The University of Toledo The University of Toledo Digital Repository Theses and Dissertations 2013 An examination of emergency contraception use by undergraduate college students in the Midwest using the integrated behavioral model Jennifer J. Wohlwend The University of Toledo Follow this and additional works at: http://utdr.edu/theses-dissertations Recommended Citation Wohlwend, Jennifer J., "An examination of emergency contraception use by undergraduate college students in the Midwest using the integrated behavioral model" (2013). Theses and Dissertations. This Dissertation is brought to you for free and open access by The University of Toledo Digital Repository.
It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of The University of Toledo Digital Repository. For more information, please see the repository's About page. A Dissertation entitled An Examination of Emergency Contraception use by Undergraduate College Students in the Midwest using the Integrated Behavioral Model by Jennifer J. Wohlwend Submitted to the Graduate Faculty as partial fulfillment of the requirements for the Doctor of Philosophy Degree in Health Education _________________________________________ Dr.
Tavis Glassman, Committee Chair _________________________________________ Dr. Joseph Dake, Committee Member _________________________________________ Dr. Timothy Jordan, Committee Member _________________________________________ Dr. Sadik Khuder, Committee Member _________________________________________ Dr.
Sanford Kimmel, Committee Member _________________________________________ Patricia R. Komuniecki, PhD, Dean College of Graduate Studies The University of Toledo May 2013 Copyright 2013, Jennifer J. Wohlwend This document is copyrighted material. Under copyright law, no parts of this document may be reproduced without the expressed permission of the author.
An Abstract of An Examination of Emergency Contraception use by Undergraduate College Students in the Midwest using the Integrated Behavioral Model by Jennifer J. Wohlwend Submitted to the Graduate Faculty as partial fulfillment of the requirements for the Doctor of Philosophy Degree in Health Education The University of Toledo May 2013 The purpose of this study was to determine the factors that influence undergraduate college student use of emergency contraception as well as their level of knowledge and prevalence of using EC. Understanding the factors that influence college student use of emergency contraception will inform development of intervention programs designed to increase its use, which may lead to lower rates of unintended/ unplanned pregnancies in this population. Students at the 11 Midwestern institutions of the Mid-American Conference were surveyed with the help of faculty at each school.
A total of 1,553 surveys were completed with a response rate of 98. A small majority of students (63.5%) were female, white (75.3%) and age 18-21 years (80%). Students ranged from freshmen (23.8%), with sophomores as the largest group (32. The majority were heterosexual (92.1%); not currently in a relationship (44.1% were in a committed relationship.
Participants reported having had sexual intercourse at least once in their lifetime (78.4% of sexually active students having experienced an unintended/unplanned pregnancy. Students who have used emergency contraception in the last 12 months made up 18.1% of the students who also reported having had sexual intercourse at least once. iii Knowledge of emergency contraception was not high in this group. Knowledge was compared to emergency contraceptive use.
As knowledge increased, use of EC increased; as use of EC increased. The Integrated Behavioral Model was used to investigate intention to use emergency contraception and predicted 50% of the variance in intention to use emergency contraceptives. Each construct contributed a portion of variance and could be used in any future interventions to increase its use and decrease unintended/unplanned pregnancies for college students. iv This dissertation is dedicated to my late sister, Donna Kruse Tischer, who would have whole-heartedly approved my topic; and my late father, Richard H.
Kruse, who would have been pleased that his daughter worked for her doctoral degree. Acknowledgements I am extremely grateful to my dissertation chairman, Dr. Tavis Glassman, who not only brought this topic to my attention, but enthusiastically worked with me from inception to completion; and through frustration and excitement. I am also thankful to my committee members, Drs.
Dake, Jordan, Khuder and Kimmel, who each provided their own unique contribution to my study. Without their dedication, hard work, and willingness to assist, completing my dissertation would have been much more difficult. I also want to thank every faculty member of the Health Education Department, as each person provided invaluable input at some point along the way, from suggestions to encouragement. Special thanks go to the faculty at each of the 10 Mid-American Conference schools who made it possible for me to collect my survey data.
Finally, I must thank my family, starting with my husband, Roger Wohlwend, who lived with me through the entire doctoral process. He provided encouragement, was usually patient, and always got me to laugh even when it was a most difficult time. My daughter, Melissa Buckland and her husband, Ryan Buckland, who lived with me through half of the battle and listened to me the other half, also provided comfort and encouragement. Thank you to all of you.
Your assistance, encouragement and suggestions have not gone unnoticed nor unappreciated. vi Table of Contents Abstract iii Acknowledgements vi Table of Contents vii List of Tables xii List of Figures xiii List of Abbreviations xiv List of Symbols xv I. Introduction to Emergency Contraception 1 A. Unintended/Unplanned Pregnancies in the United States and in College Women in the United States 1 B.
Consequences of Unintended/Unplanned Births in College-Age Women in the United States 2 C. Sexual Activity and Birth Control Practices in College Age Men and Women in the United States 3 D. Emergency Contraception (EC) Utilization by College-Age Women and Men in the United States 4 E. Introduction to Emergency Contraception 4 F.
Mechanism of Action of Emergency Contraception 5 G. Criteria for Utilizing Emergency Contraception 7 H. Using the Integrated Behavioral Model 7 I. Emergency Contraception’s Impact on Healthy Campus 2020 Goals 8 J.
Statement of the Problem 9 vii K. Purpose of the Study 10 L. Research Questions and Hypotheses 10 M. Definition of Terms 12 N.
Delimitations of the Study 16 O. Limitations of the Study 16 P. Emergency Contraception Specifics 19 a. Emergency Contraception Explained 20 b.
Mechanism of Action 21 c. When and How to Use Emergency Contraception 22 B. Emergency Contraception is not the Abortion Pill 24 C. Emergency Contraceptives Legalities and Ethics 26 D.
Use of Emergency Contraception and Possible Problems 27 a. Health Care Providers and Emergency Contraception (physicians, nurses, pharmacists and others) 34 a. Provider Knowledge, Attitudes and Beliefs 35 b. Emergency Contraception and Specific Populations 39 a.
Adolescents and Teenagers 40 viii b. Emergency Contraception Counseling 46 H. The Integrated Behavioral Model 46 I. The Integrated Behavioral Model and Contraception 48 J.
The Integrated Behavioral Model and Intention 49 K. Inclusion and Exclusion Criteria 53 B. Construct Variables and Measurement 56 a. Participant Selection and Response Rate 70 ix B.
Participant Demographic Information 73 C. Sexual Education and Religious Beliefs of Participants 73 D. Student Knowledge about Emergency Contraception 75 E. Sexual Experiences and Emergency Contraceptive Use 80 F.
Analyses of Integrated Behavioral Model Constructs 80 G. Failed to Be Rejected Hypotheses 107 C. Knowledge about Emergency Contraception 108 b. Experiential Attitudes toward Emergency Contraceptive Use 110 c.
Instrumental Attitudes toward Emergency Contraceptive Use 111 d. Injunctive Norm Related to EC Use 112 e. Descriptive Norm Related to EC Use 113 f. Perceived Control Related to Emergency Contraceptive Use 113 g.
Self-Efficacy Related to Emergency Contraceptive Use 113 h. The Integrated Behavioral Model and Predicting Intention 114 E. Summary 122 x References 123 Appendices 142 A. Initial Contact Letter to Faculty 142 B.
Institutional Review Board Approval for Study 144 C. IRB Approval/Acceptance for 10 Non-UT Schools 146 D. Institutional Review Board Approval for Focus Groups 159 E. Flyers Used for Focus Group Recruitment 161 F.
Informed Consent Form with Approval for Use of Audio-Taping Focus Group Sessions 163 G. Qualitative Analysis of Focus Group Sessions 167 H. Questions Approved for use During Focus Group Sessions 179 I. List of Expert Reviewers for Assessment of Validity 182 J.
Institutional Review Board Approval for Revised Survey 185 K. Adult Research Subject – Information Form 192 xi List of Tables Table 1 Sample Size. 52 Table 2 Stability Reliability (Test/Retest) Scores for Survey Instrument. 60 Table 3 Internal Consistency Scores for Survey Instrument.
62 Table 4 Principal Components Analysis/Rotated Component Matrix. 63 Table 5 Participant Demographics. 70 Table 6 Sexual Education and Religious Beliefs of Participants. 74 Table 7 Overall Knowledge Results of Participants.
76 Table 8 Specific Knowledge Results of Participants. 77 Table 9 Sexual Experiences and Emergency Contraceptive Use of Participants. 81 Table 10 Experiential Attitudes of Respondents Toward Using Emergency Contraceptives. 83 Table 11 Instrumental Attitudes of Respondents Toward Using Emergency Contraceptives.
86 Table 12 Injunctive Norm of Important Others. 88 Table 13 Descriptive Norm of Other People having Used Emergency Contraception. 91 Table 14 Perceived Control Regarding Emergency Contraception. 92 Table 15 Self-Efficacy Regarding Emergency Contraception.
93 Table 16 Correlations for the Integrated Behavioral Model Constructs. 99 Table 17 Goodness of Fit for Path Analysis Model ……………. 100 xii List of Figures Figure 1 Emergency Contraceptive Use and Level of Knowledge. 79 Figure 2 Path Analysis Model.
102 xiii List of Abbreviations DPN. Descriptive Norm EA. Experiential Attitude EC. Instrumental Attitude IBM …………………Integrated Behavioral Model IPN.
Injunctive Norm MAC. Mid-American Conference PC. Perceived Control SE. Self-Efficacy xiv List of Symbols ….
sample mean s …… standard deviation xv Chapter One Introduction to Emergency Contraception Chapter one provides an introduction to the topic of emergency contraception (EC) and why college students should avail themselves of this mechanism for preventing unintended/unplanned pregnancies. A brief discussion of sexual activity in and birth control practices of college age men and women in the United States will begin the chapter. This discussion is followed by a review of unintentional/unplanned pregnancies in the United States, and college-age women in particular, with prevalence rates of emergency contraceptive use by college students. An introduction to emergency contraception is presented and will include its mechanism of action and the criteria for its use.
This chapter concludes with a Statement of the Problem, Purpose of the Study, Research Questions and Hypotheses, Definition of Terms, Delimitations of the Study, and Limitations of the Study. Unintended/Unplanned Pregnancies in the United States and in College Women in the United States The majority of unintended/unplanned pregnancies in the United States occur in women 29 years old or younger (The National Campaign to Prevent Teen and Unplanned Pregnancy, 2006). Approximately three million pregnancies each year are not planned, with non-married women comprising one third of these (The National Campaign to Prevent Teen and Unplanned Pregnancy, 2006). The American College Health Association (ACHA) reports that 1.
The 2009 ACHA report, which surveyed 34,208 students, revealed that 4% (n=1,368) of students who were sexually active in the past year had either become pregnant themselves or gotten their partner pregnant (American College Health Association, 2009). The most recent ACHA/NCHA report reveals a slight increase from 1.8% of the 27,774 students surveyed reporting an unintended/unplanned pregnancy in 2011 (American College Health Association, 2012b). Consequences of Unintended/Unplanned Births in College-Age Women in the United States One of the issues with unintended/unplanned pregnancies in this age group is that 50% end in abortion (The National Campaign to Prevent Teen and Unplanned Pregnancy, n. Fifty-percent means approximately 250 terminated pregnancies occurred in the group of students who completed the National College Health Assessment survey in 2011.
It also means that of the students attending the Mid-American Conference schools being surveyed for this study, approximately 2,000 pregnancies were terminated each year. Many of these pregnancies could have been avoided if emergency contraceptives had been utilized. For the students who choose to continue their pregnancies, the young mothers and fathers are more likely to experience depression, live in poverty, and are less likely to complete their college educations or pursue their careers (The National Campaign to Prevent Teen and Unplanned Pregnancy, n.