From Barriers to Solutions: Implementing Sexual Health Programming at Community Colleges

This brief was done in partnership with IWPR’s Connect for Success initiative and innovation Research & Training (iRT).

Key Findings

• Community college administrators, faculty, and staff identified four major barriers to implementing sexual health programming: limited funding; insufficient support from senior leadership, real or anticipated community pushback, and challenges engaging students in optional programming.
• Multiple strategies were identified to strengthen sexual health programming, including: securing external funding, building community partnerships, increasing leadership buy-in, elevating student voices, aligning programs with federal requirements and national awareness events, and integrating evidence-based programming into existing campus structures.

Introduction

Community colleges face unique challenges and opportunities in providing students with sexual health programming.¹ Like their four-year college peers, many young adults attending community college engage in behaviors that increase their likelihood of experiencing poor sexual and reproductive health outcomes (e.g., STI/HIV contraction, unplanned pregnancy).² Decades of research point to the importance of comprehensive sex education for promoting healthy sexual decision-making.³ Recent data show that community college students who received comprehensive sex education report engaging in healthier sexual behaviors (e.g., condom use, STI testing, partner sexual communication) when compared to students who received no sex education or students who received less comprehensive instruction.⁴ However, many community college students do not receive comprehensive sex education in high school, leaving a gap that community colleges are well-positioned to fill.⁵

Unfortunately, community colleges are less likely than four-year universities to provide a range of sexual and reproductive health resources for students, including education aimed at promoting sexual health and preventing sexual violence.⁶ The purpose of this brief is to closely examine the challenges that personnel face in trying to provide sexual health programming at community colleges across the US and to identify opportunities and strategies to advocate for the delivery of these critical student health resources. This brief synthesizes qualitative and quantitative data collected from community college personnel (i.e., administrators, faculty, staff) as part of the Community College Health Study (CCHS). Forty-nine participants from 31 community college campuses across the US completed a quantitative survey with questions to assess the extent to which certain factors influenced the implementation of sexual health programming on their campus.⁷ Thirty-two of these participants (representing 23 campuses) participated in a one-hour in-depth interview to better understand common challenges to implementing sexual health programming at community colleges and corresponding opportunities for overcoming these challenges. Qualitative interviews were transcribed, and analysis was conducted to identify themes.⁸ Some themes related to challenges and opportunities that are highlighted in the current brief were previously published;⁹ others come from original data analysis conducted for this brief. Data collection occurred from 2021 to 2023.

Challenges and Opportunities to Implementing Sexual Health Programming at Community Colleges

Analyses of the quantitative and qualitative data revealed four key challenges that community colleges report facing in implementing sexual health programming on campus:

1. Lack of funding.
2. Insufficient support from upper-level administration.
3. Pushback (or anticipated pushback) from the larger community.
4. Difficulty encouraging student participation in programming that is not required.

The data also highlighted several opportunities for community colleges to overcome each of these challenges.

Challenge 1: Lack of funding.

For many colleges, a primary barrier to implementing sexual health programming is a lack of funding.¹⁰ On average, participants reported that financial considerations are moderately to extremely important when considering implementing sexual health programming at their college, and that their community college was not extremely likely to have sufficient resources to implement a sexual health program (Figure 1).

Community college personnel often face limited budgets in general, as well as a lack of a dedicated budget for sexual health programming.¹¹ Participants noted that limited funding often prevents them from implementing sexual health programming on a wide scale—or from offering any programming at all. They explained that even when there is general support for sexual health initiatives on campus, securing funding for wide-scale sexual health programming often remains a challenge.

“I had a conversation with a coach yesterday, who [said] ‘We need this, I mean, like, we need it,’ and I agreed with them. They need it. We want them to have it. We’re not going to get the budget money to do it. So that’s where we’re at, and I’m not saying we wouldn’t get the budget money to implement more of a wide-scale program, but that’s going to be the tough part of the ask . . . the finances and the budget to do a program like that . . . campus-wide.”
~Dean of Students

Opportunities for community colleges to address a lack of funding for sexual health programming.

Data revealed two opportunities for community colleges to address a lack of funding for sexual health education: 1) leveraging external funding sources and 2) establishing partnerships with external institutions and organizations.

1. Some community colleges found success in leveraging external funding sources, such as grant funding. However, seeking and obtaining external funding is not without obstacles. Many personnel were not aware of funding opportunities for community colleges to provide sexual health programming. This is compounded by the fact that many community colleges do not have a dedicated staff focused on student sexual health who can devote time to seeking out and applying for external funding opportunities. Further, participants noted that external grants sometimes come with stipulations requiring money to be spent in specific ways. For example, grants may specify that only certain sexual health programs can be purchased with funds; however, after reviewing the approved programs, personnel may find that these options are not relevant to their student population. Additionally, many external grants are time-limited. A grant might provide a community college with funding to implement a sexual health program for a few years; however, after the grant period expires, the college is responsible for securing additional funding to continue the program. As one participant explained, their college’s challenge in acquiring internal funding to sustain sexual health programming became a barrier to securing future external grant funding:
   

   “We talked to them about using some of that money toward [a sexual health program] as an example. And they were like, ‘We want something that you guys can keep maintaining after we pull out,’ which I understand. But it also means we can’t get started. . . . Grants can be really tough.” ~Guidance Coordinator

2. Many personnel noted that sexual health programming at their college was made possible by establishing partnerships with external institutions and organizations.¹² When colleges did not have adequate budget and resources to provide sexual health programming, some formed partnerships with local health promotion organizations (e.g., health clinics, local public health organizations), other colleges (e.g., four-year universities, other college systems), and domestic violence prevention and response organizations (e.g., local domestic violence shelters, domestic violence prevention organizations).
   

   “I think it’s being able to find people who are willing to take the time to come to your campus and share their resources and expertise. . . . we do a lot of partnering with external institutions and organizations . . . I’m on a board that consists of . . . organizations in the county . . . we meet monthly . . . it’s everything from Community Mental Health to the Department of Health and Human Services to [the local domestic violence prevention and response organization] [to the] United Way . . . to talk about the different resources and talk about things that we need and how we can get some things done in the county. And so, I think that we do a good job of partnering with local organizations, but . . . internally, it’s hard to find resources. And so, we have to go externally.”

   ~Vice President of Student Services

   The types of partnerships and level of support offered by external institutions and organizations varied greatly by college and partnership. However, in partnerships where representatives from external organizations came to a campus to directly provide—or assist with providing—sexual health programming to students, some personnel explicitly noted that a main benefit of this partnership was that the materials and time needed to implement the programming often came out of the external organization’s budget, rather than the college’s budget.

   It is important to note that while some personnel expressed having several options for partnerships with external institutions and organizations, others—notably, those in rural areas—had very limited partnership opportunities. Participants stressed the importance of vetting potential external partners before they provide programming to students to ensure that the sexual health programming is relevant for their student population. For example, one personnel member highlighted the need to review an external partners’ slide deck prior to their presentation to students to ensure that the topic areas they would cover would align with student interests and needs.

Challenge 2: Insufficient support from upper-level administration.

Buy-in from upper-level administrators is important for making sexual health promotion a campus priority, but community college personnel often expressed insufficient support.¹³ On average, participants felt that leaders at their campus found sexual health promotion only moderately important and felt that their college administration did not perceive a high need for sexual health promotion on campus (Figure 2).

During the qualitative interviews, participants acknowledged that upper-level support is important in making sexual health programming a priority but expressed that college administrators did not always perceive that there was a need for sexual health programming on campus. One health clinic director discussed that this perception among upper-level administration contradicts students’ interest in receiving sexual health programming:

“I think that there definitely is room for quite a bit more . . . particularly around sexual health. . . there’s not a lot of bandwidth and resources in the college . . . so there hasn’t been a lot of interest from higher-level administration for that, but I do think . . . that there probably would be interest from students.”
~Health Clinic Director

Opportunities for community colleges to bolster upper-level support for sexual health programming on campus.

The data revealed three key opportunities to help increase support among upper-level administration for providing sexual health programming for students: 1) raise awareness about the connection between sexual health and student well-being and success, 2) highlight what is being done at other higher-education institutions that are engaging in sexual health promotion efforts, and 3) implement sexual health programming that fulfills federal requirements (e.g., Title IX of the Education Amendments of 1972, “Title X,” and the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act, or “Clery Act”).

1. Some community college personnel expressed that upper-level administrators were not aware that their students experienced problems related to sexual health and emphasized the need to raise awareness about the connection between sexual health and student well-being and success. Participants suggested that highlighting data or anecdotal experiences of students that emphasize the need for sexual health promotion efforts could lead colleges to make them more of a priority.¹⁴ Furthermore, participants highlighted the benefits of helping key decision-makers understand the connection between student sexual health and other college priorities related to student success (e.g., student retention, graduation rates).
2. Some personnel discussed that a promising strategy to garner upper-level support for sexual health programming is to highlight what is being done at other institutions that are engaging in sexual health promotion efforts. When colleges are considering adopting a new program, they sometimes look to peer institutions to see who else is implementing similar programs and examine what their experiences have been. For some, this may be motivated by wanting to “keep up” or stay ahead of other colleges. Some participants emphasized how their college leadership was close with leadership at similar peer institutions (i.e., meeting regularly and discussing current programming). Additionally, champions at community colleges can use the experiences of other peer institutions that are implementing sexual health programming to motivate their own administrators to prioritize student sexual health.
   

   “Really showing other colleges that are doing it that are like us. So, if there are other community colleges, especially in our region, that would be great. Our president really cares about what they’re doing. Putting a real emphasis on just statistics and the need, data, numbers. Then provide what you’ve seen at other schools and the improvements you’ve seen there . . . case study scenarios.”
   ~Director of Residential Life

   Although some personnel felt that their college would be positively swayed by learning that larger community colleges or four-year universities were implementing sexual health programming, others explicitly noted that their college was unlikely to conform to a certain practice just because a “big four-year school” is doing it, as they do not see themselves as similar to these environments (i.e., different resources, different campus culture). Many noted the persuasiveness of learning that colleges “like us” are implementing programming—especially other community colleges.

3. Proposing to implement sexual health programming that fulfills federal requirements (e.g., Title IX and Clery Act)—while also addressing additional sexual health topics—may be an effective strategy for motivating upper-level administrators to prioritize student sexual health programming. Many personnel reported that their college had programming to “cover” the Title IX and Clery Act requirements. In this way, for some colleges, sexual health programming has grown synonymous with efforts to satisfy these requirements. Compliance with local, state, or federal policies greatly influences decisions to implement sexual health programming (Figure 3).Relatedly, many personnel noted that there are no external policies or laws that require community colleges to implement comprehensive sexual health programming covering topics related to STI/HIV and unplanned pregnancy prevention. Some explicitly stated that having an external policy requiring their college to implement comprehensive programming would be an effective way to motivate their college to provide this resource to students:
   

   “Right now there’s nothing in place. . . . But I think if a law was in place that says ‘Hey, community colleges now need to provide three hours of sexual health for every student graduating or taking classes,’ then I think that would completely change the landscape.”
   ~Director of Student Support

Challenge 3: Pushback (or anticipated pushback) from the larger community.

Colleges may be hesitant to implement evidence-based sexual health programming when they perceive there might be pushback from the larger community. Perceived community norms influence what types of programming community college personnel, including upper-level administrators, feel they can implement on campus. Some participants highlighted that the conservative values of the larger community in which their college was located can be a barrier to implementing sexual health programming and discussed the anticipation of pushback limiting their ability to try new sexual health promotion efforts. Conversely, others noted that the more liberal socio-political context of the community in which their college was located made it easier to implement sexual health programming on campus. Quotes from two community college personnel—one who identified their campus as being in a more liberal area and the other who identified their campus as being in a more conservative location—illustrate this contrast.

“My first day here, I met with the dean, and the first thing out of her mouth was, ‘If you have anything sexual health related, it has to be cleared by me as well as the board. If the board finds that we’re having Free Condom Friday or anything like that, they’re going to be very, very, very upset.’ So I think it’s something that goes back to politics . . . the county is just conservative; it is what it is. So there really hasn’t been any outreach.”
~Coordinator, Student Life

 

“The college culture is very progressive. We live in a very progressive part of the country and a very progressive community. The college reflects that in its campus community. So I think that that is great because it allows people to be very open to talking about sexual health and to [our] providing services for sexual health and reproductive health. I think the culture is very supportive of that.”
~Health Clinic Director

Opportunities for community colleges to address potential or anticipated pushback from the larger community.

The data revealed two opportunities for community colleges to address potential or anticipated pushback from the larger community, especially in more conservative areas: 1) elevate the voices of students who want sexual health programming and 2) capitalize on momentum surrounding national events (e.g., National Sexual Health Awareness Month).

1. By elevating students’ voices and conveying their interest in sexual health programming, community colleges can show that they value and prioritize student needs while maintaining respect for the larger community. Personnel discussed that if students explicitly express a desire for sexual health programming, this could influence key decision-makers to adopt resources that meet this need.¹⁵ Participants felt that there were champions amongst the student body for sexual health programming, and students wanted their community college to offer this type of programming (Figure 4). Community colleges can provide opportunities for students to indicate their desire for sexual health programming through surveys, public forums, or other methods that align with individualized student-centered community practices.
2. By capitalizing on momentum surrounding national events, colleges can help create a sense of community that extends beyond a single college and positions the campus as part of a larger movement. Many personnel noted that their student wellness programming was often scheduled to coincide with national events (e.g., National Sexual Health Awareness Month, Sexual Assault Awareness Month). Around these awareness days/months, colleges are especially likely to implement programming that aims to engage the whole campus and bring it together. Notably, many participants described how, around these awareness months, they leverage free or low-cost resources provided by national organizations as well as organizations within their community. As previously noted, many colleges lack dedicated funding for sexual health promotion efforts; thus, a key component of the success of national awareness months may be the ways they increase access to program materials and break down barriers related to funding and staffing that are often experienced at community college campuses.

Challenge 4: Difficulty encouraging student participation in programming that is not required.

Understandably, community colleges do not want to implement programming—including dedicating already limited resources—if they think that students will not complete it.¹⁶ Colleges need programming that allows them to track student participation and progress. On average, participants felt that it would be highly important for their college to track student program completion of a sexual health program (Figure 5).

Personnel expressed concerns that students would not complete programming if it was voluntary, given competing demands on students’ limited time (e.g., work, class schedules, family responsibilities). Community colleges are also keenly aware that mandating students to complete a sexual health program to be enrolled in classes could create additional barriers for students.

“We don’t make anything mandatory for students at our college, because we’re a low- or no-barrier college . . . there’s no application process at a community college, so we don’t want to create barriers for someone to, for example, register for their classes, because we know our students are experiencing plenty of barriers. So a real challenge we have around implementing a universal curriculum is to ensure and track. We can track it, but it’s the accountability to ensure that students complete it.”
~Program Coordinator

Opportunities for community colleges to strengthen student completion rates of sexual health programming.

The data revealed two promising strategies to help community colleges strengthen student completion of sexual health programming while not placing additional burdens and barriers on students: 1) integrate sexual health programming into existing requirements and 2) implement evidence-based programming with a proven track record of successfully engaging students.

1. While many colleges are hesitant to implement additional mandatory student programming, as this can be perceived as a barrier to student graduation, programming that is integrated into existing requirements may be more favorable.¹⁷ Colleges can consider implementing programming as part of activities or courses that are already required of students (e.g., orientation, housing meetings, first-year student or health classes). For example, personnel indicated that colleges may have success integrating sexual health programming as part of mandatory residence life programming for students in on-campus housing; though this may leave commuter students especially in need of resources.¹⁸
   

   “Within our housing department, they have general funding for programs, and the housing office determines what that’s going to be. Sexual health has always been one of them, because we know that [when you get] a group of 100 students in the same building, you do need to cover that. And so, it’s just part of the programming—there’s not like a huge chunk of money set aside specifically for that. It’s just a line item for programming.” ~Vice President of Student Services

2. Personnel stressed the importance of selecting sexual health programming that is relevant and engaging to students. Schools can select and implement programming with a proven track record of successfully engaging students (compared to other programs) and track program completion and engagement when the program is being implemented. Additionally, learning that a program has been well attended at their school or a similar college could motivate key decision-makers to implement a new program or continue with an existing one.

Recommendations

• Federal and state policies are needed that allocate funding specifically dedicated to sexual health programming. Challenges related to securing long-term funding for sexual health programming are some of the most widely experienced barriers; thus, a cross-cutting policy that addresses this barrier is likely to have a large impact.
• There is an opportunity to reframe sexual health programming as an essential component of student health, wellness, and academic success. One barrier to implementing sexual health programming is that it is often not prioritized by college decision-makers due to several factors, including a lack of perceived need. By connecting students’ sexual health to broader outcomes—such as well-being, retention, and academic performance—sexual health programming can be elevated as a higher institutional priority.
• There is a need to expand existing federal policies to include education around additional sexual health content. Colleges are more likely to adopt programming and incorporate it into existing student activities (e.g., student orientation, required health courses) if it addresses a requirement of the college.

Conclusion

Implementing sexual health programming at community colleges has important implications for student health, well-being, and academic success. However, many community colleges do not offer such programming for a variety of reasons. Drawing on the perspectives of community college personnel—including administrators, faculty, and staff—this brief highlights common challenges community colleges face when attempting to implement sexual health programming. Key barriers, such as limited funding, are largely structural and require systemic change across multiple levels. At the same time, personnel shared valuable insights from their own experiences and identified promising strategies for expanding student access to sexual health programming at the campus level. Strengthening institutional commitment to supporting student sexual and reproductive health is essential to ensure that community college personnel have the structural supports, resources, and infrastructure needed to effectively implement and sustain sexual health programming.

This brief was prepared by Dr. Martinique Free (IWPR) and Dr. Christina V. Dodson, Dr. Reina Evans-Paulson, and Dr. Tracy M. Scull (innovation Research & Training, Durham, NC). It was made possible with support from the William and Flora Hewlett Foundation. Funding for the Community College Health Study was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (NIH) under award number R01HD099134 and award number R56HD113725-01A1 to Dr. Tracy M. Scull. Research reported in this brief is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The authors would also like to thank Jesseca Boyer for her feedback on previous drafts and Emme Rogers, Rachael Tessema, and Miranda Peterson for fact-checking.