SB 822: Quantitative Methods for Program Evaluation Research Massachusetts College of Art and Design Let’s Talk About Sex, Baby Evaluation Proposal Boston University School of Public Health Ariela Braverman Bronstein Halla Daoui Chana Leah Rosenbaum Charlotte Vieira Section 1: Intervention Overview What is the public health problem? The public health problem the intervention addresses is unsafe sex behaviors and nonconsensual sex on college campuses. The following is national data: 1 in 5 women is sexually assaulted while in college1 75-80% of the time, the victim knows their attacker1 40% of college sexual assault survivors fear their attacker will retaliate1 52.6% of college students report using a condom or other protective barrier for vaginal intercourse and less used a condom for oral and anal sex2 Individuals at ages 15-24 are at a higher risk of acquiring STDs2 Massachusetts College of Art and Design (MassArt) is an independent public college located in Boston, Massachusetts. As a school receiving federal funding, it must comply with the Campus Sexual Violence Elimination (SaVE) Act and Title IX3, which protects people from discrimination based on sex in education programs that receive federal funding. The Campus SaVE Act seeks to address violence against women on college campuses. It does this by requiring the following steps be taken by colleges:4 Incidents of domestic violence, dating violence, sexual assault, and stalking must be included in annual crime statistic reports. All victims must be provided with written rights regarding how to change their living arrangements, transportation, or working situations to avoid an unsafe environment, and receive information regarding mental health or legal counseling, and other support services. Minimum standards for dealing with disciplinary procedures with regards to domestic violence, dating violence, sexual assault, and stalking must be in place. Programming and education for students and employees about domestic violence, dating violence, sexual assault, and stalking must be provided. Many college students are uneducated about safer sex and/or choose not to engage in safer sex for a variety of reasons. This is an important concern, and needs to be addressed. While MassArt does not report an above-average amount of sexual assaults, domestic violence, dating violence, or stalking, this topic needs to be addressed to prevent it from becoming a bigger problem. By creating this program, MassArt is also complying with the Campus SaVE Act. What is the intervention? What stage is the intervention (planned or already implemented)? The intervention is a combination of an educational workshop taught to MassArt undergraduate students and a mass media campaign. The media campaign includes a common hashtag (#massart4consent), social media presence (instagram and twitter), flyers, and magnets and luggage tags (with the hashtag). The intervention is currently in its pilot year. After the pilot year, the workshop will be evaluated and mandated for all freshmen in addition to the Campus Clarity online program. What are the intervention’s outcome objectives? Students will lead healthier sex lives and engage in healthy relationships by trying to prevent STIs and unwanted pregnancies, decrease sexual assaults, and gain consent before engaging in any sexual act. Discussing STI testing and results with partner(s) Gaining and giving consent Choosing whether or not to use contraceptives together (individual and partner(s)) Regular STI testing Practicing healthy communication with partner(s) What are the program’s activities? Social media promotion o Weekly tweets with the hashtag and links to popular websites promoting consent and safer sex Moss graffiti Photo campaign Flyers posted on campus Distribute magnets and luggage tags with the hashtag Deliver a one-hour workshop using trust building activities and information about safer sex and consent (only freshman) (See Appendix 1). o Myths vs. facts exercise to discuss common misperceptions around sex, consent, and other related topics. o Fishbowl activity to demonstrate nonverbal communication and the importance of actively listening to and appreciating your partner. How will activities be implemented? Graduate student intern working with the Counseling and Wellness Center will teach the workshop to undergrads with or without co-facilitation of student leaders. The workshop is taught in residence halls and to student groups. The weekly tweets are released through the Student Development twitter account. The flyers and photos are posted throughout the campus by the graduate student intern and work study students within the Counseling and Wellness Center. Magnets and luggage tags are located in the Counseling and Wellness Center at all times for anyone to take, and given out at Counseling and Wellness events and during this program. What agency is delivering the intervention? Where will the intervention be implemented? The Counseling and Wellness Center, within MassArt, is delivering this intervention. The moss graffiti hashtag is placed in two main buildings on the MassArt campus (Tower and Kennedy lobbies). The tweets are released through the Student Development Twitter account, and students are encouraged to tweet with the hashtag. Magnets and luggage tags are given out during the program and at other health and wellness events (e.g., The Colleges of the Fenway Health and Wellness Fair). Who is the primary target population? Who is the secondary target population(s)? MassArt undergraduate students are the primary target population. The secondary target populations are other members of the Colleges of the Fenway Consortium. Input Output Resources Activities Learning Obj. Performance Obj. Promote program through hashtag o Photo campaign o Flyers posted on campus o Moss graffiti o Distribute magnets and luggage tags o Weekly tweets using the hashtag Explain importance of consent and provide examples of how to gain and give consent Reach out to supports when in need or confused about situations regarding consent and sexual health Marketing resources o Twitter o Magnets o Luggage tags o Moss o Flyers Staff/student time o Twitter feed o Maintain moss Formative research with students o Incentives o Marketing materials o Assistance with promoting the campaign MassArt Departments o Counseling and Wellness Center Interactive, educational program to inform students about topics such as o Consent o Healthy communication in relationships o Getting tested o General safer sex o o Housing and Residence Life o Provide location and student audience for consent and safer sex programming o Student Development Tweets are released from this twitter account o All flyers are approved by this department o o Facilities o Provide plywood and placement for moss graffiti o Approve locations for flyers and magnets on campus and moss Fishbowl exercise o Two concentric circles of participants facing each other o Demonstrate nonverbal communication and the importance of actively listening to your partner(s) and appreciating them o All activities and marketing tactics for this program are sent from this department o Myths vs. facts exercise o Discuss common misperceptions around sex, consent, and other related topics Outcomes/Objectives Describe healthy communication skills with partner(s) o Discuss STI testing and results o Gaining and giving consent o Choosing whether or not to use contraceptives together Explain what being sexually healthy entails o Regular STI testing o Practicing healthy communication with partner(s) Increase self-efficacy skills regarding Gaining consent before engaging in sexual acts o Engaging in healthy communication o Reaching out for help when needed o Identifying and respecting when their partner(s) is consenting to any sexual or intimate acts o Describe how not gaining consent can have legal consequences for perpetrators and emotional consequences for victims Describe what “safer sex” entails, including the following: o o o Consistent use of contraception Regular STI testing Healthy communication with partner Maintain healthy communication with sexual/intimate partner(s) o Discuss enjoyable acts with partner(s) o Relay STI testing results with partner to ensure healthy statuses o Gain consent with partner(s) before engaging in sexual acts Consistently use one or more forms of contraception when engaging in sexual acts Get tested regularly for STIs Health & Quality of Life Ultimate Obj. Students will lead healthier sex lives and engage in healthy relationships by trying to prevent STIs and unwanted pregnancies, decrease sexual assaults, more gain consent before engaging in any sexual act. Section 2: Process Evaluation Evaluation Questions Were program staff trained to implement the program as intended? What percentage of students surveyed completed questionnaires? Indicators What is the demographic makeup of the student body at each participating school? Whom are the students who completed questionnaires? How many MassArt students attended LTASB workshops? What was the reach of the LTASB marketing campaign? # of hours of training # of training sessions Staff satisfaction and preparedness post training Data Sources Performance Measures Analyze program records Survey of staff - How prepared they felt to perform jobs - How satisfied they were with trainings Analyze survey response records within each student group # of hours of training # of training sessions % of staff who received training in accordance with protocols Average levels of staff satisfaction Average levels of staff preparedness % of MassArt freshman who completed pre- and post-test surveys % of MassArt upperclassman who completed post-test surveys % of BC students completed pre- and post-test surveys Demographic characteristics of all student groups (race, income, age, sex, city/country of origin) Analyze anonymous student body demographic data available through the admissions office of participating schools Demographic characteristics of students who completed questionnaires (race, income, age, sex, city/country of origin) # of freshmen who attended LTASB workshops # of upperclassmen who attended LTASB workshops # of tweets posted per week # of views for each tweet posted # of tweets that are re-tweeted Analyze demographic questions within questionnaire None (descriptive) Analyze program records and workshop sign in records # of freshmen who attended LTASB workshops # of upperclassmen who attended LTASB workshops # of tweets posted per week # of views for each tweet posted # of tweets that are re-tweeted Analyze program records, flyer distribution plan, and twitter analytics (analytics.twitter.com) % of MassArt freshman who completed pre- and post-test surveys % of MassArt upperclassman who completed post-test surveys % of BC students completed pre- and post-test surveys None (descriptive) What are the levels of student awareness and self-reported exposure to LTASB program components? # of twitter followers # of moss sites around campus # of months during which moss is maintained # of types of flyers posted # of total flyers posted # of students who recognize hashtag # of students that have used the hashtag # of students that have completed workshop # of students that have seen flyers #of students that have seen moss Analyze awareness and self-reported exposure questions within questionnaire # of twitter followers # of moss sites around campus # of months during which moss is maintained # of types of flyers posted # of total flyers posted # of students who recognize hashtag # of students that have used the hashtag # of students that have completed workshop # of students that have seen flyers #of students that have seen moss Section 3: Outcome Evaluation -- Evaluation Design What are the outcome evaluation questions? Three Behavioral Change-based Outcome Evaluation Questions: Will the intervention lead to an increase in testing for transmitted STDs and STIs among students? Will the intervention lead to an increase in gaining and giving consent among students? Will the intervention lead to an increase in contraceptive use among students? Four Intermediate Objective Questions: Can students describe sexual consent? Can students distinguish between the multiple forms of contraception? Can students discuss sexual preference and concerns with partner? Can students list available resources for support/help on campus? The one-hour education workshop is one of the primary components of the program where certain skills will be taught to the students. The material delivered during the workshop is intended to impact positive knowledge and skills regarding gaining and giving sexual consent, increased contraceptive use, and perceived behavioral control regarding sexual consent and ability to test for STDs. Many of the social media components are directed to serve as cues to action. What study design will be used? It is a Pre-Post Control Group Design (Quasi Experimental). The following is a diagram the design: Fall semester: X1: LTASB media - all year X2: LTASB workshop - offered 3 times in fall semester Sent in July, due in August: O1: LTASB pretest O2: Campus Clarity pretest Second semester - after winter break, before spring break (mid-February): O3: LTASB posttest O4: Campus Clarity post-test Why was this design selected? Remember that the strength of the design has to be weighed against the feasibility of executing it. The LTASB workshop is to be offered to all freshmen and the media campaign to the entire student body. Randomization is impractical and therefore a quasi-experimental pre-posttest design is the best alternative. This design will allow evaluators to measure the potential effects of the intervention by examining the difference in the pre-test and post-test results. By having both groups (intervention and control), evaluators can control for the possibility that other factors not related to the intervention are causing the observed differences. What is the unit of allocation (individual, group, classroom, community, etc.)? Individual level. Who will serve as the control/comparison group? Why was this group selected? How will comparability be assessed? What will be the follow-up period and why? Intervention #1: MassArt freshmen exposed to LTASB and Campus Clarity. Control #1: Freshmen from Boston College (BC) as they have no sexual health programs in place. Intervention #2: MassArt upperclassmen exposed to social media campaign (and possibly previous LTASB pilot). Control #2: Upperclassmen from BC as they have no sexual health programs in place. Comparability: Baseline demographics for each school’s student body will be collected via demographic data from each admissions office. Demographic data specific to those participating in the evaluation will be collected via the surveys. The choice to use BC for the control groups was driven by the fact that BC has no sexual health programs, and the design required selection of a school from the Boston area. There are obvious differences between the student bodies at each school. Using the collected demographic data we can examine comparability between the groups and statistically control for differences between the two schools. MassArt freshmen will be surveyed twice prior to the workshop, once through the Campus Clarity general risky behaviors pre-test and once through the LTASB pre-test. This will be during the summer prior to the fall semester beginning. There will be a Campus Clarity posttest and LTASB post-test, as well. The BC freshmen and upperclassmen, as well as MassArt upperclassman, will be provided with LTASB pre-tests during prior to the fall semester and LTASB post-tests during spring semester of the same academic year. The follow up period: Post-tests for MassArt freshmen will be given the following semester (before spring break) to assess long-term behavioral change and knowledge gain. Post-tests for MassArt upperclassmen, BC upperclassmen, and BC freshmen will be given at the same time as MassArt freshmen during spring semester. MassArt upperclassmen will be asked if they participated in the LTASB workshop (to assess prior knowledge, comprehension of material, and long term behavior change). Another assessment could take place during the fall semester of the following year to see if those workshop participants could be followed-up with in order to get a sense of a sustained long-term change. To what extent might potential threats to internal validity operate within this design? Which are more likely and why? Which are less likely and why? How will you guard against these threats? Due to the selected study design’s lack of randomization, selection is the main threat to internal validity. This threat could be reduced, yet not eliminated, by choosing a comparison group similar to the intervention group. History, maturation, instrumentation, and testing are controlled for given that each intervention group has a control group. In terms of internal validity, interaction of selection-history, selection-maturation, and selection-testing are possible threats. Compensatory rivalry and contamination are also possible threats. Refer to table 2 for more details regarding this. Previous encounters with various sexual partners and experiences could differ between groups. Moreover, groups are maturing at different rates with respect to the measured outcome (sexual behaviors and health practices). For instance, upperclassmen in both schools are expected to have lower tendencies to experiment with multiple partners and engage in risky behaviors due their advanced maturity over freshmen. Selection - testing and selection-instrumentation are also possible threats to validity. The LTASB pre-test given to everyone, especially MassArt freshmen that are also given Campus Clarity pre-test, could possibly "prime" the students differently. The MassArt freshman could have learned differentially from the pretest (both LTASB and Clarity). Threat Threat to Validity Explanation History Freshmen: No It is controlled for because we have two-control group. One for Freshmen and one upper classmen. Notes: Upper classmen: No Instrumentation Freshmen: No It is controlled for because we have two-control group. One for Freshmen and one upper classmen. Upperclassmen: No Maturation Freshmen: No Freshmen are given two different pre-tests Clarity and LTASB while BC surveyed student body is exposed to different structured tests. It is controlled for because we have two-control group. One for Freshmen and one upper classmen. Upperclassmen: No Regression Freshmen: Maybe Upper classmen: Maybe Testing: Freshmen: Maybe It is a possibility to have a regression effect Not because of the students selected but because their scores might be extreme LTASB and Clarity Pre-tests might “prime” freshmen students. The MassArt students could have learned differentially from the pre-tests. Upper classmen: No Selection Freshmen: Yes Non-randomized selection posing greatest threat to internal validity. Upper classmen: Yes Selection-History Freshmen: Maybe Upperclassmen: Maybe Selection- Freshmen: Maybe Maturation Upper classmen: Maybe It is possible that there are different events happening at Students are impacted by certain event that one school and not another. For instance, BC religious might happen or have happened at their counsels decide to ban all sexual health services at the schools. student clinic. Could be an issue if age distributions in both samples in the two schools are different. For instance, freshmen at MassArt may be mainly 18 while freshmen majority at BC are 20. Therefore we would expect older students could have Age difference here between students could count for higher or lower tendency to engage in risky behaviors. tendency to be more careful about choosing sexual partners and more conscious regarding healthy practice of being tested. Selection-Testing Freshmen: No Not a concern. This would be an issue only if students were not all on the same baseline Upper classmen: No Selection- Freshmen: No Instrumentation Upper classmen: No Attrition Freshmen: Maybe Even though Freshmen are giving Clarity test in addition to the other survey that is given to all other groups, this should not be an issue Students in all groups taking the pre-test could drop out If any, the effect of this threat would be very of school. small. Upper classmen: Maybe Contamination Freshmen: Yes Upper classmen: Yes Hawthorne Effect Freshmen: Maybe Upper classmen: Maybe Resentful Demoralization Compensatory Rivalry Maybe: on behalf of BC or students, especially freshmen. Given that a pilot program was administrated on a previous group (now upperclassmen), interaction between this group and freshmen student body could happen, thus lead to contamination. The previous pilot may have influenced upperclassmen’s behaviors. Students who take the survey and also given the curriculum program may realize they are going to be observed and tested again and as a result may report change of behaviors due to that. BC students might be motivated as the “underdogs” to outperform MassArt students who are known to be receiving an intervention BC freshmen students are not getting any treatment, which may be a motive. Section 4: Outcome Evaluation -- Sampling How will the sample be selected and recruited? (Describe selection procedures for intervention and control/comparison groups.) Freshmen: The intervention group will be all freshmen at MassArt. LTASB workshop attendance will be mandatory so participants will be exposed to both interventions: the mass media campaign and the workshop, in addition to the Campus Clarity program. We will conduct a baseline questionnaire during the summer before the workshop, so before classes start students will have had to complete both the LTASB questionnaire and the Campus Clarity questionnaire. After the workshop, freshmen will be asked to complete a second questionnaire during the spring semester (February), and they will have to complete another questionnaire for Campus Clarity, as well. All of the questionnaires will be mandatory. The control group will be a random sample of freshmen at Boston College. They will receive the same web-based LTASB questionnaire as the intervention group during the summer before classes start and then those who answer the questionnaire will be asked to complete the second LTASB questionnaire in February. We will offer incentives for students who complete both the pre-test and the post-test questionnaires. Upperclassmen: The intervention group will be all upperclassmen at MassArt. This group will have been exposed to the mass media campaign, and the ones who participated in the pilot group of the workshop would have been exposed to that. In addition, the workshop will be offered to upperclassmen that wish to take it, attendance will not be mandatory so not all of the upperclassmen will be exposed to the workshop. These students will complete the same LTASB questionnaires as the freshmen for our intervention, at the same calendar time as the freshmen. However, this will not be mandatory for them, so we will offer incentives for those who complete both questionnaires. The control group will be a random sample of upperclassmen from Boston College. These students will be reached via email and asked to complete the LTASB questionnaire during the summer before classes start as a pre-test and then those who answer the first one will be asked to complete another LTASB questionnaire during the spring semester as a post-test. Students will also be incentivized to answer both questionnaires. What eligibility criteria will be used? Students ages 18-23 at MassArt and students within the same age group at Boston College are eligible for our study. Any student is eligible regardless of gender, sexual orientation, or sexual activity. What are the strengths and weaknesses of these sampling procedures in terms of generalizability? One of the strengths of our study is that, to our knowledge, there is no “safe sex” program at Boston College. This situation will allow us to compare the effectiveness of both interventions (the mass media campaign and the workshop) together by comparing the freshmen groups, and the mass media campaign alone by comparing the upperclassmen groups. One of the weaknesses is that not all the groups have the same selection process. For the intervention group, it will be mandatory so we expect less attrition from that group than the rest. Since participation will not be mandatory for the other 3 groups, we plan to offer incentives to people who complete both questionnaires to increase the level of participation. We could also expect some resistance from our intervention group since they will be asked to complete 4 questionnaires in total, 2 for LTASB and 2 for Campus Clarity, which might seem to them as unnecessary work. We know that the characteristics of the students enrolled in MassArt might differ from other college students, which might pose an issue for the generalizability of our results. Section 5: Outcome Evaluation – Measurement Outcome Evaluation Question Dependent Variable Outcome Objectives Will the intervention lead to an increase in testing for transmitted STDs and STIs among students? STI testing Will the intervention lead to an increase in gaining and giving consent among students? Consent practices Will the intervention lead to an increase in contraceptive use among students? Contraceptive use Intermediate Objectives Can students describe sexual consent? Attitudes and beliefs about consent Can students distinguish between the multiple forms of contraception? Attitudes and beliefs about safer sex and contraception Can students discuss sexual preference and concerns with partner? Healthy sexual communication skills Self-efficacy Can students list available resources for support/help on campus? Knowledge of support services at MassArt Selection of Measures The Sexual Health Indicators survey, created to measure indicators of sexual health among 16-24 year olds, is self-administered and contains 75 questions. Included are the following five dimensions of sexual health: 1) physical, mental, and social well-being in relation to sexuality; 2) approach to sexuality; 3) sexual relationships; 4) sexual experiences; and 5) discrimination, coercion, and violence. Items are measured using a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The Sexual Health Indicators survey was developed for use and tested among college-aged respondents, and has demonstrated high internal reliability (Cronbach’s alpha >0.7) when used with this age group. The survey has also been tested construct validity in the following areas: condom use at last vaginal sex, protection self-efficacy, STI/HIV testing self-efficacy, and sexual orientation. The relationships between opposing participant scores in each of these areas were found to be stable across gender, age, size of area of residence, and survey language.5 For the purposes of the LTASB survey, a subset of 20 questions will be chosen based on their relevance to the overall outcome evaluation questions. It will also be important to choose questions that are conservative and deemed appropriate by both MassArt and Boston College. We acknowledge that this may limit the reliability and validity of this measure. In order to address this, we will build reliability and validity testing measures into our evaluation plan. The Sexual Consent Scale-Revised (SCS-R) is a 39 item, self-administered questionnaire developed to assess attitudes, beliefs, and behaviors in relation to sexual consent. All items are measured using a Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). The overall magnitude of correlation for the SCS-R was .87 which indicates a very high level of reliability. It has been administered in other settings to undergraduate students and has shown positive correlation with awareness of consent and positive attitude toward establishing consent and a negative correlation with lack of perceived behavioral control.6 Similar to our plan for the Sexual Health Indicators survey, we will be taking a subset of 10 questions based on overall relevance and appropriateness. As referenced previously, this may limit the reliability and validity of the measure, an issue that will be addressed by incorporating reliability and validity testing into our evaluation plan. In addition, the surveys will include some general demographic questions, including age, race/ethnicity, gender, sexual orientation, grade, etc. Dependent Variable Measure Potential Measurement Error STI testing Self-report, in pre- and post-test survey (MassArt and BC): Several questions in the Sexual Health Indicators survey asses STI testing self-efficacy.5 See “Selection of Measures” above. Consent practices Contraceptive use Attitudes and beliefs about consent Sample questions include: “I feel confident I could ask my doctor or health-care provider for STI testing” “I feel confident I could ask my partner to get tested for STIs” Self-report, in pre- and post-test survey (MassArt and BC): The Sexual Consent Scale-Revised (SCS-R) contains questions regarding consent practices.6 Sample questions include: “I have not asked for sexual consent (or given my consent) at time because I felt that it might backfire and I wouldn’t end up having sex” “Typically I communicate sexual consent to my partner using nonverbal signals and body language” “I always verbally ask for consent before I initiate a sexual encounter” Self-report, in pre- and post-test survey (MassArt and BC): The Sexual Health Indicators survey contains questions regarding contraceptive use.5 Sample questions include: “I feel confident in my ability to use protection on myself and/or my partner” “If I wanted to practice “safer-sex” with someone, I would insist on doing so” “I feel confident in my ability to suggest using protection with a new partner” Self-report, in pre- and post-test survey (MassArt and BC): The Sexual Consent Scale-Revised (SCS-R) contains questions regarding attitudes and beliefs about consent.6 Sample questions include: “Not asking for sexual consent from time-totime is okay” “I would have difficulty asking for consent because it would spoil the mood” “I feel that verbally asking for sexual consent should occur before proceeding with any sexual activity” See “Selection of Measures” above. See “Selection of Measures” above. See “Selection of Measures” above. Attitudes and beliefs about safer sex and contraception Healthy sexual communication skills Self-efficacy Knowledge of support services at MassArt Self-report, in pre- and post-test survey (MassArt and BC): The Sexual Health Indicators survey contains questions regarding safe sex and contraceptive use attitudes and behaviors.5 Sample questions include: “I feel confident I could bring up the topic of protection with my health-care provider” “I feel confident I could purchase protection without feeling embarrassed” “I feel confident I could easily ask my partner if he/she had protection (or tell them that I didn’t)” Self-report, in pre- and post-test survey (MassArt and BC): The Sexual Health Indicators survey contains questions regarding healthy sexual communication skills.5 Sample questions include: “I am direct about voicing my sexual needs and preferences” “If I were to have sex with someone, I’d tell my partner what I like” “I feel confident in my ability to suggest using protection with my new partner” Self-report, in pre- and post-test survey (MassArt and BC): The Sexual Health Indicators survey contains questions regarding overall sexual self-efficacy.5 Sample questions include: “I feel confident I would be able to choose when and where to engage in sexual activity” “I feel confident I would be able to refuse sexual activity with someone I’m not comfortable with” “I feel confident I would be able to go out with someone without feeling obligated to engage in sexual activity” Self-report, in pre- and post-test survey (MassArt only): Since this measure is specific to resources at MassArt, both pre- and post- test surveys for MassArt students will include 10 questions to assess overall knowledge of support services available to students on campus. Most items will be measured using a seven-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree), with the exception of some dichotomous (yes/no) answer options. Respondents will be asked the following questions: “If I needed advice about my sexual health, I would know where to go on campus for support” “If I felt that I was in a difficult position, I would know whom to speak to at MassArt” “I know where to get condoms on campus” “I have attended a LTASB workshop” See “Selection of Measures” above. See “Selection of Measures” above. See “Selection of Measures” above. Since we are not relying on a validated measure for questions related to knowledge of support services at MassArt, we must acknowledge the possibility for some level of random or systematic error. In order to minimize potential measurement error, we plan to pilot test this question set with a small group of students. We will also conduct a focus group of students in order to assess reactions to and comprehension of questions. Section 6: Outcome Evaluation – Power Analysis Why conduct a power analysis? In order to decrease the probability of type II error, it is important to determine the sample size of students needed from each school (MassArt and BC), this will also help us to increase the precision of our study. Select one dependent variable for the power analysis. Why was it selected? The dependent variable we selected is ‘attitudes and beliefs of consent and legal and emotional consequences’. For the purpose of sample size calculation this will be classified as a dichotomous variable (yes/no), and it will be measured through the surveys based on standardized questionnaires. Of the 5 questions asked on sexual consent attitudes and beliefs those who agree with the right answer on at least 3 of them will be considered yes and those who agree on less than 3 will be considered no. We chose this variable because we are proposing a 1 year evaluation and a behavioral change would usually take longer to be detectable than knowledge. In addition, at the time we are implementing the intervention and both tests we do not know if the all the participants are sexually active and it would make it harder to evaluate a behavior. What is the intervention’s expected magnitude of change? How was this estimate derived? What is the expected baseline prevalence of the selected variable? How was this estimate derived? There is not enough data to know for certain the prevalence of knowledge on sexual consent. For this reason we decided to use the most conservative approach, and assigned a baseline prevalence of 50%. Since we are evaluating the intervention after 1 year, we are expecting a 10% increase in the knowledge of sexual consent. Based on the expected baseline prevalence and expected magnitude of change, do you expect to recruit a large, medium, or small sample? Why? Based on the estimated sexual consent prevalence of 50% among college students, and an expected increase of 10%, we would need a large sample size (305 students in each group) to have an 80% power to detect a statistically significant change. The sample size previously calculated (305 students per group) is assuming no attrition. Considering that this is a longitudinal study, we expect to have some attrition so the sample size would have to be larger. Section 7: Outcome Evaluation – Analysis Why employ statistical tests? It is crucial to employ statistical tests in order to make sense of data. Statistical tests allow evaluators to make quantitative decisions about the selected intervention. Statistical tests also help determine whether there is enough evidence to support or reject the null hypothesis. How will change be assessed for both dependent variables? Analysis of Variance, an ANOVA test will be performed to analyze the differences between group means for the different variables tested. When using ANOVA, certain specific tests such as Tukey would indicate which group variations were significantly different. What variables may confound the relationship between the independent and dependent variable? Age, gender, alcohol, and pre-testing are all possible confounders. Given the design and possible confounders, will bivariate or multivariate statistics be used? Why? Following ANOVA, multivariate analysis will be performed which will examine relationships among multiple variables at the same time. Multivariate statistics allows for understanding which variables are creating difference while taking into account the possible impact of one or more confounding factors.7 Multivariate analysis will control for potential confounders by showing the relative contribution of each independent variable (given the presence of the other independent variables) to variation in the dependent variable.7 Section 8: Summary Outline the strengths and weaknesses of your evaluation plan with regards to potential threats to validity, logistics, and other considerations. Strengths: Because LTASB is in the pilot year, there is flexibility to alter it along with the evaluation plan, as evaluations are best when created alongside the program. Surveys by email are a simple, quick, and inexpensive way to collect data. Boston College does not allow programs around sexual health, which provides a control group with less contamination possibilities than other schools. Two control groups at Boston College allows us to compare the freshmen and upperclassmen at both Boston College and MassArt separately to better determine how the intervention effects different ages. History, instrumentation, and maturation are all controlled for because there are two control groups (upperclassmen and freshman). Weaknesses: Selection is the major threat to validity, because of the lack of randomization in the control and experimental groups. However, we are going to have an internal (MassArt upperclassmen) and two external (Boston College freshmen and upperclassmen) comparison groups to best compare intervention results. Selection-history and selection-maturation may be threats to validity because different events could be occurring at each school, thus altering one student body’s actions, and the sample of students at both schools may be innately different. Contamination is also a threat because there has been a pilot year of the LTASB program at MassArt, which could lead to interactions between students who attended this program in its first year and those who are starting it afterwards. Testing may pose a threat to validity with the freshman at MassArt, because they receive both the LTASB and Clarity pre-tests, which could “prime” them to answer differently than they would have without the pre-tests. Compensatory rivalry is also a potential threat, because BC students may feel the need to outperform MassArt students to show they don’t need the intervention to accomplish the same goals. The characteristics of the student body at MassArt poses an issue for generalizability of our results. Lastly, Hawthorne effect may be a threat to validity because students, who have taken the survey and attended a LTASB program, may realize they are being observed and then tested again, which could lead to them reporting changes in behavior due to that. References 1. Centers for Disease Control and Prevention. (2013, August 20). Sexually Transmitted Diseases (STDs): Adolescents and Young Adults. Retrieved February 23, 2014, from Center for Disease Control and Prevention: http://www.cdc.gov/std/life-stagespopulations/adolescents-YoungAdults.htm. 2. STDs in Adolescents and Young Adults. (2014, January 7). Centers for Disease Control and Prevention. Retrieved February 19, 2014, from http://www.cdc.gov/std/stats12/adol.htm. 3. White House Task Force to Protect Students From Sexual Assault. (2014). Not Alone. Washington, D.C. : U.S. 4. Clery Center. (2012). The Campus Sexual Violence Elimination (SaVE) Act. Retrieved October 27, 2014, from Clery Center for Securtiy On Campus: http://clerycenter.org/campus-sexual-violence-elimination-save-act 5. Smylie, L., Clarke, B., Doherty, M., Gahagan, J., Numer, M., Otis, J., … Soon, C. (2013). The development and validation of sexual health indicators of Canadians aged 16-24 years. Public Health Reports (Washington, D.C.: 1974), 128 Suppl 1, 53–61. 6. Humphreys, T. P., & Brousseau, M. M. (2010). The sexual consent scale-revised: development, reliability, and preliminary validity. Journal of Sex Research, 47(5), 420– 428. doi:10.1080/00224490903151358 7. Boston University Modules. 2014. Multivariable Methods Modules. Retrieved from: http://sphweb.bumc.bu.edu/otlt/MPHModules/BS/BS704_Multivariable/BS704_Multivariable_print.html Appendix 1: Program Outline Let’s Talk About Sex, Baby Materials Needed o Poster board, sticky wall pad, or board to write on o Markers o Contraception o Paper for participants emails Time: about 1 hour Program Timeline: 1. Program facilitator(s) introduction 2. Explain that this program comes out of MassArt’s Counseling and Wellness Center, and then provide information about MassArt Student Health Services and the Counseling and Wellness Center. Student Health Services o Harvard Vanguard Medical Associates, located on the 2nd floor of the Treehouse Residence Hall Sick visits and physicals, check for and treat STIs, and gynecological visits Bring student ID and insurance card o Harvard Vanguard’s Kenmore location Counseling and Wellness Center o Programming throughout the year, such as Sex in the Dark and stress reduction groups o Free short-term therapy, evaluations, referrals, and other resources o Can drop in or schedule an appointment over the phone 3. Ground rules: Have participants offer suggestions, and provide a few examples they do not mention or if they are unwilling to speak up. Examples include: Confidentiality Use “I” statements No assumptions Respect Share at your own level E.L.M.O. (Enough Let’s Move On) 4. Provide a brief introduction about the program Teach about safer sex practices and healthy relationships 5. Icebreaker: Write “_ _ _ k” in front of the room and ask participants what 4-letter words end in –k and are related to sex. They can volunteer answers, but if no one offers suggestions, wait a bit and then give them the answer: “T-A-L-K.” The purpose of the icebreaker would be used to establish trust, develop a high level of comfort, and break down barriers to communication. Why did no one suggest this word? Did anyone think of it? Do people think about talking about sex before doing it, either right before or way before? Explain why communication is key before engaging in any sexual act If you don’t talk, how will the other person know what you do or don’t like, and if the act is consensual? 6. Main program activity #1: “fishbowl exercise” There will be two circles of participants, one inside the other. The inner circle will talk to one person in the outer circle about a question the facilitator will ask about, or leading to, sex and/or relationships, while the outer circle cannot speak. The roles will then be reversed and the outer circle will speak and respond to the inner circle, but the inner circle cannot speak. The idea is to understand how communication works, with both nonverbal and verbal cues, and how much we listen to each other. Choose at least 2 questions from each section: o Where are you from, and have you been enjoying Boston while at MassArt? o What are you currently studying, and why did you choose that? o Tell your partner about your family. ---------------o Tell your partner when you first learned about anything regarding relationships. (how old were you, did you observe relationships or told by someone else how they should be, such as gender) o Describe your idea of the perfect relationship. o What do you think pressuring someone to do something sounds or looks like? Discussion afterwards o How did it feel to talk to someone who wasn’t answering? Was it uncomfortable, awkward, etc.? o How was it to not be able to answer your partner? o Did you notice nonverbal cues (such as nodding or smiling)? o Do you see any connection between this exercise and intimate relationships? What if you were only relying on nonverbal cues for consent, but your partner was intoxicated? Would you enjoy always having a one sided relationship? You need to communicate to figure out what each other likes and is comfortable with, if you are both “in the mood,” or similar questions. 7. Main program activity #2: True or False Read aloud statements regarding sex, relationships, and consent, and have participants decide whether or not they believe it to be true or false by standing on one side of the room. (e.g. if you believe it is true, stand on the left side of the room) Discuss why both sides believed a statement to be true or false by asking where they had learned the information. Statements: Only do as many as time permits to stay at about 1 hour for the whole program. o All STIs are preventable. --- True, if the proper precautions are taken. If you use protection, get tested frequently (and know whether or not your partner is clean), or abstain from sexual acts, the chances of contracting an STI are extremely low. However, remember that certain STIs (crabs, scabies, and herpes) only need skin-to-skin contact for contraction. o You can contract an STI from the toilet. ---- False. STIs cannot live outside or away from the body for a long period of time. o If you are intoxicated, you can still proclaim you did not give consent. True o You can contract AIDS from unprotected sex. --- False. If your partner has HIV or AIDS, you can contract the infection if engaging in unprotected sex, but you would get HIV first. HIV can turn into AIDS if your T-cell count (for immune system) drops below a certain level or if you contract 2 opportunistic infections (e.g. pneumonia). However, you can now live for decades without ever contracting AIDS and lead a normal life. Also, you cannot get HIV/AIDS from hugging someone, if they cough on you, etc. o MassArt can tell your parents about your physical and/or mental health if you are on their insurance. --- False. Your information is completely confidential and cannot be discussed with your parents unless you give consent. o If you’ve already engaged in any sexual act with someone, you are allowed to say no in the future. ---- True. It doesn’t matter how many times you have engaged in sexual acts with someone, because it is your choice each time. Even married couples are legally allowed to say no to their spouse. 8. Debrief: Option 1: Go around the room and ask participants one thing they liked about the program, and one thing they would change. Allow the option to pass if someone does not feel comfortable speaking up. Distribute the evaluation afterwards. Option 2: Pass out post-its and have each participant write one comment about the program (good, bad, or something they would like to change) and have them place them in front of the room on the wall/board. Read them aloud and see if it brings up any more discussion among participants. If there is not enough time, then skip this debrief activity and give the evaluation. 9. End the program by telling participants that you will stay back for a few minutes if anyone has any further questions or comments. Have a sheet of paper for participants to write their email if they would like to be told about MassArt’s Counseling and Wellness Center future events. If someone asks a question about the topic or MassArt’s Health Services and you do not know the answer, take down their email and tell them you will find out the answer and email them as soon as you know.