New studies can inform programs to prevent sexual violence among teens locally, globally

PROVIDENCE, R.I.[Brown University] — Across cultures and geographic locations, the teen years are a time of growth, development and exploration into adult interactions — and romantic and sexual relationships are often some of the most critical interactions that many teenagers navigate.

A series of new studies by researchers at Brown University examines how teenagers in the United States and South Africa work through these challenges, in the hope that the findings will inform new, targeted educational programs and interventions to prevent sexual violence among teenagers locally and globally.

The U.S. study found that teenagers have an overly simplistic understand of consent that often ignores non-verbal cues also used to convey intent. The work in South Africa found that more targeted interventions are needed to both reduce sexual violence and improve resilience among teenagers.

“If we’re really committed to preventing sexual violence, then we need to engage young people in the discussion of what consent means much earlier in development,” said Caroline Kuo, an associate professor (research) of behavioral and social sciences and associate dean of diversity and inclusion at Brown University’s School of Public Health. “I think having a simplistic view of consent — of just ‘no’ or just ‘yes’ — misses the nuances of consent that we need to work into the process of preparing young people to engage in that process.”

The findings from the U. S. study were published Thursday, April 11, in the Journal of Interpersonal Violence. A series of studies focusing on 13- to 15-year-olds from a community outside Cape Town, South Africa, where approximately a fifth of the residents are living with HIV, were published the Journal of Adolescence on Feb. 13.

How high school students understand consent

For the study based in the U.S., Lindsay Orchowski, an associate professor (research) of psychiatry and human behavior at Brown’s Warren Alpert Medical School, interviewed 33 Rhode Island high school students between ages 14 and 18 about their perceptions of sexual consent.

The researchers found that while most of the students could define consent as saying “yes,” their understanding of how consent translated into real-life experiences varied. Both male and female students believed that, in general, girls conveyed consent non-verbally in sexual encounters — and, therefore, that silence during sexual activity could be interpreted as an indication of both consent to and enjoyment of that activity.

Specifically, girls indicated that their female peers would convey sexual refusal through non-verbal cues, and most boys reported their male peers would proceed with sexual activity until they heard the verbal expression of “no,” the paper reported. Additionally, most of the participants shared the view that establishing consent was unnecessary if two teenagers had already engaged in sexual activity.

These findings corroborate earlier research on socialized gender roles in sexual consent, said Kuo, who was also involved in the project.

“Although there might be gender differences, both parties need to fully engage in the consent process,” she said. “No one person is responsible for the consent process.”

Kuo added that consent is a process, changing one’s mind is natural and normal, and consent should be an important part of many activities, beyond just sexual activity.

“All too often, we talk about consent in the context of penetrative sex, but actually asking for permission and giving permission should be a principle that we infuse into everything,” she said. “If my friend wants me to play soccer, I can consent to playing soccer. If I want to hug my friend, I should ask if that is okay. Having the discussion of consent connected only to intimacy is a missed opportunity.”

The authors state that sexual violence prevention programs for high school students should include ways to provide the opportunity to practice verbal and non-verbal sexual consent communication and recognition skills, such as structured role play.

“I think that presenting consent in this simplistic verbal emphasis of ‘no means no’ is a disservice for teaching young people how to really navigate the complexities of consent,” Kuo said. “We know that for young people, especially teens, lots of communication occurs that’s non-verbal. We need to support our young people in recognizing all of those forms of communication, which have important roles to play in the consent process. The non-verbal components of consent take careful attention and are really vital.”

Orchowski said that the research addresses a significant gap in the research literature on sexual violence.

“Although adolescents are at high risk for sexual victimization, most research on sexual consent focuses on college students,” Orchowski said. “Development and evaluation of sexual assault prevention programs for high school students is also lacking. An understanding of sexual consent is at the foundation of sexual assault prevention efforts. This data can inform our efforts to educate high school students on sexual consent in the context of sexual assault prevention programs.”

A study of South African teenagers

Kuo primarily works in South Africa in a community heavily impacted by HIV, where she is focused on sexual health and HIV prevention.

When Kuo’s team surveyed 200 South African 13- to 15-year-olds, they found that sexual violence among teenagers was an aspect of sexual health that needed more targeted interventions. Specifically, they found that 24.7 percent of teens reported using coercion, force or threats of force to perpetrate unwanted sexual acts. Boys reported initiating unwanted sexual acts at higher rates than girls, and the most common unwanted sexual act was oral sex.

“This paper showed we have this enormous opportunity to prevent violence, and to do that we need to deliver educational programs younger than we think,” Kuo said.

To do that, Kuo said, there is a need to create opportunities for young people to talk about sexual violence, including through gender-tailored programming.

Spurred by these findings, Kuo and Orchowski are two years into a three-year collaborative intervention that combines primary prevention of violence with HIV prevention among 13- to 15-year-old boys in South Africa.

“Lindsay Orchowski and I are collaborating precisely because we think there are lessons that we can learn locally that we can take globally, and vice versa,” Kuo said. “I have a lot of experience tackling HIV in South Africa, and Lindsay has a lot of experience with young people and primary prevention of violence in the U.S.”

Kuo’s team also surveyed 195 South African teens about their resilience — the ability to thrive despite adversity.

Of the teens affected by adversity — in this case living with HIV or otherwise being affected by HIV — teens with higher survey-measured resilience also reported fewer behavioral conditions such as hyperactivity and inattention as well as fewer problems with peer relationships. The authors concluded that researchers should focus on interventions to increase resilience among South African teenagers.

Kuo is leading a five-year randomized study of one such intervention to see if it impacts risky sexual behavior.

“South Africa can teach us a lot about how to tackle the issues of sexual violence and HIV prevention,” Kuo said. “It sits at the global epicenter of those epidemics and it has innovative communities, families and scientists that have great ideas of how to tackle those epidemics. Some of those lessons and ideas are context-specific, but not all of them. Some of those innovative ideas are things that we can bring back locally.”

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In addition to Kuo and Orchowski, other authors on the Rhode Island paper were Mary Kirtley Righi from Brown and Katherine Bogen from Rhode Island Hospital.

The other authors on the South African studies were Ashleigh LoVette, Abigail Harrison, Jennifer Pellowski, Don Operario and Dr. Larry Brown from Brown University; Catherine Mathews from the South African Medical Research Council; Millicent Atujuna from the Desmond Tutu HIV Foundation; Dan J. Stein from the University of Cape Town; and Dr. William Beardslee from Boston Children’s Hospital.

The Rhode Island study was supported by the Centers for Disease Control and Prevention (grant U01CE002531), and the South African studies were supported by the National Institutes of Health (primarily grant K01MH096646).