Cheryse Jackson

Risky Sexual Behaviors among

Nursing Students at a
Historically Black University
Chairperson- Dr. Nayna Philipsen
Committee Members- Dr. Joan Tilghman & Dr. Charlotte Wood

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.

Introduction

The Center for Disease Control and Prevention (CDC) - Almost 20 million people each
year are infected with STIs resulting from risky unprotected sexual activity, and half of
them are under 30 years of age (CDC, 2012).

Monkguos (2013) data from Historically Black Colleges and Universities 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 under the age of
30.

Introduction

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).

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.

This study described the risky sex behaviors among African American female
undergraduate nursing students at a HBCU.

Significance of the Research

Identify the risky sex behaviors from a sample of African American female nursing
students.

Promote more effective measures to self- address the gaps between the level of
awareness, perception of risk, and the risky sex behaviors identified to help prevent STI
contraction.

Enables health care professionals to know what risky sex behaviors are being engaged
by young African American women and to educate these women based on these
specific behaviors.

Statement of the Problem

Sexually transmitted disease is a continual and growing pandemic throughout the US,
however, it is devastatingly affecting African Americans more than other communities
(Butaro, Trybulski, Bailey, & Cook, 2013).

Purpose of the Study

Examine and describe 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.

Research Question

The research question for this study was, What risky sex
behaviors that contribute to the spread and contraction of STIs
are identified by the nursing students at this Historically Black
University?

Research Variables
Conceptual Definitions

African American - An American of African and especially of black African descent

(Merriam-Webster [MW], 2014).

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).

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).

Research Variables
Operational Definitions

An African American was a participant that identified themselves to be a black American.

Historically Black Colleges and University (HBCU) was measured by students enrolled in
nursing classes at an HBCU.

Risky Sex behavior was a measured by the Aria STI Risk Assessment.

Review of Literature

African Americans and the STI disparity

The African American rate is much higher than any other racial groups when it
comes to the new cases of human immunodeficiency virus/acquired immune
deficiency syndrome (HIV/AIDS) especially among the younger population
(Thomas et al., 2008).
The CDC (2014) reports 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 they soared over the other racial ethnicities (especially ages 13-24).

Review of Literature

African Americans and the STI disparity

African Americans account for a large portion of those being affected by this
disease, but account for only 13% of the population, making this racial
disparity very noticeable (Mongkuo et al., 2010), and an urgent public health
priority.
Research shows that the HIV incidence is so prevalent in the African American
culture due to no detection or late detection caused by challenges and
barriers specific to the African American race as opposed to any other race
(Mongkuo et al., 2010).

Review of Literature
Sexually Transmitted Infection Risks
American Social Health Association (ASHA) in 2014 explored Americans sex
attitudes, knowledge, and behaviors, from ages 18-35, 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 they had sex.
Statistics revealed that 7 of 10 individuals (68%) exhibited a severe lack of
concern for contracting STIs (ASHA, 2014).
Awareness is paramount and should be strived for in effort to thwart the
transmission of HIV, especially amongst women (Macleod-Downes, Albertyn, &
Mayers, 2008).

Review of Literature

Sexually Transmitted Infection Risks

In the survey by ASHA in 2014, one of the factors presented by Dr. James
Allen, is a stigma to talk about STIs which makes the silence a barrier to
preventing their spread.
In the survey, of the 93% who believed their sex partner had no STI, only 1 in
3 actually bothered to ask their partner or have a discussion about it (ASHA,
2014).

Review of Literature

Sexually Transmitted Infection Risks

African Americans are faced with many challenges, such as drug related
sexual behaviors, homosexual men concealing their tendency due to
increasing homophobias, pressure from the black male on the woman to keep
the relationship thriving, more females than males within the community (a
1:5 male to female ratio), high poverty rate among the African American
community and many other factors, which in turn exposes them to more STIs
and at an even higher rate (Mongkuo et al., 2010).
Other included factors are exposure to violence and a lack of personal
motivation that is needed to prevent these behaviors(Mongkuo, 2013).

Review of Literature

Sexually Transmitted Infection Risks

Lower levels of education lead to proven incidences of poverty-stricken
conditions, such as poor nutrition and hygiene, and decreased opportunity in
general throughout the life span (Macleod-Downes et al., 2008).
Powerlessness experienced by the women, often enable the men to set the
tone of the relationship, deciding if or when they have sex, and if a condom
will be worn during intercourse (Macleod-Downes et al., 2008).
Being in a non-monogamous, heterosexual relationship, with inconsistent
condom use, exposes African American women unnecessarily to STIs
(Macleod-Downes et al., 2008).

Review of Literature

Perceived Risk
Commonality shared in the literature that many of the students were aware of
HIV/AIDS, but that being aware did not make the students engage in less risky
sex behaviors and they perceived themselves as being a low risk for the
contraction of STIs (Thomas et al., 2008; Duncan et al., 2002).
Some of the students at HBCUs perceived themselves as invincible because
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).

Review of Literature

Perceived Risk
Condom use, from a public health vantage point, is perceived to be the best
strategy and first line of defense against STIs (Leval et al., 2011).
In a study in 2011 by Leval and colleagues, they 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 differences.
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).

Review of Literature

Risky Sex Behaviors among the Young Adults

Thomas and colleagues (2008), noted that of the 50% of the reported
HIV/AIDS cases, 54% of them were reports from the South, consistent with
previous research conducted, noting that many of the students attending
HBCUs report risky sex behaviors.
Behaviors include sex with drugs and alcohol, unprotected sex, and sex with
multiple partners (Thomas et al., 2008).

Review of Literature

Risky Sex Behaviors among the Young Adults

A common finding of 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 felt that they engaged in risky sex
behavior (as opposed to individuals that did not engage in such risky
behavior), but did not stop the high-risk behaviors (Duncan et al., 2002;
Thomas et al., 2008).
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 (Napper, Fisher, & Reynolds, 2011).

Theoretical Framework
Health Belief Model
The Health Belief Model 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, and barriers, motivation, modifying
factors (Main Constructs, 2015).

Theoretical Framework
Health Belief Model

Health Belief Model is grounded in health promotion and disease prevention that links
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.

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.

Methodology
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.

Methodology
Sample
A convenience sampling 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.

Methodology
Limitations
The sample was limited to undergraduate nursing students.
The sample was limited to students age 30 and younger.
The sample was limited to one university.
The study used a small convenience sample.
Time to complete the tool was cut off after 10 minutes.

Methodology
Procedure

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:

An explanation of the purpose of the study was given to the participants.

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.

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.

Informed consent form was signed by the participants.

Methodology
Procedure Cont.

The survey and demographic questions were distributed with an envelope, and students
were given about 10 minutes to complete the thirteen (13) questions.

Instructions for completing the survey and placing the completed survey into the
provided envelope when completed were explained.

The participants were undisturbed and given anonymity during the survey completion
time to promote comfort in answering questions truthfully.

Envelopes containing the completed surveys were collected from the participants and
secured in a large, sealed manila envelope.

Research Instrument

The instrument was a modified STI Risk Assessment by Aria Health Systems (AH,
2014). The survey consisted of six (6) questions and was followed by three (3)
demographic questions and four (4) questions pertaining to STI testing.

The instrument 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.

Research Instrument

The instrument helped to address which risky sex behavior(s) are the most practiced to
allow health care professionals to narrow their focus on education and prevention
measures for the most practiced behavior.

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.

Data Analysis
Demographics

Data Analysis
Demographics

Data Analysis
Demographics

Data Analysis
STI Testing

Data Analysis
STI Testing

Data Analysis
STI Testing

Data Analysis
STI Testing

Data Analysis
Frequencies
Participant Responses to the Survey

Data Analysis
Frequencies

Data Analysis
Frequencies

Data Analysis
Frequencies

Data Analysis
Frequencies

Data Analysis
Frequencies

Data Analysis
Cross Tabulations
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 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.

Data Analysis
Cross Tabulations
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 having more than one sex partner, and was unsure whether their sex partner had other sex partners.

Data Analysis
Cross Tabulations
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.

Data Analysis
Cross Tabulations
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.

Data Analysis
Cross Tabulations
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.

Data Analysis
Cross Tabulations
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.

Data Analysis
Cross Tabulations
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.

Findings
Risky Behaviors

Having unprotected or inconsistent protected sex and having sex while under the
influence of drugs and/or alcohol were the highest ranking practiced behaviors. The
findings indicated that more of the nursing students who practice these risky behaviors
were between the ages of 21 -25.

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.

Thomas et al. in 2008 that drugs and alcohol influence students to have unprotected sex or sex
with multiple partners among African American students.

Findings
Risky Behaviors

ASHA (2014) reported 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.

In this study, 69% of the nursing students did not protect themselves consistently.

Findings
Monogamous Relationship

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, 12 were not wearing condoms and 10 were 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%.

In this study, the 16 participants reporting to be in a monogamous relationship

practiced risky behaviors more frequently than those who are not.

Findings
HIV/STI Testing

79.3% of the nursing students were tested which leads one to assume that they had to
be aware of HIV and STIs 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.

Findings
HIV/STI Testing

100% nursing students reported to be negative for HIV.

Only one reported to have the STI, Chlamydia. That participant practiced the following
risky behaviors: A recent change in sex partners; more than one sex partner; unsure if
sex partner has other sex partners; unprotected or inconsistent protected sex; and sex
under the influence of drugs and/or alcohol. These were all of the risky behaviors except
having more than 3 partners within the past 6 months.

Findings
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 findings confirmed that all 82.8% of the nursing students practiced at least 1 risky sex
behaviors.

All (100%) risky sex behaviors were practiced: A recent change in sex partners (31%); more
than one sex partner (10.3%); unsure if sex partner has other sex partners (24.1%);
unprotected or inconsistent protected sex (69%); sex under the influence of drugs and/or
alcohol (48.3%); and having more than 3 partners within the past 6 months (3.4%).

Of the risky behaviors, having unprotected or inconsistent protected sex and having sex while
under the influence of drugs and/or alcohol were the highest ranking practiced behaviors by
almost half of the nursing students (48.3%) in the study.

Conclusions
Implications for Nursing Education

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). These programs can focus on
promoting strategies to adopt healthier sex behaviors.

These programs can 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.

Conclusions
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, Fisher, Reynolds, 2011).

Conclusions
Implications for Nursing Research

Other 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.

Conclusions
Implications for Nursing Practice

Results from research studies are the basis for the necessary knowledge in which evidencebased practices and guidelines are built.
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.

Acknowledgements

References

Center for Disease Control and Prevention. (2010). 2010 sexually transmitted disease
surveillance. [Online]. Retrieved from http://www.cdc.gov/std/stfroms10/trends.htm

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