Running head: SEXUAL HEALTH EDUCATION FOR COLLEGE FRESHMAN 1

Sexual Health Education for College Freshman

Kayla A. McKean

James Madison University

June 2019
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Abstract

According to the Center for Disease Control (CDC, 2017) youth between the ages of 15 and 24

make up half of all new sexually transmitted infection cases, and youth 18 to 19 have the highest

rates of unplanned pregnancies. The researcher seeks to study the effect Vision of You (a self-

paced online sexual health program developed at James Madison University) could have on

college freshmen’s attitude and intended use of safer sex practices as well as perceived

usefulness of online learning. The proposed research uses the Theory of Reasoned Action to

develop appropriate methodology for determining participants’ attitudes and intended behaviors

in regards to their sexual health. The researcher proposes using a mixed method approach to

gauge participant attitude and perception with an expected sample size of around 200

participants.

Keywords: sexual health education, college freshman, online learning, intended behavior
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Introduction

There is a need to evaluate the effectiveness of the Vison of You program with college

freshman who remain at a high risk of STI contraction as well as unplanned pregnancy. Research

has not been previously conducted on Vison of You with college freshman participants. This

new research would provide the team with a broader understanding of the program’s

effectiveness across the stage of adolescence. The researcher currently works as a data specialist

on the Personal Responsibility Education Innovative Strategies (PREIS) grant funded through

the Family and Youth Services Bureau, Adolescent Pregnancy Prevention Division. The PREIS

grant was awarded to the Teen Pregnancy Prevention (TPP) program housed at the Institute in

Innovation in Health and Human Services (IIHHS) at James Madison University (JMU) in 2015.

TPP focuses on sexual health education in the city of Harrisonburg, Rockingham and Page

Counties, but was awarded the PREIS grant to work with participants across the state of

Virginia. The researcher, as part of the PREIS team, has several years of experience teaching

sexuality education courses in middle school and high school before their transition into data

collection and evaluation. Through a randomized control trial design the PREIS team is

researching the effectiveness of the online sexuality education program, Vision of You. Study

participants include students in alternative education programs, juvenile detention centers, and

students referred to community services boards. These populations were chosen due to the lack

of sexuality education received in non-traditional school settings.

According to the Center for Disease Control (CDC, 2017) people between the age of 15

and 24 make up half of all new sexually transmitted infection (STI) cases in the United States

each year. This could be due to a lack of education around using protection (like condoms), how

STIs are contracted, and how often or where to go to get tested. The state of Virginia currently
SEXUAL EDUCATION FOR COLLEGE FRESHMAN 4

only funds abstinence only education with which the main focus is to stress not engaging in any

type of sex including oral, anal, or vaginal sex. In abstinence only education if methods of

protection like condoms or birth control are incorporated into the curriculum – it is often only to

stress their failure rates. Upcoming college freshman may not have had exposure to sexual health

education in their high schools. This is especially concerning considering the risk of contracting

an STI for young people. The average age for an unplanned pregnancy to occur is also between

the age of 18 and 19 (CDC, 2017) making this post high school age group especially vulnerable.

The online sexual health program, Vision of You, was designed at James Madison

University for high school aged youth with the goals of reducing the frequency of sexual activity,

reducing the number of sexual partners, and increasing contraceptive use among participants. As

upcoming freshman are similar in age and experiencing similar risk factors to high school

students, the researcher proposes studying 1) if the Vision of You program could be effective in

increasing intended safer sex practices among college students as well as 2) understand college

students’ perception of usefulness of the online program compared to sexual health education

they received before arriving to college. This focus was defined not only by examining the risk

of the age group, but also considering what sexual health resources look like for college students.

According to Kim Hartzler-Weakley (personal communication, May 23rd, 2019) students

entering college are often required to complete trainings or modules on substance abuse

awareness, but are not required to take sexual health education courses. Those courses may be

offered to students as electives, but they are not a requirement. According to research done by

Lechner, Garcia, Frerich, Lust, and Eisenberg (2013) when asked about who’s responsibility it

was to ensure access to sexual health resources college students believed that their school had the

responsibility to provide sexual health education resources, but it should be up to students

SEXUAL EDUCATION FOR COLLEGE FRESHMAN 5

whether or not they used the resources. Providing sexual health as an elective may not be

accessible for students who have a rigid course structure or who need to choose electives more

closely related to their major. Another study by Franklin and Dotger (2011) found that college

seniors tested significantly higher than college freshman on birth control, sexual relations, and

reproduction knowledge even though there was no specific effort to educate students in these

areas over their four years. If more research existed about what students already know about

sexual health as they enter as freshman, it may help guide colleges on what education should be

provided by the college and also how it should be delivered to the students.

Literature Review and Theoretical/Conceptual Framework

Intervention

The Vision of You program includes gamified learning elements like avatars, a point

system, goals, and trophies. It also utilizes videos, games, and interactive activities for learning.

Vision of You consists of nine online modules that students can complete at their own pace.

While its effectiveness is still being tested, other similar intervention strategies have shown

positive outcomes for youth. Through a scope review of digital intervention (defined as programs

that provide sexual health information) for sexual health Mann and Bailey (2015) found that

online programs not only reached people who were less likely to engage with mainstream

services, but they allowed participants to access information when it was convenient to them.

Getting access to sexual health resources can be difficult for students who are in classes during

regular clinic hours. Many college freshman rely on public transportation which may or may not

get them to or from a clinic and their classes on time. If they have chosen to take an elective on

sexual health, they will likely have a better knowledge than their peers who are not in the
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elective, but may still lack a space or opportunity to ask more personalized questions about their

own health.

Another study by Jackson, Ingram, Boyer, Robillard, and Hunhs (2016) developed an

online app to decrease sexual risk behaviors among young college students. While they did not

find a significant change in student’s intention to reduce sexual risk behaviors, students did have

a significant increase in knowledge about condoms, contraceptives, and partner communication.

Scull, Malik, Kupersmidt & Keefe (2018) evaluated “Media Aware” a self-paced, on demand,

multimedia, web based curriculum for 18 and 19 year olds. As compared to the control group,

the intervention group in this study reported higher levels of using dental dams and

communicating about sex as well as higher levels of using protection for oral sex. Participants in

the intervention group developed skills for deconstructing media by exploring gender

stereotypes, comparing the media norm to the social norm, searching for the missing messages in

media, and comparing the effectiveness of birth control and condoms that is reported in media

versus what is medically accurate. Results showed that instances of oral, vaginal, and anal sex

were fewer in intervention participants as well as instances of sex under the influence of drugs or

alcohol. Acceptance of rape and rape myths was also lower for students in the intervention group

as compared to those in the control group (Scull et al., 2018).

In a study done by McGinn and Arnedillo- Sánchez (2015) a virtual learning environment

was used to support communication between teachers and students. A four week study included

3 teachers and 28 students in a curriculum covering friendship qualities, self-esteem, and sexual

behavior. Activities were designed to prompt discussions and included quizzes, videos, podcasts

and fact sheets. Students could engage with peers and their teacher anonymously, or not, through

email, chat, or discussion boards. The majority of the students stated that they felt less
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embarrassed to ask questions and engage with the material in the class. McGinn and Arnedillo-

Sánchez (2015) noted increased attention that they attributed to the novelty of an online course

for students or just the familiarity of using applications similar to those that students already

used. Again, the anonymity of the application put the user more at ease which made them feel

more comfortable to engage with the sensitive subject matter. An evaluation of the HEART

(Health Education and Relationship Training) curriculum with 10th grade females showed that

after engaging with 5 modules on safer sex motivation, HIV and other STIs, sexual norms and

attitudes, safer sex self-efficacy, and sexual communication skills participants in the intervention

group showed better assertiveness skills and knowledge of HIV/STIs than that of their peers in

the control group. The online program ensured that each student was receiving the same

information and they each had the opportunity to practice communication skills. Through the

online program students who may have felt too shy or embarrassed to practice communication

with a partner were given the opportunity to practice without the pressure of a watching

audience.

A systematic literature review of gamified learning in higher education found

improvements in “student engagement, motivation, confidence, attitude, perceived learning, and

performance,” (Subhash & Cudney, 2018, p. 205). Promoting competition and fun through

games encouraged students to continue learning more material and moving forward.

Furthermore, online sexual health curriculums ensure fidelity of the content delivered to

students, they are easier to update with current medical findings, and they offer more

opportunities for user interactivity (Widman, Golin, Kamke, Burnette, Prinstein, 2018).

Methods and Analysis

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According to a special report by Lieberman (2018) it is difficult for the field of sexual

health education to randomly assign or conduct research of one program against another, but

rather programs are typically evaluated against a nonintervention group. A study that did manage

to conduct a randomized control trial of a game-based learning and gamification curriculums on

sexual health used a mixed method research approach by pre-testing and post-testing students’

knowledge using the Adolescent Sexual Health Literacy Test (ASHLT), following up with

MAKE (Motivation, Attitude, Knowledge, Engagement) framework questionnaire, and finally an

focus group (Haruna, Hu, Chu, Mellecker, Gabriel, Ndekao, 2018). Participants were selected

from a secondary school in Tanzania and divided into groups of 40. The researchers used IBM

SPSS Statistics to analyze quantitative data from the MAKE and ASHLT tests. More than one

study around sexual health used anonymous online surveys to gather data about participants’

sexual behaviors (Yadlosky, Aubin, Mosack, & Devine, 2017; Wyatt & Oswalt, 2014).

Researchers in both studies recruited students through university email and used online surveys

that asked students to identify demographics and listed specific sexual behaviors for students to

indicate if they had engaged in or not. Tingey, et al (2015) developed a questionnaire that asked

participants to identify what behaviors they had engaged in or planned to engage in in the future.

This tool aligns well with the Theory of Reasoned Action (or Planned Behavior) that is referred

to often in sexual health education design and research. One study that focused more closely on

the effective use of e-learning for university students, rather than just sexual behavior, used a

mix of items from scales developed by Martin and Kellermann (2004) and Saade and Bahli

(2005) to craft a scale that would gauge perception. Due to a small sample size the researchers

used structural equation modeling to analyze their data (Moreno, Cavazotte & Alves, 2017).

Theoretical Contributions
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Activity Theory was used by the researchers Haruna et al. (2018) as a framework to

develop the instruments (gamification), objects (acquiring knowledge), community

(stakeholders), division of labor (roles of stakeholders), rules (norms and guidelines), outcomes

(change in sexual behavior), and subjects (school students). They used Activity Theory to engage

their community in their research and to inform their future practice. Researchers Jackson et al.

(2016) used constructs and concepts from the Theory of Reasoned Action as well as the Trans-

Theoretical Model of Behavior Change in the creation of their app. They included things like

comparison statistics on peer norms and attitudes, subjective norms for condom and

contraceptive use, and skill building exercises as part of their intervention to align with their

theoretical framework. The Theory of Reasoned Action is popular in the field of sexual health. It

suggests that “an individual’s intention to perform a specific behavior is a linear function of his

or her affective response to performing the behavior (attitudes) and perceived social norms about

the behavior,” (Baker, Morrison, Carter, & Verdon, 1996, 529). This can be a helpful model in

assessing whether or not youth will be more or less likely to engage in risky sexual behavior

based on their reported attitudes toward that behavior.

Using the Theory of Reasoned Action, Wulfert and Wan (1995) asked research

participants to indicate how they felt using a condom every time they engaged in sex from

extremely favorable to extremely unfavorable on a seven point Likert scale. They also asked

participants to answer the same question, but from a social norms perspective. They found that

condom use attitude was closely linked intention to use condoms. Muñoz-Silva, Sánchez-García,

Nunes, & Martins (2007) studied condom use prediction differences in gender using the Theory

of Reasoned Action and Planned Behaviour theory. Similarly, to Wulfert and Wan, they asked

participants to indicate their attitude toward condom use as well as perceived social norms of
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condom use using a Likert scale. They found that male participants intended use of condoms was

aligned with their attitude toward perceived social norms, while females showed a closer relation

to intended behavior based on their own attitudes toward condom use (Muñoz-Silva, Sánchez-

García, Nunes, & Martins, 2007).

Proposed Research Design and Methods

The researcher proposes conducting research with college freshman in the Harrisonburg,

VA area. The researcher is an employee of James Madison University with strong relationships

to faculty, staff, and students that will assist in facilitating the study. They propose forming

partnerships with local colleges and universities in the area as well to increase sample size. The

area surrounding James Madison University is also home to Eastern Mennonite University,

Bridgewater College, and Blue Ridge Community College where the desired age group of study

participants are enrolled. In 2019, JMU received 24,449 applications for undergraduate freshman

and accepted 73% of those (James Madison University, 2019). The researcher would not have

the capacity to attempt to recruit all incoming freshman, but a large freshman class provides an

opportunity to reach an appropriate sample size for this research. More research will need to be

done to determine the size of incoming freshman classes at the colleges surrounding JMU.

Participants will be recruited based on their age and year in higher education. Freshman

students are early in their academic career and should be less impacted by sexual health

information they may obtain through their college courses. This will give the researcher a better

idea of participants’ base knowledge coming from high school. Participants will need to be

between the age of 18 and 19, so that they can consent for themselves without reaching out to a
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parent or guardian to obtain consent. Approval will be sought for recruiting students via email

invitations to their university email address.

A mixed method approach will be used in this research study to gather data from

participants about their attitude toward safer sex practices and well as their perceived usefulness

of the online sexual health program, Vision of You, compared to what they received in high

school. Pre and post questionnaires will be used to determine participants intended behavior and

attitude toward safer sex practices as well as their perceived usefulness of online learning before

the intervention and after. Questionnaires will be created in Qualtrics, an online survey

management company, which is available to JMU faculty and students. The researcher will be

able to send questionnaire links to participants via email. Qualtrics also provides tools for

analyzing survey data which can be used by the researcher after data collection is complete.

As noted in the literature review findings, the Theory of Reasoned Action is commonly

used in sexual health education and indicates that intended behavior is associated with attitudes

toward that behavior. Figure 1 shows an example of questionnaire items using the Theory of

Planned Behavior to assess college students’ intentions to stay in their courses (Deberry &

Jackson, 2018). While these exact items will not be used, their grouping of items which includes

attitudes, self-efficacy, norms, and intention will be used to create appropriate items for

answering the research questions.

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Figure 1. Theory of Planned Behavior Questionnaire items and categories. This example

will be used to shape questionnaire items. (Dewberry & Jackson, 2018)

The researcher will use Likert Scale questions to assess the attitude the participant has

toward safer sex practices like abstaining from sex, using a condom, getting tested for STIs,

using hormonal birth control, and limiting their number of sexual partners. Participants will then

be asked about which of the safer sex behaviors they intend to practice if the opportunity to

engage in sexual activity arises. These questionnaires will be confidential and matched through

personal identification numbers to reduce false responses if participants feel embarrassed to

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share their sexual behaviors or obligated to say they will adhere to social norms. Participants will

be given similar questions in style to gauge their perceived usefulness of taking the online sexual

health education course. These questions will provide quantitative data for the researcher. Open

ended responses will allow participants to indicate what they felt was most helpful to their

decision making in sexual health as well as what was most and least relevant to them in the

online program. This will provide qualitative data for the researcher that should give a clearer

perspective of the participants’ experience and capture any missing information not obtained

through the quantitative questions.

This research will comply with James Madison University’s IRB protocol. Consent will

be collected from study participants before any data is collected. Only the most necessary

participant identifying information will be collected and used by the researcher. Information will

be used to contact the study participants about their completion of the intervention and

questionnaires. Identifying information will not be stored along with questionnaire responses. All

needed participant info will be kept protected on a JMU owned and encrypted computer.

Participant information and consent will only be kept on file by the researcher for as long as IRB

protocol requires at which point it will then be destroyed.

Findings, Relevance, and Significance

This research will be important to the Teen Pregnancy Prevention program at IIHHS at

JMU. Teen pregnancy rates are highest among youth between the age of 18 and 19 (CDC, 2017).

For this reason, it is important that sexual health education be implemented with youth not only

at the age of puberty, but throughout their adolescence which extends into their college years.

Despite the name, TPP is concerned with all aspects of sexual health education including STIs,
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sexual orientation, and healthy relationships as they all contribute to an individual’s overall

health. Vision of You covers all of these topics. TPP will be interested in data from this research

as it will highlight the need for further sexual health education for youth.

James Madison University may be interested in this data to further their understanding of

the health care needs and educational needs of incoming freshman. This data could help plan for

prevention services that would lower sexually transmitted infection rates as well as provide

resources to students about the range of other topics covered in Vision of You.

While this research will help to meet a program requirement of the Masters in Education

Technology at JMU for the researcher, it will also contribute to the understanding of online

learning for college students. The Vison of You curriculum incorporates gamification through

the use of avatars, a point system, and trophies. It also includes videos, games, and interactive

activities to engage learners. These elements are of interest to Ed Tech professionals as they

study and design curriculum to engage learners through effective and meaningful technologies.

Technology should not be incorporated into learning just for the sake of having it, but rather

because it has shown to increase student understanding or engagement. An outcome of this

applied research will be data on student perceptions of effectiveness of the online learning

platform that includes learning technologies.

Finally, this research will contribute to the professional development as well as the

graduate level learning for the researcher. This research experience will lay the groundwork for

developing further research initiatives in their professional setting. The ability to conduct

research can lead to more grant funding opportunities that will allow staff to increase their

community engagement as well as increase internship experiences for undergraduate and

graduate university students.

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Limitations

A limitation of the research conducted so far in this proposal is that there is not much

research about sexual health curriculums that look like Vision of You. Though the program may

not look the same as other available and tested programs, the material is the same and uses

elements of similar theories like the Theory of Reasoned Action. Another limitation of this paper

is that it does not provide an overview of what sexual health resources are required and available

to students in college in the state of Virginia currently. This could provide a greater

understanding of the need for education. Overall, research conducted so far will help inform

professionals about the need for research in sexual health education for young college students. It

will help to inform future research on the effectiveness of the sexual health program, Vision of

You.

Envisioned limitations of this study include a small sample size as well as the likelihood

that the sample will be homogenous. University campuses tend to be predominantly white and

female which is not presentative of all college freshman. Another limitation is the scope of this

study will not allow for longitudinal data to be collected. That data would allow the researcher to

understand the impact of receiving sexual health education on a person’s behavior over a longer

period of time, rather than immediately after the intervention.

Planned dissemination

As previously mentioned, the Teen Pregnancy Prevention program at IIHHS received a

federal grant in 2015 called the Personal Responsibility in Education Innovative Strategies

(PREIS) to further develop and study the effectiveness of the existing Vision of You curriculum.
SEXUAL EDUCATION FOR COLLEGE FRESHMAN 16

Programs that receive state and federal funding for sexual health education are required to

choose from a list of evidenced based curriculums to then implement with their youth. Programs

that receive this funding cannot chose to implement a sexual health curriculum that is not

evidenced based and still receive their funding. The overall goal of this project from the

perspective of TPP is to study the effectiveness of Vision of You and then be able to offer the

program as an evidenced based curriculum. In addition to the data being collected by the TPP

team, the researcher hopes to provide data from a new demographic of youth completing the

Vision of You curriculum. The researcher will offer findings from this study to accompany

findings gathered from the TPP team as it will provide a broad view of the Vision of You

curriculum and its impact on youth in Virginia. Study findings and methods may be presented by

the researcher alongside the TPP data to the Family and Youth Services Bureau.

The researcher will also present findings at the Youth Tech Health conference held

annually in San Francisco, CA that focuses on technologies used to teach sexuality and mental

health practices to young people. The researcher will present at the annual National Sex Ed

Conference held annually in New Jersey that focuses on sex education for all ages and

demographics. The researcher has presented at both of these conferences in previous years and

will have the opportunity to update a captive audience about the findings related to the Vision of

You curriculum. This research may also be presented at higher education conferences as it could

provide insight into the need for sexual health education for college students.

Work plan

If approval is given by the Education Technology Master’s Program committee following

comp reviews this research project will take place over the course of the spring 2020 semester.
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The Collaborative Institutional Training Initiative (CITI) training for human subject research has

already been completed by the researcher and will not expire until February of 2021. The

researcher will allow a month of time to complete and submit the research protocol application to

the James Madison University Institutional Review Board (IRB) and an additional two weeks for

needed changes requested by the IRB. Once approved by the IRB, study participants will be

recruited within the first four weeks of the spring 2020 semester. During this time they will be

asked to consent to the study and take the baseline questionnaire. Participants will then be given

four weeks to engage with the intervention. Survey data will be collected for two weeks after the

intervention time has ended. Data analysis will occur within the remaining four weeks of the

spring semester.

The researcher will use a James Madison University owned computer with an encrypted hard

drive. The Vision of You program is owned and managed by James Madison University and the

TPP faculty. Data will be tracked and analyzed using resources available to JMU students and

faculty.

Acknowledgement

While this project will not receive explicit funding, it does have administrative support

from the Teen Pregnancy Prevention program at the Institute in Innovation in Health and Human

Services at JMU.
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References

Baker, S.A., Morrison, D.M., Carter, W.B., & Verdon, M.S. (1996). Using the theory of

reasoned action (TRA) to understand the decision to use condoms in an STD clinic

population. Health Education Quarterly, 23(4), 528–542.

CDC, (2017, December 7). Adolescents and young adults, prevention, stds. Retrieved June 1,

2019, from https://www.cdc.gov/std/life-stages-populations/adolescents-youngadults.htm

Dewberry, C., & Jackson, D. J. R. (2018). Theory of planned behavior on student retention in

college scale [Database record]. Retrieved from PsycTESTS. doi:

https://dx.doi.org/10.1037/t68288-000

Franklin, R. M., & Dotger, S. (2011). Sex education knowledge differences between freshmen

and senior college undergraduates. College Student Journal, 45(1), 199–213.

Haruna, H., Hu, X., Chu, S.K.W., Mellecker, R.R., Gabriel, G., & Ndekao, P.S. (2018).

Improving sexual health education programs for adolescent students through game-based

learning and gamification. International Journal of Environmental Research and Public

Health, (9), 2027-2053. https://doi.org/10.3390/ijerph15092027

Jackson, D. D., Ingram, L. A., Boyer, C. B., Robillard, A., & Huhns, M. N. (2016). Can

technology decrease sexual risk behaviors among young people? Results of a pilot study

examining the effectiveness of a mobile application intervention. American Journal of

Sexuality Education, 11(1), 41–60.

James Madison University (2019). Facts & figures. Retrieved May 14, 2019 from

https://www.jmu.edu/about/fact-and-figures.shtml
SEXUAL EDUCATION FOR COLLEGE FRESHMAN 19

Lechner, K. E., Garcia, C. M., Frerich, E. A., Lust, K., & Eisenberg, M. E. (2013). College

students’ sexual health: Personal responsibility or the responsibility of the

college? Journal of American College Health, (1), 28-35.

Lieberman, L. (2018). Sex ed in the u.s.—a look back (and ahead). (2018). Perspectives on

Sexual & Reproductive Health, 50(4), 199–200. https://doi.org/10.1363/psrh.12080

Mann, S., & Bailey, J.V. (2015). Implementation of digital interventions for sexual health for

young people. In 2nd Behaviour Change Conference: Digital Health and Wellbeing,

London, United Kingdom. doi: 10.3389/conf.FPUBH.2016.01.00008

Martins, L. L., & Kellermanns, F. W. (2004). A model of business school students’ acceptance

of a webbased course management system. Academy of Management Learning &

Education, 3, 7–26.

McGinn, M., & Arnedillo-Sánchez, I. (2015). Towards supporting communication in relationship

and sexuality education through a VLE. International Association for Development of the

Information Society, 12, 253-256.

Moreno, V., Cavazotte, F., & Alves, I. (2017). Explaining university students- effective use of e-

learning platforms. British Journal of Educational Technology, (4), 995-1009.

http://dx.doi.org/10.1111/bjet.12469

Saade, R., & Bahli, B. (2005). The impact of cognitive absorption on perceived usefulness and

perceived ease of use in on-line learning: An extension of the technology acceptance

model. Information & Management, 42, 317–327

Scull, T. M., Kupersmidt, J. B., Malik, C. V., & Keefe, E. M. (2018). Examining the efficacy of

an mHealth media literacy education program for sexual health promotion in older
SEXUAL EDUCATION FOR COLLEGE FRESHMAN 20

adolescents attending community college. Journal of American College Health, 66(3),

165–177.

Tingey, L., Mullany, B., Chambers, R., Hastings, R., Lee, A., Parker, A., Barlow, A., &

Rompalo, A. (2015). Youth health risk behavior inventory--modified [Database record].

Retrieved from PsycTESTS. doi: http://dx.doi.org/10.1037/t45528-000

Widman, L., Golin, C. E., Kamke, K., Burnette, J. L., & Prinstein, M. J. (2018). Sexual

assertiveness skills and sexual decision-making in adolescent girls: Randomized

controlled trial of an online program. American Journal of Public Health, 108(1), 96–

102. https://doi.org/10.2105/AJPH.2017.304106

Wulfert, E. & Wan, C.K., (1995). Safer Sex Intentions and Condom Use Viewed from a Health

Belief, Reasoned Action, and Social Cognitive Perspective. The Journal of Sex Research,

32(4), 299-311.

Wyatt, T., & Oswalt, S. (2014). Sexual behaviors of college freshmen and the need for

university-based education. College Student Journal, (4), 603-612.

Yadlosky, L.B., Aubin, E.S., Mosack, K.E., & Devine, J.B. (2017). Sexual perceptions versus

reality in undergraduates: Data-driven praxis for sex-related campus programming.

Journal of College Student Development (5), 704 -718.

https://doi.org/10.1353/csd.2017.0055