Determinants of intention to test for sexually transmitted infections among late adolescent women in the United States
Alyssa M. Lederer
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Abstract
Individuals aged 15–24 years are disproportionately affected by sexually transmitted infections (STIs) in the United States, and young women can face severe health consequences if STIs are left undiagnosed. Yet STI testing rates in this priority population remain low. Few studies incorporate health behavior theory to examine factors associated with STI testing among young women in the United States, which is vital for intervention development. This study therefore sought to identify the determinants of college-enrolled late adolescent women’s intentions to be tested for common STIs in the next 12 months using a theory-based approach.
Students who identified as female at a large Midwestern university completed an online survey about STIs (n = 171). Hierarchical multiple regression was used to assess the relationship between STI testing intention and the Reasoned Action Approach (RAA) global constructs of attitude, perceived norm, and perceived behavioral control, supplemented by STI knowledge, STI stigma, and STI shame.
Findings indicate that the RAA global constructs predicted STI testing intention (P < 0.001), with perceived norm making the largest contribution. Neither STI knowledge, stigma, nor shame were significantly associated with STI testing intention.
Future interventions aimed at increasing STI testing among young women should focus on beliefs underlying the RAA global constructs and especially young women’s beliefs regarding other people’s support for getting tested for STIs.
Keywords: adolescents, college students, Reasoned Action Approach, sexually transmitted diseases, sexually transmitted infections, shame, stigma, testing, theory.
References
2 Kreisel KM, Spicknall IH, Gargano JW, Lewis FMT, Lewis RM, Markowitz LE, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2018. Sex Transm Dis 2021; 48(4): 208-14.
| Crossref | Google Scholar |
4 Chesson HW, Spicknall IH, Bingham A, Brisson M, Eppink ST, Farnham PG, et al. The estimated direct lifetime medical costs of sexually transmitted infections acquired in the United States in 2018. Sex Transm Dis 2021; 48(4): 215-21.
| Crossref | Google Scholar |
5 Lei J, Ploner A, Elfström KM, Wang J, Roth A, Fang F, et al. HPV vaccination and the risk of invasive cervical cancer. N Engl J Med 2020; 383(14): 1340-48.
| Crossref | Google Scholar | PubMed |
6 Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, et al. Screening for chlamydia and gonorrhea: US preventive services task force recommendation statement. JAMA 2021; 326(10): 949-56.
| Crossref | Google Scholar | PubMed |
7 Tsevat DG, Wiesenfeld HC, Parks C, Peipert JF. Sexually transmitted diseases and infertility. Am J Obstet Gynecol 2017; 216(1): 1-9.
| Crossref | Google Scholar | PubMed |
8 Cuffe KM, Newton-Levinson A, Gift TL, McFarlane M, Leichliter JS. Sexually transmitted infection testing among adolescents and young adults in the United States. J Adolesc Health 2016; 58(5): 512-19.
| Crossref | Google Scholar | PubMed |
9 Shannon CL, Klausner JD. The growing epidemic of sexually transmitted infections in adolescents: a neglected population. Curr Opin Pediatr 2018; 30(1): 137-43.
| Crossref | Google Scholar | PubMed |
12 Habel MA, Leichliter JS, Torrone E. Exploring chlamydia positivity among females on college campuses, 2008–2010. J Am Coll Health 2016; 64(6): 496-501.
| Crossref | Google Scholar | PubMed |
14 U.S. Department of Education, National Center for Education Statistics. College enrollment rates; 2024. Available at https://nces.ed.gov/programs/coe/indicator/cpb/college-enrollment-rate
15 Lederer AM, Oswalt SB. The value of college health promotion: A critical population and setting for improving the public’s health. Am J Health Educ 2017; 48: 215-18.
| Crossref | Google Scholar |
17 Habel MA, Coor A, Beltran O, Becasen J, Pearson WS, Dittus P. The state of sexual health services at US colleges and universities. J Am Coll Health 2018; 66(4): 259-68.
| Crossref | Google Scholar | PubMed |
19 Steinmetz H, Knappstein M, Ajzen I, Schmidt P, Kabst R. How effective are behavior change interventions based on the theory of planned behavior? A three-level meta-analysis. Z Psychol 2016; 224(3): 216-33.
| Crossref | Google Scholar |
20 Boudewyns V, Paquin RS. Intentions and beliefs about getting tested for STDs: implications for communication interventions. Health Commun 2011; 26(8): 701-711.
| Crossref | Google Scholar | PubMed |
21 Booth AR, Harris PR, Goyder E, Norman P. Beliefs about chlamydia testing amongst young people living in relatively deprived areas. J Public Health 2013; 35(2): 213-22.
| Crossref | Google Scholar | PubMed |
22 Martin-Smith HA, Okpo EA, Bull ER. Exploring psychosocial predictors of STI testing in university students. BMC Public Health 2018; 18(1): 664.
| Crossref | Google Scholar | PubMed |
23 Shepherd L, Smith MA. The role of fear in predicting sexually transmitted infection screening. Psychol Health 2017; 32(7): 876-94.
| Crossref | Google Scholar | PubMed |
24 ten Hoor GA, Ruiter RAC, van Bergen JEAM, Hoebe CJPA, Houben K, Kok G. Non-participation in chlamydia screening in the Netherlands: determinants associated with young people’s intention to participate in chlamydia screening. BMC Public Health 2013; 13: 1091.
| Crossref | Google Scholar | PubMed |
25 de Visser R, O’Neill N. Identifying and understanding barriers to sexually transmissible infection testing among young people. Sex Health 2013; 10(6): 553-8.
| Crossref | Google Scholar |
26 ten Hoor GA, Ruiter RAC, van Bergen JEAM, Hoebe CJPA, Dukers-Muijrers NHTM, Kok G. Predictors of Chlamydia trachomatis testing: perceived norms, susceptibility, changes in partner status, and underestimation of own risk. BMC Public Health 2016; 16(1): 55.
| Crossref | Google Scholar |
27 Backonja U, Royer HR, Lauver DR. Young women’s reasons to seek sexually transmitted infection screening. Public Health Nurs 2014; 31(5): 395-404.
| Crossref | Google Scholar | PubMed |
28 Banikarim C, Chacko MR, Wiemann CM, Smith PB. Gonorrhea and chlamydia screening among young women: stage of change, decisional balance, and self-efficacy. J Adolesc Health 2003; 32(4): 288-95.
| Crossref | Google Scholar | PubMed |
29 Thomas JA, Ditchman N, Beedle RB. The impact of knowledge, self-efficacy, and stigma on STI testing intention among college students. J Am Coll Health 2022; 70(5): 1415-25.
| Crossref | Google Scholar | PubMed |
30 Wombacher K, Dai M, Matig JJ, Harrington NG. Using the integrative model of behavioral prediction to understand college students’ STI testing beliefs, intentions, and behaviors. J Am Coll Health 2018; 66(7): 674-82.
| Crossref | Google Scholar | PubMed |
31 Pavlin NL, Gunn JM, Parker R, Fairley CK, Hocking J. Implementing chlamydia screening: what do women think? A systematic review of the literature. BMC Public Health 2006; 6: 221.
| Crossref | Google Scholar | PubMed |
32 Denison HJ, Bromhead C, Grainger R, Dennison EM, Jutel A. What influences university students to seek sexually transmitted infection testing? A qualitative study in New Zealand. Sex Reprod Healthc 2018; 16: 56-60.
| Crossref | Google Scholar | PubMed |
33 Lederer AM, Vertacnik AL. Correlates of sexually transmitted infection knowledge among late adolescents. Sex Health 2021; 18(4): 303-10.
| Crossref | Google Scholar | PubMed |
34 Scheinfeld E. Shame and STIs: an exploration of emerging adult students’ felt shame and stigma towards getting tested for and disclosing sexually transmitted infections. Int J Environ Res Public Health 2021; 18(13): 7179.
| Crossref | Google Scholar |
35 Shepherd L, Harwood H. The role of STI-related attitudes on screening attendance in young adults. Psychol Health Med 2017; 22(6): 753-58.
| Crossref | Google Scholar | PubMed |
36 Cunningham SD, Tschann J, Gurvey JE, Fortenberry JD, Ellen JM. Attitudes about sexual disclosure and perceptions of stigma and shame. Sex Transm Infect 2002; 78(5): 334-38.
| Crossref | Google Scholar | PubMed |
37 Fortenberry JD, McFarlane M, Bleakley A, Bull S, Fishbein M, Grimley DM, et al. Relationships of stigma and shame to gonorrhea and HIV screening. Am J Public Health 2002; 92(3): 378-81.
| Crossref | Google Scholar |
38 Cunningham SD, Kerrigan DL, Jennings JM, Ellen JM. Relationships between perceived STD-related stigma, STD-related shame and STD screening among a household sample of adolescents. Perspect Sex Reprod Health 2009; 41(4): 225-30.
| Crossref | Google Scholar | PubMed |
39 Morris JL, Lippman SA, Philip S, Bernstein K, Neilands TB, Lightfoot M. Sexually transmitted infection related stigma and shame among African American male youth: implications for testing practices, partner notification, and treatment. AIDS Patient Care STDS 2014; 28(9): 499-506.
| Crossref | Google Scholar | PubMed |
40 Habel MA, Haderxhanaj L, Hogben M, Eastman-Mueller H, Chesson H, Roberts CM. Does your college campus GYT? Evaluating the effect of a social marketing campaign designed to raise STI awareness and encourage testing. Cases Public Health Commun Mark 2015; 8: 51-70.
| Google Scholar | PubMed |
41 Friedman AL, Brookmeyer KA, Kachur RE, Ford J, Hogben M, Habel MA, et al. An assessment of the GYT: get yourself tested campaign: an integrated approach to sexually transmitted disease prevention communication. Sex Transm Dis 2014; 41(3): 151-7.
| Crossref | Google Scholar | PubMed |
42 McFarlane M, Brookmeyer K, Friedman A, Habel M, Kachur R, Hogben M. GYT: get yourself tested campaign awareness: associations with sexually transmitted disease/HIV testing and communication behaviors among youth. Sex Transm Dis 2015; 42(11): 619-24.
| Crossref | Google Scholar | PubMed |
43 Lederer AM, Patterson CP, Williams K. Comprehensive evaluation of a collegiate sexually transmitted infection brief online educational program. Am J Sex Edu 2024;
| Crossref | Google Scholar |
45 Jaworski BC, Carey MP. Development and psychometric evaluation of a self-administered questionnaire to measure knowledge of sexually transmitted diseases. AIDS Behav 2007; 11(4): 557-74.
| Crossref | Google Scholar | PubMed |
48 Balfe M, Brugha R, O’Donovan D, O’Connell E, Vaughan D. Young women’s decisions to accept chlamydia screening: influences of stigma and doctor-patient interactions. BMC Public Health 2010; 10(1): 425.
| Crossref | Google Scholar |
49 Stangl AL, Earnshaw VA, Logie CH, van Brakel W, Simbayi LC, Barré I, Dovidio JF. The health stigma and discrimination framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med 2019; 17(1): 31.
| Crossref | Google Scholar | PubMed |
50 Sievwright KM, Stangl AL, Nyblade L, Lippman SA, Logie CH, Veras MAdSM, et al. An expanded definition of intersectional stigma for public health research and praxis. Am J Public Health 2022; 112(S4): S356-61.
| Crossref | Google Scholar |
51 Montanaro EA, Kershaw TS, Bryan AD. Dismantling the theory of planned behavior: evaluating the relative effectiveness of attempts to uniquely change attitudes, norms, and perceived behavioral control. J Behav Med 2018; 41(6): 757-70.
| Crossref | Google Scholar | PubMed |
52 Hendry NA, Brown G, Dowsett GW, Carman M. Association between sexually transmissible infection testing, numbers of partners and talking to partners and friends about sexual health: survey of young adults. Sex Health 2017; 14(4): 378-82.
| Crossref | Google Scholar | PubMed |
53 Bulduk S, Erdogan S. The effects of peer education on reduction of the HIV/sexually transmitted infection risk behaviors among Turkish university students. J Assoc Nurses AIDS Care 2012; 23(3): 233-243.
| Crossref | Google Scholar | PubMed |
54 Calloway DS, Long-White DN, Corbin DE. Reducing the risk of HIV/AIDS in African American college students: an exploratory investigation of the efficacy of a peer educator approach. Health Promot Pract 2014; 15(2): 181-188.
| Crossref | Google Scholar | PubMed |
55 D’Costa B, Lobo R, Thomas J, Ward JS. Evaluation of the young deadly free peer education training program: early results, methodological challenges, and learnings for future evaluations. Front Public Health 2019; 7: 74.
| Crossref | Google Scholar |
56 Miller AN, Mutungi M, Facchini E, Barasa B, Ondieki W, Warria C. An outcome assessment of an ABC-based HIV peer education intervention among Kenyan university students. J Health Commun 2008; 13(4): 345-56.
| Crossref | Google Scholar | PubMed |
57 Wong T, Pharr JR, Bungum T, Coughenour C, Lough NL. Effects of peer sexual health education on college campuses: a systematic review. Health Promot Pract 2019; 20(5): 652-66.
| Crossref | Google Scholar | PubMed |
58 McClean H, Sutherland J, Searle S, Howarth P. An exploratory study of information-giving used to promote chlamydial test-seeking by students at a college family planning clinic. BMJ Sex Reprod Health 2000; 26(4): 209-12.
| Crossref | Google Scholar |
59 Habel MA, Brookmeyer KA, Oliver-Veronesi R, Haffner MM. Creating innovative sexually transmitted infection testing options for university students: the impact of an STI self-testing program. Sex Transm Dis 2018; 45(4): 272-7.
| Crossref | Google Scholar | PubMed |
60 Middlestadt SE, Bhattacharyya K, Rosenbaum J, Fishbein M, Shepherd M. The use of theory based semistructured elicitation questionnaires: formative research for CDC’s prevention marketing initiative. Public Health Rep 1996; 111(Suppl 1): 18-27.
| Google Scholar |
61 Melendez JH, Hamill MM, Armington GS, Gaydos CA, Manabe YC. Home-based testing for sexually transmitted infections: leveraging online resources during the COVID-19 pandemic. Sex Transm Dis 2021; 48(1): e8-10.
| Crossref | Google Scholar |
62 Kersh EN. Advances in sexually transmitted infection testing at home and in nonclinical settings close to the home. Sex Transm Dis 2022; 49(11S Suppl 2): S12-4.
| Crossref | Google Scholar |
63 Kersh EN, Shukla M, Raphael BH, Habel M, Park I. At-home specimen self-collection and self-testing for sexually transmitted infection screening demand accelerated by the COVID-19 pandemic: a review of laboratory implementation issues. J Clin Microbiol 2021; 59(11): e0264620.
| Crossref | Google Scholar |