31 minute read
Retrospective Study
Annemarie Rosciano, DNP, MPA, ANP-C Barbara Brathwaite, DNP, MSN, RN, CBN
n Abstract
Background: College-aged students engaging in risky sexual behavior are placed at risk for sexually transmitted infection and altered health and sexual well-being. Purpose: Identify risky sexual behaviors among college-age students and explore their plans to change behaviors using brief action planning. Method: Retrospective quantitative study Results: Revealed high-risk sexual behaviors among 70% of students, with 62% having multiple partners, 37% not using protection, and 71% not having sexually transmitted infection testing. A brief action planning model was used by 100% of the students and 100% who screened positive for risky sexual behaviors chose not to modify these behaviors. Students prioritized changes in diet and sedentary behaviors. Conclusions: Students disclose risky sexual behaviors but lack a propensity to change their behaviors. This suggests students may require knowledge about their behaviors and their associated health risks. Campus health centers can place emphasis on knowledge assessment of risky behaviors and plan how to strengthen behavioral change.
Keywords: brief action planning, health belief model, Partnership to Advance Collaborative Education (PACE) Health and Wellness Screening Instrument
Introduction
College-age students should be considered a high-risk and vulnerable population due to the stressors of their age and academic and psychosocial demands as they transition to their college environment (Benson & Ellis, 2019). They are at a critical developmental stage, undergoing changes, exploring and navigating sexual relationships, and learning about themselves (American College Health Association, 2020). Engaging in high-risk sexual behaviors, such as having multiple partners and sex without protection, place them at risk for sexually transmitted infections (STIs) (Dolphin et al., 2017) and altered health and sexual well-being. Increasing awareness of risky sexual behaviors creates opportunity to achieve a healthful life (Visalli et al., 2019).
The purpose of this study was to explore unhealthy sexual behaviors among campus students and help them create a plan to modify risky behaviors to promote health and reduce future risk of disease. In 2017, a northeastern public university school of nursing created and commenced the Partnership to Advance Collaborative Education (PACE). This clinical preventative screening program was offered weekly at the campus recreation and wellness center. It included screening for disease and mental health, provided education to increase awareness of risky behaviors, and referred students for medical and/or psychological services. The focal point of this study was to examine and modify risky sexual behaviors among college students.
Annemarie Rosciano, DNP, MPA, ANP-C and Barbara Brathwaite, DNP, MSN, RN, CBN
Stony Brook University School of Nursing, Stony Brook, New York
Background
In 2020, the World Health Organization (WHO) addressed several sexual health concerns and defined sexual health as a state of sexual wellbeing (World Health Organization [WHO], 2020). Sexual health requires a positive, respectful approach to relationships, as well as having pleasurable and safe sexual experiences free of coercion, discrimination, and violence. Sexual well-being and safety are essential to overall health and wellness and are rooted in the framework of social determinants of health (Bedree, 2019). It is important to understand how students define sexual health and what supports or hinders their well-being (Bedree, 2019).
Bedree (2019) found that students felt safe to disclose sexual activity if their community was open and nonjudgmental. Sexual behaviors may be concealed among those with marginalized identities, such as the lesbian, gay, bisexual, transgender, and the queer-plus (LGBTQ+) community. This population often lacks access to health care and may be uncomfortable and/or not forthcoming with disclosing their sexuality out of fear of discrimination. Elimination of sexual barriers must be a focus to support all individuals’ diverse needs and provide opportunities for them to change risky behaviors. Minimal knowledge and lack of affirmation of one’s sexuality increases the risk of sexually transmitted infections (STIs) (Jahanfar et al., 2021; Visalli et al., 2019).
Jahanfar et al. (2021) found that sexual education received by people in high school was inferior and had little influence on sexual behaviors once a student was in college. A person’s first sexual encounter occurs, on average, at age 18, with most people reporting their first sexual relationship as casual. Gardner and Amankwaa (2020) found that young adults between the ages of 19 and 25 were not concerned with using protection or inquiring about the sexual history of their partners. The riskiest sexual behaviors were found among 24-year-olds. Fehr et al. (2018) found that male students were twice as likely to use condoms as female students, and upper division students were less likely to use condoms regularly. Race did not influence condom use. Most students reported that they did not use condoms while having anal sex and the risk of pregnancy was not cited as a concern among many college students.
Young adults are especially inclined to participate in risky behaviors as a result of masculinity norms advocated in early teenage years and peer pressure (Amin et al., 2018). Such behavior can result in increased unwanted pregnancies and STIs (DeLacy, 2019). Data published by the Center for Disease Control (CDC) “estimates that in 2018, 1 in 5 people in the United States had an STI,” with “nearly 68 million STIs on any given day in 2018,” at a total lifetime medical cost of “nearly $16 billion” (CDC, 2021, p. 1). Young adults remain disproportionally affected by STIs (Gardner & Amankwaa, 2020).
Students entering college have more freedom, including greater access to alcohol and drugs, multiple sexual partners, and opportunities to explore their sexual identity and sexual relationships (DeLacy, 2019). According to the 2018 American College Health Association-National College Health Assessment (ACHA-NCHA), 11.1% of male and 8.5% of female college students had “four or more sexual partners within one year” (p. 10). Twenty two percent of male and 21.4% female students reported having unprotected sex when drinking (p. 9). Alcohol and gender are known to be obstacles to sexual well-being (Bedree, 2019) and increase the risk for contracting and spreading STIs (ACHA-NCHA, 2018).
Students seek knowledge related to sexual issues as their age and curiosity mutually increase (Visalli et al., 2019) and young adults often look to their peers or social media for sexual health information if they feel disconnected from providers (Ericksen, 2018). Healthcare illiteracy can often be the cause of anxiety and most students do not bring their sexual health concerns to a parent (Visalli et al., 2019). Young females report an increase in autonomy when they are comfortable asking questions and obtaining information from their healthcare provider without a parent present (Richards, 2020). However, apprehension may occur if a student (a) lacks confidence in their health care provider, (b) if confidentiality is breached, or (c) if any type of discrimination occurs (Ericksen, 2018). Providers can also negatively affect student’s health outcomes when assumptions about sexual orientation are made or a patient feels a safe environment is nonexistent (Bedree, 2019).
Sexual health resources that are readily available and accessible to college students can result in reduction of STIs and unplanned pregnancies. Screening for risky sexual behaviors, communicating, and promoting safe sex education are essential in all-inclusive health care (DeLacy, 2019). Failure to support the sexual and reproductive health (SRH) needs of young adults can result in serious social, cultural, economic, and health issues which can include unplanned pregnancy, STIs, sexual intimidation, bullying, violence, and infertility. These consequences, along with limited access to SRH information and resources, puts an economic burden on families, communities, and societies (DeLacy, 2019).
Establishing equitable access and a supportive campus environment helps ensure that all students feel safe and protected (DeLacy, 2019). Mobile campus preventative screening programs offer students access, evaluation to identify risky behaviors, and provide an opportunity to change unhealthy behaviors. There is a dearth of literature concerning the significance of screening and addressing young adults’ risky sexual behavior in campus settings. Therefore, the aim of this study was to understand the sexual practices of college students and assist them in modifying these behaviors using a brief action plan (BAP) model.
Action Planning and Changing Risky Behaviors
Brief action planning is an evidenced-based motivating support tool grounded in the principles of motivational interviewing. BAP incorporates the psychology of behavioral change theory, which is aligned with selfefficacy and action-planning theory and research. Action planning has been shown to facilitate the intention-behavior relationship, thereby increasing the likelihood of behavior change. The BAP framework guides in assisting and creating an action plan and builds self-efficacy to fulfill the goals outlined in the action plan (Connell et al., 2020; Gutnick et al., 2014). Fifty to 75% of patients developed a plan with their primary care practitioners to change risky behaviors, using BAP (Gutnick et al., 2014). Weisberg et al. (2021) reported a decrease in pain and disability after instituting BAP. The BAP technique implemented during a screening event when time is limited, is effective for modifying risk factors and changing health behaviors (Gutnick et al., 2014).
One of the most frequently used models for exploring behavior change is the health belief model (HBM). The HBM is a health-specific model that aims to predict and describe why individuals modify or maintain their health behaviors. The underlying assumption is that preventive behaviors depend
Adoption of safe sex practices by college students requires their understanding that they are susceptible and likely to develop complications (perceived susceptibility); that unsafe sexual practices lead to infection (STIs) and do harm to health. Five sexual health questions were developed by the PACE team that focused on (a) sexual activity, (b) multiple sexual partners, (c) use of protection, (d) sexually transmitted infection testing and treatment, and (e) unintended pregnancy. Sexual health questions required yes or no answers. The BAP guide was used to facilitate goal-setting and action-planning (Gutnick et al., 2014), and included open-ended questions consisting of (1) creating an action plan, (2) choosing from a behavioral menu of options, (3) reviewing of the plan, (4) rating the confidence level in creation of the plan, and (5) completing plan documentation at a 2-week follow-up phone call.
on the individual’s expectations and beliefs (Mercadante & Law, 2022; Wang et al., 2021). The HBM suggest that an individual’s belief regarding a threat of disease and the belief in the effectiveness of the suggested health behavior will predict the possibility that the individual will adopt a new behavior. This model assumes that individual involvement in healthy behaviors depends on understanding six constructs of the individual’s perceived belief: severity, susceptibility, benefit, barrier, cue to action, and self-efficacy (Houlden et al., 2021).
Based on this model, adoption of safe sex practices by college students requires their understanding that they are susceptible and likely to develop complications (perceived susceptibility); that unsafe sexual practices lead to infection (STIs) and do harm to health (perceived severity); that healthy sexual behaviors have some benefits for them (perceived benefits); that there are some barriers against behavior alterations (perceived barriers); that healthcare professionals, peers, and social media encourage them to adopt healthy behaviors (cues to action); and, finally, that they can control unhealthy sexual practices through healthy behaviors (self-efficacy). This model supports importance of health education interventions to improve sexual health knowledge, health belief, and sexual behaviors.
Purpose
The purpose of this study is to identify risky sexual behaviors among college-age students utilizing standardized evidenced-based clinical screening instruments. A secondary aim is to explore students’ brief action plan creation and completion to change behaviors using BAP.
Methods
Design
The protocol was reviewed by the university’s internal review board (IRB) and it was determined that the activity was not a systematic investigation and therefore did not meet the definition of human subjects’ research, thus the proposal did not require approval by the IRB or consent. A retrospective cohort study collection of data was used to examine sexual behaviors and gender and the application of BAP to change risky unhealthy behaviors. This was a single site study at a northeastern university in New York State. All data collection items were de-identified during their collection and responses could not be linked to any participants. This retrospective data collection was anonymously and confidentially collected from September 2017 through May 2019 using the PACE Health and Wellness Screening Instrument built by the PACE team. The data included demographic questions, height, weight, pain, vital signs, body mass index (BMI), immunization history, and screening for smoking, depression (PHQ9), anxiety (GAD-7), trauma (TSQ), alcohol (Audit-C), and drugs (DAST). Sample
This study used a voluntary convenience sample of 603 undergraduate and graduate college-aged students who were attending the university. Participants resided both on and off campus and were at least 18 years of age and able to comprehend English. Exclusion criteria included students who were unable to complete the full screening process.
Using G*power, a statistical power analysis program, the minimum total sample size was calculated using an effect size of 0.30, a probability error of 0.05, and a power of 0.95 to determine the difference between two categorical variables within the same population required a minimum total sample size of n = 220 (HHU, 2007).
Procedure
Recruitment of students occurred at the screening location in the campus recreation and wellness center. Students were provided with an overview of the components of the screening using a vision board. Adult and family nurse practitioner (NP) students screened participants in a confidential setting. The NP students and faculty huddled to discuss identified risky behaviors. The BAP model was used by the NP students to guide the participants to identify a modifiable behavior and devise a plan. Based upon the screening results and BAP, resources, referrals, and education were provided to participants by the NP students with faculty oversight. Two weeks post screening, a follow-up phone call was implemented with an NP student to determine the level of plan completion. Throughout the process, all documents were anonymized, maintained in a sealed envelope, and collected by the primary investigator.
Data Analysis
Data was maintained in a software collection site known as RedCap, a secure web application for managing online databases (Sciences, 2018). All data was downloaded and analyzed to a protected computer and backed up on flash drive using the Statistical Package for the Social Sciences version 26 (SPSS) (IBM, 2013). Descriptive statistics were computed from the scores of the screening and BAP data. A chi-squared test of independence was performed to examine the relationship between sexual activity, unprotected sex, multiple sexual partners, and gender.
Results
Sample
PACE Health and Wellness Screening demographic data was completed by 603 undergraduate and graduate participants ranging from age 18 to 24 (Table 1). Students reported their sexual practices (Table 2).
Sexual Well-Being and Screening for Risky Sexual Behaviors: A Quantitative Retrospective Study n Relationship Between Sexual Activity and Gender
The chi-squared test for independence was conducted to assess the association between sexual activity, unprotected sexual behavior, multiple sexual partners, and gender. Males were more likely to engage in sexual activity (Table 3); females were more likely to have unprotected sex (Table 4); and males were more likely to engage with multiple partners (Table 5).
Brief Action Planning
Analysis of behavior change indicated that 100% of the participants created a plan to change risky behaviors (Figure 1) with the top behaviors students chose to alter being exercise and diet. Seventy-five percent completed their plan to change (Figure 2); however, students did not choose to change their sexual behaviors.
Discussion
Sexual Activity and Gender
The findings of the current study revealed that most college students engaged in sexual activity, with males reporting having more sex than females.
Unprotected Sexual Activity
The current study found 37.5% of the participants had unprotected sex at least once within the most-recent one-year period. Females reported more unprotected sex (p = .02); however, males were less apt to use any method of birth control despite reporting having more multiple sexual partners than females. In the current study, 71% of participants reported that they did not have any testing for STIs in the past year. One-third of students had unprotected sex, while often disclosing they frequently obtained STI testing.
Table 1 Demographic Data Sexual Well-Being and Screening for Risky Sexual Behaviors (n = 603)
Question
Gender
Country of origin
Employment status
Year in college
Category Mean n %
23 100
18 to 19 20 to 21 22 to 24 No response Asian/Asian American 137 23.0 271 45.0 120 20.0 75 12.0 254 42.0
Black/African American
93 15.4 Hispanic/Latinx 102 17.0 American Indian/Alaska Native/Pacific Islander 1 1.5 White 177 29.4 Male 324 53.7
Female LGBTQ+ International 279 46.0 44 7.3 121 20.0
United States 481 80.0
Part-time Full-time Not employed Freshman Sophomore Junior Senior Graduate student Continuing education student Not employed 32 5.3 225 42.3 346 52.4 105 17.5 87 14.4 159 26.4 175 29.0 69 11.4 6 1.0 346 52.4
Table 2 Reported Sexual Practices (n = 603)
Sexual Practices (n) Yes %
Are you sexually active? Have you had unprotected sex in the last 12 months?
423 70.1
226 37.5
Have you used condoms as protection in the last 12 months?
325 53.7
Have you engaged in sexual activity with multiple partners in the last 12 months? 95 15.8
248 41.1
64 10.6
90 15.0 Have you had any STI testing in the last 12 months? 171 28.4 If you were tested for STIs, did you test positive? 8 1.3 Have you experienced unintended pregnancy? 7 1.2 Have you received the (HPV) immunization? 324 53.7 Table 3 Association of Sexual Activity and Gender Reported Sexual Activity Group No Yes n (%) n (%)
Figure 1 Creation of Behavioral Plan 80 75% (n = 603)
70
60
Multiple Partners
The current study found most respondents reported having had oral, vaginal, or anal sex in the last 12 months with one partner (n = 248, 41.1%), 62% of males (p = .06) had multiple partners. Fifteen percent of the students reported having had multiple sexual partners in the last 12 months.
Lifestyle Modification
In the current study, 33% of students had a body mass index (BMI) greater than 25, poor dietary habits, and a sedentary lifestyle in addition to a high level of risky sexual behaviors. Despite this, students did not choose to modify risky sexual behaviors. They prioritized exercise (32%) and diet (24%) in attempts to lose weight.
Sexual Activity and Gender
The findings from Scull et al. (2020) coincided with this study’s findings in that male students were inclined to have more sex, a greater number of casual sexual relationships, sex while intoxicated, and practice
50
40
30
20
10
11%
5%
0
Total
(Up partial No to 50%) more high-risk sexual behaviors. Sexual relationships are shaped by traditional stereotypes that have historically associated “masculinity” with assertiveness, violence, sexual play, and emotional distance, and
Figure 2 Completion of Behavioral Plan
80
75%
70
60
50
40
Sexual Well-Being and Screening for Risky Sexual Behaviors: A Quantitative Retrospective Study n Table 7
Post Screening Statistics (n = 603)
Reason for attending
Convenient
n %
349.7 58.0
Looked interesting
205.0 34.8 Worried about having a medical issue 247.2 41.2 Concerned about overall health 241.2 40.8 Wanted free items 156.0 26.8 Wants assistance to manage stress 132.0 22.0 Bothered by something physically and/or mentally 132.0 22.0 Concerned about sleep problem 114.5 19.4
30
20
10
0
Total 11%
(Up partial to 50%) 5%
No
Table 6 Brief Action Plan (Chosen Plan Type) (n = 603)
Type of action plan n %
Exercise
192.9 32.2
Healthier diet
144.7 24.2
Improve sleep
72.4 12.1
Lose weight
48.2 8.7
Attend counseling
24.1 4.0 Seek medical attention (for pain) 18.0 3.4 Marijuana smoking cessation 16.2 2.7 Meditate 16.2 2.7 Cut down on smoking or cessation 12.1 2.0 Gain muscle mass 12.1 2.0 Seek assistance at student health 12.1 2.0 Study daily 7.8 1.3 Table 8 Post Screening Exit Survey (n = 603)
Post screening
n (Yes) %
Was the experience what you expected? 578.8 96.5 Were all your concerns addressed? 584.9 97.3 Did you learn anything? 542.0 90.8
Would you recommend the screening to a friend?
578.0 96.2 Are you confident you will make changes? 494.0 82.5
“feminity” with passivity and emotional intimacy (Siegel, 2019). In Western cultures, males have traditionally been taught from a young age to associate masculinity with the initiation and experience of having sexual encounters and by acting “strong.” Males have also traditionally been under peer pressure to demonstrate masculinity through sex. Females have traditionally had greater restrictions placed on their sexuality and are more likely to have been taught from a young age that sexual activity is “saved for marriage” (Scull et al., 2020).
As a result, males tend to initiate sex at a younger age, likely due to the cultural double standard. Those who have sexual experiences at an earlier age tend to be more sexually active and incur more risky sexual behaviors (Scull et al., 2020). Siegel and Meunier (2019) found that cultural stereotypes influenced respondents’ sexual relations and the conception of sexual acts in the context of “domination–submission” (p. 1). Adolescent boys have been reported to more likely endorse unequal gender norms than girls (Amin et al., 2018). As per Amin, as boys grow older, peers appear to be very important in shaping and maintaining masculinity norms. Male peers may challenge each other physically or verbally, encourage risk-taking behaviors (such as substance use or unsafe sex), and practice sexual dominance over others. Peer relationships seem to reinforce traditional sexual stereotypes. Any breach of masculinity norms is punished by ridicule and intimidation (Amin et al., 2018; Kågesten et al.)
Unprotected Sexual Activity
Consistent with this study and as documented in other studies, females are known to have unprotected sex. Yi et al. (2018) assessed sexual behaviors among college students and found that females were significantly more likely to have unprotected sex. Dolphin et al. (2017) found females who reported body discontent also reported having less control during sexual activity and were more likely to defer to their partner regarding use of protection to avoid rejection.
Fairfortune et al. (2020) discovered that 67% of female students did not use condoms. Females under 20 years of age used condoms when first introduced to sexual intercourse, but condom use decreased as sexual experience increased. Those older than 20 years of age reported using condoms less frequently for their first sexual interaction, even though they used oral birth control for pregnancy prevention. Females who had sexual intercourse with experienced partners were more likely to use condoms out of fear of STI transmission. Alam et al. (2021) found that expression of relationship concerns and making decisions about condom use was suppressed for females, who were more often silenced and/or made to experience shame and guilt for requesting condom use, resulting in lack of power in their relationships and over their health.
Fehr et al. (2018) found males used condoms more regularly than females. Partners in an exclusive relationship indicated a high degree of trust in their partner to remain monogamous. (Fehr et al., 2018; Scull et al., 2020). Although the current study did not explore the type of protection used by students, future studies should focus on measures of prevention and sexual education for all genders.
Students may not value using protection because they feel safe knowing that free STI testing and Plan B contraception was available on campus. Understanding students’ viewpoints about the availability of STI testing, contraception, and unprotected sex needs further examination.
Multiple Partners
Findings from the 2018 ACHA-NCHA revealed that it was common for young adults to have multiple sexual partners within a 1-year period. This behavior increases the risk for contracting an STI and the potential to spread it to other students (ACHA-NCHA, 2018). Sexual well-being may require further exploration to understand if there is a relationship between lack of sexual satisfaction and multiple partners. The desire for multiple partners might be explained by the fact that many males were found to have more liberal attitudes about sex, which in turn were associated with an increased number of sexual partners. Young adults who initiate sexual activity at an early age have been found to exercise a higher frequency of sex and a greater number of multiple partners (Scull et al., 2020). As outlined in a systematic review by Kågesten et al. (2016), young adult males exhibit their sexual prowess by having multiple sexual partners and demonstrate dominance over their partners in relationships. Sexual education can empower young adults to make informed decisions about early intercourse.
Lifestyle Modification
By 2030, obesity in adults is estimated to increase by 50% due to diets low in fruits and vegetables and high in sugar (Opoku-Acheampong et al., 2018). Early identification of poor dietary behaviors can facilitate
Lack of knowledge pertaining to risky sexual behaviors may have influenced students’ prioritization of diet and exercise modifications instead of altering risky sexual practices.
change to promote health and prevent chronic illness. Fakhria et al. (2019) assessed college students’ perceptions toward physical activity and sedentary behaviors. Most students who chose to engage in physical activity wanted to improve their physical appearance, have fun, relax and socialize with peers, and decrease stress. Benefits of physical activity included improved physical appearance, concentration, self-assurance, and academic performance (Christianson et al., 2019). It may be that for these reasons students largely chose plans that supported exercise.
Using a Brief Action Plan to Change High-Risk Behavior
The current study supported the hypothesis that students would create an action plan to change a high-risk behavior. Most students were conscious of their poor diet habits, lack of exercise, and obesity, and chose to formulate an action plan to change their diet and begin an exercise program. Although students reported having multiple sexual partners and being deficient in using contraceptive protection, none of the participants chose to change these risky behaviors. Lack of knowledge pertaining to risky sexual behaviors may have influenced students’ prioritization of diet and exercise modifications instead of altering risky sexual practices.
Many students reported participating in the health screening out of concern for their health (n = 603, 41%). Screening for diabetes and hypertension among students with a family history of these issues was a common request. While family history of disease, BMI, and diet was not included in this study, students evidenced a great need to focus on diet and exercise through their choices.
Compliance With Safe Sexual Health Practices
Education on safe sex practices can help increase knowledge and compliance. Education includes discussion of sexual health facts, disease information, and ways students can take control of their sexual health. The most reliable way to avoid sexual disease is through abstinence, vaccinations, decreasing one’s number of sexual encounters, getting tested regularly and sharing results, agreeing to be sexually exclusive with one partner, having open and truthful discussions, and consistently using a condom every time engaging in anal, vaginal, or oral sex (CDC, 2020).
Educational Approach
Sexual health education requires a positive and respectful attitude toward both sexuality and sexual relationships and a holistic and genderneutral approach. It is evident that health education services are essential to providing holistic health care for college students, not only on campus,
but throughout the community (ACHA, 2020). Healthcare providers are in a privileged position to offer educational resources and programs that target risk misperceptions and address the ways students can be empowered to make safer sexual health decisions. This study found that 90% of students reported that they learned something new through the sex education provided during their screening for this study.
Among college students, identity, culture, and ethnicity determine the values, attitudes, beliefs, knowledge, and ways in which an individual communicates about health, sexuality, relationships, contraception, and pregnancy. Healthcare providers must have an awareness and a thorough understanding of the diverse and equitable needs of college campus students. Counseling that addresses personal risk, high-risk behaviors, and the use of individual action plan strategies, such as BAP, can assist in prevention and education about risky behaviors for diverse student communities (Bowman et al., 2018).
The study effect sizes were relatively small and future studies are warranted to replicate these results. Self-reported data may be influenced by social desirability bias. Data was collected from a small participant pool from one university making the study geographically limited. A convenience sample was used and is not as generalizable.
Implications for Nursing Practice and Research
This study identified many variables that place college-age students at risk for poor health outcomes. Assessment of college-age patients’ existing knowledge and beliefs is vital for all nurse practitioners and educators to employ, as it may help change a student’s belief system that their behaviors are inconsequential. Strategies such as the application of a health belief model to develop educational programs should be explored to avoid the consequences of unsafe sexual practices and improve students’ well-being.
Strengths and Limitations
This study highlighted the importance of student access to clinical preventative screenings, education, resources, and referrals. The sample size was 603 students, who voluntarily participated, with 75% of students agreeing to make changes in their lifestyle to improve identified risky behaviors other than high-risk sexual behaviors. The data suggest student assessment, family history, and interventions are essential to improving short- and long-term health outcomes. The PACE team unexpectedly identified unhealthy sexual practices in this population and educated student participants accordingly. Using the BAP model helped to close the educational gap, ultimately preventing disease for this diverse and vulnerable population.
This study lacked preassessment of students’ sexual health knowledge. Results of this study support the need to increase easy access to screenings that can support modifying students’ unhealthy practices.
Conclusion
PACE has effectively built a strong foundation for generating the delivery of screenings to improve the health outcomes of college-age students. This study has revealed that most college students between the ages of 18–24 engage in sexual activity, males tend to have more sex than females, one-third of the students have unprotected sex (more females than males), many have multiple partners, and the majority of those who are sexually active choose not to test for STIs. Students lack the predilection to change unhealthy sexual behaviors. There is a lack of understanding by the PACE team as to why this transpired. This study demonstrated that it is vital to understand campus students’ baseline beliefs about sexual health. Replication of this study using a larger sample to include appraisal of students’ knowledge about unhealthy behaviors and ensure that representation of the effects health education has on this vulnerable population is recommended.
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