title: Rape prevention through empowerment of adolescent girls.
abstract: OBJECTIVE
  Sexual assault is a major cause of injury, unplanned pregnancy, HIV infection, and mental health problems worldwide. In parts of sub-Saharan Africa, sexual assault has reached epidemic proportions. This study evaluated the efficacy of an empowerment and self-defense intervention for adolescent girls to decrease the incidence of sexual assault and harassment in Nairobi's large informal settlements.
  
  
  METHODS
  A prospective cohort of 1978 adolescents from 4 neighborhoods near Nairobi were taught empowerment, deescalation, and self-defense skills in six 2-hour sessions. The standard-of-care (SOC) group (n = 428) received a life skills class. Self-reported, anonymous survey data were collected at baseline and 10.5 months after intervention.
  
  
  RESULTS
  Annual sexual assault rates decreased from 17.9/100 person-years at baseline to 11.1 at follow-up (rate ratio = 1.61; 95% confidence interval [CI], 1.26-1.86; P < .001); there was no significant change in the SOC group (14.3 to 14.0, rate ratio = 1.02; 95% CI, 0.67-1.57, P = .92). Sexual assault disclosure in the intervention group increased from 56% to 75% (P = .006), compared with a constant incidence of disclosure (53%) in the SOC group. The majority (52.3%) of adolescents in the intervention group reported using skills learned to stop an assault.
  
  
  CONCLUSIONS
  This intervention decreased sexual assault rates among adolescent girls in Kenya. The intervention was also associated with an increase in the disclosure of assaults, thereby enabling survivors to seek care and support and possibly leading to the identification and prosecution of perpetrators. This model should be adaptable to other settings both in Africa and globally.
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, California;
authors.forename: Clea
authors.initials: C
authors.lastname: Sarnquist
authors.affiliation: UJAMAA Africa, Nairobi, Kenya;
authors.forename: Benjamin
authors.initials: B
authors.lastname: Omondi
authors.affiliation: John Muir Medical Center, Walnut Creek, California; UJAMAA United States of America, San Francisco, California; jakesinclairmd@gmail.com.
authors.forename: Jake
authors.initials: J
authors.lastname: Sinclair
authors.affiliation: UJAMAA Africa, Nairobi, Kenya;
authors.forename: Carolinah
authors.initials: C
authors.lastname: Gitau
authors.affiliation: No Means No Worldwide, San Francisco, California; and.
authors.forename: Lee
authors.initials: L
authors.lastname: Paiva
authors.affiliation: United States International University, Nairobi, Kenya.
authors.forename: Munyae
authors.initials: M
authors.lastname: Mulinge
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, California;
authors.forename: David N
authors.initials: DN
authors.lastname: Cornfield
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, California;
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Maldonado
mesh_terms: D000293:Adolescent; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D006801:Humans; D007630:Kenya; D011209:Power, Psychological; D011446:Prospective Studies; D011902:Rape / Q000517:prevention & control* / Q000523:psychology / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
keywords: Africa; adolescent health; empowerment; intervention; prevention; sexual violence