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Healt Briefs

Adolescents and AIDS:


A Survey of Knowledge, Attitudes and Beliefs about AIDS in San Francisco
RALPH J. DICLEMENTE, PHD, JIM ZORN, BA, AND LYDIA TEMOSHOK, PHD
In cooperation with the Division of Health Education
Abstract: To assess adolecents' knowledge, attitudes, and be- Programs for the SFUSD, all Family Life Education teachers
liefs about AIDS in San Francisco, data were obtained from 1,326 were personally contacted by the investigators. The aims of
adolescents. There was marked variability in knowledge across the project were explained and their cooperation was solic-
informational items, particularly about the precautionary measures ited.
to be taken during sexual intercourse which may reduce the risk of This project involves administering a newly developed
infection. We conclude that development and implementation of self-report questionnaire, consisting of 30 questions which
school health education programs on AIDS and other sexually evaluated students' knowledge about the cause, transmis-
transmitted diseases are needed in this population. (Am J Public sion, and treatment of AIDS. A second group of 11 questions
Health 1986; 76:1443-1445.) tapped students' attitudes and beliefs regarding personal
susceptibility, disease severity, and the need for AIDS
instruction to be included in high school curricula. Students
were requested to give "True," "False" or "Don't Know"
Introduction responses to all questions. All questionnaires were complete-
Although Acquired Immune Deficiency Syndrome ly anonymous; they were distributed and returned within a
(AIDS) is rare among adolescents,' this should not be one-week period in may 1985. Of the 1,332 questionnaires
grounds for neglecting preventive health education in school distributed, a total of 1,326 (more than 99 per cent) usable
systems. Epidemiologic data on the use of drugs and the questionnaires were returned and represent the sample upon
spread of other sexually transmitted diseases (STD) among which all analyses are based. Students ranged in age from
this population suggest that the rate of disease transmission 14-18 years. All major ethnic groups were represented.
may far exceed its reported rate,2- and that STDs and
adolescent drug use are the most pervasive, destructive, and Results
costly health problems confronting adolescents today in the
United States. Knowledge about high-risk behaviors associ-
ated with AIDS virus infection could help prevent the spread The findings suggest that students possess some knowl-
of disease in this population. edge of AIDS-although this knowledge is uneven (see Table
One published report suggests that the high school 1). With respect to disease transmission, 92 per cent of the
students did not possess a great deal of information about students correctly indicated that "sexual intercourse was one
AIDS nor were many concerned about the threat of AIDS.7 mode of contracting AIDS," however, only 60 per cent were
The findings, however, are based on a relatively small sample aware that "use of a condom during sexual intercourse may
size (n = 250), and reflect a geographic area of the United lower the risk of getting the disease." This large discrepancy
States which has a low incidence of AIDS. The present study suggests that many adolescents, while knowing a major route
reports a survey of adolescents' knowledge, attitudes, and of disease transmission, nonetheless, will be engaging in
beliefs about AIDS in an AIDS epicenter (San Francisco). unprotected sexual activity. Most adolescents were aware
that receiving infected blood from a transfusion (84 per cent)
or sharing intravenous drug needles (81 per cent) were also
Methods identified routes of disease transmission.
Students enrolled in Family Life Education classes at 10 On the other hand, only 66 per cent of students surveyed
high schools in the San Francisco Unified School District were aware that AIDS could not be spread by using
(SFUSD) were eligible to participate in this project. The someone's personal belongings and only 68 per cent knew
schools selected represent those with the largest enrollment that engaging in casual contact (i.e., shaking hands) would
in the SFUSD. Family Life Education classes are mandatory not lead to contracting the disease. Moreover, less than half
in the SFUSD. the students (41 per cent) correctly reported that kissing was
not a route of AIDS transmission. Adolescents were less
Address reprint requests to Ralph J. DiClemente, PhD, Department of informed with respect to the treatment of AIDS. Surprisingly,
Psychiatry, School of Medicine, University of California, Langley Porter only 25.3 per cent and 36.8 per cent, respectively, were aware
Psychiatric Institute, 6-B, 401 Parnassus Avenue, San Francisco, CA 94143. that "no new vaccine was available for treating AIDS" nor
Dr. DiClemente is a Post-doctoral Fellow in Social and Behavioral Sciences of
the American Cancer Society, California Division. Mr. Zorn is Research "could AIDS be cured if treated early," and only 60.5 per
Associate, and Dr. Temoshok is Assistant Professor of Medical Psychology, cent reported that "AIDS could not be cured."
both in the Department of Psychiatry, School of Medicine, University of With respect to adolescents' attitudes and beliefs about
California-SF. This paper, submitted to the Journal May 27, 1986, was revised AIDS (Table 2), 78.7 per cent of the adolescents report
and accepted for publication July 30, 1986.
"being afraid of getting AIDS" and 73.7 per cent report being
© 1986 American Journal of Public Health 0090-0036/86$1.50 "worried about contracting the disease." Over half the

AJPH December 1986, Vol. 76, No. 12 1 443


PUBLIC HEALTH BRIEFS

TABLE I-Subject Responses for Each Knowledge Statement


True False Don't Know
Statement % % %

AIDS is a medical condition in which your body cannot fight off


diseases. 73.9 (964)* 12.4 (161) 13.7 (179)
AIDS is caused by a virus. 60.3 (790)' 16.6 (218) 23.1 (303)
AIDS is a condition you are bom with. 6.9 (90) 84.4 (1105)* 8.8 (115)
Stress causes AIDS. 6.7 (87) 76.4 (998)' 17.0 (222)
If you kiss someone with AIDS you will get the disease. 41.9 (553) 41.0 (541)' 17.1 (225)
If you touch someone with AIDS you can get AIDS. 17.1 (226) 67.9 (896)* 14.9 (197)
All gay men have AIDS. 11.6 (152) 80.5 (1057)* 7.9 (104)
What you eat can give you AIDS. 9.6 (126) 75.0 (987)* 15.4 (203)
Anybody can get AIDS. 84.6 (1114)* 10.3 (136) 5.1 (67)
AIDS can be cured. 13.4 (175) 60.5 (790)' 26.1 (341)
Women are more likely to get AIDS during their period. 7.8 (102) 56.9 (747)' 35.4 (465)
AIDS can be spread by using someone's personal belongings
like a comb or hairbrush. 15.7 (206) 66.3 (869)' 17.9 (235)
AIDS is not at all serious, it is like having a cold. 3.3 (43) 89.9 (1179)* 6.9 (90)
AIDS is caused by the same virus that causes VD. 20.0 (261) 41.4 (541)* 38.6 (504)
The cause of AIDS is unknown. 46.5 (608) 33.8 (442)* 19.7 (257)
Just being around someone with AIDS can give you the disease. 15.3 (200) 70.4 (926)' 14.0 (183)
Having sex with someone who has AIDS is one way of getting it. 92.4 (1213)* 3.9 (51) 3.7 (49)
If a pregnant woman has AIDS, there is a chance it may harm
her unborn baby. 85.7 (1124)* 3.0 (39) 11.3 (148)
Most people who get AIDS usually die from the disease. 79.6 (1036)* 9.7 (126) 10.8 (140)
Using a condom during sex can lower the risk of getting AIDS. 60.0 (782)' 14.2 (185) 25.8 (336)
You can get AIDS by shaking hands with someone who has it. 10.0 (131) 74.7 (975)' 15.3 (200)
Receiving a blood transfusion with infected blood can give a
person AIDS. 84.4 (1099)* 5.8 (75) 9.8 (128)
You can get AIDS by sharing a needle with a drug user who has
the disease. 81.1 (1055)* 6.3 (82) 12.6 (164)
AIDS is a life-threatening disease. 83.8 (1087)* 5.9 (77) 10.3 (134)
People with AIDS usually have lots of other diseases as a result
of AIDS. 36.6 (475)' 27.1 (351) 36.3 (471)
All gay women have AIDS. 8.3 (108) 73.4 (950)' 18.3 (237)
There is no cure for AIDS. 60.5 (783)* 16.9 (219) 22.6 (293)
I can avoid getting AIDS by exercising regularly. 6.8 (88) 77.4 (1003)' 15.8 (205)
AIDS can be cured if treated early. 30.1 (389) 36.8 (476)' 33.1 (428)
A new vaccine has recently been developed for the treatment of
AIDS. 31.7 (411) 25.3 (328)* 42.9 (556)
NOTE: Actual frequencies in parentheses.
An asterisk denotes correct response.

TABLE 2-Subject Responses for AttIudes and Beliefs about AIDS

True False Don't Know


Statement % % %

AIDS is not as big a problem as the media suggests. 8.2 (106) 76.5 (995) 15.4 (200)
am afraid of getting AIDS. 78.7 (1003) 15.9 (202) 5.4 (69)
Living in the Bay Area increases my chances of
getting AIDS. 41.8 (535) 41.1 (526) 17.0 (218)
am not worried about getting AIDS. 26.3 (336) 66.3 (847) 7.36 (94)
am not the kind of person who is likely to get AIDS. 61.5 (784) 20.0 (255) 18.5 (236)
I am less likely than most people to get AIDS. 52.5 (662) 20.7 (261) 26.9 (339)
I'd rather get any other disease than AIDS. 50.6 (641) 18.1 (229) 31.3 (397)
If a free blood test was available to see if you have
the AIDS virus, would you take it? 51.5 (653) 25.3 (321) 23.2 (294)
I've heard enough about AIDS and I don't want to
hear any more about it. 28.9 (367) 58.8 (745) 12.3 (156)
It is importantfthat students learn about AIDS in
Family Life Education classes. 87.6 (1119) 5.8 (74) 6.6 (84)
Have you had any instruction about AIDS in your
school curriculum? 35.3 (447) 54.4 (689) 10.3 (131)
NOTE: Actual frequencies in parentheses.

adolescents surveyed (50.6 per cent) would rather contract Discussion


"any other disease than AIDS." One attitude, which was
most pervasive (87.6 per cent agreeing), was that it is Our findings are in stark contrast to those reported by
important for students to receive AIDS instruction in the Price, et al.,7 suggesting that geographic proximity to a high-
school curriculum. density AIDS epicenter has a great deal of saliency for what
1444 AJPH December 1986, Vol. 76, No. 12
PUBLIC HEALTH BRIEFS

students know and the attitudes and beliefs they possess about 2. Robins LN: The natural history of adolescent drug use. Am J Public Health
AIDS. Furthermore, these findings indicate the need for a 1984; 74:656-657.
3. National Institute of Allergies and Infectious Disease Study Group:
teaching module which would be included in the school curric- Sexually Transmitted Diseases-Summary and Recommendations, 1980.
ula to overcome misconceptions about AIDS. Preferably AIDS US Department HEW, National Institutes of Health.
education would not be provided in isolation, but as part of the 4. Kroger F, Wiesner PJ: STD Education: Challenge for the 80s. J Sch Health
teaching plan to instruct students about communicable dis- 1981; 51:242-246.
eases, in general. Equally important as understanding the cause 5. Shafer M, Beck A, Blain B, Dole P, Irwin C, Sweet R, Schacter J:
and transmission of AIDS, as Yankauer points out, is providing Chlamydia trachomatis: Important relationships to race, contraception,
education on the role that social values play in the control of lower genital tract infection, and Papanicolaou smear. J Pediatr 1984;
sexually transmitted diseases.8 104:141-146.
As the projected epidemic of AIDS cases and HTLV-III 6. Bell TA, Holmes KK: Age-specific risks of syphilis, gonorrhea, and
hospitalized pelvic inflammatory disease in sexually experienced US
infection continue to escalate,9 increased attention must be women. Sex Transm Dis 984; 11:291-295.
directed at the adolescent population, which has heretofore 7. Price JH, Desmond S, Kukulka G: High school students' perceptions and
been neglected, if in the long run we are to curtail the spread misperceptions of AIDS. J Sch Health 1985; 55:107-109.
of disease in this population. 8. Yankauer A: The persistence of public health problems: SF, STD, and
AIDS. (editorial) Am J Public Health 1986; 76:494-495.
REFERENCES 9. Curran JW, Morgan WM, Hardy AM, Jaffe HW, Darrow WW, Dowdle
1. Centers for Disease Control: AIDS Weekly Surveillance Report, May 12, WR: The epidemiology of AIDS: Current status and future prospects.
1986. Science 1985; 229:1352-1357.

Students in Health Professions Eligible for HHS Secretary's Award


Health and Human Services Secretary Otis R. Bowen, MD, recently announced the fifth annual
national competition among health professions students for the Secretary's Award for Innovations in
Health Promotion and Disease Prevention. Winners will receive awards of $3,000 for first place, $2,000
for second, and $1,000 for third. Up to 17 semifinalists will receive $250 each.
The competition is open to a broad range of health professions students enrolled in baccalaureate
or higher degree programs affiliated with the Federation of Associations of Schools of the Health
Professions, co-sponsor of the competition. Eligible to compete are students of medicine, osteopathy,
dentistry, nursing, veterinary medicine, optometry, pharmacy, podiatry, public health, health admin-
istration, health education and allied health professions.
Papers should present innovative proposals for health promotion or disease prevention in the
community, at the worksite, in an educational setting, or for a special population group. Entries for the
1987 competition should focus on one of the following health matters: high blood pressure, family
planning, pregnancy and infant health, immunization, sexually transmitted diseases, toxic agents,
occupatonal safety and health, accident prevention and injury control, fluoridation and dental health,
infectious diseases, smoking cessation, alcohol and drug abuse, physical fitness and exercise, nutrition,
and violent behavior.
Proposals will be judged on: 1) innovation in approach to health promotion and disease prevention;
2) feasibility of approach; and 3) potential impact on a community or population. An entry may be no
longer than 2,500 words.
The deadline for submitting entries is January 15. A paper must be submitted to the school attended
by the author or authors. Papers will be judged first by the school and then by the professional
associations. A departmental panel will make the final selections and the secretary will announce the
winners in July.

AJPH December 1986, Vol. 76, No. 12 1445