The assessment of university students'
knowledge, attitudes, and behaviors
toward sex

By: Melissa Castora
Mentor: Jana Jasinski

Review of Literature

"Sex education has been found to have a positive effect on attitudes toward condom use. However, this does not mean that people actually used condoms more, only that they had an increased willingness, or attitude adjustment, to do so. "

Students' sexual education background

Evaluating the effectiveness of sex education is important. If a goal of sex education is to promote safe sex practices, it can only be assumed that programs are having the desired effects without assessing actual knowledge, attitudes, and behaviors. Much previous research (Kyes, 1990; Moran, 1991; Kirby, 2002; Abdullah, Fielding, & Hedley, 2003) found that sex education guides students? attitudes toward promoting safer sex practices.

Sex education has been found to have a positive effect on attitudes toward condom use. However, this does not mean that people actually used condoms more, only that they had an increased willingness, or attitude adjustment, to do so. One study, for example, found that learning about sexuality in a sex education class had a very strong relationship to reports of increased condom use (Moran, 1991). Another study also found that there is a strong relationship in the use of condoms or other forms of contraceptives following sex and HIV education (Kirby, 2002). Furthermore, Kyes (1990), reports that viewing a safe sex film does affect positive change in attitudes toward condoms and an increased willingness, in women, to have their partners use them.

Important to sex education is the relevance and content of the subject matter. Over the past decade, Abdullah, Fielding, and Hedley (2003) found an increase in the amount of content in which schools are educating their students about safe sex. For example, beginning in the mid-1990?s, a widespread campaign for AIDS education in secondary schools promoted consistent condom use. Results from the AIDS awareness campaigns in schools concluded a positive impact in the rates of condom use, as well as shaping negative attitudes toward casual sex (Abdullah, Fielding, & Hedley, 2003). As a result of integrating vital information that at one time was considered taboo into sex education, positive, safer outcomes for young people are now possible.

However, not all research has found a positive correlation between sex education, positive attitudes, and safe sex behaviors. Guthrie and Bates (2003) compared data collected in 1991 to data collected in 2000, and found that although students more frequently reported receiving sex education in 2000, their attitudes toward utilizing sexual precautions became more lax. How can sex education be viewed as beneficial if those receiving the education are developing attitudes that are in opposition to the goals of sex education? It is this example that provides support for the need for consistent assessment of the nature and needs of sex education.

Although sex educators have made great strides toward improving the accuracy and thoroughness of the content of information covered, many pressing issues still are not discussed. For example, a study that assessed the sex education programs in multiple schools found that there are many important topics not covered in schools (Kirby, 2002). Additional research has found that students had a common misunderstanding about the prevalence of STIs (Cohen & Bruce, 1997); they did not seem to understand that each disease is unique in transmission and prevalence rates. Perhaps topics such as these need to be consistently integrated into contemporary sex education.

Attitudes toward condom use

Being able to identify and understand attitudes toward condom use is important so that education can be geared to adjust attitudes that may predict high-risk behavior. Previous research has identified high-risk attitudes toward condoms that lead to risky sexual behavior. For example, Symons (1993) found that participants felt condoms reduced pleasure and intimacy in the relationship, and resulted in making safe sex decisions more difficult.

Like many issues, attitudes toward condom use differ among males and females. Previous research finds that attitudes toward condoms are significantly related to gender (Campbell, Peplau, & DeBro, 1992); women were consistently more positive about using condoms than were men. Also, women with less traditional attitudes?that is, attitudes which did not adhere to the historical sexual double standard?were found to be more likely to discuss, provide, and use a condom during sexual activity (Caron & Halteman, 1993). These differences between genders, as well as differences within genders, are important for sex educators in order to provide an all-encompassing education.

Norms surrounding condom use also play a significant role in predicting condom use and these norms also vary by gender. Mizuno, Kennedy, Seals, & Myllyluoma (2000) found that for female adolescents, the most powerful norm predicting condom use was the number of friends perceived to be using condoms. For male adolescents, the most powerful norm predicting condom use was the pressure exerted by parents, peers, or sexual partners to use condoms. These important findings provide support for norms that predict safe sex behavior.

Sexual behavior

In addition to creating safe sex attitudes, another goal of sex education is to focus on ways to produce consistent safe sex behaviors. One study found that among heterosexual college students, hooking up (i.e. any form of high-risk sexual behavior) has become normative behavior (Lambert, Kahn, & Apple, 2003). Therefore, if this norm continues, and sexual behaviors are not consistent with safe sex attitudes, many college heterosexuals may be putting themselves at high risk for sexually transmitted infections or unwanted pregnancies. Furthermore, a study conducted among college students found that there are high estimates (65%) of sexual activity, sex without the use of a condom, and sex without a condom after drinking (LaBrie, 2000). The study pointed out the need to target more interventions for safe sex, especially when under the influence of alcohol. The ability to make safe sex decisions has been difficult for many, whether under the influence of alcohol or not. Foreman (2003) found that there is a typical ?override of cognition? when in the heat of the moment, and that until students realize that, their personal risk, high-risk sexual behaviors are unlikely to change. These high-risk behaviors among college students are largely due to students not recognizing any personal risk and due, in part, to the influence of alcohol when engaging in sexual activity.

Although some research has found increased safe sex practices, students? knowledge about safe sex practices and their attitudes about condom use do not always comply with their actual behavior. Baldwin and Whiteley (1990) found that a ten-week course on human sexuality did not predict actual condom use during sex, indicating that knowledge is not a strong predictor of behavior. Research such as this indicates that knowledge about sexuality is not a single predictor of safe sex behavior.

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