05 October, 2014

Gone girls: a discussion of campus safety and sexual assault with an extended digression into clinical trial design

My dad had a consistent blogging schedule, as many long-time readers will know: Sundays a good religious joke, Mondays {this moment}, and so on. I contemplated the many subjects I like to write about and considered trying to assign them to specific days of the week but finally realized I'm just not that organized! But I did like the idea of trying to, at least once a week, write about a policy- or advocacy-type topic that is important to me. So here goes...

In 2009, a young woman named Morgan Harrington disappeared during a Metallica concert at the University of Virginia. Her body was found on a farm 10 miles south of the university three months later, and although a forensic connection was made to a sexual assault in 2005, no suspects (or "persons of interest") were ever identified (at least not publicly).

As a Virginia alumna, I followed the case closely in the beginning and checked in every few months over the years. As thinking about grief and bereavement became more a part of my daily life, I read Morgan's mom's blog posts with a heavy heart and with many prayers for her family. I learned firsthand that it is very, very hard to find consolation when someone you love dies in pain and fear - no matter how many times I try to remember that wherever they are, they are beyond that pain.

I started my first year at UVA in 1998. I don't remember most of my orientation, but I do remember that a group called Grounds for Discussion performed a series of sketches on topics like sexual assault and binge drinking. Afterwards, more senior students facilitated small group discussions of the issues raised (a role I would take on myself every August for the next three years). Later than night, a boy from an adjacent suite knocked on our door, doling out Oreos he had won in an (you guessed it) Oreo-stacking contest. My suitemates invited him in and we all sat around one girl's room, joking about the awkwardness of much of orientation. "Today we learned not to sit next to boys unless you want to be raped," one girl parodied, causing another girl to slide off the bed onto the floor, in a mock attempt to put distance between herself and our male visitor.

During my first semester, I rarely walked alone after dusk, but over time, I fell into the familiarity and apparent safety of life on the idyllic university grounds, nestled beneath my beloved Blue Ridge Mountains. My suite took a self-defense course, but I never deluded myself that a little basic training meant I could go anywhere I wanted, whenever I wanted, and be immune to the threat of violence. Rather, once I knew the nooks and crannies, the shortcuts and secret rendezvous spots, very little about the University grounds and parts of Charlottesville surrounding grounds looked threatening. I had similar experiences in every place I moved subsequently, from big cities like Copenhagen and Philadelphia, to other universities, like Oxford: you start out cautious, then you get comfortable, and then (maybe/sometimes/I'm not convinced) you get complacent.

By the time I graduated, I thought very little about dashing back and forth between my apartment and my boyfriend's apartment several blocks away, at pretty much any time of the night.

In college, I volunteered a lot. There was a running joke that if your student organization, activity or event needed 20 people to join and posted a sign-up sheet for volunteers, you'd get ten. If you posted an application and held interviews with a "Selection Committee", you'd get a hundred. Heck, you could get people to fight for the opportunity to be on the selection committee. Of course, it was probably true that students who felt they had been chosen to participate over others would be psychologically more committed to the group. Before my last interview in college - for the Luce Foundation Scholarship, which I did not get - I did a mental tally and estimated I had been interviewed more than 30 times in the previous four years.

Yes, I was a "joiner."

And yes, I got really good at talking about myself. So good that sometimes the lines between my real, authentic self and my interview-persona got a bit blurry, but that's another story, for another post.

Summer orientation: a mix of leaders and incoming
first-year students in my dorm room, July 2000
In all sincerity, many of my extracurricular activities have had as much bearing on my life today as the courses I took. I was a peer health educator. A volunteer at a community organization fighting sexual violence. A co-chair of Take Back the Night. A big sister for a middle school girl, through a group called Young Women Leaders. An orientation leader.

I spent a lot time thinking about student health and safety and trying to teach students to be healthy and safe.

Drinking was a not a key part of my undergraduate experience (we could have a separate discussion of whether growing up in an Italian-American family where enjoying wine in moderation was common, and teenagers were welcome to participate, affected my choices…it certainly made me picky about what I was willing to drink). None of my close friends joined a fraternity or sorority, and most didn't even try out rush. When I was active in peer health education, the single most successful effort to reduce binge drinking among students was what was called a "social norms marketing" campaign. The basic idea was to use the discrepancy between student perceptions and student behavior to reduce alcohol consumption. Student surveys had suggested that students believed heavy drinking was more widespread and severe than it actually was, and preliminary data suggested that flyers posted in bathrooms and stairwells with facts like "70% of students have fewer than 4 drinks per week" (I am making up the numbers) led to students drinking less. Peer pressure via statistics.

At least as of 2006, multisite randomized controlled trials (RCTs) had shown this type of intervention to be effective. RCTs are generally considered, in Western medicine today, to be the gold standard for health research. By using a control, researchers try to minimize the risk that the intervention has a placebo effect, e.g. by making sure all participants had some sort of alcohol education, they tried to eliminate the possibility that any attention to the problem leads to a reduction in alcohol consumption. By randomly assigning individuals or groups to receive an intervention, the researchers hope to minimize or eliminate the effect of variation, e.g. if they had allowed schools or students to choose who received social norms marketing, the schools and students with a larger drinking problem might be more or less likely to choose the intervention. For instance, assume that schools with a serious student alcohol problem are more likely to choose the social norms approach, because they are frustrated with conventional methods of educating students. Then assume that students on campuses where drinking is already not a large part of campus culture benefit equally from either approach. In this situation, it would look like social norms is not any more effective than the standard approach.

Okay, that concludes our unexpected foray into Clinical Trial Design 101. It is, however, major progress to see universities using these methods to evaluate community health interventions. For a long, long time, leaders and educators simply threw more and more resources at methods - like peer-led education sessions, no matter how interactive and fun - shown to be completely ineffective at changing behavior.

All summer, I've followed the growing media and legislative attention to the problem of sexual assault and violence on college campuses with interest and hope that somewhere out there is an idea like social norms marketing that will begin to turn the tide of the problem. Mostly, though I think that the key is prosecution - that, until sexual assault is treated as what it is, a crime, the people who are most likely to commit it won't be motivated to change their behavior and the culture they have a hand in creating.

Three weeks ago, another young woman, a second-year UVA student named Hannah Graham, disappeared from Charlottesville. She still has not been found, though this time they have a suspect whose DNA is a preliminary match to DNA found in Morgan Harrington's case. The suspect was reportedly accused of sexual assault twice while a student at two different universities. In at least one of those cases, the district attorney has claimed that the victim decided she did not want to press charges (although there is plenty of anecdotal evidence to suggest that "did not want to press charges" is in the eye of the beholder, that is, women often report that they felt pressured to drop charges - the New York Times has recently described several such cases all around the U.S.).

This morning, I read a Washington Post article about campus safety concerns and efforts. I felt again that they were missing the point, creating fear in the wrong places, rather than teaching common sense.

All the evidence in both Morgan's and Hannah's cases suggests that the two young women were impaired and vulnerable (perhaps due to alcohol), that for unknown reasons, perhaps due to this impairment, they turned down or didn't seek help from their friends - and their friends failed to actively protect them - and that they voluntarily accompanied the person who eventually abducted them. (I base that last statement at the fact that Morgan was seen attempting to hitchhike, and that Hannah was seen at a bar with the suspect.)

Everyone I know has made a stupid decision at some point or another, and so we are all lucky that our mistakes didn't get us killed. No one "asks" to be assaulted or murdered by choosing to drink or walk alone at night. Morgan and Hannah did not do anything "wrong." 

But the approach that UVA is taking to keeping future students safe seems to completely overlook what the police think actually happened to these two young women. The aforementioned article talks about improved lighting, and one student mentions carrying pepper spray. The only useful suggestion is the expansion of a safe ride service and better awareness of students to make sure all members of their group get home safely. The latter was promoted even when I was a student, without ever addressing just how assertive students should be with their friends. What do you do when your clearly intoxicated friend insists that she wants to go upstairs with the fraternity member she just met? Say "absolutely not" and physically restrain her?

Things like concerns about dark stairwells and self-defense perpetuate the myth of the attacker jumping out from behind a bush, when the vast majority of sexual violence involves people loosely known to each other. If Morgan or Hannah had been carrying pepper spray, all accounts and available information thus far suggest that by the time they might have realized they were in danger, it would have been too late for it to do much good. The time for pepper spray and running away isn't after someone has wandered miles from familiar territory and climbed into a car with a potential attacker.

In focusing students on the threat in the darkness, I worry we are giving students, especially young women, an exaggerated sense of fear of the world, when we should be teaching them the importance of sticking together, not hesitating to speak up when a friend is clearly impaired, and not being afraid of the repercussions of seeking help from reliable sources. Video footage of the downtown mall in Charlottesville show other women walking past Hannah: when I saw it, even though I knew the outcome, I leaned forward, biting my lip and praying that she would approach them to explain that she was lost or that they would notice her confusion and offer to help her.

I also worry that, in our efforts to distance ourselves from the kinds of misogynists who use phrases like "asking for it", we are losing sight of the real dangers of excessive drinking, dangers that apply to both men and women. Sexual assault is a huge problem, seriously exacerbated by the presence of intoxication by both the assailants and the survivors. But plenty of other bad things can happen when you hand over your self-control to a drug - from fatal motor vehicle crashes to accidental drowning. The risk of bumping into a serial killer is a terrifying but ultimately tiny one, and the people with the power to change things are doing a disservice by focusing only on this aspect in their drive to address campus safety.

I can't remember if this story was one I experienced or just heard re-told several times. It goes like this: a third-year student is walking home from the library around 9 o'clock on a brisk fall evening. She sees a first-year student who lived on her hall during his summer orientation session (two days meant to prepare students for college life), walking back to the first-year dorms (or "houses", if you prefer). Oddly, he is walking in the middle of road, instead of on the sidewalk. She makes a joke about how he apparently didn't listen to any of that safety stuff about not walking alone, though she obviously doesn't practice what she preached, and tells him to get out of the road before he gets hit by a car. He says, "That's why I'm walking in the middle of the road! So no one can jump out of the bushes and attack me."

It is slightly unrelated but this is possibly my favorite essay addressing the concept of "rape culture": "The Problem with 'Boys Will Be Boys'" by Soraya Chemely.