-Defense Training for the Prevention of Victimization of Transgender Women

Violence, Sexual Clinical Trial

Official title:

Empowerment Self-Defense Training for the Prevention of Victimization of Transgender Women

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04934189
• Other study ID #: R21MD014807
• Secondary ID: 5R21MD014807-02
• Status: Completed
• Phase: N/A
• Start date: July 11, 2021
• Est. completion date: February 26, 2024

Study information

• Verified date: April 2024
• Source: Hunter College of City University of New York
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The proposed project aims to develop and refine a tailored Empowerment Self Defense (ESD) violence prevention training for diverse TW through a series of sequential Aims: a) develop an initial draft of an ESD violence prevention curriculum tailored to TW (Aim 1); b) evaluate the feasibility and acceptability of recruitment, assessment procedures, retention and follow-up procedures, and implementation of the new intervention (Aim 2); and c) assess the preliminary efficacy of the tailored intervention program to increase use of self-protective resistance strategies, mitigate minority stressors and attitudinal barriers to self-defense, and reduce rates of exposure to violence (Exploratory Aim). The investigators will accomplish these aims using a two-phase research design that begins with formative qualitative work engaging research partners on a community board and a small sample of research participants. Information for Phase 1 can be located in Protocol number 2020-0017. Further refinement and assessment of the feasibility and acceptability of the curriculum using Phase 1 findings will occur in Phase 2 through the delivery of the tailored ESD curriculum to 3 groups of 16 TW. To assess the preliminary efficacy of the tailored intervention, program participants will complete a battery of validated questionnaires assessing use of resistance strategies, gender-minority and general psychological factors hypothesized to mediate the behavioral effects of the intervention, and exposure to victimization experiences prior to, immediately following, and 6 months post-completion of the training. Together, the proposed research will lay the foundation for a large-scale randomized controlled trial (RCT) of the tailored ESD violence prevention curriculum.

Description:

This study leverages the strong evidence-base for Empowerment Self-Defense (ESD) violence prevention to address disparities in violence exposure among TW. The overarching goal of this R21 is to develop and refine a tailored ESD violence prevention training for diverse TW through a series of sequential Aims: a) develop an initial draft of an ESD violence prevention curriculum tailored to TW (Aim 1); b) evaluate the feasibility and acceptability of recruitment, assessment procedures, retention and follow-up procedures, and implementation of the new intervention (Aim 2); and c) assess the preliminary efficacy of the tailored intervention program to increase use of self-protective resistance strategies, mitigate minority stressors and attitudinal barriers to self-defense, and reduce rates of exposure to violence (Exploratory Aim). Together, the proposed research will lay the foundation for a large-scale randomized controlled trial (RCT) of the tailored ESD violence prevention curriculum. The investigators will accomplish these aims using a two-phase research design that begins with formative qualitative work engaging research partners on a community board and a small sample of research participants. This data will be used to inform the development and refinement of the ESD violence prevention curriculum for TW. Further refinement and assessment of the feasibility and acceptability of the curriculum will occur in Phase 2 through the delivery of the tailored ESD curriculum to 3 groups of 16 TW. To assess the preliminary efficacy of the tailored intervention, program participants will complete a brief survey assessing the program directly after completion, as well as a battery of validated questionnaires assessing use of resistance strategies, gender-minority and general psychological factors hypothesized to mediate the behavioral effects of the intervention, and exposure to victimization experiences prior to, immediately following, and 6 months post-completion of the training. The overall goal of this study is to use findings from Phase 1 to deliver and refine a tailored ESD violence prevention training for diverse trans women. Participants for Phase 2 (n = 48) will be recruited from online forums including social media sites (e.g., Facebook, Twitter), banner ads on social networking/dating sites (e.g., Scruff, BGC Live, OK Cupid, Lex) that are trans-inclusive and through dissemination of paper and/or electronic recruitment flyers with leaders of community organizations that connect transgender individuals (e.g., AVP; Callen Lorde, Trans-lantinx network). Participants from prior studies who consented to future contact will be sent the study flyer by email. The proposed curriculum will be systematically refined based on delivery of the intervention to 3 groups of 16 TW each in a 20-hour training program, in 5 4-hour sessions. The investigators have contracted with Prepare, Inc., the New York City chapter of IMPACT International to deliver the tailored ESD violence prevention intervention. IMPACT is an international ESD violence prevention organization with chapters across the United States. Prepare, Inc. will provide facilitators who have completed IMPACT's nationally standardized ESD violence prevention program requirements that include receipt of over 100 hours of training. IMPACT training is open to trans and cisgender women. The extensive training of IMPACT facilitators promotes intervention efficacy, while the risk of potential bias conferred by their experience with a pre-existing curriculum is mitigated by our community-engaged approach (i.e.,TW community members, service providers, and scientists [PI and Co-I] collectively shape the content of the final tailored ESD intervention, and TW co-facilitators will be present in every training session). Prior to the start of group, facilitators will review the tailored curriculum in detail and attend 2-3 supervision/training meetings with the PI. These meetings will consist of reviewing the curriculum, role-plays of critical intervention components, and discussion of questions or concerns. The primary outcome of Aim 2 is to evaluate our ability to recruit our target (n = 48) and retain >75% over the course of the intervention. Successful completion of the pilot trial, including meeting or exceeding these benchmarks for success, will determine the feasibility and acceptability of recruiting participants into a future RCT. Preliminary efficacy of the tailored ESD violence prevention intervention will be evaluated as an exploratory aim. Participants enrolled in the pilot trial will be administered a battery of validated baseline questionnaires at baseline, immediately following the course, and 6 months after course completion including: - Demographics - Social Class Ladder - Community Ladder - Service Utilization Form - Sexual experiences Survey - Everyday Discrimination Scale - Conflict Tactics Scale - Gender Minority Stress Risk and Resilience Scale - Post Traumatic Stress Disorder Symptom Checklist for DSM-5 (PCL-5) - Sexual Assertiveness Questionnaire - Resistance Tactics Survey - Dating Self-Protection - Illinois Rape Myth Acceptance - Resistance Self-Efficacy - Personal Progress - Transgender Congruence Scale - Depression Anxiety and Stress Scale - Quick Drinking Screen - DAST-10 Brief acceptability checklists will be administered after each course session, which will contain a brief list of topics covered during that training session and participants will indicate which of the topics participants felt were adequately covered. Lastly, an exit interview will be scheduled on the final day of the course, and will take place over the weeks immediately following the completion of the course. Interviews will be video recorded using the Zoom videoconferencing platform. The video-recorded qualitative interviews will be recorded and transcribed verbatim using the Zoom transcription function (omitting identifying information) and verified for accuracy. The investigators will use three strategies to improve retention, based on an intensive evidence-based follow-up protocol with which the PI has considerable experience. First, participants will be compensated for completion of the assessment appointments at increasing increments over time. Second, at baseline, participants will be asked to provide extensive locating information and to provide names of two local persons to be contacted in the event that the participant cannot be reached. This information will be updated at the time of follow-up survey administration. Third, participants will receive cash for each of the five session acceptability checklists the participants complete. Analyses will be of two primary types: (a) examinations of whether feasibility targets were met across a variety of measures; and (b) examinations of the efficacy of the tailored ESD violence prevention intervention. The investigators will use repeated measures one-way ANOVA to test if the tailored ESD curriculum has statistically significant effect on measures of behavioral and psychological/attitudinal change. If a significant effect is detected, the investigators will use Tukey's pairwise-comparison procedure to compare all treatment means, with a 95% family confidence coefficient. To assess changes in exposure to victimization, the investigators will collapse into three levels: (a) no history of victimization; (b) moderate victimization; (c) severe victimization. For this categorical data, a chi-square test of independence will be performed to compare posttreatment vs. pre-treatment, and 6-month FU vs. pre-treatment respectively to assess the preliminary efficacy of the program, with a family-wise type I error controlled at 0.05 using Bonferroni procedure. Our efficacy outcomes are exploratory and powered to detect large effect sizes. In the largest scale RCT of an ESD violence prevention program to date, rates of completed assault among women receiving resistance training were reduced by half at 1-year follow-up. However, as there are no existing studies that report on ESD efficacy among TW, the investigators will use results of our exploratory efficacy analysis to shape power analyses for a subsequent, fully powered, RCT.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 62
• Est. completion date: February 26, 2024
• Est. primary completion date: June 25, 2022
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

• Transgender women (i.e., male assigned at birth, currently identified on the transfeminine spectrum)
• Between the ages of 18 and 65.

Exclusion Criteria:

• Cisgender men and women
• Transgender men

Related Conditions & MeSH terms

• Violence, Sexual

Intervention

Behavioral:
• Empowerment Self Defense Training
We have contracted with Prepare, Inc., the New York City chapter of IMPACT International to deliver the tailored ESD violence prevention intervention. IMPACT is an international ESD violence prevention organization with chapters across the United States. Prepare, Inc. will provide facilitators who have completed IMPACT's nationally standardized ESD violence prevention program requirements that include receipt of over 100 hours of training. IMPACT training is open to trans and cisgender women. The extensive training of IMPACT facilitators promotes intervention efficacy, while the risk of potential bias conferred by their experience with a pre-existing curriculum is mitigated by our community-engaged approach (i.e.,TW community members, service providers, and scientists [PI and Co-I] collectively shape the content of the final tailored ESD intervention, and TW co-facilitators will be present in every training session).

Locations

Country	Name	City	State
United States	Hunter College, City University of New York	New York	New York

Sponsors (3)

Lead Sponsor	Collaborator
Hunter College of City University of New York	National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health (NIH)

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Average Rating on Sexual Assertiveness at Baseline	The Sexual Assertiveness Questionnaire uses a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Higher scores are indicative of more impaired assertiveness. The measure comprises a 14-item Relational Sexual Assertiveness subscale and consists of items such as "I worry that my partner won't like me unless I engage in sexual behavior" and "I am easily persuaded to engage in sexual activity" and a 7-item Confidence and Communication subscale. A sample item is "I lack confidence in sexual situations." A total score was created by taking the average of all 14 items (range = 1-5).	Baseline
Primary	Change in Sexual Assertiveness From Baseline to 3 Month Followup	The Sexual Assertiveness Questionnaire uses a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Higher scores are indicative of more impaired assertiveness. The measure comprises a 14-item Relational Sexual Assertiveness subscale and consists of items such as "I worry that my partner won't like me unless I engage in sexual behavior" and "I am easily persuaded to engage in sexual activity" and a 7-item Confidence and Communication subscale. A sample item is "I lack confidence in sexual situations." A total score was created by taking the average of all 14 items (range = 1-5).	Change from Baseline at 3 months
Primary	Change in Sexual Assertiveness From Baseline to 6 Month Follow up	The Sexual Assertiveness Questionnaire uses a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Higher scores are indicative of more impaired assertiveness. The measure comprises a 14-item Relational Sexual Assertiveness subscale and consists of items such as "I worry that my partner won't like me unless I engage in sexual behavior" and "I am easily persuaded to engage in sexual activity" and a 7-item Confidence and Communication subscale. A sample item is "I lack confidence in sexual situations." A total score was created by taking the average of all 14 items (range = 1-5).	Change from Baseline at 6 months
Primary	Average Number of Resistance Tactics Endorsed at Baseline	The Resistance Tactics Questionnaire will be used to measure participants use of six self-defense strategies via "yes" or "no" responses to the question prompt. The self-defense strategies assessed included (a) assertive body language (e.g., walking confidently), (b) assertive verbal responses (e.g., saying "no"), (c) avoiding telegraphing emotions (e.g., providing an assertive verbal response even when nervous), (d) attention to your intuition (e.g., trusting your gut), (e) yelling and running, and (f) physical self-defense. Higher scores indicate greater use of resistance tactics. A total score was created by calculating the sum of all 6 items (range: 0-6).	Baseline
Primary	Change in Resistance Tactics From Baseline to 3 Month Follow up	The Resistance Tactics Questionnaire will be used to measure participants use of six self-defense strategies via "yes" or "no" responses to the question prompt. The self-defense strategies assessed included (a) assertive body language (e.g., walking confidently), (b) assertive verbal responses (e.g., saying "no"), (c) avoiding telegraphing emotions (e.g., providing an assertive verbal response even when nervous), (d) attention to your intuition (e.g., trusting your gut), (e) yelling and running, and (f) physical self-defense. Higher scores indicate greater use of resistance tactics. A total score was created by calculating the sum of all 6 items (range: 0-6).	Change from Baseline at 3 months
Primary	Change in Resistance Tactics From Baseline to 6 Month Follow up	The Resistance Tactics Questionnaire will be used to measure participants use of six self-defense strategies via "yes" or "no" responses to the question prompt. The self-defense strategies assessed included (a) assertive body language (e.g., walking confidently), (b) assertive verbal responses (e.g., saying "no"), (c) avoiding telegraphing emotions (e.g., providing an assertive verbal response even when nervous), (d) attention to your intuition (e.g., trusting your gut), (e) yelling and running, and (f) physical self-defense. Higher scores indicate greater use of resistance tactics. A total score was created by calculating the sum of all 6 items (range: 0-6).	Change from Baseline and 6 months
Primary	Average Use of Dating Self-Protection Against Rape Strategies at Baseline	Participant's use of protective strategies against sexual victimization will be assessed with the Dating Self-Protection Against Rape Scale. Participants will report the frequency with which they engage in a series of 15 behaviors used to for self-protection (e.g., "How often do you pay attention to your dating partner's drug/alcohol intake?"). Responses are provided along a 6-point scale ranging from never to always. Higher scores indicate greater use of self-protective strategies. A total score was created by calculating the average of all 15 items (range: 1-6).	Baseline
Primary	Change in Dating Self-Protection Against Rape From Baseline to 3 Month Follow up	Participant's use of protective strategies against sexual victimization will be assessed with this scale. Participants will report the frequency with which they engage in a series of 15 behaviors used to for self-protection (e.g., "How often do you pay attention to your dating partner's drug alcohol intake?"). Responses are provided along a 6-point scale ranging from never to always. Higher scores indicate greater use of self-protective strategies. A total score was created by calculating the average of all 15 items (range: 1-6).	Change from Baseline at 3 months
Primary	Change in Dating Self-Protection Against Rape From Baseline to 6 Month Follow up	Participant's use of protective strategies against sexual victimization will be assessed with the Dating Self-Protection Against Rape Scale. Participants will report the frequency with which they engage in a series of 15 behaviors used to for self-protection (e.g., "How often do you pay attention to your dating partner's drug alcohol intake?"). Responses are provided along a 6-point scale ranging from never to always. Higher scores indicate greater use of self-protective strategies. A total score was created by calculating the average of all 15 items (range: 1-6).	Change from Baseline at 6 months
Secondary	Average Endorsement of Rape Myth Acceptance at Baseline Scale	The 45-item scale Illinois Rape Myth Acceptance Scale assesses the endorsement of rape myth attitudes supportive of sexual coercion and aggression. Rape myths include "beliefs about rape (i.e., about its causes, context, consequences, perpetrators, victims, and their interaction) that serve to downplay, or justify sexual violence that men commit again women" (Gerger et al., 2007). The scale is formatted on a 7-point Likert-type scale ranging from "1" (strongly disagree) to "7" (strongly agree). A total score was created by calculating the average rating across all 45-items (range: 1-7).	Baseline
Secondary	Change in Rape Myth Acceptance From Baseline to 3 Month Follow up	The Illinois Rape Myth Acceptance Scale is a 45-item scale assessing the endorsement of rape myth attitudes supportive of sexual coercion and aggression. Rape myths include "beliefs about rape (i.e., about its causes, context, consequences, perpetrators, victims, and their interaction) that serve to downplay, or justify sexual violence that men commit against women" (Gerger et al., 2007). The scale is formatted on a 7-point Likert-type scale ranging from "1" (strongly disagree) to "7" (strongly agree). A total score was created by calculating the average rating across all 45-items (range: 1-7). Higher scores indicate greater endorsement of rape myths.	Change from Baseline at 3 months
Secondary	Change in Rape Myth Acceptance From Baseline to 6 Month Follow up Scale	This 45-item Illinois Rape Myth Acceptance Scale assesses the endorsement of rape myth attitudes supportive of sexual coercion and aggression. Rape myths include "beliefs about rape (i.e., about its causes, context, consequences, perpetrators, victims, and their interaction) that serve to downplay, or justify sexual violence that men commit against women" (Gerger et al., 2007). The scale is formatted on a 7-point Likert-type scale ranging from "1" (strongly disagree) to "7" (strongly agree). Higher scores indicate greater endorsement of rape myths. A total score was created by calculating the average rating across all 45-items (range: 1-7).	Change from Baseline at 6 months
Secondary	Baseline Average Rating of Resistance Self-Efficacy	Participants' confidence in utilizing assertive responses to potentially threatening dating situations was assessed by seven items on the Resistance Self-Efficacy Scale (i.e., "If someone you were with was attempting to get you to have sex with them and you were not interested, how confident are you that you could successfully resist their advances?"; Marx, Calhoun, Wilson, & Meyerson, 2001; Ozer & Bandura, 1990). Responses are provided along a 7-point scale, ranging from not at all confident to very confident. Higher scores indicate great resistance self-efficacy. A total score was created by calculating the average rating across all items (range: 1-7).	Baseline
Secondary	Change in Resistance Self-Efficacy From Baseline to 3 Month Follow up	Participants' confidence in utilizing assertive responses to potentially threatening dating situations was assessed by seven items on the Resistance Self-Efficacy Scale (i.e., "If someone you were with was attempting to get you to have sex with them and you were not interested, how confident are you that you could successfully resist their advances?"; Marx, Calhoun, Wilson, & Meyerson, 2001; Ozer & Bandura, 1990). Responses are provided along a 7-point scale, ranging from not at all confident to very confident. Higher scores indicate great resistance self-efficacy. A total score was created by calculating the average rating across all items (range: 1-7).	Change from Baseline at 3 months
Secondary	Change in Resistance Self-Efficacy From Baseline to 6 Month Follow up	Participants' confidence in utilizing assertive responses to potentially threatening dating situations was assessed by seven items on the Self-Efficacy Scale (i.e., "If someone you were with was attempting to get you to have sex with them and you were not interested, how confident are you that you could successfully resist their advances?"; Marx, Calhoun, Wilson, & Meyerson, 2001; Ozer & Bandura, 1990). Responses are provided along a 7-point scale, ranging from not at all confident to very confident. Higher scores indicate great resistance self-efficacy. A total score was created by calculating the average rating across all items (range: 1-7).	Change from Baseline at 6 months
Secondary	Average Rape Attribution at Baseline	Participants attributions of blame following experiences of sexual victimization will be assessed by 25 items on the Rape Attribution Scale (Frazier, 2002; Frazier & Seales, 1997). Responses are provided along a 5-point scale, ranging from never to very often, whereby higher scores indicate higher levels of blame. Five subscales will be utilized to explore various attributions of blame, including (a) societal blame, (b) behavioral selfblame, (c) characterological self-blame, (d) chance, and (e) rapist blame. A total score was to be created by calculating the average rating across all items (range: 1-5).	Baseline
Secondary	Change in Rape Attribution From Baseline to Follow up Assessments	Participants attributions of blame following experiences of sexual victimization will be assessed by 25 items on the Rape Attribution Scale (Frazier, 2002; Frazier & Seales, 1997). Responses are provided along a 5-point scale, ranging from never to very often, whereby higher scores indicate higher levels of blame. Five subscales will be utilized to explore various attributions of blame, including (a) societal blame, (b) behavioral selfblame, (c) characterological self-blame, (d) chance, and (e) rapist blame. A total score was to be created by calculating the average rating across all items (range: 1-5).	Change from 3 months at 6 months
Secondary	Average Rating of Gender Identity Non-Affirmation, Internalized Transphobia, Concealment, Community Connectedness, and Pride	Designed for use with transgender and gender nonconforming people, the Gender Minority Stress and Resilience measure is one of the few that assesses gender identity-related constructs. It was designed to take into account unique gender minority distal stressors as was a resilience factors. These subscales will be used in this current study to test hypothesized mediators of the effects of the ESD violence prevention training on behavioral outcomes. Responses are given on a a 5-point Likert response scale (Strongly Disagree to Strongly Agree). Higher scores are indicative of greater phenomena. Six subscale scores were created by calculating the average rating for measure items corresponding with each construct: nonaffirmation of transgender identity, internalized transphobia, identity nondisclosure, negative expectations, community connection, and pride. Range for all subscales: 1-5	Baseline
Secondary	Change in Non-Affirmation, Internalized Transphobia, Concealment, Community Connectedness, and Pride From Baseline to 3 Month Follow up	Designed for use with transgender and gender nonconforming people, the Gender Minority Stress and Resilience measure is one of the few that assesses gender identity-related constructs. It was designed to take into account unique gender minority distal stressors as was a resilience factors. These subscales will be used in this current study to test hypothesized mediators of the effects of the ESD violence prevention training on behavioral outcomes. Responses are given on a a 5-point Likert response scale (Strongly Disagree to Strongly Agree). Higher scores are indicative of greater phenomena. Six subscale scores were created by calculating the average rating for measure items corresponding with each construct: nonaffirmation of transgender identity, internalized transphobia, identity nondisclosure, negative expectations, community connection, and pride. Range for all subscales: 1-5	Change from Baseline at 3 months
Secondary	Change in Gender Identity Non-Affirmation, Internalized Transphobia, Concealment, Community Connectedness, and Pride From Baseline to 6 Month Follow up	Designed for use with transgender and gender nonconforming people, the Gender Minority Stress and Resilience measure is one of the few that assesses gender identity-related constructs. It was designed to take into account unique gender minority distal stressors as was a resilience factors. These subscales will be used in this current study to test hypothesized mediators of the effects of the ESD violence prevention training on behavioral outcomes. Responses are given on a a 5-point Likert response scale (Strongly Disagree to Strongly Agree). Higher scores are indicative of greater phenomena. Six subscale scores were created by calculating the average rating for measure items corresponding with each construct: nonaffirmation of transgender identity, internalized transphobia, identity nondisclosure, negative expectations, community connection, and pride. Range for all subscales: 1-5	Change from Baseline at 6 months
Secondary	Percentage of Participants Endorsing Rape, Sexual Assault, and No Sexual Victimization at Baseline	The Sexual Experience Survey Short Form Victimization (SES-SFV) is the most widely used measure in sexual assault research. A primary strength of the measure is that it does not require participant to label their experiences as "sexual assault" or "rape." Rather, it utilizes a series of 10 sexually explicit questions that assess t past sexual behavior along a variety of dimensions. Experiences can be classified as "completed rape," "attempted rape," "coercion," "attempted coercion," or "nonconsensual sexual contact." Participants were assigned a score of "0" if they denied the question and a score of "1" if they endorsed the question. Participants with a score of 0 for all items were categorized as having no history of victimization. Participants with a score of 1 for any item assessing sexual coercion or nonconsensual sexual contact were categorized as having experienced sexual assault. Participants with a 1 for any rape item were catagorized as having experienced rape.	Baseline
Secondary	Change in Percentage of Participants Endorsing Rape, Sexual Assault, and No Victimization From Baseline to 3 Month Followup	The Sexual Experience Survey Short Form Victimization (SES-SFV) is the most widely used measure in sexual assault research. A primary strength of the measure is that it does not require participant to label their experiences as "sexual assault" or "rape." Rather, it utilizes a series of 10 sexually explicit questions that assess t past sexual behavior along a variety of dimensions. Experiences can be classified as "completed rape," "attempted rape," "coercion," "attempted coercion," or "nonconsensual sexual contact." Participants were assigned a score of "0" if they denied the question and a score of "1" if they endorsed the question. Participants with a score of 0 for all items were categorized as having no history of victimization. Participants with a score of 1 for any item assessing sexual coercion or nonconsensual sexual contact were categorized as having experienced sexual assault. Participants with a 1 for any rape item were catagorized as having experienced rape.	Change from Baseline at 3 months
Secondary	Change in Percentage of Participants Endorsing Rape, Sexual Assault, and No Victimization From Baseline to 6 Month Followup	The Sexual Experience Survey Short Form Victimization (SES-SFV) is the most widely used measure in sexual assault research. A primary strength of the measure is that it does not require participant to label their experiences as "sexual assault" or "rape." Rather, it utilizes a series of 10 sexually explicit questions that assess t past sexual behavior along a variety of dimensions. Experiences can be classified as "completed rape," "attempted rape," "coercion," "attempted coercion," or "nonconsensual sexual contact." Participants were assigned a score of "0" if they denied the question and a score of "1" if they endorsed the question. Participants with a score of 0 for all items were categorized as having no history of victimization. Participants with a score of 1 for any item assessing sexual coercion or nonconsensual sexual contact were categorized as having experienced sexual assault. Participants with a 1 for any rape item were catagorized as having experienced rape.	Change from Baseline at 6 months
Secondary	Baseline Average Likelihood of Endorsing Gender-Based Victimization	This subscale of the Gender Minority Stress and Resilience Measure will be used to assess the exploratory hypothesis that the ESD violence prevention training will produce reductions in rates of exposure to gender-related violence. At baseline, participants will indicate whether they have been exposed to a list of gender-related victimization experiences since the age of 18. At the 3- and 6- month post-intervention followup, participants will indicate whether they have been exposed to these experiences "since your last assessment." Sample items include "I have been threatened with physical harm because of my gender identity or expression." "I have been pushed, shoved, hit, or had somethin thrown at me because of my gender identity or expression." Higher scores indicate greater exposure to gender-related violence. A likelihood of victimization score was calculated based on the average response to all measures on this subscale ("yes" vs "no"). Range: 0-1	Baseline
Secondary	Change in Endorsement of Gender-Based Victimization From Baseline to 3 Month Follow up	This subscale of the Gender Minority Stress and Resilience Measure will be used to assess the exploratory hypothesis that the ESD violence prevention training will produce reductions in rates of exposure to gender-related violence. At baseline, participants will indicate whether they have been exposed to a list of gender-related victimization experiences since the age of 18. At the 3- and 6- month post-intervention followup, participants will indicate whether they have been exposed to these experiences "since your last assessment." Sample items include "I have been threatened with physical harm because of my gender identity or expression." "I have been pushed, shoved, hit, or had somethin thrown at me because of my gender identity or expression." Higher scores indicate greater exposure to gender-related violence. A likelihood of victimization score was calculated based on the average response to all measures on this subscale ("yes" vs "no"). Range: 0-1	Change from Baseline at 3 months
Secondary	Change in Endorsement of Gender-Based Victimization From Baseline to 6 Month Follow up	This subscale of the Gender Minority Stress and Resilience Measure will be used to assess the exploratory hypothesis that the ESD violence prevention training will produce reductions in rates of exposure to gender-related violence. At baseline, participants will indicate whether they have been exposed to a list of gender-related victimization experiences since the age of 18. At the 3- and 6- month post-intervention followup, participants will indicate whether they have been exposed to these experiences "since your last assessment." Sample items include "I have been threatened with physical harm because of my gender identity or expression." "I have been pushed, shoved, hit, or had somethin thrown at me because of my gender identity or expression." Higher scores indicate greater exposure to gender-related violence. A likelihood of victimization score was calculated based on the average response to all measures on this subscale ("yes" vs "no"). Range: 0-1	Change from Baseline at 6 months