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EVALUATION of an INNOVATIVE CONDOM DISTRIBUTION PROGRAM and POINT- OF-ACCESS MESSAGING TARGETING BLACK COLLEGE WOMEN Diane B. Fr

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EVALUATION of an INNOVATIVE CONDOM DISTRIBUTION PROGRAM and POINT- OF-ACCESS MESSAGING TARGETING BLACK COLLEGE WOMEN Diane B. Fr EVALUATION OF AN INNOVATIVE CONDOM DISTRIBUTION PROGRAM AND POINT- OF-ACCESS MESSAGING TARGETING BLACK COLLEGE WOMEN Diane B. Francis A dissertation submitted to the Faculty of the University of North Carolina Chapel Hill in partial FulFillment of the requirements for the degree of Doctor of Philosophy in the School of Media and Journalism. Chapel Hill 2016 Approved by: Seth M. Noar Adaora A. Adimora Joan R. Cates Deborah A. Fortune Brian G. Southwell © 2016 Diane B. Francis ALL RIGHTS RESERVED ii ABSTRACT DIANE B. FRANCIS: Evaluation of an innovative condom distribution program and point-of- access messaging targeting Black college women (Under the direction of Seth M. Noar) Condom access is a major issue on some college campuses in the United States, including Historically Black Colleges and Universities (HBCUs). Lack of access increases risk oF adverse sexual health outcomes, especially For young Black women. This project evaluated a structural intervention—a condom distribution program (via dispensers with Free condoms) and point-of-access messaging (via posters on the dispensers)—on an all-female HBCU campus in North Carolina. The three-month intervention occurred between November 2015 and January 2016. We used a pre-post intervention only longitudinal panel design. We recruited N = 195 sexually active students to complete a baseline survey and N = 118 students completed the follow-up survey. The retention rate was 61%. The majority oF students (89%) were aware oF the dispensers. Slightly less than half (44%) used the dispensers, and 22% had those condoms with them at Follow-up. Students mainly used dispensers to access condoms in the dorm bathrooms (81%, n = 42). They felt extremely comFortable using the dispensers, especially when alone. More than 70% (n = 38) who took condoms used them for sexual intercourse. Most students (77%) recognized at least one oF the messages that had been posted on the dispensers. They reported that the messages made them feel confident and proud to be taking condoms, and motivated them to take a condom. More than a third oF students (38%) talked about the dispensers or messages. Students were most likely to talk to their friends or sexual partners. iii Condom acquisition and carrying increased signiFicantly (p <. 05) after the intervention. Perceptions oF condom availability and accessibility also increased significantly (p <. 05). Perceptions oF condom acceptability and norms did not change. Condom intentions and use decreased significantly among the sample as a whole. In multivariate analyses, dispenser use was associated with greater condom use. This study provides empirical evidence that condom distribution and safer sex messaging can improve perceptions of condom access (particularly availability and accessibility) and impact condom preparatory behaviors (acquisition and carrying). The findings add to our understanding of HIV/STI prevention interventions targeted at young Black women on an HBCU campus. iv ACKNOWLEDGMENTS A West African proverb says, “It takes a village to raise a child.” I believe it takes a village to get an individual through graduate school. Few words can truly express how grateFul I am to my village—people who supported, encouraged, and inspired me throughout this doctoral degree and beyond. To my late grandma Mary, although you did not live to see one oF your babies get this degree, you did so much of this walk with me. I thank you for raising me to be the person I am today. You will always be one of my Saints. To my grandpa Oscar, thank you For being the strong, invisible hand guiding me through every stage of my life. Without you, I would not have been here today. You have been one of my biggest supporters all along and always believed in me even when I didn’t believe in myselF. Words cannot express the gratitude I have For my parents, siblings, grandmothers, sister-in-law and extended Family. Thank you For your patience, encouragement, and unconditional love during not only the last Four years but always. Gerard, thank you For always providing an ear when needed. I have made a habit of making life-long Friends at the start oF new beginnings. Mikyla, I owe my life to you. I am glad I met you on the first day of undergrad orientation. You have been my best Friend, champion, and confidant. Thank you For your unwavering Friendship and continued support. To Nidhi, Catherine, and Whoopi, thank you so much For believing so strongly in me. I am eternally grateful to my community in the Triangle and beyond. Thank you to my Holy Cross Catholic Church Family—especially the Caribbean Community and Young Adults v Ministry—for praying for me through this process. I truly believe your prayers and well wishes guided me through this degree. To my adopted Haitian Family, many thanks For the memories that will always remind me there is liFe beyond academia. My Dominica and broader West Indian Family, I know you walked alongside me in this journey. Yves-Marie, I was blessed the day my dad had the common sense to introduce us. Cara, thank you For being a true Friend and colleague. Cassie, thank you For Feeding me physically and spiritually. Karen, I owe so much oF my Formal and inFormal education to you. Many thanks. With sincere appreciation, I also thank my advisor, Seth Noar, For his guidance, instruction, and mentorship. There is absolutely no way I will ever be able to repay or thank you For all you have done For me. I had no idea how much I would learn and gain From you in the process. The training you provided will follow me throughout my career. To the rest oF my amazing committee: Joan, Ada, Brian, and Deborah. Thank you For the knowledge you have imparted to me. Ada, thank you For taking the chance on someone who just wanted to learn about health communication and public health research. Joan, thank you for your enduring caring and support. A special thanks to the Faculty, staFF, and students at the UNC Chapel Hill School oF Media and Journalism. Nori Comello, thank you for giving me the opportunity to work with you. Daniel Kreiss, thank you For always supporting minority doctoral students. Heidi Hennick-Kaminski, thank you for coming through for me time and time again, and for not allowing me any moments of panic. I also greatly appreciate the amazing work done by Dana McMahan and her students Alex Brusko and Maddie Baldwin. Without their creative genius, the messages designed for this study would not have happened. I want to extend my deepest gratitude to Erica McDonald-Finch at Bennett College, without whom this study would not have been possible. From the First letter of support to shepherding our ideas to the Bennett administration to ensuring the proper installation of the condom dispensers, Erica has been an invaluable part oF this team. vi To the Park Family and the Roy H. Park Foundation, I thank you For your generous giFt, without which my Four years at the M-J School would not be possible Without my village this doctoral degree certainly never would have happened. vii TABLE OF CONTENTS LIST OF TABLES ................................................................................................................... X LIST OF FIGURES ................................................................................................................ XI CHAPTER 1: PREVENTING HIV/STIS AMONG COLLEGE-AGED BLACK WOMEN ........... 1 Introduction ......................................................................................................................... 1 The HIV/STI Epidemic Among Young Black Women ......................................................... 4 Interventions to Address HIV/STI Among Young Black Women ........................................ 7 Project Belles: Condom Distribution Program and Point-Of-Access Messaging ................ 9 Theoretical Approach ........................................................................................................ 10 Intention-Action Conceptual Model ................................................................................... 12 CHAPTER 2: EFFECTS OF A CONDOM DISTRIBUTION PROGRAM ON SAFER SEX PERCEPTIONS AND BEHAVIOR AMONG BLACK HBCU WOMEN ................................... 15 Introduction ....................................................................................................................... 15 Methods ............................................................................................................................ 21 Results .............................................................................................................................. 26 Discussion ........................................................................................................................ 31 Conclusion ........................................................................................................................ 35 CHAPTER 3: EXPOSURE AND IMPACT OF CONDOM DISPENSERS AND POINT-OF- ACCESS SAFER SEX MESSAGING TARGETING BLACK COLLEGE WOMEN ................ 42 Introduction ....................................................................................................................... 42 Methods ............................................................................................................................ 46 Results .............................................................................................................................. 50 Discussion and Conclusion ..............................................................................................
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