Monday, May 20, 2013

Broadening the Scope of Sexual Assault Prevention: Contextualizing, Reframing, and Social Marketing – Christine Lundquist

            Sexual assault is an important public health problem, and an especially difficult one due to its complex nature. It ties into a number of other aspects of our lives, including friendship, dating, drinking, and mental health. It is also an emotionally charged issue, and is often difficult to discuss in public. Preventing sexual assault is a complicated endeavor, since it falls on a spectrum that includes healthy behavior (i.e. healthy relationships and consensual sexual activity) and occurs along with social factors. Current campaigns promoting awareness of rape often fail to recognize the nuances of sexual assault or consider the complexity of human behavior. They can overcome these weaknesses by broadening the perception of what rape can look like and utilizing social psychology theories to more effectively change people’s thoughts and behaviors.
Failure to Contextualize and Consider Social Factors
            One problem with current sexual assault campaigns is that they fail to adequately contextualize rape. Sexual assault does not occur in a vacuum—there are a number of other social factors that come into play. For instance, about half of all cases of sexual assault involve alcohol consumption, by the victim, perpetrator, or both (Abbey). A number of studies have shown that alcohol is a key mediator in committing sexual assault. In one study, men were randomly assigned to drinking or sober conditions, and were then asked to assess a hypothetical scenario involving acquaintance rape. Compared to the sober men, those who had been drinking found the perpetrator’s use of force more acceptable and reported greater willingness to act in the same way (1). Another study found that this effect may be due to perceptions of female sexual arousal: in a similar study design, men were randomly assigned to drinking or sober conditions and then listened to a recording of a sexual assault. Those who had been drinking rated the woman’s level of sexual arousal as significantly higher than those who were sober (2). Sexual assault prevention campaigns rarely address potential perpetrators, let alone the effect that alcohol may have on them to commit acts that they would not do while sober.
            The effect of alcohol on the victim is also important to consider. One study assigned women to a drinking or sober condition, and then assessed their level of awareness and discomfort with cues (some overt, some ambiguous) of sexual assault. Women in the intoxicated group were less aware of the cues, especially if the cues were ambiguous (3). Sexual assault campaigns must address alcohol consumption on the victims’ side as well. The fact that the women who had been drinking were especially prone to missing ambiguous social cues speaks to the importance of contextualizing sexual assault. Social situations often rely on ambiguous or subtle behaviors, and this is not adequately portrayed in current rape awareness campaigns. The public service announcements (PSAs) currently in use tend to portray clear and obvious cues that a sexual assault will occur, which is not an effective prevention method because it does not mimic real world scenarios.
            It is also important to consider that sexual assault often occurs in the context of dating and relationships. This is key not only for effectively preventing sexual assault, but for ensuring that victims get help as soon as possible after an assault. A sexual assault victim is more likely to delay seeking care if the perpetrator was a date or someone close to her (4). This delay can make catching the perpetrator exceedingly difficult—the ideal time frame for forensic sampling is as short as 12 hours for digital penetration, and still only 7 days for vaginal penetration (5). Even then, almost half of sexual assault events may not be reported to anyone—neither the police nor family and friends (5, 6). This is one of the major difficulties of addressing sexual assault. The victim is less likely to report the incident if it was committed by a partner (6). He or she may not report it due to feelings of guilt or shame, may not acknowledge that the incident was rape, or may want to preserve her relationship with the perpetrator. Additionally, about half of sexual assaults are committed by someone that the victim knows, so he or she likely considers all of the social implications of admitting to it. Given the importance of social factors in whether the assault even gets reported, it is a major weakness of sexual assault campaigns that they do not acknowledge the context in which rape might occur.
            Sexual assault is also associated with issues of mental health, both directly and through other factors. One study found that alcohol use significantly affects the association between sexual assault and suicidal tendencies in high-school girls (7). We have already seen that alcohol plays a significant role in sexual assault, and this research suggests that its influence may extend to other areas of our lives as well. Additionally, the prevalence of post-traumatic stress disorder (PTSD) is significantly higher in survivors of sexual assault than in the general population (8). Mental health should thus play a significant role in any discussion about sexual assault, but current campaigns rarely address this. Mental health issues could be a cause, result, or simultaneous phenomenon with sexual assault, but whatever the connection may be, they play an important role.
            Another factor associated with sexual assault is pregnancy. This should be an obvious connection to make, but pregnancy is rarely addressed in sexual assault campaigns. One study has shown that teenage girls who experienced dating violence were twice as likely to exhibit risky sexual behaviors and were 1.8 times more likely to have been pregnant (9). This suggests that there may be a connection between sexual assault and sexual behavior in general, which in turn can lead to pregnancy. Also, even for one-time victims of sexual assault, pregnancy may occur. For a number of reasons, the victim may remain pregnant—maybe they chose to keep the baby, or perhaps did not have access to emergency contraception or abortion services. Whatever the circumstance may be, pregnancy can be a direct result of sexual assault, and campaigns should address this consequence.
            Sexual assault must be placed in the context of social factors, as they are fundamental pieces of most public health problems. Epidemiologists have tended to focus on more proximate causes of disease, rather than the social factors at play in leading to a given public health problem (10). Contextualizing social factors will help to understand why certain people are more at risk for sexual assault, in what conditions they are at the highest risk, and how sexual assault can be prevented. With this information, campaigns would better know who to target and how best to reach them. Any given behavior occurs under the influence of our lives, the lives of everyone around us, and our environment. Campaigns should not address only one piece of the puzzle, but the entire picture.
Failure to Account for Human Behavior
            Not only do many sexual assault campaigns fail to consider a broader social perspective, but they also do not account for the irrationality of human behavior. There are many ways in which people are irrational, and these campaigns do nothing to address this. For example, according to the fundamental attribution error, people tend to attribute other people’s behavior to their character, and to attribute their own behavior to the context in which that behavior occurs (11). In order to counteract this error, campaigns should strive to show people that sexual assault can occur as the result of interplay of many social factors, not just the character of the perpetrator or the victim. The rapist may not always realize in the moment that his or her behavior is rape, and the victim may have been raped despite being vigilant and making smart decisions. Character is not always the determining factor is whether sexual assault will occur. However, current campaigns fail to include all of these nuances.
            Sexual assault campaigns also do not address our tendency to think we have much more control than we really do. We think that we have control both over ourselves and our environment, and if it appears we do not have control, we assume that we can work to obtain it (12). A campaign that shows us a girl at a party having drinks with her friends and then later getting raped does not necessarily lead the audience to believe that this can happen to them. People assume that they have control over the events in their lives, and that such an awful thing would never happen to them. PSAs need to do more than simply show the situation in which assault can occur—they need to show that events like this are sometimes completely out of your control.
            Similar to our exaggerated notion of how much control we have, we also make decisions based on our past experiences. If a person often goes to parties and drinks with his or her friends, or goes out on dates frequently and has never experienced sexual assault, that person is not likely to think that his or her experiences will change. Our experiences influence how we approach every day of our lives (13). PSAs need to show us that no matter what our past experiences are, sexual assault is still a risk and we need to be vigilant of our surroundings.
Lack of Emphasis on Prevention
            There has been much work done on the aftermath of sexual assault, including treatment for victims and long-term psychological consequences, but there is very little focus on prevention. This is a major weakness due to social expectations theory. According to this theory, there is a close link between social norms and the way that people behave (14). With a great deal of emphasis on treatment and consequences, and very little emphasis on prevention, these campaigns promote the idea that sexual assault is a social norm that will inevitably occur, and that controlling it is out of our hands. This also relates to the aforementioned issue of expectations. Our expectations affect how we view the world, and if we expect that sexual assault is going to occur, we have less drive to make a change.
            One approach to addressing sexual assault has been to make stricter consequences for sex offenders and implement regulatory laws that aim to reduce recidivism among those convicted for sexual offenses. Such strategies include registration as sex offenders, notifying the community, monitoring via a GPS-like system, and restrictions on residency, loitering, and Internet use (15). While it is certainly important to have these ramifications in place, they should not be implemented at the expense of prevention efforts. This is especially important in light of the fact that many sexual assaults go unreported, so these laws only have an effect if the incident is reported in the first place. Prevention, on the other hand, would have a more universal effect.
            Additionally, a greater emphasis on prevention might affect potential perpetrators as well as victims. As discussed earlier, other factors such as alcohol consumption can influence how the perpetrator might interpret the situation. Campaigns addressing this issue might prevent people from committing these acts by making them aware of the changes in their behavior in certain situations. Sexual assault campaigns tend to focus on the victim, by urging him or her to be safe and aware of the surroundings at all times. Campaigns rarely focus on the person committing the act, thus failing to utilize a potentially powerful prevention effort. Prevention campaigns should increase their focus on those committing the act.
Increase the Ability to Identify with Victims and Perpetrators
            Sexual assault campaigns should have a more diverse display of what rape can look like. Many campaigns tend to depict a woman being assaulted by a man at night, but this is only one of many scenarios in which sexual assault can occur. By showing that rape can manifest itself in different ways, campaigns would allow people to more easily identify with the problem. The “I Will” campaign, founded at the University of Michigan, is an excellent example of a campaign that strives to include everyone in the conversation about assault and acknowledges that it can occur in any number of ways (16). This campaign also emphasizes that the community at large, not only individuals, is affected by sexual assault, which increases people’s ability to identify with and feel invested in the issue.
            Not only does sexual assault occur in a variety of ways, but it is also defined differently depending on the individual. People may have different definitions of rape, and it is important to convey that any act done to you that you consider sexual assault is sexual assault. The “Where Is Your Line” campaign has done an excellent job of doing this, by focusing on how different people will draw different lines for what they consider sexual assault. The web site is full of snapshots of people holding handwritten cards about where they would draw the line between consensual activity and assault, and videos of people discussing exactly how they would define sexual assault. The organization also offers communities the opportunity to create a unique media campaign that will work best for them (17).
            This also relates to the problem of current campaigns failing to contextualize sexual assault. If they broaden the image of what rape looks like and how it is personally defined, they allow room for people to see how rape can occur as a function of a number of other social factors. Rape is often depicted in similar ways from campaign to campaign, but showing people that rape can be defined differently for different people will show the public that rape does not always look the same.
            Increasing people’s ability to identify with the issue may also serve as a prevention effort targeted at potential perpetrators. Broadening the scope of what sexual assault looks like may teach someone that their behavior could be considered rape, or prevent them from later committing an act that they would otherwise have interpreted as normal or consensual. Committing sexual assault, as shown heretofore, is influenced by drinking, social context, and personal boundaries. Showing all of the gray areas around the definition of sexual assault may prevent perpetrators from committing assault in the first place.
Reframing the Issue as Freedom from Sexual Assault
            Framing is a powerful public health tool, and sexual assault campaigns should utilize it to a much greater degree than they do. People are greatly influenced by how an issue is framed, and the frame used can be a powerful determinant for changes in health behavior (18). Many sexual assault campaigns focus on statistics, and in fact, one of the most well-known rape campaigns—the One in Four campaign—is named for a statistic and has the phrase “statistics can change” on the very first page of its web site (19). Statistics are a useful tool within the field of public health, but they are not evocative or emotional, and thus are not useful for persuading people to change or even influencing the way people think. The One in Four campaign has good intentions in spreading the word about the prevalence of sexual assault, but they could be much more effective if they simply reframed the problem. Issues are much more likely to catch people’s attention and persuade them to change their behavior when the issue is framed in an emotional or easily identifiable way. To really raise awareness of sexual assault and get people emotionally invested in prevention efforts, campaigns need to focus on reframing the issue.
            One of the most powerful frames is freedom. Public health campaigns tend to use the frame of health—that is, people should perform a certain behavior for the health benefits—but the freedom frame is much stronger. The “Freedom from Fear” campaign in Western Australia has done an excellent job of framing, and should serve as an example to other assault campaigns (20). The basic message of this campaign is that women deserve to live their lives free of the fear of being sexually assaulted. This is a powerful frame because freedom is one of our most fundamental rights both as Americans and as human beings. By appealing to such a core desire, this campaign has a universal appeal and is relevant to anyone who feels strongly about their freedom. This campaign empowers people to hold on to their freedom.
            The freedom frame is also powerful in this context due to psychological reactance theory. According to this theory, people react strongly when their freedom is threatened and work to eliminate that threat (21). If sexual assault is framed as a threat to women’s freedom, people will be more likely to take up the cause and fight to be able to keep that freedom. People are averse to losing something that they own, and campaigns that frame sexual assault in this way have a broader appeal.
Utilize Social Marketing
            Another approach that sexual assault campaigns should take is that of social marketing theory. This is likely not the first thing that comes to mind when devising a public health strategy, but marketing theory is useful because it pays close attention to how people think and behave. Marketing theory appeals more to people’s core values, by asking, “What do people want?” and then appealing to those basic desires. Freedom is a frequent answer to this question, and is addressed by campaigns such as “Freedom from Fear” mentioned above. Another basic desire that people have is for safety—the security to go out with friends and have a good time, the security to go on dates and return home safely, the security to be in a relationship and never fear for your safety. By addressing these core concerns and appealing to what people do want—rather than what they do not want—sexual assault campaigns would have a much more powerful and effective message.
            Marketing theory is also useful for letting people know what services are available to them after a sexual assault. One study used aspects of social marketing theory to advertise Sexual Assault Nurse Examination (SANE) services on a college campus, and showed a statistically significant increase of students’ awareness of these services and hypothetical encouragement of others to use the services (22). Posters were placed in residence halls and public bathrooms, both of which are places that students would frequently spend their time. The campaign was geared specifically towards its audience and made use of social marketing to get its point across. More public health campaigns should do exactly this.
            One reason that this study of social marketing was successful was the medium chosen for the message. Any campaign must be able to reach its audience effectively. With technology and communication ever advancing, television ads and posters in a city are insufficient for mass communication. Campaigns need to update their method by using ads on the internet, especially YouTube or Pandora, or by placing visual ads in strategic locations, such as college campuses and the surrounding areas. Campaigns need to consider how they are sending out their message, and not only the content of the message itself.
            Sexual assault is a complex public health problem, and effectively implementing these changes will not be an easy task. The solutions proposed in this paper require an overhaul of the current thinking about sexual assault campaigns, and so require an open mind for those with the power to implement them. Of fundamental importance across all of these criticism and solutions is the importance of contextualizing sexual assault within the sphere of social factors. Rape does not occur in a vacuum, and rape campaigns should not act as if it does. Only after these campaigns have a full appreciation for the social aspects of sexual assault and address the perspective of all parties involved will we see true progress in preventing such terrible events.

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