Assessing the Need and Receptivity for an Integrated Healthy Sexual and Dating Relationships Intervention for Community College Students
" Journal of
Applied Research on Children: Informing Policy for Children at Risk: Vol. 8 : Iss. 1
Assessing the Need and Receptivity for an Integrated Healthy Sexual and Dating Relationships Inter vention for Community College Students
Opportunities for Teen Pregnancy Prevention 0
Christine M. Markham 0
Robert C. Addy 0
J. Michael Wilkerson 0
Kimberly Johnson Baker 0
0 University of Texas Health Science Center at Houston School of Public Health , USA
See next page for additional authors
Follow this and additional works at: http://digitalcommons.library.tmc.edu/childrenatrisk
Assessing the Need and Receptivity for an Integrated Healthy Sexual and
Dating Relationships Intervention for Community College Students
Acknowledgements: This study was funded in part by the Center for Health Promotion and Prevention
Research and the Department of Health Promotion and Behavioral Sciences at the University of Texas Health
Science Center at Houston School of Public Health. The authors thank the collaborating community college
personnel and students for their participation.
Christine M. Markham, Melissa Peskin, Robert C. Addy, J. Michael Wilkerson, Kimberly Johnson Baker,
Diane M. Santa Maria, Belinda Hernandez, Vanessa Schick, Ross Shegog, Susan R. Tortolero, Yok-Fong Paat,
and Jeff R. Temple
This article is available in Journal of Applied Research on Children: Informing Policy for Children at Risk:
Although the American Academy of Pediatrics defines adolescence as a
period lasting up to the age of 21 years,1 increasing attention has focused
on 18- to 25-year-olds, referred to as “emerging adults,” because they
face developmental challenges and threats to health and well-being
similar to those of adolescents.2 In emerging adulthood, youth often
become involved in more serious romantic relationships.3 However, many
youth lack the skills needed to avoid an unplanned pregnancy or sexually
transmitted infection (STI) and to ensure a healthy dating relationship. In
2015, young women 18 to 19 years of age accounted for 73% of teen
births in the United States (40.7 per 1000 vs 22.3 per 1000 among 15- to
19-year-olds), with still higher rates (76.8 per 1000) among young women
20 to 24 years of age.4 In 2015, youth 20 to 24 years of age had the
highest reported rates of chlamydia and gonorrhea compared with all
other age groups.5 Further, 47% of female and 39% of male adult victims
of intimate partner violence first experienced dating violence between the
ages of 18 and 24 years.6 Effective interventions in emerging adulthood
may help to prevent unplanned pregnancy and STIs and to promote
longterm healthy dating relationships. The current study examined the need
and receptivity for an integrated healthy sexual and dating relationships
intervention for community college students, an understudied subgroup of
youth in emerging adulthood.
Sexual Behavior Among Community College Students
Community colleges serve nearly half of all undergraduate students in the
United States – more than 12.3 million students. More than half (57%) are
female, 37% are age 21 or younger, 46% are members of racial/ethnic
minorities, and 36% are first-generation college students.7 Compared with
traditional 4-year colleges, community colleges enroll more students from
lower socioeconomic backgrounds and serve students at higher risk for
poor health outcomes.8 Studies in California and Minnesota indicate
higher rates of sexual risk behavior, including sex without a condom or an
effective birth control method, emergency contraception, unplanned
pregnancy, and STIs among community college students than among
students attending 4-year colleges.9,10 These health outcomes may
negatively influence students’ higher education goals. Nationally,
unplanned births account for 7% of dropouts among community college
students overall and for 1 in 10 dropouts among female students.11 Of
community college students who give birth after enrolling in college, 61%
fail to complete their education – a rate almost two times higher than that
of students who do not give birth during college.11 Community colleges
typically have fewer resources than 4-year colleges for sexual health
promotion and student health services,12 indicating the need for low-cost,
minimal-resource strategies to promote sexual and reproductive health in
this underserved population.
Dating Violence in Emerging Adulthood
Dating violence, which comprises physical (eg, hitting, kicking, or
punching), psychological or emotional (eg, threatening, shaming, or name
calling), and sexual (eg, physically or nonphysically forcing a partner to
have sex) violence, is also a significant public health problem among
emerging adults.13 Cyber or electronic dating abuse (eg, texting
threatening messages or posting embarrassing photos online) is related to
offline dating aggression.14 Dating violence has been studied extensively
among 4-year college students, with estimates ranging widely by the type
of dating violence and the population studied. For example, estimates of
physical dating violence in the past year range from 7% to 48%,15-18 for
psychological dating violence from 24% to 89%,15,16,19 for sexual dating
violence from 17% to 33%,17 and for cyber dating abuse from 50% to
92%.14,20 The experience of dating violence is associated with adverse
physical, behavioral, and psychological health outcomes, including
unwanted pregnancy and STIs,21-23 physical injury,24 substance use,20,25,26
depression, suicidality, and posttraumatic stress disorder.24,26,27 The
experience of dating violence may also negatively influence academic
performance.28,29 These findings point to the pervasiveness of dating
violence in college students’ lives and its potential to have a negative
effect on overall health and well-being.
Studies among 4-year college students indicate that the prevalence of
dating violence may vary by gender, race/ethnicity, and sexual identity.
For example, Cercone and colleagues15 found similar physical and
psychological perpetration and victimization rates for male and female
undergraduate students at a large southeastern university; however,
female students were more likely than male students to perpetrate severe
physical assault. On the other hand, a study conducted at four universities
in the United States and Mexico found no significant differences between
male and female students in overall prevalence of physical aggression or
in the prevalence of severe attacks.30 Dating violence among college
students may occur in the context of a mutually violent relationship, and
women’s use of violence may be influenced by their experiences as
victims.31,32 Regarding sexual dating violence, Harned33 reported that
female students experience more sexual victimization than males. Studies
of cyber dating abuse indicate mixed findings, with one study of urban
undergraduates reporting that male students experience more electronic
victimization20 and another study of undergraduates reporting no
significant differences by gender.14
Research is more limited regarding the prevalence of dating violence
among college students by race/ethnicity and sexual identity. Studies
conducted specifically among historically black colleges or universities
(HBCUs) indicate a high prevalence of physical (18%-48%) and
psychological (64%) dating violence victimization among female
students.16,18 Felix and colleagues19 found that a higher percentage of
lesbian, gay, bisexual, and transgender (LGBT) students than of
heterosexual students attending a large rural southeastern university
experienced psychological dating violence. This is consistent with national
and other data suggesting LGBT adolescents are at increased risk for
partner violence.34 The perpetration of physical and sexual violence
among LGBT students has been associated with internalized
homonegativity and identity concealment.35 Understanding the differences
in the experience of dating violence among student subgroups may help to
inform the development of more tailored prevention strategies that are
relevant and engaging.
Multiple psychosocial factors have been identified as risk and protective
factors for dating violence among youth. Coping strategies may moderate
the effects of stressful experiences, including experience of dating
violence.36,37 A greater use of positive coping strategies, such as
problemfocused or emotion-focused coping, has been associated with reduced
odds of physical dating violence victimization; negative coping responses,
such as avoidance or disengagement, have been associated with
increased odds of physical victimization.37,38 Constructive conflict
management skills, including compromise and negotiation, have been
inversely associated with physical and psychological dating violence.39,40
Acceptability of dating violence reflects an individual’s justifications,
attitudes, and tolerance for violence in a dating relationship.41 Acceptability
of dating violence has been shown to moderate the association between
dating violence and relationship satisfaction among female college
students, and the association between dating violence and mental health
problems among males.41 College students, in particular female students,
who experience dating violence often report a lower level of relationship
Compared with the extensive literature on dating violence among 4-year
college students,3,14-20 very little is known about the prevalence of dating
violence perpetration and victimization and its associated psychosocial
factors among community college students. A 2007 survey of 4487
California community college students 18 to 24 years of age indicated that
two in five students (40%) reported relationship difficulties in the past year;
the nature of the difficulties was not specified. However, 41% of those
reporting difficulties indicated that these relationship difficulties had
adversely affected their academic performance.43 Further research is
needed to understand patterns of dating violence perpetration and
victimization among community college students, and to examine potential
differences among student subgroups, given the diverse student
population that community colleges serve. Further, identifying
psychosocial risk and protective factors that are modifiable through
intervention may help to decrease the prevalence and effect of dating
violence perpetration and victimization among community college
Need for Integrated Healthy Sexual and Dating Relationship
Promoting responsible sexual behavior and dating violence prevention are
part of the American College Health Association’s Healthy Campus 2020
student objectives.44 Dating violence is strongly associated with sexual
risk behaviors, suggesting the need to integrate prevention strategies to
address both sexual health and dating violence prevention. Female
victims of dating violence are at higher risk for teen pregnancy and STI
because male perpetrators may be less likely to use condoms,45 and
victims of dating violence may be less likely to negotiate condom use.46
However, few resources exist to help community colleges meet these dual
objectives. Web-based prevention approaches have proved effective at
traditional 4-year colleges, particularly for reducing alcohol consumption,
and have become widely disseminated across US college campuses.47
Similarly, a Web-based sexual violence bystander intervention for male
college students has proved effective for reducing sexual violence
perpetration and positively influencing psychosocial factors related to
sexual violence among males.48 Recently, the National Campaign to
Prevent Teen and Unplanned Pregnancy partnered with the American
Association of Community Colleges to develop a Web-based portal for
community college students to access sexual health information
(www.studentsexlife.org)49 and a brief contraceptive educational
intervention. Post-intervention results from a single group trial
demonstrated significant increases in knowledge of contraception.50
Although promising for sexual risk reduction, these interventions do not
dually address dating violence prevention. However, these findings
collectively indicate the potential feasibility and scalability of an integrated
Web-based intervention developed to address both sexual health and
dating violence prevention effectively on low-resource community college
The Present Study
We present findings from formative research to assess the need and
receptivity for a Web-based, integrated healthy sexual and dating
relationships intervention among community college students in South
Central Texas. Texas ranks third highest among U.S. states in its overall
teen birth rate; 69% of those births are among females 18 to 19 years of
age.51 Texas also ranks No. 1 among U.S. states in its repeat teen
pregnancy rate,52 reflecting the need for effective pregnancy and dating
violence prevention among young adults. The goals of this study were the
following: (1) examine patterns of sexual behaviors, dating violence, and
related psychosocial factors among students attending community
colleges in South Central Texas; (2) examine differences in patterns of
specific types of dating violence perpetration and victimization by gender,
race/ethnicity, and sexual identity; (3) examine associations between
psychosocial factors and dating violence perpetration and victimization;
and (4) assess the usability and short-term psychosocial outcomes of
activities from a Web-based healthy sexual and dating relationships
intervention. Collectively, these findings will inform the development of an
integrated Web-based healthy sexual and dating relationship intervention
that is acceptable and engaging, and potentially scalable for use in
community college settings.
In the spring of 2016, we invited five community colleges in South Central
Texas to participate in a pilot study about healthy sexual and dating
relationships. The study comprised an online survey of students’ behavior
related to sexual and dating relationships, in addition to usability testing of
activities from an integrated, Web-based healthy sexual and dating
relationships intervention. Three colleges agreed to participate, collectively
serving more than 170,000 credit students. Previous community college
studies indicate that a combination of in-person recruitment and online
survey administration yields the highest participation rates with minimal
classroom interruption.8 College administrators identified courses with a
high level of enrollment of students 18 to 25 years old (eg, General
Psychology). Faculty for these courses received information about the
online survey to share with students. Additional recruitment was
conducted through on-campus activities (eg, information table at a blood
drive) and flyers posted on campus. One college provided email
addresses for students 18 to 25 years old, which allowed recruitment via
direct e-mail. Recruitment continued from August to December 2016, until
an a priori defined sample of 300 students was achieved. This sample size
was similar to that of a previous study conducted among 4-year college
students, powered to detect gender differences in dating violence,42 and
previous sexual health studies conducted among community college
students.53-55 Students who completed the online survey were eligible to
participate in the usability testing. The study was approved by the
University of Texas Health Science Center at Houston (UTHealth)
Institutional Review Board (IRB) and by the IRBs of the participating
Online survey. Students accessed the online survey via their own personal
computers or online devices outside class time. Upon accessing the URL
Web link, students viewed an online consent form, which informed them
about the voluntary nature of the study and their ability to stop taking the
survey at any time without negative consequence. Students who agreed to
participate were directed to the survey, which took about 20 minutes to
complete. No names were associated with the survey. Upon completion,
students were directed to a separate database to provide an e-mail
address to receive a $10 e-gift certificate. The survey was programmed in
Qualtrics and hosted on a secure server at UTHealth.
Usability testing. In usability testing, a product is evaluated by testing it
with representative users. The goal is to assess participants’ satisfaction
and ability to complete specified tasks, and to identify changes required to
improve performance or satisfaction.56 Approximately one-quarter of the
students (n=85, 28%) who provided e-mail addresses after completing the
online survey received an e-mail invitation to participate in the usability
testing, which was conducted on campus at one participating college.
There were 14 students who agreed to participate. Reasons for not
participating included inconvenient location, time conflict, and lack of
interest. A single-group, pretest/posttest study was conducted to assess
usability and the short-term psychosocial outcomes of viewing 10
interactive, Web-based activities related to healthy sexual and dating
The Web-based activities were originally developed for middle and high
school students as part of three theory-based interventions designed to
reduce sexual risk and dating violence behaviors in these younger age
groups.57-60 Based in social cognitive and social influence models,61,62 the
activities included interactive quizzes, skills training, modeling, and peer
video to address psychosocial factors, including self-efficacy and
perceived importance for selecting an effective birth control method,
negotiating condom and birth control use with a partner, using condoms
and birth control correctly, accessing sexual and reproductive health care
services, recognizing healthy and unhealthy dating relationships, and
getting out of an unhealthy relationship (Figure 1).
Consenting students accessed activities on laptop computers equipped
with headphones for privacy. Laptops were arranged so that screens were
not visible to others. Students viewed 10 activities, providing standardized
feedback on usability parameters. Students completed pre-test/post-test
surveys to assess effect on psychosocial factors. Usability testing took
approximately 90 minutes to complete; students received a $50 gift card
as compensation for their time.
Online survey. The online survey comprised items to assess students’
sexual behavior, experience of dating violence perpetration and
victimization, psychosocial factors associated with healthy/unhealthy
dating relationships, awareness of community resources, and preferred
topics and delivery mode for a healthy relationships intervention.
Demographic items assessed age, race/ethnicity, current gender
identity,63 sexual identity, relationship status, enrollment status, and typical
SEXUAL BEHAVIOR. Lifetime experience, number of partners in the past
year, and frequency of condom use in the past 30 days (never, rarely,
sometimes, most of the time, always) were assessed for vaginal
intercourse and anal intercourse, respectively, with items adapted from the
National College Health Assessment (NCHA).64 Type(s) of birth control
used at last vaginal intercourse, use of emergency contraception in the
past year, and lifetime number of pregnancies were also assessed with
DATING VIOLENCE PERPETRATION AND VICTIMIZATION in the past year were
assessed with the Conflict in Adolescent Dating Relationships Inventory.65
Eight subscales were created: physical perpetration (four items, eg, “I
pushed, shoved, or shook him/her”) and victimization (four items, eg,
“He/she kicked, hit, or punched me”); threatening perpetration (four items,
eg,“I threatened to hurt him/her”) and victimization (four items, eg,“He/she
tried to frighten me on purpose”); psychological perpetration (13 items,
eg,“I spread rumors about him/her”) and victimization (13 items,
eg,“He/she insulted me with put-downs”), and sexual perpetration (four
items, eg, “I forced him/her to have sex when he/she didn’t want to”) and
victimization (four items, eg, “He/she kissed me when I didn’t want him/her
to”). Cyber dating abuse perpetration (11 items, eg, “I sent threatening text
messages to him/her”) and victimization (11 items, eg, “He/she pressured
me to send a sexual or naked photo of myself”) in the past year were
assessed with items from Peskin and colleagues.66 Each subscale of
dating violence was dichotomized so that any positive response meant
any experience within the subscale.67 To avoid over-representing
students’ involvement in psychological abuse, given its frequency in youth
relationships,67,68 participants had to endorse four or more (of 13) items to
be considered perpetrators/victims of psychological abuse.
PSYCHOSOCIAL FACTORS. Coping strategies were assessed with items from
the Brief COPE scale.36 The frequency of positive coping strategies (12
items, eg, “I think hard about what steps to take,” α=.80) and the
frequency of negative coping strategies (10 items, eg, “I criticize myself,”
α=.77) in the face of difficulties were assessed on a 5-point Likert scale
ranging from “never” to “most of the time.” Corresponding items were
summed to form composite scores, with higher scores reflecting more
frequent use of positive and negative coping strategies.
Constructive conflict management skills were assessed with eight items
from the Adolescent Interpersonal Competence Questionnaire.69 Students
responded to the following prompt: “How good are you at …?” Example
items included “resolving disagreements in ways that make things better
instead of worse” and “resolving disagreements in ways so neither person
feels hurt or resentful.” Participants rated items on a 5-point Likert scale
ranging from “poor at this” to “extremely good at this.” Item responses
were averaged to form a composite score (α=.85), with a higher score
reflecting a greater ability to use constructive conflict management skills.
Acceptability of dating violence was assessed with the five-item
Acceptance of General Dating Violence subscale from The Acceptance of
Couple Violence Questionnaire.70 Example items included “Violence
between dating partners can improve the relationship” and “Sometimes
violence is the only way to express your feelings.” Participants rated items
on a 4-point Likert response scale ranging from “strongly disagree” to
“strongly agree.” Item responses were averaged to form a composite
score (α=.83), with a higher score reflecting greater acceptance of dating
Relationship satisfaction was assessed with seven items from the
Relationship Assessments Scale.71 Five items were positively valenced
(eg, “How well does your partner meet your needs?”); two items were
negatively valenced (eg, “How many problems are there in your
relationship?”). Participants rated items on a 5-point Likert scale ranging
from “low” to “high.” Negatively valenced items were reverse coded. Item
responses were averaged (α=.89), with a higher score reflecting greater
AWARENESS OF COMMUNITY RESOURCES. One item asked students about
their awareness of community services or resources for victims or
perpetrators of dating or intimate partner violence.72
PREFERRED TOPICS AND DELIVERY MODE. Participants were asked to identify
topics that would be helpful to include in a healthy relationships
intervention for community college students. Nine topics (eg, love and
relationships, money matters) were identified from a review of existing
healthy marriage and relationship education programs,73 along with an
“other” option for write-in responses. Participants identified their preferred
delivery mode(s) for a healthy relationships intervention for community
college students by selecting from five responses: mobile phone
application, text messages, optional online modules, mandatory online
modules, and “other” (with a write-in response).
Usability testing. Usability parameters, including ease of use, credibility,
understandability, acceptability, motivation, and perceived effect, were
assessed with Likert scale ratings adapted from pre-existing usability
assessment instruments.74,75 Pre-use and post-use ratings were obtained
on psychosocial outcomes, including the importance of sexual risk
reduction skills (eg, explaining to a partner how to use condom, going to a
clinic with your partner to discuss contraception) and healthy relationships
skills (eg, effectively resolving a disagreement, getting out of an unhealthy
dating relationship) and self-efficacy in performing these skills.
Participants rated the importance of items on a 10-point Likert scale
ranging from “not important” to “very important,” and self-efficacy items on
a 4-point Likert scale ranging from “I definitely could not” to “I definitely
could.” Open-ended questions asked participants for recommendations on
how to make activities more relevant for people their age. Usability
pretest and post-test surveys were administered via paper-and-pencil
Online survey. The online survey was initiated in 300 students; 19 were
dropped from analysis because they are age ineligible and 10 were
dropped because of minimal survey completion, leaving an analytical
sample of n = 271. All analyses were conducted with SAS analytic
software, version 9.4. Frequencies, means, and standard deviations were
used to describe the sample by demographic characteristics, sexual
behaviors, and psychosocial factors. Each dating violence outcome
measure was coded as either 0 or 1, in which 0 denoted the absence of
the specific type of dating violence and 1 denoted the presence of that
specific type of dating violence in the past year. Students who did not
report having a boyfriend/girlfriend/partner in the past 12 months were
coded as 0 (ie, not participating in dating violence behaviors). The
prevalence of specific types of dating violence perpetration and
victimization (physical, threatening, psychological, sexual, and cyber) and
of any dating violence perpetration or victimization in the past year was
calculated for the total sample, and by gender, race/ethnicity, and sexual
identity with chi-square and Fisher exact tests. For race/ethnicity, when
the initial P value was <.05, additional post hoc chi-square and/or Fisher
exact tests were conducted to identify statistically significant differences
between categories. Independent t tests were used to assess associations
between psychosocial factors and experience of any dating violence
perpetration or victimization in the past year.
Usability testing. Usability ratings and short-term effect on psychosocial
outcomes were analyzed with descriptive statistics and the Wilcoxon
signed rank test.
The participants in the analytical sample (n=271) were 70% female, 38%
Hispanic, 24% White, 17% Black, 16% Asian, and 4% other race/ethnicity.
Mean age was 20.8 years (standard deviation [SD]=2.05). More than
three-quarters (78%) of participants self-identified as heterosexual, 10%
as gay or lesbian, 9% as bisexual, and 2% as another sexual identity. Just
under half (47%) were single; 30% were in a dating relationship but not
living together, and 21% were in a dating relationship and living with their
partner. Most participants (71%) were full-time students, typically receiving
A and B grades (63%) (Table 1).
Sexual behavior. Regarding sexual behavior, 163 (64%) participants had
experienced vaginal intercourse, 37% of whom had had two or more
vaginal intercourse partners in the past year. Of those who had had
vaginal intercourse in the past 30 days, just over one in four (26%)
reported using condoms “most of the time” or “always”. Among those who
had ever had vaginal intercourse, birth control methods used at last
vaginal intercourse included male condoms (35%); withdrawal (31%); birth
control pills (25%); birth control shot, patch, or ring (12%); and an
intrauterine device (IUD) or implant (10%). One in five (22%) had not used
a birth control method at last vaginal intercourse. One in ten (10%) had
used dual protection (a condom and effective birth control method) at last
vaginal intercourse. One-quarter (25%) of participants had used
emergency contraception in the past year, and 21% had been pregnant or
made their partner pregnant. Approximately one-quarter (26%) of
participants had experienced anal intercourse, 11% of whom had had two
or more anal intercourse partners in the past year. Of those who had had
anal intercourse in the past 30 days, 30% reported using condoms “most
of the time” or “always” (Table 1).
Psychosocial factors. Overall, participants reported a low to moderate
frequency of using positive (mean [M]=22.6, SD=3.37) and negative
(M=14.9, SD=3.28) coping strategies when dealing with problems, and
moderate to good use of constructive conflict management skills (M=3.4,
SD=0.76). Most participants reported low acceptance of dating abuse
(M=1.3, SD=0.49), and relatively high relationship satisfaction was
reported by those who were currently dating (M=4.1, SD=0.79) (Table 1).
Dating violence perpetration. Overall, two-thirds of participants (n=167,
66%) reported perpetrating any type of dating violence in the past year.
Almost one in four reported perpetrating physical (24%), threatening
(23%), or cyber (23%) dating violence, specifically. Close to one-third
(32%) reported perpetrating sexual dating violence, and just under
twothirds (60%) reported perpetrating psychological dating violence in the
past year (Table 2).
Regarding gender, female participants were significantly more likely than
males to report perpetrating any dating violence in the past year (71% vs
54%) and to report perpetrating physical (28% vs 14%), threatening (27%
vs 15%), and psychological (66% vs 42%) dating violence perpetration,
specifically. No statistically significant differences were reported by gender
for sexual and cyber dating violence perpetration.
Current gender identity
In a relationship, not living together
In a relationship, living together
Mostly A’s and B’s
Mostly B’s and C’s
Ever had vaginal intercourse
2+ vaginal intercourse partners in past yeare
Condom use for vaginal intercourse
in past 30 dayse
Most of the time/always
Birth control method at last vaginal
Birth control pills
Birth control shot, patch, or ring
Intrauterine device (IUD) or implant
Did not use a birth control method
Used both a condom and birth control
pills, shot, patch, ring, IUD or implant
Used emergency contraception in past yeare
Ever been pregnant or made partner
Ever had anal intercourse
2+ anal intercourse partners in past yearf
Condom use for anal intercourse in past 30
Most of the time/always
Psychosocial factorsg (possible
Positive coping strategies (
Negative coping strategies (
Conflict management skills (1-5)
Acceptability of dating violence (1-4)
Relationship satisfactionh (1-5)
SD, standard deviation.
a Numbers vary because of missing data.
b Includes students who self-identify as trans man, trans woman, gender queer, agender,
or something else.
c Includes students who self-identify as American Indian or Alaska Native, Native
Hawaiian or Pacific Islander, or multiracial.
d Includes students who self-identify as queer, asexual, pansexual, or something else.
e Of those students who reported ever having had vaginal sex.
f Of those students who reported ever having had anal sex.
g Higher scores indicate greater endorsement of the variable (eg, more frequent use of
positive coping skills).
h Of those students who reported having a current boyfriend/girlfriend/partner.
Regarding race/ethnicity, the only statistically significant difference noted
for perpetration was in psychological dating violence. Post hoc analyses
indicated that Hispanic participants were significantly more likely than
those of “other” race/ethnicity (students who self-identified as Asian,
American Indian or Alaska Native, Native Hawaiian or Pacific Islander, or
multiracial) (66% vs 46%) to report psychological perpetration. Black
participants were also significantly more likely than white non-Hispanic
(72% vs 53%) participants and those of “other” race/ethnicity (72% vs
46%) to report psychological perpetration. No statistically significant
differences in dating violence perpetration in the past year were noted by
Dating violence victimization. Overall, two-thirds of participants (n=164,
66%) reported having been the victim of any type of dating violence in the
past year. One in four, or just over, reported experiencing physical (25%),
threatening (28%), sexual (30%), or cyber (28%) dating violence
victimization, specifically. More than half (56%) reported experiencing
psychological dating violence in the past year (Table 2).
Regarding gender, female participants were significantly more likely than
males to report experiencing in the past year any dating violence
victimization (70% vs 56%) and psychological victimization specifically
(62% vs 39%). No statistically significant differences by gender were
reported for physical, threatening, sexual, and cyber dating violence
victimization in the past year.
Regarding race/ethnicity, the only statistically significant difference noted
for victimization was in psychological dating violence. Post hoc analyses
indicated that Hispanic participants were significantly more likely than
white non-Hispanic (67% vs 48%) participants and those of “other”
race/ethnicity (67% vs 39%) to report psychological victimization. Black
participants were also significantly more likely than participants of “other”
race/ethnicity (64% vs 39%) to report psychological victimization. No
statistically significant differences in dating violence victimization in the
past year were noted by sexual identity.
Associations between psychosocial factors and dating violence.
Participants who experienced any dating violence perpetration or
victimization in the past year reported significantly lower relationship
satisfaction compared with those who did not experience dating violence
(both P<.05). Conversely, participants who did not experience dating
violence victimization or perpetration reported significantly higher
constructive conflict management skills compared with those who
experienced violence (P<.05). No statistically significant associations were
noted between positive and negative coping strategies, or acceptability of
dating violence, with dating violence perpetration or victimization in the
past year (Table 3).
Awareness of community resources. Among the participants, 41%
reported being aware of community services or resources for victims and
perpetrators of dating or intimate partner violence; 37% were not aware of
such services, and 22% were not sure if they knew of such resources.
Preferred topics and delivery mode. Participants endorsed multiple topics
for a healthy relationships intervention for community college students:
love and relationships (90%), birth control (68%), managing conflict (66%),
STI/HIV prevention (64%), surviving a breakup (60%), sexual assault
(50%), money matters (47%), career opportunities (47%), sexual pleasure
(45%), and LGBTQ issues (39%). Additional topics suggested by
participants included coping with cheating, communication skills,
recognizing emotional control in relationships, handling stress and anxiety,
study habits, and mental and physical health. Preferred delivery modes for
community college students were mobile phone application (55%),
optional online modules (45%), mandatory online modules (44%), and text
messages (43%). Additional delivery modes suggested by participants
included in-person classes, e-mail, face time, group events, and a
billboard poster campaign.
Type of Dating Violence (DV) Perpetration Experienced in Past Year
Physical Threatening Psychological Sexual Cyber
na (%) na (%) na (%) na (%) na (%)
Type of Dating Violence (DV) Victimization Experienced in Past Year
Physical Threatening Psychological Sexual Cyber
na (%) na (%) na (%) na (%) na (%)
a Numbers vary because of missing data; percentages are calculated as (positive responses)/(total responses).
c Includes students who self-identify as Asian, American Indian or Alaska Native, Native Hawaiian or Pacific Islander, or
d Includes students who self-identify as queer, asexual, pansexual, or something else.
§ Significant difference between Hispanic and other race/ethnicity students (P<.05).
¶ Significant difference between Black and White students (P<.05).
// Significant difference between Black and other race/ethnicity students (P<.05).
# Significant difference between Hispanic and White students (P<.05).
§§ Significant difference between Hispanic and other race/ethnicity students (P<.001).
Psychosocial Factor a
Dating violence perpetrationc
Positive coping strategies
Negative coping strategies
Conflict management skills
Acceptability of dating violence
Dating violence victimizatione
Positive coping strategies
Negative coping strategies
Conflict management skills
Acceptability of dating violence
Experienced Any Dating Violence in Past Year
M, mean; SD, standard deviation.
a Higher scores indicate greater endorsement of the variable (e.g., more frequent use of positive coping skills).
b Numbers vary due to missing data.
c Includes any experience of physical, threatening, psychological, sexual, or cyber dating violence perpetration in the past year.
d Of those students who reported having a current boyfriend/girlfriend/partner.
e Includes any experience of physical, threatening, psychological, sexual, or cyber dating violence victimization in the past year.
Participants (N=14) were 86% female, 42% Hispanic, 50% Asian or Pacific
Islander, 14% Black, and 7% White. Mean age was 20.7 years (SD=1.64;
range, 19-24), and 71% were sexually experienced. Overall, usability
parameters were well rated. The Web-based sexual risk reduction and
healthy relationship activities were rated as likeable (77%-100%), easy to
use (92%-100%), and acceptably paced (62%-93%). Most participants
rated the lessons as credible (86%100%) and helpful for making healthy
choices (85%-100%). Many indicated they would recommend the activities
to a friend (71%-100%) (Table 4). Open-ended responses suggested
overall satisfaction with the activities (eg, “This activity is just great!”;
“Overall, I think the content is spot-on”; “Very useful, especially for people
who are unaware of how to put on a condom”), along with
recommendations to enhance their appeal for community college students
(eg, “Include situations that college students would relate to more”; “Speed
up the audio”; “Make the answers less obvious”; “More graphics! [of types
of birth control methods]”; “Include how to use a female condom also”; and
“Add a list of Web sites where we can find clinics near us”).
Likeability “A lot” or “a little”
Ease of use “Very easy” or “kind of easy”
Acceptability “Pace of activity just right”
Credibility “Information correct”
Motivational “Would tell a friend to try this
Perceived effect “Information will help me have 85-100
healthier dating relationship”
a A range of agreement across activities is presented. For example, for “Likeability,”
participants’ agreement that they liked a lesson (“a little” or “a lot”) ranged from 77% for
the lowest rating to 100% for the highest rating among students who viewed the activity.
Short-term outcomes. Significant increases in self-efficacy to use a
condom correctly (or explain to your partner how to use a condom
correctly) and in self-efficacy to visit a clinic with a partner to discuss
effective birth control were observed at post-test (P<.01). A significant
increase in the importance of resolving disagreements so that neither
person felt hurt or resentful was also observed at post-test (P<.05). For
two items (self-efficacy to tell your partner you want to start using
condoms and importance of using condoms to help prevent STIs and
pregnancy), a ceiling effect was noted, as mean scores at pre-test
reflected the maximum possible score with no room for improvement at
post-test. No statistically significant differences were observed at post-test
for other self-efficacy and importance items (Table 5).
The goal of the current study was to assess the need and receptivity for
an integrated healthy sexual and dating relationships intervention among
community college students in South Central Texas. Quantitative data
from the online survey align with findings from previous studies among
community college students, indicating high rates of sexual risk behavior,
including sex without a condom or an effective birth control method.9,10,53
Current findings also corroborated limited use of long-acting reversible
contraception such as IUDs and implants, frequent use of emergency
contraception, and limited use of dual protection to prevent pregnancy and
STIs.9,43 Qualitative studies among community college students indicate
that although most students do not feel emotionally or financially ready to
be a parent, many are not using effective birth control methods or do not
use them consistently.49,76 Reasons for lack of use or inconsistent use
include misperceptions about pregnancy and STI risk, misinformation
about the effectiveness of birth control methods or concerns about side
effects, and changes in relationship status – either breaking up or
becoming involved in a more serious long-term relationship.49,76 These
findings indicate the need to increase education about preventing
unplanned pregnancy and STIs among community college students that
addresses myths and misconceptions and that enhances communication
skills to make shared sexual health decisions. Although many students
may receive sexual health education in middle or high school,77 a booster
session in emerging adulthood would provide up-to-date information on
sexual risk reduction strategies that is more relevant to the students’
current relationship status.43
Self-efficacy to …b
Resolve a disagreement in ways that make things better
instead of worse
Resolve a disagreement so that neither person feels hurt or
Get out on unhealthy dating relationship
Tell your partner you want to start using condoms
Use, or explain to your partner how to use, a condom
Have a condom with you when you need it
Tell your partner you want to start using an effective birth
Go to a clinic with your partner to discuss effective birth
Importance of …c
Resolving a disagreement in ways that make things better
instead of worse
Resolving a disagreement so that neither person feels hurt or
Using condoms to help prevent STIs and pregnancy
Using effective birth control methods to help prevent
Mean Score (SD)
Post-test Mean Score (SD)
SD, standard deviation.
* P<.05; **P<.01.
a Wilcoxon signed rank test.
b Range of possible scores, 1-4.
c Range of possible scores, 1-10.
Our study is one of the first to examine patterns of dating violence
perpetration and victimization among community college students. Overall,
two-thirds of the students who participated in the online survey reported
perpetrating, or being the victim of, dating violence in the past year.
Frequencies of physical, threatening, psychological, and sexual dating
violence perpetration and victimization fell within ranges previously
reported among 4-year college students.15-18,20 Frequencies of cyber
dating abuse were lower than those previously reported; 28% of
participants in the current study reported being victims of cyber dating
abuse, compared with 50% to 92% of participants in previous studies of
4year college students.14,20 This discrepancy may be due to measurement
differences – we omitted an item about sending frequent text messages to
check on a dating partner because of it’s being considered normative
among youth.66,78 The previous studies included an item about electronic
checking or monitoring, with a high rate of student endorsement, which
may have increased overall reporting of cyber dating abuse.14,20 Overall,
the current findings reiterate the pervasiveness of dating violence in young
people’s lives and the need to provide effective intervention for community
college students to help them achieve healthier dating relationships.
Patterns of dating violence by gender indicated that a greater percentage
of female community college students reported perpetrating physical
dating violence than of males, a finding previously reported among 4-year
college students.15 However, in the current sample, female students also
reported perpetrating more threatening and psychological dating violence
than males, as well as experiencing greater psychological victimization.
Although these findings may be due in part to reporting bias (females may
be more open to reporting dating violence perpetration and victimization
than males),79,80 they underscore the need for interventions to address
psychosocial factors that reduce perpetration and victimization among
both male and female students, and that address the dynamics of
relationships characterized by mutual violence.31 They also reiterate the
need to include a variety of scenarios when depictions of dating violence
are represented to avoid reinforcing traditional gender stereotypes of
Regarding patterns of dating violence by race/ethnicity, for psychological
dating violence perpetration and victimization only, the current findings
indicate significant differences between Hispanic or Black students and
White students or students of other race/ethnicity.. Patterns of physical,
threatening, and sexual dating violence, and of cyber dating abuse, were
not significantly different across racial/ethnic groups. These findings stand
in contrast to those from previous studies among adolescents and young
adults82,83 and may in part reflect the greater diversity of racial/ethnic
minorities attending community colleges and the greater parity in low
socioeconomic status among community college students, regardless of
racial/ethnic background. Interventions that address dating violence
prevention and healthy dating relationships need to reflect the racial/ethnic
diversity that is present on community college campuses.
Few studies among community college students have specifically
addressed issues related to LGBT youth. In fact, most sexual health
studies among community college students have been specifically
restricted to youth who either self-identified as heterosexual9 or did not
report data on sexual identity.10,53 In contrast, the current study asked
participants specifically about their current gender identity and sexual
identity, contributing to the limited literature in this area.84 Overall, 3% of
the online survey sample self-identified as trans man, trans woman,
gender queer, agender, or another identity; 20% self-identified as gay,
lesbian, bisexual, queer, asexual, pansexual, or another identity. These
findings highlight the diversity of students attending community colleges in
South Central Texas. However, in contrast to previous studies among
4year college students and adolescents, which consistently reported
greater experience of dating violence among LBGTQ students than
among heterosexual students,19,85,86 we did not observe any statistically
significant differences in dating violence perpetration or victimization by
sexual identity. Although the study was sufficiently powered to detect
significant differences by gender, it may have been underpowered to
detect significant differences by sexual identity. Additionally, to maximize
power, all sexual minority individuals were combined into a single
category, obscuring potential differences in dating violence by gender,
sexuality, and partner type.87 Qualitative inquiry among LGBTQ
community college students indicates a high rate of homonegativity and
identity concealment, 84 both of which are associated with an increased
risk for dating violence victimization,35 and a high rate of heteronormativity
in curricular programming. 84 These findings suggest that further research
is needed among LGBTQ community college students to better
understand their experience of dating violence perpetration and
victimization, and to inform more culturally relevant sexual health and
healthy dating relationship interventions for sexual gender minority
Overall, participants in the online survey reported relatively low to
moderate use of positive and negative coping strategies, and moderate
ability to use constructive conflict management skills. This indicates room
for improvement in relationship skills to enhance healthy dating
relationships, especially as students who reported greater conflict
management skills also reported less experience of dating violence
victimization. In alignment with previous studies among 4-year college
students, community college students who had experienced dating
violence perpetration or victimization in the past year also reported poorer
relationship satisfaction.41,42 Furthermore, 59% of participants were unsure
or unaware of community resources for victims and perpetrators of dating
or intimate partner violence. Collectively, these findings indicate a critical
need to provide community college students with relationship skills training
and resources to prevent and mitigate the potential negative outcomes of
Usability study data indicated a high level of receptivity and acceptability
for an integrated Web-based healthy sexual and dating relationships
intervention. Overall, tested activities were highly rated in terms of
usability parameters, and they positively influenced specific short-term
psychosocial outcomes related to condom use, access to contraceptive
health services, and constructive conflict resolution. Given that the
activities were originally developed for a younger audience, participants
provided salient recommendations to make content and delivery more
relevant and engaging for students of community college age. Their input
will inform adaptations to the intervention for this older age group. These
findings are promising because Web-based interventions have multiple
advantages over face-to-face interventions. They are easier and less
expensive to implement and disseminate because they do not require
trained facilitators, scheduling, or allocation of space and time.47 Further,
they afford the opportunity to tailor intervention messages to user
characteristics and provide a multimedia experience, including videos,
interactive feedback, and personalized messaging.88 These attributes are
particularly important when a diverse youth population such as community
college students is targeted.
Overall, the study findings point to potential policy implications for
community college administrators. Given the effect of unplanned
pregnancy on academic outcomes, community colleges may consider
incorporating sexual health education modules into student orientation,
first-year experience success courses, or academic courses, and
providing resources (eg, www.studentsexlife.org49) and links to community
health care services on college Web sites.89 Given the prevalence of
different types of dating violence reported by students besides sexual
violence, administrators may also consider expanding Title IX education
initiatives to encompass the prevention of physical, threatening, and
psychological dating violence and cyber abuse, and providing links to
community services or resources for victims and perpetrators of dating or
intimate partner violence on college Web sites. Such strategies would help
to provide students with the education and resources they need to make
healthier decisions in their sexual and dating relationships.
As with all studies, several limitations should be considered when these
findings are interpreted. The small sample size for the online survey may
have reduced power to detect statistically significant differences in dating
violence by subgroups; however, the sample size was similar to that of
previous published studies conducted among 4-year college and
community college students.42,53-55 Further, the use of nonprobabilistic
sampling may limit the generalizability of the findings beyond the three
participating community colleges, and the cross-sectional study design
precludes conclusions about directionality or causality. Similarly, although
the usability study was underpowered to examine statistical differences,
the sample size was consistent with previous usability testing protocols
that do not require statistical significance to determine major usability
problems.90-92 Reasons for students’ nonparticipation in the usability study
reiterate the need to provide interventions at a time and place that are
convenient for community college students.
Despite these limitations, the current study makes an important
contribution to the limited literature on sexual health and dating violence
among community college students. Specifically, these findings expand
our understanding of the patterns of dating violence perpetration and
victimization among community college students and highlight the diversity
and needs of LGBTQ students on community college campuses. Further,
they highlight the potential of an integrated Web-based healthy sexual and
dating relationship intervention to provide a scalable, low-cost prevention
approach for resource-limited community colleges.47,12
The current study underscores a high degree of need and receptivity for
an integrated healthy sexual and dating relationship Web-based
intervention among community college students. Web-based interventions
are inexpensive and highly scalable. Community college students account
for nearly half of all undergraduate students in the United States, making
them an underutilized setting in which to positively influence sexual health
and dating relationships among youth in emerging adulthood.
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