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Chlamydia, gonorrhea, and syphilis, also known as the big three, are on the rise in the state of Hawaii. According to the Centers for Disease Control and Prevention (CDC), individuals between 15-24 years of age account for nearly half of all new STD infections. This should be of great concern to the University at Hawaii of Hilo because these ages fall within the demographic age group of students who attend the university. The purpose of this paper; therefore, is first and foremost to bring awareness to the subject by describing the issue at hand, and why it is a problem for our university. Secondly, to bring more awareness to our campus. Third, to describe a detailed intervention that could be carried out at the University of Hawaii at Hilo, in social psychological terms, including detail on why my intervention would work, and lastly, a description of how I would evaluate the effectiveness of the intervention if it was carried out.
Giving justification to the task of promoting safer sex practices is necessary at UH Hilo. We live in a small community, and, therefore, we face the challenge of awareness. Many individuals are not aware of the dangers that they are exposing themselves to when they “jump into bed with someone” without using safe sex practices. To start, I have gathered information from numerous reliable resources to show what we are up against.
First, the CDC states that Hawaii is “ranked 14th among the 50 states in chlamydial infections (498.3 per 100,00 persons) and ranked 34th among the 50 states in gonorrheal infections (87.3 per 100,00 persons).” It is also said that “reported rates of chlamydia among women (672.9 cases per 100,00) were 2.1 times greater than those among men (327.5 cases per 100,00).” Having untreated STD’s can lead to a variety of health issues in both men and women, such as; pelvic inflammatory disease, infertility, chronic pelvic pain, increase spread of HIV, cancer, and exposing newborn babies who are vulnerable to such diseases.
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It is commonly known that many young people engage in risky sexual behaviors that put them in danger. Dr. Christina Wang, in an interview with Allyson Blair at Hawaii News Now, states that “one of the reasons that might be contributing is that we don’t have standardized health curriculum in the state”, and she also goes on to say that “it’s a challenge because our youth don’t actually know the risk that they are putting themselves in.” Another article by Alan R Katz, MD, MPH, titled Insights in
Public Health: The Hidden Epidemic: Sexually Transmitted Diseases in 2014 which was published by the Hawaii Journal of Medicine and Public Health states that “sexually transmitted infections (STIs) are among the most common infections in the United States (US) and pose a significant public health challenge for prevention and control.”
I feel that this is a necessary topic that requires attention to ensure the safety of students here at UH Hilo and around our state. The stigma of shame is also a big part of the problem when it comes to sexually transmitted diseases. It is my belief that the youth in our community are not being adequately educated on safe sex practices, and struggle with the stigma that comes as a result of discussing the topic of sex in general. Most adolescents struggle with the fear of condom negotiation, partner communication, partner communication frequency, parent-adolescent communication, self-efficacy, refusal self-efficacy, condom use efficacy, and STD knowledge.
As I read about and researched the topic of safer sex practices and the epidemic of sexually transmitted diseases, there is one thing that stayed consistent throughout every article: age 15-24. In the journal article ‘Age Differences in STDs, Sexual Behaviors, and Correlates of Risky Sex among Sexually Experienced Adolescent African-American Females’ a statement was made that really caught my attention; ‘at a time of life when adolescent females are just beginning their sexual decision-making, they
are at greatest risk for contracting sexually transmitted diseases’. I feel that this statement could be applied to male adolescence as well, because this is the time in any adolescence life where they get curious, especially with sexual behaviors.
An article that was published in the Malama Ola UH Hilo school newspaper brings some awareness about STDs with a question and answer interview featuring Heather Hirata, APRN Uh Hilo’s nurse practitioner. One specific question Interviewer Solomon Kauka Singer asked Hirata is “how many cases of STDs are in Hawaii each year?” Hirata’s answer was “in 2015, the state of Hawaii reported 7,074 cases of chlamydia, and 1,239 cases of gonorrhea.” This statement gave light to how many students are at risk.
UH, Hilo’s currently has an enrollment of 2,971 undergraduates and 568 graduate students. The demographic data provided by the University of Hawaii at Hilo admissions state that 62% of students who are in attendance consist of women with the average age of 25. With this demographic data, we must make STD awareness a key component to ensuring the safety and well-being of students who are attending.
Proposed Intervention
Sex is a highly debatable and touchy subject for most individuals. Many people are uncomfortable talking about sex because of the stigma that is placed upon it in our society, but it is of utmost importance that we do talk about it so that when sex is practiced, it is practiced in a safe way. The intervention that I propose would use multiple persuasion techniques.
The first step would be to get students aware of the problem that we face. To carry this out I would suggest having the university host a campaign on practicing safe sex called ‘SEX: 101’. I would suggest using the elaboration likelihood model because this model uses communication that involves two routes to attitude change: the central route, which is the way people are persuaded when they focus on the quality of the message, and the peripheral route, how people are persuaded when they focus on factors other than the quality of the arguments in the message, like the number of arguments.
Providing motivation and ability are key factors in getting students to participate in safe sex. An article published in National Center for Biotechnology Information (NCBI) called “safe sex advice is good-but so difficult to follow”. Views and experiences of the youth in a health center in Kampala written by Eva-Britta Rassjo and Elizabeth Darj finds that ‘most of the interviewed youth claimed that the advice is good and helpful but there are many obstacles. The results showed that information given in schools about condom use and safer sex behavior is not always adequate. However, despite a lack of clear health education messages, the risk of being HIV positive is a major concern to many youths.’ Although this research was done in Uganda, I believe that many adolescents in Hawaii could relate to these findings.
Method of Intervention
The goal of this intervention is to get students to change their attitude from a favorable evaluation not to use safe sex because it can be inconvenient at times, to having students’ attitudes change to seeing unsafe sex as unfavorable. First, to get students to the campaign I would use operant conditioning, a method of learning that occurs through rewards and punishments for behavior. By using operant conditioning students could make an association between practicing safe sex and participating in risky sexual behaviors. For this to be carried out I would suggest sending out an email invitation along with paper invitations to all registered students by using both technology and mail, making it more likely that it all students would receive the invite.
The advertisement on the email and invitation would consist of the name of the campaign “SEX:101” to draw attention toward the subject. On the invite there will be two pictures, the first picture of a girl and a boy curled up lost in their own thoughts facing their backs to one another with cloud headings containing statements such as: “I wish I used a condom”, “I’m so ashamed”, “I feel terrible about myself”, “I’m not good enough”. The other photo would be on the opposite side, having again a boy and girl standing up using thought clouds with statements such as: “I feel so good about myself”, “I’m so proud that I use condoms”, “Thankfully we talked about how to be safe when having sex”. The heading of the invite would be “Do YOU struggle with making the decision to be safe when you SEX” if so this really is perfect for you!
At the bottom of the invitation, I would create a scarcity tactic by using the statement ‘Sign up now, space is limited’. Another perk that could be added is free food, along with other surprise grab bags full of fun. This would encourage people to attend the campaign by not wanting to miss their chance to learn about SEX. Lastly added would be “JUDGMENT FREE ZONE”; this would help students feel more eager to attend, knowing that there would be zero tolerance on any judgment. A week prior to the event, I would have a follow-up email go out to remind students of the upcoming event and give students a “Last chance opportunity to sign up”.
On the day of the campaign, I would have the décor set up in a manner that makes students comfortable. Having a comfortable atmosphere would aid in students being more open to receiving information and lessen the fear of being judged. As students enter the event, they would be greeted with a beverage of choices such as coffee, tea, juice, soda, or water (of course non-alcoholic due to it being a school function), along with a lei to have a feeling of being welcomed and congratulated for showing up.
Each student who enters would be asked to take a pledge of “No judgment” during the rally so that everyone in attendance is aware that there is zero tolerance for judgment. Food would be served, and mingling would be encouraged to create a positive environment for person-situation interaction. Each student would be directly asked to write a question relating to sex on a blank note card which would remain anonymous and be dropped in a locked box so that the expert speaking on the topic of safe sex could do a question and answer segment. This would help with student compliance during the rally because of the direct request when they entered.
As students get settled into their seats up-to-date and upbeat music would be playing to help students get excited to be in attendance. This should create a fun, and welcoming environment for all students of every gender, and sexual preference. On stage would be a ‘Hypeman/women’ getting the crowd pumped for what they are about to learn.
To kick off the event expert power would be used introducing a known Dr. in the subject of sex. By using expert power students would be influenced by his or her presumed wisdom and knowledge. This expert would conduct a speech based on statistical research findings that show how unsafe sex can be detrimental to a student’s overall quality of life. I would recommend giving examples on studies that were conducted to bring the subject to life, for example, research conducted by Enna Kore, explained in the article ‘The Impact of Sexually Transmitted Diseases on Quality of Life: Application of Three Validated Measures’.
This research states that ‘the attitude and practice toward patients with sexually transmitted diseases (STDs) are of ongoing interest, particularly since these infections have had an increasing worldwide distribution over the years’. A Pearson’s correlation was used in evaluating statistical evaluation and the results were quite fascinating: ‘data suggested that experiences of shame and self-esteem were negatively and significantly associated.
Length of pathology was found to be the most relevant factor interfering with the quality of life (QoL). It weakens the personality and reduces the capability to face daily problems. In addition, the fear of serious complications can create a psychological state of depression. Subsequently, regarding its possible consequences (e.g., carcinoma), HPV potentially has a higher impact on patients psychological wellness in comparison with TV and CT).’ By providing this data it will show students the effects that STDs can have not only to your physical health but also your mental health.
I would then recommend having another expert such as a social psychologist speak on what STDs can do to relationships, and how it creates negative person-situation interactions, relationship difficulties, and so forth. A third speaker could be more relatable by using a student that would speak to the crowd and create an environment of relatability, creating a social influence. This student could talk about self-efficacy, which is an individual’s belief in his or her innate ability to achieve goals, and what they can to uphold their values and beliefs. Social validation would also be addressed; one or more passive individuals following or conforming to the actions of others within a group. Having the students in attendance understand that they are the individuals that will set the standard on using safe sex, would be one of the main goals.
Then all three speakers on stage would conduct the question and answer part of the rally. This would help to give students the opportunity to have their questions answered by multiple perspectives. At the end of the rally, booths could be set up where students are able to learn about different ways to protect themselves, how to have the conversation with their partner about using protection by doing role play and fun goodie bags that they can use to protect themselves.
At the end of the speech, instead, of doing a balloon drop over everyone, you could do a balloon drop but also have condoms drop as well–showering students and participants with protection. To ensure that the subject stays relevant I would suggest also having flyers in the men and women’s restrooms, similar to the ‘stall talk’ at UH Hilo. This would be a great place to remind students of the dangers that unprotected sex can lead to, because sex is a greatly personal subject and so is using the restroom, creating a correlation with one another.
Method of Measurement
The method of measurement that I would use to test if this intervention was effective would be a survey that could be sent out to students prior to attendance, as well as another survey post-rally. Both surveys would consist of the same questions. The survey would ask questions such as
- How sexually active are you?
- Did you partake in any sex education program?
- How likely are you to talk about safe sex with a sexual partner?,
- How likely are you to use protection during sexual intercourse?
- Are you familiar with the STD rates here in Hawaii?, and
- Do you feel that it is your responsibility to use protection during intercourse?
After students have taken the pre-rally and post-rally surveys, I would use a T-test to compare answers. I would hypothesize that after students attended the rally their answers should lean toward wanting to use safer sex practices and be more aware of partners that they sleep with.
Another way that we could measure the reliability of the rally would be to have the group of students participate in a safe sex quiz which tests the students’ knowledge that was gathered after the rally, and then compare that to the survey answers of students that did not attend the rally to see if the rally aided in student’s knowledge of using safer sex. The questions should be related to safe sex along with the statistical danger that they are in if they participate in risky sexual behaviors. The questions should not be too hard or too easy so that the knowledge accumulated from the rally can be measured accurately. It is in great hopes, a positive correlation will be found between attending the campaign rally and having knowledge of safe sex practices.
Overall, I believe that it is everyone’s responsibility to be aware of the dangers that STDs can cause and to be mindful of the ways they are putting themselves at risk when they do not have protected sex. We live in a very small community here in Hilo, where every person should be taking responsibility for their actions. So many individuals are not aware of the dangers that are being faced when they “jump into bed with someone” without using safe sex practices.
To revisit the statistics, CDC states that Hawaii is “ranked 14th among the 50 states in chlamydial infections (498.3 per 100,00 persons) and ranked 34th among the 50 states in gonorrheal infections 87.3 per 100,00 persons).” It is also said that “reported rates of chlamydia among women (672.9 cases per 100,00) that were 2.1 times greater than those among men (327.5 cases per 100,00).” Having untreated STD’s can lead to a variety of health issues in both men and women. Such as, pelvic inflammatory disease, infertility, chronic pelvic pain, increase the spread of HIV, cancer, and exposing newborn babies who are vulnerable to such diseases. The spread of syphilis in its primary and secondary forms are a huge health concern here in Hawaii as well. I feel that if more students are aware of the danger, they put themselves in when not using safe sex, the more they will reconsider using safer sex practices.
