“What Should Sex Look Like?” Students’ Desires for Expanding University Sexual Assault Prevention Programs to Include Comprehensive Sex Education

Abstract

Rates of sexual assault and sexual violence among college-aged adults are much higher than the national rates of sexual assault and sexual violence. Therefore, reduction and prevention of sexual violence among university students is critical and is consistent with national public health priorities. Often times, messages to students focus only on sexual assault and omit larger notions of sexual health. Four focus groups with a total of 24 participants (nine men, 15 women) highlighted three main perceptions about the sexual assault programming offered at this large university: themes of resistance to traditional programming, a need for holistic sexual health programming, and a desire to have an environment, which normalizes conversations surrounding sex, sexuality, and sexual health.

Keywords

college health sexual health sexual assault prevention health programming qualitative Oklahoma

Rates of sexual assault and sexual violence among college-aged adults remain higher than national rates, with approximately 15% to 25% of college students reporting having experienced some form of sexual violence or assault within their lifetime (Cantor & Fisher, 2015; Fedina, Holmes, & Backes, 2016; Tjaden & Thoennes, 2006). Reduction and prevention of sexual violence among university students is critical and is consistent with national public health priorities (Black et al., 2012; Cantor & Fisher, 2015; Fedina et al., 2016; Fisher, Daigle, & Cullen, 2009; Jozkowski, 2015; Jozkowski & Sanders, 2012; Turchik & Hassija, 2014). Research has documented the various short-term and long-term health consequences associated with sexual assault, including poor mental health (Black et al., 2012; J. Campbell et al., 2002; R. Campbell, Dworkin, & Cabral, 2009; Coker et al., 2002), sexually transmitted infections (STIs; J. Campbell et al., 2002; Lamba & Murphy, 2000; World Health Organization, 2013), and engaging in risk behaviors such as binge drinking and substance use (Champion et al., 2004; Gidycz, Orchowski, King, & Rich, 2008; Turchik & Hassija, 2014). The high prevalence of sexual violence within campus communities and the demonstrated health consequences associated with being a survivor of sexual assault highlight a necessary need to provide comprehensive sexual health programming that includes a focus on preventing sexual assault for this population (Fedina et al., 2016; Kilmartin & Berkowitz, 2014; Scholly, Katz, Gascoigne, & Holck, 2005).

Research has demonstrated that students want more education on sexual violence, consent, and resources available to prevent sexual violence on their campuses (Garcia, Lechner, Frerich, Lust, & Eisenberg, 2012), as well as more information about sexual health and sexuality (Downing-Matibag & Geisinger, 2009; Pingel, Thomas, Harmell, & Bauermeister, 2013; Pound, Langford, & Campbell, 2016). It is difficult, however, to determine whether current programming is efficacious in deterring sexual violence or increasing awareness of sexuality. Although most programs are effective in immediately changing attitudes and increasing awareness about sexual violence, few have demonstrated long-term success in reducing incidence rates on campus (Anderson & Whiston, 2005). Evaluating effectiveness of campus sexual health programming is hindered due to each program having different outcome measures to demonstrate efficacy (Amar, Strout, Simpson, Cardiello, & Beckford, 2014; Vladutiu, Martin, & Macy, 2010). Although it may be difficult to determine how successful a program may be, recent research indicates that a brief, one-session sexual assault prevention program does not demonstrate a lack of lasting change on risk factors and behaviors (DeGue, 2014).

Research within the campus environment is important, given this is the primary context in which violence occurs and often is where care is sought (Fedina et al., 2016; Sable, Danis, Mauzy, & Gallagher, 2006). Students’ perceptions of the campus environment can facilitate or hinder the diffusion of campus programming, accessing sexual assault resources, and influencing decisions whether to report an incident (Clements & Ogle, 2009; DeGue et al., 2012; Garcia et al., 2012). Researchers have previously discussed the continued need for the evaluation of the social context in which programs are implemented (Jozkowski, 2015). College health professionals have long advocated for sexual assault and sexual health programming on campus. However, the extent to which these programs are effective in meeting students’ needs and changing long-term behaviors among college students is less understood (Breitenbecher, 2001; Jozkowski, 2015). College sexual health programs traditionally have focused on shaping attitudes toward rape, increasing reporting by victims, and increasing the likelihood of bystanders intervening (Bennett & Banyard, 2016; Breitenbecher, 2001; Jozkowski, 2015; Mahlstedt & Welsh, 2005; Sable et al., 2006; Simon, Paris, & Ramsay, 1994). Such approaches often fail to interweave larger notions of sexual health, including rights to sexual pleasure, sexual self-comfort, and the alleviation of sexual guilt (Higgins, Mullinax, Trussell, Davidson, & Moore, 2011).

Universities are uniquely positioned to offer preventive education and outreach programming addressing sexual assault and sexual health to students. However, there is a need to evaluate whether current sexual assault prevention programs are meeting the needs of the students in which they are designed to help. To this end, we had three goals: (a) to examine students’ perspectives on current sexual assault programming on a campus, (b) to determine students’ preferred methods of sexual assault and sexual health information delivery, and (c) to evaluate students’ perception of the campus environment and how it may influence current sexual assault and sexual health programming.

Theoretical Framework

The study was informed by the social ecological model as proposed by McLeroy and colleagues (McLeroy, Bibeau, Steckler, & Glanz, 1988). At its core, the ecological perspective proposes that behavior has multiple levels of influence, often including intrapersonal (e.g., biological, psychological), interpersonal (e.g., social, cultural), organizational, community, and policy. In addition, theorists posit that there are multiple influences on specific health behaviors, and these influences on behaviors interact across the different levels (McLeroy et al., 1988). Given that sexual assault, sexual violence, and overall sexual health of students do not occur within a social vacuum, it is imperative to evaluate proximal and distal factors that contribute to negative sexual health outcomes. Identifying such factors allows for the development of multilevel programming to address relevant potential influences at each level.

Method

Four one-time in-depth focus groups lasting approximately 90 minutes exploring preferences for sexual health and sexual assault programming on campus were conducted. A total of 24 students (eight cisgender men, 14 cisgender women, one transgender man, one transgender woman) who attended a large public university within a relatively rural and socially conservative area of the South Central United States participated in one of the four focus groups. Focus group participants were referred to the study through members of their social network, advertisements placed on social networking applications geared toward emergent adults (e.g., Twitter), and flyers distributed throughout the campus. Participants were directed to a screener questionnaire to identify whether an individual met inclusion criteria. Focus group participants were eligible if they spoke English fluently, were currently enrolled as a student in the university, and were older than 17 years. Understanding that gender is a nonbinary construct but indeed fluid, participants were assigned to focus groups based on their identified gender. All participants were compensated with a US$20 gift card. Focus groups were facilitated by trained members of the research team, with two individuals facilitating and a third individual present to take notes on group discussion to ensure the research team could match transcribed quotes back to the proper participant. Interview teams were matched to the gender of the group. Focus group sizes were nine (Women Group 1), six (Women Group 2), five (Men Group 1), and four (Men Group 2). The institutional review board at the authors’ home institution approved the study, and each study participant completed an informed consent process.

Focus groups were gender specific based on participant’s self-identification. As college men and women tend to socialize in gender-specific groups, including Greek life (i.e., fraternities and sororities) and residence halls, homogeneous focus groups by gender would allow for the discussion of these unique environments which may affect student perceptions (Barone, Wolgemuth, & Linder, 2007; Jozkowski & Wiersma-Mosley, 2017). The groups were conducted by those of the same gender in an effort to create a comfortable atmosphere to facilitate dynamic conversation. Previous work and guidance from methodological experts, particularly with regard to research on sexual assault and sexual violence, have noted that the presence of the opposite gender within focus groups discussing sensitive topics may hinder disclosure of experiences to the group (Hollander, 2004; Kitzinger, 1995).

Study instruments and protocols were developed in collaboration with a team of students, sexual health practitioners, and members of the local university community. This included the development and refinement of topical domains, development of interview questions, and recruitment strategies. Members were integral to ensuring protocols, particularly the semi-structured focus group guide (see supplemental material), were culturally relevant to student populations. The focus group guide consisted of main questions and content-specific probes designed to elicit narratives from participants regarding dating and relationship development, current sexual health and sexual assault programming, and desired sexual health programming. Questions were developed in a manner to identify both proximal and distal factors affecting student sexual health and sexual assault programming on campus. A brief questionnaire elicited standard demographic items.

All focus groups were audio recorded, transcribed, and double-checked for accuracy. Focus group data from this study were analyzed using thematic analysis to inductively identify and interpret concepts and themes that emerged from the focus group transcripts (Corbin & Strauss, 2008). Concepts were the most basic unit of meaning from which our results developed, and related concepts were grouped into themes. Processing the qualitative interview data occurred in several stages of organization, analysis, and reflection. Text data served as the basis from analysis. Thematic analysis highlighted the themes embedded in the text in a manner that was sensitive to subjective meanings. Data organization, analysis, and interpretation took place by (a) establishing and ensuring consistency among coders, (b) constructing the codebook and mapping the themes, and (c) interpreting and developing the thematic matrix. This method involved multiple readings of transcripts and analytic induction via open and axial coding of data using NVivo qualitative data analysis software (QSR International Pty Ltd. Version 10, 2014) to thematically organize transcripts. Coding was completed by three researchers independently and compared for agreement, with all codes having a k ≥ 0.80. Guba’s model of trustworthiness of qualitative research (Guba & Lincoln, 1982; Krefting, 1991) provided a framework in which the authors established rigor. Strategies included (a) completing member checks with students to ensure the research team’s data interpretation was consistent with participant’s original statements, (b) peer examination by topical experts in the realm of sexual health programming, and (c) triangulation of researchers—in which the current study team comprised investigators from varied academic, practice, and methodological backgrounds. Approximately 2 months after the completion of the focus groups, member checks were conducted with four participants (two men, two women) of the focus groups. Demographic data were used to provide a more comprehensive portrait of occurring themes. Wherever necessary, descriptive analyses were conducted using the SPSS statistical software.

Results

Of the 24 participants who participated in the current study, 22 provided insightful remarks utilized during analysis. Participant ages ranged between 18 and 25 years (median = 21 years, M [SD] = 20.88 [1.75] years), with most of the participants identifying as White (83.3%, n = 20), heterosexual (87.5%, n = 21), single (91.7%, n = 22), and currently enrolled in undergraduate coursework (87.5%, n = 21). Notably, 37.5% (n = 9) of participants reported being an active member of a social Greek organization.

A number of themes emerged from the data with regard to preferred sexual health and assault prevention service delivery, including the following: (a) resistance to traditional programming, (b) a need for holistic sexual health programming, and (c) creating environments that normalize conversations surrounding sex, sexuality, and sexual health. Verbatim exemplars from data are presented below with additional text dedicated to highlighting and expounding on connections.

Resistance to Traditional Programming

Large-scale programming across a campus is often grounded in the desire to reach all students, faculty, and staff; however, diffusion of programming did not equate to effectiveness for some students. Particularly, movement toward providing mandatory online training to all stakeholders within a university setting was viewed by students as not being sensitive to their overall needs: “Sexual assault is a problem at all colleges and I think colleges should deal with that. Because, I mean, we have online training right now for everyone, but . . . is that really effective?” (Man, 20 years old). Mandatory sexual assault prevention programming, specifically those online, was seen as a “necessary hoop to jump through” (Man, 21 years old) to lift a hold on a student’s account to allow access to course registration or access to other university services. Whereas a minority of students felt that such programming helped create a dialogue on campus, the majority of students expressed both they and their peers were likely to not absorb the material. Instead, students felt they were focused on evading potential penalties for failure to complete the mandatory program (e.g., inability to register for classes, accessing transcripts) and were resentful to the overall process.

To supplement the mandatory online program, university-led media campaigns and events were implemented across the campus. Respondents emphasized that both the online program and supplemental programs did not incorporate the social context for which students live their lives, particularly ignoring campus climate and culture. Current university-led programs were viewed as reinforcing existing campus climates surrounding sex and sexuality. Participants reiterated communication and media programs (both programs that include media as a component of a larger program and those in which media is used as a standalone intervention) related to sexual assault rarely address sexual health. Instead, such approaches were perceived as intending to increase visibility and promote responsibility of students without providing necessary tools for behavior change:

The current posters on campus don’t work. The one thing we [the university] do that has to do with sex, doesn’t say anything about sex . . . it doesn’t exactly help our non-open communication about sex on this campus. (Woman, 19 years old)

Holistic Sexual Health Programming

The majority of students indicated they had little-to-no formal sexual health education before attending college, which is consistent with previous research (e.g., Currin et al., 2017; Elliott, 2014; Jones, Jensen, & Selzer King, 2014). Students discussed the need for comprehensive sexual health programs that not only discuss sexual violence and coercion but also address issues related to dating and intimacy, sexuality, and drugs and alcohol. Participants indicated there was a direct intersection between sexual pleasure and consent; however, focusing on pleasurable aspects of sexual experiences among peer groups can lead to shaming, stigmatization, and isolation:

I think our programs spend so much time telling people what sex shouldn’t look like that I think it would help if we discussed what sex should look like. Sex should hit these three boxes: was it enjoyable, mutual, and consensual. (Woman, 21 years old)

Efficacious programming, according to participants, would not only be educational but also contain information on how to have a better sexual experience.

Preferred program delivery

Students expressed they preferred peer-driven sexual health and sexual assault programming, which incorporates campus-popular opinion leaders. Particularly, students wanted to be engaged by popular opinion leaders from their own community (e.g., members of social Greek organizations [i.e., Fraternities, Sororities], college athletes, student leaders) in an effort to build off established rapport already evident within these subcommunities of the larger university. All participants echoed the opinion of one man (18 years old) during the course of our focus groups:

If other Fraternity guys or Sorority girls came to us as members of the Greek community and said here’s what we should be doing. Or, if its athletes, people who are athletes at the same university . . . or graduate students that have been in our shoes. That would be a lot more effective . . . I feel comfortable to speak with you all because I know we’ve had similar experiences. That shared experience helps break down barriers on campus.

In an effort to highlight the shared unique experiences of students on campus, participants discussed the need to transform programming to incorporate the personal experiences of their peers. Doing so was portrayed as an act of community building and also increasing student buy-in. As noted by one participant,

I think making a program more realistic is important, having people telling their own personal story. Having people come speak about real, personal issues and experiences on campus make things realistic and less cheesy . . . otherwise people are doing the online trainings and just clicking, clicking and not reading. They don’t feel it applies to them and their community. (Woman, 20 years old)

Programming during the college years was viewed as an opportunity to foster lifelong learning regarding sexual health and sexual violence, information which could continually be diffused through social networks both on campus and after graduation. Students viewed themselves as consumers of sexual pop and media culture; thus, opportunities to critically assess sexual information for validity are necessary.

Normalizing Sex

All participants indicated their desire for the creation of environments where sex, sexuality, and sexual health could be discussed without stigma. Both men and women were particularly concerned about existing environments which stigmatize sex and thus could lead to shaming of individuals who openly discuss sexual health concerns on campus. Men were particularly concerned about how women are viewed in the college environment, noting,

There’s a lot of stigma with talking about sex. Especially for women . . . women who talk about sex get slut shammed or whatever just because they said something. We need to be able to talk about sex; I don’t think it’s entirely sexually healthy if you can’t bring it up around your peers. (Man, 20 years old)

Men within the focus group understood their views may be in the minority within the larger campus and that this realization was reflective of the need for larger programming to change cultural norms.

Programs are viewed by students as necessary to facilitate the discussion surrounding sexual assault and sexual health within campus communities. Hesitation to initiate these conversations by students is grounded in current normative beliefs on when and where these conversations are appropriate. Participants, however, indicated the creation of receptive atmospheres would allow for popular opinion leaders to drive future discussion:

I just think it just honestly has to start with somebody talking about it [sexual health and sexual assault] . . . that’s going to inspire somebody else to talk about it. These conversations are already occurring in our own mind. (Man, 20 years old)

A sentiment across focus groups was the direct relationship between sexual stigma and understandings of sexual consent. Minimizing barriers to discussions of sexuality among peer groups was viewed as an opportunity to increase an individual’s ability to discuss concepts of consent with peers, including romantic and sexual partners.

Role of the university professional and the institution

Students uniformly expressed the need for the active engagement of campus faculty, staff, and administration in addressing the larger systemic issues surrounding sexual assault and sexual health within their community. In particular, students viewed faculty and administration as setting the tone for which sexual health conversations occurred on campus. Although students were keenly aware of potential repercussions that may inhibit action by university personnel (e.g., losing potential donors to the university), it remained imperative to students that campus stakeholders support students through attending campus events, funding sexual health and sexual assault programming, and creating dialogue that interweaves sexual health as part of larger wellness initiatives on campus:

It is important to have important people on campus involved with activities . . . I never see the administrators, the Deans . . . I don’t see the big-wigs getting involved in these things. They don’t want to be the face of sex and health, you know. It’s a dirty subject, it’s a dangerous subject, but everyone should not be afraid to get their hands dirty if they want to really make a difference. Having them show support and create a culture of openness, I think, would be a good idea. (Woman, 21 years old)

Across the focus groups, participants voiced concern that faculty and staff have been absent from larger campus discussions on sexual assault and sexual health. According to participants, faculty and staff should advocate for student needs, create environments conducive to learning, and lead social justice initiatives on campus. Prescribed faculty roles are grounded in the legacy of academic freedom and questioning societal norms, areas which participants discussed they had immense respect. Furthermore, students felt by having discussions about sexual assault and sexual health within the classroom environment would normalize the experience for students outside of the classroom: “Professors can help by removing stigma by talking about it . . . it would definitely break down walls and barriers to people talking about sexual health and violence on campus” (Woman, 20 years old).

The discussion on the unique roles faculty, staff, and administrators serve in advancing students’ sexual health led to a discussion of the role the larger institution plays. Although students initially agreed there were some emergent discussions of sexual health and sexual assault currently on their campus, they viewed conversations about sex as having negative connotations. This resonated with women who perceived programming to be top down, not considering the vast number of reasons students may want to engage in sexual behavior (e.g., pleasure, build connection with romantic partner):

If our campus and other campuses could help direct the sexual health agenda to a healthier outlook, I think that would be really beneficial. All we currently hear about sex is really negative stuff like you can be raped, there are diseases, you can get pregnant . . . there’s nothing good said about sex and it is the most natural thing people do. (Woman, 23 years old)

Constrained conversations surrounding sexuality on campus were discussed by students as a potential artifact of attending a large university serving a relatively rural state. Students who were reared in rural areas perceived the institutional climate to be reflective of the smaller towns and cities they came from.

Discussion

At the environmental level, students are subjected to a social context that is not conducive to the discussion of sex, sexuality, and sexual health (Eisenberg, Lechner, Frerich, Lust, & Garcia, 2012; Faulkner & Lannutti, 2010; Higgins et al., 2011; Walsh, Banyard, Moynihan, Ward, & Cohn, 2010). Ultimately, these environments influence interpersonal factors such as disclosure, development of romantic and sexual relationships, and sexual behavior (Fisher et al., 2009; Higgins et al., 2011; Orchowski, Creech, Reddy, Capezza, & Ratcliff, 2012). A larger number of students enter college with limited knowledge about sex, consent, and sexual health (Muehlenhard, Humphreys, Jozkowski, & Peterson, 2016). Instead, students are forced to draw on individual-level factors such as their limited knowledge, experiences, and peers (Kuperberg & Padgett, 2015; Muehlenhard et al., 2016; Scholly et al., 2005). This trajectory extends through the college years in university environments that are reactive in terms of their sexual health programming instead of being proactive to develop the skills necessary to have both safe and pleasurable sexual experiences. Concurrently, larger structural stigma surrounding sexual health on campus presents challenges to university staff who are trying to create policies and programming, which maximize student health outcomes (Muehlenhard et al., 2016).

Similar concerns extend to faculty who may not have the confidence, training, or inclination to directly address sexual assault prevention on their campus (Hayes-Smith, Richards, & Branch, 2010). Improving university environments around sexual health will necessitate the training of faculty who may have received little to no training in this area during their own education and who may lack experience with or knowledge about sexual health (Amar et al., 2014; Hayes-Smith et al., 2010). This is particularly true given the diversity of academic disciplines for which faculty comprise. Faculty can facilitate the development of “sex-positive” environments, promoting positive attitudes about sex rather than shame (Williams, Prior, & Wegner, 2013), by encouraging inclusive language inside and outside the classroom (Cress, 2008; Ottenritter, 2012), developing strong student–faculty relationships (Branch, Hayes-Smith, & Richards, 2011; Cress, 2008), and tailoring discipline-related courses to be inclusive of diverse students (Killpack & Melón, 2016; Mansh et al., 2015). Creating affirmative and welcoming spaces involves going beyond educating students and faculty to ensure that universities have programs in place to address student sexual health needs.

Sexual assault prevention outreach programs and sexual health outreach programs must address the broad psychosocial needs of emergent adults across ecological levels (Satcher, Hook, & Coleman, 2015). Students identified an array of needs specific to creating campus environments, which encourage the open discussion of items related to sexual health, including sexual assault. Use of popular opinion leaders to diffuse public health messaging has long been a component of sexual health programming, specifically interventions targeting populations at risk of HIV and STI (Guadamuz et al., 2013; Kelly et al., 1991; NIMH Collaborative HIV/STD Prevention Trial Group, 2010). Tailoring approaches to address sexual assault and creating active bystander prevention programming are necessary to best reach college-aged students (Coker et al., 2014; Cook-Craig, Coker et al., 2014; Cook-Craig, Millspaugh, et al., 2014). Local campus-based outreach programs should continue to explore the potential adaption of peer-driven programming as a component of larger sexual assault prevention programming (McMahon, Postmus, Warrener, & Koenick, 2014). Certainly, use of established campus leaders increases diffusion of sexual health messaging to portions of the campus community not reached through traditional programming. Overall, use of these varied approaches may not only shape cultural norms within the student body but also lead to development of campus-level policy that is conducive to affirming student sexual health needs.

Future Directions and Implications for Prevention

Student counseling centers are often tasked with developing outreach programming that addresses various student health concerns including alcohol use (e.g., Halligan, Pohl, & Smith, 2006), sexual assault (e.g., Menning & Holtzman, 2015), and mental health (e.g., Parcover, Mays, & McCarthy, 2015). In addressing overall sexual health needs along with sexual assault prevention, counseling centers can begin to create an environment of openness and inclusion that allows students to learn about their own sexual health.

Use of popular opinion leaders is an effective tool to decrease resistance to health messaging (Banyard, Moynihan, & Crossman, 2009; Banyard, Plante, & Moynihan, 2004; Moran, Walker, Alexander, Jordan, & Wagner, 2017; Piccigallo, Lilley, & Miller, 2012), and public health interventions utilizing peer leaders are at least, if not more, effective (Kelly, 2004; MacArthur, Harrison, Caldwell, Hickman, & Campbell, 2016; Mellanby, Rees, & Tripp, 2000). However, additional training is necessary to ensure leaders present material that is consistent with participants’ desire for sex-positive programming. One specific approach could be the use of the sexual health model (Robinson, Bockting, Rosser, Miner, & Coleman, 2002) to train leaders, which accounts for cultural and sexual identity, intimacy and relationships, and other domains within the context of positive sexuality. Within programs utilizing the sexual health model, positive sexuality includes setting sexual boundaries based on what one prefers, as well as what one knows is safe and responsible (Robinson et al., 2002). Thus, new or existing programming could be tailored to account for the core concepts of the sexual health model in an effort to create sex-positive cultural norms for health education programming.

There remains a continued need for further large-scale campus climate studies that are sensitive to campus culture. In particular, given that the majority of sexual health research includes samples from urban areas, there is a need to evaluate the university culture within more relatively rural and historically socially conservative states. In addition, nuanced data are required to address potential pattern differences among subpopulations of university students. Current research may not address the need of lesbian, gay, bisexual, and transgender (LGBT) students, those who identify as part of a social Greek organization (i.e., Fraternity or Sorority), graduate students, international students, and those residing in residence life and student housing (e.g., residence halls and dormitories).

Among the ages of 18 to 24, those who are nonstudents experience rape and sexual assault 0.9 to 1.6 times higher than their student peers (Sinozich & Langton, 2014). Further research is needed to assess proximal and distal factors which facilitate differences and potential methods for intervention among these community groups. Such findings may indicate the need for more robust sexual health programming during later adolescence in an effort to sustain behavior change during early adulthood (Lundgren & Amin, 2015). Furthermore, the use of community-level interventions to prevent sexual violence can be effective by modifying the characteristics of environments (e.g., schools, neighborhoods, workplaces) that increase risk of violence victimization and perpetration (DeGue et al., 2012). Interventions that seek to change community-level norms, risk factors, or policies within communities are beneficial to both student and nonstudent populations.

Findings provide insights, which can be utilized by institutions to inform the development of strategic outreach interventions that can minimize barriers, enhance access, and address the unique sexual health needs of college students. Our findings underscore the fact that multilevel interventions are necessary to address sexual assault on college campuses. Specifically, the use of media and other standalone programming to increase sexual assault awareness, perceived susceptibility, and perceived risk may not lead to substantial sexual behavior change over longer periods of time. The sole use of Internet-based programming across campus can ensure all students are reached; however, it creates unique challenges for college mental and medical health practitioners. Program content should include holistic perspectives of sex, such as healthy relationships, and not simply bystander interventions. As such, environmental and policy changes are necessary to supplement existing programming to maximize health outcomes. Institutional support and outreach programming, which are reflective of the social contexts shaping college students’ sexual behavior, ultimately may lead to better understanding of sexual consent, what constitutes sexual assault, and overall sexual health.

Limitations

Our findings are limited by the fact that this was a relatively small, qualitative study of students at one large public university in the South Central United States. Given responses are from participants at one public university, our results may not be representative of the larger population of students residing throughout the United States. In addition, our sampling framework and the size of our sample limited our ability to observe potential pattern differences among subpopulations of university students. We relied on the self-reported experiences, preferences, and behaviors provided by participants in an effort to collect rich and detailed narratives of preferred delivery methods for university sexual assault prevention programs. Because participants within the focus groups did not know each other, there is always the potential for social desirability bias, which could inhibit participants from sharing unpopular opinions. The richness of data generated from qualitative approaches serves as an important starting point to further larger campus climate studies on the sexual health needs of college students.

Conclusion

Even within the confines of these limitations, the study findings suggest college students desire sexual assault programming on campus, which takes into account their overall sexual health. Furthermore, they are interested in gaining skills and knowledge related to sexual behavior, sexual assault, and relationship development, however, they feel current institutional climates are not conducive to addressing these larger concerns. The impact of institutional climates on sexual assault programming and resource allocation should be further investigated.

Supplemental Material

QHR844502_Supplemental_Material – Supplemental material for “What Should Sex Look Like?”: Students’ Desires for Expanding University Sexual Assault Prevention Programs to Include Comprehensive Sex Education

Supplemental material, QHR844502_Supplemental_Material for “What Should Sex Look Like?”: Students’ Desires for Expanding University Sexual Assault Prevention Programs to Include Comprehensive Sex Education by Randolph D. Hubach, Chandra R. Story, Joseph M. Currin, Audrey Woods, Ashlee Jayne and Christopher Jayne in Qualitative Health Research

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Randolph D. Hubach

Supplemental Material

Supplemental Material for this article is available online at . Please enter the article’s DOI, located at the top right hand corner of this article in the search bar, and click on the file folder icon to view.

Author Biographies

Randolph D. Hubach is assistant professor of Rural Health and Co-Director of the Sexual Health Research Lab at Oklahoma State University. His research focuses on sexual health and health inequities within rural and underserved populations.

Chandra R. Story is associate professor of Community & Public Health at Middle Tennessee University. Her research focuses on health inequities among underserved populations, analyzing the role of social support and other psychosocial correlates.

Joseph M. Currin is assistant professor of Counseling Psychology at Texas Tech University. His research focuses on sexuality, sexual health, and sexual behaviors with a goal of highlighting the impacts of stigma on mental and physical health disparities of marginalized individuals.

Audrey Woods is a graduate of the counseling program at Oklahoma State University where she focused on sexual assault, violence, and trauma-informed programming.

Ashlee Jayne is a doctoral student in counseling psychology at Oklahoma State University where she focuses on sexuality-related health disparities.

Christopher Jayne is a doctoral student in counseling psychology at Oklahoma State University where he focuses on body image, body dysmorphia, and men’s health.

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