Factors associated with adverse sexual outcomes among college students.
Abstract: This study examined factors associated with adverse sexual outcomes among 24,963, 18-24 year old undergraduate college students participating in the Spring, 2004 National College Health Assessment Survey. Alcohol use, mental health problems, and higher rates of perceived peer sexual activity were associated with increased odds of sexually transmitted infections (STIs) and unintended pregnancy. In contrast, living on campus reduced students' odds for STI acquisition, and high grade point average was associated with reduced odds for unintended pregnancies. Results suggest that factors associated with college students' sexual health behaviors are complex and often interrelated and deserve further and more in-depth study.
Subject: Mental health (Health aspects)
College students (Sexual behavior)
College students (Surveys)
College students (Health aspects)
Disease transmission (Health aspects)
Authors: Scholly, Kristen
Katz, Alan R.
Cole, Darnell
Heck, Ronald H.
Pub Date: 09/22/2010
Publication: Name: American Journal of Health Studies Publisher: American Journal of Health Studies Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 American Journal of Health Studies ISSN: 1090-0500
Issue: Date: Fall, 2010 Source Volume: 25 Source Issue: 4
Product: Product Code: E197500 Students, College
Organization: Organization: American College Health Association
Accession Number: 309069159

Sexual health problems are one of the most serious health concerns among the adolescent and young adult population (Eng & Butler, 1997). Young adults, including college and university students, frequently engage in behaviors that put them at increased risk for sexually transmitted infections (STIs) and unintended pregnancy. According to the Centers for Disease Control and Prevention, of the fifteen million new cases of STIs that occur in the United States every year, an estimated 9.1 million occur among 15-24 year olds (Weinstock, Berman, & Cates, 2004). In addition, approximately 900,000 teenagers become pregnant in the United States every year. The majority of these pregnancies occurs among 18-19 year olds, and most are unintended (Klein, 2005).


Nearly three fourths of undergraduate college students report they are sexually active, with many college students engaging in increased levels of sexual activity and sexual experimentation (ACHA, 2006). Sexually active college students are more likely to be at risk for contracting STIs and experiencing unintended pregnancy due to patterns of sexual behavior including having multiple partners and inconsistent use of condoms (Kirby, 2001; Lewis, Melton, Succop, & Rosenthal, 2000; Scholly, Katz, Gascoigne, & Holk, 2005).

Although most college students are aware that condom use should be the primary method of STI prevention for sexually active individuals, fewer than half report using condoms consistently (Scholly et al., 2005; Zak-Place & Stern, 2004). One key reason may be the importance of social norms and group connectedness in affecting sexual behavior. Research indicates that if a group has clear norms against unsafe sexual practices, then adolescents associated with this group will be less likely to engage in sexual risk-taking. In contrast, when adolescents are connected to groups with more permissive values, there is an increased likelihood that they will engage in risky sexual behavior (Kirby, 2001). The impact of social norms on sexual health behavior has been documented in a small number of studies within the college student population (Lynch, Mowrey, Nesbitt, & O'Neill, 2004; Scholly et al., 2005; Seal & Agostinelli, 1996).

Another factor impacting college students' sexual risk-taking is an unrealistic perception of low vulnerability to STIs and unintended pregnancy. Students are often aware of the dangers of contracting an STI such as HIV, yet most college students view HIV infection as an improbable health concern (Sands, Archer, & Puleo, 1998). The gap between levels of awareness and actual behavioral practices results in students who demonstrate low rates of STI preventive behavior (Sands et al., 1998; Zak-Place & Stern, 2004).

Excessive alcohol use is also a factor linked to high-risk sexual health practices among college students (Turchik, Garske, Probst, & Irvin, 2009). Alcohol use often diminishes inhibitions and rational decision-making, thereby increasing the incidence of unprotected sex (Kirby, 2001). Thousands of students annually experience problems related to their alcohol use. Common practices such as binge drinking, drinking rituals and drinking games often contribute to students' increased risk for unprotected sex, sexual assault and abuse (Maney, Laurenceau-Medina, Mortensen, Vasey, Moore, & Gates, 2003; Wechsler, Lee, Kuo, & Lee, 2000). The link between college students' excessive alcohol use and risky sexual behavior may be the result of a campus environment that supports such behavior. It is difficult for students to say "no" to alcohol misuse when the campus culture encourages activities which result in high risk health behaviors (Maney et al., 2003; Wechsler, Lee, Nelson & Kuo, 2001).

Mental health problems can also have a profound effect on all aspects of campus life, negatively impacting students' physical, emotional, cognitive, and interpersonal functioning (Kitzrow, 2003). The severity of problems for which students are seeking help at college counseling centers has increased since the 1980s and includes suicidal ideation, severe depression, substance abuse, anxiety, and feelings of distress (Pledge, Lapan, Heppner & Roehlke, 1998). These mental health issues are also potentially linked to high-risk sexual practices that put students at greater risk for unintended pregnancies and contracting STIs (Martens, Page, Mowry, Damann, Taylor, & Cimini, 2006; Sax, 1997).

The purpose of this study is to examine factors that influence the sexual health practices of undergraduate college students ages 18-24 years old and to identify factors independently associated with becoming unintentionally pregnant or contracting a sexually transmitted infection.


This study utilizes a secondary data source, the 2004 National College Health Association's National College Health Assessment (NCHA) Survey. Eighty U.S. post-secondary institutions from all Carnegie classifications representing varied geographic regions of the United States participated. The NCHA survey currently provides the most comprehensive secondary data set available for investigating the factors that influence college students' health behavioral practices (ACHA, 2006). Only those institutions that used a random sampling technique to identify student participants were included in this study's final data set. This study was reviewed and approved by the University of Hawaii's Institutional Review Board.

The sample for this study was limited to 18-24 year old full-time students who reported being sexually active, defined as having had sexual intercourse in the last school year. Sexually active students were selected, as they were potentially at risk for an unintended pregnancy or STI. The 18-24 year old age range was selected, as numerous studies indicate that this age group has a high incidence of health risk behaviors, including sexual risk-taking and alcohol misuse (Dekin, Cabrera, Vogt, & Volkwein 1995; Lewis et. al, 2000; Wechsler et al., 2000), and the vast majority of unintended pregnancies and STIs occur among this age group (Cooper, 2002; Kirby, 2001; Klein, 2005). Because one of the study's research questions was to determine the impact of campus involvement on sexual risk-taking behavior, it was necessary to include only full- time students, as they are on campus more often, which provides greater opportunities to participate in activities related to academic and social involvement (Astin, 1993). Adopting these criteria resulted in a final sample size of 24,963.

Two dichotomous dependent variables were selected to reflect adverse sexual health related outcomes: contracting an STI, or experiencing an unintended pregnancy in the last school year.

Independent variables included sociodemographic variables: age, gender, ethnicity (white vs. other), sexual orientation (heterosexual vs. not heterosexual), year in school, domestic vs. international student status, relationship status (single, uncommitted vs. in a committed relationship). Other independent variables included four school-involvement variables: living on campus (yes or no), being a member of a fraternity or sorority (yes or no), number of hours working per week for pay, and grade point average (GPA) with high GPA defined as greater than or equal to 3.0 on a 4 point scale.

Alcohol use/abuse was assessed through three questions: number of drinks ingested last time student "partied/socialized," number of hours student drank alcohol last time student "partied/socialized," and number of times five or more alcoholic drinks were ingested at one sitting over the past two weeks. These items were analyzed individually and also aggregated to form a composite "alcohol use" variable for logistic regression analyses. Cronbach's alpha coefficient for the three items = 0.79.

Two questions were used to assess STI risk reduction behaviors: use of condom at last oral intercourse (yes or no) and use of condom at last vaginal intercourse (yes or no). Three questions were used to assess risk reduction behaviors for pregnancy prevention: use of oral contraceptive to prevent pregnancy (yes or no), condom use to prevent pregnancy (yes or no), emergency contraception use in the last school year (yes or no). Three questions were asked to assess sexual activity: how many times within the past 30 days did you have oral sex, vaginal sex, anal sex. An additional three questions were asked to assess perceived peer sexual behaviors: how many times within the past 30 days do you think the typical student at your school had oral sex, vaginal sex, anal sex. These latter three items were analyzed individually and also aggregated into a composite "perceived peer norms" variable for logistic regression analyses. Cronbach's alpha for responses to the three perceived peer sexual behavior questions = 0.77.

Student emotional health was assessed through six questions each pertaining to the last school year: how many times have you felt things were hopeless, how many times have you felt overwhelmed by all you had to do, how many times have you felt very sad, how many times have you felt so depressed that it was difficult to function, how many times have you seriously considered attempting suicide, and how many times have you attempted suicide. These items were analyzed individually and also aggregated into a composite "emotional health" variable for logistic regression analyses (Cronbach's alpha = 0.84). Student assault and relationship abuse was assessed by the answers to six questions each pertaining to the last school year: have you experienced verbal threats, have you experienced sexual touching against your will, have you experienced an attempted sexual assault, have you experienced a sexual assault, have you been in a relationship that was physically abusive, and have you been in a relationship that was sexually abusive. These six items were analyzed individually and also aggregated into a composite "relationship abuse" variable for logistic regression analyses (Cronbach's alpha = 0.66).

A logistic regression model was developed for each of the two dichotomous dependent variables (STI or unintended pregnancy in last year) to assess which independent variable(s) were independently associated with each of the two outcome variables. Each sociodemographic, school involvement, composite alcohol use, composite perceived peer sexual behavior, composite emotional health, and composite relationship abuse variable was included in the two logistic regression models. For the STI model, additional variables related to STI risk reduction behaviors were added. For the unintended pregnancy model, only students identifying as heterosexual females were included in the analysis, and pregnancy prevention risk reduction behaviors were added.

Descriptive statistics and logistic regression analyses were performed using SPSS version 15.



Tables 1-4 provide the descriptive statistics for the study. The mean age of the study population was 20.35 years, 34% of the study population was male, and the majority of students in this study ethnically identified as Caucasian (80%). The race/ethnicity demographics total more than 100% as categories were not mutually exclusive. Forty-seven percent of students were "single" (e.g., in an uncommitted relationship) (Table1).

Forty-six percent of students in the study sample reported living on campus versus living off campus. Ten percent reported membership in a fraternity or sorority. Eighty-six percent reported having a high GPA of at least 3.00 on a 4 point scale (Table 2).

Forty-seven percent of students reported using a condom the last time they had vaginal intercourse. In terms of pregnancy risk reduction strategies, 68% used oral contraceptives and 64% used condoms (although not necessarily consistently). Twelve percent reported using emergency contraception (morning after pill) in the last school year (Table 3).

The study results indicated a relatively low frequency of reported relationship abuse. Only 12% of students reported experiencing unwanted touching, while 5% reported verbal threats, 4% reported attempted sexual assault, and 2% reported being sexually assaulted (Table 4).

During the past school year students reported feelings of "being overwhelmed" a mean of 4.66 times and being sad 3.41 times. Suicidal feelings and actual suicide attempts were reported less frequently (Table 4).

In terms of the study's dependent variables, 4.5% of students reported being diagnosed with one or more STIs, and 2.5% of female students reported becoming unintentionally pregnant within the past school year.


Table 5 provides the results of the logistic regression analysis examining the association between the independent variables and students' likelihood of being diagnosed with an STI (Table 5). Older students (within the 18-24 year old age group) were more likely to have been diagnosed with an STI during the past year [odds ratio (OR) = 1.17, 95% confidence intervals (CI): 1.10-1.26]. Heterosexuals were significantly less likely to have contracted an STI (OR = 0.64, 95% CI: 0.49-0.83). Males were significantly less likely than females to have been diagnosed with an STI during the last school year (OR = 0.39, 95% CI: 0.32-0.47).

Two variables related to student involvement on campus were significant. Membership in a fraternity or sorority compared with not being a member of a fraternity or sorority increased the likelihood of contracting an STI (OR = 1.33, 95% CI: 1.07-1.63). In contrast, living on campus significantly reduced the likelihood of contracting an STI (OR = 0.69, 95% CI: 0.58-0.81).

Perception of peers' sexual activity was significantly related to likelihood of contracting an STI (OR = 1.12, 95% CI: 1.05-1.21). This can be interpreted as students who perceived their peers to be the most sexual active were more likely to contract an STI.

Students with higher levels of alcohol use were at greater odds of contracting an STI (OR = 1.13, 95% CI: 1.04-1.23).

Students' emotional health also had an impact on their odds of contracting an STI. Students who experienced higher levels of depression and/ or suicidal ideation than the sample mean had an increased likelihood for infection (OR = 1.38, 95% CI: 1.23-1.52).

Finally, in terms of sexual practices, students who reported condom use during last oral intercourse and last vaginal intercourse showed a decreased likelihood for STI acquisition (OR = 0.55, 95% CI: 0.30-0.98 and OR = 0.85, 95% CI: 0.730.98 respectively).


Table 6 provides the results of the logistic regression analysis to explain students' likelihood of becoming pregnant (Table 6). Students who identified as Caucasian were at decreased odds for unintentional pregnancy during the past school year (OR = 0.51, 95% CI: 0.38-0.67). Other background variables such as year in school (OR = 0.80, 95% CI: 0.68-0.94) and age (OR = 1.18, 95% CI: 1.02-1.34) were also significant.

Students with higher GPAs (3.0 or above) had approximately 2.6 times lower odds of an unintentional pregnancy (OR = 0.39, 95% CI: 0.29-0.52).

Students who perceived their peers to be the most sexually active had an increased odds of unintentional pregnancy (OR = 1.27, 95% CI: 1.121.44).

Greater emotional health challenges (i.e., depression and suicidal ideation) were associated with an increased odds of an unintentional pregnancy (OR = 1.36, 95% CI: 1.06-1.60). Students who reported using a condom to prevent pregnancy were at decreased odds of unintentional pregnancy (OR = 0.46, 95% CI: 0.38-0.68). In contrast, students who reported that they used emergency contraception during the last school year were at increased odds for unintentional pregnancy (OR = 2.77, 95% CI: 2.02-3.71).


A unique aspect of this study was its ability to identify a wide array of variables that were independently associated with college students' likelihood of contracting an STI or experiencing an unintended pregnancy. The inclusion of a large nationally distributed sample and the use of a validated survey instrument are key strengths of this study.

Increasing age was related to increased odds for contracting an STI and experiencing an unintended pregnancy. Results from an earlier NCHA Survey, found that 8 of 10 college students between the ages of 18 and 24 years were sexually active, 25% of students had six or more lifetime sex partners, and only a small percentage of students used condoms consistently to prevent pregnancy or STI (Douglas, Collins, Warren, Kann, Gold, Clayton, Ross, & Kolbe, 1997). College students' risk for STIs and unintended pregnancies, therefore, likely increases as they get older due to their increased exposure to multiple sexual partners without the use of adequate protection (Cooper, 2002; Douglas et al., 1997).

The finding that women were at increased odds for STIs, is consistent with national surveillance data for both gonorrhea and chlamydia among 15-24 year olds (CDC, 2007). Gender differences in STI rates may reflect more aggressive screening programs targeting women. Many college women are screened annually for a variety of STIs, however routine STI testing is much less common among college males.

The finding of increased odds of STIs among nonheterosexuals is also consistent with national reports (CDC, 2007; Hall, Song, Rhodes, Prejean, An, Lee, Karon, Brookmeyer, Kaplan, McKenna, & Janssen, 2008). Gay and bisexual men are currently the groups most affected by HIV infection in the United States (Hall et al., 2008).

Although the current study lends support to the link between alcohol use and STIs, it did not demonstrate a significant relationship between alcohol use and unintended pregnancy. This unique finding is in contrast to previous research, which does demonstrate a link between alcohol and unintended pregnancy, especially among women who were binge drinkers (Naimi, Lipscomb, & Gilbert, 2003). One possible explanation for the discrepancy in findings could be explained by college students' methods of birth control. Research has shown that alcohol use is related to inconsistent condom use (Cooper, 2002; Martens et al. 2006). However, college students often use birth control pills rather than condoms for pregnancy prevention (Douglas et. al, 1997; NCHA, 2005) and oral contraception would be potentially less negatively affected by excessive alcohol use.

Previous research has demonstrated that psychological dysfunction associated with emotional health problems can result in increased risk-taking and decreased self-care (McNutt, Carlson, Persuad, & Postmus, 2002). In addition, students who experienced moderate to severe depression were at greater risk for academic impairment, which included interpersonal problems with members of the campus community and decreased academic productivity (Heiligenstein et al., 1996). The current study establishes a specific connection between impaired emotional health and increased STI and unintended pregnancy occurrence among college students. One possible explanation for this finding is that emotional health problems impede students' ability to practice risk reduction strategies, such as consistent condom use and correct and consistent use of other contraceptive methods such as remembering to take oral contraceptive pills as prescribed.

The study results did not reveal any consistent relationship between sexual assault and/or dating violence and increased occurrence of unintended pregnancy and STI acquisition. One possible explanation may be related to how the relationship abuse variable was defined in the study and the general nature of the construct itself. For example, experiencing verbal threats may not have the same impact on students' STI and pregnancy risk as if they experienced physical assault. If this variable was more narrowly defined (e.g., including only physical violence within a dating relationship), a statistically significant relationship between assault and the study's outcomes might have been found.

College students' sexual behavior is often characterized by inconsistent condom use (Dahl, Gorn, & Weinberg, 1997; Lewis et al., 2000; Zak-Place & Stern, 2004). However, when used correctly and consistently condoms are a highly effective method for preventing both STIs and pregnancy (Cates & Steiner, 2002). The findings from the current study reinforce the importance of condom use among the college population. Students who used condoms during last oral and vaginal intercourse were at decreased odds for STIs and those students who used condoms as a method of birth control also reduced their odds for pregnancy.

Over the past decade, emergency contraceptive pills (ECPs) have become much more readily available at college health centers and ECPs have been shown to be extremely safe for the vast majority of women who use it (Miller & Sawyer, 2006). When ECP is taken within 72 hours of unprotected intercourse, it is estimated to be 75-86% effective in preventing pregnancy (Miller & Sawyer, 2006). Although the number of women who used ECP as a method of preventing pregnancy during the last school year was relatively small, the findings indicated that ECP use was associated with significantly increased odds of unintended pregnancy. One possible explanation may be that these students failed to use ECP within a 72 hour period after unprotected sex. It is also not known if students took ECP after every incidence of unprotected vaginal intercourse, which would also increase their risk for unintended pregnancy. Another possible explanation is that students taking ECP were relying on ECP as their primary birth control method and were not using a more effective contraceptive method. A recent study of college students in Hawaii also demonstrated a positive association between ECP use and unintended pregnancy (Parrish, Katz, Grove, Maddock, & Myhre, 2009).

A significant association was demonstrated between students' perceived normative behaviors and their odds of acquiring an STI and becoming pregnant. Previous social norms research found that college students consistently overestimated the sexual health norms on campus (Cooper, 2002; Lewis & Neighbors, 2006). These misperceptions may result in increased risk-taking as students try to conform to inaccurately perceived prevalence of high-risk sexual practices (Martens et. al., 2006; Scholly et al., 2005). It may also be that students at greater risk for STIs and unintended pregnancies associate themselves more closely to peers with perceived high-risk sexual behaviors.

The elevated odds of STIs associated with fraternity or sorority membership and the reduced odds of STIs and unintended pregnancy associated with living on campus may be related to differences in rates of alcohol consumption between the two groups. Greek members comprise a subgroup on campus that consumes alcohol in greater quantities, misperceives the risks of alcohol abuse, and emulates a social environment in which drinking alcohol is a key part of college life (Barry, 2007). In contrast to the high rates of binge drinking that are common in fraternities and sororities, over 40% of all college students under the age of 21 live in on-campus substance-free housing, where the lowest undergraduate binge drinking rates can be found (Wechsler et al., 2002).

The inverse relationship between high GPA, year in school and odds of unintended pregnancy conforms with Astin's findings that pregnancy was a common reason for women to drop out of college (Astin 1993). Hence high GPA may reflect greater engagement in academics and greater adherence to effective contraceptive practices allowing women to avoid an unintended pregnancy, and successfully progress in their college career.



The study's findings should be interpreted in light of some key limitations. First, the data used in this study were cross-sectional thus limiting the researchers' ability to draw causal inferences. The use of a cross-sectional data set to create a main effects model also limited the researchers' ability to examine the interaction effects between specific variables within the study. Although cross-sectional studies can provide useful data, they are not optimal for illuminating processes by which health-risk behaviors are temporally associated (Cooper, 2002). As a result, additional research is needed to examine factors that contribute to STIs and unintended pregnancy among college students from a more in-depth, and longitudinal, perspective.

Another limitation is the generalizability of the study's findings. Although the NCHA survey is the largest nationwide comprehensive sample of college students' health behaviors, the study population is predominately Caucasian. This may limit the ability of the study's findings to reflect the behaviors of all students currently enrolled in higher education institutions. Current research in higher education has demonstrated a need to expand the vision of the college experience to reflect the growing diversity of U.S. college students (Pascaralla & Terenzini, 2005).

Lastly, with such a large sample size and number of comparisons, there is the possibility that some of the observed findings may reflect type I error. This would be of particular concern for independent variables demonstrating significant associations but with odds ratios close to the null value (e.g., small effect sizes). However, over half of our observed significant associations were highly significant with very low p-values (p [less than or equal to] 0.001) making chance an unlikely explanation.[less than or equal to]


College health professionals must work to develop effective education and intervention strategies for the early identification of students exhibiting high risk health behaviors. Given how strongly alcohol use is associated with risky sexual behavior, education programs designed to promote safer sexual practices should also address college students' alcohol use patterns. Educational efforts might also include social norms interventions designed to help students adopt less exaggerated views of their peers' drinking and sexual behavior norms.

Expanded education efforts and future research to examine the interrelationship between mental health, sexual health, social and residential factors, and academic performance will hopefully result in more effective strategies for reducing rates of STIs and unintended pregnancies on college campuses. The need for a greater understanding of college students' health risk behaviors is underscored by the potential repercussions for these individuals' personal and academic goals.


American College Health Association. (2006). American College Health Association--National College Health Assessment (ACHA-NCHA) Spring 2004 reference group data report (abridged). Journal of American College Health, 54, 201-211.

Astin, A. W. (1993). What matters in college: Four critical years revisited. San Francisco: Jossey-Bass.

Barry, A. E. (2007). Using theory-based constructs to explore the impact of Greek membership on alcohol-related beliefs and behaviors: a systematic literature review. Journal of American College Health, 56, 307-315.

Cates, W. Jr., & Steiner, M. J. (2002). Dual protection against unintended pregnancy and sexually transmitted infections: what is the best contraceptive approach? Sexually Transmitted Diseases, 29, 168-174.

Centers for Disease Control and Prevention (2007). Sexually transmitted disease surveillance, 2006. Atlanta: US Department of Health and Human Services.

Cooper, M. L. (2002). Alcohol use and risky sexual behavior among college students and youth: evaluating the evidence. Journal of Studies on Alcohol, Supplement No. 14: 101-117.

Dekin, B. J., Cabrera, A. F., Vogt, W. P., & Volkwein J. F. (1995).Condom use in college: student's self-protection against HIV. Paper presented at the 20th Annual Meeting of the Association for the Study of Higher Education, Orlando, FL, 2-5 November 1995. Available at URL: http://www.eric.ed.gov/ PDFS/ED391424.pdf Accessed 29 June 2010.

Douglas, K. A., Collins, J. L., Warren, C., Kann, L., Gold, R., Clayton, S., Ross, J. G., & Kolbe, L. J.(1997). Results from the 1995 National College Health Risk Behavior Survey. Journal of American College Health, 46, 55-66.

Eng, T. R., & Butler, W. T. (Eds.). (1997). The hidden epidemic: confronting sexually transmitted diseases. Washington, DC: National Academy Press.

Hall, H. I., Song, R., Rhodes, P., Prejean, P., An, Q., Lee, L. M., Karon, J., Brookmeyer, R., Kaplan, E. H., McKenna, M. T., Janssen, R. S., & HIV Incidence Surveillance Group (2008). Estimation of HIV Incidence in the United States. Journal of the American Medical Association, 300, 520-529.

Kirby, D. (2001). Emerging answers--Research findings on programs to reduce teen pregnancy; The National Campaign to Prevent Teen Pregnancy, Washington, May 2001.

Kitzrow, M. A. (2003). The mental health needs of today's college students: challenges and recommendations. NASPA Journal, 41, 167-181.

Klein, J. D. & American Academy of Pediatrics Committee on Adolescence (2005). Adolescent pregnancy: current trends and issues. Pediatrics, 116, 281-286.

Lewis, L. M., Melton, R. S., Succop, P. A., & Rosenthal, S. L. (2000). Factors influencing condom use and STD acquisition among African American college women. Journal of American College Health, 49, 1923.

Lewis, M. A. & Neighbors, C. (2006). Social norms approaches using descriptive drinking education: A review of the research on personalized normative feedback. Journal of American College Health, 54, 213-218.

Lynch, J., Mowrey, R., Nesbitt, G., & O'Neill, D. (2004). Risky business: misperceived norms of sexual behavior among college students. NASPA Journal, 42, 21-35.

Maney, D. W., Laurenceau-Medina, J. P., Mortensen, S., Vasey, J. J., Moore, B., & Gates, S. C. (2003). An exploration of student perceptions and practices by ethnicity regarding alcohol-free late-night entertainment. American Journal of Health Studies, 18,146-155.

Martens, M. P., Page, J. C., Mowry, E. S., Damann, K. M., Taylor, K. K., & Cimini, M.D. (2006). Differences between actual and perceived student norms: an examination of alcohol use, drug use, and sexual behavior. Journal of American College Health, 54, 295-300.

McNutt, L. A., Carlson, B. E., Persaud, M. & Postmus, J. (2002). Cumulative abuse experiences, physical health and health behaviors. Annals of Epidemiology,12, 123-130.

Parrish, J. W., Katz, A. R., Grove, J. S., Maddock, J., & Myhre, S. (2009). Characteristics of women seeking emergency contraception at a university-based women's health clinic. American Journal of Obstetrics & Gynecology, 201, 22.e1-7.

Pascarella, E. T., & Terenzini, P. T. (2005). How college affects students (Vol. II): A third decade of research. San Francisco: Jossey-Bass.

Pledge, D., Lapan, R., Heppner, P., & Roehlke, H. (1998). Stability and severity of presenting problems at a university counseling center: A 6-year analysis. Professional Psychology Research and Practice, 29, 386-389.

Sands, T., Archer, J., & Puleo, S. (1998). Prevention of health-risk behaviors in college students: evaluating seven variables. Journal of College Student Development, 39(4), 331-342.

Sax, L. J. (1997). Health trends among college freshmen. Journal of American College Health, 45, 252-262.

Scholly, K., Katz, A. R., Gascoigne, J., & Holk, P. S. (2005). Using social norms theory to explain perceptions and sexual health behaviors of undergraduate college students: an exploratory study. Journal of American College Health, 53, 159-166.

Seal, D. W., & Agostinelli, G. (1996). College students' perceptions of the prevalence of risky sexual behavior. AIDS Care, 8, 453-466.

Turchik, J. A., Garske, J. P., Probst, D. R., & Irvin, C. R. (2009). Personality, sexuality, and substance use as predictors of sexual risk taking in college students. Journal of Sex Research,46, 1-9.

Wechsler, H., Lee, J. E., Kuo, M. & Lee, H. (2000). College binge drinking in the 1990s: a continuing problem. Results of the Harvard School of Public Health 1999 College Alcohol Study. Journal of American College Health, 48, 199-210

Wechsler, H., Lee, J. E., Nelson, T. F., & Lee, H. (2001). Drinking levels, alcohol problems and secondhand effects in substance-free college residences: results of a national study. Journal of Studies on Alcohol and Drugs, 62, 23-31.

Weinstock, H., Berman, S., & Cates W. Jr. (2004). Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspectives on Sexual and Reproductive Health, 36, 6-10.

Woosley, S., Slabaugh, K., Sadler, A. E., & Mason, G. W. (2005). The mystery of stop-outs: do commitment and intention predict re-enrollment? NASPA Journal, 42, 188-201.

Zak-Place, J & Stern, M.(2005). Health belief factors and dispositional optimism as predictors of STD and HIV preventive behavior. Journal of American College Health, 52, 229-236.

Kristen Scholly, PhD

Alan R. Katz, MD, MPH

Darnell Cole, PhD

Ronald H. Heck, PhD

Kristen Scholly, PhD, is affiliated with the Department of Educational Administration, College of Education, University of Hawaii at Manoa, Honolulu, HI 96822. Alan R. Katz, MD, MPH, is affiliated with the Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96822. Darnell Cole, PhD, is affiliated with the Rossier School of Education, University of Southern California, Los Angeles, CA 90089. Ronald H. Heck, PhD, is affiliated with Department of Educational Administration, College of Education, University of Hawaii at Manoa, Honolulu, HI 96822.
Table 1. Sociodemographic variables for 24,963 18-24 year old,
full-time, sexually active, undergraduate
college students participating in the Spring 2004 National
College Health Assessment Survey

Independent Variables   Mean (standard deviation)
                              or Proportion

Age in years                  20.35 (1.57)
Male                              0.34
White *                           0.80
Black *                           0.06
Hispanic *                        0.05
Asian *                           0.09
Mixed race *                      0.03
International student             0.03
Year in school                 2.61 (1.43)
Heterosexual                      0.95
Single                            0.47

* Race/ethnicity totals are greater than 100% as categories
are not mutually exclusive

Table 2. School involvement variables for 24,963 18-24 year old,
full-time, sexually active, undergraduate college students
participating in the Spring 2004 National College
Health Assessment Survey

Independent Variables               Mean (standard deviation)
                                          or Proportion

Live on campus                                0.46
Fraternity or Sorority membership             0.10
Work (hours/week)                          1.41 (1.42)
High grade point average                      0.86
  [[greater than or equal to]
  3.0 (out of 4.0)]

Table 3. Sexual activity variables for 24,963 18-24 year old,
full-time, sexually active, undergraduate
college students participating in the Spring 2004 National
College Health Assessment Survey

Independent Variables                    Mean (standard deviation)
                                               or Proportion

Oral sex: number of times per month             2.78 (1.87)
Vaginal sex: number of times per month          3.74 (2.31)
Anal sex: number of times per month             1.36 (0.91)
Oral sex, perceived norm: number                2.47 (1.43)
of times per month
Vaginal sex, perceived norm: number             2.81 (1.57)
of times per month
Anal sex, perceived norm: number                1.57 (1.12)
of times per month
Condom use: last time vaginal sex                  0.47
Condom use: last time oral sex                     0.03
Oral contraception use to prevent                  0.68
Condom use to prevent pregnancy                    0.64
Emergency contraception use:                       0.12
  last school year

Table 4. Psychosocial factors (alcohol use, emotional health,
relationship abuse) for 24,963 18-24 year old,
full-time, sexually active, undergraduate college students
participating in the Spring 2004 National College
Health Assessment Survey

Independent Variables                     Mean (standard deviation)
                                                or Proportion

Number of drinks: last time partied              5.36 (4.56)
Number of hours drinking: last                   3.50 (2.85)
  time partied
Number of times drank 5 or more drinks:          2.39 (2.00)
  past two weeks
Number of times felt hopeless: last              2.75 (1.96)
  school year
Number of times felt overwhelmed: last           4.66 (1.99)
  school year
Number of times felt very sad: last              3.41 (2.04)
  school year
Number of times felt depressed: last             2.24 (1.84)
  school year
Number of times felt suicidal: last              1.21 (0.79)
  school year
Number of times attempted suicide:               1.03 (0.27)
  last school year
Experienced unwanted touching: last                 0.12
  school year
Experienced verbal threats: last                    0.05
  school year
Experienced attempted sexual assault:               0.04
  last school year
Experienced sexual assault: last                    0.02
  school year
Physically abused in relationship:                  0.02
  last school year
Sexually abused in relationship:                    0.02
  last school year

Table 5. Multivariate logistic regression analysis assessing
independent associations with the acquisition of
a sexually transmitted infection

                                     Logit    Standard Error

Male                                 -0.938       0.097
Year in school                       0.008        0.037
Age                                  0.157        0.035
Caucasian                            -0.110       0.090
International student                -0.111       0.227
Single                               0.086        0.074
Heterosexual                         -0.451       0.136
High grade point average             -0.044       0.102
  [[greater than or equal to] 3.0
  (out of 4.0)]
Fraternity or sorority membership    0.284        0.109
Live on campus                       -0.377       0.085
Work (hours/week)                    0.019        0.025
Perceived peer sexual activity       0.116        0.035
Alcohol use                          0.124        0.042
Relationship abuse                   -0.011       0.054
Emotional health                     0.319        0.055
Condom: last oral sex                -0.592       0.299
Condom: last vaginal sex             -0.168        .073

                                     Odds Ratio   95% Confidence

Male                                 0.39 ***       0.32-0.47
Year in school                       1.01           0.94-1.08
Age                                  1.17 ***       1.10-1.26
Caucasian                            0.95           0.78-1.10
International student                0.90           0.59-1.42
Single                               1.09           0.95-1.26
Heterosexual                         0.64 **        0.49-0.83
High grade point average             0.96           0.78-1.16
  [[greater than or equal to] 3.0
  (out of 4.0)]
Fraternity or sorority membership    1.33 **        1.07-1.63
Live on campus                       0.69 ***       0.58-0.81
Work (hours/week)                    1.02           0.97-1.07
Perceived peer sexual activity       1.12 ***       1.05-1.21
Alcohol use                          1.13 **        1.04-1.23
Relationship abuse                   0.99           0.90-1.10
Emotional health                     1.38 ***       1.23-1.52
Condom: last oral sex                0.55 *         0.30-0.98
Condom: last vaginal sex             0.85 *         0.73-0.98

* p < 0.05, ** p < 0.01, *** p [less than or equal to] 0.001

Table 6. Multivariate logistic regression analysis assessing
independent associations with occurrence of
unintended pregnancy

                                     Logit    Standard

Year in school                       -0.223    0.091
Age                                  0.169     0.080
Caucasian                            -0.669    0.169
International student                -0.321    0.474
Single                               -0.052    0.162
High grade point average             -0.947    0.170
  [[greater than or equal to] 3.0
  (out of 4.0)]
Sorority membership                  -0.222    0.281
Live on campus                       -0.117    0.176
Work (hours/week)                    -0.018    0.058
Perceived peer sexual activity        0.236    0.072
Alcohol use                          -0.010    0.084
Relationship abuse                   -0.100    0.117
Emotional health                      0.305    0.115
Pregnancy prevention: oral           -0.311    0.160
contraceptive use
Pregnancy prevention: condom use     -0.769    0.162
Emergency contraception pill          1.020    0.170

                                     Odds Ratio   95% Confidence

Year in school                       0.80 *         0.68-0.94
Age                                  1.18 *         1.02-1.34
Caucasian                            0.51 ***       0.38-0.67
International student                0.73            032-1.68
Single                               0.95           0.71-1.26
High grade point average             0.39 ***       0.29-0.52
  [[greater than or equal to] 3.0
(out of 4.0)]
Sorority membership                  0.80           0.48-1.31
Live on campus                       0.89           0.64-1.18
Work (hours/week)                    0.98           0.89-1.09
Perceived peer sexual activity       1.27 ***       1.12-1.44
Alcohol use                          0.99           0.86-1.16
Relationship abuse                   0.91           0.75-1.15
Emotional health                     1.36 **        1.06-1.60
Pregnancy prevention: oral           0.77           0.60-1.09
contraceptive use
Pregnancy prevention: condom use     0.46 ***       0.38-0.68
Emergency contraception pill         2.77 ***       2.02-3.71

* p < 0.05, ** p < 0.01, *** p [less than or equal to] 0.001
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