Emergency contraception (EC) Definition & Use An examination of emergency contraceptive use by Midwestern college students using the Integrated Behavioral Model Jennifer Wohlwend, Ph.D., MPH, CHES; Tavis Glassman, Ph.D., MCHES; Joseph Dake, Ph.D., MPH; Timothy Jordan, Ph.D.; Sadik Khuder, Ph.D.; and Sanford Kimmel, M.D. Introduction The American College Health Association (ACHA) reports that 1.8% (n=500) of 27,774 students experienced an unintentional pregnancy (either they or their partner got pregnant) in 2011. Approximately 50% of the unintended pregnancies in this age group end in abortion. Many of these pregnancies could have been avoided if emergency contraceptives had been utilized. Emergency contraception (EC) Definition & Use Secondary birth control used when the primary method failed or no birth control was used condom breaks diaphragm displacement pill not taken appropriately sexual assault impaired decision making i.e., substance use EC or Abortion Pill? Emergency contraception - Prevents pregnancy from occurring - NOT classified as or considered abortifacient - Ineffective once pregnancy has occurred Mifepristone (or RU-486) - The abortion pill - Terminates a pregnancy that already exists Objectives Purpose : Determine the factors that influence undergraduate college student use of EC. Research Questions: What do undergraduate college students know about EC? Which constructs within the Integrated Behavioral Model are most predictive of undergraduate college students’ intention to use EC? How much variance does the Integrated Behavioral Model explain in undergraduate college students’ intention to use EC? Methods Participants A convenience sample of undergraduate college students attending 1 of 11 Midwestern-most institutions of the Mid-American Conference schools and enrolled in a general education course. Sample size analysis: 770 across all schools – actual sample size 1,553. Procedures Integrated Behavioral Model, the research questions and information from focus group participants were instrumental in designing the survey instrument. Liaisons at each school were given instructions and surveys were mailed to them for disseminating to students. Measures were determined using the Integrated Behavioral Model constructs: Experiential attitude – dichotomous semantic scales: (bad/good…) Instrumental Attitude - dichotomous semantic scales (immoral/moral…); Injunctive Norm - 5-point Likert scale (disapprove, disapprove…) answering “When it comes to me (or my partner) using emergency contraception” and using various important persons in the participant’s life; Descriptive Norm - 5-point Likert scale (unlikely, unlikely…) based on how likely the person named had used emergency contraception; Perceived Control - 5-point Likert scale (under my control, not under my control…) to answer: “If you (or your partner) wanted to use emergency contraception, how much control would you have over each of the following?” such as buying the product on campus; Self-Efficacy - 5-point Likert scale (not confident, confident…). Results 18.1% of sexually active students reported using emergency contraception. The relationship between mean EC use was statistically significant with mean knowledge scores, t(332.14) = -8.71, p = 0.00. Students who have not used EC (x̅ = 5.66, s = 2.12) scored lower in level of knowledge of EC than students who have used EC (x̅ = 6.81, s = 1.70). Path analysis was used to assess intention to use EC . The determinant with the largest causal effect was instrumental attitude (0.31), followed by injunctive norm (0.20), descriptive norm (0.18), self-efficacy (0.14) and perceived control (0.07). Experiential attitude was not statistically significant in the model (0.02, p>0.05). Path analysis revealed 50% variance in intention to use emergency contraception (R2 = 0.495) using all six constructs. Path Analysis Model 0.20* 0.07* 0.14* Discussion Disseminating Information about EC on College Campuses Utilize first-year orientation classes to help students take responsibility for their sexual health; Make EC available on-campus, at the student health centers and subsidize the cost Conduct group discussions in residence halls Make sexual health classes a required part of the curriculum and increase time spent teaching about EC Use brochures and posters to address each construct of the IBM and place them in strategic places on campus where students spend their free time Limitations Self-reported data may include inaccuracies. The convenience sampling technique may not be representative of the overall undergraduate student population. 0.02 0.31* R 2 = 0.50 0.18* *p < 0.05 Note: percentages do not add to 100%; only most frequent responses included.