Evidence-based prevention programming in the United States military: validating measures, evaluating effectiveness, and exploring factors influencing integration

Abstract:Preventing harmful behaviors in the U.S. military is critical to service members' well being and mission readiness. Sexual assault (SA) and alcohol misuse (AM) have well documented negative impacts, yet prevention efforts remain siloed, valid and reliable measures for military populations are lacking, and evidence on program effectiveness is limited. This dissertation addresses these gaps by assessing SA prevention measures, evaluating a novel Air Force SA prevention program, and exploring factors shaping integrated prevention in the military. Aim 1 evaluated the structural validity and reliability of four measures used to assess the Sexual Communication and Consent (SCC) program in Air Force Basic Military Training (BMT). Analyses identified a two-factor structure for the date rape attitudes scale, though reliability was low among females. Self-efficacy to resist unwanted advances and bystander intentions scales had one-factor structures with excellent reliability. The factor structure of the dating behaviors scale was not confirmed, with issues traced to the risk behaviors subscale. Findings inform recommendations for refining measures in future SA prevention program evaluations in Air Force BMT. Aim 2 evaluated SCC effectiveness using multilevel regression modeling in a sample of 3,557 trainees who had matched pre and post-training survey data. SCC participation significantly increased SA and consent knowledge and self-efficacy to resist unwanted advances. SCC significantly decreased date rape attitudes and, unexpectedly, bystander intentions. Stratified analyses revealed subgroup differences, highlighting considerations for future research and implementation for at-risk populations. Aim 3 explored the integration of SA and AM prevention programming at two military sites representing different branches and populations. Focus groups (n=40) with cadets and service members and interviews (n=15) with personnel and leadership revealed that, despite DoD policies supporting integration, prevention efforts remained siloed. Implementation barriers included time constraints, unengaging training formats, and limited personnel. Participants emphasized that demonstrating program effectiveness and resource savings is critical to obtain leadership support. This research expands the limited evidence base on prevention programming in the U.S. military, offering insights into adapting and implementing evidence-based approaches across diverse military contexts. Findings will inform Department of Defense (DoD) decision-making and support the effective, widespread adoption of integrated prevention programs.

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