Emergency Contraceptive Pill, Contraceptive, and Sexually Transmitted Infection Service Availability among U.S. College Health Centers
In the U.S., sexually transmitted infections (STIs) and unintended pregnancy are associated with a variety of medical, public health, and economic factors (Centers for Disease Control and Prevention [CDC], 2011; Chesson, Blanford, Gift, Tao, & Irwin, 2004; Institute of Medicine, 1995; Monea & Thomas, 2011). The Patient Protection and Affordable Care Act of 2010 (PPACA; U.S. Department of Health and Human Services, 2010) has facilitated national discourse regarding the role of sexual healthcare availability and coverage among U.S. colleges and universities. In addition to other preventative services, the PPACA provides coverage of FDA-approved contraceptive methods and contraceptive counseling, HIV screening and counseling, as well as STI counseling for sexually active women (U.S. Department of Health and Human Services, 2011a). The PPACA also provides consumer benefits to students who purchase student health plans through their college or university (U.S. Department of Health and Human Services, 2011b).
Despite the importance of sexual healthcare availability among colleges and universities, few studies have been conducted to assess the prevalence of sexual health services among college health centers. The identification of these trends may be useful to college health clinicians, prevention specialists, and administrators who advocate for comprehensive sexual healthcare within their institution and may influence health center policy by identifying key service-related disparities nationally. In addition, large-scale national investigations are needed to establish sexual healthcare benchmarks among colleges and universities.
Finer and Zolna (2011) estimated that 51% of the pregnancies in the U.S. are unintended. A similar study by Finer and Henshaw (2006) reported an unintended pregnancy rate of 104/1,000 among women 20-24 years old, a rate twice that of the overall population (51/1,000). According to the 2010 Sexually Transmitted Disease Surveillance Report, 19 million or 6.1% of Americans are diagnosed with an STI each year (CDC, 2011). Adolescents and young and adults 15-24 years old represent significant STI-related disparities and account for nearly half of all new infections (Weinstock, Berman, & Cates, 2004).
Recent findings of the Spring 2011 American College Health Association (ACHA): National College Health Assessment II Survey revealed that 70.8% of college students have had vaginal, anal, or oral sex with at least one partner over the last 12 months (ACHA, 2011a). Among those who had sex with at least one partner during that time, collegiate men reported a M of 2.52 (SD = 4.33) sexual partners and women a M of 1.87 (SD = 2.07) partners. Among students who were sexually active, 60.6% used birth control pills to prevent pregnancy. In addition, 16.0% of participants reported that they (or their sexual partner) had used emergency contraceptive pills (ECP) within the last 12 months.
A national study of 358 institutions conducted by McCarthy (2002) indicated that 52.2% of schools nationally offer ECP. Recent studies by Miller (2011) and Miller and Sawyer (2006) have indicated that nearly half (43% and 49%, respectively) of colleges and universities in Mid-Atlantic States offer ECP to their students. According to the 2011 study by Miller, 56.9% of schools offering ECP to students are public institutions, 43.1% were private, 100% were 4-year institutions, and none were faith-based institutions. In addition, faith affiliation and institutional ideology have been reported as significant barriers to condom and safer sex product availability within colleges and universities in rural settings (Butler, Procopio, Ragan, Funke, & Black, 2010).
Another study by Koumans and colleagues (2005) assessed STI-related services including testing and education strategies among higher education institutions. Of the 910 colleges selected for participation, the investigators received completed questionnaires from 736 institutions (81% response rate). Results indicated more than 75% of health centers currently offered common STI testing for students including chlamydia (91%), gonorrhea (90%), herpes simplex virus (HSV; 81%), and HIV (78%). Similarly, 88% of all schools offered Pap tests for students. However, only 38% currently offered syphilis testing. An assessment of demographic variables indicated that when compared to 2-year colleges and universities, 4-year institutions were more likely to offer six of the eight key STI testing services (p
According to the 2010 American College Health Association Pap Test and STI Survey (n = 174), 97.7% of colleges and universities surveyed nationally offer routine STI screening for asymptomatic women and 92.4% for asymptomatic men (ACHA, 2011b). Nearly all (85.1%-96.0%) offer chlamydia, gonorrhea, HIV, and syphilis screening for asymptomatic students and just over half (57.5%) offer HSV screening. With regard to HIV testing, three-quarters (75.9%) offer standard blood tests, while the minority offer HIV rapid blood and HIV rapid oral tests (23.6% and 21.3%, respectively).
The purpose of the present study was to assess ECP, hormonal and barrier...