Review of: Hirsch JS et al, J Adolesc Health 2019;64(1):26–35

Study type: Ethnographic research

Sexual assault prevention on college campuses often centers on an affirmative consent policy (“yes means yes”). This standard requires that both parties verbally and consciously agree before each specific sexual activity. Many students can recite this standard, but sexual assault remains common. Recognizing this problem, researchers explored the social factors that make consent more complicated than “yes” or “no.”

Researchers used ethnographic methods to examine real-life behaviors and interactions. Their approach included in-depth interviews, in which 150 students shared personal experiences and attitudes about consent; participant observation, in which researchers observed interactions in dorms, parties, and other social settings over 16 months; and small focus groups where discussions explored norms and expectations around sexual encounters.

This approach helped identify hidden social rules influencing consent practices and revealed areas where an affirmative consent policy falls short. The study found seven social factors that complicate how consent is understood:

1. Gender roles and expectations

• Finding: Men are expected to initiate sexual activity, and women are expected to regulate it. These expectations can lead to assumptions instead of explicit ­communication.
• Advice: Both partners should actively ask for and give consent. It’s not just one person’s job to bring it up.

2. Uncertainty about the right to say “no”

• Finding: Some people worry about being impolite or hurting someone’s feelings by saying “no.”
• Advice: Practice clear communication: “I don’t want to do that.” Other things that mean “no” include suggesting other things to do instead, telling someone why you want to wait, or leaving the situation. Remember, it’s always okay for someone to stop or change their mind.

3. Cultural and racial dynamics

1. Finding: Social norms and stereotypes tied to race, gender, or culture can make navigating consent more complicated, such as when Black men date White women. 
2. Advice: Be especially clear about consent when there are racial or power ­differences.

4. Fear of being accused

• Finding: Some men worry about being falsely accused of sexual assault because consent wasn’t clearly ­communicated.
• Advice: Always ask directly: “Is this okay?” Verbal communication protects all involved.

5. Alcohol and intoxication

• Finding: Drinking is common at college events, but people cannot consent when they cannot make responsible decisions or communicate them clearly.
• Advice: Ask students when, if ever, anyone can consent to sex while drinking or using other substances. Recommend they stick to activities where everyone is fully aware. 

6. Peer group influence

• Finding: Friends and social groups often create unspoken expectations about hooking up during or after parties or events.
• Advice: Choose friends who respect your decisions. Plan out your boundaries and stick to them, regardless of peer pressure. 

7. Assumptions based on context

• Finding: Some students assume that being in a private space, like a dorm room, means consent is implied.
• Advice: Context doesn’t equal consent. Ask first: “Do you want to do this?”

The article recommends participatory and skills-based consent education, as well as measures to reduce the harms of drunk sex (eg, providing food and water at events serving alcohol; space planning to build safer campuses).

CARLAT TAKE 
Talk with patients about social pressures, alcohol use, and clear communication. Advocate for schools and colleges to implement programs and structural changes to reduce the likelihood of nonconsensual sex.