Download Jeanne Hernandez, Frank Smith 1990

JOURNAL OF ADOLESCENT HEALTH CARE 1990;11:295-297
BRIEF SCIENTIFIC REPORT
JEANNE
T. HERNANDEZ,
Ph.D.,
p-
AND FRANK J. S
College students are often viewed as being at high risk
for human immunodeficiency virus (l-W) infection, due
to their needs to engage in exploratory behavior and their
needs for peers’ social approval, and their sense of invulnerability. The Rroportion of adolescents who are sexually active is known to be relatively stable; however,
the amount of unsafe sex taking place on the college
campus is still in question, as well as the relationship
between dating patterns and HIV-risk behavior. In this
study college students’ self-reports of sexual and dating
practices were related to sexual frequency and condom
use. The results highlight the amount of unprotected sexual behavior in the college group and the difficulty in
assessing adolescents’ risk of HIV transmission on the
basis of self-reported sexual activity and dating behavior.
Key issues to target in educating college students about
WIV infection are the roles of planning and spontaneity
in dating and the fact that inaccurate self-perceptions of
monogamy an& abstinence may lead them to assume
falsely that they are safe from sexually transmitted
diseases.
KEY WORDS:
HIV infection
AIDS
Sexually transmitted disease
Given the importance of preventing the spread of
human immunodeficiency
virus (HIV) infection,
new studies are providing information on the sexual
behaviors of the population at large (1) and on target
groups in particular (2). The sexual activity patterns
From the Department of Psychiutry, University of North Carolirra
School of Medicine, Chapel Hill (1.T.H.L and the Deparfment of Psy&ology, North Carolina State University, Raleigh fF.J.S.J.
Address reprint requests to: Dr. J.T. Henlmndez, Department of
Psychiatry, University of North Carolina, School of Medicine, CB
#7160, Chapel Hill, NC 27514-7160.
Manuscript accepted ]uly 25, 1989.
of adolescents and young adults are of particular
interest because the majority of AIDS patients are
young adults, and the lag time between the transmission of HIV and the presentation of symptoms
suggests that many are infected as adolescents. Furthermore, it may be more effective to assist young
people in the formation of healthy behaviors before
unhealthy patterns are established (3). Recent reports conclude that even though adolescents possess
at least moderate knowledge of disease transmission
and symptoms (4), they underestimate the personal
relevance of acquired immunodeficiency syndrome
(AIDS) (5) an d are still not protecting themselves
appropriately (6). Designed to test the effects of
AIDS education programs on college students’ inteiltions and behaviors, our research allowed us to
compare self-reports of sexual and dating practices
with sexual frequency and condom use. The results
reveal the amount of unprotected sexual behavior
in one college sample and the difficulty in assessing
adolescents’ risk of HIV transmission on the basis
of self-repor% sexual activity and dating behavior.
Methods
Three hundred eighty-eight student volunteers from
two Southeast state university campuses took part
in this study and received credits in an Introductory
Psychology class. Subjects were scheduled for participation in groups of approximately 20. When the
students reported for the experiment on AIDS education, they were asked to complete a preprogram
questionnaire that asked about their sexual orientation: whether or not they were sexually active;
whether or not they had beer in a monogamous
relationship in the past 2 years; whether they were
dating,one or more people; and whether or not they
were interested in dating different people. Subjects
8 Society for Adokent Medicine, 1990
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HERNANDEZANDSMITH
were also asked questions about their sexual activity
and contraceptive behavior over the previous 23
weeks (since the beginning of the previous semester). Anonymity and veracity were guaranteed in
several ways: students did not use their names on
the form; they were seated so that others could not
read their answers; the room was monitored to prevent talking and the consent form, guaranteeing
confidentiality of the questionnaire results, was read
out loud by the researcher before the subjects signed
it. These data were collected on the first of two visits
for all subjects. The attrition rate was only 5%, which
suggests that students’ commitment to the study
was excellent. (Students knew that they would be
questioned about sexual behavior and attitudes and
agreed to answer as truthfully as possible or not
at all,)
Results
The sample was 55% male and 85% Caucasian. The
proportion
: .r la-, 19-, 20-, and 21-year-old students
was 2796, 36%,22%, and 15%, respectively. Eighty
percent of the subjects were students at a campus
in a large urban setting, where 62% live off campus.
The other 20% were students at a campus in a
smaller urban setting.
Ten percent (41) reported being personally involved in a pregnancy, and 8% (32) reported having
a previous or existing sexually transmitted disease
(STD). One percent (4) of the sample said that they
were bisexual, and 1.5% (5) admitted to being homosexual. These reports of homosexuality and bisexuality are similar to another recent self-report
study (7). The report of pregnancy and previous STD
were similar to the prevalence rates estimated from
university student health service data (J. Cowan,
pers. comm.). Previous experience with a pregnancy
or an STD did not appear to deter students from
sexual activity; those students were significantly
more likely to be sexually active (n [368] = -2.46,
p < 0.01) and significantly less likely to use condoms
than their counterparts.
Fifty-one percent (199) reported currently dating just one person. Of those, 83% (165) were sexually active, and 44% were still interested in
dating different people. Overall, 67% (260) said
that they were sexually active (59% of these were
male). These findings are consistent with other research (8). There were 38 previous pregnancies reported in the sexually active group (15%) and 3
(3%) in the inactive group. Eleven percent of the
active group and 3% of the inactive group re-
JOURNAL OF ADOLESCENT HEALTH CARE Vol. 11, No. 4
ported an STD. Twenty-seven percent (34) of the
inactive group reported abstaining from sex because of the danger of AIDS.
Forty-six percent of those who considered themselves sexually inactive said that they had at least
one sex partner during the previous 23 weeks, with
20% having more than one partner. Three percent
of the sexually active group reported having no partners. Sixty percent of the active group and 20% of
the inactive group had more than one partner.
Thirty-seven percent (96) of the active group and
15% (19) of the inactive group ha.d picked up someone for sex during the 23-week period, and 24% of
the active group and 7% of the inactive group did
so more than once.
Three percent of the sexually active group reported abstaining during the previous 23 weeks,
whereas 56% had sex with more than one person.
Ten percent had more than one ongoing sexual relationship. Sixty-two percent said that they were
dating just one person at the time of the questionnaire. Thirty-nine percent (101) of the sexually active
group carried a condom during the 23 weeks, as did
28% (36) of the sexually inactive group. Seventythree percent of the sexually active students reported using a condom during that time, with 35%
using condoms regularly.
Forty-eight percent (187) reported that they
were “dating around now or interested in doing
so.” Interest in dating, however, did not indicate
sexual activity any more than any other categorization. Fifty-seven percent (106) of the interested
group stated that they were sexually active,
whereas 77% (154) of those who were not interested in dating different people were also sexually active. The majority of those reporting a
monogamous relationship (81%) were not interested in dating different people.
Seventy-one percent (153) of the males and
62% (107) of the females reported being sexually
active. An equal proportion of men and women
(58%) had used a condom during the previous 23
weeks. Three percent (5) of the women and 20%
(43) of the men carried a condom much of the
time or all of the time. Overall, there were more
men (52%) than women (38%) with multiple partners, more women (41%) than men (2%) with
only one partner, and a similar percentage of
men (19%) and women (21%) with no partner.
Thirty-five percent (75) of the men and 7% (13) of
the women said that on a date they used alcohol
or drugs, enough to have their judgement impaired one or more times a month.
July 1990
Discussion
AIDS education is still a critical need on the college
campus for the minority of college students who are
putting themselves at risk by their sexual behavior
and for those who may in the future. Some students
did not appear to learn from a past experience, as
unplanned or at least unscheduled sex is not uncommon, and many who generally use a condom
do not always use one. There were 68 sexually active
students who were not serially monogamous and
were interested in dating different people. Of those,
80% had had more than one sex partner, and only
25% had used a condom during the previous 23
weeks. Of greatest concern were the 34 sUents
who were sexually active with multiple partners and
who were still not using a condom, even after the
experimental AIDS program presentations. They
represented 9% of this sample. What differentiates
these 34 students from the 91 sexually active students who used a condom regularly and from the
69 students who were abstinent is unclear and therefore an important subject for future study.
The highlights of this study help to clarify the
relationships among perceived and actual dating
patterns and sexual behaviors. Self-report of sexual
inactivity did not predict abstinence, interest in dating different people, monogamy, or sexual orientation. One correlate was noteworthy: Students who
reported that they were sexually inactive were significantly more likely than their counterparts to say
that they would abstain during the upcoming month
(n [386] = - 17.33, p < 0.01). Apparently, perception
of oneself in the present depends on one’s expectations for the future as much as on one’s recollections of the past, i.e., a self-report of sexual activity
may be time bound or mood specific. When AIDS
educators-teachers,
physicians, or others-know
the sexual and dating patterns of their audience,
they can target behaviors and attitudes more specifically in their educational message. The findings
from this study may serve as a guide to more applied
AIDS education work. For example, key attitudes to
target in AIDS education are the roles of planning
and spontaneity in dating, and the self-perception
of monogamy and abstinence, which are not always
consistent and could lead young people to assume
AIDS-RISK DATING BEHAVIOR
297
falsely that they are safe from STD. The often conflicting responses among the categories of dating
and sexual behavior suggest that researchers, programmers, and service providers need to ask about
specific behaviors and blocks of time when using
young people’s self-report to design or target edncation programs. Inconsistencies in attitudes and behavior may be a productive area for open discussions
with adolescent audiences.
Generalization of the results of our study to 18to 21-year-old subjects who live in AIDS epicenters
or in other areas of the country, or do not attend
college should be made with caution. Southernstate
university students’ attitudes toward sexual behavior, or their abilityto discuss those attitudesopenly,
-maybe different than that of their peers in other
circumstances. _Althoughthe percentages of behaviors may be different, it is probable that misperceptions about safe dating and monogamy that occur
among this sample of better educated and less vulnerable students are present in other adolescent
groups as well.
References
1. Leads from the Morbidity and Mortalitv Weeklv Reoort. Number of sex partners and potential risk of sexual exposure to
human immunodeficiincy virus. JAMA 1988; 260(14):2020-l.
2. National Institute of Mental Health (NIMH). Program announcement: Research on behavior change and prevention
strategies to reduce transmission of human immunodeficiency
(HIV). Rockville, MD: AIDS Program Office, NIMH. September, 1988.
3. Hochbaum GM. Health behavior. Belmont, CA: Wadsworth
Publishing, 197043-54.
4. Goodwin MP and Roscoe B. AIDS: Students’ knowledge and
attitudes at a midwestern university. J Am COBHealth Assor
1988; 3621422.
5. McCleary K. Students believe they won’t get AIDS. In The
National College Newspaper, February, 1988,4U.
6. Kegeles SM, Adler NE, and Irwin CE. Sexually active adolescents and condoms: changes over one year in knowledge,
attitudes, and use. Am J Public Health, 1988; 78(4):460-l.
7. Hingson R, Strunin L, Craven DE et al. Survey of AIDS knowledge and behavior changes among Massachusetts adults.
Presented at the 116th Annual American Public Health Association Meeting, Public Health Education Section, Boston,
MA, November, 1988.
8. Lester, LF and Leach JH. College student behavior: a ten-year
look. J Am COB Health Assoc 1983; 31(5):209-13.