721 Final Thesis Body For Portfolio (Jackson, Cheryse)

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS
Risky Sexual Behaviors among Nursing Students at a Historically Black University
by
Cheryse Jackson
Coppin State University

A Thesis Paper Submitted to the Faculty of the School of Graduate Studies of
Coppin State University in Partial Fulfillment of the Requirements for the
Degree of Master of Science in Nursing
Acknowledgements
This thesis is dedicated in loving memory of my grandmother, Evelyn M. Jackson. I know she is
very proud of my accomplishments and the success that she helped to inspire over the years. I
love and miss you.
I first humbly give thanks to Almighty God, for granting me the grace to complete this process.
Without Him nothing is possible.
A loving thanks to my son, Christian, for having patience and enduring this journey with me.
A loving thanks to my mother for her wisdom, support, and encouragement throughout my
continuing education.
I sincerely thank my committee chair and members, Dr. Joan Tilghman, Dr. Nayna Philipsen, and
Dr. Charlotte Wood. Their instrumental role in providing expert guidance and their diligent
patience lead to the success of my first thesis experience.
Abstract
The title of this thesis is Risky Sexual Behaviors among Nursing Students at a Historically
Black University. The purpose was to examine and describe risky sex behaviors among the
African American female nursing students under the age of 30. This is significant because health
care professionals can target risky sex behaviors among young African American women and
provide appropriate education to the women based on specific behaviors. The conceptual
framework used was the Health Belief Model which focuses on addressing problem behaviors
that evoke health concerns. This thesis used a quantitative descriptive design. The convenient
sample was African American nursing students under the age of 30. The sample study was
conducted in an urban area of the middle Atlantic region of the United States. The study showed
that all of the risky sex behaviors in the study were practiced. Providing knowledge, through
continual research and competent health care providers, and increasing self-perception of being
at risk of contracting disease will hopefully help curve these unhealthy behaviors.
Chapter one
The Problem
Introduction
Sexually Transmitted Infections (STIs) are a growing threat to the well-being of society
across the United States (US) and a serious public health challenge (Buttaro, Trybulski, Bailey,
& Cook, 2013). The Center for Disease Control and Prevention (CDC) reports that almost 20
million people each year are infected with STIs, and half of them are under 30 years of age
(CDC, 2012). There are many types of STIs that result from risky unprotected sexual activity.
In addition to the well-publicized cost of the human immunodeficiency virus (HIV), threats from
gonorrhea, chlamydia, herpes, bacterial vaginosis, trichomoniasis, syphilis, and human
papillomavirus, among the most common of the 25 infectious organisms considered to be STIs,
are sweeping across the nation (Buttaro et al., 2013).
STIs affect individuals regardless of racial, social or economic stature, but there is a
great disparity with regards to age and race (Buttaro et al., 2013). Buttaro and colleagues (2013)
noted that when there is a decline in the incidence of disease throughout the population, the
decline is usually the smallest within the black community. Monkguos (2013) data from
historically black colleges and universities (HBCUs) consistently shows that when the HIV rate
is steady or at a decreasing rate among the other students, they continue to rise among the
African American students at HBCUs. This is occurring mostly with African American students
who are under the age of 30, specifically between the ages of 18-25 (Monkguo, 2013).
STIs are becoming more prevalent, as the numbers are quickly increasing among African
Americans in general, particularly between the ages of 13-24 years of age (Thomas et al., 2008).
The numbers were notably disproportionate between the years 2001-2005, when African
Americans accounted for 50% of all new HIV cases (CDC, 2012). African Americans account
for approximately 71% of the cases for gonorrhea, with young black women holding the highest
gonorrhea burden, and half of the cases for chlamydia in 2009 (Buttaro et al., 2013). Buttaro and
colleagues (2013) point out that while African Americans make up only 14% of the population,
their gonorrhea rate is 20 times higher than that of whites, and 10 times higher than Hispanics.
The chlamydial rates hold at 8% higher than whites and 3% higher than Hispanics (Buttaro et al.,
2003). The CDC (2012) reports that syphilis cases which occur primarily between men who
have sex with men, and they are responsible for 75% of all primary and secondary cases of
syphilis, while Buttaro et al. (2013), adds that 52% of these are black males.
Statistics from the CDC (2010), show that with the almost 20 million new STI cases each
year, there is an estimated $17 billion spent within the US to help treat chlamydia, gonorrhea,
and syphilis infections. Americans have to spend additional monies to account for their
subsequent health issues that arise as a result of these STIs (CDC, 2010). STIs are on the rise
throughout the US effecting many different populations and cultures (Buttaro et al., 2013; CDC,
2012) but especially the African American community (Buttaro et al., 2013).
Although many of the HBCU students have some awareness of STIs, their perception of
their own risk, and their risk-taking behaviors, especially in those younger than 30 (Mongkuo,
Mushi, & Thomas, 2010), put them in a direct line of fire for STIs. For example, an individual
who does not have sufficient awareness or perception of STIs can reflect that through risky
sexual behaviors due to ignorance. Likewise, if an individual does possess a high level of
awareness of STI risk, but does not perceive it as a personal risk or simply chooses to ignore it,
his or her sex behaviors can again be just as risky and expose them to STIs. There are many
scenarios to be considered. These coupled with other social and economic factors, such as drugs
and alcohol use, peer pressure, low income, education level, and low self-perception may
influence the students to have unprotected sex or sex with multiple partners (Thomas et al.,
2008). One can reasonably postulate that there is an urgent need to heighten the awareness and
perception of STI risks and decrease the risky sex behaviors taken by college students. This
effort can get a hold on and reverse the STI epidemic that is effecting the African American
community as a whole, as well as the nation.
This study described the risky sex behaviors among African American female
undergraduate nursing students at a HBCU. This will not only help to aid in identifying risky
sex behaviors that pose substantial health risks for African American women, but can aid in
developing resources to target these behaviors to reduce or prevent future contraction of STIs.
Significance of the Study
This study identified whether there were risky sex behaviors in a sample of African
American female nursing students. This information can enable health care professionals to not
only know what risky sex behaviors are being engaged by young African American women but,
with this knowledge, equips them to educate women based on these specific behaviors. This can
promote more effective measures to self- address some of the gaps between their level of
awareness, perception of risk, and the reality of their actual risky sex behaviors to help prevent
STIs. Identifying risky sex behavior is the first step in prevention, and this better understanding
can help put an end to this STI disparity within the African American community.
The relevance of this topic is validated with the CDC findings. CDC (2008) statistics
show that African American women made up 64% of the women who are affected with HIV.
Eighty percent of the newly diagnosed cases result from heterosexual relationships. HIV was
also the first cause of mortality for African American women aged 25-34 (CDC, 2008). It is
important to understand that these statistics are an outcry for help, and something must be done
to help these women of black African descent.
Statement of the Problem
Sexually transmitted disease seems to be a continual and growing pandemic throughout
the US, however, affecting African Americans more than most (Buttaro et al., 2013). There is a
large range of complex socioeconomic components, as well as challenges and barriers, which
causes this wide disparity to continue to expand throughout the African American culture, and
effect a great number of HBCU students (Mongkuo et al., 2010; Thomas et al., 2008).
Additionally, when risky sex behaviors are compounded with barriers to healthcare and STI
prevention information, it is more difficult for these members of the community to prevent STIs
(CDC, 2010).
Purpose of the Study
Considering that African Americans have been excessively burdened with HIV
contraction over the years (Sutton et al., 2011), as well as with other STIs, this study examined
and described risky sex behaviors among the African American female nursing students age 30
and younger.
Research question
What risky sex behaviors that contribute to the spread and contraction of STIs are
identified by the nursing students at this Historically Black University?
Assumptions
The assumptions for the study were the following:
1. Risky sex behavior is related to perception of nursing students under the age of 30,
2. Risky sex behavior is related to the rate if STIs, and
3. Risky sex behavior is related to health outcomes.
Conceptual Definitions
The conceptual definitions for the study were the following:
1. African American - An American of African and especially of black African descent
(Merriam-Webster [MW], 2014).
2. Historically Black Colleges and Universities (HBCU) - Collection of majority black
colleges and universities across the nation that were founded by African Americans
(Urban Dictionary [UD], 2014).
3. Risky Sex Behavior - Behavior or pattern which strongly yet adversely affects health. It
increases the chance of disease, disability, or syndrome. Examples include tobacco use,
alcohol consumption, smoking, obesity, physical activity, and sexual activity (Psychology
Dictionary [PD], 2014).
Operational Definitions
The operational definitions for the study were the following:

1. An African American was a participant that identified themselves to be a black American.
2. Historically Black Colleges and University (HBCU) was measured by students enrolled in
nursing classes at an HBCU.
3. Risky Sex behavior was a measured by the Aria STI Risk Assessment.
Summary
Sexually Transmitted Infections are affecting many Americans by the millions across the
U.S., regardless of age, race, or gender, and are continuing to increase (Buttaro et al., 2013;
CDC, 2012). Billions of dollars are being spent to correct this health disparity, but many of the
discovered cases are still greatly impacting the African American communities, especially
women and those attending a HBCU that have risky sex practices (CDC, 2010; Mongkuo et al.,
2010; Thomas et al., 2008). This study was aimed at identifying if the African American female
nursing students at a HBCU, in a particular area, practiced risky sex behaviors that would
contribute to them contracting STIs.
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Chapter Two
Review of Literature
This chapter describes previous studies related to the population and variables of this
thesis. These include the health disparity of STIs among the African Americans, their risk and
perceived risk, and their risk-taking behaviors.
African Americans and the STI disparity
According to the CDC, the rate of STIs, including HIV, is on a rise and is affecting more
people every day (CDC, 2014a; Mongkuo, 2013). Nearly twenty million newly diagnosed STI
cases surface around the country, but this number does not reflect the true number of cases
because the Sexually Transmitted Disease Surveillance 2012 notes that not all the cases are
reported (CDC, 2014a). The CDC statistics are even more alarming, and supported with studies
by Thomas et al. (2008), and Mongkuo et al. (2010), when they address the African Americans
who are being infected with these diseases. The African American rate is much higher than any
other racial group, with regards to the new cases of HIV, especially among the younger
population (Thomas et al., 2008). The CDC publicized that between the years 2001-05, 50% of
the 184,170 HIV cases that were reported were African Americans, and that in every age
category their numbers soared over other racial ethnicities, particularly in individuals under the
age of 30 (CDC, 2014). African Americans account for a large portion of those being affected by
this disease, but account for only 13% of the population, thereby making this racial disparity
very noticeable, and an urgent public health priority (Mongkuo et al., 2010). Furthermore, their
study showed that HIV incidences are so prevalent in the African American culture because of
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late detection or no detection, caused by challenges and barriers specific to the African American
community (Mongkuo et al., 2010). Since the peak age for these diseases fall amongst the
younger population (CDC, 2014), it can be postulated that college students are a very susceptible
target.
A key strategy to ending the dissemination of STIs is education on prevention of risky
sex behaviors and awareness of the risk (Mongkuo, 2013). Findings show that education needed
for the African American students at HBCUs has to be focused not only on resisting risky sex
behaviors, but also geared toward theory-driven socio-cognitive determinants of HIV
prevention intentions (Mongkuo et al., 2010; Jemmont, Jemmont III, & OLeary, 2007).
Evidence-based practice is the best option for HIV prevention programs to be successful in
HBCUs (Monkguo, 2013; Mongkuo et al., 2010). Since these risky sex behaviors start early in
life, evident by the reports of STI incidences quickly increasing among African Americans
between the ages of 13-24 (Thomas et al., 2008), engagement of this education should take place
during the preteen years of the African American youth if possible.
Sexually Transmitted Infection Risks
A survey conducted by the American Social Health Association [ASHA] in 2014 to
explore Americans sex attitudes, knowledge, and behaviors, from ages 18-35, found that many
individuals put themselves in harms way and make themselves susceptible to STIs. The risks
they take are related to a lack of general awareness of STIs. ASHA reported that even though
84% of the people surveyed felt they did what was necessary to keep from contracting STIs,
there was a disconnect because many of them did not protect themselves on a regular basis when
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they had sex. Statistics revealed that 7 of 10 individuals (68%) exhibited an extreme lack of
concern for contracting STIs (ASHA, 2014). Awareness is paramount and should be strived for
in an effort to thwart the transmission of HIV, especially amongst women (Macleod-Downes,
Albertyn, & Mayers, 2008). The president and chief executor of ASHA, James R. Allen, M.D.,
M.P.H, said, Peoples lack of awareness about STDs only underscores the need for continued
education to prevent the spread of these serious diseases (ASHA, 2014). Also from ASHAs
2014 survey, Dr. Allen noted that there is stigma associated with talk on STIs. This silence is a
barrier to preventing their spread. Dr. Allen believes that, This false sense of security is
problematic, as it can lead to exposure to serious, incurable diseases. Of the 93% who believed
their sex partner had no STI, only 1 in 3 actually bothered to ask their partner or to have a
discussion about it (ASHA, 2014). In their research, Sutton and colleagues (2011), in effort to
increase HIV prevention strategies, asserted that is imperative that African American students at
HBCUs assess and evaluate their partners risk status in order to decrease their chances of
contracting HIV.
African Americans are additionally faced with many barriers and challenges, including
drug related sexual behaviors, homosexual men concealing their tendency due to increasing
homophobia, pressure from black males on the women to keep the relationship thriving, more
females than males within the community (a 1:5 male to female ratio), high poverty rate among
the community and many other factors, which in turn expose them to more STIs and at an even
higher rate (Mongkuo et al., 2010). African American women are also challenged with
intravenous drug use and heterosexual relationships that are major risk for STI contraction (Cole,
Logan, & Shannon, 2008). In another independent study of HBCU students, Monkguo (2013)
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reflected on factors that contribute to risky sex behaviors leading to increased STI risk. These
factors included exposure to violence and a lack of personal motivation needed to prevent these
behaviors (Mongkuo, 2013).
Concerns about African Americans contracting STIs at a young age, and African
Americans having low STI risk perception and engaging in risky behaviors, are also shared by
Macleod-Downes and colleagues (2008), but they also suggest that education and gender are also
factors determining the susceptibility to STI. Lower levels of education lead to proven incidents
of poverty-stricken conditions, such as poor nutrition and hygiene, and decreased opportunity in
general throughout the life span. Findings show that HIV greatly and more prevalently impacts
those burdened with economic hardships. African American women left to deal with the
negative social and economic influences of their community, are at a greater risk of contracting
HIV (Macleod-Downes et al., 2008).
With respect to gender, Macleod-Downes and colleagues (2008) also claim that African
American women often times submit to the men in their lives when in a heterosexual
relationship. A heterosexual relationship is the most common conduit of HIV transmission for
African American women. The men hold the power, resulting in the women feeling powerless.
This powerlessness experienced by the women often enables the men to set the tone of the
relationship, deciding if or when they have sex, and whether a condom will be worn during
intercourse. The women also often believe that they are participating in monogamous
relationships, when the men know they are not. Being in a non-monogamous, heterosexual
relationship, with inconsistent condom use, exposes African American women unnecessarily to
STIs (Macleod-Downes et al., 2008).
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Perceived Risk
There was a commonality shared in the literature that many of the college students were
aware of HIV/AIDS, but being aware did not make the students engage in less risky sex
behaviors, and many of them perceived themselves as being a low risk for the contraction of the
STI (Thomas et al., 2008; Duncan et al., 2002; Adefuye, Abiona, Balogun, & Lukobo-Durell,
2009; Sutton et al., 2011). Duncan and colleagues (2002), also note that some of the students at
HBCUs perceived themselves as invincible with regards to contracting STIs. They elaborate by
saying that with some STIs, the timeframe between the transmission of the infection and the
manifestation of symptoms can be so drawn out, that the students are not really as concerned
about preventing risky behaviors as they are with living in the moment (Duncan et al., 2002;
Mehrothra, Noar, Zimmerman, & Palmgreen, 2009). This low risk perception was also
supported by James R. Allen, M.D., saying that the findings of the survey were disturbing,
with such widespread sexual diseases and the risk that are associated with them, that a vast
majority of people still feel like they are invincible (ASHA, 2014). Sutton and colleagues
(2011), recognized in their research that even though a pattern emerged showing consistently that
low perception of risk was accompanied by risky sex behaviors, this phenomenon occurred in
communities among African Americans at HBCUs in disproportionate numbers when compared
to non-minority communities (Sutton et al., 2011).
Condom use, from a public health perspective, is perceived to be the best strategy and
first line of defense against STIs (Leval, et al., 2011). Leval and colleagues (2011) found that a
womens risk perception for STIs were directly linked to their condom use with multiple
partners, but this did not ring true for the men in the study, bringing about definite gender-based
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differences. Interestingly enough, the condoms that were used by both sexes had nothing to do
with their knowledge of the disease or the severity of their consequences, but were based on their
education level (Leval et al., 2011). A study headed by Eissen and colleagues (2007) confirmed
that individuals with a higher level education had a low risk perception to STIs. However they
also discovered that these same participants held a higher risk perception when they engage in
activities such as marijuana and alcohol use (Eissen et al., 2007).
Womens perception of themselves, wholly, considering aspects such as culture, gender,
sexuality, and even education, influence their sexual behavior decisions (Jarama, Belgrave,
Bradford, Young, & Honnold, 2007). Research by Jarama and colleagues (2007), attested that
the African American women in their study had little-to-no fear of acquiring HIV. They
perceived their risk to be very low, despite their partners infidelity, their own drug use, and no
condom use (even though they are fully aware that anyone can catch the disease having these
risk factors). The study implied that perhaps this perception that the women embrace, can be
attributed to their social upbringing and parental teaching, largely displayed throughout their
data, to trust in God, mistrust men, and control their sexual urges (Jarama et al., 2007).
Accurate measures of risk perception are needed to examine how people think and feel about
risk, how perceived risk relates to behavior and actual HIV infection, and how effective
interventions are at enhancing perceived risk (Napper, Fisher, & Reynolds, 2011; Janssen, Osch,
Vries, & Lechner, 2011).
Risky Sex Behaviors among the Young Adults
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Thomas et al. (2008) indicated 54% of the reported HIV/AIDS were from the South,
which is consistent with previous research conducted reporting that many of the students
attending HBCUs engage in risky sex behaviors. These include combining sex with drugs and
alcohol, unprotected sex, and sex with multiple partners. In their research, they discovered that
the most frequent risk factor among the participants was that they were not using a condom
(36%). They second highest factor was not knowing their partners HIV status (17%), closely
followed by having sex while intoxicated or abusing drugs (11%) (Thomas et al., 2008; CDC,
2008). Having multiple sex partners was the preferred risky behavior by students under 30,
while older students enjoyed sex without condoms according to another study by Adefuye et al.
(2009), which also determined that both were attributed to marijuana and alcohol use.
Jemmont et al. (2007) found that condom use is very low, and providing awareness about
STIs and their prevention does not seem to be an effective strategy to curve these behaviors.
However, in research conducted by Jemmont and colleagues in 2007, behavior-building
workshops for condom use and for negotiations proved to be helpful in increasing favorable
compliance (Jemmont et al., 2007). Another study by Jarama and colleagues (2007), found that
if women did not feel a sense of self-value or worth, they would not demand condom use with
their partners. It also revealed that not only did the women not negotiate for condom use, but the
male dictated when she would have sex with him, whether it was willingly or not (Jarama et al.,
2007; Macleod-Downes et al., 2008).
A study by Mongkuo et al. (2010) reported that many of the African American college
students had often used condoms, even more often than their white American counterparts.
However, results showed that both groups often reported poor sex habits. The African American
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students agreed that they would use safer sex practices in the future. Mongkuo and colleagues
went on to explain that through the analysis of their data, they saw that the sex behaviors of
HBCU students are guided by not only by their awareness of HIV or controlling for age, but also
from their knowledge of HIV and its transmission, their willingness to associate with persons
affected with HIV (regardless of the stigma), their engagement in HIV education classes, and
their own academic class. The students intentions to deviate or not from the risky sex behaviors,
are influenced by their collective thoughts about the particular situation. Their findings are
consistent with the Theory of Reasoned Action (TRA), which focuses on the psychological
determinants on HIV/AIDS prevention behaviors (Mongkuo et al., 2010).
In spite of many HIV prevention programs set up in HBCUs to help put an end to risky
sex behaviors, HIV and other STIs are at an all-time high among the young, heterosexual
enrolled students (Monkguo, 2013). Mongkuos 2013 study identified personal motivation as the
best strategy to stop risky behavior. This was supported by Napper et al. who stated, Beliefs
about personal risk for HIV infection are central to understanding what motivates people to
engage in behaviors that reduce or increase their risk of HIV infection (2011). However, in
order for the participants to practice positive sex behaviors, triggered by personal motivation,
they must first perceive that they are actually capable from within of controlling and negating the
risky sex behaviors (Mongkuo, 2013).
A shared finding was that the young students of HBCUs, and other young African
Americans of the community not attending HBCUs, had an awareness of HIV and were likely to
be tested for it, if they believed that they engaged in risky sex behavior, but unfortunately that
belief did not stop the high-risk behaviors (Duncan et al., 2002; Thomas et al., 2008). Thomas
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and colleagues (2008), also found that of the students in their sample who reported engaging in
risky sex behaviors, male reporting was higher than that of females, but the number of males
actually tested for HIV was lower than the number of females. This finding was also consistent
with other African American college students attending different schools during the time of their
research (Thomas et al., 2008). However, of the respondents who perceived themselves to be at
high risk for HIV, more of them were males than females, which Thomas and colleagues stated
was in contrast with a comparable study by Johnson and colleagues, which found that men care
far less than women about contracting HIV (Thomas et al., 2008).
Summary
This literature review was conducted to investigate peer-reviewed articles on the disparity
of STIs among African American community. The literature strongly substantiates the
significance of STIs becoming an epidemic among members of the African American community
especially the younger population within that community. A consistent theme is present
throughout the studies, which stresses the relevance of identifying STI risks and risky behaviors,
the importance of preventing STIs, and the urgent need to determine the best way to educate the
community. This study adds to that wealth of knowledge in this area by exploring risky sex
behaviors among young African American women at an urban HBCU, to discover which
behavior is more prevalent among them. The results of this study can be evaluated and integrated
by health care professionals to provide enhanced evidence-based care.
Conceptual Framework
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The Health Belief Model (HBM) is a good model for addressing problem behaviors that
evoke health concerns (e.g., high-risk sexual behavior and the possibility of contracting HIV)
(Croyle, 2005. The paradigms which represent and guide this model include perceived illness,
susceptibility, benefits, barriers, motivation, and modifying factors. The Health Belief Model
explores the individuals perception of : 1) the severity of a particular illness; 2) their
susceptibility and chances of having that illness; 3) how health behaviors can prevent the illness;
4) the barriers they are challenged with to adopt healthy preventative behaviors, such as cost,
pain, or inconvenience; 5) their desire to do the right action based on how badly they view the
severity of the disease and their level of susceptibility; and 6) their culture, environment,
satisfaction with their health behaviors, and their confidence level to succeed (Main Constructs,
2015; Glasgow, 2015). The Health Belief Model focuses on behaviors geared towards disease
prevention that is ultimately influenced or motivated by an individuals perception of the severity
of an illness and their susceptibility to that illness being greater than the barriers. One study by
Kim and associates in 2012 to determine college students healthy eating behaviors based on
their nutritional beliefs used the HBM as a basis for their research. They concluded that not only
are the positively influencing behaviors adopted by individuals triggered by the threat of the
disease outweighing the perceived barriers, but they also believe that if the perceived barriers are
viewed more negatively than the threat of disease, then a person will not adopt new healthy
behaviors (Kim, Ahn, & No, 2012). Additionally, motivation is increased when the individual
feels as though the decision to take a correct action is going to prevent illness and harm. They
must believe that they have what it takes to be successful with these newly adopted behaviors.
This model also serves as a guide to enable health care professionals to have insight to
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understanding and getting a person to comply with health care therapies (Main Constructs, 2015;
Glasgow, 2015).
The Health Belief Model was grounded in health promotion and disease prevention, thus,
making it a supportive conceptual framework that is consistent with this study that linked sexual
behavior and STIs with health education to prevent harmful diseases. Incorporating the Health
Belief Model in this study supports the exploration of risky sex behaviors among the African
American female nursing students to describe if they are doing the right action to maintain the
best health status. Discovering what risky sex practices are being practiced, can lead to the
development of specific interventions and more educational material for disease prevention
among this population and others. Educational strategies to communicate the severity of STIs, a
persons susceptibility, and empowering techniques can impact an individuals motivation level
to change to healthier behaviors as necessary. Education resulting in prevention would also be a
way to be able the avoid some of the barriers presented as a challenge when illness is present.
Health care providers are at times the initial educators and faced with the challenge of
knowing how to appropriately educate their patients. It is important to know what behaviors are
practiced and what other factors have influenced those decisions. This knowledge, coupled with
appropriate education through health care providers and other educational strategies, can
definitely have a positive impact on reducing the number of those infected with STIs, on the
HBCU campuses and within the community. The application of the Health Belief Model of
disease prevention can facilitate the success of caregivers in reaching this public health goal
among minority populations who need it most.
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Chapter Three
Methodology
Design of the Study
This descriptive quantitative study described the risky sex behaviors of African American
female undergraduate nursing students. The site of the study was an HBCU located in an urban
area of the middle Atlantic region of the United States.
Research Question
The Sample
A conveniencesampling method was used to recruit participants for this study among
undergraduate nursing students at an HBCU in Baltimore Maryland, who self-identify as African
American women. The participants were all the age of 30 or younger. The goal for the size of
the sample was no less than 25 participants.
Limitations of the Study
1. The sample was limited to undergraduate nursing students.
2. The sample was limited to students age 30 and younger.
3. The sample was limited to one university.
4. The study used a small convenience sample.
5. Time to complete the tool was cut off after 10 minutes.
Procedure
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Permission to utilize the instrument was obtained from the assistant deputy counsel of
Aria Health Systems (Appendix A). Permission was next obtained from the chairperson for the
perspective undergraduate nursing department (Appendix B), then finally from the HBCUs
Institutional Review Board (IRB) (Appendix C).
This study was conducted within the
classrooms of the university, with instructor permission, using the following procedure:
1. An explanation of the purpose of the study was given to the participants.
2. The participants were informed that the study was going to be conducted on a voluntary
basis and they could withdraw from the study at any time without penalty.
3. The participants were assured that their survey would be kept totally confidential and
advised that they themselves should avoid adding any identifying information to their
survey.
4. Informed consent form was signed by the participants.
5. The survey and demographic questions (reverse side of survey) were distributed with an
envelope, and students were given about 10 minutes to complete the thirteen (13)
questions.
6. Instructions for completing the survey and placing the completed survey into the
provided envelope when completed were explained.
7. The participants were undisturbed and given anonymity during the survey completion
time to promote comfort in answering questions truthfully.
8. Envelopes containing the completed surveys were collected from the participants and
secured in a large, sealed manila envelope.
Protection of Human Subjects
24
There was no personal identifying information associated with the survey. The consent
forms (Appendix D) were held in a separate, sealed manila envelope to ensure no connection
between the consent forms and the survey to create embarrassment or release of personal
identity. All individual surveys were shredded within 30 days of the conclusion of this research.
The results of the study were only reported as aggregate group data for the participants.
Additionally, the participants were reminded that they were participating on a voluntary basis
and could withdraw from the study at any time.
Instrument
The instrument was a modified STI Risk Assessment by Aria Health Systems (Aria
Health [AH], 2014) (Appendix E). The instrument consisted of six (6) questions and was
followed by three (3) demographic questions and four (4) questions pertaining to STI testing on
the reverse side. The instrument specifically identified whether the participants engage in risky
sex behaviors, and in doing so, incidentally made the participants aware or increased their
awareness of their STI risks (AH, 2014). The instrument can also help to address which risky
sex behavior(s) are the most practiced. Beyond face validity, the instruments reliability and
validity have not been published. However, it has been used worldwide as a screening tool and
can be implemented and evaluated for evidence-based practice.
Data Analysis
The data retrieved, from the six (6) modified STI Risk Assessment questions as well as
the demographic and STI testing questions for risky sex behaviors was collated. The compiled
data was analyzed for frequencies and cross-tabulation using the Statistical Package for the
Social Sciences (SPSS) to describe risky behaviors reported by this sample.
Summary
25
This descriptive, quantitative study analyzed a small, convenience sample of African

American female undergraduate HBCU nursing students under the age of 30, to determine their
involvement in risky sex behaviors. The survey used was the STI Risk Assessment, a simple
screening tool designed to examine the risky sex behaviors among the respondents.
The
participants were protected from any potential harm of breach of confidentiality by the careful
procedures put in place for this study. At the conclusion of the study, the data revealed which
risky sex behaviors were being practiced by the participants and to what degree.
This
information can be utilized to prioritize and address any gaps that may exist between the risky
behaviors and the education provided to prevent the contraction of STIs, and to allow health care
professionals to narrow their focus on education and prevention measures for the most practiced
behavior.
26
Chapter Four
Findings
Introduction
The purpose of this study was to examine and describe risky sex behaviors among the
African American female nursing students age 30 and younger. This chapter presents the
statistical analysis of study participants responses on a modified survey called the STI Risk
Assessment developed by Aria Health Systems. The survey specifically identified whether the
participants engage in risky sex behaviors. Findings also include a description of the participants
in the study and their responses to the questionnaire. Twenty nine surveys were completed at an
urban university. The Statistical Package for the Social Sciences (SPSS) was used to analyze the
data.
Description of the Sample
The convenience sample that consisted of 29 African American female, undergraduate
nursing students at an urban university were used. The participants were also 30 years of age or
younger. The demographic variables for the study were: Age, whether they lived on or off
campus, and whether they were in a monogamous relationship.
Research Question
27
Table 1 displays the ages of the participants at the time of the study. The ages ranged
from 21 to 30. The largest groupings were 22 and 23 totaling 20.7% (n=6), as well as those that
were 24, 25, and 29, totaling 10.3% (n=3).
Table 1
Age
Frequency
Valid
Percent
Valid Percent
Cumulative Percent
21.00
3.4
3.4
3.4
22.00
20.7
20.7
24.1
23.00
20.7
20.7
44.8
24.00
10.3
10.3
55.2
25.00
10.3
10.3
65.5
26.00
6.9
6.9
72.4
27.00
6.9
6.9
79.3
28.00
3.4
3.4
82.8
29.00
10.3
10.3
93.1
30.00
6.9
6.9
100.0
Total
29
100.0
100.0
Table 2 displays if the participants resided on or off campus. Most of the participants,
86.2% (n=25), lived off campus, while 10.3% (n=3) lived on campus.
Table 2
Housing/Location of residence
Frequency
Valid
Percent
Valid Percent
Cumulative Percent
on campus
10.3
10.3
10.3
off campus
25
86.2
86.2
96.6
no answer
3.4
3.4
100.0
29
100.0
100.0
Total
28
Table 3 displays if the participants were in a monogamous relationship at the time of the
study. Fifty five percent (n=16) of the participants reported that they were currently in a
monogamous relationship, while 41.4% (n=12) reported to not be in a monogamous relationship.
Table 3
Are you currently in a monogamous relationship?
Frequency
Percent
Valid Percent
Cumulative Percent
yes
16
55.2
55.2
55.2
no
12
41.4
41.4
96.6
3.4
3.4
100.0
29
100.0
100.0
Valid
no answer
Total
Table 4 displays if the participants had been tested for HIV within the past year. Of the
29 participants, 79.3% (n=23) had been tested. Seventeen percent (n=5) had not been tested.
Table 4
Have you been tested for HIV within the past year?
Frequency
Percent
Valid Percent
Cumulative Percent
yes
23
79.3
79.3
79.3
no
17.2
17.2
96.6
no answer
3.4
3.4
100.0
29
100.0
100.0
Valid
Total
Table 5 displays what the results were if the participants had ever been tested for HIV
within the past year. Almost 83% (n=24) participants results were negative.
Table 5
29
If tested, what were the HIV results?

Frequency
negative
Valid
no answer
Total
Percent
Valid Percent
Cumulative Percent
24
82.8
82.8
82.8
17.2
17.2
100.0
29
100.0
100.0
Table 6 displays if the participants had ever been tested for STIs within the past year. Of
the 29 participants, 79.3% (n=23) had been tested. Seventeen percent (n=5) had not been tested.
Table 6
Have you been tested for STIs within the past year?
Frequency
Percent
Valid Percent
Cumulative Percent
yes
23
79.3
79.3
79.3
no
17.2
17.2
96.6
no answer
3.4
3.4
100.0
29
100.0
100.0
Valid
Total
Table 7 displays what the names of the STIs if the participants had been tested for STIs
within the past year and the results were positive. Chlamydia was reported by one participant.
Table 7
If yes, what was the STI if results were positive?
Frequency
Percent
Valid Percent
Cumulative Percent
Valid
30
chlamydia
3.4
3.4
3.4
no answer
28
96.6
96.6
100.0
Total
29
100.0
100.0
Participant Responses to the Survey

For the question on the survey, Have you had a recent (in last six months) change in
sexual partner? (Table 8), the responses were that 69% (n=20) of the participants had changed
partners, while the remaining 31% (n=9) had not changed partners.
Table 8
Have you had a recent change in sexual partner in the last six months?
Frequency
Valid
Percent
Valid Percent
Cumulative Percent
yes
31.0
31.0
31.0
no
20
69.0
69.0
100.0
Total
29
100.0
100.0
For the question on the survey, Do you have more than one sexual partner? (Table 9),
89.7% (n=26) participants responded that they only have one sexual partner. Only 10.3% (n=3)
participants have more than one sexual partner.
Table 9
Do you have more than one sexual partner?
Frequency
Valid
Percent
Valid Percent
Cumulative Percent
yes
10.3
10.3
10.3
no
26
89.7
89.7
100.0
Total
29
100.0
100.0
For the question on the survey, Have you had more than three sexual partners during
the last six months? (Table 10), the most common answer among the participants, 96.6%
(n=28), was No, and only 3.4% (n=1) had more than three sexual partners.
31
Table 10
Have you had more than three sexual partners during the last six months?
Frequency
Valid
Percent
Valid Percent
Cumulative Percent
yes
3.4
3.4
3.4
no
28
96.6
96.6
100.0
Total
29
100.0
100.0
For the question on the survey, Does your sexual partner have other sexual partners?
(Table 11), 24.1% (n=7) participants were unsure, 72.4% (n=21) responded No, and the
remaining 3.4% (n=1) admitted to their sexual partner having other sexual partners.
Table 11
Does your sexual partner have other sexual partners?
Frequency
Valid
Percent
Valid Percent
Cumulative Percent
yes
3.4
3.4
3.4
no
21
72.4
72.4
75.9
24.1
24.1
100.0
29
100.0
100.0
unsure
Total
For the question on the survey, Have you had unprotected sex or protected sex
inconsistently (not every time)? (Table 12), 69% (n=20) of the 29 participants had done so,
while the remaining 31% had not.
Table 12
Have you had unprotected sex or protected sex inconsistently?
Frequency
Valid
Percent
Valid Percent
32
Cumulative Percent
yes
20
69.0
69.0
69.0
no
31.0
31.0
100.0
29
100.0
100.0
Total
For the question on the survey, Have you had sex under the influence of drugs and/or
alcohol? (Table 13), the responses were divided pretty equally showing 48.3% (n=14) to say
Yes, while the other 51.7% (n=15) said No.
Table 13
Have you had sex under the influence of drugs and/or alcohol?
Frequency
Valid
Percent
Valid Percent
Cumulative Percent
yes
14
48.3
48.3
48.3
no
15
51.7
51.7
100.0
Total
29
100.0
100.0
Cross tabulation statistics were used to compare some of the demographic and STI/HIV
testing information with the risky sex behavioral variables. The cross tabulations provide a
visual comparison of variables. Below, Bar Chart 1 displays a cross tabulation of the
participants age and the risky sex behaviors. The age of the participants range from 21- 30 years
(Table 1). Of the 29 participants, only 9 of them reported to have a recent change in sex partners
and 4 of the nine were 25 or younger. Three participants reported to have more than 1 sex
partner and one of them were under the age of 25. When asked of the participants if they had
more than 3 sex partner within 6 months, only one person responded to have done so but was
33
over the age of 25. Seven of the participants were unsure whether their sex partner had other sex
partners and 6 of them were 25 or younger. Of the participants, 20 reported to having
unprotected sex or protected sex inconsistently and 11 of them were 25 or younger. Fourteen of
the participants reported to have had sex under the influence of drugs and/or alcohol and half of
them were 25 or younger.
Bar Chart 1
Recent change in sex partner (6 months)

12
10
8
More than 1 sex partner
More than 3 sex partners (6 months)
6
4
2
0
Unsure if partner has other sex partners
Unprotected sex
25 years and under
Over 25 years old
Sex under the influence of drugs &/or alcohol
Age
Bar Chart 2 displays the cross tabulations of monogamous relationships and the risky sex
behaviors. Of the 29 participants, 16 reported to being in a monogamous relationship (Table 3).
Six of them reported to have had a recent change in their sex partner, 4 were unsure whether their
sex partner had other sex partners, 12 had unprotected or inconsistent protected sex, and 10 of
them reported to have sex under the influence of drugs and/or alcohol. Three of the 12
participants who reported not to be in a monogamous relationship had a recent change in sex
partners, and one of them had more than 3 sex partners within the past 6 months, in addition to
34
having more than one sex partner, and was unsure whether their sex partner had other sex
partners.
Bar Chart 2
14
12
Recent change in sex
partner (6 months)
10

More than 3 sex partners (6
months)
Unsure if partner has other

sex partners
Unprotected sex
Sex under the influence of
drugs &/or alcohol
4
2
0
Yes
No
Currently in a monogomous relationship
Bar Chart 3 displays the cross tabulations of the participants tested for HIV within the
past year and the risky sex behaviors. Of the twenty three participants had been tested (Table 4),
only 8 of them had a recent change in sex partners and 2 had more than one sex partner.
However, 17 of them had unprotected or inconsistent protected sex and 13 had sex under the
influence of drugs and/or alcohol. Seven of the participants were unsure whether their sex
partner had other sex partners. Of the 5 participants who were not tested for HIV within the past
year, only one practiced all risky sex behaviors.
35
Bar Chart 3
18
16
14
Recent chang ein sex

partner (6 months)
12
10
More than 3 sex partners (6

months)

sex partners
Unprotected sex

drugs &/or alcohol
4
2
0
Yes
No
Testing for HIV within the past year
Bar Chart 4 displays the cross tabulations of the participants tested for STIs within the
past year and risky sex behaviors. Of the 23 participants who had been tested (Table 6), only 9
of them had a recent change in sex partner, 3 had more than one sex partner, and one of them had
more than 3 sex partners within 6 months. Eighteen of the participants had unprotected or
inconsistent protected sex and 13 of them had sex under the influence of drugs and/or alcohol.
Six of the participants were unsure whether their sex partner had other sex partners. Of the 5
participants who were not tested for HIV within the past year, only one participant practiced
unprotected sex and sex under the influence of drugs and/or alcohol.
36
Bar Chart 4
18
16
14
Recent chang ein sex

partner (6 months)
12
10
More than 3 sex partners

(6 months)
Unsure if partner has
other sex partners
Unprotected sex

drugs &/or alcohol
4
2
0
Yes
No
Tested for STIs within the past year
Bar Chart 5 displays the cross tabulations for positive STI results and the risky sex
behaviors. Of the 23 participants tested for STIs within the past year (Table 6), only one reported
a positive result of Chlamydia. The participant practiced all risky sex behaviors with the
exception of having more than 3 partners within the past 6 months.
37
Bar Chart 5
1
0.9
0.8

partner (6 months)
0.7
0.6

(6 months)
0.5

other sex partners
Unprotected sex
0.4

drugs &/or alcohol
0.3
0.2
0.1
0
Tested positive for Chlamydia
Bar chart 6 displays the cross tabulations of the participants housing and the risky sex
behaviors. Of the 25 participants living on campus (Table 2), 8 of them had a recent change in
sex partners, 3 of them had more than one sex partner and one of them had more than 3 sex
partners within the past 6 months. Seven of the participants were unsure whether their sex
partner had other sex partners, 18 of them had unprotected or inconsistent protected sex and 14
of them had sex under the influence of drugs and/or alcohol. Of the 3 participant living on
campus, only one had a recent change in sex partner and had practiced unprotected sex.
38
Bar Chart 6
20
18
16
partner (6 months)
14
12

(6 months)
10

other sex partners
Unprotected sex
drugs &/or alcohol
6
4
2
0
On Campus
Off Campus
Housing
Bar Chart 7 displays the percentages of the participants that practiced each risky sex
behavior (Tables 8-13). The most commonly practiced risky sex behavior is having unprotected
sex (69%). The least practiced risky sex behavior is being unsure whether their sex partner had
other sex partners.
39
Bar Chart 7
69
70
partner (6 months)
60
48.3
50
40

(6 months)
sex partners
31
30
Unprotected sex
24.1

drugs &/or alcohol
20
10.3
10
3.4
0
Pecentages of practiced risky sexual behaviors
Summary
There are many risky sex behaviors that lead to the contraction of and the pandemic of
STIs. The results identified that the participants practiced many of the risky sex behaviors even
though they could potentially cause harm. The participants responses also indicated that most
were aware of the risk of contracting HIV and STIs by the number of them that were tested for it.
The study was successful to determine the risky sex behaviors that may contribute to the spread
and contraction of STIs by this sample HBCU students.
40
Chapter 5
Discussion, Conclusions, and Implications
Discussion
This study examined and described the risky sexual behaviors among African American
female, nursing students attending an urban Historically Black University that are 30 years of
age or younger. The sample was limited to undergraduate nursing students and because of their
education, they may have less risky sex behaviors than other non-nursing students. The
population of the sample was limited to students age 30 and younger which may limit the
generalization of older students. Since the study was conducted at one university, the sample
may not represent the students at other HBCUs. A small convenience sample is not optimal for
quantitative research and also may or may not represent the students at other HBCUs.
The results of the study showed that 100% of the African American nursing students
participated in risky sexual behavior of some sort that could contribute to them contracting HIV
or an STI. As the Health Belief Model points out, individuals must be aware of their potential to
become ill, the severity of that illness, and motivated enough to change to behaviors that will
provide healthier outcomes (Croyle, 2005). Seventy nine percent of the nursing students seemed
to be aware of their risk because they were tested, but it is uncertain if they are aware of the
impact that the disease would have on their life if it is contracted, as these risky sex behaviors
continued in spite of testing. In order for the goal of the HBM to be reached, these African
American nursing students must not only realize the risk of disease, but have self-perception of
high risk and immediately adapt sex behaviors that are not considered to be risky.
41
Conclusions
The findings confirmed that 100% of the nursing students practiced risky sex behaviors.
Of the risky behaviors, having unprotected or inconsistent protected sex (69%) and having sex
while under the influence of drugs and/or alcohol (48.3%) were the highest ranking practiced
behaviors by almost half (48.3%) of the nursing students in the study. These findings are
supported in a study by Mongkuo, Mushi, &Thomas in 2010 reporting that 34% of other HBCU
students that practice risky sex behaviors have contracted HIV and are younger than the age of
30, and a study by Thomas et al. in 2008 that drugs and alcohol influence students to have
unprotected sex or sex with multiple partners among African American students. The findings
indicated that more of the nursing students who practice these risky behaviors were between the
ages of 21 -25. Another compelling fact which is supported by ASHA (2014) reported statistics
showing that 68% of the participants seemed to have no concern for contracting STIs and did not
protect themselves on a regular basis when they had sex is also found in this study, which
showed that 69% of the nursing students did not protect themselves consistently.
Of the 16 nursing students who reported being in a monogamous relationship, 6 of them
had a recent change in their sex partner and 4 were unsure whether their sex partner had other
sex partners. Twelve of them are also are not wearing condoms and 10 of them are having sex
with drugs and alcohol. This high- risk situation is strongly supported by Cole, Logan, and
Shannon (2008) reporting that heterosexual relationships are major risk for STI contraction by
40%. Even though the nursing students consider themselves to be in a monogamous
relationship, they are changing partners and are unaware whether their partner is having sex
outside of their relationship. Two of the nursing students reporting to be monogamous actually
42
had other sex partners during that time themselves. One can postulate that being in a
monogamous relationship makes their situation safer, but since their behavior is not much
different than those that report that they are single, they have just as much of a precarious
predicament as the others. In this study, the 16 participants reporting to be in a monogamous
relationship practiced risky behaviors more frequently than those who are not. However, there
was one single nursing student having unprotected sex with someone knowing they were
sleeping with others.
When it comes to HIV and STI testing, 79.3% of the nursing students were tested which
leads one to assume that they had to be aware of the disease and of the fact that they are at risk
for catching diseases based on their risky sex behaviors. This is also a reported assumption by
Thomas et al., 2008; Duncan et al., 2002; Adefuye, Abiona, Balogun, & Lukobo-Durell, 2009
and Sutton et al., 2011 in their research. The findings in this study also show that with the HIV
testing, the numbers of nursing students practicing most risky sex behavior categories were
slightly lower (by one individual) than with the STI testing. This could mean that the nursing
students perceived a higher risk of contracting HIV than STIs. Of those tested, they also
practiced one less risky behavior, which was having sex with more than 3 people within 6
months, than those not tested. Perhaps they perceived a higher risk of HIV and/or STIs
contraction than those not tested, thus partaking in less behaviors. There was only one nursing
student who was not tested and practiced the following risky behaviors: A recent change in sex
partners; more than one sex partner; more than 3 sex partners in 6 months; unsure if sex partner
has other sex partners; unprotected or inconsistent protected sex; and sex under the influence of
drugs and/or alcohol. It is possible that she was simply not aware of the danger. Twenty three
43
of the nursing students reported to be negative for HIV. Only one reported to have the STI,
Chlamydia. That participant practiced all aforementioned risky sex behaviors with the exception
of having more than 3 partners within the past 6 months, which holds to the old but famous
clich, it only takes one! As merely a matter of information, most risky sex behaviors occurred
off campus, but that is to be expected as there was a substantial number more of the nursing
students living off campus.
Implications for Nursing Education
HIV and STIs are hitting the home front hardly for African Americans more than most
(Thomas et al., 2008). It is imperative that educational programs are developed that will address
knowledge deficits to HIV/STIs and their severity, raising African Americans' perception of their
own risk and risk to others, and risky sex behaviors leading to the contraction of these healthchallenging diseases (Mongkuo et al., 2010; Jemmont, Jemmont III, & OLeary, 2007). These
programs can focus on promoting strategies to adopt healthier sex behaviors. These programs be
instituted within the communities through community centers, hospitals and clinics, in the
colleges and universities, and be integrated into the homes of these African American
individuals. This is necessary to further comprehend what motives risky sex behaviors among
within the African American community.
Implications for Nursing Research
The risky sexual behaviors that the nursing students practiced can be used in conjunction
with future studies conducted to determine if there is a cause and motivation for such risky
behaviors among African American women and their communities (Napper et al., 2011). Other
44
descriptive-type studies describing the risky sex behaviors of HBCU students can be performed
to determine if the findings from this study is a common thread among African American women
throughout several other HBCUs. Research can also be conducted to examine if there is a
relationship between being a nursing student and the risky sex behaviors, as compared to risky
sex behaviors among non-nursing students. This could help to determine if a higher level of
health education would lead to less risky behaviors than those not exposed to health education in
any fashion.
Implications for Nursing Practice
Results from research studies are the basis for the necessary knowledge in which
evidence-based practices and guidelines are built. These results become the cornerstone for
future use within clinical settings as well as other research projects. Health care providers share
the responsibility to educate, promote, and prepare individuals to move towards their best health
status and they look towards research as a guide. Since health care providers are often the first
people these African American women come in contact with for help, knowing the riskiest sex
behaviors that these women practice can help guide the type of education necessary for these
women to practice healthier behaviors. Playing a key role in helping African American women
to not contract HIV and other STIs is made possible through research supporting evidence-based
practice as a teaching tool. This study provided the necessary evidence of practiced risky sex
behaviors for health care providers to use as a guide. The quicker African American women are
educated about their risks for disease and the direct threat they impose upon themselves with
their risky sex behaviors, perhaps the quicker the risky sex behaviors can become new healthy,
habit-forming behaviors.
45
Summary
Even though there is a great public health risk of contracting HIV and STIs especially
in the African American community (Buttaro, Trybulski, Bailey, & Cook, 2013), many of the
nursing students practice very risky sex behaviors. Protective measures to prevent disease will
not and cannot occur unless these African American women recognize that their risk of catching
disease is great and understand that their risky behaviors must cease (CDC, 2012). The
community in which these African American women live must provide a venue (universities,
hospitals, community centers, etc) to educate and create awareness of HIV and STI contraction
to those individuals. Providing knowledge that is necessary, through continual research and
competent health care providers and teachers, and increasing self-perception of being at risk of
contracting disease will hopefully help to curve these unhealthy behaviors. So again, it is asked,
What risky sex behaviors that contribute to the spread and contraction of STIs are identified by
the nursing students at this Historically Black University? The studys message was all of them;
with having unprotected or inconsistent protected sex ranked as number 1 at 69%.
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Practice. [Online]. Retrieved from http://www.med.upenn.edu/hbhe4/part2-ch3-mainconstructs.shtml
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Macleod-Downes, L., Albertyn, R., & Mayers, P. (2008). Factors determining the vulnerability of
women to sexually transmitted HIV: A literature review. Health Sa Gesonhdid, 13(3), 6982.
Medline Plus. (2014). Sexually transmitted infections. [Online]. Retrieved from
http://www.nlm.nih.gov/medlineplus/sexuallytransmitteddiseases.html
Mehrothra, P., Noar, S., Zimmerman, R., & Palmgreen, P. (2009). Demographic and personality
factors for predictors of HIV/STD partner-specific risk perceptions: implications for
interventions. AIDS Education and Prevention, 21(1), 39-54.
Merriam-Webster. (2014). [Online]. African-American. Retrieved from http://www.merriamwebster.com/dictionary/african-american
Mongkuo, M. (2013). Assessing the influence of exposure to violent living condition,
knowledge, and personal motivation on HIV prevention behavior among historically
black college students. Government and History Faculty Working Papers, 16. Retrieved
http://digitalcommons.uncfsu.edu/cgi/viewcontent.cgi?
article=1016&context=govt_hist_wp
Mongkuo, M. Mushi, R. Thomas, R. (2010). Perception of HIV/AIDS and socio-cognitive
determinants of safe sex practices among college students attending a historically black
college and university in the USA. Journal of Aids and HIV Research, 2(3), 32-47.
Retrieved from http://www.academicjournals.org/article/article1379413050_Mongkuo
%20et%20al.pdf
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Napper, L., Fisher, D., & Reynolds, G. (2011). Development of the perceived risk of HIV scale.
PubMed Central, 16(4), 1075-1083. doi: 10.1007/s10461-011-0003-2
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APPENDICES
51
52
APPENDIX A
Tool Permission
Tool Permission
On Sep 18, 2014, at 1:33 PM, Santo Caruso <sacaruso@ariahealth.org> wrote:
Ms. Jackson,
Pleasure speaking with you. I confirm that you have been granted permission to utilize portions
of our STD Risk Assessment as found on our website for educational purposes. Best of luck with
your project.
Santo
Santo R. Caruso
Asst. Deputy Counsel
Aria Health System
sacaruso@ariahealth.org
215-710-3786- PLEASE NOTE THE CHANGE
www.ariahealth.org
53
APPENDIX B
Site Permission
54
55
Site Permission
December 3, 2014
Dear Ms. Cheryse Jackson,
Thank you for expressing an interest in conducting research with the female nursing
students on Risky Sex Behaviors among Nursing Students at a Historically Black
University. Please accept my written permission and approval to be granted for
conducting your research at the College of Health Professions Helene Fuld School of
Nursing. Please let me know if I could be of further assistance.
Thank you,
Danita Tolson, EdD/CI, MSN, RN
Dr. Danita Tolson

Dr. Danita Tolson
Interim Undergraduate Nursing Chairperson
2601 W. North Ave, HHSB 430
Baltimore, Md 21216
410-951-3757/6165
APPENDIX C
IRB Approval
56
57
IRB Approval
Office of the Institutional Review Board
Health & Human Services Bldg., Room 218
Tel: 410 / 951-3516; Fax: 951-410-3511
______________________________________________________________________
Approval To Conduct Research Involving Human Participants
To: Principal Investigator: Dr. Joan Tilghman
From: Dr. Michelle P. Pointer, Chairperson, IRB
Project: Risky Sexual Behaviors among Students at a Historically Black College and University
Student: Cheryse Jackson
Date: February 26, 2015
On behalf of the IRB at Coppin State University, I am pleased to inform you that your request to
conduct research has been approved. Please note that this approval covers one year, beginning with
the date above, and it assumes that you agree to the following items prior to beginning the data
collection.
1. The IRB does NOT approve research already completed and your signature below confirms this
research has NOT been completed or started. You should sign this form, obtain the students
signature, and return this signed form, to Dr. Pointer in the Department of Applied Psychology &
Rehabilitation Counseling for her signature. You should retain a duplicate of this signed document
for your records.
2. You should have a copy of this signed approval document with you as you administer the research
project.
3. You should forward a copy of this document to your Dean or other designated person, if required.
4. You must honor the standards of confidentiality and informed consent as stated in the policy of the
Institutional Review Board.
My best wishes to you for the successful completion of this research project.
___________________________________________ ______________
Dr. Michelle Pointer, Chair, Institutional Review Board Date
___________________________________________ ______________
Signature of Faculty Principal Investigator
Date
___________________________________________ ______________
Signature of 2nd Faculty Principal Investigator
Date
APPENDIX D
Consent Form
58
59
Consent Form
Risky Sexual Behavior among Students at a Historically Black College and University
The purpose of this study will examine and determine if there are risky sex behaviors among the
African American female nursing college students, under the age of 30, which may contribute to
them taking unnecessary sexual risk and contracting STIs. A potential benefit of this study will
be to add to the wealth of knowledge in this area by exploring risky sex behaviors among young
African American women at a particular HBCU. The findings can be implemented and
evaluated by health care professionals for evidence-based care. Although the Principal
Investigator does not anticipate any significant risks associated with your participation in this
study, there is the possibility that you may experience embarrassment and/or anxiety while
participating in the study. At the conclusion of your participation, you will have an opportunity
to discuss your experience with the Principal Investigator, and receive information and referral,
as appropriate.
Your personal identity and privacy, and the confidentiality of any personal information that is
disclosed, will be protected. All information that is gathered will be kept in a locked file that is
accessible only to the Principal Investigator. All individual records will be shredded within 30
days of the conclusion of this research. The results of this research will only be reported in the
aggregate for the total group of participants. The personal identity of any participant will not be
revealed at any time.
Your participation in this research study is voluntary, and you may withdraw from participation
at any time, without penalty.
By your signature below you confirm that you understand this agreement, that you have had an
opportunity to have any questions answered in advance of your participation, and that you may
contact the Principal Investigator, Dr. Nayna Philipsen 410-951-2630 nphilipsen@coppin.edu at
any time if you have an additional question(s) regarding this study.
I, _____
consent to participate in this research study.
______________________________
Name (printed)
_____________________________
Signature
__________
Date
______________________________
Principal Investigator
_____________________________
Signature
___________
Date
APPENDIX E
STI Risk Assessment Survey
60
61
STI Risk Assessment Survey

DO NOT COMPLETE SURVEY IF YOU HAVE NOT HAD SEX IN THE LAST 6 MONTHS.
The completion of this survey is completely voluntary and anonymous. There are 6 questions on
this survey and should take less than 10 minutes to complete. Circle your response to the
questions.
1. Have you had a recent (in last six months) change in sexual partner?
Yes
No
2.
Do you have more than one sexual partner?

Yes
No
3. Have you had more than three sexual partners during the last six months?
Yes
No
4. Does your sexual partner have other sexual partners?
Yes
No
Unsure
5. Have you had unprotected sex or protected sex inconsistently (not every time)?
Yes
No
6. Have you had sex under the influence of drugs and/or alcohol?
62
Yes
No
Demographics
Please Complete the Following Information
AGE: _________
HOUSING/LOCATION OF
RESIDENCE?
ON CAMPUS
OFF CAMPUS
ARE YOU CURRENTLY IN A

MONOGOMOUS RELATIONSHIP?
YES
NO
HAVE YOU BEEN TESTED FOR HIV

WITHIN THE PAST YEAR?
YES
NO
POSITIVE
NEGATIVE
HAVE YOU BEEN TESTED FOR STDs

WITHIN THE PAST YEAR?
YES
NO
IF YES, WHAT WAS THE STD/S IF

RESULTS WERE POSITIVE? (CIRCLE
ALL THAT APPLY)
CHLAMYDIA
SYPHILIS
GONNORHEA
TRICHOMONIASIS
IF YES, WHAT WERE THE HIV

RESULTS?
63

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Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Risky Sexual Behaviors among Nursing Students at a Historically Black University

Coppin State University

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

The operational definitions for the study were the following:

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

This study was conducted within the

Protection of Human Subjects

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

This descriptive, quantitative study analyzed a small, convenience sample of African

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

If tested, what were the HIV results?

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Participant Responses to the Survey

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Recent change in sex partner (6 months)

More than 1 sex partner

More than 3 sex partners (6 months)

Unsure if partner has other sex partners

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

More than 1 sex partner

Unsure if partner has other

Currently in a monogomous relationship

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Recent chang ein sex

More than 1 sex partner

More than 3 sex partners (6

Unsure if partner has other

Sex under the influence of

Testing for HIV within the past year

Running Head: RISKY SEXUAL BEHAVIORS AMONG NURSING STUDENTS

Recent chang ein sex

More than 1 sex partner

More than 3 sex partners

Sex under the influence of

Tested for STIs within the past year