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AIDS and College Health: Knowledge, Threat, and Prevention at a Northeastern University a
Quint C. Thurman PhD & Kathryn M. Franklin MS a
Washington State University , Pullman Published online: 09 Jul 2010.
To cite this article: Quint C. Thurman PhD & Kathryn M. Franklin MS (1990) AIDS and College Health: Knowledge, Threat, and Prevention at a Northeastern University, Journal of American College Health, 38:4, 179-184, DOI: 10.1080/07448481.1990.9938439 To link to this article: http://dx.doi.org/10.1080/07448481.1990.9938439
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
AIDS and College Health: Knowledge, Threat, and Prevention at a Northeastern University
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QUINT C. THURMAN, PhD, and KATHRYN M. FRANKLIN, MS
We performed secondary analyses on data originally collected by telephone from a random sample of 294 undergraduates from a large northeastern university to examine students’ knowledge about acquired immunodeficiency syndrome (AIDS) and the students’ reactions to the health threat posed by human immunodeficiency virus (HIV). Our findings indicated that students are reasonably well informed about AIDS, are aware of the recommended precautions for avoiding HIV infection, and are fearful that the virus may spread within the student population. These data also show that students are re ludant to change their sexual behavior unless the threat of infection is personalized. The implications of our findings for future research are briefly discussed.
Results reported in this journal by Goodwin and Roscoe’ marked the beginning of concern for public opinion research into college students’ knowledge about AIDS. Their study of a convenience sample of college undergraduates at a midwestern university pointed out that one sexually active segment of the American population had been largely overlooked in the early stages of survey research on AIDS information. We used data gathered from a random sample of college students at a northeastern university that supported the initial conclusions of Goodwin and Roscoe. We also found that students a p peared to be knowledgeable about the transmission of HIV and generally feared that the virus would spread. Subsequent analysis, however, also showed that only a small proportion of students who worry about their own risk of infection take steps toward prevention. Reports from the Centers for Disease Control of the US Public Health Service indicate that more than 66,400
Quint C. Thurman, an assistant professor of political science at Washington State University, Pullman, was formerly assistant director of student affairs at the University of Massachusetts, Amherst, where Kathryn M. Franklin is completing work for a doctoral degree in social psychology and statistics.
VOL 38, IANUARY 1990
Americans have died from AIDS as of October 1989 and that the death toll from the disease could climb to 263,000 by 1992. The surgeon general’ has estimated that as many as 1.5 million persons probably now carry the HIV virus. Curran et a13 reported that mortality from AIDS disproportionately affects persons between the ages of 20 and 44. College students’ high level of sexual activity, coupled with the false sense of invulnerability that is characteristic of youth, may unnecessarily increase their danger of contracting the virus. The Task Force on AIDS Education at the University of Massachusetts collected figures to assess students’ knowledge about HIV infection and prevention. Although generalization from these data is limited because a single undergraduate population was examined, our secondary analysis of the results suggests that administrators and public health educators face a serious challenge in trying to encourage students to adopt measures to prevent the spread of HIV and reduce the threat of AIDS. Public health officialsbelieve that a well-informed p u b lic can be sufficiently prepared against the possibility of contracting AIDS. The model operating here is an old one-knowledge will lead to recognition of the danger, which in turn will lead to a change in risky behavior. The widely used Health Belief Model, reviewed elsewhere by Janz and B e ~ k e r ,has ~ attempted to explain changes in the behavior of smokers, drinkers, and others trying to improve their health status. Theoretically, once serious health risks are recognized, behavior modification follows. Unfortunately, the utility of this model in principle does not assure success in practice, as can be seen in the case of the association between cigarette smoking and ~ a n c e r Many .~ smokers seem quite willing to ignore this health hazard, especially as it applies to their own behavior. Few people believe that the worst can happen to them per~onally.~-~ The data presented here provide some indication of the level of AIDS awareness among college students at a large northeastern university and of their response to the
179
COLLEGE HEALTH threat of HIV infection. This research is a logical extension of data gathered earlier on high school campuses by DiClemente et al” and Price et all’ and on college campuses by Goodwin and Roscoe.’
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METHODS Two hundred ninety-four students participated in telephone interviews conducted by the University of MassachusettslAmherst’s Student Affairs Research and Evaluation Office (SAREO) in the 1987 spring semester as part of SAREOs regularly scheduled weekly surveys of full-time undergraduates. Trained student interviewers administered the brief, 22-item survey by telephone on two consecutive Wednesday evenings (March 4 and March 1 1 ) between 5:OO and 1O:OO PM. Confidentiality of the responses was guaranteed. In order to ease any potential embarrassment inherent in a sensitive topic, women interviewed female students and men responded to questions posed by male interviewers. Students in the sample were selected at random from the university‘s database of full-time undergraduates. O f the 394 students asked to participate in the “survey about AIDS knowledge and sexual behavior,” 294 (74.6%) consented to an interview. Demographic information from those interviewed indicated that respondents were not sta-
tistically different from typical students at the university. The students in the study were evenly distributed by class year; 52% of the sample were women; the modal category for age was between 19 and 20 years. Confidentiality was assured by separating respondents’ names from the data so that specific responses could not be attributed to particular individuals.
RESULTS Students were asked a series of questions about their beliefs about how HIV is transmitted. Two kinds of questions were included. The first set focused on information directly related to AIDS that an informed public should know in order to protect itself against infection. The remainder concerned items of false information and myths about AIDS. Both sets used a Likert-type, 4-point scale of “strongly agree” to “strongly disagree.” Table 1 shows that, generally, more than 80% of the respondents on each item tended to choose an answer that agreed with the current state of scientific knowledge. Relatively few respondents in the sample appeared to be uneducated or misinformed about AIDS. The next series of items asked students their opinion about the effectiveness of various means of preventing HIV infection. Also included were a few measures that are
TABLE 1 Beliefs About Contracting HIV ( N = 294) Strongly agree %
Somewhat agree %
Somewhat disagree %
Strongly disagree %
Unsure/ missing
2.4
12.2
39.8
43.9
1.7
27.6
53.7
11.9
3.4
3.4
53.4
41.8
3.4
0.7
0.7
62.6
34.0
2.4
0.3
0.7
67.6
31.3
0.0
0.7
0.3
0.7
2.7
39.8
56.1
0.7
1.7
15.0
58.8
18.4
6.1
9.9
24.8
37.8
26.2
1.4
OIO
Informative There is effective medical treatment available for people who have contracted the AIDS virus. A person can be infected with the AIDS virus and not have any symptoms. It’s possible to become infected with the AIDS virus by having sex with members of the opposite sex. having sex with members of the same sex. intravenous drug use with shared needles. Misinformative It’s possible to become infected with the AIDS virus by social contact, such as shaking hands with a person who has AIDS. other drug use-not involving needles. donating blood at a blood drive.
180
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AIDS AND COLLEGE HEALTH typically associated with birth control rather than control of sexually transmitted disease (STD). Table 2 shows these responses. The data reported in Table 2 suggest that students tend not to confuse birth control measures with methods of preventing HIV infection. Instead, they recognize that using condoms and limiting the number of sexual partners are reasonable precautions to take to prevent infection. Ninety-seven percent view condoms as at least somewhat effective against the threat of infection, and 86.4% believe that limiting the number of sexual partners is very, or somewhat, effective. To assess the general risk of infection on campus and to estimate students' own personal risk of contracting the virus, the students were asked how their behavior had changed as a result of the threat of infection. The data in Table 3 show that 6O.6% of the students presently fear a campus-wide spread of the virus, at least to some extent. This is quite a change from the previous
year, when 41.3'10 of the students surveyed feared some spread of HIV infection throughout the campus population. In spite of their fears, only 18.3'10 of the students questioned during the present study admitted they felt personally susceptible to the virus, at least to some extent. Finally, despite the fact that students are well educated on how HIV is transmitted and on the preventive measures necessary to avoid contracting the virus, most students have not changed their behavior in response to the epidemic. Zero-order correlations of the items introduced in Tables 1 through 3 that might be used to predict whether or not students changed their behavior in response to the threat of HIV infection are shown in Table 4. The few cases with uncertain responses or missing data were recoded to their statistical mean in order to make data analysis easier. Table 4 includes the behavioral items that appear in Table 3, along with the general fear of infection and per-
TABLE 2 Beliefs About Preventing AIDS ( N = 294)
I Not effective
%
Somewhat effective %
Yo
Unsurel missing %
48.0 4.1 1.7 32.7
49.0 25.6 20.5 53.7
1.7 62.1 73.3 13.3
1.4 8.2 4.5 0.3
7.8
15.0
74.5
2.7
Very effective Question
I How effective do you think each of the following is in preventing AIDS infection? Using condoms (rubbers) Using a spermicide Using a diaphragm Limiting the number of sexual partners Using oral contraceptives I
TABLE 3 The Risk of AIDS and Changes in Behavior (N = 294)
Question
Very great %
Great %
Some %
Little %
Not %
Unsurel missing %
5.8
10.9
43.9
35.7
3.1
0.7
0.3
2.7
15.3
36.7
44.6
0.3
I To what extent are you afraid that AIDS will spread throughout the UMass population? To what extent do you feel susceptible to contracting the AIDS virus?
I Unsurel Yes No missing % % Oh ~-~ Has your behavior changed in response to the AIDS epidemic?
42.5
56.8
0.7
I
VOL 38, IANUARY 7990
78 7
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COLLEGE HEALTH sonalized susceptibility items, also from Table 3. In addition, sex and age are included, as well as a composite variable that was made up of the last three informational items from Table 1. These three items, when added together, form a reliable scale (Cronbach's alpha = .78) that seems to measure knowledge about contracting AIDS. The figures in Table 4 indicate that the behavioral item is positively related to both the general fear and personalized susceptibility items and also to the knowledge composite. The behavioral item is coded so that a high score (1) indicates that the student's behavior had changed and a low score (0) reflects no change. The direction of these correlations suggests that, as general and specific fear of AIDS and knowledge about the disease increase, so does the tendency to change behavior in response to the threat of infection. Regressions of the behavioral item on these two models appear in Table 5. The dependent variable in the analysis is a dummy variable coded 0 if respondents had changed their behavior and 1 if they had not. Researchers using ordinary least squares regression typically use binary dependent variables to present their analyses because OLS regression is widely known and easily understood. This is a reasonable procedure, as Goodrnan12and G i l l e ~ p i ehave ' ~ indicated, as long as scores on the dummy dependent variable are not badly skewed, which is true in the present case. Both models indicate that although knowledge was statistically inconsequential in affecting behavioral change in response to the threat of infection (see Table 5), each measure of fear was significant in predicting change. Model 1 shows that generalized fear was positively correlated with a change in behavior (b = .076, p < .05). Model 2 also indicates that the effect of personalized susceptibility on behavior was statistically significant and positive (b = .141, p < .001), although substantially larger than in the first model. Furthermore, although the amount of explained variance attributed to either model is relatively small, the R 2 for the second model is notice-
ably larger than for the first (3.6% for model 1 v 7.4% for Model 2).
DISCUSSION The data presented in Tables 1, 2, and 3 suggest that University of Massachusetts students seem reasonably well informed about AIDS, have an idea about the means of preventing the spread of infection, and are concerned about the possibility of a campus-wide epidemic. In terms of their own personal risk, however, a relatively large number of students (57.2% of our sample) see little or no personal threat. It seems reasonable to assume that many of the students at the university do not engage in intravenous drug use and are not at risk from that practice. Abstinence from sexual activity, on the other hand, cannot be relied on to reduce the threat of HIV infection. A SAREO telephone survey conducted in March 1988 revealed that 61.5% of a random sample of 309 undergraduates reported they had been sexually active in high school and 81.1 o/o had had sexual relations since entering college. It also seems unlikely that much of the apparent lack of concern for personal health risk is justified on the basis of individuals' practicing "safe-sex." The previously mentioned SAREO survey indicated that, of those students who are sexually active, less than half (43.9%) use condoms. A more likely explanation that commonly accounts for ignoring warnings against warranted health risks is that students do not pay attention to public health officials unless such a risk is personalized. Nearly three fifths of the students in the sample did not change their behavior as a result of the threat of infection (Table 3), yet the same proportion of the students judged there was some risk of infection spreading on campus. A smaller number (18.3%) viewed the virus as posing a personal health threat, at least to some extent. Treating these ordinal measures as intervals in the case of the single item allows multivariate analysis to examine the unique contribution of these variables, along with the
TABLE 4 Zero-Order Correlations of the Knowledge, Fear, Behavior, and Demographic Items (N = 294)
(1) Knowledge
-
(2) General risk (3) Personal risk (4) Behavior (5) Age (6) Sex
.02 .04 .10 .08 .21
.27 .13 .01 - .23
-
.24 .02 - .02
- .09
.02
.05
-
Note: Age i s collapsed into 5 categories (17-18, 19-20, 21-24, 25-30, and 31 +); sex is coded 0 for females and 1 for males.
7 82
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AIDS AND COLLEGE HEALTH TABLE 5 Regression of Behavior on Knowledge, General Risk, Personal Risk, Age, and Gender (N = 294) Model 2
Model 1
b
Variable Knowledge General risk Personal risk Age Gender
B
F
b
B
2.67 5.20
.019
,095
-
-
-
.141** - .053 .012
.236** - ,099 ,012
17.30 3.03 0.04
,019 .076*
.097 .136*
-
-
-
- .052
- .097
.036
.036
2.81 0.35
0.056 0.036
Intercept R2
F
2.65
0.037 0.074
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Note: Age is collapsed into 5 categories (17-18, 19-20, 21-24, 25-30, and 31 +); sex is coded 0 for females and 1 for males. * p < .05; * * p < ,001.
knowledge scale, to explain variance in behavior. Accordingly, we tested two models with these data. First, we examined the relationship between general fear of infection and behavior (controlling for age, gender, and knowledge about AIDS). In addition, we tested a model that looked at behavior as a consequence of personalized susceptibility, keeping constant the same list of Model 1 control variables. The data in Table 5 indicate that the campus-wide fear of AIDS was weakly related to the distribution of scores on the behavioral item. In contrast, the regression coefficient for the personal risk item was twice as large, showing that personalized risk is more highly correlated with a change in behavior than it is with generalized fear. Accordingly, we concluded that those persons who fear for their own health are more apt to take individual action than those who believe that they are not at risk. Finding that a generalized fear of AIDS is weakly related to the behavior of college students should not be surprising because a large body of literature indicates that widely acknowledged health risks often are ignored by the general population. The serious and potentially lifethreatening consequences of contracting HIV, however, make such a finding less palatable. At this time, infection cannot be reversed; for those who ultimately contract AIDS, there is no known cure. Table 5 also shows that more than 90% of the variance in .behavior was left unexplained by either model. One explanation is that the model is underspecified, meaning additional variables, if available, might be added to the model to improve the fit to the data. These might include sensitive information, such as data about sexual preference, the frequency of sexual encounters, and the duration of relationships, that is difficult to collect in surveys of this type.
CONCLUSION Our data are descriptive and preliminary with respect to the level of public knowledge about a deadly and cost-
VOL 38, IANUARY I990
ly disease on one college campus. They suggest that college students probably are reasonably well informed a b u t AIDS, but they do not accept that this risk applies to them. Reliable first-hand information about students’ sexual behavior might have been more useful in clarifying the objective risks of students’ contracting HIV. Future research on and off college campuses is needed to determine better the perceived susceptibility to the disease of students and the general public. Only then will we be able to evaluate the extent to which society is preparedto deal with such an epidemic and, thus, how critical is the need for education about prevention. INDEX TERMS AIDS prevention, college students’ AIDS knowledge
REFERENCES 1. Goodwin MP, Roscoe 6. AIDS: Students’ knowledge and attitudes at a midwestern university. / Am Coll Health
1988;6:214-222. 2. Surgeon General’s Report on Acquired Immune Deficiency Syndrome. Washington, DC, US Dept of Health and Human Services; 1986. 3. Curran JW, Jaffe HW, Hardy AM, Morgan WM, Selik RM, Dondero TI. Epidemiology of HIV infection and AIDS in the United States. Science 1988;239:610-616. 4. Janz N, Becker M. The Health Belief Model: A decade later. Health Educ Q 1984;1 1 :1-47. 5. Surgeon General’s Report on the Health Consequences of Smoking: Cancer. Washington, DC, US Dept of Health and Human Services; 1982. 6. Perloff LS. Perceptions of vulnerability to victimization. I Social Issues 1983;39:41-61. 7. Weinstein ND. Unrealistic optimism about future life events. 1 Pers Soc Psychol 1980;39:806-820. 8. Weinstein ND. Reducing unrealistic optimism about illness susceptibility. Health Psychol 1983;2:11-20. 9. Weinstein ND, Lachendro E. Egocentrism as a source of unrealistic optimism. Personality and Social Psychology Bulletin 1982;8:195-200.
I83
COLLEGE HEALTH 10. DiClemente RJ, Zorn J, Temoshok L. Adolescents and AIDS: A survey of knowledge, attitudes and beliefs about AIDS in San Francisco. Am 1 Public Health 1986;76:14431445. 11. Price JH, Desmond S, Kukulka G. High school students' perceptions and misperceptions of AIDS. 1 Sch Health 1985; 55: 107- 109. 12. Goodman LA. The relationship between modified and usual multiple regression approaches to the analysis of dichotomous variables. In Heise DR, ed, Sociological Methodology. San Francisco, CA, Jossey-Bass; 1976. 13. Gillespie MW. Log-linear techniques and the regression analysis of dummy dependent variables. Sociological Methods and Research 1977;6:103-122.
T h e 5ook for t h e 9 0 W
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Joseph Kerrins, M.D. & George W. Jacobs
D CIHCULATIUN
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7 84
IACH
Journal of American College Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vach20
AIDS and College Health: Knowledge, Threat, and Prevention at a Northeastern University a
Quint C. Thurman PhD & Kathryn M. Franklin MS a
Washington State University , Pullman Published online: 09 Jul 2010.
To cite this article: Quint C. Thurman PhD & Kathryn M. Franklin MS (1990) AIDS and College Health: Knowledge, Threat, and Prevention at a Northeastern University, Journal of American College Health, 38:4, 179-184, DOI: 10.1080/07448481.1990.9938439 To link to this article: http://dx.doi.org/10.1080/07448481.1990.9938439
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
AIDS and College Health: Knowledge, Threat, and Prevention at a Northeastern University
Downloaded by [Temple University Libraries] at 19:05 10 January 2015
QUINT C. THURMAN, PhD, and KATHRYN M. FRANKLIN, MS
We performed secondary analyses on data originally collected by telephone from a random sample of 294 undergraduates from a large northeastern university to examine students’ knowledge about acquired immunodeficiency syndrome (AIDS) and the students’ reactions to the health threat posed by human immunodeficiency virus (HIV). Our findings indicated that students are reasonably well informed about AIDS, are aware of the recommended precautions for avoiding HIV infection, and are fearful that the virus may spread within the student population. These data also show that students are re ludant to change their sexual behavior unless the threat of infection is personalized. The implications of our findings for future research are briefly discussed.
Results reported in this journal by Goodwin and Roscoe’ marked the beginning of concern for public opinion research into college students’ knowledge about AIDS. Their study of a convenience sample of college undergraduates at a midwestern university pointed out that one sexually active segment of the American population had been largely overlooked in the early stages of survey research on AIDS information. We used data gathered from a random sample of college students at a northeastern university that supported the initial conclusions of Goodwin and Roscoe. We also found that students a p peared to be knowledgeable about the transmission of HIV and generally feared that the virus would spread. Subsequent analysis, however, also showed that only a small proportion of students who worry about their own risk of infection take steps toward prevention. Reports from the Centers for Disease Control of the US Public Health Service indicate that more than 66,400
Quint C. Thurman, an assistant professor of political science at Washington State University, Pullman, was formerly assistant director of student affairs at the University of Massachusetts, Amherst, where Kathryn M. Franklin is completing work for a doctoral degree in social psychology and statistics.
VOL 38, IANUARY 1990
Americans have died from AIDS as of October 1989 and that the death toll from the disease could climb to 263,000 by 1992. The surgeon general’ has estimated that as many as 1.5 million persons probably now carry the HIV virus. Curran et a13 reported that mortality from AIDS disproportionately affects persons between the ages of 20 and 44. College students’ high level of sexual activity, coupled with the false sense of invulnerability that is characteristic of youth, may unnecessarily increase their danger of contracting the virus. The Task Force on AIDS Education at the University of Massachusetts collected figures to assess students’ knowledge about HIV infection and prevention. Although generalization from these data is limited because a single undergraduate population was examined, our secondary analysis of the results suggests that administrators and public health educators face a serious challenge in trying to encourage students to adopt measures to prevent the spread of HIV and reduce the threat of AIDS. Public health officialsbelieve that a well-informed p u b lic can be sufficiently prepared against the possibility of contracting AIDS. The model operating here is an old one-knowledge will lead to recognition of the danger, which in turn will lead to a change in risky behavior. The widely used Health Belief Model, reviewed elsewhere by Janz and B e ~ k e r ,has ~ attempted to explain changes in the behavior of smokers, drinkers, and others trying to improve their health status. Theoretically, once serious health risks are recognized, behavior modification follows. Unfortunately, the utility of this model in principle does not assure success in practice, as can be seen in the case of the association between cigarette smoking and ~ a n c e r Many .~ smokers seem quite willing to ignore this health hazard, especially as it applies to their own behavior. Few people believe that the worst can happen to them per~onally.~-~ The data presented here provide some indication of the level of AIDS awareness among college students at a large northeastern university and of their response to the
179
COLLEGE HEALTH threat of HIV infection. This research is a logical extension of data gathered earlier on high school campuses by DiClemente et al” and Price et all’ and on college campuses by Goodwin and Roscoe.’
Downloaded by [Temple University Libraries] at 19:05 10 January 2015
METHODS Two hundred ninety-four students participated in telephone interviews conducted by the University of MassachusettslAmherst’s Student Affairs Research and Evaluation Office (SAREO) in the 1987 spring semester as part of SAREOs regularly scheduled weekly surveys of full-time undergraduates. Trained student interviewers administered the brief, 22-item survey by telephone on two consecutive Wednesday evenings (March 4 and March 1 1 ) between 5:OO and 1O:OO PM. Confidentiality of the responses was guaranteed. In order to ease any potential embarrassment inherent in a sensitive topic, women interviewed female students and men responded to questions posed by male interviewers. Students in the sample were selected at random from the university‘s database of full-time undergraduates. O f the 394 students asked to participate in the “survey about AIDS knowledge and sexual behavior,” 294 (74.6%) consented to an interview. Demographic information from those interviewed indicated that respondents were not sta-
tistically different from typical students at the university. The students in the study were evenly distributed by class year; 52% of the sample were women; the modal category for age was between 19 and 20 years. Confidentiality was assured by separating respondents’ names from the data so that specific responses could not be attributed to particular individuals.
RESULTS Students were asked a series of questions about their beliefs about how HIV is transmitted. Two kinds of questions were included. The first set focused on information directly related to AIDS that an informed public should know in order to protect itself against infection. The remainder concerned items of false information and myths about AIDS. Both sets used a Likert-type, 4-point scale of “strongly agree” to “strongly disagree.” Table 1 shows that, generally, more than 80% of the respondents on each item tended to choose an answer that agreed with the current state of scientific knowledge. Relatively few respondents in the sample appeared to be uneducated or misinformed about AIDS. The next series of items asked students their opinion about the effectiveness of various means of preventing HIV infection. Also included were a few measures that are
TABLE 1 Beliefs About Contracting HIV ( N = 294) Strongly agree %
Somewhat agree %
Somewhat disagree %
Strongly disagree %
Unsure/ missing
2.4
12.2
39.8
43.9
1.7
27.6
53.7
11.9
3.4
3.4
53.4
41.8
3.4
0.7
0.7
62.6
34.0
2.4
0.3
0.7
67.6
31.3
0.0
0.7
0.3
0.7
2.7
39.8
56.1
0.7
1.7
15.0
58.8
18.4
6.1
9.9
24.8
37.8
26.2
1.4
OIO
Informative There is effective medical treatment available for people who have contracted the AIDS virus. A person can be infected with the AIDS virus and not have any symptoms. It’s possible to become infected with the AIDS virus by having sex with members of the opposite sex. having sex with members of the same sex. intravenous drug use with shared needles. Misinformative It’s possible to become infected with the AIDS virus by social contact, such as shaking hands with a person who has AIDS. other drug use-not involving needles. donating blood at a blood drive.
180
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AIDS AND COLLEGE HEALTH typically associated with birth control rather than control of sexually transmitted disease (STD). Table 2 shows these responses. The data reported in Table 2 suggest that students tend not to confuse birth control measures with methods of preventing HIV infection. Instead, they recognize that using condoms and limiting the number of sexual partners are reasonable precautions to take to prevent infection. Ninety-seven percent view condoms as at least somewhat effective against the threat of infection, and 86.4% believe that limiting the number of sexual partners is very, or somewhat, effective. To assess the general risk of infection on campus and to estimate students' own personal risk of contracting the virus, the students were asked how their behavior had changed as a result of the threat of infection. The data in Table 3 show that 6O.6% of the students presently fear a campus-wide spread of the virus, at least to some extent. This is quite a change from the previous
year, when 41.3'10 of the students surveyed feared some spread of HIV infection throughout the campus population. In spite of their fears, only 18.3'10 of the students questioned during the present study admitted they felt personally susceptible to the virus, at least to some extent. Finally, despite the fact that students are well educated on how HIV is transmitted and on the preventive measures necessary to avoid contracting the virus, most students have not changed their behavior in response to the epidemic. Zero-order correlations of the items introduced in Tables 1 through 3 that might be used to predict whether or not students changed their behavior in response to the threat of HIV infection are shown in Table 4. The few cases with uncertain responses or missing data were recoded to their statistical mean in order to make data analysis easier. Table 4 includes the behavioral items that appear in Table 3, along with the general fear of infection and per-
TABLE 2 Beliefs About Preventing AIDS ( N = 294)
I Not effective
%
Somewhat effective %
Yo
Unsurel missing %
48.0 4.1 1.7 32.7
49.0 25.6 20.5 53.7
1.7 62.1 73.3 13.3
1.4 8.2 4.5 0.3
7.8
15.0
74.5
2.7
Very effective Question
I How effective do you think each of the following is in preventing AIDS infection? Using condoms (rubbers) Using a spermicide Using a diaphragm Limiting the number of sexual partners Using oral contraceptives I
TABLE 3 The Risk of AIDS and Changes in Behavior (N = 294)
Question
Very great %
Great %
Some %
Little %
Not %
Unsurel missing %
5.8
10.9
43.9
35.7
3.1
0.7
0.3
2.7
15.3
36.7
44.6
0.3
I To what extent are you afraid that AIDS will spread throughout the UMass population? To what extent do you feel susceptible to contracting the AIDS virus?
I Unsurel Yes No missing % % Oh ~-~ Has your behavior changed in response to the AIDS epidemic?
42.5
56.8
0.7
I
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COLLEGE HEALTH sonalized susceptibility items, also from Table 3. In addition, sex and age are included, as well as a composite variable that was made up of the last three informational items from Table 1. These three items, when added together, form a reliable scale (Cronbach's alpha = .78) that seems to measure knowledge about contracting AIDS. The figures in Table 4 indicate that the behavioral item is positively related to both the general fear and personalized susceptibility items and also to the knowledge composite. The behavioral item is coded so that a high score (1) indicates that the student's behavior had changed and a low score (0) reflects no change. The direction of these correlations suggests that, as general and specific fear of AIDS and knowledge about the disease increase, so does the tendency to change behavior in response to the threat of infection. Regressions of the behavioral item on these two models appear in Table 5. The dependent variable in the analysis is a dummy variable coded 0 if respondents had changed their behavior and 1 if they had not. Researchers using ordinary least squares regression typically use binary dependent variables to present their analyses because OLS regression is widely known and easily understood. This is a reasonable procedure, as Goodrnan12and G i l l e ~ p i ehave ' ~ indicated, as long as scores on the dummy dependent variable are not badly skewed, which is true in the present case. Both models indicate that although knowledge was statistically inconsequential in affecting behavioral change in response to the threat of infection (see Table 5), each measure of fear was significant in predicting change. Model 1 shows that generalized fear was positively correlated with a change in behavior (b = .076, p < .05). Model 2 also indicates that the effect of personalized susceptibility on behavior was statistically significant and positive (b = .141, p < .001), although substantially larger than in the first model. Furthermore, although the amount of explained variance attributed to either model is relatively small, the R 2 for the second model is notice-
ably larger than for the first (3.6% for model 1 v 7.4% for Model 2).
DISCUSSION The data presented in Tables 1, 2, and 3 suggest that University of Massachusetts students seem reasonably well informed about AIDS, have an idea about the means of preventing the spread of infection, and are concerned about the possibility of a campus-wide epidemic. In terms of their own personal risk, however, a relatively large number of students (57.2% of our sample) see little or no personal threat. It seems reasonable to assume that many of the students at the university do not engage in intravenous drug use and are not at risk from that practice. Abstinence from sexual activity, on the other hand, cannot be relied on to reduce the threat of HIV infection. A SAREO telephone survey conducted in March 1988 revealed that 61.5% of a random sample of 309 undergraduates reported they had been sexually active in high school and 81.1 o/o had had sexual relations since entering college. It also seems unlikely that much of the apparent lack of concern for personal health risk is justified on the basis of individuals' practicing "safe-sex." The previously mentioned SAREO survey indicated that, of those students who are sexually active, less than half (43.9%) use condoms. A more likely explanation that commonly accounts for ignoring warnings against warranted health risks is that students do not pay attention to public health officials unless such a risk is personalized. Nearly three fifths of the students in the sample did not change their behavior as a result of the threat of infection (Table 3), yet the same proportion of the students judged there was some risk of infection spreading on campus. A smaller number (18.3%) viewed the virus as posing a personal health threat, at least to some extent. Treating these ordinal measures as intervals in the case of the single item allows multivariate analysis to examine the unique contribution of these variables, along with the
TABLE 4 Zero-Order Correlations of the Knowledge, Fear, Behavior, and Demographic Items (N = 294)
(1) Knowledge
-
(2) General risk (3) Personal risk (4) Behavior (5) Age (6) Sex
.02 .04 .10 .08 .21
.27 .13 .01 - .23
-
.24 .02 - .02
- .09
.02
.05
-
Note: Age i s collapsed into 5 categories (17-18, 19-20, 21-24, 25-30, and 31 +); sex is coded 0 for females and 1 for males.
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AIDS AND COLLEGE HEALTH TABLE 5 Regression of Behavior on Knowledge, General Risk, Personal Risk, Age, and Gender (N = 294) Model 2
Model 1
b
Variable Knowledge General risk Personal risk Age Gender
B
F
b
B
2.67 5.20
.019
,095
-
-
-
.141** - .053 .012
.236** - ,099 ,012
17.30 3.03 0.04
,019 .076*
.097 .136*
-
-
-
- .052
- .097
.036
.036
2.81 0.35
0.056 0.036
Intercept R2
F
2.65
0.037 0.074
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Note: Age is collapsed into 5 categories (17-18, 19-20, 21-24, 25-30, and 31 +); sex is coded 0 for females and 1 for males. * p < .05; * * p < ,001.
knowledge scale, to explain variance in behavior. Accordingly, we tested two models with these data. First, we examined the relationship between general fear of infection and behavior (controlling for age, gender, and knowledge about AIDS). In addition, we tested a model that looked at behavior as a consequence of personalized susceptibility, keeping constant the same list of Model 1 control variables. The data in Table 5 indicate that the campus-wide fear of AIDS was weakly related to the distribution of scores on the behavioral item. In contrast, the regression coefficient for the personal risk item was twice as large, showing that personalized risk is more highly correlated with a change in behavior than it is with generalized fear. Accordingly, we concluded that those persons who fear for their own health are more apt to take individual action than those who believe that they are not at risk. Finding that a generalized fear of AIDS is weakly related to the behavior of college students should not be surprising because a large body of literature indicates that widely acknowledged health risks often are ignored by the general population. The serious and potentially lifethreatening consequences of contracting HIV, however, make such a finding less palatable. At this time, infection cannot be reversed; for those who ultimately contract AIDS, there is no known cure. Table 5 also shows that more than 90% of the variance in .behavior was left unexplained by either model. One explanation is that the model is underspecified, meaning additional variables, if available, might be added to the model to improve the fit to the data. These might include sensitive information, such as data about sexual preference, the frequency of sexual encounters, and the duration of relationships, that is difficult to collect in surveys of this type.
CONCLUSION Our data are descriptive and preliminary with respect to the level of public knowledge about a deadly and cost-
VOL 38, IANUARY I990
ly disease on one college campus. They suggest that college students probably are reasonably well informed a b u t AIDS, but they do not accept that this risk applies to them. Reliable first-hand information about students’ sexual behavior might have been more useful in clarifying the objective risks of students’ contracting HIV. Future research on and off college campuses is needed to determine better the perceived susceptibility to the disease of students and the general public. Only then will we be able to evaluate the extent to which society is preparedto deal with such an epidemic and, thus, how critical is the need for education about prevention. INDEX TERMS AIDS prevention, college students’ AIDS knowledge
REFERENCES 1. Goodwin MP, Roscoe 6. AIDS: Students’ knowledge and attitudes at a midwestern university. / Am Coll Health
1988;6:214-222. 2. Surgeon General’s Report on Acquired Immune Deficiency Syndrome. Washington, DC, US Dept of Health and Human Services; 1986. 3. Curran JW, Jaffe HW, Hardy AM, Morgan WM, Selik RM, Dondero TI. Epidemiology of HIV infection and AIDS in the United States. Science 1988;239:610-616. 4. Janz N, Becker M. The Health Belief Model: A decade later. Health Educ Q 1984;1 1 :1-47. 5. Surgeon General’s Report on the Health Consequences of Smoking: Cancer. Washington, DC, US Dept of Health and Human Services; 1982. 6. Perloff LS. Perceptions of vulnerability to victimization. I Social Issues 1983;39:41-61. 7. Weinstein ND. Unrealistic optimism about future life events. 1 Pers Soc Psychol 1980;39:806-820. 8. Weinstein ND. Reducing unrealistic optimism about illness susceptibility. Health Psychol 1983;2:11-20. 9. Weinstein ND, Lachendro E. Egocentrism as a source of unrealistic optimism. Personality and Social Psychology Bulletin 1982;8:195-200.
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COLLEGE HEALTH 10. DiClemente RJ, Zorn J, Temoshok L. Adolescents and AIDS: A survey of knowledge, attitudes and beliefs about AIDS in San Francisco. Am 1 Public Health 1986;76:14431445. 11. Price JH, Desmond S, Kukulka G. High school students' perceptions and misperceptions of AIDS. 1 Sch Health 1985; 55: 107- 109. 12. Goodman LA. The relationship between modified and usual multiple regression approaches to the analysis of dichotomous variables. In Heise DR, ed, Sociological Methodology. San Francisco, CA, Jossey-Bass; 1976. 13. Gillespie MW. Log-linear techniques and the regression analysis of dummy dependent variables. Sociological Methods and Research 1977;6:103-122.
T h e 5ook for t h e 9 0 W
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Joseph Kerrins, M.D. & George W. Jacobs
D CIHCULATIUN
J Up-to-date Z d Edition J Ideal Educational Text J Easy-to-understand J Adopted 6y Colleges J Used i n Many Schools J Maximum Expertise $14.95 hardcover, 160 pp., ISBN 0-9618059-2-7 Generous educational discounts are available "One of the most acceptable, intelligent, unhysterical and concisely informative AIDS books yet." American Library Association in Booklisr
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