Term of Award

Spring 2014

Degree Name

Doctor of Public Health in Community Health Behavior and Education (Dr.P.H.)

Document Type and Release Option

Dissertation (restricted to Georgia Southern)


Jiann-Ping Hsu College of Public Health

Committee Chair

Gulzar Shah

Committee Member 1

Andrew Hansen

Committee Member 2

Claire Robb


While it is known that healthy sexual behaviors should begin early, it is evident that among some populations (minorities and marginalized populations) it is more challenging to achieve optimal sexual health due to the stigma and class status (Barth, Cook, Downs, Switzer, & Fischoff, 2002). However, what is not clear is how this affects their health-seeking behaviors. The most common barriers to STI prevention/treatment include stigma, concerns of providers’ judgment, and shame; however, these factors have not been measured congruently (Cunningham, Kerrigan, Jennings & Ellen, 2009). Thus, by studying the diverse population of college students and their sexual behaviors, this study sought to gain a better understanding of these dynamics and how they affect health-seeking behaviors, treatments and their subsequent re-infection rates.

The purpose of this study was to determine how layered-stigma affects college-aged students’ sexual health-seeking behavior. Furthermore, this study sought to determine their perceptions of stigma in an attempt to identify barriers to healthcare that may be affecting them.

This mixed-methods study was conducted via a web-based survey of students (n=306) at a rural university and focus groups. Survey and focus group items were derived from factors identified in Barth et al. (2002).

The study findings indicate that layered-stigma does affect several individual level factors predicting past STI testing history of respondents. Furthermore, this study found that health system factors do not predict past STI testing decisions nor predict their intentions to get tested. Focus group data confirmed that students’ STI testing decisions primarily rest with the individual. Therefore, it is imperative that new strategies to create a pro-testing community among college students are employed to reduce the stigmas associated with testing.