A Public Health Approach to Sexual Health

Turn on your faucet and clean, safe water comes out. It’s because our public health system—working alongside governments, community organizations, and regular people—figured out how to prevent disease-causing bacteria and chemicals from infiltrating the water supply.

Sex, of course, is much more complicated than turning on the tap—but can we combine students’ perspectives and public health expertise about the many factors that shape behavior to create a healthy sexual environment on campus? That’s exactly what a new study called Sexual Health Initiative to Foster Transformation (SHIFT) hopes to do. Jennifer Hirsch, professor of Sociomedical Sciences at the Mailman School of Public Health, and Claude Ann Mellins, professor of Medical Psychology in the Departments of Psychiatry and Sociomedical Sciences at Columbia University Medical Center, co-direct the effort, which is supported by the Office of the President.

According to recent data, as many as one in five women and one in 16 men have experienced some form of sexual assault in college, with an estimated 90 percent of assaults going unreported. Over the past few years, the conversation about sexual violence on campus has been growing larger and louder. Last fall, President Obama called on “all of us, every one of us, to fight campus sexual assault,” sparking commitments from universities across the country. At Columbia, students, faculty, and administration have begun a series of efforts to examine the links between sexual health and the university community, including the University's Sexual Respect and Community Citizenship Initiative, which gets underway this month.

SHIFT is critical to the University’s long-range strategy to create a safer, healthier climate for students. Amidst the burgeoning nationwide conversation on sexual assault, Hirsch sees many unasked public health questions—questions that SHIFT aims to answer. To come up with effective strategies to prevent sexual violence and promote healthy sex, says Hirsch, “we must understand the ways in which the environment might be creating vulnerabilities for students to either perpetrate or experience sexual violence.”

Healthy sex is defined by each of us, for ourselves, and those definitions are shaped at many different levels: individual—your background, experiences, how you think, behave, and make choices; social—who you choose to hang out with, what groups you’re a part of; community—where you live and what social structures you’re a part of; and institutional—the policies and structures you live under. SHIFT is exploring all these levels and how they intersect from the perspectives of Columbia University undergraduate students.

This multilevel approach makes SHIFT unique—as is the fact that the study is exploring sexual health and sexual violence at the same time, at one university. Thirty years ago, the first research on campus sexual behavior began. Hirsch and Mellins are building on this foundation, while updating it to reflect the lives and experiences of college students in 2015. Not only has the problem of sexual violence grown more prominent and public in recent years, but the ways students interact is very different from thirty years ago. “This is a particular moment in time. Now, students have access to new ways of communicating online and through social media. There’s an increased prevalence of alcohol and substances on campus,” says Mellins. To come up with effective sexual violence prevention strategies, we need to understand how all these things, as well as other social and community factors, impact relationships and sexual misconduct.

SHIFT relies heavily on students, and not only as research participants. An Undergraduate Advisory Board (UAB) of 18 students provides input on crucial aspects of the study, such as the phrasing of the questions asked, implementation of surveys, recruitment of student participants, and more. Students on the UAB, who are compensated for their time, come from diverse backgrounds, representing a variety of gender and sexual identities, races, ages, academic programs, activities, and more. The breadth of perspectives in the UAB is meant to reflect the richness and diversity of Columbia’s undergraduate population—because, as one student told Hirsch and Mellins, “if they wanted all the students to agree, they would only need one student.”

SHIFT is collecting both qualitative and quantitative data. For the qualitative aspect, a yearlong ethnographic study of student life is already underway, involving interviews, focus groups, and observations. The quantitative work includes a daily diary study that prompts students to report on everything from their mood and stress level to substance use and sexual activities, as well as a one-time survey of a larger group of students that will take place this spring.

Once all the data has been collected and analyzed, Hirsch and Mellins won’t let the results sit in a journal. In addition to plans for scientific publications, they’ve built a policy dialogue into SHIFT’s framework. In a series of meetings, students and university stakeholders will share perspectives and create intervention strategies to promote sexual health and prevent sexual violence. SHIFT’s vision is not only to gather data across individual, social, cultural, and institutional levels, but to find transformational solutions that work across all those levels. After all, the public health community worked together to make sure our tap water is clean and safe. Why can’t a similar multi-level approach work for sexuality, too?