Gufi
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Prevention: WHAT is the focus?
To prevent sexual violence, we have to understand what circumstances and factors influence its occurrence.
There are many different theoretical models that attempt to describe the root causes of sexual
violence: biological models, psychological models, cultural models, and grassroots, feminist, power-based
models. Each of these models contributes to a better understanding of sexual violence and helps experts
build programs that sustain protective factors and reduce modifiable risk factors. The CDC working group
(see inside front cover) chose to use an ecological model as part of the framework for our discussion
because it allows us to include risk and protective factors from multiple domains. Thus, if there is evidence
from psychological models about individual risk factors and from feminist models about societal risk
factors, it can all be incorporated in the same ecological model. Building such a model offers a framework
for understanding the complex interplay of individual, relationship, social, political, cultural, and environmental
factors that influence sexual violence (Dahlberg and Krug 2002) and also provides key points for
prevention and intervention (Powell, Mercy, Crosby, et al. 1999). We use the four-level ecological model
presented in the World Report on Violence and Health for this discussion (Dahlberg and Krug 2002);
however, there are a variety of ecological models that have been developed (see, for example, Heise
1998).
The examples in Table 1 illustrate the levels of the ecological model. The examples of risk factors are also
taken from the chapter on sexual violence in the World Report on Violence and Health (Jewkes, Sen,
Garcia-Moreno 2002) and are not a comprehensive list of risk factors for sexual violence perpetration.
There is a lack of research on protective factors so no such examples are presented in the model.
• Individual-level influences are biological and include personal history factors that increase the
likelihood that an individual will become a victim or perpetrator of violence. For example, factors
such as alcohol and/or drug use; attitudes and beliefs that support sexual violence; impulsive and
other antisocial tendencies; preference for impersonal sex; hostility towards women; and childhood
history of sexual abuse or witnessing family violence may influence an individual’s behavior
choices that lead to perpetration of sexual violence (Dahlberg and Krug 2002). Interventions for
individual-level influences are often designed to target social and cognitive skills and behavior and
include approaches such as counseling, therapy, and educational training sessions (Powell et al.
1999).
• Interpersonal relationship-level influences are factors that increase risk as a result of
relationships with peers, intimate partners, and family members. A person’s closest social circle—
peers, partners, and family members—can shape the individual’s behavior and range of experience
(Dahlberg and Krug 2002). Interventions for interpersonal relationship-level influences could
include family therapy, bystander intervention skill development, and parenting training (Powell et
al. 1999).
4
Individual Relationship Community Societal
Influences: attitudes and beliefs Influences: association Influences: general tolerance Influences: inequalities
that support sexual violence; with sexually aggressive of sexual assault; lack of based on gender, race,
impulsive and antisocial behavior; peers; family environment support from police or judicial and sexual orientation,
childhood history of sexual abuse that is emotionally system; poverty; lack of religious or cultural
or witnessing violence; alcohol unsupportive, physically employment opportunities; beliefs, economic and
and drug use violent or strongly weak community sanctions social policies
patriarchal against perpetrators
• Community-level influences are factors that increase risk based on community and social
environments and include an individual’s experiences and relationships with schools, workplaces,
and neighborhoods. For example, lack of sexual harassment policies in the workplace can send a
message that sexual harassment is tolerated, and that there may be few or no consequences for
those who harass others. Interventions for community-level influences are typically designed to
impact the climate, systems, and policies in a given setting.
• Societal-level influences are larger, macro-level factors that influence sexual violence such as
gender inequality, religious or cultural belief systems, societal norms, and economic or social
policies that create or sustain gaps and tensions between groups of people. For example, rape is
more common in cultures that promote male sexual entitlement and support an ideology of male
superiority (Dahlberg and Krug 2002). Interventions for societal-level influences typically involve
collaborations by multiple partners to change laws and policies related to sexual violence or
gender inequality. Another intervention would be to determine societal norms that accept violence
and to identify strategies for changing those norms (Powell et al. 1999).
The ecological model supports a comprehensive public health approach that not only addresses an
individual’s risk factors, but also the norms, beliefs, and social and economic systems that create the
conditions for the occurrence of sexual violence.
Table 1. The Ecological Model