Sexual knowledge of college students in a southern state: relationship to sexuality education.

Abstract: Participants were college students (602 female, 313 male) attending four Louisiana state universities. The instrument contained 27 sexual knowledge (SexK) items and 18 items assessing previous sexuality education and its perceived quality. Group SexK mean percentage score was only 55. 39 (SD= 15. 59). Statistical differences on SexK were found on gender, race, year in college and previous sexuality education. Participants' perceptions about the quality of their previous HIV/ AIDs and STD sexuality education were inversely proportionate to their HIV/AIDS and STD knowledge scores. Results clearly demonstrate the need for pre-college and college sexuality education programs.

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Sexuality is a lifelong process that encompasses the biological, emotional, psychological, and social domains and is a natural and healthy part of living (National Guidelines Task Force, 1996). Sexuality education aids young people in understanding a positive view of sexuality and helps them make responsible decisions regarding their sexual health (Sexuality Information and Education Council of the United States [SIECUS], 1999). Many schools, however, have inadequate school sexuality education programs concomitant with a lack of program evaluation.

PHILOSOPHY OF SEXUALITY EDUCATION

PRIMARY RESPONSIBILITY

Sexuality messages are first learned from parents who have primary responsibility for the sexuality education of their children (SIECUS, 1999), but communities also have an obligation to provide quality sexuality education programs (National Commission on Adolescent School Health, 1995). By developing advisory boards, students, teachers, parents, and other community professionals can give input about the type and content of school sexuality education programs (Bensley, 1991; Bensley & Bensley, 1997). The mission of sexuality education programs should reinforce and strengthen parental sexuality messages.

PARENTAL SUPPORT

Controversy about school sexuality education programs does exist, but a greater number of parents support rather than oppose them. Of 1,050 adults surveyed across the nation, 93 percent support the teaching of sexuality education in high school, and 84 percent support sexuality education in middle school (Haffner & Wagner, 1999; SIECUS, 2000). In addition to parental support of sexuality education, approximately 117 national, non-profit organizations have formed a national coalition to support and provide advocacy for sexuality education programs (SIECUS, 1999).

GOAL AND FOCUS OF PROGRAMMING

The primary goal of sexuality education is to promote adult sexual health (SIECUS, 1999). To that end, comprehensive sexuality education programs (k-12) incorporate age and developmentally appropriate goals and objectives, focusing on abstinence messages because of the strong belief that youth should attain emotional growth and maturity before committing to sexual relationships. Many individuals, however, believe that school sexuality education programs do not advocate abstinence (Vincent, Lammers, & Strack, 1999). For those communities divided on whether or not to offer abstinence-only or sexual health protection, a solution is to offer dual-track programs which allow parents a choice of abstinence-only or abstinence-plus safer sex curriculum (Kempner, 1999). While most pre-college sexuality programs do not include certain sexuality topics (abortion, homosexuality/gender issues, sexual response & sexual disorders), the preceding topics are included within college sexuality education curricula.

BENEFITS

Rather than encouraging sexual experimentation or increased sexual activity, studies commissioned by several organizations (the National Campaign to Prevent Teen Pregnancy, Joint United Nations Programme on HIV/AIDS, and the World Health Organization's Global Programme on AIDS) demonstrate the reverse is true (SIECUS, 1999). The reviews concluded that discussion of condoms and contraception delayed the onset of intercourse, reduced the frequency of intercourse, reduced the number of a person's sexual partners, promoted safer sexual behaviors, and reduced the number of unplanned pregnancy and STD rates.

Other studies (Gordon, 1992; Kirby, 1997, 2000) also indicate that sexuality education has been found to: (a) promote abstinence, (b) decrease sexual activity, (c) increase use of safer sexual practices, (d) increase teenage sexual responsibility, (e) increase sexuality related knowledge, (f) aid youth in more responsible sexual decision making, (g) delay the age at which first sexual intercourse occurred, and (h) not encourage earlier or increased sexual activity or the number of sexual partners.

THE PROBLEMS

By the time individuals begin attending college (age 18), they should possess basic sexuality knowledge. States vary on policies or laws regarding the teaching of sexuality education in schools. In Louisiana, other than one parish in the state, sexuality education may not be taught before 7th grade, and the quality of instruction has not been established.

As evidenced by national and Louisiana teenage pregnancy and STD rates, pre-college and college age individuals are engaging in sexual behaviors (many at, or even before, age 13). According to estimates from the 1999 Youth Risk Behavioral Survey (CDC, 2000) and 1995 College Risk Behavioral Survey (CDC, 1997), the percentage of students nationwide who reported engaging in sexual intercourse by age 13 was 8.3%; by the senior year of high school, 49.9%; and by college age, 79.5%.

In 1996, the number of Louisiana teens ages 15 to 19 reported to be pregnant was 17,350, and the teen pregnancy rate was 97 per 1000 which matched the national teen pregnancy rate (National Campaign to Prevent Teen Pregnancy, 2001). Louisiana ranked 32 among all states in the nation (National Campaign to Prevent Teen Pregnancy, 2001). The state 1999 birth rate among teens was 62.8 per 1000 compared to the national at 49.6 per 1000, and the state ranked 42 on teen birth rate (National Campaign to Prevent Teen Pregnancy, 2001).

Louisiana STD rates are also problematic. Nationally, Louisiana ranks fourth highest on teen STD rates (LA Office of Public Health, 2000). In 1999, the total number of gonorrhea cases was 13,198 in which 32% of the cases occurred among teens 15-19 year old, and 34% occurred among 20-24 year olds. In 1999, of 16,573 Chlamydia cases, 42% were among 15-19 year-olds, and 36% occurred among 20-24 year-olds. The Louisiana chlamydia rate for 1998 was 349 per 100,000 population (Census 1990), while the national rate for 1998 was 236.6. The state ranked 7th highest on HIV/AIDs in 1998 with 70% of newly-diagnosed AIDS cases in African-Americans (over five times higher than those among whites and two times higher than those among Hispanics).

PURPOSES OF THE STUDY

Unwanted or unexpected pregnancies and STDs are the result of engaging in unprotected sexual behaviors. Certainly, lack of sexual knowledge (e.g., condom or contraceptive use, harmful effects of STDs) could contribute to unprotected sexual behaviors. The researchers intended to determine if college students were knowledgeable on various sexuality topics and to gain insight about their perceptions of previous sexuality education. Ideally, this information should also be obtained from middle or high school age youth but, in Louisiana, persons under the age of 18 are not allowed to complete externally administered sexuality surveys. Specifically, purposes of this study were to: (a) assess level of college students' sexual knowledge (SexK), (b) identify SexK differences on various factors, (c) determine the factor/s predictive of SexK, and (d) assess the relationship between perceived quality of previous sexuality education and SexK.

METHODS

SUBJECTS

The subjects were 915 college students (602 female, 313 male) age 18 and above who were attending four Louisiana universities. The number of college subjects who completed the surveys numbered 947, but due to incomplete surveys, data from 915 subjects were analyzed.

A systematic sampling process was utilized in order to obtain fairly equal numbers of students by gender, race and year in college and to provide inter-university uniformity in the selection of classes. Of 55 classrooms selected from the four universities, the researchers were permitted to enter 37 classrooms (response rate = 67%).

PROCEDURES

The Institutional Review Board (IRB) at all four universities approved the study. Departments of Biology, Psychology, English, Kinesiology/Physical Education and Health Education were selected because they typically offer a variety of general education classes as well as major's classes containing large numbers of male and female students and those of differing ethnic diversity. From the semester schedule of courses, every fourth class was marked and the professor's name identified. A formal e-mail letter describing the purposes of the study and a request for permission to use their classrooms was sent to all faculty teaching the selected classes. A copy of the survey instrument and covet letter was sent by file attachment. Each professor subsequently obtained an indication of student/class willingness to participate in the study.

At the time of survey administration, the cover letter was read aloud and a copy was given to each participating student. Students were read their rights according to human subjects review, given information about the types of questions to be asked, not coerced to complete the questionnaire and assured of full anonymity. All individuals who participated in data collection were briefed on the proper procedure. The current researchers, a few classroom professors, and undergraduate and graduate students (paid to help with data collection) administered the surveys.

LIMITATION

A limitation of the study was that sample selection was based on a systematic selection of classrooms rather than a random selection of students. Although the researchers intended to obtain fairly equal numbers of students according to age, year in college, gender and race, the sample was unequal on number of students by gender and race: less males than females and less African American/other ethnic groups than Caucasian.

INSTRUMENT

The instrument was developed by the researchers and contained the following: (a) 27 multiple choke sexuality knowledge items; (b) five demographic questions; (c) three items ascertaining subjects' K-12 school sites; (d) four items ascertaining if subjects had received sexuality education in grade school, middle school, high school or college; and (e) 15 items asking perception of quality of previous sexuality education on various sexuality topics using a scale of extremely poor (1) to extremely good (5). The 27 sexuality knowledge items tested four areas of sexuality: (a) reproductive system anatomy & physiology (9 items), (b) gender (2 items), (c) contraception or birth control (7 items), (d) STDs (5 items), and (e) HIV/AIDS (4 items).

To assess content validity, a sampling of multiple choice items from college human sexuality tests (examinations) was selected based on sexuality content known to be taught at pre-college level. The sexual knowledge multiple choice items were then sent to four experts in the field of sexuality education for review and comment. After revision, 27 knowledge items comprised the sexual knowledge portion. To ascertain readability of the instrument, it was first piloted to approximately 100 undergraduate students. As a result, some items were revised but none deleted. Reliability (coefficient of internal consistency) was assessed by Guttman split-half which yielded a correlation of .71, equal length Spearman-Brown (.71) and unequal-length Spearman-Brown (.71). Alpha for part 1 (14 items) was .60 and Alpha for part 2 (13 items) was .56.

RESULTS

SUBJECTS

Of the 915 participants, the majority were Caucasian (77%), female (66%), and between 19 and 23 years old (68%). Less than one-quarter of the sample indicated never having school-based sexuality education (13%) or having sexuality education at the elementary (K-8)level (15%). Over half (64%)indicated having sexuality education in high school, and 43% indicated having sexuality education at the college level. The sample was divided fairly equally between freshman, sophomore, junior, and senior level students, and represented the three major areas of the state's population. Characteristics of the sample are provided in Table 1.

DESCRIPTIVE STATISTICS OF DEPENDENT MEASURES

SEXUALITY KNOWLEDGE. In general, the sample performed poorly on the sexuality knowledge test, averaging 55.39% (SD=15.59) correctly answered items. Mean scores on sections of the knowledge test were, in decreasing order: contraception (66.4%), gender (60.6%), anatomy (53.7%), and STDs (47.4%).

REPORTED PERCEPTIONS OF QUALITY OF SEXUALITY EDUCATION. Subjects were asked to rate perceived quality of former sexuality education on a scale from 1 (extremely poor) to 5 (extremely good). The group mean rating was 3.17 (SD=0.85). Content areas receiving the highest ratings were HIV/ AIDS, STDs, STD protection, abstinence, and anatomy. Content areas receiving the lowest ratings were homosexuality, abortion, resistance skills, and date rape (see Table 2).

SEXUAL KNOWLEDGE (SEXK) AS A FUNCTION OF GENDER, RACE, LOCATION OF RESIDENCE, COLLEGE CLASSIFICATION, AND PREVIOUS SEXUALITY EDUCATION

To analyze the effects of selected variables on overall SexK (the total knowledge test score), t-tests and one-way ANOVAs were used. Variables that were found to significantly impact participants' overall SexK were further investigated by examining their impact on test performance in specific areas of knowledge (e.g., anatomy, gender, contraception, STDs). Discriminant analysis was used to identify which of the four test content areas separated groups. The content areas identified were then further analyzed using t-tests or one-way ANOVAs.

SEXUAL KNOWLEDGE AS A FUNCTION OF GENDER. A t-test comparing the overall SexK among males and females indicated a significant difference, t (913) = 5.87, p < .001. As shown in Figure 1, females scored significantly higher on the knowledge test than did males. Discriminant analysis indicated males and females were differentiated primarily by their knowledge of contraception, F = 40.65, p < .001. A t-test confirmed this difference, t (913) = 6.38, p < .001, with females' knowledge of contraception significantly greater than males'.

SEXUAL KNOWLEDGE AS A FUNCTION OF RACE. Overall SexK was also found to vary according to race, t (856) = 6.04, p < .001 (see Figure 1). Due to a limited number of participants in race categories, these analyses were conducted only comparing Caucasian and African American participants. Discriminant analysis indicated these two groups could be differentiated by their knowledge in two areas: anatomy, F = 51.01, p < .001, and gender, F = 28.84, p < .001. T-tests confirmed these differences, with Caucasian students' knowledge scores in anatomy, t (856) = 7.14, p < .001 and gender, t (856) = 4.19, p < .001, significantly higher than African American students.

[FIGURE 1 OMITTED]

SEXUAL KNOWLEDGE AS A FUNCTION OF LOCATION OF RESIDENCE. A one-way ANOVA was used to compare the overall SexK of students divided by the location of their residence (north, southeast, and southwest) in the state. The results indicated no significant differences, F (2, 879) = 0.03, p > .10.

SEXUAL KNOWLEDGE AS A FUNCTION OF COLLEGE CLASSIFICATION. A one-way ANOVA revealed that overall SexK varied with college classification, F (3, 902) = 38.66, p < .001. Depicted in Figure 2, SexK increased with each year in college. Further examination of this effect using the Tukey HSD procedure indicated significant differences among all classifications. Discriminant analysis indicated college classifications were separated by knowledge in two areas, STDs, F = 30.79, p < .001, and contraception, F = 20.22, p < .001. Scores in these two content areas were analyzed using one-wap ANOVAs and the Tukey HSD procedure. The ANOVA conducted on STD knowledge revealed a significant group effect, F (3, 902) = 30.79, p < .001. Tukey follow-up indicated freshman and sophomores scored significantly lower than juniors who were significantly lower than seniors. Knowledge of contraception was also found to differ among groups, F (3, 902) = 20.11, p < .001, with the scores of freshmen significantly lower than sophomores whose scores were significantly lower than juniors and seniors.

[FIGURE 2 OMITTED]

SEXUAL KNOWLEDGE AS A FUNCTION OF PREVIOUS SEXUALITY EDUCATION. To analyze group differences as a function of sexuality education, participants were placed into five groups reflecting past sexuality education: (a) no sexuality education (NONE, n = 118), (b) the highest level of sexuality education at the elementary or junior high school level (ELEM, n = 95), (c) the highest level of sexuality education at the high school level (HS, n = 284), (d) sexuality education at the college level only (COL, n = 68), and (e) sexuality education at the college level as well as some lower level (COL+, n = 310). Figure 2 presents SexK scores of these groups. Analysis of these groups using a one-way ANOVA indicated overall SexK varied with previous sexuality education, F (4, 894) = 2.92, p < .05. Tukey HSD follow-up tests indicated significantly lower scores in NONE and ELEM groups as compared to HS, COL, and COL+ groups. In addition, the COL group had a significantly higher score than both the HS and COL+ groups. The results of the discriminant analysis indicated that sexuality education groups could not be discriminated by any of the content area knowledge scores.

RELATIONSHIPS BETWEEN SEXUAL KNOWLEDGE AND PERCEIVED QUALITY 0F SEXUALITY EDUCATION

To examine the association between SexK and participants' perception of the quality of the sexuality education they had received, Pearson Product Moment correlation coefficients were computed between overall quality of sexuality education and overall SexK score, and quality of specific content areas with knowledge scores from content areas (see Table 2).

Participant's ratings of the overall quality of sexuality education were inversely related to overall sexuality knowledge and inversely related on STDs and HIV/ AIDS. This relationship was in the opposite direction than expected, with higher ratings of quality of perceived previous sexuality education associated with lower levels of knowledge. Positive correlations between knowledge were found in two areas: anatomy and contraception. Despite correlations reaching traditional levels of significance, the values reflect only weak associations, and should therefore be interpreted cautiously (see Table 2).

VARIABLES WHICH PREDICT TOTAL SEXUAL KNOWLEDGE

To determine the variables predicting SexK, a stepwise multiple regression was conducted using gender, race, college classification, location of residence, previous sexuality education, and perceived quality of sexuality education. The alpha level to enter variables into the equation was set at .01. College classification entered into the regression equation first and accounted for 10.80% of the total variance in total SexK. Race entered next adding 4.30% followed by gender which added 3.30%. Finally, perceived quality of sexuality education and previous sexuality education were also added to the equation, with the entire set of variables accounting for 19.8% (20%) of the variance in SexK (see Figure 3).

SUMMARY OF FINDINGS

Females were higher in overall knowledge and on the topic of contraception. Total SexK as well as knowledge on reproductive system anatomy and gender were higher in Caucasian than African American students. Overall sexuality knowledge increased with year in college as did knowledge of STDs and contraception. Overall knowledge was lowest in those who received no previous sexuality education or had received it in elementary school and higher in students who received sexuality education at the college level. Students' perceptions of the quality of sexuality education they had received were inversely correlated to their knowledge of STDs and HIV/AIDS and positively correlated to knowledge of reproductive system and contraception.

DISCUSSION

The overall mean percentage score of 55.39 on sexual knowledge (considered to be academically failing) was poor. African American participants' scores were significantly lower than Caucasian students which is similar to a previous study on sexual knowledge (Eisen & Zellman, 1986). Sexual knowledge increased significantly as subjects progressed in college and could be attributed to greater opportunity for learning (sexuality classes, seminars, peers). But, puzzling was the finding that students who had obtained sexuality education only in college had a mean score four points higher that those who said they had sexuality education at college plus some level of secondary schooling. It would be interesting to investigate further the reasons for this (e.g., misinformation given, non-retention of facts, poor test-taking skills). Nonetheless, the poor overall sexuality knowledge score indicates a need for better pre-college and college sexuality education.

An unforeseen finding was the relationship of the perceived quality of students' former sexuality education instruction and their sexual knowledge scores. The mean perceived quality of previous sexuality education was 3.17 on scale of 1 to 5 (fair to good). On all but two areas of instruction (anatomy and contraception), however, the higher they rated quality of instruction, the lower their test scores. Most importantly, the higher that students perceived their former instruction in STDs and HIV/AIDS, the lower the knowledge scores. Either the students did not receive proper instruction in those topics or they had forgotten factual information at the time of the present study: Individuals who don't possess a clear understanding about STDs and HIV/AIDS may not have the skills and competencies to protect themselves from disease, perhaps as evidenced by this state's ranking in the top four in the nation on STD rates.

To determine the variables predicting sexual knowledge level yielded only 20% of the variance (year in college [10.8%], being male or female [4.3%], being black or white [3.3%], quality of previous sexuality education [0.7%], and previous sex instruction [0.9%]). If previous sexuality instruction were of high quality, one would expect it to account for much more than less than 1% of the variance. The findings of this study demonstrate that large numbers of college age students do not have command of basic sexuality knowledge.

IMPLICATIONS FOR THE FUTURE

There is great need in Louisiana for the development of quality sexuality education programs for pre-college and college age students. At the pre-college level, the legislature should consider a change in state laws to allow schools to teach sexuality education before the 7th grade. Besides Louisiana, results from a national study reveal that a large proportion of schools nationwide are not doing enough in grades five and six to prepare students for puberty nor for dealing with sexual pressuring and decision making (Landry, Singh, & Darroch, 2000). More information about the quality of existing sexuality programs should be obtained, and for those deemed inadequate, help should be given. In order to help teachers gain in level of comfort and self-efficacy, they should be trained in various sexuality curricula which have been tested and approved for age and developmentally appropriate content material (Krueger, 1991; Levenson-Gingiss & Hamilton, 1989; Lowden, 1995). This study revealed that college students need added information about sexuality matters. Realizing that not all students take human sexuality courses, university campuses should provide other opportunity for learning through seminars, residence hall talks, peer education groups, and speakers.

In summary, it is essential that pre- and college age individuals increase their sexual knowledge level. The ultimate goal is to protect our youth from sexual diseases that could prove fatal and from becoming children who beget children.

Table 1. Demographic Characteristics of the Sample.

    Characteristic         n      %

Age Group
  18 years old            122    13%
  19 years old            192    21%
  20 to 23 years old      430    47%
  24 to 28 years old      114    13%
  29 years or older        54     6%

College Classification
  Freshman                226    25%
  Sophomore               259    28%
  Junior                  193    21%
  Senior                  228    25%

       Characteristic              n      %

Race / Nationality
  White Non-Hispanic              703    77%
  African American                158    17%
  Hispanic                         22     2%
  Asian                            20     2%
  Other                            11     1%

Location of Residence in State
  Southeastern                    452    49%
  Southwestern                    323    35%
  Northern                        129    14%

Note. Sums in each category may not reflect the total sample due
to participants failing to provide an answer to the item.

Table 2. Sexual Knowledge and Relationship to Perceived Quality of Sex
Education.

Topic                   Quality of sex education    Sexual knowledge
                               Mean (SD)               Mean (SD)

Anatomy/Physiology            3.41 (1.10)            53.73 (20.90)
STDs                          3.53 (1.14)            44.13 (24.88)
HIV/AIDS                      3.57 (1.14)            51.37 (22.36)
Contraception                 3.25 (1.23)            66.39 (21.77)
Abstinence                    3.42 (1.19)
Decision Making               3.25 (1.12)
Resistance Skills             2.93 (1.19)
Condom Use                    3.27 (1.26)
Abortion Techniques           2.52 (1.30)
Pregnancy Issues              3.31 (1.15)
Birth Information             3.14 (1.16)
STD Protection                3.47 (1.17)
Dating Relationships          3.14 (1.16)
Date Rape                     2.91 (1.19)
Gender/Homosexuality          2.41 (1.26)
Overall                       3.17 (0.85)            55.39 (15.59)

Topic                   Correlation coefficient

Anatomy/Physiology                 .15 **
STDs                              -.05
HIV/AIDS                          -.04
Contraception                      .08 *
Abstinence
Decision Making
Resistance Skills
Condom Use
Abortion Techniques
Pregnancy Issues
Birth Information
STD Protection
Dating Relationships
Date Rape
Gender/Homosexuality
Overall
Overall

* p [less than or equal to] .05 ** p [less than or equal to] .01

Figure 3. Results of Stepwise Multiple Regression Predicting Overall
Sexual Knowledge.

College class     10.8
Race               4.3
Gender             3.3
Qual of sex ed     0.7
Loc of sex ed      0.9
Unexplained       80

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Linda Synovitz, RN, Ph.D., CHES, FASHA and Eddie Hebert, Ph.D. are Assistant Professors in the Department of Kinesiology and Health Studies at Southeastern Louisiana University. R. Mark Kelley, Ph.D. is an Assistant Professor in the Department of Health Education and Health Promotion at the University of Wisconsin LaCrosse.

Gerald Carlson, Ph.D. is the Associate Dean of Education at the University of Louisiana at Lafayette. Address all correspondence to Linda Synovitz, RN, Ph.D., CHES, FASHA, Assistant Professor, Department of Kinesiology and Health Studies, Southeastern Louisiana University, SLU 10845, Hammond, LA 70402; PHONE: [phone]; FAX: [phone]; E-MAIL: [e-mail].