An examination of emergency contraception use by undergraduate college students in the Midwest using the integrated behavioral model The University of Toledo The University of Toledo Digital Repositor[.]
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.utoledo.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 Paper 235 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 98.4% A small majority of students (63.5%) were female, white (75.3%) and age 18-21 years (80%) Students ranged from freshmen (23.8%) through seniors (13.8%), with sophomores as the largest group (32.6%) The majority were heterosexual (92.1%); not currently in a relationship (44.6%), with 34.1% were in a committed relationship Participants reported having had sexual intercourse at least once in their lifetime (78.9%) with 8.4% 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 A Unintended/Unplanned Pregnancies in the United States and in College Women in the United States B Consequences of Unintended/Unplanned Births in College-Age Women in the United States C Sexual Activity and Birth Control Practices in College Age Men and Women in the United States D Emergency Contraception (EC) Utilization by College-Age Women and Men in the United States E Introduction to Emergency Contraception F Mechanism of Action of Emergency Contraception G Criteria for Utilizing Emergency Contraception H Using the Integrated Behavioral Model I Emergency Contraception’s Impact on Healthy Campus 2020 Goals J Statement of the Problem 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 Summary 17 II Literature Review 19 A 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 Awareness 28 b Access 29 c Advanced Provision 31 E Health Care Providers and Emergency Contraception (physicians, nurses, pharmacists and others) 34 a Provider Knowledge, Attitudes and Beliefs 35 b Provider Practices 37 F Emergency Contraception and Specific Populations a Adolescents and Teenagers viii 39 40 b College Students 42 G 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 Summary 49 III Methods 51 A Participants 51 a Inclusion and Exclusion Criteria 53 B Instrument 54 C Construct Variables and Measurement 56 a Experiential Attitude 57 b Instrumental Attitude 57 c Injunctive Norm 57 d Descriptive Norm 58 e Perceived Control 58 f Self-Efficacy 58 D Instrument Testing 58 E Procedures 65 F Data Analysis 66 G Summary 69 IV Results 70 A Participant Selection and Response Rate ix 70 Appendix H Questions Approved for use During Focus Group Sessions 179 180 181 Appendix I List of Expert Reviewers for Assessment of Validity 182 Expert Reviewers for Validity Assessment Kelly Cleland, MPA, MPH 218 Wallace Hall Office of Population Research Princeton University Princeton, NJ 08544 kcleland@princeton.edu Samantha Evans, MS, CHES GatorWell Health Promotion Services Division of Student Affairs P.O Box 112662 3190 Radio Road Gainesville, FL 32611-2662 s.evans@ufl.edu Richard Glotzer, Ph.D The University of Akron School of Social Work 411 Polsky Building Akron, OH 44325-8001 glotzer@uakron.edu Jagdish Khubchandani, Ph.D Department of Physiology and Health Science Cooper Science Building, CL 325 Ball State University Muncie, IN 47306] jkhubchandan@bsu.edu E Maureen Miller, MPH, CHES Interim Director GatorWell Health Promotion Services Division of Student Affairs P.O Box 112662 3190 Radio Road Gainesville, FL 32611-2662 emm@ufl.edu James Price, Ph.D The University of Toledo 2801 W Bancroft Mail Stop 119 Toledo, OH 43606-3390 James.price@utoledo.edu 183 Amy Thompson, Ph.D The University of Toledo 2801 W Bancroft Mail Stop 119 Toledo, OH 43606-3390 Amy.Thompson@utoledo.edu James Trussell, Ph.D Princeton University Office of Population Research 202 Wallace Hall Princeton, NJ 08544 trussell@princeton.edu Rose Marie Ward, Ph.D Miami University Kinesiology & Health 202P Phillips Hall 501 East High Street Oxford, OH 45056 wardrm1@muohio.edu Faith Yingling, Ph.D Dept of Research and Wellness 11B Student Recreation Center Bowling Green, OH 43403 faithy@bgsu.edu 184 Appendix J Institutional Review Board Approval for Revised Survey 185 186 Appendix K Final Survey 187 188 189 190 191 Appendix L Adult Research Subject - Information Form 192 193