What college students do not know: where are the gaps in sexual health knowledge?

Comprehensive sexuality education for fraternity-affiliated undergraduates: a pilot program to improve sexual and reproductive health knowledge, attitudes, and communication

Objective: Comprehensive sexuality education (CSE) allows for informed and healthy decisions. College students often lack understanding of sexual and reproductive health (SRH). Conversations and Pizza (CAP), an interactive curriculum, was designed to address gaps in CSE and improve SRH outcomes. Participants: 66 fraternity affiliated undergraduate students. Methods: A six-session intervention discussed gender norms, biology, consent, harassment, and bystander intervention. Pre- and post-quantitative surveys assessed attitudes and behaviors; plus-delta format was used for qualitative feedback. Results: Qualitative data reflected engagement. Post-intervention, multiple measures improved (McNemar p < 0.05): perceived self-efficacy in consent and peer norms (4/8 measures), bystander intervention (5/6), and awareness of harassment (2/5). Participants reported more conversations with partners (pregnancy and STI prevention, 50% to 75%); human papillomavirus (HPV) vaccination receipt increased (60% to 93%, McNemar p < 0.001). Conclusion: Reproductive health outcomes improved in this pilot, laying the groundwork for continued testing. CAP is a successful pilot program that can be evaluated for a variety of groups and formats.

Condom Acquisition, Errors, and Breakage among U.S. Cisgender College Students

High rates of sexually transmitted infections and unplanned pregnancy continue to plague young adults in the USA with low condom use a contributing factor. To better understand condom acquisition, errors, and breakage among US cisgender college students, a survey was conducted across six structurally diverse institutions of higher education in 2019-2020 prior to the COVID-19 pandemic. Students who had used external condoms in the last year (N = 1584) were asked about specific on- and off-campus locations of condom acquisition and practices related to condom use. Findings indicate that students most frequently acquired condoms off-campus with location differences between genders and relationship status. Condom errors were common, with no consistent patterns related to gender, but unpartnered students were more likely than those in relationships to experience condom errors. Multivariate logistic regression indicated that relationship status, applying condom on wrong side, adding condom after sex started, removing condom during sex, condom slipping off, and problems with fit were predictors for condom breakage. The study results provide guidance for healthcare and sexuality education professionals working with college students to better address the differing needs of college students regarding condom acquisition and correct condom use.

Protocol for designing and evaluating an undergraduate public health course on sexual and reproductive health at a public university in California

Introduction

Comprehensive sexuality education (CSE) is associated with positive sexual and reproductive health (SRH) outcomes, including increased contraceptive use, lower rates of unintended pregnancy and prevention of sexual violence. However, implementation of and requirements for CSE vary across the United States which can negatively impact students, both during and beyond high school, including among college students.

Methods

and Analysis: This paper describes the research protocol for a multi-staged approach for designing, implementing and evaluating an SRH course for up to 60 undergraduate students at a public university in California. Before the class is offered, we will conduct 20 in-depth interviews with current students, educators and course design experts to learn from their experiences and seek their guidance on course design. To evaluate the course, enrolled students will complete a pre-course and a post-course survey before and after class is taught, to assess students' attitudes and values relevant to educational concepts and the format and delivery of the course and its modules and activities. Approximately 20 students will take part in an in-depth exit interview, after completing the course, to gather perceptions about how the course impacted their knowledge and behavior. The goal is to refine materials for future in-person course offerings and develop a prototype for a fully online version of the course.

Discussion

This study introduces a novel university-level course to provide young adult students comprehensive, evidence-based education on sexual and reproductive health from a public health perspective. The program leverages existing CSE efforts, enhancing them with academic rigor, inclusive content and digital inclusion. This approach, inclusive of diverse sexual orientations, content on pleasure and sexual violence prevention, aims to fill existing gaps in university curricula and also set a new standard in CSE. The project's innovative and multidisciplinary design offers a model for broader impact within a large public university system and beyond.

Sexual risk behavior among individuals seeking outpatient mental health services: Associations with childhood emotional neglect and identity dysfunction

This study was developed to examine sexual risk behavior among patients seeking community-based mental health services, including associations with psychological distress, identity dysfunction, and childhood emotional neglect. A mediation model was examined regarding identity dysfunction mediating the link between emotional neglect and sexual risk behavior. A total of 245 outpatients completed questionnaires regarding perceived risky sexual behavior, psychological distress, identity dysfunction, and emotional neglect. Sexual risk behavior was found to be a prevalent issue among individuals seeking outpatient mental health services, with 13% reporting engagement in unsafe sexual practices at least some of the time. Mediation analysis revealed that childhood emotional neglect was indirectly linked with sexual risk behavior through the mediating effect of identity dysfunction. Thus, findings suggest a pathway to sexual risk behaviors through perceived childhood emotional neglect and identity dysfunction. Clinical attention to identity-related vulnerability among this population may be warranted in aiming to mitigate risk-taking associated with sexual practices.

"I Was Learning Every Step of the Way": Student Perceptions About a New Required Foundational Master of Public Health Program Planning Course

OBJECTIVE

Tulane University School of Public Health and Tropical Medicine created a program planning course required for all master of public health (MPH) students to address the revised 2016 Council on Education for Public Health (CEPH) foundational competencies. The objective of this study was to examine students' feedback on this new class based on their reflective writing.

METHODS

Students across 3 class sections during 3 semesters (fall 2018, spring 2019, and fall 2019) wrote a reflection paper as a final assignment about their course experience (N = 102). We conducted a conventional qualitative content analysis of deidentified student responses to systematically examine themes in the overarching areas of what students found valuable about the course and what they would want to be improved. We calculated frequency counts of themes to further contextualize the findings.

RESULTS

Students found the following aspects of the course valuable: a positive perception shift toward program planning (93.1%), new transferable career skills (87.3%), the course format (77.5%), course content (69.6%), working in teams (52.0%), course assignments (47.1%), and the instructional team (31.4%). Critiques included the following: more support for course assignments (39.2%), challenges of working in teams (27.5%), aspects of the course format (25.5%), gaps in course content (19.6%), and wanting more consultations with the instructional team (5.9%). About 14% of students stated there was nothing or little they would change about the course.

CONCLUSION

Overall, the course received positive feedback from students. They identified several valuable course components and areas that could be enhanced, which we have worked to improve. We offer the course as a potential model for how schools and programs of public health can meet the 2016 CEPH competencies.

Sexual Violence and Nonconsensual Experiences Among Alt-Sex Communities' Members

BACKGROUND

As behaviors, alternative sexual (alt-sex) (i.e., kink, bondage, discipline, dominance, submission, sadism, and masochism , consensual non-monogamy, swinging, leather, and fetish practices) practitioners often emphasize that consent and boundaries are key elements of alt-sex activities. Despite these emphases, individuals experience consent violations and sexual assault both prior to engaging and during their involvement in alt-sex activities.

PURPOSE

This study examines alt-sex practitioners' sexual assault and nonconsensual experiences in order to highlight potential means of intervention and prevention, as well as inform clinical and legal professionals.

METHODS

In collaboration with the National Coalition for Sexual Freedom, this study uses an international survey of adults in alt-sex communities (N = 2996) to examine sexual assault and nonconsensual experiences both within and outside of alt-sex contexts.

RESULTS

We found a lower rate of consent violations in the alt-sex community (26%) compared to sexual assault as an adult outside of alt-sex contexts (34%) and sexual assault as a minor (40%). We found significant differences by groups in sexual assault as a minor (gender, sexual orientation, age, and live in the US or not), sexual assault outside of alt-sex contexts (gender, sexual orientation, and age), nonconsensual experiences in alt-sex contexts (gender, sexual orientation, age, and race), receiving nonconsensual touch in alt-sex contexts (gender, sexual orientation, and age), giving nonconsensual touch in alt-sex contexts (sexual orientation, age, living in the US or not, and race), and being falsely accused of nonconsensual touching in alt-sex contexts (gender, age, and living in the US or not). Within the most recent consent violation, the most common behaviors were non-kink related, except for lack of aftercare. Nearly 40% of participants reported the reasons for their most recent consent violation in alt-sex contexts were being selfish or caught up in the moment.

IMPLICATIONS

Focused interventions are needed to address how different populations are experiencing assault and violations in alt-sex contexts.

Sexual sensation seeking, hookups, and alcohol consumption among first-year college students

OBJECTIVE

To explore sexual sensation seeking (SSS) among an ethnically-diverse sample of first-year college students and their hookup behaviors.

PARTICIPANTS

1,480 first-year college students who hooked up in the last 30 days were recruited from four universities in 2016.

METHODS

Students completed an online survey before completing an online STI and alcohol prevention intervention.

RESULTS

Male and sexual minority students had significantly higher SSS scores compared to female and heterosexual students respectively. Students with higher SSS scores were less likely to report condom use at last vaginal and anal hookup, more likely to hookup under the influence of alcohol and participate in a wide range of sexual behaviors. There were no significant mean differences in SSS scores by level of intoxication during their last hookup.

CONCLUSION

These findings highlight the role of SSS in predicting sexual risk behaviors of first-year college students and the overall low SSS scores among this sample.

Condoms, Trust and Stealthing: The Meanings Attributed to Unprotected Hetero-Sex

University students tend to have greater sexual health knowledge than the general public, yet condom use among this group continues to be a public health concern because effective condom use could reduce sexually transmitted infections and, for heterosexual women, unwanted pregnancies. We report findings from a small, qualitative study of condom use among sexually active heterosexual university students in the UK. In interviews, students shared their views about condom use and sometimes their personal experiences too. This paper identifies some of the meanings attributed to condom use in the accounts of nine heterosexually active 20-25 year-olds. Participants explained that when they felt comfortable communicating with their partners, they were more likely to use condoms, and those with negative sexual experiences or under social or psychological pressure were less likely to use them. The findings highlight issues of trust and power between men and women in heterosexual relationships, and describe contexts for dishonest sexual practice, including the traditional notions of femininity that were linked to condom use by this group. The issue of stealthing arose in one woman's account of her experience and in several others' reports of what occurs commonly. Stealthing, the secretive removal of a condom by a (usually male) partner during sexual intercourse without a partner's knowledge or permission, produces non-consensual unprotected sex. We present stealthing as a product of the sexual double-standards described and as a form of interpersonal violence (IPV) and, among these heterosexual partners, as a form of gender-based violence. This study provides a glimpse into university students' decision-making regarding condom use and highlights how gendered inequalities shape heterosex, in particular, communication about safer sex, that in some cases, compromise women's decisions about (safer) sex.

(Mis)perceptions of HIV and HPV among female college students: a qualitative study

Background This study aims to investigate college women's misperceptions about the human papillomavirus virus (HPV) and the human immunodeficiency virus (HIV).

METHODS

Twenty college women from an urban, Midwestern university in the United States were recruited to participate in interviews exploring their beliefs about HIV and HPV. In-depth interviews were conducted and analysed via interpretive methods.

RESULTS

The college women in this study often conflated or confused HPV and HIV and revealed misperceptions about the severity and prevalence of HPV and HIV.

CONCLUSION

The results have important implications for understanding college women's sexual risk behaviour and, as a result, can inform the practices of both healthcare providers and public health professionals.

"You Do It without Their Knowledge." Assessing Knowledge and Perception of Stealthing among College Students

In recent years, the act of nonconsensual condom removal, termed stealthing, has become commonly discussed on social and print media; yet, little to no evidence exists on the current knowledge and perception of stealthing among young adults. As such, we assessed what college students know and feel regarding stealthing. We employed an exploratory mixed-method analysis where focus groups were followed by a quantitative survey. A qualitative assessment was conducted using grounded theory analyses and questions for a quantitative survey were developed based on emergent themes from focus groups. Quantitative data was analyzed using descriptive and bivariate analyses with alpha less than 0.05 to denote significance. Though limited knowledge exists, participants felt that stealthing was a violation of their privacy, trust, sexual consent, and their ability to make a health decision, and should be considered an assault. Participants noted stealthing may have become acceptable due to its popularity in social media and young adult culture, especially porn. We also found sex differences in the perception of stealthing being considered a sexual assault with lower rates among males as compared to females. Our results demonstrate that there is a need for health educators to assess the prevalence of such a behavior among college students and policy makers to assess the legal implications of nonconsensual condom removal.

Family Religiosity, Parental Monitoring, and Emerging Adults’ Sexual Behavior

The processes through which families play a role in the religious and sexual socialization of children are varied and complex. Few studies have considered the impact of parental or family religiosity on young people’s sexual behaviors, either directly or through influence on adolescents’ own religiosity. This study of college students at a large, public university in the mid-Atlantic uses multidimensional measures to examine the relationships among family religiosity, parental monitoring during adolescence, students’ religiosity, and students’ specific sexual behaviors. Results suggest that greater family religiosity is associated with a decreased likelihood of engaging in certain sex acts, but for students who do engage, family religiosity is not associated with any differences in the timing of sexual onset or in the numbers of partners with whom students engaged. Results also suggest that parental monitoring may mediate the relationship between family religiosity and some sexual risk behavior. Greater individual religiosity is associated with a lower likelihood of having engaged in any sexual activity, and a higher likelihood of condom use for students who have had vaginal sex. This study offers valuable insights into the role that religiosity, at both the family and the individual level, plays in college students’ sexual behavior.

Emergency contraceptive pill users' risk perceptions for sexually transmitted infections and future unintended pregnancy

BACKGROUND AND PURPOSE

The availability of emergency contraception pills (ECP) over the counter (OTC) has the potential to reduce the incidence of unintended pregnancy; however, the increased risk for sexually transmitted infection (STI) acquisition, related to unprotected intercourse, has not been adequately addressed. The purpose of this study is to gain insight into risk perceptions for STIs and subsequent unintended pregnancy in women who have purchased ECP OTC.

METHODS

Twenty-one women, aged 18-24, attending a private university in an urban setting, who purchased and used ECP OTC participated in 1-h, individual interviews.

CONCLUSIONS

Narrative, descriptive findings indicated that these women did not consider themselves at risk for STI or unintended pregnancy, despite having used ECP OTC. Pregnancy prevention was paramount for these women, which overshadowed concerns regarding STIs.

IMPLICATIONS FOR PRACTICE

Women at risk for unintended consequences of sexual activity are not fully cognizant of those potential outcomes and do not take measures to prevent their occurrence. The availability of ECP OTC offers protection against unintended pregnancy; however, opportunities for health promotion and prevention counseling may be lost.

University Students' Sexual Health Knowledge: A Scoping Literature Review

Sexual health plays an important role in the well-being of university students. The literature shows that the majority of university undergraduates are sexually active and at high risk of contracting sexually transmitted infections (STIs); however, the breadth and degree of the literature on their sexual health knowledge is unclear. The purpose of this scoping review was to gain a deeper understanding of the state of research on the sexual health knowledge of university/college students globally. A 5-stage framework was used to guide the review and to characterize the literature on sexual health knowledge. Articles published in English between 2000 and 2014 were reviewed if they included university students as a population of interest and described the methods used to measure sexual health knowledge. Of the 2,386 articles retrieved, 91 met the criteria. The majority of the articles (n = 79) used a cross-sectional design to investigate students' knowledge about HIV/AIDS (n = 45), STIs (n = 23), HPV (n = 9), and contraception (n = 24). The review highlights gaps in the literature and in findings relating to the research dominance of various geographic locations, common research designs, the wide range of measurement tools used, and the variety of sexual health knowledge outcomes of interest. The review provides a useful description of the literature on sexual health knowledge among university/college students and some recommendations for moving the field forward.

Assessing the effects of a sexually transmitted disease educational intervention on fraternity and sorority members' knowledge and attitudes toward safe sex behaviors

BACKGROUND AND PURPOSE

College years are a time young adults examine high-risk sexual behaviors, increasing their risk for sexually transmitted diseases (STDs). Fraternity/sorority membership has been identified as one factor contributing to increased risky sexual behavior in college students. This study measured the effectiveness of an educational intervention targeting STD prevention in fraternity and sorority members, and examined relationships between STD knowledge, attitudes, and demographics.

METHODS

A descriptive, correlational design was used. Pre- and posttest data were collected from fraternity and sorority members (N = 132). Instruments measured demographic characteristics, STD knowledge, and attitudes toward safe sex behaviors.

CONCLUSIONS

There was a significant increase in STD knowledge from baseline (M = 13.03, SD = 6.5) to 1 week (M = 20.27, SD = 4.9) t (131) = -13.53, p = .000. Males were more likely to report attitudes toward risky sexual behavior rs(132) = .323, p = .000, and as knowledge increased, attitudes became more favorable to safe sex behaviors (pre-STD knowledge and preintervention attitudes, r(132) = -.249, p = .004; post-STD knowledge and postintervention attitudes, rs(132) = -.307, p = .000).

IMPLICATIONS FOR PRACTICE

Results support that brief STD educational interventions can increase STD knowledge. College health centers must aim to provide sexual health education to all students at every visit.

Man Up Monday: An integrated public health approach to increase sexually transmitted infection awareness and testing among male students at a midwest university

OBJECTIVE

This campaign sought to (a) increase awareness of sexual health and chlamydia testing; (b) motivate students, particularly sexually active men who do not pursue regular sexually transmitted infection (STI) testing, to get tested; and (c) improve the capacity of the student health center to provide free chlamydia testing and treatment for all students.

PARTICIPANTS

Students enrolled at a 4-year public research university (N = 333).

METHODS

Collaborative partnerships formed the foundation of a campus marketing and testing campaign, with treatment for students testing positive for chlamydia.

RESULTS

A total of 333 students were tested over 5 consecutive Mondays, showing a chlamydia incidence of 9.6%. The incidence for females and males were 8.6% and 10.8%, respectively.

CONCLUSIONS

The campaign was effective in reaching men, an at-risk population not traditionally emphasized in STI testing.

Psychometric Confirmation of the Sexual Health Survey as a Useful Tool for College Health Professionals

OBJECTIVE

To conduct a confirmatory factor analysis on the 17-item Sexual Health Survey (SHS), a comprehensive instrument designed to be used with college students.

PARTICIPANTS

College students (N = 515) aged 18 to 26 years enrolled at a Midwest public university October 2009.

METHODS

Confirmatory factor analysis with maximum likelihood estimation was performed to test the stability of the constructs.

RESULTS

All factor loadings were significant (p < .001), ranging from .55 to .99 (standardized). The range of squared multiple correlations of items was .31 to .98, and the intercorrelations among the 5 factors were from -.03 to .52. These small to moderate levels of intercorrelation support discriminant validity of 5 constructs.

CONCLUSIONS

This study supports the 5-factor version of the 17-item SHS as a viable scale that can measure sexual health overall and 5 distinct areas. College health professionals should consider use of this scale for assessment purposes and evaluation of programmatic efforts.

Awareness of sexually transmitted infection and protection methods among university students in Ireland

BACKGROUND

Sexually transmitted infections (STIs) are a major public health challenge. In 2012, young people (20-29 years) represented 59.1 % of STI notifications in Ireland. In studying awareness and knowledge of STIs, methods of protection, and sexual practices of young people, many researchers have accessed university students.

AIMS

Survey of 419 university students, investigating awareness and knowledge of sexual health and STIs, and risky sexual behaviour as a surrogate indicator of sexual activity in that age group.

METHODS

Self-administered questionnaire on students' demographics, sexual activity, knowledge, attitude and awareness of sexual health and STIs.

RESULTS

419 students responded: 56.1 % female and 78.1 % undergraduate students. 74.2 % remembered receiving sexual education in secondary school and 84 % of those found it useful, but only 51.8 % remembered education regarding STIs. 44.4 % believed that STIs do not pose a long-term health risk. 90.7 % of respondents were sexually active, and 10.3 % had contracted STIs. 94.7 % of sexually active students used contraception, with condoms most frequently used. 69.1 % of those active had experienced penetrative vaginal sex, 86.4 % oral sex and 19.2 % anal sex without a condom in the prior 2 years. Condom usage initiated by women was primarily for STI prevention.

CONCLUSION

Young people do not always have the information needed for them to take responsibility for their sexual health. In this study, university-provided medical and information resources were available, but large numbers of students were unaware or uncomfortable accessing them. Future work is needed to determine factors contributing to effective communication of sexual health information to young people.