KNOWLEDGE, INTENTIONS, AND BELIEFS ABOUT FERTILITY AND ASSISTED REPRODUCTIVE TECHNOLOGY AMONG ILLINOIS COLLEGE STUDENTS by Akilah Morris Smith B.S., Illinois State University, 2006 M.S., Illinois State University, 2008 A Dissertation Submitted in Partial Fulfillment of the Requirements for the Doctorate in Philosophy Department of Public Health and Recreation Professions in the College of Education Southern Illinois University Carbondale Spring 2018 Copyright by Akilah Morris Smith, 2018 All Rights Reserved i DEDICATION I want to thank My Heavenly Father for all his guidance, support and love during this time. Thanks for challenging and blessing me. I have learned that you are authentic and real in my life. I also want to thank my mother and father Olivia and Arthur Morris for loving and supporting me unconditionally through this time. I am grateful for the best brother in the world Oheni Morris, thank you for your light heartedness, positivity and love. Thanks to my husband Wayon Smith III, son Wayon Smith IV (KJ) and in laws Mr. and Mrs. Wayon Simth Jr. and Mrs. Faye Freeman Smith for helping me during graduate school. ii ACKNOWLEDGEMENTS Thanks to my extended family and friends who listened and added valuable input during this season of my life. Special thanks to Dr. Ogletree, Dr. Wallace, Dr. Melonie Ewing, Dr. Shelby Caffey, and Dr. Diehr for their commitment in seeing me through this process. iii AN ABSTRACT OF THE DISSERTATION OF AKILAH MORRIS SMITH, for the Doctor of Philosophy degree in Public Health, presented on April 11th 2018, at Southern Illinois University Carbondale. TITLE: KNOWLEDGE, INTENTIONS, AND BELIEFS ABOUT FERTILITY AND ASSISTED REPRODUCTIVE TECHNOLOGY AMONG ILLINOIS COLLEGE STUDENTS MAJOR PROFESSOR: Roberta Ogletree H.S.D and Juliane P. Wallace PhD The purpose of this quantitative cross sectional study was to examine knowledge, beliefs, and intentions about fertility and assisted reproductive technology among college students. This study differs from previous studies in that it examines knowledge, beliefs, and intentions about fertility and assisted reproductive technology among Illinois college students. The researcher examined differences among college students, including race, sexual orientation, age, parental status, relationship status, and gender. The researcher applied parts of the theory of planned behavior constructs to the survey instrument. The researcher studied the thought process of male and female students at Illinois universities taking foundational health courses. The researcher found that African Americans were less likely to delay parenthood compared to Caucasian Americans. While women felt that they wanted children at a younger age compared to men. Also some students felt they were ready for parenthood in their late twenties to mid-30’s as oppose to earlier twenties. iv TABLE OF CONTENTS CHAPTER PAGE CHAPTER 1 INTRODUCTION .................................................................................................... 1 CHAPTER 2 REVIEW OF RELATED LITERATURE .............................................................. 16 CHAPTER 3 METHODS AND PROCEDURES ........................................................................ 33 CHAPTER 4 RESULTS ............................................................................................................... 54 CHAPTER 5 FINDINGS & CONCLUSION ............................................................................... 80 REFERENCES ............................................................................................................................ 91 APPENDIX A ............................................................................................................................. 126 APPENDIX B ............................................................................................................................. 130 APPENDIX C ............................................................................................................................. 131 APPENDIX D ............................................................................................................................. 132 APPENDIX E ............................................................................................................................ 133 APPENDIX F.............................................................................................................................. 134 APPENDIX G ............................................................................................................................. 135 APPENDIX H ............................................................................................................................. 136 APPENDIX I ............................................................................................................................. 141 APPENDIX J .............................................................................................................................. 142 APPENDIX K ............................................................................................................................. 143 v LIST OF TABLES TABLE PAGE Table 1. Fertility by Race and Ethnicity Births Per 1000 ............................................................. 20 Table 2. Participating University and Introductory Health Courses ............................................. 35 Table 3. Modified and Adapted Fertility Survey Questions ......................................................... 39 Table 4. Instrument Constructs and Measurement Scales ............................................................ 39 Table 5. Summary of Research Questions, Instrument Items, and Data-Analysis Methods ........ 44 Table 6. Number and Percentages of Participants from Illinois Universities ............................... 56 Table 7. Number and Percentages of Race, Sexual Orientation and Age ..................................... 58 Table 8. Number and Percentages of Parental & Relationship Status and Children .................... 59 Table 9. Results of Reliability Analyisis ...................................................................................... 60 Table 10. Range of Values, Means, and Standard Deviation for scales ....................................... 61 Table 11. Results of Kruskal Wallis test for Intentions ................................................................ 63 Table 12. Pairwise Comparison for the mean Ranks of Intentions by Race................................. 64 Table 13. Pairwise Comparision for the Mean Ranks by Intentions by Age Caterogy ................ 65 Table 14. Results of the Krusal Wallis Tests for Beliefs .............................................................. 66 Table 15. Pairwise Comparision for the Mean Ranks of Beliefs by Race .................................... 67 Table 16. Pairwise Comparision for the Mean Ranks of Beliefs by Gender ................................ 68 Table 17. Results of Krusal Wallis Test for Knowledge .............................................................. 69 Table 18. Variance Inflater Factor Value for the Regression Predicting Intentions ..................... 71 Table 19. Results of Multiple Linear Regression Predicting Intentions ....................................... 72 Table 20. VIF Vaules for the Regression Predictor Beliefs ......................................................... 74 Table 21. Results of the Multiple Linear Regression Prediction Beliefs ...................................... 76 vi Table 22. VIF Values for the Regression Predictor Knowledge .................................................. 78 Table 23. Results of Multiple Linear Regression Knowledge ...................................................... 78 vii LIST OF FIGURES FIGURE PAGE Figure 1. Theory of Planned Behavior. ......................................................................................... 30 Figure 2. Mean Values of Fertility and ART intention scores by race ......................................... 64 Figure 3. Mean values of Fertility and ART intentions by age category. ..................................... 65 Figure 4. Mean values for Fertility and ART beliefs scores by race. ........................................... 67 Figure 5. Mean values of Fertility and ART beliefs scores by gender. ........................................ 68 Figure 6. Residuals scatterplot testing homoscedastcity for Regression predicting intention. ..... 70 Figure 7. Residuals scatterplot testing homoscedasticity for Regression predicting beliefs. ....... 74 Figure 8. Residuals scatterplot testing homoscedasticity for Regression predicting knowledge. 77 viii CHAPTER 1 INTRODUCTION Preface After a diagnosis of polycystic ovarian syndrome (PCOS) in 2004, I experienced a struggle with the syndrome, which leads to acne, hair growth on the stomach and chest, weight gain, and hormonal imbalance. PCOS involves multiple cysts in a woman’s ovaries that impact the hormone balance in the woman’s system and may lead to infertility and conception difficulties. Fortunately, our family conceived in our mid-30s and welcomed our first child on October 24th, 2016. For my husband and myself, like many college students and young professionals, delaying parenthood seemed as though it would be the best choice for our family even though we knew there might be a risk of infertility. Like some couples our age, we chose to delay parenthood in the hopes of establishing careers and purchasing a home for our new family. As a result, I decided