The overall goal of the five-year project is to conduct both a process and rigorous outcome evaluation of The Set Me Free Project (SMFP)'s READY to Stand (RTS)© curriculum with an eye toward widespread dissemination to other U.S. communities, if deemed effective. Broadly, the investigators seek to determine the effect participation has on students: reductions in commercial sexual exploitation of children (CSEC) perpetration (the primary outcome); reductions in CSEC victimization, teen dating violence (TDV), and sexual violence victimization and perpetration; as well as increases in bystander intervention in CSEC situations compared to participants in the control condition (secondary outcomes).
The commercial sexual exploitation of children (CSEC) is a public health crisis in the United States. Research has documented risk and protective factors across the social ecology for CSEC, that many perpetrators (traffickers, clients, recruiters) of CSEC are peers (e.g., romantic partners) and adolescents report opportunities to intervene in situations of peer victimization (although not necessarily specific to CSEC). Prevention efforts with adolescents that seek to (1) reduce risk for CSEC perpetration; (2) reduce risk for CSEC victimization; and (3) increase positive bystander intervention in situations of CSEC is urgently needed. Thus, the goal of this multi-stakeholder collaboration-which includes researchers, educators, practitioners, and youth-is to conduct both a process and rigorous outcome evaluation of The Set Me Free Project© (SMFP)'s READY to Stand (RTS)© curriculum-with an eye toward widespread dissemination to other U.S. communities, if deemed effective. The RTS programming is for both students and school personnel. Student programming includes six, 45-minute modules implemented to high school students in mixed gender groups of \~25 students and provides students with CSEC psychoeducation, healthy relationship skills, identification of safe people, bystander intervention in CSEC situations, shifting school norms to be intolerant of all forms of violence, and valuing of self and others. School personnel participate in a training to equip them with skills to effectively respond to students' disclosures of CSEC, enhance cultural humility, and reinforce programming messages. Despite its potential for reducing CSEC, the RTS© has never been evaluated. The investigators will conduct a quasi-experimental design study in which four traditional high schools and two alternative high schools (not including the two high schools that participated in NCT05988398) are assigned to treatment or control conditions. Students enrolled in spring elective courses (e.g., healthy relationships, psychology) in the four traditional high schools and all students in the two alternative high schools (n=3,218 \[enrolled\]) will complete baseline and immediate post, 6-, 12-, and 18-month follow-up surveys to test the hypothesis that participation in the RTS© program will lead to reductions in CSEC perpetration (primary outcome), as well as reductions in CSEC victimization and teen dating violence (TDV) and sexual violence victimization and perpetration, and increases in bystander intervention in CSEC situations compared to participants in the control condition (secondary outcomes) (Aim 2a). The investigators will assess mediators and demographic moderators of program impact (Aim 2b). Document via program observations of student and school personnel programming (Aim 2c), post-session surveys (n=1,459 students \[enrolled in treatment schools\]; n=150 school personnel \[enrolled in treatment schools\]) (Aim 2d), and post program implementation of key informant and stakeholder interviews (n=40: program facilitators \[n=10\], students \[n=20\], school personnel \[n=10\]) (Aim 2e) variations in implementation, unanticipated challenges, lessons learned, and perceptions of program impact. Determine costs associated with the program implementation (both student and school personnel programming) to inform future economic evaluation of the RTS (Aim 2f).
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
3,218
Students will receive the Ready to Stand (RTS)© programming over six school days, spread over six weeks. The program is delivered in mixed-gender groups of 20 to 40 students and includes videos, small and large group discussions, activities, worksheets, and ample opportunities for skill-building. This curriculum is intended to be one piece of comprehensive prevention strategies that has the potential to make immediate and sustained impacts on reducing rates of CSEC perpetration in the lives of youth, including those most vulnerable to this pernicious crime.
[school districts in the Midwest]
Des Moines, Iowa, United States
RECRUITINGCommercial Sexual Exploitation of Children (CSEC)-Victimization Experiences
Behaviorally worded items to assess students' self-reports of commercial sexual exploitation of children (CSEC) victimization; answers are binary (Yes/No) with an option not to answer. Scale information: items are summed and used to create two variables, one indicating if a student has ever experienced these activities and the other indicating if a student has experienced these activities in the past month. Higher scores indicate worse outcomes.
Time frame: Time 1 (baseline), Time 3 (six months post-baseline), Time 4 (twelve months post-baseline, Time 5 (eighteen months post-baseline)
Commercial Sexual Exploitation of Children (CSEC)-Perpetration Experiences
Behaviorally worded items to assess students' self-reports of commercial sexual exploitation of children (CSEC) victimization perpetration; answers are binary (Yes/No) with an option not to answer. Scale information: items are summed and used to create two variables, one indicating if a student has ever experienced these activities and the other indicating if a student has experienced these activities in the past 1 or 6 months (1-month time frame utilized at baseline, 6-month time frame utilized for all follow ups). Higher scores indicate worse outcomes.
Time frame: Time 1 (baseline), Time 3 (six months post-baseline), Time 4 (twelve months post-baseline, Time 5 (eighteen months post-baseline)
Commercial Sexual Exploitation of Children (CSEC)-Bystander Opportunity and Action
Response options range from 0 to "10 or more" with an option to not answer. If participants report "one or more times" they are then asked how many times they took the specified actions. Eleven actions are listed, two of which are negative behaviors, such as doing nothing, with the other nine actions being positive behaviors, such as trying to stop the situation. For each positive action, students' responses are re-coded into a binary variable where 0=did not take action and 1=did take action. For each negative item, responses are reverse-scored. Items are then summed to create an overall score that could range from 2 to 7, with a higher score indicating better outcomes.
Time frame: Time 1 (baseline), Time 3 (six months post-baseline), Time 4 (twelve months post-baseline, Time 5 (eighteen months post-baseline)
Sexual Assault
Behaviorally worded items to assess students' self-reports of experiencing sexual assault victimization and perpetration; answers are binary (Yes/No) with an option not to answer. Items are summed, with higher scores indicating worse outcomes.
Time frame: Time 1 (baseline), Time 3 (six months post-baseline), Time 4 (twelve months post-baseline, Time 5 (eighteen months post-baseline)
Sexual Harassment
Behaviorally worded items to assess students' self-reports of experiencing sexual harassment victimization and perpetration; answers are binary (Yes/No) with an option not to answer. Items are summed, with higher scores indicating worse outcomes.
Time frame: Time 1 (baseline), Time 3 (six months post-baseline), Time 4 (twelve months post-baseline, Time 5 (eighteen months post-baseline)
Stalking
Behaviorally worded items to assess students' self-reports of experiencing stalking victimization and perpetration; answers are binary (Yes/No) with an option not to answer. Items are summed, with higher scores indicating worse outcomes.
Time frame: Time 1 (baseline), Time 3 (six months post-baseline), Time 4 (twelve months post-baseline, Time 5 (eighteen months post-baseline)
Dating Violence (MARSHA)
Behaviorally worded items to the Measure of Adolescent Relationship Harassment and Abuse (MARSHA) will be used to assess dating violence victimization and perpetration. Each subscale was summed so that higher scores indicate higher frequencies of Intimate Partner Violence (IPV), a worse outcome. Each subscale is also dichotomized to represent the absence or presence of that type of IPV.
Time frame: Time 1 (baseline), Time 3 (six months post-baseline), Time 4 (twelve months post-baseline, Time 5 (eighteen months post-baseline)
Youth Violence
Behaviorally worded items from the Youth Risk Behavior Surveillance System (YRBSS) will be used to measure physical fights, fear of going to school, and weapon carrying; answers are binary (Yes/No) with an option not to answer. Items are summed, with higher scores indicating worse outcomes.
Time frame: Time 1 (baseline), Time 3 (six months post-baseline), Time 4 (twelve months post-baseline, Time 5 (eighteen months post-baseline)
Depression
The Patient Health Questionnaire (PHQ-9) modified will be used to measure depression; items are rated from 0 ("Not at all") to 3 ("Nearly every day"). Higher scores indicate higher depressive symptomology, a worse outcome.
Time frame: Time 1 (baseline), Time 3 (six months post-baseline), Time 4 (twelve months post-baseline, Time 5 (eighteen months post-baseline)
Alcohol Use
Items from Monitoring the Future will be used to measure past month alcohol use and alcohol intoxication; items are rated from 0 ("0 times") to 9 ("40+ times"), with higher scores indicating worse outcomes.
Time frame: Time 1 (baseline), Time 3 (six months post-baseline), Time 4 (twelve months post-baseline, Time 5 (eighteen months post-baseline)
Academic and Career Commitment
Items to measure students' intentions on graduating high school/getting a GED as well as having a job/career, rated from 1 ("not true at all of me") to 4 ("extremely true of me"), with an option not to answer. A total score is calculated by taking the average of the five items, with higher scores indicating better outcomes.
Time frame: Time 1 (baseline), Time 2 (approximately three months post-baseline), Time 3 (six months post-baseline), Time 4 (twelve months post-baseline, Time 5 (eighteen months post-baseline)
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