Running Head: MEASURING KNOWLEDGE AND ATTITUDE

Will a Comprehensive Sexual Education

Program on Knowledge and Attitude of
Sexual Health among CSUSB College
Students change at-risk Sexual Behaviors?
Nicole Celera

Valentina Chawdhury

Jennifer Diaz

Cindy Mahoney

Marwa Mohamed

Abstract
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A large number of unwanted pregnancies, sexually transmitted infections (STI), and sexual

violence have been common themes surrounding college students. These themes have stemmed

from a lack of knowledge and attitude towards safe sex practices on college campuses. The

ability to evaluate if a comprehensive sexual education program on knowledge and attitude for

college students will reduce risky behavior, gaps in literature will be addressed. We anticipate

that there will be a need for a comprehensive sexual education program on an existing program

based on the lack of knowledge and attitude of sexual health among CSUSB college students.

With a randomized cluster sampling, the sample population will be CSUSB college students

using a random selection process of groups. Using a pre- and -post test, dependent variables

measured included race, age, and gender, knowledge of condom use, consent, contraception, and

reproductive health, and positive and negative variables of attitude.

Keywords: College students, knowledge, attitude, variables

Rationale/Background

College students who hook up under the influence of alcohol are at a high risk of sexual
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trasmitted infections (STI), unwanted pregnancies, and sexual violence (Berg et al., 2014).

Alcohol consumption and binge drinking are commonly involved in hook ups and are associated

with high levels of sexual risk taking (Downing-Matibag & Geisinger, 2009). Young adults are

likely to initiate sexual risk behaviors such as lack of condom use, drug or alcohol use prior to

intercourse, and excessive number of partners (Berg et al., 2014). One of many safe sex practices

involves consistent and proper use of a condom and other contraceptives, which potentially

protects an individual from many STIs. According to the Center of Disease Control (CDC), the

largest number of HIV infections are accounted for persons age 15-29 years old. Furthermore,

young adults aged 15-24 years old have the highest rates of STI of all age groups (Moore &

Smith, 2012). Almost half of newly diagnosed STIs are seen among those who are the age of

traditional college students 15-24 years (Wong,Pharr, Bungum, Coughenour, and Lough, 2018).

This increased prevalence may be due to the lack of proper condom use during sex and the lack

of STI and HIV testing among college students (Moore & Smith, 2012).

College students are frequently unsure of how STIs are transmitted or diagnosed, which

can make it difficult for young adults to protect themselves or discourage them from engaging in

risky sexual behavior (Moore & Smith, 2012). Previous studies have indicated that college

students are not aware of HIV transmission. For example, studies of Chinese college students in

China found that 15% to 35% of students were unaware that HIV transmission could be

prevented by using condoms (Chen et al., 2012; Maimaiti, Shamsuddin, Abdurahim, Tohti, &

Memet, 2010; Sun et al., 2012; Zhou et al., 2012).

Research indicates that the lack of sexual and reproductive health knowledge is one of

the main explanatory factors for the increase transmission of AIDS, STIs, and unintended

pregnancies, especially among young adults.(Zhang, Bi, Maddock, and Li, 2010). Risky sexual
MEASURING KNOWLEDGE AND ATTITUDE
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behaviors can negatively affect sexual health and increase the risk of infection from STIs,

especially if the lack of knowledge on sexual health exist (Wong,Pharr, Bungum, Coughenour,

and Lough, 2018).

Results from a previous studies indicated in the quantitative portion that students

perception on their self efficacy in using protection against STI varied based on the situational

context (Berg et al., 2014). The qualitative results demonstrated several emerging themes such as

partner trust, community trust, and lack of knowledge (Berg et al., 2014). Sexual consent plays

an important factor among partners’ trust and sexual health. Sexual consent is important as it

does prevent sexual assault (Jozkowski & Peterson, 2013).Three studies have examined how

consent is communicated among college students (Hall, 1998; Hickman & Muehlenhard, 1999;

Jozkowski, 2011). Results indicated that college students tend to indicate their consent most

frequently via nonverbal cues. For example, not saying no; not refusing partner’s advances.

Addressing the Gap

Due to an extensive gap in lack of knowledge and attitude in sexual health, it is important

to identify variables in relation to building a comprehensive sexual health education program for

college students. Multiple studies addressed college students’ knowledge regarding sexual health

information, specifically information regarding condom use, STI’s, and available resources.

Findings showed that sexually experienced students tend to be more knowledgeable than those

who report being sexually inexperienced, particularly regarding condoms (Moore & Smith,

2012). Individuals who are not having sex may be less interested in learning about STI

transmission and prevention methods than those practicing sex. Therefore, there is a need for

sexual health education programs for freshman, there are moderate rates of sexual activity with

low documented testing rates for STIs (Moore & Smith, 2012, Wyatt & Oswalt, 2014). Low
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numbers for STI testing on college campuses should be a health concern because individuals are

not getting the services they need. They might have contracted an infection, but because of the

lack of knowledge they may not know or not be knowledgeable in getting help and treatment.

Therefore, it is important to bring attention in which there is a need for specific related services

to colleges where students can use as a resource. Secondly, when measuring attitude, results

indicated that higher levels of self-efficacy relate to higher intentions to use condoms. By

increasing one’s belief in their ability to obtain, ask, and use condoms, safer sex practices

normalize behavioral intentions (Artistico et al. 2014). Findings showed that researching specific

variables on knowledge and attitude, may address the gap in helping destigmatize condom use,

as well as providing resources to college students through proper health education programs.

Research Goal

The purpose of this study is to evaluate if a comprehensive sexual education program on

knowledge and attitude of sexual health among CSUSB college students reduce sexual health

risks and increase sexual health knowledge among college students.

Research Hypothesis

We anticipate that there will be a need for a comprehensive sexual education program on

an existing program based on the lack of knowledge and attitude of sexual health among CSUSB

college students.

Methods

The sample population are college students who are currently enrolled full- or part-time

at California State University, San Bernardino (CSUSB). With randomized cluster sampling as

our method, data is collected from a random selection of groups that represent the sample

population. Inclusion and exclusion criteria include CSUSB students that are at least eighteen
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years of age. The dependent variables are knowledge on condom usage, consent, contraception,

and reproductive health and attitude, either positive or negative, of CSUSB students. The

independent variable for this study is sexual education. Data on socio-demographic

characteristics such as age, gender, and race are confounding variables. These variables are

present in the survey to analyze how these confounders changes the effect of the dependent and

independent variables. Data was collected by pre- and post-surveys; therefore, the research

design is categorized as a longitudinal study. The survey will be administered prior to the

beginning of the comprehensive sexual health education program. After the quarter (10 weeks) is

over, the same survey will be administered as a post-survey, to assess any change in knowledge

and attitude. Data is categorized as primary data due to researchers collecting data firsthand. IRB

approval will be needed to ensure the survey used for this program is appropriate. Participants

are informed verbal consent prior to taking the surveys. A sample of the survey can be found in

Appendix A of this document.

Health Implications

Further research is needed to explore the connection between increased knowledge and

intent to practice safer sex behaviors and the actual practice of safer sex behaviors after exposure

to comprehensive sexual health education. With spreading awareness on safe sex practices to

students of diverse cultures, it is essential to diminish possible misconceptions. Individuals who

possess strong cultural beliefs are likely to have misconceptions of the need for contraceptives.

For instance, some cultures believe any type of sexual act is wrong before marriage, which is

considered a sin. They are key determinants of poor uptake of contraceptives. Additionally, It is

important that STI prevention interventions for college students incorporate drug and alcohol

education, particularly in the context of sexual activity. Promoting this issue is vital considering
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the population being dealt with as students are affected by this issue because they are not in the

right state of mind when engaging in sexual activities when under the influence. This may impact

their decision making skills and refrain one from asking or consenting to any sexual activity,

risking students to contract STI’s and unwanted pregnancies. Furthermore, it is evident that there

is a need for a comprehensive sexual health education program on the CSUSB campus. A great

number of students shared that purchasing condoms is embarrassing, therefore this tailors into

their attitude on this topic which can insinuate they are not practicing safe sex. This sexual

education program will increase the knowledge and attitude of sexual health among students,

which is significant to the public health field in order to decrease the rate of unwanted

pregnancies and STIs.

Appendix A: Survey Sample

The purpose of this survey is to assess if a comprehensive sexual education program on

knowledge and attitude of sexual health among CSUSB college students change at-risk
behaviors. By filling out the questionnaire, you are voluntarily agreeing to participate. Be aware
that this survey requests the discussion of personal sexual practices and may be uncomfortable.
If for any reason you feel uncomfortable, please let the survey administrator know and you will
be excused without penalty.

This survey will take approximately 5 minutes to complete.

INSTRUCTIONS:
Please read each question or statement carefully, check responses legibly.
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1. What is your biological sex?
▢ Male
▢ Female

2. What is your age?

▢ 18-24 years old
▢ 25-29 years old
▢ 30 years old and older

3. What is your race?

▢ Latino/Hispanic
▢ Asian/Pacific Islander
▢ African American
▢ Caucasian
▢ Other: _________________

4. Do you know what your at-risk sexual behavior is?

▢ Yes
▢ No
▢ Not sure

5. Can you identify two or more forms of contraceptive methods?

▢ Yes
▢ No

6. How confident are you in your ability to define sexual consent?

▢ Very confident
▢ Fairly confident
▢ Confident
▢ Slightly confident
▢ Not confident

7. How important is it for both parties to understand sexual consent before any
sexual activity?
▢ Very important
▢ Fairly important
▢ Important
▢ Slightly important
▢ Not important
8. Have you ever been tested for an STI?
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▢ Yes
▢ No
▢ Not Applicable
9. You do not need a condom if you do not have a lot of sexual partners.
▢ True
▢ False
10. It is embarrassing to purchase condoms.
▢ Yes
▢ No
11. How much do you understand the benefits and importance of sexual and
reproductive health?
▢ Very understanding
▢ Fairly understanding
▢ Understanding
▢ Slightly understanding
▢ Not understanding

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