Predictors of Sexual Behavior among Korean College Students: Testing the Theory of Planned Behavior by Eun-Seok Cha BSN, Chung-Ang University, Seoul, Korea, 1993 MPH, Seoul National University, 1998 Submitted to the Graduate Faculty of the School of Nursing in partial fulfillment of the requirements for the degree of Doctor of Philosophy University of Pittsburgh 2005 UNIVERSITY OF PITTSBURGH SCHOOL OF NURSING This dissertation was presented by Eun-Seok Cha It was defended on September 13, 2005 and approved by Willa M. Doswell, PhD, RN, FAAN, School of Nursing Kevin H. Kim, PhD, School of Education Thelma E. Patrick, PhD, RN, School of Nursing Denise Charron-Prochownik, PhD, RN, School of Nursing Dissertation Advisor: Willa M. Doswell, PhD, RN, FAAN, School of Nursing ii Copyright © by Eun-Seok Cha 2005 iii PREDICTORS OF SEXUAL BEHAVIOR AMONG KOREAN COLLEGE STUDENTS: TESTING THE THEORY OF PLANNED BEHAVIOR Eun-Seok Cha, PhD, RN University of Pittsburgh, 2005 Purpose: This study examined the relationships among variables derived from Ajzen’s Theory of Planned Behavior (TpB) in order to explain intentions of premarital sex and condom use in Korean college students. Methods: This study used a cross-sectional, correlational design using an exploratory survey methodology through self-reported questionnaires. Several instruments were used to measure the variables studied. Students aged 18-25 were recruited from a university in Seoul, Korea using a flyer and self-referral (male =165, mean age: 22.6; female=133, mean age: 20.67). Since there was a small amount of missing data (6.88%) and no differences in sample characteristics between the missing (n=22) and the non-missing groups (n=298), list-wise deletion was performed. The analytic approach included descriptive statistics, spearman rank correlation, and multi-sample structure equation modeling. All instruments showed good reliabilities. Cronbach’s alphas were used to examine internal consistencies of the instruments (α=0.77 - 0.98). Results: Forty nine percent of male students and around 12% of the female students had engaged in premarital sex; however, only 26.7% of sexually active students always used condoms. Looking at the model of premarital sex, premarital attitude was the strongest predictor of intention of premarital sex for both genders. For males, the TpB components of attitude, perceived behavior control, subjective norms explained intention of premarital sex; however, perceived behavioral control did not predict intention of premarital sex for females. A Lagrange iv Multiplier (LM) test showed that male and female students had different models to explain intention of premarital sex (S-Bχ²(22) =20.55, p=0.55, CFI=1.00, RMSEA=0.000). Looking at the model of condom use, condom efficacy was the strongest predictor of intention of condom use, and all TpB components significantly predicted intention of condom use. Higher condom efficacy predicted a higher intention. The LM test showed that male and female students shared one model to explain this intention (S-Bχ²(17) =22.72, p=0.16, CFI=0.98, RMSEA=0.03). Conclusion: The TpB has demonstrated applicability for predicting intentions of premarital sex and condom use as a way to decrease risky sexual behavior within the Korean culture. Findings provide information for developing better sex education programs for Korean late adolescents and young adults. v TABLE OF CONTENTS PREFACE.................................................................................................................................. XIII 1. CHAPTER ONE..................................................................................................................... 1 1.1. INTRODUCTION ................................................................................................. 1 1.2. THEORETICAL FRAMEWORK......................................................................... 5 1.3. SPECIFIC AIMS, RESEARCH QUESTIONS, AND HYPOTHESES................ 7 1.3.1. Specific aims................................................................................................... 7 1.3.2. Research questions.......................................................................................... 8 1.4. SECONDARY AIMS.......................................................................................... 13 1.5. DEFINITIONS OF TERMS................................................................................ 14 1.6. SIGNIFICANCE TO NURSING RESEARCH................................................... 16 2. CHAPTER TWO.................................................................................................................. 20 2.1. ADOLESCENCE ................................................................................................ 21 2.1.1. Definition of adolescence ............................................................................. 21 2.1.2. Characteristics of adolescence ...................................................................... 22 2.1.3. Perceptions of late adolescents toward sexual behavior............................... 23 2.2. THE PREVALENCE OF SEXUAL BEHAVIOR.............................................. 24 2.3. NEGATIVE OUTCOMES OF SEXUAL BEHAVIOR...................................... 27 2.3.1. Sexually transmitted diseases ....................................................................... 27 2.3.2. AIDS ............................................................................................................. 30 2.3.3. Teen pregnancy and abortion........................................................................ 31 2.4. THE INFLUENCE OF CULTURE ON KOREAN COLLEGE STUDENTS’ SEXUALITY........................................................................................................................ 34 2.5. THE COMPONENTS OF THE THEORY OF PLANNED BEHAVIOR.......... 38 2.5.1. Attitudes........................................................................................................ 39 2.5.2. Subjective norms........................................................................................... 40 2.5.2.1. General (or global) subjective norms .................................................. 41 2.5.2.2. Peer (Friend) norms ............................................................................. 41 2.5.2.3. Parents’ norms ..................................................................................... 42 2.5.2.4. Social norms ........................................................................................ 43 2.5.2.5. Partner norms....................................................................................... 44 vi 2.5.3. Perceived behavioral control......................................................................... 45 2.6. SUMMARY AND GAPS IN THE LITERATURE ............................................ 46 3. CHAPTER THREE .............................................................................................................. 49 3.1. RESEARCH DESIGN AND METHODS........................................................... 49 3.1.1. Design ........................................................................................................... 49 3.1.2. Target population and sample....................................................................... 49 3.1.3. Setting ........................................................................................................... 50 3.1.4. Sample size justification ............................................................................... 50 3.1.5. Procedure for data collection ........................................................................ 52 3.1.6. Protection of human subjects........................................................................ 52 3.1.7. The amount of time to complete questionnaires........................................... 52 3.2. VARIABLES....................................................................................................... 53 3.2.1. Background and sexual behavior.................................................................. 53 3.2.1.1. Perceived risk of sexual behavior........................................................ 53 3.2.2. Quality of parent-adolescent communication ............................................... 54 3.2.3. Independent variables ................................................................................... 54 3.2.3.1. Attitude ................................................................................................ 54 3.2.3.2. Subjective norms ................................................................................. 55 3.2.3.3. Perceived behavioral control (Self-efficacy)....................................... 56 3.2.4. Dependent variables...................................................................................... 57 3.2.5. Feedback questionnaire................................................................................. 58 3.3. DATA SCREENING PROCEDURE.................................................................. 58 3.3.1. Outlier assessments and checking underlying assumptions.......................... 58 3.3.2. Treatment of missing data............................................................................. 59 3.4. DESCRIPTIVE STATISTICS............................................................................. 59 3.5. DATA ANALYSIS PROCEDURE..................................................................... 60 3.5.1. Data analysis for preliminary aims ..............................................................