Quasi-experimental Evaluation of Safe Sex Practices among CSUSB College Students:

Knowledge, Attitudes, and Self-Efficacy Behaviors

Nicole Celera, BS, MPH(c), Valentina Chawdhury, BS, MPH(c), Jennifer Diaz, BS, MPH(c),

Cindy Mahoney, BS, MPH(c), Marwa Mohamed, BS, MPH(c)

Department of Health Science, California State University of San Bernardino

Keywords: CSUSB college students, stealthing, survey, consent, knowledge, attitude

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TABLE OF CONTENTS

1. Abstract …………………………………………………………………………..…page 2

2. Background …………………………………………………………………………page 3

3. Methods …………………………….……………………………………..………page 4-5

4. Results ……………………………………………………………………….……page 5-6

5. Discussion ………………………….………………………………….………….page 7-8

6. References ………………………….……………………………………..………...page 9

7. Appendix ………………………….…………………………………………....page 10-25

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ABSTRACT

The purpose of this study was to evaluate knowledge, behavior, and self-efficacy of safe

sex practices among CSUSB college-students. A twenty-five-question survey was developed and

given to a sample size of HSCI 315 of CSUSB college-students. Student participants were given

both a pre- and post-test surveys in which it was comprised as a quasi-experimental approach in

order to evaluate the different components of safe sex practices. All analyses were conducted in

SPSS version 24 and significance was set at p less than .05. 72% of participants did not know

the meaning of stealthing. After viewing the public service announcement, 100% of study

participant were aware of the stealthing concept. The results of the safe sex practices study reveal

that the usage of a public service announcement given to CSUSB college-students was effective

in measuring safe sex practices. Although the study sample was limited to a small sample size,

further studies may be done on a larger scale in providing more data to advance safe sex

education on college campuses.

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Background

Sexually active students at California State University of San Bernardino (CSUSB) not

practicing safe sex methods are at risk for unwanted pregnancies and exposure to sexually

transmitted infections (STIs). Furthermore, students not practicing safe sex methods can become

victims of stealthing, a new trend in which the condom is removed during intercourse without the

consent of the partner, which can lead to stress, physical and emotional harm. The need of an STI

and safe sex practice health education intervention program among college students at CSUSB is

vital because STI rates in San Bernardino County are significantly high among 15-25 year olds.

According to the County of San Bernardino Department of Public Health, “The United States has

the highest prevalence of sexually transmitted diseases in the developed world. San Bernardino

County ranks 16th in chlamydia cases, 25th in gonorrhea cases, and 41st in syphilis cases in all of

the United States in 2015.” According to the CSUSB Health Center data, in 2017-2018 there

were a total of 88 cases of patients with positive STI screening, which included 56 cases of

chlamydia. To decrease STIs and unwanted pregnancy rates while encouraging students’ sexual

safety, a PSA was shown to CSUSB students along with the use of pre and post-surveys. The

main purpose of this evaluation was to assess the knowledge, attitude, and self-efficacy

behaviors of CSUSB students. As such, the research question discussed within this context is

“What is the level of self-efficacy, knowledge, and attitude for safe sex practices among college

student at CSUSB?”
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Methods

Data Source

We undertook an quasi-experimental evaluation approach where quantitative data was

analyzed. Survey questions were developed to understand the knowledge, attitude, and practice

of consent and safe sex practices. College students from a four-year university were selected as

study participants from the Health Science 315 courses at California State University, San

Bernardino. The Health Science 315 courses gave out extra credit incentives for participants that

participated. Data was collected in one phase: survey questionnaires. Participants were assigned

to an intervention and given pre and post-test survey that included both open and closed ended

questions to assess their knowledge, attitude, and practice on consent and safe sex practice.

Participants were aware that survey requests the discussion of personal sexual practices and may

be uncomfortable, if participants felt uncomfortable, they were excused without penalty.

Variables

There are a total of 25 questions in our “Consent and Safe Sex Questionnaire”. There are

20 pre-test items and 5 post-test items. These questions were qualitative and predominantly

closed-ended questions, with the exception of one post-test question that was open-ended. All

questions in the pre- and post-surveys were categorized. The categories of questions included

demographics, knowledge, attitudes, and practices. The pre-test has a five-item 2-3-5 point

Likert scale on demographics. This was developed to understand the sex, age, race, education

level, and relationship composition of the participants. A five-item 2-3-5 point Likert scale was

developed to assess the knowledge of consent and safe sex practices. A five-item 2-5 point Likert

scale was created to measure participants’ attitudes on the subject. The last five-item 2-3-5 point
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Likert scale in the pre-test aimed to assess current practices relating to consent and safe sex

practices.

Data Analyses

Quantitative data from survey questionnaire were input into SPSS software for analyses.

The Quasi-experimental evaluation of safe sex practice among CSUSB college students:

knowledge, attitudes, and self-efficacy behaviors used frequencies and chi- square statistics

analysis were used to formulate and analyze differences before and after the intervention. All

analyses were conducted in SPSS version 24 and significance was set at p less than .05.

Results

Descriptive Data

Demographics information

The demographics information on STI testing on sex resulted in 76% females and 24%

were male participants (See Appendix B). Out of 25 participants, the data shows that 13 females

in the sample do not get tested for sexually transmitted diseases (STIs), while also including 5

males who do not (72% vs. 28%). There were two age groups being compared, 19 students were

of ages 18-24 and 6 students were of ages 25-29 (see Appendix C). Out of the 25 participants,

there were 14 students who did not get STI testing from ages 18-24 and only 4 out of the 25-29

age group did not hence, the majority of the sample population was 18-25 years old (76%).

Lastly, there is a vast difference in age for those who do not get tested for STIs. The

demographics of race/ethnicity and usage of condom was examined. Out of the 25 participants,

the majority of individuals who did not practice condom usage when engaging in sexual

intercourse were Latino/Hispanic compared to the other races that were asked.
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Bivariate Data

Descriptive Statistics: Attitude (See Appendix D and Appendix E)

Our Define Sexual Consent table shows the frequency of responses in pre- and post-

tests. There is a significantly higher percent of participants who reported very confident or fairly

confident in post-tested to defining sexual consent as compared to our pre-test, though it did not

reach significance (70% vs. 48%, p> .05) and no interpretation as to why. Similarly, a higher

percent reported very confident or fairly confident in how to use a condom in post-test as

compared to pre-test.

Descriptive Statistics: Knowledge (See Appendix F, Appendix G and Appendix I)

16% of participants were resulted when incorrectly answering when the way a person

dresses, smiles, looks, or acts is an indication of the desire to have sex, while 64% reported that

the way a person dresses, smiles, looks, or acts is not an indication of the desire to have sex. 72%

participants reported that they did not know the meaning of stealthing, 8% reported that they

knew the meaning of stealthing and 20% reported not sure. After viewing the PSA, 100% of the

participants understood the meaning of stealthing.

Descriptive Statistics: Self-efficacy (See Appendix H)

Based on the data analysis on self-efficacy of our sample population, it was found that the

p value was less than .05, thus expressing a significance. There was an increase of self-efficacy

from slightly confident, confident, and fairly confident when participants were asked about how

to use a condom. The self-efficacy increased to 100% after the intervention.

Survey Validation

A survey validation was not ran and it was the first survey because it was a pilot survey.
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Discussion

Data Interpretation

Data presented more female than male participants and that more females do not get

tested for STIs. This may be due to more females attending CSUSB than males (Facts and Stats).

The majority of participants are 18-24 years old which aligns with the typical age of

undergraduates and within that age group, 14 out of 19 students do not get tested for STIs. The

majority of CSUSB students are Latino/Hispanic (Facts and Stats). In this study, most are

Latino/Hispanic and do not practice condom usage during sexual activity.

For our data on attitude, we did not have both pre- and post-survey questions. Since there

is no comparison, there is no significant results. After the intervention, 100% of the participants

understood the meaning of stealthing. However, during the data collection, knowledge did not

display statistical significant data. We need to decipher what may be the cause. Self-efficacy had

statistical significance, which shows that the intervention helped increase the participant’s self-

efficacy for condom usage.

There is no data to interpret for a survey validation.

Limitations

The limitations of the overall data analysis are the small sample size and narrow sample

of college students attending CSUSB. Most participants are Latino/Hispanic, females, and all are

health science majors. This may play a role in affecting data analysis, since this sample’s results

may not necessarily represent the overall consensus of the study population accurately. Results

on knowledge did not display significant data and we did not have both pre- and post-survey

questions on attitude.
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Future Directions and Implications

Health promotion programs need to ensure consent is a priority before presenting

sensitive and personal material, a broader sample selection for a more true sample size for

CSUSB students would be beneficial for future projects, and CSUSB’s health center needs to

emphasize and educate college students on sexual health practices.

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References

Facts and Stats | CSUSB [Internet]. [cited 2019 Mar 20]. Available from:

https://www.csusb.edu/about-csusb/facts-and-stats

Sexually Transmitted Diseases | Department of Public Health [Internet]. [cited 2019 Mar 20].

Available from: http://wp.sbcounty.gov/dph/programs/cds/stds/

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Appendix A
Table 1
Chi-Square Tests

Value df Asymptotic Significance (2-

sided)

Pearson Chi-Square 13.839a 4 .008

Likelihood Ratio 12.758 4 .013

Linear-by-Linear Association 6.572 1 .010

McNemar-Bowker Test . . .b

N of Valid Cases 25

a. 8 cells (80.0%) have expected count less than 5. The minimum expected count is .16.

b. Computed only for a PxP table, where P must be greater than 1.

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Appendix B

Figure 1
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Appendix C
Figure 2
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Appendix D
Figure 4
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Appendix E
Figure 5
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Appendix F
Figure 6
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Appendix G
Figure 7
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Appendix H
Figure 8
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Appendix I

Figure 9
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Appendix J

Data Dictionary

Consent and Safe Sex Practice

Pre and Post-Test
January 22, 2018

Adult Respondents Age 18 and Older

Contact:
California State University San Bernardino
5500 University Parkway,
San Bernardino, CA 92407

Collaborating Agencies:

CSUSB Student Health Center

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Table of Contents
SECTION A- Demographics…………………….…………………………………………....1
SECTION B- Health Knowledge…………………………………………………………...3-
4
SECTION C- Heath Practice……………………………………………………………….5-6
SECTION D- Health
Attitude………………………………………………………………….7

INSTRUCTIONAL NOTE:

A = Pre-test
B = Post-test
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SECTION A- DEMOGRAPHIC INFORMATION

Q1A
What is your biological sex?
Male = 1
Female = 2

Q2A
What is your age?
18-24 years old = 1
25-29 years old = 2
30 years old and older = 3

Q3A
What is your race?
Latino/Hispanic = 1
Asian/Pacific Islander = 2
African American = 3
Caucasian = 4
Other: ______= 5

Q4A
What year of schooling are you currently in?
First year = 1
Second year = 2
Third year = 3
Fourth year = 4
Fifth year + = 5
Q4A
What is your relationship status?
Single = 1
Married = 2
In a relationship = 3
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SECTION B- HEALTH KNOWLEDGE

Q6A
How confident are you in your ability to define sexual consent?
Very confident = 1
Fairly confident = 2
Confident = 3
Slightly confident = 4
Not confident = 5
Q7A
Do you know what stealthing is?
Yes = 1
No = 2
Not sure = 3
Q9A
I am aware of the available resources on campus to receive STI testing,
free condoms, and/or contraceptives, etc.
Yes = 1
No = 2
Q10A
I understand the emotional distress that results from stealthing.
Yes = 1
No = 2
Not sure = 3
Q1B
After viewing the PSA, how confident are you in your ability to define sexual consent?
Very confident = 1
Fairly confident = 2
Confident = 3
Slightly confident = 4
Not confident = 5

Q2B
After watching the PSA, do you understand what stealthing is?
Yes = 1
No = 2

Q3B
After watching the PSA, I understand the emotional distress that results from stealthing.
Yes = 1
No = 2
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Q6B
What were the most impactful takeaways from the PSA?
Learned Stealthing = 1
Learned how to use a condom = 2
Importance of STI testing = 3
Learned how to define consent = 4
Identify contraceptive methods = 5
Identify resources = 6
Negative effects of stealthing = 7

SECTION C- HEALTH PRACTICE

Q8A
Can you identify two or more forms of contraceptive methods?
Yes = 1
No = 2

Q13A
It is embarrassing to purchase condoms.
Yes = 1
No = 2

Q14A
Having sex without a condom is not important.
Strongly agree = 1
Fairly agree = 2
Agree = 3
Slightly agree = 4
Do not agree = 5
Q15A
You do not need a condom if you do not have a lot of sexual partners.
True = 1
False = 2
Q16A
I am fully confident on how to properly use a condom.
Very confident = 1
Fairly confident = 2
Confident = 3
Slightly confident = 4
Not confident = 5
Q17A
Do you always check the expiration date of a condom prior to usage?
Yes = 1
No = 2
Not applicable = 3
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Q18A
During sexual activity I always use a condom.
Yes = 1
No = 2
Not applicable = 3

Q19A
Consent is always communicated between me and my sexual partner(s) prior
to any sexual activity.
Yes = 1
No = 2

Q20A
Have you ever been tested for a sexually transmitted infection?
Yes = 1
No = 2

Q4B
After watching the PSA, how important is it for both parties to understand
sexual consent before any sexual activity?
Very important = 1
Fairly important = 2
Important = 3
Slightly important = 4
Not important = 5

Q5B
After watching the PSA, I am fully confident on how to properly use a condom.
Very confident= 1
Fairly confident=2
Confident= 3
Slightly confident= 4
Not confident= 5

SECTION D- HEALTH ATTITUDE

Q11A
Is the way a person dresses, smiles, looks, or acts an indication of the desire to have
sex?
Yes= 1
No= 2
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Q12A
How important is it for both parties to understand sexual consent before any
sexual activity?
Very important = 1
Fairly important = 2
Important = 3
Slightly important = 4
Not important = 5