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Titlei PERSONAL, ENVRIONMENTAL, & BEHAVIORAL FACTORS INFLUENCING CONDOM USE IN ...
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Table of Contents
                            TITLE PAGE
COMMITTEE MEMBERS
ABSTRACT
TABLE OF CONTENTS
LIST OF TABLES
	Table 1 Community characteristics for participating school districts
	Table 2 The anticipated gender and minority distribution of the participants
	Table 3 Reliability coefficients for scales measuring personal, environmental, and behavioral variables
	Table 4 Demographic characteristics of the sample
	Table 5 Behavioral Characteristics of the sample
	Table 6 Evaluation of differences in the personal, environmental, and behavioral factors between those who use condoms at last intercourse and those who do not
	Table 7 Strength of associations between condom use and selected personal, environmental and behavioral factors
	Table 8 Summary of multivariate logistic regression between condom use at last sex and selected personal, environmental, and behavioral variables
	Table 9 Descriptive statistics for selected personal and environmental variables among sexually active youth
	Table 10 Prevalence of condom use behavior among sexually active youth by grade and gender
	Table 11 Prevalence of sexual behaviors among sexually active youth by grade and gender
	Table 12 Chi-square analysis for differences in the prevalence of high risk behaviors among sexually active youth between those who use condoms and those who do not
	Table 13 Chi-square analysis for differences in the prevalence of high risk behavior among sexually active youth by grade level for those who use condoms and those who do not
	Table 14 Examination of the pattern of differences among sexually active youth in personal and environmental factors by grade for those who use condoms and those who do not using two-factor GLM
	Table 15 Differences in personal and environmental factors among sexually active youth by grade for those who use condoms and those who do not
	Table 16 Significant differences between grade for selected personal, environmental and behavioral variables among sexually active youth for those who use condoms and those who do not
	Table 17 Differences in the prevalence of high-risk behavior among sexually active youth by gender for those who use condoms and those who did not at last intercourse
	Table 18 Examination of the pattern of differences among sexually active youth in personal and environmental factors by gender for those who use condoms and those who do not using two-factor GLM
	Table 19 Differences in personal and environmental factors among sexually active youth by gender for those who use condoms and those who do not
	Table 20 Differences in the prevalence of high-risk behavior among all high-school youth by gender
	Table 21 Differences in the prevalence of high risk behavior among all high-school youth by grade level
	Table 22 Examination of the pattern of differences in personal and environmental factors by gender and grade level using two-factor GLM
	Table 23 Evaluation of differences in the personal, and environmental factors by gender and grade level
	Table 24 Differences between grade for selected personal, environmental and behavioral variables
	Table 25 Spearman’s Rho correlations between condom use goals and personal, environmental and behavioral factors
	Table 26 Logistic regression analysis final model summary: Statistically significant predictors of high goals for condom use
LIST OF FIGURES
	Figure 1 Bandura’s representation of triadic reciprocity in Social Cognitive Theory
	Figure 2 Application of Bandura’s Social Cognitive model of triadic reciprocity
	Figure 3 Theoretical model combining concepts from Bandura’s SCT and Lerner’s Developmental Contextualism
	Figure 4 Prevalence of substance use among sexually active youth
	Figure 5 Method of pregnancy prevention at the most recent episode of intercourse
1.0  INTRODUCTION
	1.1 BACKGROUND AND SIGNIFICANCE
	1.2 PROBLEM STATEMENT
		1.2.1 Purpose
		1.2.2 Specific Aims
	1.3 THEORETICAL FRAMEWORK
	1.4 DEFINITION OF TERMS
	1.5 INNOVATION AND SIGNIFICANCE TO NURSING
2.0  LITERATURE REVIEW
	2.1 OVERVIEW
	2.2 RURAL POPULATIONS
	2.3 RURAL ADOLESCENTS
	2.4 RURAL ADOLESCENT CONDOM USE
		2.4.1 Personal Factors Influencing Condom Use
		2.4.2 Environmental Factors Influencing Condom Use
		2.4.3 Behavioral Factors Influencing Condom Use
	2.5 PRELIMINARY STUDIES
		2.5.1 Study 1
		2.5.2 Study 2
3.0  METHODOLOGY
	3.1 STUDY DESIGN
	3.2 SETTING AND SUBJECTS
		3.2.1 Setting
		3.2.2 Sampling frame
		3.2.3 Sample size determination
	3.3 MEASURES AND LEVEL OF MEASUREMENT
		3.3.1 Demographic Form
		3.3.2 Sexual Risk Knowledge
		3.3.3 Rosenberg Self-Esteem Scale
		3.3.4 Worry About Sexual Outcomes
		3.3.5 Sexual Risk Behavior Beliefs and Self-Efficacy
		3.3.6 Goals for Condom Use
		3.3.7 Parent-Adolescent Communication
		3.3.8 Multidimensional Scale of Perceived Social Support
		3.3.9 Behavior
	3.4 DATA COLLECTION
		3.4.1 Data Management
		3.4.2 Data Screening Procedures
			3.4.2.1 Preliminary analyses.  The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 17.0.  Data were assessed for accuracy by examining for inconsistencies in data entry or coding using univariate descriptive statistics. A detailed descriptive analysis included the generation of frequency counts and percentages for the categorical variables (race, gender, grade, grade performance, parental education level, sexual activity, alcohol and drug use, condom use).  Measures of central tendency, which include the arithmetic mean for normally distributed data and the median for data that may be skewed, along with the standard deviation and range, respectively, were calculated for all continuous variables (age, summative scores) used in the analysis.
		3.4.3 Data Analysis Plan for Primary Aim 1
		3.4.4 Data Analysis Plan for Primary Aim 2
		3.4.5 Data Analysis Plan for Primary Aim 3
		3.4.6 Data Analysis Plan for Secondary Aim 1
		3.4.7 Data Analysis Plan for Secondary Aim 2
			3.4.7.1 Amendment to Data Analysis Plan for Secondary Aim 2.  Upon assessment of the regression diagnostics, several violations of fundamental assumptions for multiple regression were noted.  These violations included non-linearity, non-normality of the residuals, and heteroscedasticity of the data.  Attempts were made to transform the independent and dependent variables individually and in combination, however, this did not result in satisfactory improvement of the data.  Due to the identified violations the use of multiple regression was deemed inappropriate for these data.  The dependent variable was dichotomized to reflect those having high goals for condom use and those having lower goals for condom use and logistic regression was used to examine the relationships among variables of interest.  To meet the assumption of linearity in the logit the variables of Worry about STI and Worry about Pregnancy were also dichotomized (1=worry; 0=no worry) when attempts at transformation failed.
		3.4.8 Limitations
	3.5 HUMAN SUBJECTS
		3.5.1 Human subjects
		3.5.2 Protection of human subjects
		3.5.3 Inclusion criteria for the project
		3.5.4 Potential risk
		3.5.5 Recruitment and informed consent
		3.5.6 Protection against risks
		3.5.7 Potential Benefits of the Research to the Subjects and Others
		3.5.8 Importance of Knowledge Gained from the Study
		3.5.9 Inclusion of Women and Minorities
		3.5.10 Inclusion of Children
		3.5.11 Data Safety Monitoring Plan
4.0  RESULTS
	4.1 OVERVIEW OF THE RESEARCH PROJECT
		4.1.1 Participants and Response Rate
		4.1.2 Problems Encountered
	4.2 MANUSCRIPT
		4.2.1 Abstract
		4.2.2 Manuscript Introduction
		4.2.3 Review of the literature
		4.2.4 Conceptual framework
		4.2.5 Purpose
		4.2.6 Methods
		4.2.7 Measures
		4.2.8 Data analysis
		4.2.9 Results
		4.2.10 Discussion
		4.2.11 Limitations
		4.2.12 Implications for school nursing practice
	4.3 ADDITIONAL ANALYSES
		4.3.1 Primary Aim 1
			To describe the personal, environmental and behavioral factors related to condom use in sexually active rural youth.
		4.3.2 Primary Aim 2
			To compare differences in the personal, environmental, and behavioral factors among sexually active rural youth who currently use condoms and those that do not.
		4.3.3 Secondary Aim 1
			To compare differences in the personal, environmental, and behavioral factors among all rural youth.
		4.3.4 Secondary Aim 2
			To examine the associations among personal, environmental, and behavioral factors and to identify predictors of personal condom use goals in rural high-school youth.
5.0  CONCLUSIONS
	5.1 IMPLICATIONS
		5.1.1 Strengths and Limitations
		5.1.2 Future research directions
		5.1.3 Implications for global health
APPENDIX A IRB
APPENDIX B INSTRUMENTS
APPENDIX C INSTRUMENTS: APPROVAL FOR USE
APPENDIX D PARENTAL NOTIFICATION FORM
APPENDIX E ADDITIONAL RESULTS TABLES
BIBLIOGRAPHY
                        
Document Text Contents
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PERSONAL, ENVRIONMENTAL, & BEHAVIORAL FACTORS INFLUENCING
CONDOM USE IN RURAL YOUTH










by

Tammy Michelle Haley

ASN, Macon College, 1990

BSN, Georgia College and State University, 1995

MSN, University of Pittsburgh, 2002










Submitted to the Graduate Faculty of

School of Nursing in partial fulfillment

of the requirements for the degree of

Doctor of Philosophy










University of Pittsburgh

2012

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included: 1) current high school enrollment, 2) age 13 - 19 years, and 3) ability to speak and

understand English. The survey was administered by a trained member of the research team

during the students’ regularly scheduled health, physical education, or homeroom class. The time

for completion of the instrument battery was approximately 40 minutes.

The study protocol was approved by the Institutional Review Board (IRB) of the

University of Pittsburgh, and letters of support were obtained from participating school districts.

A waiver of informed consent was granted due to the low-risk nature of the study. Although

written consent was not required, parents were informed of the survey by mail and provided the

opportunity to restrict their child’s participation.

4.2.7 Measures

Measures selected were psychometrically sound (Sales, et al., 2009; Sales, et al., 2008; Brenner,

et al., 2002; Shrier, et al., 2001; Basen-Engquist, et al., 1999; Zimet, et al., 1990; Robinson,

1973) and used previously in adolescent samples. To evaluate scale reliability in this population,

Cronbach’s alpha was estimated for all scales using all participants (N=1082) enrolled in the

parent study (Table 3). Measures evaluated knowledge (Shrier, et al., 2001), self-esteem

(Robinson, 1973), perception of risk reflected by worry (Sales, et al., 2009), personal standards,

self-efficacy for communication, condom use, and refusal of intercourse, condom use barriers,

peer norms (Basen-Engquist, et al., 1999), condom use goals (Delaney, et al., 1997),

communication with parents about sexual topics (Sales, et al., 2008) perceived support from

peers, parents and a significant other (Zimet, et al., 1990), and high-risk behavior (CDC, 2011c).

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Additionally, participants reported their age, grade, gender, race, academic performance, family

living arrangements, and parents’ highest level of education to create a demographic profile.





Table 3 Reliability coefficients for scales measuring personal, environmental, and behavioral variables
(N=1082)


Variable # Items Reliability
Sexual Knowledge Scale 15 .678
Rosenberg Self-Esteem Scale 10 .895
Worry About Sexual Outcomes 10 .902
WASO-pregnancy 2 .809
WASO-STI 8 .932
Sexual Risk Behavior Beliefs & Self-efficacy Scale
Self-efficacy Refusing unwanted intercourse 3 .795
Self -efficacy Communicating about condoms 3 .810
Self-efficacy Buying and using condoms 3 .684
Norms for Condom use 3 .902
Barriers for condom use 3 . 790
Personal Standards for condom use 3 .929
Goals for condom use 5 .854
Parent Adolescent Communication Scale 5 .911
Multidimensional Scale of Perceived Social Support 12 .933
MSPSS-significant other 4 .920
MSPSS-friends 4 .926
MSPSS-family 4 .916





Knowledge. Knowledge was defined as factual understanding of information relative to

condom use and STI transmission as measured by 15 true/false items such as “condoms must be

stored in a cool, dry place.” The scale was originally developed to assess knowledge of condom

use and STI in high risk adolescent females (Shrier, et al., 2001). Four items were modified in

collaboration with Dr. Shrier to construct gender neutral items for this study. Responses were

coded (1-correct, 0-incorrect) with higher scores reflecting higher levels of knowledge.

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