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<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="1.3" xml:lang="en" article-type="research-article"><?properties open_access?><?properties manuscript?><processing-meta base-tagset="archiving" mathml-version="3.0" table-model="xhtml" tagset-family="jats"><restricted-by>pmc</restricted-by></processing-meta><front><journal-meta><journal-id journal-id-type="nlm-journal-id">0376370</journal-id><journal-id journal-id-type="pubmed-jr-id">5259</journal-id><journal-id journal-id-type="nlm-ta">J Sch Health</journal-id><journal-id journal-id-type="iso-abbrev">J Sch Health</journal-id><journal-title-group><journal-title>The Journal of school health</journal-title></journal-title-group><issn pub-type="ppub">0022-4391</issn><issn pub-type="epub">1746-1561</issn></journal-meta><article-meta><article-id pub-id-type="pmid">39112017</article-id><article-id pub-id-type="pmc">11739540</article-id><article-id pub-id-type="doi">10.1111/josh.13496</article-id><article-id pub-id-type="manuscript">HHSPA2045615</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>School District Leader Perspectives on Surveying Middle School Youth
About Sexual Violence</article-title></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-3582-2990</contrib-id><name><surname>Adhia</surname><given-names>Avanti</given-names></name><degrees>ScD</degrees><role>Assistant Professor</role><xref rid="A1" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>Lucas</surname><given-names>Ruby</given-names></name><degrees>MPH</degrees><role>Graduate Research Assistant</role><xref rid="A2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0009-0006-8298-7145</contrib-id><name><surname>Richey</surname><given-names>Ann E.</given-names></name><degrees>BA</degrees><role>Graduate Research Assistant</role><xref rid="A3" ref-type="aff">c</xref></contrib><contrib contrib-type="author"><name><surname>Rogers</surname><given-names>Megan</given-names></name><degrees>MS</degrees><role>Evaluation Manager</role><xref rid="A4" ref-type="aff">d</xref></contrib><contrib contrib-type="author"><name><surname>Van Wagner</surname><given-names>Nikki</given-names></name><degrees>MA</degrees><role>Program Consultant</role><xref rid="A5" ref-type="aff">e</xref></contrib><contrib contrib-type="author"><name><surname>Dils</surname><given-names>Laurie</given-names></name><degrees>MSW</degrees><role>Associate Director</role><xref rid="A6" ref-type="aff">f</xref></contrib><contrib contrib-type="author"><name><surname>Rivara</surname><given-names>Frederick P.</given-names></name><degrees>MD, MPH</degrees><role>Professor</role><xref rid="A7" ref-type="aff">g</xref></contrib><contrib contrib-type="author"><name><surname>Bekemeier</surname><given-names>Betty</given-names></name><degrees>PhD, MPH, RN, FAAN</degrees><role>Professor</role><xref rid="A8" ref-type="aff">h</xref></contrib></contrib-group><aff id="A1"><label>a</label>Department of Child, Family, and Population Health Nursing,
University of Washington, Seattle, WA; Department of Epidemiology, School of Public
Health, University of Washington, Seattle, WA.</aff><aff id="A2"><label>b</label>Department of Epidemiology, School of Public Health,
University of Washington, Seattle, WA; Department of Health Systems and Population
Health, School of Public Health, University of Washington, Seattle, WA; Northwest
Center for Public Health Practice, University of Washington, Seattle, WA.</aff><aff id="A3"><label>c</label>Department of Epidemiology, School of Public Health,
University of Washington, Seattle, WA.</aff><aff id="A4"><label>d</label>Department of Health Systems and Population Health, School
of Public Health, University of Washington, Seattle, WA; Northwest Center for Public
Health Practice, University of Washington, Seattle, WA.</aff><aff id="A5"><label>e</label>Sexual Violence Prevention, Office of Superintendent of
Public Instruction, Olympia, WA.</aff><aff id="A6"><label>f</label>Health and Sexual Health Education, Office of
Superintendent of Public Instruction, Olympia, WA.</aff><aff id="A7"><label>g</label>Department of Epidemiology, School of Public Health,
University of Washington, Seattle, WA; Department of Pediatrics, University of
Washington, Seattle, WA.</aff><aff id="A8"><label>h</label>Department of Child, Family, and Population Health Nursing,
University of Washington, Seattle, WA; Department of Health Systems and Population
Health, School of Public Health, University of Washington, Seattle, WA; Northwest
Center for Public Health Practice, University of Washington, Seattle, WA.</aff><author-notes><corresp id="CR1">Address correspondence to: Avanti Adhia, Assistant Professor,
(<email>aadhia@uw.edu</email>), Department of Child, Family, and Population
Health Nursing, University of Washington, Health Sciences Building, Box 357263,
1959 NE Pacific Ave, Seattle, WA 98195.</corresp></author-notes><pub-date pub-type="nihms-submitted"><day>5</day><month>1</month><year>2025</year></pub-date><pub-date pub-type="ppub"><month>1</month><year>2025</year></pub-date><pub-date pub-type="epub"><day>07</day><month>8</month><year>2024</year></pub-date><pub-date pub-type="pmc-release"><day>18</day><month>1</month><year>2025</year></pub-date><volume>95</volume><issue>1</issue><fpage>34</fpage><lpage>44</lpage><permissions><license><ali:license_ref xmlns:ali="http://www.niso.org/schemas/ali/1.0/" specific-use="textmining" content-type="ccbylicense">https://creativecommons.org/licenses/by/4.0/</ali:license_ref><license-p>This is an open access article under the terms of the <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution</ext-link> License,
which permits use, distribution and reproduction in any medium, provided the
original work is properly cited.</license-p></license></permissions><abstract id="ABS1"><sec id="S1"><title>BACKGROUND:</title><p id="P1">Schools are important contexts for preventing sexual violence (SV)
among adolescents. Evaluating whether programming is effective requires
surveying youth about SV experiences. However, school communities often have
concerns about asking students, particularly those in middle school, about
these experiences. This study sought to understand the types of concerns
that school district leaders have related to surveying middle school
students about SV and to identify ways to mitigate these concerns.</p></sec><sec id="S2"><title>METHODS:</title><p id="P2">We conducted semi-structured interviews with superintendents and
school board members (n = 19) across Washington State and used inductive
thematic analysis.</p></sec><sec id="S3"><title>RESULTS:</title><p id="P3">Concerns regarding surveying students about SV centered around 3 main
themes: community norms and misconceptions, parental/caregiver discomfort,
and survey language and administration. Concerns were particularly salient
for sixth-grade students. Suggestions for mitigating concerns included:
providing clear motivation and reframing messaging to community members,
involving parents and students in the survey process, and modifying survey
language and administration.</p></sec><sec id="S4"><title>CONCLUSIONS:</title><p id="P4">Researchers administering surveys to middle school students on
sensitive topics including SV may face pushback and must consider flexible
approaches to allow research and evaluation to be conducted.</p></sec></abstract><kwd-group><kwd>sexual violence</kwd><kwd>adolescents</kwd><kwd>surveys</kwd><kwd>middle school</kwd><kwd>school board members</kwd><kwd>superintendents</kwd></kwd-group></article-meta></front><body><p id="P5">Adolescence is a period of particularly high risk of sexual violence (SV),
including sexual activity without consent (eg, unwanted touching, sexual harassment,
sexual assault).<sup><xref rid="R1" ref-type="bibr">1</xref></sup> Over half of women
who experience unwanted sexual contact first do so before age 18, with 22% first
victimized when they are 10 years or younger.<sup><xref rid="R2" ref-type="bibr">2</xref></sup> Early adolescence&#x02014;including middle school (grades
6&#x02013;8)&#x02014;is a critical developmental period for precursors of SV and early SV
experiences. Among middle school students, SV can include lewd or harassing comments
about someone&#x02019;s body or sexuality, sharing photos without consent, sending
unwanted sexual messages, homophobic teasing, and coerced sexual contact.<sup><xref rid="R3" ref-type="bibr">3</xref>&#x02013;<xref rid="R5" ref-type="bibr">5</xref></sup> Given that SV is associated with myriad negative health consequences
such as depression, substance use, and poor academic performance,<sup><xref rid="R6" ref-type="bibr">6</xref>,<xref rid="R7" ref-type="bibr">7</xref></sup>
prevention of SV is a priority.</p><p id="P6">School-based programs are effective in preventing adolescent SV and other forms
of interpersonal violence, including among middle and high school students.<sup><xref rid="R8" ref-type="bibr">8</xref>&#x02013;<xref rid="R10" ref-type="bibr">10</xref></sup> Comprehensive sexual health education can also improve
knowledge and skills, supporting healthy relationships and decreasing
violence.<sup><xref rid="R11" ref-type="bibr">11</xref></sup> Research
emphasizes the need for early and scaffolded approaches to prevention.<sup><xref rid="R11" ref-type="bibr">11</xref></sup> Moreover, SV prevention aligns with
national education standards for health and sexuality, which advise including SV and
interpersonal violence.<sup><xref rid="R12" ref-type="bibr">12</xref>,<xref rid="R13" ref-type="bibr">13</xref></sup> In December 2020, Washington State passed a law
mandating comprehensive sexual health education in public schools, including content
about interpersonal relationship skills, healthy sexual relationships, consent,
bystander training, and age-appropriate information on sexual offenses.<sup><xref rid="R14" ref-type="bibr">14</xref></sup></p><p id="P7">Surveying students is required to understand the burden of SV and to evaluate
effectiveness of prevention programming, especially given low rates of formal reporting
of SV.<sup><xref rid="R15" ref-type="bibr">15</xref></sup> These surveys often include
questions related to SV knowledge, attitudes, and victimization and/or perpetration of
specific behaviors.<sup><xref rid="R8" ref-type="bibr">8</xref>,<xref rid="R9" ref-type="bibr">9</xref></sup> School district leaders and families sometimes
have concerns about asking students, particularly those in middle school, these types of
questions. Previous studies with parents about SV education and surveys identified
barriers like denial of or discomfort with the topic, fear about introducing SV to
children (eg, loss of innocence), and beliefs in parental responsibility for protection
against SV.<sup><xref rid="R16" ref-type="bibr">16</xref>,<xref rid="R17" ref-type="bibr">17</xref></sup> In addition, school staff face challenges in
implementing school-wide SV prevention due to school culture and relatively low priority
of SV compared to other school concerns.<sup><xref rid="R18" ref-type="bibr">18</xref></sup></p><p id="P8">Given the importance of SV prevention among youth, strategies to effectively
partner with schools and ensure rigorous evaluation of programming are needed. Our study
had 2 aims: (1) to understand the types of concerns related to surveying students about
SV from the perspective of school district leaders (eg, superintendents and school board
members), and (2) to identify ways to mitigate these concerns to allow research and
evaluation to be conducted. The current study was part of a larger evaluation of an SV
prevention program being developed and piloted in nonurban middle schools in Washington
State, which involved data collection from students via surveys.<sup><xref rid="R19" ref-type="bibr">19</xref></sup> While schools involve many invested parties (eg,
parents, staff), superintendents and school boards often have high-level decision-making
authority. More recently, school leadership has been plagued by controversy, such as
threats related to COVID-19 public health measures.<sup><xref rid="R20" ref-type="bibr">20</xref></sup> Investigating contemporary attitudes about surveying students
can inform current and future research-practice efforts to address SV.</p><sec id="S5"><title>METHODS</title><sec id="S6"><title>Participants</title><p id="P9">We interviewed superintendents and school board members associated with
public middle schools across Washington State. We used purposive sampling to
ensure representation from nonurban school districts, given the focus of the
pilot program and because urban and nonurban districts may differ in factors
that influence attitudes about surveying students. We divided Washington into 6
quadrants and chose 2 districts in each (large and small). We encountered
substantial nonresponse to email invitations to participate and contacted
potential participants in waves if individuals did not respond. In total, we
contacted school board chairs and district superintendents in 48 districts (out
of 295 total districts in the state). The research team sent up to 3 interview
requests to each individual. Our final sample represented 13 districts. We
received no response from 31 districts, 2 declined participation, and 2
initially responded but were unable to schedule interviews. As we interviewed
participants, we used snowball sampling to identify additional participants who
would share alternative perspectives. Two participants were recruited this way.
We continued recruitment until we reached sufficient information power based on
the specificity of our research questions, participants with shared and relevant
experiences in school leadership, and dialogue quality centered around focused
interview questions on surveying students about SV.<sup><xref rid="R21" ref-type="bibr">21</xref></sup> We also monitored geographic
representation to ensure we were covering different regions of the state and
differing levels of urbanicity of school districts. While we were conducting
interviews, we had regular full research team discussions (including the
interviewers and notetakers) and began preliminary analyses in parallel. In
addition, we found school leaders from diverse districts had similar concerns
and recommendations related to our interview questions. As a team, we thus
decided to end recruitment after 17 interviews with 19 participants representing
13 districts. By participant request, 2 interviews were conducted with 2
participants from 1 district simultaneously. Some participants were parents
themselves with children in school. In addition, some participants were
concerned about having their school district or identity revealed, so we do not
report identifying information about participants and districts. The study was
approved by the University of Washington Institutional Review Board.</p></sec><sec id="S7"><title>Instrumentation and Procedure</title><p id="P10">We conducted 60-minute interviews on Zoom between July and November
2022. The interviewer provided a study overview, including a statement of
confidentiality, and participants verbally consented to participate. Interview
topics included school community (eg, administrators, staff, parents) attitudes
and concerns about SV surveys, acceptable language in survey questions, and
strategies to alleviate concerns about surveys. Participants were also shown
example survey questions for their reactions (see <xref rid="SD1" ref-type="supplementary-material">Supporting Information</xref>). While our
unit of analysis was individual participants, we did not collect demographic
data on individuals or provide school district names given their hesitation
about identifiability. For context about the student populations that school
leaders served, we provide characteristics of included school districts (eg,
student demographics, size, student-teacher ratio).<sup><xref rid="R22" ref-type="bibr">22</xref></sup></p></sec><sec id="S8"><title>Data Analysis</title><p id="P11">Descriptive statistics on district characteristics were calculated using
R Studio and Excel. Interviews were recorded, transcribed, and analyzed using
ATLAS.ti version 9.1.3 (ATLAS.ti Scientific Software Development GmbH, Berlin,
Germany). We used a codebook approach to thematic analysis for the interview
data.<sup><xref rid="R23" ref-type="bibr">23</xref>,<xref rid="R24" ref-type="bibr">24</xref></sup> Two team members initially read through
6 transcripts to inductively develop an initial codebook. We collectively
established initial codes and code definitions, iteratively revising them
throughout the coding process. Three interviews were randomly selected and
independently double-coded using the initial codebook. The team then met to
discuss coding discrepancies. Four team members (AA, RL, MR, AR) built consensus
around the codes, definitions, and application. The remaining interviews were
randomly assigned and coded by 2 team members (RL or AR). The research team met
regularly to debrief and discuss challenges until consensus was reached. After
coding, the full team used an iterative, consensus-based approach to identifying
themes and subthemes, collaboratively interpreting findings. We maintained
trustworthiness through credibility (eg, debriefing with our Office of
Superintendent of Public Instruction research partners), confirmability (eg,
having multiple independent coders, consensus-based theme development), and
audit trails (eg, maintaining detailed notes about coding, analysis, and
decision points).<sup><xref rid="R25" ref-type="bibr">25</xref></sup></p></sec></sec><sec id="S9"><title>RESULTS</title><p id="P12">We interviewed 19 school leaders&#x02014;7 superintendents and 12 school
board members&#x02014;representing 13 school districts across 11 counties of varying
population density and rurality in Washington State (<xref rid="F1" ref-type="fig">Figure 1</xref>). School districts ranged in size from 1694 to 23,067 students
(<xref rid="T1" ref-type="table">Table 1</xref>). On average, 60% of the school
districts&#x02019; students identified as White and 25% as Hispanic/Latino. Nearly
half of students (47%) were eligible for free/reduced lunch, and 11% were English
language learners.</p><p id="P13">We present results in line with our research questions to identify (1)
concerns related to surveying students about SV and (2) potential solutions to
mitigate concerns. While many participants expressed support for such survey
efforts, our results focus on participant concerns to inform potential solutions for
researchers and practitioners to conduct future work. In addition, while our
research and interview questions focused specifically on SV surveys, participants
often answered by discussing broader issues about SV programs/interventions and
attitudes about topics related to SV (eg, gender identity), which is reflected in
the quotes. For each category, we identified 3 themes with associated subthemes. Our
analysis demonstrated no substantive differences in themes between participants from
rural, suburban, and urban school districts, so results are presented together.
<xref rid="T2" ref-type="table">Tables 2</xref> and <xref rid="T3" ref-type="table">3</xref> provide additional illustrative quotes.</p></sec><sec id="S10"><title>CONCERNS RELATED TO SURVEYING STUDENTS ABOUT SV</title><sec id="S11"><title>Theme 1: Community Norms and Misconceptions</title><sec id="S12"><title>Political or religious climate.</title><p id="P14">Participants described the political and/or religious climate that
has led to certain topics, like SV, becoming more divisive. They reflected
on how parents and families were scrutinizing school activities (eg,
social-emotional learning) with a more critical eye, leading to a rise in
pushback and criticism in the last few years alongside the COVID-19 pandemic
and increased political polarization. Many participants mentioned it was a
small&#x02014;but vocal&#x02014;minority of parents/caregivers opposed to SV
research and prevention. Participants also noted a tendency for some
community members to oppose anything perceived as liberal (including sexual
health and violence prevention education). In the current climate, topics
like sexual health and violence were being conflated with gender identity
and critical race theory, generating pushback based on misconceptions of
what was being discussed and a general distrust of the
&#x0201c;agenda&#x0201d; of schools: <disp-quote id="Q1"><p id="P15">Given the political climate in the country right now, it
doesn&#x02019;t take much for community members to latch onto
misinformation or to be rattled by something that they believe the
school is doing &#x02026; For example, a teacher was teaching
critical thinking skills in her class and she abbreviated it to CTS,
and she got quite a bit of pushback on that from some members of the
community because they thought that the CTS, critical thinking
skills, [was] similar to CRT, critical race theory.</p><attrib>(Superintendent)</attrib></disp-quote></p><p id="P16">For some communities, religious beliefs played an important role in
attitudes around acceptability and appropriateness of surveying students
about SV. There was a sense that for individuals holding strong religious
beliefs, discussions about SV should happen within the home or within the
extended religious family, so parents can choose how and when children
engage in those discussions.</p></sec><sec id="S13"><title>Tension about sexual health education.</title><p id="P17">School leaders described how the 2020 passage of comprehensive
sexual health education legislation was an important context for discussing
SV. The rollout of that education gave rise to resistance &#x0201c;mostly due
to misunderstanding and misinformation about what that curriculum is&#x0201d;
(school board member). Participants discussed how quickly rumors would
spread through hearsay (eg, kindergarteners are being taught about sex),
which would fuel reactionary backlash. Even if many districts were already
teaching the same content about sexual health, the introduction of the new
state standards ignited resistance.</p></sec></sec><sec id="S14"><title>Theme 2: Parental/Caregiver Discomfort</title><sec id="S15"><title>Responsibility of parents versus schools.</title><p id="P18">Participants discussed the tension parents feel about their own
responsibility versus the responsibility of schools in educating students
about SV and related topics. There was a sense that parents/caregivers
sometimes question why schools engage in certain topics, asking, &#x0201c;why
is the school district in this lane?&#x0201d; (school board member) when
there are survey questions related to attitudes about gender roles, for
example. One school board member expressed how parents may get defensive or
upset when they feel like their ability to have an important conversation
with their child gets &#x0201c;pulled out from under them.&#x0201d;</p></sec><sec id="S16"><title>Introducing students to SV too early.</title><p id="P19">Participants noted age was a primary concern for parents/caregivers,
with middle school perceived as early for introducing topics like SV. There
was concern that students may not be familiar with certain terminology (eg,
&#x0201c;intercourse&#x0201d;) and school surveys should not be the initial
exposure to these words. Parents were described as still viewing sixth-grade
students &#x0201c;as not young adults, not teenagers, but still elementary
age students,&#x0201d; especially at the beginning of the school year (school
board member). However, many participants acknowledged middle school
students do experience SV and recognized the importance of asking questions
to understand their experiences. There was a tension some participants felt
between feeling concerned a survey would expose students to topics youth
don&#x02019;t yet know and knowing that some students have already
experienced forms of SV, particularly in the developmental period of middle
school where students are at different phases and levels of exposure.</p></sec></sec><sec id="S17"><title>Theme 3: Survey Language and Administration</title><sec id="S18"><title>Wording of survey questions as too explicit or reinforcing a gender
binary.</title><p id="P20">Participants expressed concerns about specific language used in the
survey questions, including phrases that were explicit or reinforced a
gender binary. Concerns centered around descriptive definitions of sex (eg,
&#x0201c;Sex includes oral (involving the mouth), vaginal (involving the
vagina) or anal (involving the anus) sex&#x0201d;), which school leaders felt
would generate negative interest from parents/caregivers who would find that
inappropriate. Related to questions about normative gender roles and rape
myths (eg, &#x0201c;a girl wearing revealing clothing deserves to have
comments made about her&#x0201d;), some participants felt such language could
reinforce binary and potentially harmful gender norms. One school board
member said: &#x0201c;Guy/girl is simplified in a way that would be offensive
to some members of our community.&#x0201d;</p></sec><sec id="S19"><title>Traumatizing students and confidentiality issues.</title><p id="P21">Some participants expressed concerns about traumatizing students by
asking sensitive questions about SV, especially for students who have
experienced SV. One school board member noted the school may not know what
the student or family is going through, so &#x0201c;that&#x02019;s a very
uncomfortable and inappropriate position to put that student in.&#x0201d; In
addition, participants brought up the need to protect student data,
especially around sensitive information, and to carefully consider what goes
in health files and what might be public record.</p></sec></sec></sec><sec id="S20"><title>SUGGESTED STRATEGIES TO MITIGATE CONCERNS AND INCREASE ACCEPTABILITY</title><sec id="S21"><title>Theme 1: Clear Messaging That Emphasizes Purpose, Safety, and Health</title><sec id="S22"><title>Providing clear motivation that builds trust.</title><p id="P22">Participants emphasized the need to provide clear motivation and
purpose for surveying students about SV, as a means of building trust with
the school community. Before launching a survey, education with
parents/caregivers and students about why the survey is being done, who has
access to the data, and how the information is being used is critical.</p><disp-quote id="Q2"><p id="P23">People need clear communication. I think sometimes when we put
out surveys, I don&#x02019;t think we always necessarily do such a good
job of just making it simple and clear about why we&#x02019;re doing
it.</p><attrib>(Superintendent)</attrib></disp-quote><p id="P24">One school leader mentioned the idea that soliciting input from
parents, for example, would be helpful to spread the word to other parents.
Participants emphasized this communication should be done well in advance of
survey administration to ensure parents/caregivers have time to understand
what is happening and to ask questions. Some participants mentioned no
matter how much education is done, there will still be some
parents/caregivers who do not want their children to participate or will not
find these efforts appropriate.</p></sec><sec id="S23"><title>Reinforcing safety and health messaging.</title><p id="P25">Relatedly, participants underscored messaging around surveys should
be about student safety or health, rather than emphasizing sexual terms.
Participants felt safety was a &#x0201c;common core shared value and
goal&#x0201d; for parents/caregivers (school board member). Participants also
felt emphasizing healthy relationships or relationship violence would be
more palatable compared to SV, given that the word &#x0201c;sexual&#x0201d;
can raise concerns.</p></sec></sec><sec id="S24"><title>Theme 2: Involving Parents and Students</title><sec id="S25"><title>Engaging school community (eg, parents, students) with data.</title><p id="P26">Participants recommended engaging parents and students with the
data, so they can understand the importance of the survey and see what the
survey results were used for. Some school leaders mentioned their districts
are increasingly cognizant of making visible use of survey data once it is
collected so there is a clear purpose for the survey. One school board
member described how, for some students, seeing the use for survey results
can be valuable:</p><disp-quote id="Q3"><p id="P27">What would really value [students&#x02019;] time is to have the
opportunity to see what a difference taking the survey meant, what you
did with the results and whether you used it to advocate for certain
things &#x02026; to see what the results were and then what next steps
you are taking.</p></disp-quote></sec><sec id="S26"><title>Amplifying student perspectives that normalize SV discussions.</title><p id="P28">Given that students sometimes have differing opinions from
administrators or parents/caregivers about SV prevention, school leaders
emphasized that amplifying the student perspective may help build trust and
provide a &#x0201c;countermeasure to parental angst&#x0201d; (superintendent).
Having parents/caregivers hear directly from students that such surveys and
conversations are useful and welcome may help to counter pushback.</p><disp-quote id="Q4"><p id="P29">The students want to talk about it, the students are embracing
it, the students want to know how to help, what to look for, how to get
help, how to have that conversation with a caring adult who can help
facilitate and navigate through those awkward, horrible situations.</p><attrib>(School board member)</attrib></disp-quote><p id="P30">A couple of participants felt a balance was needed between elevating
student voice and placing students in the middle of an argument to avoid
inadvertently directing negativity at the students.</p></sec></sec><sec id="S27"><title>Theme 3: Modifying Survey Language and Administration</title><sec id="S28"><title>Soften/tailor language.</title><p id="P31">Many participants recommended softening more explicit language in
survey questions. For example, there were several questions where
participants suggested removing the word &#x02018;sexual&#x02019; (eg,
&#x0201c;Made me do sexual things I didn&#x02019;t want to&#x0201d;). Some
participants saw these types of changes as tailoring questions to be more
age appropriate for middle school students and palatable to community
members.</p></sec><sec id="S29"><title>Flexibility in survey administration.</title><p id="P32">In addition to changing question wording, participants recommended
ensuring flexibility in survey administration, differentiating surveys for
sixth-, seventh-, and eighth-grade students since eighth-grade students
might have different vocabulary, maturity levels, and experiences than
sixth-grade students. One school board member likened this to teaching math:
&#x0201c;Obviously when we teach students about math, we don&#x02019;t teach
them the same thing in eighth grade as we do in sixth grade.&#x0201d; Timing
during the school year was an important consideration. Participants
recommended administering surveys in the spring versus the fall to give
students time to acclimate to the school year, especially sixth-grade
students who may be starting in a new school that year.</p><disp-quote id="Q5"><p id="P33">Definitely don&#x02019;t ask these in the fall of any grade
because the kids have all been home with their parents over summer. The
parents, if anything, need the acclimation to school again, almost more
than the kids do. Secondly, I&#x02019;m not sure that you should ask
these of sixth graders at all. Maybe the spring of seventh grade.</p><attrib>(School board member)</attrib></disp-quote><p id="P34">Ability to opt out for both parents and students was also seen as
important. In addition to opting out of the survey entirely, having more
nuanced opt-out options for certain questions or sections was
recommended.</p></sec><sec id="S30"><title>Alignment with existing school efforts.</title><p id="P35">Finally, participants emphasized surveys needed to align with
existing school sexual health education. School leaders did not want survey
questions to be the first introduction to certain words or ideas, so survey
language needs to fit with what students have already learned in school (eg,
by grade and by timing during the school year). Some participants brought up
that teachers and staff would be more comfortable fielding questions and
talking about the survey if topics like SV were already introduced in
school. Surveys could be seen as valuable if they assessed student
comprehension of the education.</p></sec></sec></sec><sec id="S31"><title>DISCUSSION</title><p id="P36">Our findings highlight concerns related to surveying students about SV from
the perspective of superintendents and school board members and identify practical
strategies to mitigate these concerns to support future success in SV surveys and
evaluation. These real-world barriers associated with school-based SV research pose
consistent challenges for researchers and practitioners.<sup><xref rid="R26" ref-type="bibr">26</xref></sup> Furthermore, several participants commented
on a recent rise in resistance and distrust amidst an increasingly polarized
political climate and the COVID-19 pandemic. Strategies to facilitate SV research
need to be responsive to current and changing context. Our results offer broad and
contemporary considerations to inform strategies for researchers and practitioners
when planning SV research and evaluation in middle schools.</p><p id="P37">Among the concerns that school leaders highlighted was parental/caregiver
discomfort. Parents are vital to ensuring SV is taken seriously in schools, but
parental engagement is often overlooked in school-based SV research and
prevention.<sup><xref rid="R18" ref-type="bibr">18</xref></sup> Our
participants emphasized the need to engage parents by providing them clear purpose
for surveying students, answering questions, and sharing back results from collected
data. While school leaders are often the ultimate decision-makers about which
surveys are implemented, some noted they had to be responsive to parental concerns,
especially from vocal groups. This may mean altering or blocking efforts that could
benefit students to appease parents. As participants suggested, focusing on student
safety and health as underlying goals may help to allay some parental concerns.
Participants reported parents often felt like it was their responsibility to address
SV with their children rather than the responsibility of schools. While parents are
an important source of information and model for youth attitudes/behaviors, parents
may require specific resources and additional support to increase their confidence
to have discussions on sensitive topics like SV.<sup><xref rid="R27" ref-type="bibr">27</xref></sup> There can be tension between parents wanting to protect
students from violence and wanting to protect their children&#x02019;s innocence,
leading to conflicting ideas of how to achieve &#x0201c;safety.&#x0201d;<sup><xref rid="R17" ref-type="bibr">17</xref></sup></p><p id="P38">Participants noted age as a potential concern where middle school might be
seen as too early to discuss SV. Accurate and developmentally appropriate education
on sexuality and healthy relationships helps to promote healthy sexual development
for youth and provides a foundation for improved sexual health into
adulthood.<sup><xref rid="R28" ref-type="bibr">28</xref></sup> Current
sexual health education curricula are often inadequate, and youth feel ill-equipped
to pursue healthy romantic relationships.<sup><xref rid="R29" ref-type="bibr">29</xref></sup> In addition, studies on the timing of adolescent-parent
discussions have identified middle school as an ideal time to discuss sexuality
topics (eg, dating relationships, safe sex, sexting, consent, SV).<sup><xref rid="R11" ref-type="bibr">11</xref>,<xref rid="R16" ref-type="bibr">16</xref>,<xref rid="R17" ref-type="bibr">17</xref>,<xref rid="R30" ref-type="bibr">30</xref></sup> To mitigate concerns around age,
participants recommended differentiating surveys for sixth-, seventh-, and
eighth-grade students, which can then be tailored to the vocabulary and maturity
levels of students in those grades. Given that patterns of violence change across
middle school years, with increasing victimization from 6th through 8th
grades,<sup><xref rid="R31" ref-type="bibr">31</xref></sup> this approach
may be effective, even though students may be at varying developmental stages in
each grade.</p><p id="P39">Participants raised concerns about potentially traumatizing students,
especially those with a trauma history, by asking sensitive questions about
experiences of violence. Research shows relatively low prevalence of distress among
adolescents from taking surveys on sensitive topics like violence and maltreatment,
with distress stemming from concerns about confidentiality/privacy, feeling awkward
or weird, or being reminded of something.<sup><xref rid="R32" ref-type="bibr">32</xref>&#x02013;<xref rid="R34" ref-type="bibr">34</xref></sup> Generally,
research on violence is well-tolerated by adolescents, who are capable of assessing
potential risks for themselves and often find research to be positive, enjoyable,
reflective, and even cathartic.<sup><xref rid="R32" ref-type="bibr">32</xref>,<xref rid="R35" ref-type="bibr">35</xref>,<xref rid="R36" ref-type="bibr">36</xref></sup> Participants&#x02019; suggestions to mitigate potential
negative reactions&#x02014;for example, to involve and amplify students&#x02019;
perspectives and to have flexible opt- out options&#x02014;align with recommendations
from prior research.<sup><xref rid="R32" ref-type="bibr">32</xref>,<xref rid="R36" ref-type="bibr">36</xref>,<xref rid="R37" ref-type="bibr">37</xref></sup>
Indeed, having youth involved in or leading SV survey efforts may help to counter
resistance, increasing acceptability and sustainability of SV research and
prevention.<sup><xref rid="R38" ref-type="bibr">38</xref></sup></p><sec id="S32"><title>Implications for school health policy, practice, and equity</title><p id="P40">Our findings have important implications for rigorous evaluation of
school SV prevention programs. Discouraging surveying of students early in the
school year makes it difficult to conduct pre-and post-surveys to assess program
impact. This may necessitate restricting intervention programming to the second
half of the school year or using other study designs for SV program evaluation.
Concerns about SV surveys may mean research is conducted among increasingly
selected schools and populations willing to engage with sensitive topics,
limiting external validity of evaluation findings. Schools may also be unable to
gauge prevalence of SV among students, rendering this already hard to identify
public health problem more invisible and limiting potential resource allocation.
Given the level of concern voiced by some leaders about conducting SV surveys in
middle schools, there may be opportunities for schools to leverage surveys on
broader topics, such as school climate or bullying, that may be seen as more
acceptable and still able to support policies and practices that ultimately
contribute to student safety and SV prevention.<sup><xref rid="R39" ref-type="bibr">39</xref>&#x02013;<xref rid="R43" ref-type="bibr">43</xref></sup> Outside of conducting surveys to establish the need for
SV education, national health and sexuality education standards can help to
promote the implementation of SV programs that are aligned with adolescent
development.<sup><xref rid="R12" ref-type="bibr">12</xref>,<xref rid="R13" ref-type="bibr">13</xref></sup></p></sec><sec id="S33"><title>Limitations</title><p id="P41">While we attempted to capture perspectives of school district leaders
from diverse geographic regions with purposive sampling, our study was conducted
only in Washington State. Given the importance of political, religious, and
cultural norms in attitudes about SV, results may differ across populations in
other states. However, participants across school districts shared common
concerns, regardless of geographic region. Participation in the study was based
on willingness to be interviewed, so our sample was generally in favor of SV
efforts in schools. We may not have captured perspectives of school district
leaders most opposed to SV surveys. While we reached sufficient information
power to answer our research questions, future research should consider how to
further diversify the sample population and assess concerns in districts
representing more divergent views.</p></sec><sec id="S34"><title>Conclusions</title><p id="P42">Our study identifies concerns about surveying students about SV and
highlights avenues for researchers and practitioners to more effectively conduct
school-based SV research, particularly in middle schools. Engaging and educating
all school community members (eg, school leadership, school boards, school
staff, parents, students) to build trust, in addition to carefully considering
survey language and administration, are important steps to increase
acceptability of such efforts. Our results also point to the importance of
understanding and attending to political and cultural norms within communities,
including the spread of misinformation, as they relate to SV. These data can
help researchers and schools anticipate and navigate concerns school community
members might have in implementing SV surveys for students.</p></sec></sec><sec sec-type="supplementary-material" id="SM1"><title>Supplementary Material</title><supplementary-material id="SD1" position="float" content-type="local-data"><label>Supplement</label><caption><p id="P50"><bold>Data S1.</bold> Supplementary Information.</p></caption><media xlink:href="NIHMS2045615-supplement-Supplement.docx" id="d67e541" position="anchor"/></supplementary-material></sec></body><back><ack id="S35"><p id="P43">This study was funded by a cooperative agreement with the Centers for
Disease Control and Prevention (U01CE003210). The opinions expressed in this work
are those of the authors and do not necessarily represent those of the funders. We
are grateful to the school leaders who volunteered their time to participate in this
study and for openly sharing their perspectives and experiences with the research
team.</p></ack><fn-group><fn id="FN1"><p id="P44">Human Subjects Approval Statement</p><p id="P45">The University of Washington Institutional Review Board approved the
study.</p></fn><fn fn-type="COI-statement" id="FN2"><p id="P46">CONFLICT OF INTEREST</p><p id="P47">The authors declare no conflicts of interest.</p></fn></fn-group><ref-list><title>REFERENCES</title><ref id="R1"><label>1.</label><mixed-citation publication-type="book"><name><surname>Basile</surname><given-names>KC</given-names></name>, <name><surname>Smith</surname><given-names>SG</given-names></name>, <name><surname>Breiding</surname><given-names>MJ</given-names></name>, <name><surname>Black</surname><given-names>MC</given-names></name>, <name><surname>Mahendra</surname><given-names>RR</given-names></name>. <source>Sexual Violence Surveillance: Uniform Definitions and Recommended Data Elements, Version 2.0</source>. <publisher-loc>Atlanta,
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district; lightest blue indicates rural county as defined by WA State law (ie,
population density &#x0003c;100 persons per square mile or smaller than 225
square miles).</p></caption><graphic xlink:href="nihms-2045615-f0001" position="float"/></fig><table-wrap position="float" id="T1"><label>Table 1.</label><caption><p id="P53">Characteristics of school districts from which participants were
drawn</p></caption><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/></colgroup><thead><tr><th align="left" valign="middle" rowspan="1" colspan="1"/><th colspan="2" align="center" valign="middle" style="border-bottom: solid 1px" rowspan="1">All school districts (n=13)</th></tr><tr><th align="left" valign="middle" rowspan="1" colspan="1"/><th colspan="2" align="center" valign="middle" rowspan="1">Mean (Range)</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">
<bold>Student gender</bold>
</td><td align="right" valign="bottom" rowspan="1" colspan="1"/><td align="left" valign="bottom" rowspan="1" colspan="1"/></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">&#x02003;Male</td><td align="right" valign="bottom" rowspan="1" colspan="1">51.4%</td><td align="left" valign="bottom" rowspan="1" colspan="1">(48.8% - 53.0%)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">&#x02003;Female</td><td align="right" valign="bottom" rowspan="1" colspan="1">47.7%</td><td align="left" valign="bottom" rowspan="1" colspan="1">(43.2% - 49.1%)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">&#x02003;Gender X</td><td align="right" valign="bottom" rowspan="1" colspan="1">0.8%</td><td align="left" valign="bottom" rowspan="1" colspan="1">(0.0% - 8.0%)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">
<bold>Student race/ethnicity</bold>
</td><td align="right" valign="bottom" rowspan="1" colspan="1"/><td align="left" valign="bottom" rowspan="1" colspan="1"/></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">&#x02003;White</td><td align="right" valign="bottom" rowspan="1" colspan="1">60.3%</td><td align="left" valign="bottom" rowspan="1" colspan="1">(37.1% - 81.4%)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">&#x02003;Hispanic/Latino</td><td align="right" valign="bottom" rowspan="1" colspan="1">24.9%</td><td align="left" valign="bottom" rowspan="1" colspan="1">(5.6% - 56.3%)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">&#x02003;Two or more races</td><td align="right" valign="bottom" rowspan="1" colspan="1">6.7%</td><td align="left" valign="bottom" rowspan="1" colspan="1">(2.2% - 12.3%)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">&#x02003;Asian or Asian Pacific Islander</td><td align="right" valign="bottom" rowspan="1" colspan="1">4.4%</td><td align="left" valign="bottom" rowspan="1" colspan="1">(0.3% - 24.6%)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">&#x02003;American Indian/Alaska Native</td><td align="right" valign="bottom" rowspan="1" colspan="1">1.2%</td><td align="left" valign="bottom" rowspan="1" colspan="1">(0.2% - 5.1%)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">&#x02003;Black or African American</td><td align="right" valign="bottom" rowspan="1" colspan="1">2.0%</td><td align="left" valign="bottom" rowspan="1" colspan="1">(0.4% - 8.8%)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">&#x02003;Native Hawaiian or other Pacific
Islander</td><td align="right" valign="bottom" rowspan="1" colspan="1">0.6%</td><td align="left" valign="bottom" rowspan="1" colspan="1">(0.0% - 2.8%)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">
<bold>Number of students</bold>
</td><td align="right" valign="bottom" rowspan="1" colspan="1">9,136</td><td align="left" valign="bottom" rowspan="1" colspan="1">(1,694 &#x02013; 23,067)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">
<bold>Student-teacher ratio</bold>
</td><td align="right" valign="bottom" rowspan="1" colspan="1">16:1</td><td align="left" valign="bottom" rowspan="1" colspan="1">(13:1 &#x02013; 18:1)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">
<bold>Student eligible for free/reduced
lunch</bold>
</td><td align="right" valign="bottom" rowspan="1" colspan="1">47.1%</td><td align="left" valign="bottom" rowspan="1" colspan="1">(9.1% - 69.2%)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">
<bold>English language learners</bold>
</td><td align="right" valign="bottom" rowspan="1" colspan="1">10.9%</td><td align="left" valign="bottom" rowspan="1" colspan="1">(1.1% - 24.6%)</td></tr></tbody></table><table-wrap-foot><fn id="TFN1"><p id="P54">Source: Washington Office of Superintendent of Public Instruction
data portal for the 2021&#x02013;2022 school year</p></fn></table-wrap-foot></table-wrap><table-wrap position="float" id="T2" orientation="landscape"><label>Table 2.</label><caption><p id="P55">Illustrative quotes of concerns related to surveying middle school
students about sexual violence (SV)</p></caption><table frame="hsides" rules="rows"><colgroup span="1"><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/></colgroup><thead><tr><th align="left" valign="middle" rowspan="1" colspan="1">Theme</th><th align="left" valign="middle" rowspan="1" colspan="1">Subtheme</th><th align="left" valign="middle" rowspan="1" colspan="1">Illustrative quotes</th></tr></thead><tbody><tr><td rowspan="2" align="left" valign="top" colspan="1">
<bold>Community norms &#x00026;
misconceptions</bold>
</td><td align="left" valign="top" rowspan="1" colspan="1">Political or religious climate</td><td align="left" valign="top" rowspan="1" colspan="1">&#x0201c;I feel like there&#x02019;s a big shift
where there&#x02019;s not a lot of trust, &#x02026;parents are not
trusting the systems &#x02026; I don&#x02019;t even know what caused that,
but &#x02026; there&#x02019;s a big disconnect right now between some
parents and the education system, and I think there always has been to
some degree, but with the polarization of everything it&#x02019;s become
more intense.&#x0201d; [School board member]<break/>&#x0201c;[The concern
or the pushback is] going to come from our very religious and very
conservative&#x02026; they&#x02019;re two different groups. There&#x02019;s
an overlap obviously. But our very religious group is not necessarily
our very, very vocal anti-CRT [critical race theory], anti-SEL
[social-emotional learning], &#x02026; anti-everything. Our religious
group tends to be more specifically focused on concerns and
appropriateness than our ultra conservative group.&#x0201d; [School board
member]</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Tension about sexual health education</td><td align="left" valign="top" rowspan="1" colspan="1">&#x0201c;[Comprehensive sexual health
education] got passed a couple years ago, and that is the major pushback
that we are experiencing at the local and state level. Mostly due to
misunderstanding and misinformation about what that curriculum is.
There&#x02019;s a bit of an environment, particularly in conservative
faith communities, that this is introducing things or teaching kids how
to have sex way too early or teaching kids, or indoctrinating kids into
LGBTQIA lifestyles or identities.&#x0201d; [School board
member]<break/>&#x0201c;I think what&#x02019;ll happen is
somebody&#x02019;s at some community event and starts talking about,
&#x0201c;Can you believe what they&#x02019;re teaching kids about sex
ed&#x0201d; and somebody else says, &#x02018;Yeah, I opted my kid
out&#x02019; and they said, &#x02018;Well, I&#x02019;m going to opt my kid
out too.&#x02019;&#x02026; And the reality is &#x02026; the new state
curriculum around sex ed, most districts have been teaching that for
years and there wasn&#x02019;t any concern about that. And now all of a
sudden everybody&#x02019;s like, &#x02018;Oh my gosh.&#x02019;&#x0201d;
[Superintendent]</td></tr><tr><td rowspan="2" align="left" valign="top" colspan="1">
<bold>Parental/ caregiver
discomfort</bold>
</td><td align="left" valign="top" rowspan="1" colspan="1">Responsibility of parents vs. schools</td><td align="left" valign="top" rowspan="1" colspan="1">&#x0201c;We are asking school districts in
general to take on a lot around culture, around sex, around various
norms in our communities. The more questions that there are like this,
the more I could imagine some parents saying, &#x0201c;Why is the school
district in this lane?&#x0201d; We get that already for different things,
but because there&#x02019;s so much here &#x02026; I could imagine parents
and community members saying, &#x0201c;Why is the school district asking
questions about household chores and the role of men with women and
children?&#x0201d; [School board member]<break/>&#x0201c;I think parents
start to become defensive and upset when they feel like their ability to
lead this important conversation got pulled out from under them.
It&#x02019;s being discussed as parental rights, but it&#x02019;s more
about, &#x0201c;I&#x02019;m entrusted with this really important thing and
I&#x02019;m caring and raising these humans and they&#x02019;re amazing
and beautiful and perfect and I want to like keep that going.&#x0201d;
[School board member]</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Introducing students to SV too early</td><td align="left" valign="top" rowspan="1" colspan="1">&#x0201c;At the middle school level, [the
parents] are highly, highly protective. And in our community, I think
they see 11&#x02013;15 year olds as being very vulnerable and very young.
Talking about these kinds of issues, we are scaring them. We&#x02019;re
talking to them about things that they don&#x02019;t need to know about
yet.&#x0201d; [School board member]<break/>&#x0201c;At sixth grade the
parents would still view their children as not young adults, not
teenagers, [but] still elementary age students. In some school
districts, you&#x02019;re also going to find that sixth graders are still
in an elementary environment, not in a middle school. That has a lot to
do with the perception of the students. But for&#x02026; those seventh
and eighth grade students who are being more outwardly observable in
relationships, then I think this would be an appropriate
question.&#x0201d; [Superintendent]</td></tr><tr><td rowspan="2" align="left" valign="top" colspan="1">
<bold>Survey language &#x00026;
administration</bold>
</td><td align="left" valign="top" rowspan="1" colspan="1">Wording of survey questions as too explicit or
reinforcing a gender binary</td><td align="left" valign="top" rowspan="1" colspan="1">&#x0201c;When you start getting into the
different types of sexual activities [that] may involve some concern,
more descriptive, and then obviously the anal sex, that would prompt
some [negative] interest from groups of community and parents.&#x0201d;
[Superintendent]<break/>&#x0201c;The guy/girl is simplified in a way that
would be offensive to some members of our community. And even I think
the board would have issues with this. This would not be consistent with
our values in our district improvement plan that is very much focused on
equity because not all students would see themselves in these
questions.&#x0201d; [School board member]</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Traumatizing students and confidentiality
issues</td><td align="left" valign="top" rowspan="1" colspan="1">&#x0201c;If we put questions like this in front
of a child who has been abused sexually already and is already dealing
with that personally and in their family and maybe beyond what we might
know about as a school, that&#x02019;s a very uncomfortable and
inappropriate position to put that student in.&#x0201d; [School board
member]<break/>&#x0201c;Anything that&#x02019;s public, we want to make
sure that it&#x02019;s held in a way that it doesn&#x02019;t pinpoint or
share information that could potentially showcase that particular
student or population group.&#x0201d; [Superintendent]</td></tr></tbody></table></table-wrap><table-wrap position="float" id="T3" orientation="landscape"><label>Table 3.</label><caption><p id="P56">Illustrative quotes of strategies to mitigate concerns and increase
acceptability of surveying middle school students about sexual violence (SV)</p></caption><table frame="hsides" rules="rows"><colgroup span="1"><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/></colgroup><thead><tr><th align="left" valign="middle" rowspan="1" colspan="1">Theme</th><th align="left" valign="middle" rowspan="1" colspan="1">Subtheme</th><th align="left" valign="middle" rowspan="1" colspan="1">Illustrative quotes</th></tr></thead><tbody><tr><td rowspan="2" align="left" valign="top" colspan="1">
<bold>Clear messaging that
emphasizes purpose, safety, and health</bold>
</td><td align="left" valign="top" rowspan="1" colspan="1">Providing clear motivation that builds
trust</td><td align="left" valign="top" rowspan="1" colspan="1">&#x0201c;People need clear communication.
Sometimes when we put out surveys, I don&#x02019;t think we always
necessarily do such a good job of just making it simple and clear about
why we&#x02019;re doing it, what we&#x02019;re doing with the information,
who has access to it, or does not have access to it, and how that
directly is going to come back on their kid. The [parents] that do have
those concerns will want to know that information.&#x0201d;
[Superintendent]<break/>&#x0201c;Soliciting stakeholder input, I think
that will help where you have a focus group with diverse parent
representation, just having that conversation, because they&#x02019;ll
talk to each other and to other people, they&#x02019;ll talk to friends.
If you have a key communicators group that really understands the point
of the survey and why collecting this kind of data is actually helpful
and that it is not about sexualizing anything at the middle school. This
is not about pushing a particular agenda; this is not about forcing
students to embrace a particular set of values related to gender
diversity. This really is about protecting students, making sure that
they&#x02019;re safe.&#x0201d; [Superintendent]</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Reinforcing safety and health messaging</td><td align="left" valign="top" rowspan="1" colspan="1">&#x0201c;I am not familiar with any parent who
doesn&#x02019;t want their kid to be safe. That&#x02019;s a common core
shared value and goal &#x02026;I would encourage reflecting,
&#x02018;Here&#x02019;s what we are hearing from students. Here&#x02019;s
what we understand from the&#x02026;surveys we do. Here&#x02019;s what we
know from our own population and this is important to us because your
kids being safe is important to us.&#x02019; One of the ways that we can
help them be more safe is having a real picture of what they&#x02019;re
experiencing and that&#x02019;s what this survey is going to help us
understand.&#x0201d; [School board member]<break/>&#x0201c;From the
standpoint of being able to educate our families at the middle school,
it&#x02019;s about relationship violence prevention. I think the word
sexual can be taken off and just talk about what a healthy relationship
is as we complete these surveys. Because this tells me more than just
sexual violence, right? This tells me about somebody that is treated
unfairly or is bullied or made to do something they were not comfortable
doing. Which goes back to the health and development of what is consent?
What does a healthy relationship look like?&#x0201d;
[Superintendent]</td></tr><tr><td rowspan="2" align="left" valign="top" colspan="1">
<bold>Involving students &#x00026;
parents</bold>
</td><td align="left" valign="top" rowspan="1" colspan="1">Engaging school community (e.g., parents,
students) with data</td><td align="left" valign="top" rowspan="1" colspan="1">&#x0201c;We&#x02019;ve become really involved in
the use of data, the whole idea of individualizing education for
students. We look at individual students in every piece of data that we
can glean and then try to build systems to support individual students
in groups of students. We use survey data to either support students or
build systems that are going to support large groups of students. There
was a time that we would just survey to survey, but we wouldn&#x02019;t
do anything with the data. I think public education has gotten by [with]
that. Now if we&#x02019;re going to survey, then there&#x02019;s almost an
unwritten rule or expectation that we are going to evaluate that
data.&#x0201d; [Superintendent]</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Amplifying student perspectives that normalize
SV discussions</td><td align="left" valign="top" rowspan="1" colspan="1">&#x0201c;I think that&#x02019;s a great
countermeasure to parental angst when we do intentionally include
student voice. Our kids learn all sorts of stuff outside the walls of
our schoolhouses, at dinner table with parents. They&#x02019;re learning
all sorts of stuff - good, bad, ugly, whatever&#x02026;that&#x02019;s eye
opening for parents when they realize that. Frankly, many of our
students are very good at just saying, this is okay and this is
normalized to be able to have these kinds of discussions with their
peers.&#x0201d; [Superintendent]<break/>&#x0201c;We want to elevate
student voice, but we also know that it&#x02019;s a pretty nasty world
out there. We&#x02019;re always mindful, how do we elevate student voice
without putting our students inadvertently into becoming targets or in
the crosshairs that will last for them a lifetime, potentially?
That&#x02019;s where parents and students have to think through on a
family by family basis.&#x0201d; [School board member]</td></tr><tr><td rowspan="3" align="left" valign="top" colspan="1">
<bold>Modifying survey language
&#x00026; administration</bold>
</td><td align="left" valign="top" rowspan="1" colspan="1">Soften/tailor language</td><td align="left" valign="top" rowspan="1" colspan="1">&#x0201c;If this is sixth through eighth [grade
students], I would probably reword the &#x0201c;made me do sexual
things&#x0201d; and &#x0201c;showed friends and posted pictures naked or
doing something sexual.&#x0201d; I think it could be more age appropriate
with the same understanding and meaning that didn&#x02019;t maybe come
off as quite as harshly received by our community.&#x0201d; [School board
member]<break/>[Instead of &#x0201c;Made me do sexual things I
didn&#x02019;t want to&#x0201d;] How about just, &#x0201c;Made me do things
I didn&#x02019;t want to. Or made me do things I was uncomfortable
doing.&#x0201d; [School board member]</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Flexibility in survey administration</td><td align="left" valign="top" rowspan="1" colspan="1">&#x0201c;I think definitely these would be more
eighth grade type of questions. And, it does matter when, because in the
fall, especially for sixth graders, they&#x02019;re coming into a new
school most of the time. So, there&#x02019;s not a lot of trust
necessarily with the staff yet. It hasn&#x02019;t had a chance to be
established. Whereas an eighth grade cohort, in theory, many of those
kids have maybe been in that school for a while. If it&#x02019;s the
counselor that&#x02019;s helping facilitate this, maybe it&#x02019;s
somebody that they trust and maybe there&#x02019;s some rapport with that
person and the families too around that.&#x0201d; [Superintendent]
<break/>&#x0201c;I wonder if there&#x02019;s even the ability to say like,
&#x02018;Fine for my kid to take this part of the survey, but not this
part of the survey&#x02019;&#x02026;that full binary opt-in, opt-out can
really exclude an important data set, especially if it&#x02019;s a more
conservative family, or for whatever reason, the family hasn&#x02019;t
yet had this conversation within the family.&#x0201d; [School board
member]</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Alignment with existing school efforts</td><td align="left" valign="top" rowspan="1" colspan="1">&#x0201c;I would not want any of these
questions going out in my school district without it aligning with our
other curriculum&#x02026;I don&#x02019;t want to be the first time they
are asked these kinds of questions. A prerequisite to any of these
questions has to be in line with what&#x02019;s being taught already in
the school with the state required bill that was passed regarding sex ed
education.&#x0201d; [School board member]<break/>&#x0201c;I&#x02019;m not
sure what they talk about in sex ed in sixth and seventh grade. So if
these topics have already been talked about and it&#x02019;s been
introduced with teachers who know how to talk about this stuff, then
asking these questions I think really is valuable to us. Did we get
through to the kids or not? It comes in a context as opposed to a series
of questions.&#x0201d; [School board member]</td></tr></tbody></table></table-wrap></floats-group></article>