Trial Outcomes & Findings for Empowerment Self-Defense Training for the Prevention of Victimization of Transgender Women (NCT NCT04934189)

Participants were adults recruited from the community between July 2021 and November 2021. Participants were recruited through advertisements on social media and via email flyers distributed to community organizations and leaders. Recruitment materials (advertisements and flyers) advertised a no cost group Empowerment Self-Defense program for Trans Women and Trans Femmes and indicated that participants would be compensated up to $230.

Participants were excluded from analyses if they did not meet inclusion/exclusion criteria; met screening criteria but did not respond to enrollment invitation; replied to enrollment invitation emails but did not complete baseline survey and never attended class; completed baseline survey but missed the first three consecutive sessions (i.e., dropped out). Participants across each of the three groups received the same active treatment and were therefore assigned to a single treatment arm.

Empowerment Self-Defense Training for the Prevention of Victimization of Transgender Women

The Sexual Assertiveness Questionnaire uses a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Higher scores are indicative of more impaired assertiveness. The measure comprises a 14-item Relational Sexual Assertiveness subscale and consists of items such as "I worry that my partner won't like me unless I engage in sexual behavior" and "I am easily persuaded to engage in sexual activity" and a 7-item Confidence and Communication subscale. A sample item is "I lack confidence in sexual situations." A total score was created by taking the average of all 14 items (range = 1-5).

The Sexual Assertiveness Questionnaire uses a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Higher scores are indicative of more impaired assertiveness. The measure comprises a 14-item Relational Sexual Assertiveness subscale and consists of items such as "I worry that my partner won't like me unless I engage in sexual behavior" and "I am easily persuaded to engage in sexual activity" and a 7-item Confidence and Communication subscale. A sample item is "I lack confidence in sexual situations." A total score was created by taking the average of all 14 items (range = 1-5).

The Sexual Assertiveness Questionnaire uses a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Higher scores are indicative of more impaired assertiveness. The measure comprises a 14-item Relational Sexual Assertiveness subscale and consists of items such as "I worry that my partner won't like me unless I engage in sexual behavior" and "I am easily persuaded to engage in sexual activity" and a 7-item Confidence and Communication subscale. A sample item is "I lack confidence in sexual situations." A total score was created by taking the average of all 14 items (range = 1-5).

The Resistance Tactics Questionnaire will be used to measure participants use of six self-defense strategies via "yes" or "no" responses to the question prompt. The self-defense strategies assessed included (a) assertive body language (e.g., walking confidently), (b) assertive verbal responses (e.g., saying "no"), (c) avoiding telegraphing emotions (e.g., providing an assertive verbal response even when nervous), (d) attention to your intuition (e.g., trusting your gut), (e) yelling and running, and (f) physical self-defense. Higher scores indicate greater use of resistance tactics. A total score was created by calculating the sum of all 6 items (range: 0-6).

The Resistance Tactics Questionnaire will be used to measure participants use of six self-defense strategies via "yes" or "no" responses to the question prompt. The self-defense strategies assessed included (a) assertive body language (e.g., walking confidently), (b) assertive verbal responses (e.g., saying "no"), (c) avoiding telegraphing emotions (e.g., providing an assertive verbal response even when nervous), (d) attention to your intuition (e.g., trusting your gut), (e) yelling and running, and (f) physical self-defense. Higher scores indicate greater use of resistance tactics. A total score was created by calculating the sum of all 6 items (range: 0-6).

The Resistance Tactics Questionnaire will be used to measure participants use of six self-defense strategies via "yes" or "no" responses to the question prompt. The self-defense strategies assessed included (a) assertive body language (e.g., walking confidently), (b) assertive verbal responses (e.g., saying "no"), (c) avoiding telegraphing emotions (e.g., providing an assertive verbal response even when nervous), (d) attention to your intuition (e.g., trusting your gut), (e) yelling and running, and (f) physical self-defense. Higher scores indicate greater use of resistance tactics. A total score was created by calculating the sum of all 6 items (range: 0-6).

Participant's use of protective strategies against sexual victimization will be assessed with the Dating Self-Protection Against Rape Scale. Participants will report the frequency with which they engage in a series of 15 behaviors used to for self-protection (e.g., "How often do you pay attention to your dating partner's drug/alcohol intake?"). Responses are provided along a 6-point scale ranging from never to always. Higher scores indicate greater use of self-protective strategies. A total score was created by calculating the average of all 15 items (range: 1-6).

Participant's use of protective strategies against sexual victimization will be assessed with this scale. Participants will report the frequency with which they engage in a series of 15 behaviors used to for self-protection (e.g., "How often do you pay attention to your dating partner's drug alcohol intake?"). Responses are provided along a 6-point scale ranging from never to always. Higher scores indicate greater use of self-protective strategies. A total score was created by calculating the average of all 15 items (range: 1-6).

Participant's use of protective strategies against sexual victimization will be assessed with the Dating Self-Protection Against Rape Scale. Participants will report the frequency with which they engage in a series of 15 behaviors used to for self-protection (e.g., "How often do you pay attention to your dating partner's drug alcohol intake?"). Responses are provided along a 6-point scale ranging from never to always. Higher scores indicate greater use of self-protective strategies. A total score was created by calculating the average of all 15 items (range: 1-6).

The 45-item scale Illinois Rape Myth Acceptance Scale assesses the endorsement of rape myth attitudes supportive of sexual coercion and aggression. Rape myths include "beliefs about rape (i.e., about its causes, context, consequences, perpetrators, victims, and their interaction) that serve to downplay, or justify sexual violence that men commit again women" (Gerger et al., 2007). The scale is formatted on a 7-point Likert-type scale ranging from "1" (strongly disagree) to "7" (strongly agree). A total score was created by calculating the average rating across all 45-items (range: 1-7).

The Illinois Rape Myth Acceptance Scale is a 45-item scale assessing the endorsement of rape myth attitudes supportive of sexual coercion and aggression. Rape myths include "beliefs about rape (i.e., about its causes, context, consequences, perpetrators, victims, and their interaction) that serve to downplay, or justify sexual violence that men commit against women" (Gerger et al., 2007). The scale is formatted on a 7-point Likert-type scale ranging from "1" (strongly disagree) to "7" (strongly agree). A total score was created by calculating the average rating across all 45-items (range: 1-7). Higher scores indicate greater endorsement of rape myths.

This 45-item Illinois Rape Myth Acceptance Scale assesses the endorsement of rape myth attitudes supportive of sexual coercion and aggression. Rape myths include "beliefs about rape (i.e., about its causes, context, consequences, perpetrators, victims, and their interaction) that serve to downplay, or justify sexual violence that men commit against women" (Gerger et al., 2007). The scale is formatted on a 7-point Likert-type scale ranging from "1" (strongly disagree) to "7" (strongly agree). Higher scores indicate greater endorsement of rape myths. A total score was created by calculating the average rating across all 45-items (range: 1-7).

Participants' confidence in utilizing assertive responses to potentially threatening dating situations was assessed by seven items on the Resistance Self-Efficacy Scale (i.e., "If someone you were with was attempting to get you to have sex with them and you were not interested, how confident are you that you could successfully resist their advances?"; Marx, Calhoun, Wilson, \& Meyerson, 2001; Ozer \& Bandura, 1990). Responses are provided along a 7-point scale, ranging from not at all confident to very confident. Higher scores indicate great resistance self-efficacy. A total score was created by calculating the average rating across all items (range: 1-7).

Participants' confidence in utilizing assertive responses to potentially threatening dating situations was assessed by seven items on the Resistance Self-Efficacy Scale (i.e., "If someone you were with was attempting to get you to have sex with them and you were not interested, how confident are you that you could successfully resist their advances?"; Marx, Calhoun, Wilson, \& Meyerson, 2001; Ozer \& Bandura, 1990). Responses are provided along a 7-point scale, ranging from not at all confident to very confident. Higher scores indicate great resistance self-efficacy. A total score was created by calculating the average rating across all items (range: 1-7).

Participants' confidence in utilizing assertive responses to potentially threatening dating situations was assessed by seven items on the Self-Efficacy Scale (i.e., "If someone you were with was attempting to get you to have sex with them and you were not interested, how confident are you that you could successfully resist their advances?"; Marx, Calhoun, Wilson, \& Meyerson, 2001; Ozer \& Bandura, 1990). Responses are provided along a 7-point scale, ranging from not at all confident to very confident. Higher scores indicate great resistance self-efficacy. A total score was created by calculating the average rating across all items (range: 1-7).

Participants attributions of blame following experiences of sexual victimization will be assessed by 25 items on the Rape Attribution Scale (Frazier, 2002; Frazier \& Seales, 1997). Responses are provided along a 5-point scale, ranging from never to very often, whereby higher scores indicate higher levels of blame. Five subscales will be utilized to explore various attributions of blame, including (a) societal blame, (b) behavioral selfblame, (c) characterological self-blame, (d) chance, and (e) rapist blame. A total score was to be created by calculating the average rating across all items (range: 1-5).

Participants attributions of blame following experiences of sexual victimization will be assessed by 25 items on the Rape Attribution Scale (Frazier, 2002; Frazier \& Seales, 1997). Responses are provided along a 5-point scale, ranging from never to very often, whereby higher scores indicate higher levels of blame. Five subscales will be utilized to explore various attributions of blame, including (a) societal blame, (b) behavioral selfblame, (c) characterological self-blame, (d) chance, and (e) rapist blame. A total score was to be created by calculating the average rating across all items (range: 1-5).

Designed for use with transgender and gender nonconforming people, the Gender Minority Stress and Resilience measure is one of the few that assesses gender identity-related constructs. It was designed to take into account unique gender minority distal stressors as was a resilience factors. These subscales will be used in this current study to test hypothesized mediators of the effects of the ESD violence prevention training on behavioral outcomes. Responses are given on a a 5-point Likert response scale (Strongly Disagree to Strongly Agree). Higher scores are indicative of greater phenomena. Six subscale scores were created by calculating the average rating for measure items corresponding with each construct: nonaffirmation of transgender identity, internalized transphobia, identity nondisclosure, negative expectations, community connection, and pride. Range for all subscales: 1-5

Designed for use with transgender and gender nonconforming people, the Gender Minority Stress and Resilience measure is one of the few that assesses gender identity-related constructs. It was designed to take into account unique gender minority distal stressors as was a resilience factors. These subscales will be used in this current study to test hypothesized mediators of the effects of the ESD violence prevention training on behavioral outcomes. Responses are given on a a 5-point Likert response scale (Strongly Disagree to Strongly Agree). Higher scores are indicative of greater phenomena. Six subscale scores were created by calculating the average rating for measure items corresponding with each construct: nonaffirmation of transgender identity, internalized transphobia, identity nondisclosure, negative expectations, community connection, and pride. Range for all subscales: 1-5

Designed for use with transgender and gender nonconforming people, the Gender Minority Stress and Resilience measure is one of the few that assesses gender identity-related constructs. It was designed to take into account unique gender minority distal stressors as was a resilience factors. These subscales will be used in this current study to test hypothesized mediators of the effects of the ESD violence prevention training on behavioral outcomes. Responses are given on a a 5-point Likert response scale (Strongly Disagree to Strongly Agree). Higher scores are indicative of greater phenomena. Six subscale scores were created by calculating the average rating for measure items corresponding with each construct: nonaffirmation of transgender identity, internalized transphobia, identity nondisclosure, negative expectations, community connection, and pride. Range for all subscales: 1-5

The Sexual Experience Survey Short Form Victimization (SES-SFV) is the most widely used measure in sexual assault research. A primary strength of the measure is that it does not require participant to label their experiences as "sexual assault" or "rape." Rather, it utilizes a series of 10 sexually explicit questions that assess t past sexual behavior along a variety of dimensions. Experiences can be classified as "completed rape," "attempted rape," "coercion," "attempted coercion," or "nonconsensual sexual contact." Participants were assigned a score of "0" if they denied the question and a score of "1" if they endorsed the question. Participants with a score of 0 for all items were categorized as having no history of victimization. Participants with a score of 1 for any item assessing sexual coercion or nonconsensual sexual contact were categorized as having experienced sexual assault. Participants with a 1 for any rape item were catagorized as having experienced rape.

The Sexual Experience Survey Short Form Victimization (SES-SFV) is the most widely used measure in sexual assault research. A primary strength of the measure is that it does not require participant to label their experiences as "sexual assault" or "rape." Rather, it utilizes a series of 10 sexually explicit questions that assess t past sexual behavior along a variety of dimensions. Experiences can be classified as "completed rape," "attempted rape," "coercion," "attempted coercion," or "nonconsensual sexual contact." Participants were assigned a score of "0" if they denied the question and a score of "1" if they endorsed the question. Participants with a score of 0 for all items were categorized as having no history of victimization. Participants with a score of 1 for any item assessing sexual coercion or nonconsensual sexual contact were categorized as having experienced sexual assault. Participants with a 1 for any rape item were catagorized as having experienced rape.

The Sexual Experience Survey Short Form Victimization (SES-SFV) is the most widely used measure in sexual assault research. A primary strength of the measure is that it does not require participant to label their experiences as "sexual assault" or "rape." Rather, it utilizes a series of 10 sexually explicit questions that assess t past sexual behavior along a variety of dimensions. Experiences can be classified as "completed rape," "attempted rape," "coercion," "attempted coercion," or "nonconsensual sexual contact." Participants were assigned a score of "0" if they denied the question and a score of "1" if they endorsed the question. Participants with a score of 0 for all items were categorized as having no history of victimization. Participants with a score of 1 for any item assessing sexual coercion or nonconsensual sexual contact were categorized as having experienced sexual assault. Participants with a 1 for any rape item were catagorized as having experienced rape.

This subscale of the Gender Minority Stress and Resilience Measure will be used to assess the exploratory hypothesis that the ESD violence prevention training will produce reductions in rates of exposure to gender-related violence. At baseline, participants will indicate whether they have been exposed to a list of gender-related victimization experiences since the age of 18. At the 3- and 6- month post-intervention followup, participants will indicate whether they have been exposed to these experiences "since your last assessment." Sample items include "I have been threatened with physical harm because of my gender identity or expression." "I have been pushed, shoved, hit, or had somethin thrown at me because of my gender identity or expression." Higher scores indicate greater exposure to gender-related violence. A likelihood of victimization score was calculated based on the average response to all measures on this subscale ("yes" vs "no"). Range: 0-1

This subscale of the Gender Minority Stress and Resilience Measure will be used to assess the exploratory hypothesis that the ESD violence prevention training will produce reductions in rates of exposure to gender-related violence. At baseline, participants will indicate whether they have been exposed to a list of gender-related victimization experiences since the age of 18. At the 3- and 6- month post-intervention followup, participants will indicate whether they have been exposed to these experiences "since your last assessment." Sample items include "I have been threatened with physical harm because of my gender identity or expression." "I have been pushed, shoved, hit, or had somethin thrown at me because of my gender identity or expression." Higher scores indicate greater exposure to gender-related violence. A likelihood of victimization score was calculated based on the average response to all measures on this subscale ("yes" vs "no"). Range: 0-1

This subscale of the Gender Minority Stress and Resilience Measure will be used to assess the exploratory hypothesis that the ESD violence prevention training will produce reductions in rates of exposure to gender-related violence. At baseline, participants will indicate whether they have been exposed to a list of gender-related victimization experiences since the age of 18. At the 3- and 6- month post-intervention followup, participants will indicate whether they have been exposed to these experiences "since your last assessment." Sample items include "I have been threatened with physical harm because of my gender identity or expression." "I have been pushed, shoved, hit, or had somethin thrown at me because of my gender identity or expression." Higher scores indicate greater exposure to gender-related violence. A likelihood of victimization score was calculated based on the average response to all measures on this subscale ("yes" vs "no"). Range: 0-1