Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Public Health


Epidemiology and Biostatistics

First Advisor

Dr. Heather M. Bush


Community (or cluster) randomized trials are trials in which communities or groups of individuals (clusters) are randomized to receive the intervention of interest. Community randomized trials frequently more closely resemble a natural experiment than a randomized controlled trial (RCT) following intervention allocation. In particular, the effects of non-compliance can pose methodologic challenges in estimating the intervention effect which may require a quasiexperimental approach in order to minimize bias.

The motivating example to illustrate these issues is the Green Dot High School (GDHS) study. The GDHS study was a longitudinal, cluster-randomized controlled trial designed to assess the effectiveness of a bystander prevention program, the Green Dot (GrDt) (, on reducing sexual violence (SV) among high school students. One SV outcome examined by the GDHS study was Reproductive Coercion (RC), a form of SV in which control or manipulation of contraception or pregnancy outcomes is the tool utilized to perpetrate violence. RC often co-occurs with other forms of intimate partner violence (IPV), but has not been as widely studied as other forms of IPV. In particular, although there is evidence that RC occurs among adolescents, very little research has been conducted into either the prevalence or prevention of RC among adolescents and there are no published studies on a community-based prevention strategy for RC.

The purpose of this dissertation has been to examine and propose solutions to the analytical challenges in assessing the effectiveness of the GrDt program. Specifically, this dissertation seeks to (1) identify and contrast methodological strategies for evaluating prevention programs aimed at community-level change, (2) to describe the burden of RC among Kentucky high school students, and (3) to assess the impact of the GrDt program on RC.

Digital Object Identifier (DOI)