Nearly two-thirds of college students reported having experienced sexual and/or physical violence at some time in their lives, according to the results of a new study.1

Investigators analyzed data from 2,291 students enrolled in a cluster-randomized, controlled trial from 2015 to 2017. They also found that students had low rates of self-efficacy to obtain consent.

The students also had low levels of communication about condom use.

“We looked at sexual violence and physical violence and grouped them together,” says lead author Briana Edison, MPH, doctoral student at Georgia State University’s department of health promotion and behavior.

About 65% had experienced at least one incident of lifetime sexual and physical violence, including any form of unwanted sexual contact or sexual assault, physical violence, and dating violence. “We don’t know if it involved dating partners or family members; that’s not something we delved into,” she adds. “It does include unwanted kissing or touching.”

Edison and colleagues also studied the students’ experience with campus resources, sexual health communication, consent self-efficacy, and confidence in obtaining consent and understanding what consent means. “We looked at condom use as a desired healthy sexual behavior outcome,” Edison adds.

In a sample of students who said they were sexually active, sexual communication was low. Many did not talk about condom use or prevention of sexually transmitted infections (STIs). “Close to 70% indicated communication about pregnancy prevention, and less than one-third of the sample talked about STI and HIV prevention,” she says.

Investigators measured condom use in terms of frequency: Did they rarely, sometimes, often, or always use condoms? “We looked at consistent vs. inconsistent condom use, which was anything except ‘always,’” Edison says.

Edison and colleagues found that 30% of students reported consistent condom use, and 70% were inconsistent. To assess self-efficacy to obtain sexual consent, they used a scale that ranged from strongly agree to strongly disagree.

“About 90% of people agreed with items related to obtaining consent from a sexual partner,” Edison says. “Women felt more confident, so they had higher scores of self-efficacy than the males did.”

The findings suggest it is important to provide sexual violence programming on college campuses, including skills training — such as role-playing — between sexual partners.

“It would be beneficial to show students how to communicate with partners and make sure they feel comfortable talking about condom use, contraceptive use, and STI prevention,” Edison explains. “It seems like students do feel comfortable obtaining consent from their partners, but that conversation shouldn’t stop there. The discussion should go further and make sure there are conversations and both parties are free of STIs.”

It is important for providers to encourage patients to discuss actual sexual health practices, such as using condoms and getting tested regularly for STIs. They also need to know they have to disclose any positive STIs.

“Promoting better-quality communication between sexual partners should be part of sexual violence prevention programming,” Edison adds. “Usually, in cases of sexual violence, you may see more negative outcomes in terms of STI transmission and pregnancy, so it’s a beneficial conversation to have in terms of sexual violence and dating violence on campuses.”

Colleges also need to improve access to condoms on campus. “When I was an undergrad student, it was hard to get condoms, unless you walked 20 minutes to the nearest Walgreens,” Edison explains.

More recently, colleges are stocking at least some condoms. “In many of the back rooms in campus buildings, they had free condoms in both male and female bathrooms,” she says. “Every time it was full, the very next day it was empty. It was obvious students were taking them when they were available.”

Another tactic is to improve education about STI and HIV risk. Providers should share statistics and make it clear that STIs can happen to anyone who engages in risky sexual contact.

“Adolescents and young adults both are populations that think they are invincible,” Edison says. “People don’t think about STIs until it happens to them, or they don’t think it’s that prevalent of a problem in their lives.”

STIs are more common than college students imagine. “If you talk with students, there probably is someone in their friend group who has an STI or had one before,” Edison says.

Providers at college campuses and in the community — where many students receive their care — should do a better job of making sure students know about community resources for contraception care, STI prevention and education, and resources for victims of sexual violence.

“If students don’t want to use college campus health centers, then there are student and affiliation groups that do this type of work, and students should know about their community resources,” Edison says. “It’s not just the responsibility of the campus or student; local organizations could be more prevalent on college campuses and get information to students, hosting events if possible.”

REFERENCE

  1. Edison B, Coulter RWS, Miller E, et al. Sexual communication and sexual consent self-efficacy among college students: Implications for sexually transmitted infection prevention. J Adolesc Health 2021 Oct 4;S1054-139X(21)00408-0. doi: 10.1016/j.jadohealth.2021.08.012. [Online ahead of print].