Graduation Year

2018

Document Type

Thesis

Degree

M.S.P.H.

Degree Name

MS in Public Health (M.S.P.H.)

Degree Granting Department

Community and Family Health

Major Professor

Stephanie L. Marhefka, Ph.D.

Committee Member

Alicia Best, Ph.D.

Committee Member

Sara Green, Ph.D.

Keywords

People with Disabilities, Sex Education, Social Determinants of Health, Young Adult

Abstract

There is limited knowledge on the sexual health behaviors of young adults with physical disabilities, as people with disabilities have traditionally been treated homogenously without acknowledgement of the potential differences between disability types. The objective of this study was twofold. The first goal was to take a novel approach by guidance of the Social Determinants of Health (SDOH) framework to compare how young adults with physical disabilities compare against those without physical disabilities in: 1) vaginal sexual activity, 2) condom usage, and 3) the effect of SDOH factors as potential mediators in predicting unprotected vaginal sex. Relatedly, the second goal was to investigate whether there was a difference in condom usage based on disability type criteria, specifically examining membership into the following impairment groups: physical disability, chronic health conditions, vision impairments, hearing impairments, and stuttering/stammering problems.

This study employed secondary data analysis based on data from the National Longitudinal Adolescent to Adult Health Survey (ADD Health) – Wave III, in-home interview, public-use dataset. The variables used for the SDOH proxies were job status, student status, housing type, level of education, mentor status, cohabitation status, and health insurance status. Additionally, other social and demographic factors were also accounted in the model: age, race/ethnicity, gender and sexual orientation.

Results from bivariate regression suggest that only those young adults with visual impairments and those with stuttering/stammering issues are less likely to engage in sexual activity when compared to their healthy counterparts. Regarding condom usage among sexually active individuals, those with physical disabilities, chronic health conditions, and hearing impairments may be less likely to use protection than their counterparts. However, further investigation revealed that the associations between condom usage and those disability type groups are mediated by 1 of the 7 measures of SDOH (cohabitation status) and three demographic factors – gender, race, and age. Hence, it is not the disability type that reduces safe sex practices compliance, but rather that those disability groups are associated to social and demographic factors that are, in turn, linked to unsafe sex practices. Furthermore, it appears that irrespective of disability membership, gender, age, race, and cohabitation status are all associated with condom use compliance. Findings advocate for a supplementary investigation of the relative contributions of the particular social factors that mediate the effect between disability status and condom usage.

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