Bystander intervention for problematic alcohol use among graduate and international students: opportunities and challenges

OBJECTIVES

Bystander intervention (BI) is a prevention approach commonly used for interpersonal violence, but is less studied for problematic alcohol use (PAU). Domestic graduate and international students' life experiences bring a unique context for the potential application of BI to PAU.

METHODS AND MEASURES

We conducted a mixed methods study that consisted of a needs assessment and focus groups at a southeastern university in the U.S. The aims of this study were to understand (1) differences in PAU BI opportunities for domestic graduate versus international students, (2) reasons for differences in PAU BI use, and (3) barriers/facilitators in use of PAU BI.

RESULTS

Overall, participants had few opportunities to use BI. Domestic graduate students had slightly more opportunities compared to international students. Most prominent reasons for lack of opportunities included not wanting to drive, the cost of drinking, and holding a graduate student identity (e.g. not interested in heavy drinking). Trusting others to be responsible for themselves was a common barrier noted for not using BI for PAU.

CONCLUSION

PAU BI programs should contextualize experiences of domestic graduate and international students to provide appropriate skill development that considers unique barriers and facilitators to intervention use.

The Mentors in Violence Prevention programme: impact on students' knowledge and attitudes related to violence, prejudice, and abuse, and willingness to intervene as a bystander in secondary schools in England

BACKGROUND

Violence is a leading cause of death and disability for young people and has serious impacts on prospects across the lifecourse. The education sector is a crucial setting for preventing youth violence through incorporating programmes that address attitudes and behaviours. The Mentors in Violence Prevention (MVP) programme aims to change harmful attitudes and norms, and increase non-violent bystander intervention, through a peer mentoring approach. To date there is limited evidence on the effectiveness of the intervention in UK school settings. The aim of the current study was to evaluate the impact of the programme on students' attitudes and knowledge related to violence prevention.

METHODS

The study employed a mixed methods design. Pre and post surveys measured changes in students' (aged 11-18) attitudes and knowledge related to violence prevention and bystander behaviour, gender stereotyping, acceptability of violence, and perceptions of others' willingness to intervene. Interviews/focus groups with programme delivers and students, and anonymised programme data were used to explore and supplement survey findings.

RESULTS

Overall, perceptions of the programme content and delivery were positive. Several beneficial impacts of the programme were found for mentors (students delivering the programme), including significant positive changes on measures of knowledge and attitudes towards violence prevention and the bystander approach, acceptability of violence perpetration, and perceptions of other students' willingness to intervene (effect sizes were small-medium). However, the study found no significant change on any of the outcomes amongst mentees (younger students receiving the programme from mentors). Despite this, qualitative evidence suggested mentees enjoyed the content of the programme and the peer-led delivery, and this built relationships with older students. Qualitative evidence also identified additional benefits of the programme for mentors, including leadership and communication skills, and increased confidence and supportive relationships.

CONCLUSIONS

Evidence from this study suggests MVP is effective as a targeted programme for mentors, but no significant evidence was found to demonstrate its effectiveness as a universal bystander and violence prevention programme for mentees. Whilst further research with more robust study design is needed, developing mentors as leaders in violence prevention is a valuable impact of the programme in its own right.

Knowledge and barriers of out of hospital cardiac arrest bystander intervention and public access automated external defibrillator use in the Northeast of England: a cross-sectional survey study

Intervention by members of the public during an out of hospital cardiac arrest (OHAC) including resuscitation attempts and accessible automated external defibrillator (AED) has been shown to improve survival. This study aimed to investigate the OHCA and AED knowledge and confidence, and barriers to intervention, of the public of North East England, UK. This study used a face-to-face cross-sectional survey on a public high street in Newcastle, UK. Participants were asked unprompted to explain what they would do when faced with an OHCA collapse. Chi-Square analysis was used to test the association of the independent variables sex and first aid trained on the participants' responses. Of the 421 participants recruited to our study, 82.9% (n = 349) reported that they would know what to do during an OHCA collapse. The most frequent OHCA action mentioned was call 999 (64.1%, n = 270/421) and 58.2% (n = 245/421) of participants reported that they would commence CPR. However, only 14.3% (n = 60/421) of participants spontaneously mentioned that they would locate an AED, while only 4.5% (n = 19/421) recounted that they would apply the AED. Just over half of participants (50.8%, n = 214/421) were first aid trained, with statistically more females (57.3%, n = 126/220) than males (43.9%,  n = 87/198) being first aiders (p = 0.01 χ2 = 7.41). Most participants (80.3%, n = 338/421) knew what an AED was, and 34.7% (n = 326/421) reported that they knew how to use one, however, only 11.9% (n = 50/421) mentioned that they would actually shock a patient. Being first aid trained increased the likelihood of freely recounting actions for OHCA and AED intervention. The most common barrier to helping during an OHCA was lack of knowledge (29.9%, n = 126/421). Although most participants reported they would know what to do during an OHCA and had knowledge of an AED, low numbers of participants spontaneously mentioned specific OHCA and AED actions. Improving public knowledge would help improve the public's confidence of intervening during an OHCA and may improve OHCA survival.

How Helpful Is Bystander Intervention? Perspectives of Dating and Sexual Violence Survivors

While bystander intervention education has demonstrated promise as a strategy to reduce dating and sexual violence (DSV) on campus, little is known about whether survivors on whose behalf the interventions take place find these helpful. This paper uses qualitative, in-depth interviews with 33 DSV survivors to explore their perspectives on bystander intervention. Results indicate that while some interventions were identified as helpful, especially those that provided support to the survivor, many were not helpful enough or even harmful. Further work is needed to understand the consequences of bystander action.

The bystander intervention for problematic alcohol use model (BIPAUM)

Objective: The study aimed to identify phases of bystander intervention (BI) for problematic alcohol use (PAU) among college students. Participants: Twenty focus groups and nine interviews were conducted. Methods: Transcripts were thematically analyzed. Results: The phases of the Bystander Intervention for Problematic Alcohol Use Model (BIPAUM) include: (1) plan in advance, (2) notice and interpret a sign, (3) decide (i.e., assume responsibility, assess support/feasibility to intervene, and identify intervention strategy), (4) intervene, and (5) assess outcomes. Assessing outcomes loops to influence future behavior and each phase is influenced by barriers and facilitators. Conclusions: These unique phases should be considered when designing and evaluating intervention programs for PAU to meet students' needs and better reduce PAU. Future research should empirically test the BIPAUM. The results of the current study demonstrate a promising opportunity for applying BI to PAU, with the goal of reducing risky drinking among college students.

Evaluating Mentors in Violence Prevention: A Longitudinal, Multilevel Assessment of Outcome Changes

There is a need to increase understanding of the effectiveness of bystander programmes targeting gender-based violence in the United Kingdom. There is also a need to utilise a robust theoretical models of decision-making while doing so. Changes were examined in bystanders' attitudes, beliefs, motivations towards intervening, and intervention behavior in situations of gender-based violence. To achieve this, a quantitative examination of Mentors in Violence Prevention was conducted. There were 1396 participants (50% female, 50% male) who were aged 11 to 14 years old (M = 12.25, SD = 0.84) attending high school at the first time point. Participants were attending 17 schools (53% Mentors in Violence Prevention and 47% control) in Scotland. Outcome variables were assessed approximately one year apart using questionnaires. Multilevel linear regressions revealed that Mentors in Violence Prevention did not change outcomes reflecting bystanders' attitudes, beliefs, motivations towards intervening, or intervention behavior in gender-based violence. Discrepancies between the current findings and those of other evaluations may be due to other studies including small numbers of schools that may be more motivated to implement the program. This study also identified two key issues that need to be addressed at stakeholder level before concluding that Mentors in Violence Prevention is ineffective at targeting gender-based violence. That the program has moved towards a more gender-neutral approach in the United Kingdom could explain the null results of this study. Furthermore, the current findings could be attributed to a failure to adequately address the theoretical model underpinning the program in practice.

Behavioral Intentions of Bystanders to Image-Based Sexual Abuse: A Preliminary Focus Group Study with a University Student Sample

Image-based sexual abuse (IBSA) represents a form of technology-facilitated sexual abuse that encompasses the taking, creating, and/or sharing (including threats to share) of nude or sexual images without consent. Unlike physical sexual violence contexts, little is known regarding if and how bystanders intervene in IBSA contexts. The current preliminary study aimed to address this gap in the literature. Specifically, seven focus groups with a sample of 35 university students (31 females, 4 males) were conducted to explore how they think they would behave (i.e., their behavioral intentions) if they were bystanders to three different IBSA scenarios: non-consensual taking, non-consensual sharing, and threatening to share nude or sexual images. Transcripts were analyzed using thematic analysis and the following themes were identified: perpetrator-centered action, victim-centered action, justice-centered action, and intervention as a well-informed and controlled process. Participants discussed how they would intervene by approaching the perpetrator, either in a confrontational or non-confrontational way, or approach the victim to inform them of what was happening, provide advice, or to support them. They also discussed involving the police. However, some group members were against these forms of intervention, particularly approaching the perpetrator and involving the police. Finally, many participants indicated that their actions need to be well-informed. These findings highlight a wide range of bystander actions in IBSA contexts that have implications for the development of policies, educational materials, and measures of bystander intervention behavior in future research.

Adolescents' Expectations for Types of Victim Retaliation Following Direct Bullying

Little is known about adolescents' expectations around how victims of bullying might retaliate following victimization. These expectations are important as they may inform adolescent's own behaviors, particularly intervention behaviors, in regard to bullying and potential retaliation. This study investigated adolescents' retaliation expectations and expected bystander reactions to retaliation following physical and social bullying. Participants included 6th grade (N = 450, M_age = 11.73 years, SD = 0.84) and 9th grade (N = 446, M_age = 14.82 years) adolescents (50.2% female, 63.3% European American, 22.9% African American, 3.9% Latino/a, 7% Multiracial, 2.9% Other) from middle-to-low-income U.S. public schools. Participants responded to open-ended prompts about victim responses to bullying, rating retaliation acceptability, and likelihood of engaging in bystander behaviors. ANOVAs were conducted to examine differences in retaliation expectation by type of aggression. Further, linear regressions were used to explore what factors were related to participants' expectations regarding bystander intervention. Participants expected victims to retaliate by causing harm and expected the type of retaliation to match the type of bullying. Younger participants were more specific and males were more likely to expect physical harm than females. Finally, acceptability of retaliation predicted bystander interventions. Adolescents expect aggressive retaliation suggesting that intervention might focus on teaching them ways to respond when they are bullied or observe bullying.

Lifesaving skills training in schools - A qualitative study to explore students, teachers, and parent's perceived opportunities and challenges

OBJECTIVE

The objective of this study is to explore the perception of teachers, parents and students' regarding implementation of a school-based lifesaving skills program and help predict potential barriers and solutions.

METHODS

This qualitative exploratory study was conducted in Karachi, Pakistan, from December 2020- to October 2021. We included students, teachers, and parents of secondary (grades VIII, IX, and X) and higher secondary level students (grades XI and XII) in Karachi, Pakistan's public and private schools and colleges. We selected one public, two semi-private, and two private schools. We recruited students, teachers, and parents through convenience sampling. We conducted fifteen focus group discussions (FGDs) with the students, six FGDs with the teachers, and eighteen in-depth interviews (IDIs) with parents. We transcribed the data from audio recordings and translated it into the English language. Finally, we manually analyzed the data using thematic analyses.

RESULTS

This study found that bystanders' main barriers to performing lifesaving skills are lack of knowledge, fear of legal involvement, fear of hurting the patient by incorrect technique, lack of empathy among community stakeholders, and gender bias. However, the participants had a positive and supportive attitude toward implementing lifesaving skills training in schools. They suggested starting student training in the early teenage years, preferred medical staff as trainers, and suggested frequent small sessions in English/Urdu both or Urdu language and training via theory and practical hands-on drills. Furthermore, the training was proposed to be integrated into the school curriculum to make it sustainable. Finally, the government needs to support the program and make the legal environment more conducive for bystanders.

CONCLUSION

This study identified the significant barriers to performing lifesaving skills in an emergency in a low- and middle-income country (LMIC). The participants supported implementing a national lifesaving skills program in schools and colleges. However, the participants expressed that support is needed by the government for sustainability, integrating lifesaving skills into the school curriculum, providing legal support to the bystanders, and creating awareness among the general public.

Examining the Effect of Perceived Responsibility on Online Bystander Intervention, Target Hardening, and Inaction

Failure to take responsibility for intervening has been identified as a primary barrier to bystander intervention. Building on these findings, we examine how perceptions of responsibility affect responses to witnessing victimization in the online realm-a topic that has received limited attention. Using a maximum-likelihood selection model, we analyze data from the Pew American Trends Panel (N = 3709) to estimate the effects of respondents' perceptions of the role different groups should play in addressing online harassment on their likelihood to engage in intervention, target hardening, or inaction in response to witnessing online harassment, conditioned upon their likelihood of having witnessed such behavior. Findings indicate that the greater role respondents believe online users should have in addressing online harassment, the more likely they are to intervene. (b = .310). The greater role respondents believe law enforcement or elected officials should have in addressing online harassment, the less likely they are to intervene (b = -.135 and -.072, respectively). These findings have implications for future efforts to curb online harassment through users' crime prevention efforts.

Event-specific and individual factors impacting college students' decisions to intervene in a potentially risky scenario

Universities have attempted to address sexual violence on campuses through various prevention programs, including bystander intervention. Unfortunately, the extant literature on bystander intervention has primarily focused on bystander characteristics. Little is known about how situational characteristics affect the likelihood of intervening during sexual violence; yet, these variables have the potential to influence the effectiveness of bystander intervention programs. Using data collected from college students (N = 626) at a single university located in a large Southern metropolitan city, the present study utilizes a factorial survey design to investigate the impact of location, victim/offender sex, and perceptions of alcohol use on self-reported probability of intervention in an ambiguous sexual scenario. Results indicate that participants were more likely to intervene in scenarios that depicted a fraternity-hosted social (vs. on-campus) and less likely when there was a female perpetrator and a male victim. Perceived alcohol use did not impact intervention.

The role of campus environment on bystander intentions and behaviors

OBJECTIVE

This study examined students' perceptions of campus environmental factors related to bystander intentions and behaviors, and if intentions mediated the relationship between students' perceptions and behaviors.

PARTICIPANTS

Participants were 274 students at a southern university who observed a situation they believed was, or could lead to, a sexual assault.

METHODS

Participants completed an online campus climate survey in April 2015.

RESULTS

Nearly 70% reported intervening, 21.5% did nothing, 9.5% waited to see if they needed to intervene. Students' knowledge of campus policies and procedures and their bystander intentions were associated with bystander behaviors. Students' knowledge of campus policies and procedures and being female were related to bystander intentions. The indirect path between being female, bystander intentions, and taking action, as well as the indirect path between knowing campus policies and procedures, bystander intentions, and taking action were significant.

CONCLUSIONS

Findings provide important implications for prevention programing.

An exploratory qualitative study of undergraduate men's perspectives on sexual violence bystander education

ObjectiveThis study examined the experiences of men in sexual violence bystander education programs at one institution of higher education. Participants: Twenty-three men participated in the study, of which 15 identified as men of color. Methods: Four focus groups were conducted, transcribed, and analyzed in Dedoose 8.2.14 using thematic analysis. Results: Many men questioned the applicability of national rates of sexual assault to their local campus. While bystander programing helped the men learn and use intervention skills, they critiqued these programs for unfairly characterizing all/most men as perpetrators. Additionally, Black men felt that the programing did not take into account potentially negative consequences of intervention for men of color. Conclusions: Presenting national statistics on sexual assault during bystander intervention programing may not increase men's threat perception if not paired with local campus data. Future programing should consider addressing the complicated nature of intervention specifically for men of color.

Bystander Intervention Programming with Faculty: Recommendations for Institutions of Higher Education

While bystander intervention programs have been implemented to help prevent sexual violence on campus, little is known about the impact of these programs on faculty members. We examined faculty perspectives and motivations regarding participation in a faculty-focused bystander intervention program. We facilitated three faculty focus groups (N = 10) in 2017 at a southwestern university in the U.S. Faculty were recruited through their voluntary participation in a faculty bystander intervention program. We found that faculty gained a variety of new skills from their participation in this program including new vocabulary to facilitate sensitive conversations, increased awareness regarding best practices for intervention, and practical tools to apply when intervening. Study results also revealed strategies for implementing faculty-focused bystander intervention programs that will increase the likelihood that they will affect changes in bystander behavior at all levels of the university and promote cultures of non-violence at institutions of higher education.

Development and evaluation of the red flag campaign for the primary prevention of sexual and dating violence on college campuses

Objective Sexual and dating violence (SV/DV) on college campuses is a pervasive problem with far-reaching implications for public health. This paper describes the development and evaluation of a widely disseminated SV/DV primary prevention program, the Red Flag Campaign (RFC). Participants and Methods: An online survey was administered to 203 freshmen at a southeastern US university, of whom 82% reported exposure to the RFC in the previous month. Results: College students exposed to the RFC reported greater efficacy for intervening as a bystander compared to those students who were not exposed. These results held when looking at exposure to RFC messages specifically, but not RFC events. Conclusions: This evaluation offers preliminary evidence that the RFC is effective at increasing determinants of prosocial bystander behavior, the enactment of which could reduce SV/DV on college campuses. Implications and recommendations for college personnel implementing the RFC are discussed.

PulsePoint dispatch associated patient characteristics and prehospital outcomes in a mid-sized metropolitan area

BACKGROUND

Mobile phone-based dispatch of volunteers to out-of-hospital cardiac arrests (OHCA) has been shown to increase the likelihood of early CPR and AED application. In the United States, limited characterization of patients encountered as a result of such systems exists.

AIMS

Examine prehospital case characteristics and outcomes from a multi-year deployment of PulsePoint Respond in Pittsburgh, Pennsylvania.

METHODS

PulsePoint event timing, location, and associated prehospital electronic health records (ePCRs) were obtained for EMS-encountered OHCA cases that did and did not generate PulsePoint alerts within the service area of Pittsburgh EMS from July 2016 to October 2020. ePCRs were reviewed and OHCA case characteristics were extracted according to the Utstein template. PulsePoint-associated OHCA and non-PulsePoint-associated OHCA were compared.

RESULTS

Of 840 total PulsePoint dispatches, 64 (7.6%) were for OHCA associated with a resuscitation attempt. Forty-one (64.1%) were witnessed, 38 (59.4%) received bystander CPR, and 13 (20.0%) of these patients had an AED applied prior to EMS arrival. Twenty-seven (39.7%) had an initial shockable rhythm, and 31 (48.4%) patients achieved ROSC in the field. In the city of Pittsburgh, there were 1229 total OHCA during the study period, with an estimated 29.6% occurring in public. When PulsePoint-associated and publicly occurring non-PulsePoint-associated OHCA were compared, baseline characteristics (age, sex, witnessed status) were similar, but PulsePoint-associated OHCA received more bystander CPR (p = 0.008).

CONCLUSIONS

A minority of PulsePoint dispatches in Pittsburgh were triggered by true OHCA. The majority of OHCA during the study period occurred within private residences where PulsePoint responders are not currently dispatched. PulsePoint dispatches were associated with prognostically favorable OHCA characteristics and increased bystander CPR performance.

Bystander Intervention Efficacy to Reduce Teen Dating Violence Among High School Youth Who Did and Did Not Witness Parental Partner Violence: A Path Analysis of A Cluster RCT

Youth who witness parental intimate partner violence (IPV) are at increased risk of teen dating violence (DV). This analysis of secondary data investigated whether a bystander intervention program, Green Dot, was effective at reducing physical and psychological DV victimization and perpetration among youth who had and had not previously witnessed parental IPV. The parent RCT assigned 13 schools to control and 13 schools to the Green Dot intervention. Responses from 71,797 individual surveys that were completed by high school students were analyzed across three phases of a 5-year cluster randomized control trial. Multigroup path analyses revealed that students in intervention schools who witnessed parental IPV had a reduction in psychological (p < .001) and physical DV (p < .01) perpetration and psychological DV victimization (p < .01) in Phase 2 of the intervention, while those who did not witness parental IPV had a significant reduction in psychological DV victimization (p < .01). Individuals in the intervention received more training (p < .001), which was associated with lower levels of violence acceptance (p < .001). Violence acceptance was positively associated with DV victimization and perpetration (p < .001), especially for individuals who previously witnessed parental IPV. Green Dot is an effective program at reducing DV victimization and perpetration among the high-risk group of youth who previously witnessed parental IPV, largely operating through violence acceptance norms. This underscores the bystander intervention approach as both a targeted and universal prevention program.

Preliminary development of a bystander intervention scale for depression and the examination of socio-demographic correlates amongst Singapore university students

Background

Despite peer involvement having a positive impact on help-seeking behavior, there is a lack of a scale quantifying the possibility of an individual intervening upon noticing peers who show signs of depression. The aims of this study were to (1) develop a bystander intervention scale for depression that assesses the likelihood of university students intervening when a peer shows signs of depression based on the theory of bystander intervention, (2) identify the underlying factors contributing to the behavior, and (3) explore the socio-demographic correlates of the scale.

Methods

The proposed scale, the Bystander Intervention Scale for Depression (BISD), is a 17-item self-reported questionnaire that was developed based on existing bystander intervention theory and inputs from mental health experts. Data was collected as part of a larger study to evaluate the effectiveness of an anti-stigma intervention amongst university students from a local university. A total of 392 participants were recruited. Exploratory factor analyses were performed to identify the underlying factor structure. Multiple linear regressions were conducted to explore the socio-demographic correlates of the scale.

Result

Four key factors were identified for the proposed scale: (1) Awareness of depression among peers; (2) Vigilance towards possible symptoms of depression; (3) Knowledge on how to intervene; (4) Acceptance of responsibility to intervene. Having experience in the mental health field was associated with all factors while having family members or friends with mental illness was associated with all factors except for knowledge on how to intervene. Students of older age were associated with higher vigilance towards possible symptoms of depression and knowledge on how to intervene. Those of non-Chinese ethnicity were associated with acceptance of responsibility to intervene.

Conclusion

This study provides a preliminary tool to assess bystander intervention in depression amongst university students. This study identifies sub-groups of the student population that require more education to intervene with depressed peers and also informs the development of future strategies.

Bystander Program Effectiveness to Reduce Violence and Violence Acceptance Within Sexual Minority Male and Female High School Students Using a Cluster RCT

Bystander interventions have been highlighted as promising strategies to reduce sexual violence and sexual harassment, yet their effectiveness for sexual minority youth remains largely unexamined in high schools' populations. This rigorous cluster randomized control trial addresses this gap by evaluating intervention effectiveness among sexual majority and minority students known be to at increased risk of sexual violence. Kentucky high schools were randomized to intervention or control conditions. In intervention schools, educators provided school-wide Green Dot presentations (phase 1) and intensive bystander training to student popular opinion leaders (phase 2). Each spring from 2010 to 2014, students attending 26 high schools completed anonymous surveys about violence acceptance and violent events. An analytic sample of 74,836 surveys with no missing data over the 5 years was available. Sexual violence acceptance scores declined significantly over time in intervention versus control schools among all but sexual minority males. This intervention was also associated with reductions in both perpetration and victimization of sexual violence, sexual harassment, and physical dating violence among sexual majority yet not sexual minority youth. Both sexual minority and majority youth experienced reductions in stalking victimization and perpetration associated with the intervention. In this large cluster randomized controlled trial, the bystander intervention appears to work best to reduce violence for sexual majority youth. Bystander programs may benefit from explicitly engaging sexual minority youth in intervention efforts or adapting intervention programs to include attitudes that shape the experience of sexual minority high school youth (e.g., homophobic teasing, homonegativity).

Evaluation of the One Love Escalation Workshop for Dating Abuse Prevention: a Randomized Controlled Trial Pilot Study with a Sample of US Navy Sailors

The purpose of this study was to evaluate the efficacy of the Escalation Workshop with a sample of US Navy sailors. Escalation is a one-session workshop designed to promote bystander behavior related to dating abuse. We conducted a two-arm RCT with follow-up at 4 and 8 months. Participants were 335 Navy sailors, recruited from two comparable ships based in the USA. The unit of randomization was the ship. The primary outcomes were as follows: (a) attitudes related to intervening as a bystander in dating abuse situations, (b) injunctive norms about dating abuse, (c) dating abuse-related prevention-oriented behaviors (e.g., such as posting dating violence prevention messages online), and (d) bystander behaviors including acting as a bystander to prevent peer self-harm, peer bullying, peer intoxication, or peer dating abuse, or being a proactive bystander and initiating conversations about dating abuse prevention with friends and others. Hierarchal linear models (HLMs) indicated that, compared to participants in the control group, participants in the intervention group demonstrated improvement in attitudes [β = .09, p < .001] and had more engagement than controls in prevention-oriented behavior at 8-month follow-up [β = 0.11, p < .01]. Those in the intervention group also reported larger increases than controls in bystander behavior related to peer self-harm, peer bullying, peer intoxication, and starting conversations about dating abuse. Results for dating abuse bystander behavior were mixed. At 4 months, workshop participation was marginally associated with increased bystander behavior with peers who had perpetrated dating abuse (β = 0.89, p = 0.06) and with peers experiencing physical or sexual dating abuse, or stalking or threats (β = 1.11, p = .07). However, workshop participation was not associated with increased bystander behavior with peers experiencing only physical abuse. The Escalation Workshop may be a promising strategy to promote change in dating abuse-related attitudinal change and prevention-oriented behavior, and bystander behavior with peers related to self-harm, bullying, intoxication, and some aspects of dating abuse prevention.

Pioneer Legislation on Second Order of Sexual Harassment: Sociolegal Innovation in Addressing Sexual Harassment

BACKGROUD

Countless efforts to combat sexual harassment have been proposed, and for the first time in history, the second order of sexual harassment (SOSH) has been legislated under the term second-order violence (SOV) by a unanimous vote of the Catalan Parliament. Advances in preventing and responding to sexual harassment contribute to highlighting the intervention as being crucial to supporting survivors against retaliation. A lack of support provides a general explanation on why bystanders tend not to intervene and highlights the reality that reprisals are suffered by those who support victims.

METHODS

From the existing knowledge about sexual harassment prevention and response mechanisms, this paper analyzes scientific evidence through a review of the literature published in databases, as well as legislation, reports, and other materials.

RESULTS

The context that enables SOV legislation is grounded in three realms: (1) bystander intervention and protection, (2) the role of support networks in protecting survivors, and (3) awareness and legislation of SOSH. An active bystander refers to the involvement of someone who is aware of potential sexual harassment situations.

CONCLUSIONS

The lack of legislation against SOSH limits bystander intervention and support; therefore, legislating protection for supporters has become urgent and necessary. Legislating SOSH has great social implications because gender equality cannot be fully achieved if bystander protection is not legally considered. Policy Implications: As no legal system has previously contemplated SOSH, its pioneering parliamentarian approval and establishment by Catalan law constitute a legal key innovation for the field of gender and women's studies. In fact, evidence reported here are important in developing further regulations and policy.

POLICY IMPLICATIONS

As no legal system has previously contemplated SOSH, its pioneering parliamentarian approval and establishment by Catalan law constitute a legal key innovation for the field of gender and women's studies. In fact, evidence reported here are important in developing further regulations and policy.

Reactions to Actions: Exploring How Types of Bystander Action Are Linked to Positive and Negative Consequences

Sexual and dating violence (SDV) are growing public health problems in the United States. Prevention programs have sought to engage potential bystanders so they can safely and effectively intervene in situations involving SDV. However, the ability of these programs to prepare bystanders may be limited if they do not address the possible outcomes of their actions. Few studies have examined positive and negative consequences of bystander action, and only one has examined how various types of action impact these consequences. The purpose of our study was to explore how specific types of bystander actions and their number of actions were related to positive and negative consequences. We recruited participants (N = 615) through Amazon's Mechanical Turk and a university subject pool, all of whom were between the ages of 18 and 24. Participants described the type of action they took in response to risk for SDV (i.e., harassing comments, dating violence, unwanted sexual advances, and controlling behavior). We performed a content analysis on participants' written responses about the type of action taken. New measures of bystander consequences were used to examine bystander feelings and reactions of others (e.g., the victim, perpetrator). A range of action types were identified (i.e., direct, distract, distance, delegate, and physical action). Of note, direct action toward the perpetrator was related to more negative feelings and responses, whereas distract and distance action were associated with more positive feelings and responses from others. Further, taking multiple actions (as opposed to a single one) was related to more positive feelings and responses from others. Implications for research and practice are discussed, with a specific focus on prevention programming.

Crowdsourcing to save lives: A scoping review of bystander alert technologies for out-of-hospital cardiac arrest

AIM

Out-of-hospital cardiac arrest (OHCA) constitutes a significant global health burden, with a survival rate of only 10-12%. Mobile phone technologies have been developed that crowdsource citizen volunteers to nearby OHCAs in order to initiate resuscitation prior to ambulance arrival. We performed a scoping review to map the available literature on these crowdsourcing technologies and compared their technical specifications.

METHODS

A search strategy was developed for five online databases. Two reviewers independently assessed all articles for inclusion and extracted relevant study information. Subsequently, we performed a supplementary internet search and consulted experts to identify all available bystander alert technologies and their specifications.

RESULTS

We included 65 articles examining bystander alerting technologies from more than 15 countries. We also identified 25 unique technologies, of which 18 were described in the included literature. Technologies were text message-based systems (n = 3) or mobile phone applications (n = 22). Most (21/25) used global positioning systems to direct bystanders to victims and nearby AEDs. Response radii for alerts varied widely from 200 m to 10 km. Some technologies incorporated advanced features such as video-conferencing with ambulance dispatch and detailed alert settings. Not all systems required volunteers to have training in cardiopulmonary resuscitation. Only ten studies assessed impact on clinical outcomes. Key barriers discussed included false positive alerts, legal liability, and potential psychological impact on volunteers.

CONCLUSION

Our review provides a comprehensive overview of crowdsourcing technologies for bystander intervention in out-of-hospital cardiac arrest. Future work should focus on clinical outcomes and methods of addressing barriers to implementation.

Alcohol Intoxication Impairs the Bystander Intervention Process in a Hypothetical Sexual Assault: A Field Investigation

OBJECTIVE

High rates of alcohol-related sexual assault among young adults represent a significant public health problem. Bystander intervention programs are a promising strategy to reduce sexual assault incidence. However, little is known about how bystander intoxication may modify bystander intervention effectiveness. We examined the role of bystander intoxication and intoxication levels of the hypothetical victim and perpetrator on outcomes associated with Latané and Darley's (1970) steps of bystander intervention, which include noticing a situation, assessment of risk and need for intervention, taking personal responsibility for intervening, and selecting an intervention.

METHOD

In a field setting, participants were recruited from a downtown area surrounded by several drinking establishments. After providing informed consent, 327 participants (45% women) ages 21 - 29 years listened to one of four sexual assault vignettes (varied by victim and perpetrator intoxication), responded to questionnaires assessing outcomes related to steps of bystander intervention, and completed a field breathalyzer test to measure intoxication level.

RESULTS

We found that increased participant intoxication was related to decreased accuracy of situation recall and assessment of risk and need for intervention, but not ratings of personal responsibility to intervene, chosen intervention strategy, or confidence to intervene.

CONCLUSIONS

Intoxication could influence how a bystander interprets a hypothetical nonconsensual sexual interaction at the level of accurate situation recall and risk assessment. If the early steps of information processing are impaired by intoxication, later steps of intervention enactment may not occur successfully. Bystander intervention programming may consider incorporating training to overcome the impairing effects of intoxication for identifying harmful situations and choosing to intervene.

Who Will be a Bystander? An Exploratory Study of First-Person Perception Effects on Campus Bystander Behavioral Intentions

PURPOSE

The purpose was to explore the underlying mechanisms that drive relationships between knowledge, attitudes and intervening bystander behavior to improve bystander violence prevention program effectiveness. Perceptual effects theory was used to understand third-person and first-person perceptions (TPP and FPP) as related to bystander intervention programs and to what extent perceptual gaps influence one's intention to intervene.

METHODS

A web-based survey was conducted with 379 undergraduate students recruited from a large, Northeastern University. The survey covered demographics, previous bystander training, self-efficacy to engage in bystander behavior, social desirability of bystander intervention training programs, and perceived effects on self and others. Participants indicated how they would act in six hypothetical dating violence/bullying and sexual violence scenarios, and how they thought an average student on campus would act. Perceived ambiguity and risk for each of the scenarios were also measured.

RESULTS

Descriptive statistics, paired-sample t-tests, and multilevel model analyses were conducted. Results showed that a robust first-person perception effect existed (i.e., the student perceived themselves being more influenced by bystander interventions/messages than their peers). The magnitude of FPP was increased by sex (significantly larger gap among female students) and previous training.

CONCLUSIONS

Results show promise to further tailor and refine bystander interventions and provide directions to improve program effectiveness. Despite study limitations, the results indicate the first-person effect warrants further consideration for programming and messaging. Tailoring bystander training or repeated exposure may increase bystander behaviors. More research is needed to fully uncover TPP/FPP effects, predictors, and impacts on bystander intervention programs.

Dimensions of empathy and bystander intervention in bullying in elementary school

The current study investigated associations among cognitive empathy, affective empathy, internalizing problems, and the five steps of the bystander intervention model (notice bullying events, interpret as an event requiring intervention, accept responsibility for intervening, know how to intervene, and act). Participants included 336 fourth and fifth grade students (58.9% boys) at a school in the Midwest region of the United States. Hierarchical regression analyses indicated that greater cognitive empathy was related to noticing bullying events, accepting responsibility to intervene, and knowing how to intervene. Affective empathy was significantly related to the actual act of intervention. Further, significant interactions revealed that affective empathy was positively associated with interpreting bullying as an event that required intervention at low and moderate levels of internalizing problems, but not at high levels of internalizing problems. Overall these findings underscore the need to examine the decision to intervene as the culmination of a series of steps as outlined in the bystander intervention model, with each step potentially influenced by a unique set of precursors.

An application of the theory of normative social behavior to bystander intervention for sexual assault

Objective: Given the high prevalence of sexual assault on U.S. college campuses, the current study examines predictors of college students' intentions to intervene to prevent sexual assault through the lens of the theory of normative social behavior (TNSB). Participants: One hundred eighty-six undergraduate students age 18-25 were recruited from an introductory course at a large Midwestern university. Methods: Data were collected through an online survey during the 2015-2016 academic year. Results: Results indicated that descriptive norms, injunctive norms, and outcome expectations had direct positive effects on behavioral intention. However, no direct effect of group identity on intention was found. In addition to these main effects, an interaction between descriptive and injunctive norms was also observed. Conclusions: The results of the current study speak to theoretical questions surrounding the nature of TNSB variables, as well as several practical implications for coordinated efforts to promote bystander intervention on college campuses.

Observing the stages of bystander intervention in virtual reality simulation

BACKGROUND

Understanding bystander reactions to an emergency is an important component of effective training. Four stages of bystander intervention (BI) have been previously described: noticing the situation as a problem, interpreting when it is appropriate to intervene, recognizing personal responsibility to intervene, and knowing how to intervene. Using virtual reality (VR) to simulate emergencies such as sudden cardiac arrest (SCA) can be used to study these stages.

METHODS

In a secondary analysis of an observational cohort study, we analyzed bystander self-efficacy for stages of BI before and after simulated SCA. Each subject participated in a single-player, immersive, VR SCA scenario. Subjects interacted with simulated bystanders through voice commands ("call 911", "get an AED"). Actions taken in scenario, like performing CPR, were documented. Scenario BI actions were compared based on dichotomized comfort/discomfort.

RESULTS

From June 2016 to June 2017, 119 subjects participated. Average age was 37±14 years, 44% were female and 46% reported CPR training within 2 years. During the scenario, 98% "noticed the event" and "interpreted it as a problem", 78% "took responsibility", and 54% "possessed the necessary skills". Self-efficacy increased from pre- to post-scenario: noticing the event increased from 80% to 96%; interpreting as a problem increased from 86% to 97%; taking responsibility increased from 56% to 93%; possessing necessary skills increased from 47% to 63% (P<0.001).

CONCLUSION

Self-efficacy to respond to an SCA event increased pre- to post-scenario. Bystanders who reported feeling comfortable "taking responsibility to intervene" during an emergency were more likely to take action during a simulated emergency.

School and Family Factors Predicting Adolescent Cognition Regarding Bystander Intervention in Response to Bullying and Victim Retaliation

Youth aggression occurs at high rates. Aggressive acts can be curbed through bystander intervention; yet, little is known about school and family factors that predict bystander intervention in response to both aggression and victim retaliation. This research examines school and family factors related to standing up to aggression and intervening before possible retaliation occurs. Participants included 6^th and 9^th graders (N = 896, 52.8% female), who evaluated how likely they would be to intervene if they observed aggression and if they heard the victim was planning to retaliate. Family and school factors are important predictors of bystander intervention, with higher family management, and more positive school climate associated with greater likelihood of intervention and higher feelings of social exclusion and teacher and peer discrimination associated with inactive responses to aggression and retaliation. Thus, a complex constellation of factors relate to the likelihood of intervening if someone is being victimized or considering retaliation in response to victimization. The results provide guidance and new directions for possible school- and family-based interventions to encourage bystander intervention in instances of aggression.

The influence of excluding patients with bystander return of spontaneous circulation in the current OHCA database

BACKGROUND

The effect of bystander interventions has been extensively evaluated by cerebral function after 1 month post-resuscitation. However, patients who received bystander cardiopulmonary resuscitation (BCPR) and achieved the return of spontaneous circulation (ROSC) before the arrival of the emergency medical system (EMS) are routinely defined with an unknown electrocardiogram (ECG) and are usually excluded before analysis. The aim is to determine the influence of excluding patients with unknown first monitored rhythm, which includes cases of bystander ROSC, from the out-of-hospital cardiac arrest (OHCA) database.

METHODS

This nationwide population-based observational study was conducted in Japan using Utstein data from 2011 to 2014. In total, 91,995 patients with bystander-witnessed cardiogenic OHCA received resuscitation attempts in the pre-hospital setting. These patients were divided into three groups by the first monitored rhythm upon EMS arrival. We analysed the differences of datasets that included and excluded the unknown group and determined the effect on outcomes by multivariate logistic regression and odds ratios (ORs) with 95% confidence intervals (95% CIs).

RESULTS

When the unknown group was excluded from the data, the adjusted odds ratio (AOR) of cardiopulmonary resuscitation (CPR) to favourable cerebral performance category (CPC) 1 or 2 was decreased (conventional CPR: AOR, 1.90 to 1.58; chest-compression-only CPR: AOR, 2.08 to 1.69) compared to the unknown group's inclusion. Conversely, the AOR of public-access defibrillation (PAD) was increased (AOR, 4.51 to 6.13).

CONCLUSIONS

The exclusion of unknown ECGs from a dataset may lose ROSC patients by bystander CPR, causing selection bias to affect outcomes.

The assessment of bystander intervention in bullying: Examining measurement invariance across gender

Research on bystander intervention in bullying has indicated that prosocial helping behavior is not consistent across gender, with girls engaging in more bystander intervention; however, a search of the literature does not reveal any studies that have examined the validity of bystander intervention measurement across subpopulations. The purpose of the current study was to investigate measurement invariance across gender in both the elementary and middle school versions of the Bystander Intervention Model in Bullying measure among a sample of 682 fourth to eighth grade students (46% girls, 47% low income, 87% White). Results suggest evidence of measurement equivalence of the five-step bystander intervention model across gender in the elementary and middle school samples. Given this, there is evidence that the measure can be used for research and practical purposes in these grade levels and that comparisons between boys and girls are appropriate.

Measuring Bystander Behavior in the Context of Sexual Violence Prevention: Lessons Learned and New Directions

Bystander intervention is receiving increased attention as a potential sexual violence prevention strategy, especially to address campus sexual assault. Rather than focusing on potential perpetrators or victims, the bystander approach engages all members of a community to take action. A growing body of evaluative work demonstrates that bystander intervention education programs yield increased positive attitudes and behaviors related to sexual violence and greater willingness to intervene in pro-social ways. Future program outcome studies, however, would benefit from more refined measures of bystander action as it is a key variable that prevention education programs attempt to influence. The purpose of the current article is to present key issues, identified by four different research teams, on the measurement of bystander behavior related to sexual violence in the context of college campuses. Comparisons among the methods are made to suggest both lessons learned and new directions for bystander behavior measurement using self-report surveys in program evaluation.

Increased cardiac arrest survival and bystander intervention in enclosed pedestrian walkway systems

BACKGROUND

Cities worldwide have underground or above-ground enclosed walkway systems for pedestrian travel, representing unique environments for studying out-of-hospital cardiac arrests (OHCAs). The characteristics and outcomes of OHCAs that occur in such systems are unknown.

OBJECTIVE

To determine whether OHCAs occurring in enclosed pedestrian walkway systems have differing demographics, prehospital intervention, and survival outcomes compared to the encompassing city, by examining the PATH walkway system in Toronto.

METHODS

We identified all atraumatic, public-location OHCAs in Toronto from April 2006 to March 2016. Exclusion criteria were obvious death, existing DNR, and EMS-witnessed OHCAs. OHCAs were classified into mutually exclusive location groups: Toronto, Downtown, and PATH-accessible. PATH-accessible OHCAs were those that occurred within the PATH system between the first basement and third floor. We analyzed demographic, prehospital intervention, and survival data using t-tests and chi-squared tests.

RESULTS

We identified 2172 OHCAs: 1752 Toronto, 371 Downtown, and 49 PATH-accessible. Compared to Toronto, a significantly higher proportion of PATH-accessible OHCAs was bystander-witnessed (62.6% vs 83.7%, p=0.003), had bystander CPR (56.6% vs 73.5%, p=0.019), bystander AED use (11.0% vs 42.6%, p<0.001), shockable initial rhythm (45.5% vs 72.9%, p<0.001), and overall survival (18.5% vs 33.3%, p=0.009). Similar significant differences were observed when compared to Downtown.

CONCLUSIONS

This study suggests that OHCAs in enclosed pedestrian walkway systems are uniquely different from other public settings. Bystander resuscitation efforts are significantly more frequent and survival rates are significantly higher. Urban planners in similar infrastructure systems worldwide should consider these findings when determining AED placement and public engagement strategies.

A High School-Based Evaluation of TakeCARE, a Video Bystander Program to Prevent Adolescent Relationship Violence

Although bystander programs to prevent relationship and sexual violence have been evaluated with college students, few evaluations have been conducted with high school students. This study evaluated the effectiveness of TakeCARE, a brief video bystander program designed to promote helpful bystander behavior in situations involving relationship violence among high school students. Students (N = 1295; 52.5% female; 72.3% Hispanic) reported their bystander behavior at a baseline assessment. Classrooms (N = 66) were randomized to view TakeCARE or to a control condition, and high school counselors administered the video in the classrooms assigned to view TakeCARE. Students again reported their bystander behavior at a follow-up assessment approximately 3 months afterward. Results indicate that students who viewed TakeCARE reported more helpful bystander behavior at the follow-up assessment than students in the control condition. Results of exploratory analyses of the likelihood of encountering and intervening upon specific situations calling for bystander behavior are also reported. TakeCARE is efficacious when implemented in an urban high school by high school counselors.

See Something, Do Something: Predicting Sexual Assault Bystander Intentions in the U.S. Military

Sexual assault is a pervasive problem in the U.S. military, especially against women. Bystander intervention is increasingly promoted as important for reducing sexual violence, and it may be particularly helpful in contexts with high rates of sexual violence. Bystander training encourages and enables people to intervene safely and stop sexual violence. In this study, we drew from an ecological model to investigate intrapersonal, microsystem, and exosystem factors that predicted Service members' assumption of personal responsibility to intervene in an alcohol-involved sexual assault. Moreover, we examined how these predictors played a role in decisions about how to intervene: confronting the perpetrator, assisting the victim, or finding someone to help. We analyzed data from 24,610 active duty personnel collected by the Department of Defense. Several factors significantly related to Service members' bystander intentions: gender, rank, morale, attitudes about sexual assault, training, and trust in the military sexual assault system predicted the likelihood and method of bystander intervention. These findings help identify how and why people intervene (or fail to intervene) when they witness situations that could develop into sexual violence.

Factors influencing decision-making by social care and health sector professionals in cases of elder financial abuse

This study aimed to identify the factors that have the greatest influence on UK social care and health sector professionals' certainty that an older person is being financially abused, their likelihood of intervention, and the type of action most likely to be taken. A factorial survey approach, applying a fractional factorial design, was used. Health and social care professionals (n = 152) viewed a single sample of 50 elder financial abuse case vignettes; the vignettes contained seven pieces of information (factors). Following multiple regression analysis, incremental F tests were used to compare the impact of each factor on judgements. Factors that had a significant influence on judgements of certainty that financial abuse was occurring included the older person's mental capacity and the nature of the financial problem suspected. Mental capacity accounted for more than twice the variance in likelihood of action than the type of financial problem. Participants from social care were more likely to act and chose more actions compared to health sector participants. The results are discussed in relation to a bystander intervention model. The impact of the older person's mental capacity on decision-making suggests the need for training to ensure action is also taken in cases where older people have full mental capacity and are being abused. Training also needs to highlight the more subtle types of financial abuse, the types that appear not to lead to certainty or action.