Study shows that refusal skills training before age 18 may reduce risk of sexual assault in college

Students who receive sexuality education, including refusal skills training, before college matriculation are at lower risk of experiencing sexual assault during college, according to new research published today in PLOS ONE. The latest publication from Columbia University’s Sexual Health Initiative to Foster Transformation (SHIFT) project suggests that sexuality education during high school may have a lasting and protective effect for adolescents.



The research found that students who received formal education about how to say no to sex (refusal skills training) before age 18 were less likely to experience penetrative sexual assault in college. Students who received refusal skills training also received other forms of sexual education, including instruction about methods of birth control and prevention of sexually transmitted diseases. Students who received abstinence-only instruction did not show significantly reduced experiences of campus sexual assault.



“We need to start sexuality education earlier,” said John Santelli, MD, the article’s lead author, a pediatrician and professor of Population and Family Health at Columbia Mailman School of Public Health. “It’s time for a life-course approach to sexual assault prevention, which means teaching young people - before they get to college - about healthy and unhealthy sexual relationships, how to say no to unwanted sex, and how to say yes to wanted sexual relationships.”



The findings draw on a confidential survey of 1671 students from Columbia University and Barnard College conducted in the spring of 2016 and on in-depth interviews with 151 undergraduate students conducted from September 2015 to January 2017.



The authors found that multiple social and personal factors experienced prior to college were associated with students’ experience of penetrative sexual assault (vaginal, oral, or anal) during college. These factors include unwanted sexual contact before college (for women); adverse child experiences such as physical abuse; ‘hooking up’ in high school; or initiation of sex and alcohol or drug use before age 18.



Ethnographic interviews highlighted the heterogeneity of students’ sex education experiences. Many described sexuality education that was awkward, incomplete, or provided little information about sexual consent or sexual assault.



The research also found that students who were born outside of the United States and students whose mothers had lived only part of their lives or never lived in the U.S. had fewer experiences of penetrative sexual assault in college. Religious participation in high school did not prevent sexual assault overall, but a higher frequency of religious participation showed a borderline statistically significant protective association.



“The protective impact of refusal skills-based sexuality education, along with previous research showing that a substantial proportion of students have experienced assault before entering college, underlines the importance of complementing campus-based prevention efforts with earlier refusal skills training,” said Santelli.



Co-authors include: Stephanie A. Grilo, Tse-Hwei Choo, Gloria Diaz, Kate Walsh, Melanie Wall, Jennifer S. Hirsch, Patrick Wilson, Louisa Gilbert, Shamus Khan, and Claude A. Mellins



The study was funded by Columbia University with support by the National Institute of Child Health & Human Development.

The Sexual Health Initiative to Foster Transformation (SHIFT), led by co-principal investigators Dr. Jennifer S. Hirsch, PhD, professor of Sociomedical Sciences, and Dr. Claude A. Mellins, PhD, professor of Medical Psychology in the Departments of Psychiatry and Sociomedical Sciences is a comprehensive research project that examines the individual, interpersonal, and structural (cultural, community, and institutional) factors that shape sexual health and sexual violence for undergraduates at Columbia and Barnard. SHIFT’s research aims are 1) To understand the prevalence of sexual assault on campus; 2) To understand the ecology of sexual assault by examining key individual, interpersonal/social, and contextual and institutional risk and protective factors associated with sexual violence and sexual health and 3) To work with key stakeholders to translate findings into interventions and policy. SHIFT will generate important new information that Columbia, Barnard, and other institutions of higher education can use to inform innovative evidence-based programming to prevent sexual assault and to promote sexual health. Research that has been done to date has largely focused on individual factors, rather than on the social and institutional factors that play a significant role in shaping young people’s experiences on campus. SHIFT, which is supported by the Office of the President, looks holistically at the undergraduate experiences, using a public health approach to examine policies and practices.