Using Social Cognitive Theory to Explore the Influence of Sexual Health Education on Young Adults Open Access

Phillips, Ashley Laura (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/9z9030850?locale=en
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Abstract

Introduction. While 15-24 years olds are only 25% of the sexually active population in the U.S., they make up half of new sexually transmitted infections (STIs). Young adults face barriers to adopting positive sexual health behaviors--condom use, STI testing, partner communication--and receive sexual health education from multiple sources. Utilizing the Social Cognitive Theory, the current study assessed relationships between personal determinants (knowledge, self-efficacy), environmental determinants (education source, receipt of education before or after first sexual encounter), and behavioral determinants (condom use, STI testing, partner communication) to better understand the effects of different educational sources on young adults' sexual health behaviors.

Methods. This was a cross-sectional study of sexually active 18-24 year old college students and graduates. Data was gathered via on online survey on participant demographics, determinants of sexual health, and being from the Southern vs. non-Southern U.S.

Results. 272 individuals completed this study. Education from parents, friends, and doctors were each associated with condom use self-efficacy, STI testing knowledge, and STI testing behavior. Education from parents and doctors were each associated with STI testing self-efficacy and partner communication about STI testing and condom use, respectively. Education from doctors, as well as from a class or program in college, was associated with condom use during vaginal sex. The total number sexual health education sources was associated with condom use self-efficacy, STI testing knowledge, STI testing self-efficacy, and partner communication about STI testing behavior. In turn, condom use self-efficacy, STI testing knowledge, and STI testing self-efficacy were each associated with partner communication about STI testing and STI testing behavior. Finally, those from the Southern U.S. were more likely to have had an STI and received sexual health education from friends before their first sexual encounter, and less likely to have received sexual health education from middle or high school.

Implications. Initiatives to improve sexual health knowledge and self-efficacy should encourage doctors and parents in particular to educate their patients and children. Young adults appear to understand risk behaviors, but need to be given the tools they need to reduce risk through reinforcement from multiple different educational sources.

Table of Contents

Table of Contents

Background....................................................................................................................................................................................... 1

Introduction................................................................................................................................. 3

Sexual Health among Young Adults..................................................................................................3

Social Cognitive Theory and Young Adults' Sexual Health............................................................................. 4

Personal Determinants of Healthy Sexual Behavior............................................................................................. 8

Environmental Determinants of Healthy Sexual Behavior......................................................................... 10

Gaps in the Literature................................................................................................................................................................... 17

Research Questions & Hypotheses.................................................................................................................................... 17

Methods....................................................................................................................................... 21

Study Design.......................................................................................................................................................................................... 21

Study Participants............................................................................................................................................................................ 21

Measures................................................................................................................................................................................................... 22

Participant Demographics......................................................................................................................................................... 22

Personal Determinants................................................................................................................................................................ 23

Behavioral Determinants........................................................................................................................................................... 26

Environmental Determinants................................................................................................................................................ 28

Analysis....................................................................................................................................... 30

Research Question 1....................................................................................................................................................................... 31

Research Question 2....................................................................................................................................................................... 31

Exploratory Aim.................................................................................................................................................................................. 34

Results......................................................................................................................................... 35

Participant Demographics......................................................................................................................................................... 35

Personal Determinants................................................................................................................................................................ 37

Behavioral Determinants........................................................................................................................................................... 40

Environmental Determinants................................................................................................................................................ 41

Research Question 1....................................................................................................................................................................... 46

Research Question 2....................................................................................................................................................................... 53

Exploratory Aim.................................................................................................................................................................................. 70

Discussion.................................................................................................................................. 76

Research Question 1....................................................................................................................................................................... 76

Research Question 2....................................................................................................................................................................... 83

Reciprocal determinism............................................................................................................................................................... 94

Exploratory Aim.................................................................................................................................................................................. 95

Strengths & Limitations............................................................................................................................................................... 97

Conclusion.................................................................................................................................. 98

Implications & Future Directions........................................................................................................................................ 98

References................................................................................................................................ 101

Appendix A: Participant Survey................................................................................................ 1

Tables & Figures

Figure 1. Schematic of triadic reciprocal causation in Social Cognitive Theory........................... 2

Figure 2. Fictional example of reciprocal determinism in sexual health........................................... 6

Table 1. Participant Demographics.................................................................................................................................. 36

Table 2. Self-Efficacy..................................................................................................................................................................... 38

Table 3. STI Knowledge.............................................................................................................................................................. 39

Table 4. Condom Use Behavior and Partner Communication................................................................. 41

Table 5. Condom Use Education Source and Temporality......................................................................... 42

Table 6. STI Testing Education Source and Temporality............................................................................. 43

Table 7. Partner Communication Education Source and Temporality............................................ 45

Table 8. Partner Communication Education Effectiveness........................................................................ 46

Table 9. Bivariate Associations between Condom Use Education Source & Personal Determinants of Sexual Health 49

Table 10. Bivariate Associations between Number of Condom Use Education Sources and Personal & Behavioral Determinants 50

Table 11. Bivariate Associations between Number of STI Testing Education Sources and Personal & Behavioral Determinants 52

Table 12. Bivariate Associations between Number of Partner Communication Education Sources and Personal & Behavioral Determinants.................................................................................................................................................................................................. 53

Table 13. Bivariate Associations between Personal & Environmental Determinants and Condom Use Behavior 55

Table 11. Bivariate Associations between Personal & Environmental Determinants and STI Testing Behavior 58

Table 15. Bivariate Associations between Personal & Environmental Determinants and Partner Communication Behavior 61

Table 16. Demographics and Personal & Environmental Determinants' Associations with Condom Use Behavior During Vaginal Sex: Multiple Linear Regression.................................................................................................................................................... 64

Table 17. Demographics and Personal & Environmental Determinants' Associations with STI Testing Behavior: Multiple Logistic Regression.................................................................................................................................................................................................. 67

Table 18. Demographics and Personal & Environmental Determinants' Associations with Partner Communication about Condom Use Behavior: Multiple Linear Regression................................................................................................... 68

Table 19. Demographics and Personal & Environmental Determinants' Associations with Partner Communication about STI Testing Behavior: Multiple Logistic Regression........................................................................................................................... 70

Table 20. Bivariate Associations between Geography & Participant Characteristics......... 70

Table 21. Bivariate Associations between Geography & Personal Determinants.................. 72

Table 22. Bivariate Associations between Geography & Behavioral Determinants............. 73

Table 23. Bivariate Associations between Geography and Environmental Determinants 75

Table 24. Significant Associations between Environmental and Personal Determinants of Sexual Health 82

Table 25. Significant Associations between Personal and Environmental Determinants and Behavioral Determinants of Sexual Health 93

Figure 3. Significant Instances of Reciprocal Determinism........................................................................ 95

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