Final Proposal

Sexual Health Education for College-Aged Women (SHECAW)
Laura Santilla
PH 3596, Spring 2016
Temple University

Sexual Health Education for College-Aged Women | 1
Executive Summary
Chlamydia trachomatis (C. trachomatis) is a highly preventable sexually
transmitted disease (STD) in the United States. This infection is most common in a younger
demographic of sexually active women and goes largely undetected in many instances. In 2014,
over 1,441,789 cases were reported, or a current rate of 456.1 out of every 100,000 (CDC[B],
2015). An infection such as this affects the reproductive health, fertility, and physical well-being
of those who experience it. It is extremely important that screening and education are
emphasized as important methods in preventing the spread of this disease. If individuals are
engaging in risky sexual behavior, they are putting themselves at risk for C. trachomatis as well
as other STDs.
The target population for this intervention is college-aged women, 18-22 years old, who
are of any racial descent. The program will use various methods that focus on the primary and
secondary prevention of this disease as well as some form of treatment to decrease the incidence
of cases.
Currently, very few programs exist that specifically examine this common health
concern. The Sexual Health Education for College-Aged Women (SHECAW) is designed to
address this specific health problem. The goals of SHECAW are as follows:
1. Provide education that will result in the reduction of new cases of C. trachomatis
in women ages 18-22 years of age in the University City vicinity of Philadelphia
2. Ensure all enrolled participants will have the knowledge and coaching provided to
be properly versed on the possibility of transmission when engaging in risky
sexual behavior

3. Provide a safe, judgement free support network in which participants are
comfortable and likely to implement the proposed strategies
Background to the Health Problem
Introduction
In the following section, the health issue of Chlamydia trachomatis (C. trachomatis) will
be described in a detailed manner. This largely preventable disease still affects an immense
amount of sexually active individuals in the United States, but women carry the greatest burden
of the disease (CDC, 2015[A]). C. trachomatis is responsible for most of the sexually transmitted
disease cases worldwide, affecting over 90 million people (Gewirtzman, Bobrick, Conner, &
Tyring, 2011). According to the CDC[B] (2015), in 2013, there were over 1.4 million cases of C.
trachomatis in the United States reported, although it is estimated that more 2.86 million cases
occur that were not reported because treatment or screening for this often asymptomatic
condition was not sought out. This is the greatest issue as it contributes to the spread of the
disease as well as the adverse health of the individual infected.
In this section, an overview and etiology of the disease will be discussed as it pertains to
college-aged young women, which includes symptoms, risk factors, and the negative health
effects of the women experiencing this disease. An epidemiological portion explaining incidence
and prevalence for the given population as well as diagnosis and treatment of the disease are
described. Lastly, prevention measures will be examined.
Overview and Etiology
Chlamydia trachomatis is a common sexually transmitted disease (STD) that affects
mostly a younger population or individuals with multiple sexual partners. It affects both men and
women, though for the sake of this proposal, only the effects on college-aged women will be

discussed. Untreated, this disease causes many problems in the reproductive tract as well as other
parts of the body and may result in several short or long term consequences (CDC[B], 2015).
C. trachomatis is caused by the bacteria Chlamydiae, which is spherical or ovoid in
shape. These bacteria are intracellular and ubiquitous and the parasitism makes C. trachomatis
different from other bacteria. The bacteria Chlamydiae has both DNA and RNA as well as
ribosomes, which differentiates them from viruses (Malhotra, Malhotra, M., Sood, S., Mukherjee
A., Muralidhar, S., & Bala M., 2013). They reproduce via binary fission, a form of asexual
reproduction in which the cell grows twice its original size and then splits in half. It is important
that the cell remains a viable bacterium, therefore the right conditions are necessary as well as
the correct and complete duplication of the original cell’s genetic makeup (Cornell University,
2015). Chlamydiae have what are known as serovars and serovars D-K cause infections in
humans. Serovars A-C are associated with trachoma in developing countries (Gaydos, 2013).
One may come in contact with this bacteria via a penis, vagina, mouth, or anus of an
individual who has the infection. It is important to note that a male does not need to ejaculate in
order to spread the disease, rather it is contact with an infected person that passes it along. It is
also possible for infants to be affected, as it will cause eye infections as well as pneumonia if
their mother is infected with it at the time of childbirth (CDC, 2015[B]).
Symptoms. Like most sexually transmitted diseases, C. trachomatis is generally
asymptomatic and goes largely undetected by sexually active individuals who are not being
screened regularly (Bébéar & De Barbeyrac, 2009). This is the largest issue clinicians or public
health professionals face as it contributes to the continued spread of the disease as well as
skewed statistics on its incidence and prevalence. However, according to Bebear & De
Barbeyrac (2009), there are a number of manifestations that are complications of this disease

which include cervicitis, which is asymptomatic in 70% of women. It is common to see certain
infections such as cervicitis, which is defined as the inflammation of the cervix, in women with
genital C. trachomatis (Mayo Clinic Staff, 2015). Cervicitis could lead to pelvic inflammatory
disease (PID) as infection moves from cervix to upper reproductive tract (CDC, 2015[B]).
Perihepatitis is the inflammation of peritoneal tissue coating the liver which may also develop
(Saunders, 2003) and is a complication of pelvic inflammatory disease (Ris, 1984). When
women have undiagnosed or untreated C. trachomatis, their symptoms may include post-sex
bleeding, spotting in between menstrual cycles, and unusual vaginal discharge. Another cause for
concern is dyspareunia, defined as painful intercourse, and lower abdomen pain (Tiran, 2009). It
is also possible for women to develop Bartholinitis, the infection of one or both Bartholin’s
glands or ducts in a woman’s vulva (Home of Health, 2010). A female with C. trachomatis may
show signs of any of these conditions by themselves or in unison, though they occur from other
issues as well.
Risk factors. The first risk factor is being an unmarried individual (Bébéar & De
Barbeyrac, 2009). This may be because it is assumed an unmarried person is more likely to have
more than one sexual partner as time passes rather than a monogamous partner and therefore
increases their risk of contracting the disease.
Other risk factors include unprotected sexual intercourse with multiple and frequently
rotating partners. This disease affects mainly young people between the ages of 16 and 24. It is
noted that it is dispersed among the general population, but incidence is high among this age
group (Bébéar & De Barbeyrac, 2009). It is also noted that sex workers or prostitutes, inmates,
and intravenous drug users are at a higher risk of contracting this STD as well as others due to
their probable high risk sexual behavior (Gewirtzman, et al., 2011).

The last risk factor is prior sexually transmitted infections (STIs) or chronic STDs, such
as HIV. Women who have been diagnosed and treated for other STIs or STDs are at risk for
getting another based on individualistic behaviors and susceptibility because of existing
conditions. A prevalent uncommitted “hook up” cultures exists in the United States that is
quickly and popularly becoming the norm, which leaves many vulnerable to these types of
diseases because they are engaging in casual sex with multiple partners. A common mindset of
this age group in this day and age is a nonchalant attitude towards sex and sexual fluidity
(Garcia, Reiber, Massey, Merriwether, 2012). Combine this attitude with a popular drinking
culture and this population is highly at risk due to behavioral implications (Labhart, Graham,
Wells, & Emmanuel Kuntsche, 2012).
Negative health effects. Untreated C. trachomatis contributes to a number of grave
outcomes for women. As discussed before, C. trachomatis infection can lead to a plethora of
infections throughout the reproductive tract as well as other parts of the body in more severe
cases. Conjunctivitis, an infection of the eye, may occur when infected genital secretions come in
contact with the eye (CDC, 2015[B]). Complications occur if a woman is pregnant, including
preterm labor and delivery, chorioamnionitis, and postpartum endometritis. Chorioamnionitis is
the infection of the membranes surrounding the fetus as well as the amniotic fluid that may lead
to preterm labor and long delivery (Tita, & Andrews, 2010). Postpartum endometritis is similar,
but instead involves the lining of the womb after childbirth (Mackeen, Mackeen A., Packard,
Ota, & Speer, 2015).
Infants with mothers who have the disease when giving birth are at a risk of developing
conjunctivitis which may lead to blindness or pneumonia (CDC[B], 2015). This occurs because
fluid during childbirth containing the bacteria is passed along to the fetus, as transfer rate from

the vaginal fluid is high at 50-70%. Conjunctivitis will develop in 30-50% of infants with
infected mothers about 5 or 10 days after delivery. These infants are also at risk for developing
nasopharyngeal infections, which is in the back of the throat and causes upper respiratory
infections. Left untreated, these infections occurring in infants can last for months or even years
(Bébéar & De Barbeyrac, 2009). Some women may even become infertile due to different
infections from C. trachomatis such as salpingitis, the inflammation of the fallopian tubes which
may cause scarring (Home of Health, 2011).
The last infection caused by the C. trachomatis bacteria is lymphogranuloma venereum
or LGV. This condition presents symptoms such as lymphadenopathy (Gewirtzman et al., 2011),
which is pain in the lymph nodes due to a change in size, consistency, or number (Ferrer, 1998).
LGV is caused by the L1, L2, and L3 serovars of C. trachomatis and manifest as a painless ulcer.
The second stage involved the painful lymphadenopathy which could lead to ruptures in the
inguinal or femoral lymph nodes, afflicting about one third of the people who have it. The third
stage of LGV occurs because of fibrosis, which is the thickening or scarring of connective tissue.
The results of this are lymphatic obstructions, edema or swelling, abscesses, and strictures, and
abnormal narrowing of a bodily passage (Gewirtzman et al., 2011).
Epidemiology
Chlamydia trachomatis signs and symptoms are nonspecific and often go undetected for
this reason. This creates problems in the diagnosis and treatment of the condition. A high
prevalence of this condition is the result of the nonspecific symptoms as well as lack of adequate
screening for those at high risk. It is pertinent that a patient diagnosed with this disease traces
their sexual contacts as well as alert their current partner if they have one (Stamm, 2008).

The prevalence of C. trachomatis is dependent upon each population studied. C.
trachomatis infections are generally diffused among the population (Bébéar, & De Barbeyrac,
2009). In the United States, a higher prevalence is seen in non-white and Hispanic ethnicities
than that of other groups. There are variations and confounders based on race and socioeconomic
status, with a 5% prevalence of C. trachomatis infection among suburban adolescent females and
a 25-30% prevalence in urban populations of the same age. Based on these results, it is
calculated that an overall prevalence of 12% for this age group has been infected with C.
trachomatis as of 2011 and prevalence among females is three or four times greater than that of
males. Overall, women carry the greatest burden of disease. The best method of reducing
morbidity and mortality of STIs is prevention (Gewirtzman et al., 2011). In the last 10 years,
incidence of this disease has increased (Bébéar, & De Barbeyrac, 2009).
A study of the incidence and prevalence of C. trachomatis was conducted from
2007-2012. This research found an incidence of 1.4 million cases in 2012. A table illustrates the
statistics as it relates to females presented in the report. This graph shows that in 2012, the most
highly affected were 14-19 year olds and 20-24 year olds, which falls slightly outside of the
target population for this proposal but can still be applied to general distribution of this disease in
the United States. Black, non-Hispanic females 14-19 years of age are disproportionately
affected, equating to double the amount of all other racial groups, excluding white, non-Hispanic
and Mexican-American. The data was collected over a five year span, revealing a need for
specialized intervention methods based on race and ethnicity groups. This data only includes
sexually active females and the prevalence was estimated based on urine specimen collected and
tested using Gen-Probe Immunoassay (Torrone, Papp, Weinstock, 2014).
Diagnosis and Treatment

Diagnosis. There are several ways in which C. trachomatis is diagnosed. According to
the CDC (2015[A]), the incubation period of this disease is poorly defined. This is commonly an
asymptomatic disease among women who contract it. If symptoms do occur, these tests are
helpful in determining the cause, as most of the complications cannot be rectified until the
underlying cause is addressed. Available tests include nucleic acid amplification tests, traditional
cultures, direct fluorescent antibodies, and enzyme immunoassay (Carder, Mercey, & Benn,
2006). This following points will illustrate how each of these function in diagnosing C.
trachomatis as well as any limitations to these tests.
Nucleic acid amplification tests (NAATs). These tests are the most advanced and
least invasive of the options for diagnosing C. trachomatis (Marrazzo, 2001). A specimen
of urine or vaginal fluid can be used to test whether or not the bacteria is present in the
patient (Marrazzo, 2001). There are three commercial assays that are available:
polymerase chain reaction, strand displacement amplification, and transcription mediated
amplification. Increased sensitivity, making NAATs the best available test, is attributed
to the method’s ability to yield positive signals from a single copy of the DNA or RNA in
the C. trachomatis bacteria. It is acknowledged that no test is 100% accurate but the only
way to check the accuracy of NAATs is testing them against other NAATs (Carder, et al.
2006).
Traditional cultures. This form of testing is the original diagnosing method of C.
trachomatis, though it is not widely used today because it takes too much time and labor
and is the least cost effective. Cell culture only detects viable organisms and in ideal
conditions sensitivity is only 75% (Carder et al. 2006) though is has nearly 100%
specificity (Bébéar & De Barbeyrac, 2009).

Direct fluorescent antibodies (DFAs). According to Bébéar and De Barbeyrac
(2009), DFAs are fast with high specificity although they are subjective and cannot be
used in large numbers of specimens. This method involved using a swab to collect a
sample from the patient, where it is then rolled onto a slide and allowed to air dry. It is
then stained using a major outer membrane protein (MOMP) or a lipopolysaccharide
(LPS) and the bodies can be identified using a fluorescent microscope. Specificity and
sensitivity are determined by laboratory expertise and DFAs can detect viable and
nonviable organisms (Carder, et al. 2006).
Enzyme immunoassay (EIAs). EIAs detect the presence of an antigen in a liquid
or wet sample. It is possible for EIAs to be automated. Any positive EIAs must be tested
via other methods because it is possible that they yield false-positive results due to cross
reactions with the LPS (Bébéar & De Barbeyrac, 2009). Confirmation may be conducted
via DFA tests or a test involving the blocking of antibodies (Carder, et al. 2006).
Point of care test. These tests are best used for patients who are unlikely to return
for test results. Any non-invasive specimen can be used in the point of care test, such as
vulvo-vaginal site collection. This test has moderate sensitivity but is not recommended
to be utilized in a lab setting. Recently developed by the Wellcome Trust is a rapid
diagnosis with promising initial results via a dipstick, which works with the basis of
second-generation EIA for chlamydial LPS (Bébéar & De Barbeyrac, 2009).
Testing sites. Samples or specimens may be taken from a few different parts of
the body. This first specimen collected in order to test for C. trachomatis is urine,
specifically first catch urine. The patient must not have urinated for at least an hour
before administering this specimen, sometimes two hours depending on the test kit

Sexual Health Education for College-Aged Women |
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instructions. Urine may be used for NAATs but offer less sensitivity in comparison to
samples from the urethra or cervix. Female urine is not suitable for EIAs or traditional
cultures, and is fine to use but not recommended for DFAs (Carder, et al., 2006).
An additional testing site for women is cervical, which is suitable to use in each
test. The process of collection is via speculum, where a swab is inserted to collect the
specimen and then inserted into a collection pack. It is then rotated at least two times in a
period of 15-30 seconds. Urethral samplings are collected in a similar fashion via swab
and are also suitable to each test. Lastly, a vulvo-vaginal sample may be taken, but not to
be used for NAATs, though it has been shown to produce the same sensitivity to cervical
testing (Carder, et al., 2006).
A pharyngeal sample may be taken to be used for the traditional tissue culture,
this test has one of the highest recommendation grades. Samples involving the pharynx
are not suitable for EIAs or NAATs, but may be used for DFAs (Carder, et al., 2006).
Treatment. C. trachomatis is readily curable with antibiotics. One option is a single-dose
therapy of azithromycin. The other antibiotic option that is also commonly used is doxycycline.
This drug has been found to have more instances of noncompliance because it is taken over 7
days by the individual and they may stop before they are finished or not use it correctly (Bébéar
& De Barbeyrac, 2009). Infantile conjunctivitis or pneumonia are also treatable with antibiotics.
It is pertinent to take the antibiotics correctly and completely, otherwise the risk of reinfection or
of the treatment working improperly is possible. It is not unlikely for people who have had this
infection to become infected again, especially women, due to their male sexual partners being
improperly treated or not treated at all. This is especially adverse for women, who become more

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prone to the conditions discussed in the symptoms section of this proposal with each new
infection of C. trachomatis (CDC, 2015[B]).
Although not well studied, resistance to the antibiotics may occur. It is found that this is
due to treatment failure or noncompliance (Bébéar & De Barbeyrac, 2009). Individuals should
never share their medications. Individuals undergoing the 7-day treatment process are advised to
not engage in sexual intercourse until the treatment is done and they become or remain
asymptomatic. Patients seeking treatment who have HIV are administered the same treatment as
those who do not. Medication will cure the infection, but any subsequent damage that occurs to
the reproductive tract is irreversible (CDC, 2015[C]).
Prevention
An effective preemptive step in assuring this disease does not spread further is education.
By teaching at risk individuals how easily this disease spreads and the damage it does to the
reproductive tract in an open environment in which learners are well informed is a substantial
primary prevention measure. This measure assumes that some individuals have the incorrect
information or not enough information to protect themselves. Studies have also shown the most
effective secondary measure to stop the spread of this disease is screening and treatment.
Prevention is a crucial component in controlling the spread of C. trachomatis, as well as all other
STI/STDs. Realistic and effective measures must be used in order for prevention to be effective
for the target population. Many Chlamydia trachomatis control programs focus on screening of
asymptomatic females based on a number of factors. These include demographic, clinical, and
behavioral precedents (Gaydos, 2013). Some experts suggest that partners of those diagnosed are
also tested and treated as necessary to prevent the likelihood of reinfection.
Conclusion

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A detailed background of this health issue is important to fully understand the health
implications of contracting this infection and how serious it is for women. It is essential to
comprehend the components of the background of the health issue in order to discern further
discussion and the information regarding the sections following. An overview of the etiology,
epidemiology, diagnosis and treatment, and prevention were presented in this section.
Community Needs Assessment
Quantitative Information
After some research on the largest university in the city of Philadelphia, the school with
the second largest population in 2016 is University of Pennsylvania (UPenn), where the initial
community visit was conducted. The zip code of UPenn is 19104. For the sake of this
intervention, the most appropriate area for widespread and well attended recruitment for the
intervention would be somewhere on UPenn’s campus, such as Locust Walk, which extends all
the way through most of UPenn’s classroom buildings on campus and it is where Penn Women’s
Center is located, which is the venue for the program.
According to the University of Pennsylvania’s website, in 2014 there were nearly 25,000
full and part-time students in attendance (2015). Upon further investigation, it was found that the
male and female ratio is split directly down the middle (US News & World Report, 2015).
Penn’s student to teacher ratio is 5 to 1 (University of Pennsylvania, 2015).
American Community Survey Data. The fact finder geographical region was defined
via zip code, 19104, or the University of Pennsylvania area. According to the University of
Pennsylvania’s website, they have both a Student Health Service (SHS) center and a Women’s
Health center open for up to twelve hours on certain days of the week, making it highly available
to student should they choose to utilize it (Vice Provost for University Life, 2015).

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According to the Census Bureau (2013), the population for this area as of 2013 was
52,800 people. This population consists of 26,439 males, or 50.1%, and 26,361 females, or
49.9% of the total population. The median age of these individuals is 22.3 years old. A majority
of the community are between the ages of 15 and 24, accounting for about 38% of the total
population. Age distribution for 15 to 19 year olds is 10,315 or 19.5% and the distribution of 20
to 24 year olds is 15,087 or 28.6%. These figures are representative of the target population for
this proposal.
The majority of race in this area is distributed highly between only a few races and
people of only one racial background. The majority of the population consists of white and black
or African American, coming in at 20,909 and 21,379, respectively. These totals account for over
80% of the racial distribution for this zip code. Asian is the next highest with 7,748 or 14.7%,
which encompasses Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese and other
Asian. Racial disbursement for the remainder is low, accounting for about 5% of the total. About
3% of the population consists of people of more than one racial background, White and Asian
being the highest at 1.3% or 678. White and black or African American is 205 or 0.4%. White
and American Indian or Alaska Native consisted of 87 people, or 0.2%. Finally, black or African
American and American Indian and Alaska Native had a total of 10 people, or less than .01% of
the total population. People of Hispanic or Latino origin accounted for 5.3% of the total (U.S.
Census Bureau, 2013).
According to the Census Bureau (2013), 81% of the total population speak only English.
The foreign born population in this area is 7,319. Those who speak a language other than English
encompass 19% of the total population (U.S. Census Bureau, 2013).

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The average household income is $34,292 and the median household income is $19,236
annually. Approximately 52.8% of the individuals and families living here are below the poverty
line although 80.4% are reported to have graduated high school or higher (U.S. Census Bureau,
2013).
As shown before, young women of black or African American heritage are at the highest
risk for contracting this disease. Based on the statistics, it is found that half of the population is
female, and the majority of the females are within the age range of the chosen target population.
This will make an intervention in this area especially useful and relevant to the population.
Qualitative Information
The focus population is college-aged women. In order to gain a more diverse and
subjective perspective, a visit to the University of Pennsylvania seemed like the best option. This
campus is quite large, much larger than that of something like Temple’s campus and, for this
reason, one would be able to obtain a broader and more encompassing observation of the area. It
also sits right next to Drexel’s campus, so close and vague that the end of Penn’s campus and the
beginning of Drexel’s is indiscernible. The bulk of the campus is located between Ludlow and
Spruce streets, with a handful of buildings past Spruce that reach almost to the river. The zip
code of UPenn is 19104 and the name of the area where it is located is called University City.
The community visit took place on Thursday, October 8, 2015, around 3 p.m. As far as the
criteria, evaluating some aspects that may tie into what the topic at hand was important, so an
observation of community resources, health care delivery, social cohesion, active community
groups, culture and entertainment, public transportation, infrastructure, and community safety
seemed like that best options.

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The first criteria evaluated was community resources, which there is an abundance of on
Penn’s campus. There is a great deal of green space on many parts of campus, even if it is a
small field of grass where students and faculty like to spend free time, but the largest on campus
is located on 40th and Walnut. The second largest is 34th and Walnut across campus which
seemed to have fewer people hanging out, most likely because this entire area serves mostly as a
walkway to and from many parts of campus. There is one main recreation center near the middle
of campus that is also their exercise facility.
Health care delivery on this campus is presumably easy to access and available. UPenn
has its own hospital, but this location on the outskirts of campus and a long walk or quick drive
would provide access to this. There is also a health service center available to students marked
on the map below. This is about average size for a campus health center.
In the social cohesion aspect of this observation, it was found that there is a large
presence of people on the streets as well as hundreds of students on campus at all times. The
overall mood of students is stressed and determined based on the academic expectation and
Penn’s reputation, but an aura of negativity does not exist in this area. As explained in the green
space note, there are many people hanging out around campus, weather dependent as well as the
time of day. There were many people on campus around the time that this was conducted.
There are a number active intramural community groups, many of which can be seen on
Locust walk or advertised there. All over campus and in campus buildings are bulletins boards
for different clubs and organizations for students to participate in. The groups that exist are
abundant in variety and a club for community service, sports, leisure, or other subjects are
available or can be commenced by students if the criteria are met.

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The culture and entertainment that exists on this campus, as well as surrounding areas, is
abundant. Restaurants and small cafes are available for the public to use and are classy, clean,
and reasonably priced. The oldest buildings on campus are historic and are on a national
registrar. There are interesting facts on plaques posted for passersby to read and learn about the
history. Access to other parts of Philadelphia is easy via the public transportation from many
parts of campus.
There is a plethora of public transportation around to choose from. This is one feature the
school prides itself on for ease of access to many parts of the entire campus as well as the rest of
the city. It is a very well used and popular form of transportation with trolley lines, buses, and
the Market-Frankford line easy and close to access. It is used by both people local to the
Philadelphia community but also many students and employees of the campus. This type of
transportation is relatively easy to use depending on the comfort of the user and their knowledge
of direction and it is also relatively inexpensive.
As far as community safety, the police and fire stations were not prominent. The
community is monitored by security and is well lit at night, especially centers of campus where
walkability is highest.
Within this community, there are three prevalent groups who could be employed to aid in
the intervention program. The first and possibly most obvious is student health services. This is
likely the place students visit when they are having health issues unless they turn to their primary
care physician at home. The reach of health services only goes as far as the utilization of them,
meaning if a student does not go, the information will not be given to them. The next group that
may be helpful in the intervention would be sororities or fraternities around campus. Penn has
prominent fraternity and sorority rows, of which both engage in volunteering and community

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outreach. Their voices and programs can be heard throughout campus and spread around given
the quantity of members in each group as well as the goal of their initiatives. This would also be
helpful because many people look up to or have trust in the students in these groups and there is
a certain camaraderie. Correct information coming from a peer, as opposed to an authority
figure, may be better received. This is the same instance for the third group, which is similar to
fraternities and sororities. Clubs and activity groups that exist on campus, particularly ones like
the LGBTQ center and other sexual awareness or liberation groups would be extremely helpful
to utilize and intervention. Unfortunately, a more detailed list of clubs with descriptions is only
available to students who can log on with a PennKey, so specific organization within the clubs
and activities section is not attainable. Each of these groups has some type of influence on the
community at large, so their assistance would be a great tool.
Below is a map of the University of Pennsylvania’s campus, followed by a key to explain
what each symbol represents:

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Conclusion
Holding a program at the University of Pennsylvania provides an appropriate medium for
the target population, college-aged women. College students are at a high risk for contracting
STDs and STIs due to their attitudes toward sexual activity. They are also at risk because of the
behavior a majority of students engage in, including alcohol consumption that may lead to risky
sexual behaviors. Women of this age group are at higher risk than their male counterparts and an
intervention would be useful and beneficial for all involved.
Proposed Intervention
Introduction

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Sexual Health Education for College-Aged Women (SHECAW), aims to provide
comprehensive and relatable sexual health education to a highly at-risk population of college-
aged women. The program will take place on the University of Pennsylvania main campus in the
quad where many students spend their time. This intervention will highlight the importance of
safe sex and the outcomes of risky sexual behavior, which lead to rampant rates of treatable
STDs, such as Chlamydia trachomatis in this population. UPenn’s Women’s center is a valuable
resource for female students and will serve as an effective venue for the intervention.. This
program aims to recruit at least 100 participants within the age range, a representative 5% of the
female student population.
This initiative will provide screenings for chlamydia as well as other STDs, an in-depth
dialogue between instructors and learners focusing on understandable and appropriate materials,
and provide effective forms of contraception that protect against STDs. A fitting model to be
used for the support and success of the program would be the Health Belief Model. The Health
Belief Model focuses on each decision-maker, in which they calculate whether or not a certain
behavior change will prove more beneficial despite the psychological costs. There are four main
components that make us this model, which include perceived risk or one’s susceptibility to bad
health, the severity of that condition, the advantages of changing behavior, and perceived barriers
or challenges in changing behavior (Green & Murphy, 2014). This model acknowledges the
health concern but will be implemented by the comprehensive educational approach and
eliminates any perceived limitations of available resources to the students by explaining the risks
and teaching learners to engage in less risky sexual behavior. This model will encourage students
to think about their behaviors and how those behaviors affect their health. An interactive

20
program will help alleviate perceived barriers to behavior change as well as highlight the
advantages of changing said behavior.
Table 1－Target Health Behaviors
Target Health Behavior Predisposing Factors Enabling Factors Reinforcing Factors
Risky Sexual Behavior ● Low self-efficacy in
ability to properly
use protection
● Receiving inaccurate
information from
peers about sexual
health
● Students think
condoms are too
expensive
● Nonchalance from
peers about sexual
health risk
behaviors
● Friends who do not
use proper
protection during
intercourse
STD Screening ● Lack of knowledge
of STIs and their
transmission
● Perceived personal
insusceptibility
● Limited access to
campus health
services
● Sexually active
peers do not get
screened
● Low social support
after confirmed STI
contraction
Existing Program Critique
Introduction
During the process of new project implementation, it is important to look at existing
programs concerning the same adverse health effect for various reasons. Consideration of the
methods and ideas that worked and did not is important so something that proved ineffective is
not repeated in the new program. The best practices can be pulled and redesigned to work for the
new project. If knowledge has since been discovered since the prior program, it can be properly
incorporated into the new one. A review of past programs will promote advancement in the
efficacy of the new intervention.
Intervention #1
Semaan, S., Neumann, M. S., Hutchins, K., D’Anna, L. H., Kamb, M. L. (2010). Brief

21
counseling for reducing sexual risk and bacterial STIs among drug users－
Results from project RESPECT. Drug and Alcohol Dependence, 106(1), 7-15.
doi:10.1016/j.drugalcdep.2009.07.015 or
http://www.sciencedirect.com/science/article/pii/S0376871609002919?np=y
Project Overview. The purpose of project RESPECT brief risk reduction counseling
(BRRC) is to assess how well HIV counseling reduces risky behavior and prevent HIV and other
STD contraction in participants versus participants who receive educational messages only. The
target audience was made up of approximately 4,000 HIV-negative, sexually active, heterosexual
present-day users of drugs such as heroin, cocaine, speedball, or crack. These individuals were
identified as at risk for STIs and selected from five different clinics in Baltimore, MD; Denver,
CO; Long Beach, CA; Newark, NJ; and San Francisco, CA. Risky behavior as well demographic
and economic determinants were identified as well.
Participants were identified as ever-injectors (EIs) or never-injectors (NIs) via their
answer to a question about using a needle to inject drugs into their veins or under their skin at
any time before their involvement in RESPECT. A participant identified as an EI answered yes
to this question and an NI answered no but reportedly had used drugs via smoking, inhaling, or
ingesting them. The intervention was a randomized controlled trial that ran from July 1993 to
September 1996.
Individuals were assigned at random to one of three different prongs of the program.
These interventions were individual, in person sessions with differing lengths of time and
varying subject matter classified as enhanced, brief, or informational. The enhanced intervention
consisted of four interactive counseling sessions that focused on theories of behavior change.

22
The brief risk reduction counseling was two sessions long and focused on client-centered
counseling for HIV, encouraging the participants to take action and set goals in order to reduce
their sexual health risk and included a pre and post test. The informational sessions were lecture
based messages about HIV and STIs and also included a pre and post evaluation. All participants
in any session received free treatment for bacterial STIs and condoms. The components of this
intervention addressed individual level determinants.
The resulting data of this study showed RESPECT brief or enhanced counseling was
successful at reducing sexual behavior risk and bacterial STIs among EIs and NIs. After 12
months, participants who received either type of counseling instead of attending the educational
workshops had fewer STIs. This is evident from the baseline comparisons and bacterial STI
correlates. At baseline, 19% of EIs had bacterial STIs versus 4% at 12 months. At baseline, 29%
of NIs had bacterial STIs versus 7% at 12 months. EIs reported they engaged in less risky sexual
behavior than baseline comparison.
Critique. A strength of this intervention is its 3-pronged approach at intervention
strategies. It also had behavioral and biological data which allows for stronger conclusions on the
effectiveness of the intervention. There have been few interventions that focus on STIs and
reduced health risk in drug users, and there are few that include EIs and NIs. A weakness of this
intervention is that it did not collect additional data regarding enough variables describing illicit
drug use by participants. Also, randomized controlled trials have a chance of being conducted
inconsistently.
Main Points.

23
● The program included three different (brief, enhanced, or informational)
intervention strategies of varying lengths randomly assigned to each individual
participant
● This trial assessed changes in behavior and STIs for ever-injectors and never-
injectors at 12 months
● A high amount of EIs (86%) and NIs (81%) completed the program and provided
follow-up data at 12 months, demonstrating satisfactory program efficacy
Intervention #2
Tucker, J., Teijlingen, E. V., Philip, K., Shucksmith, J., & Penney, G. (2006). Health
demonstration projects: Evaluating a community-based health intervention programme to
improve young people’s sexual health. Critical Public Health, 16(3). 175-189. doi:
10.1080/09581590600986358 or http://www.tandfonline.com/doi/abs/10.1080/
09581590600986358
Project Overview. Project Healthy Respect aims to address teenage sexual health in
vulnerable or socially excluded groups. Its goal also is to reduce teen pregnancy rates and the
adverse health effects of STIs and unwanted pregnancy. It is a complex and multi-stranded
intervention in Lothian Region of Scotland. This program utilized education and health
promotion activities as well as different ways to provide sexual health services to teenage
groups. This program argues that adopting quantitative and qualitative data will provide a
comprehension of both the context and process. It also records outcomes of behavioral change in
the target group. This intervention was community-based health promotion as well as service
delivery.

24
Healthy Respect wants to achieve the goals set forth by promoting good sexual health,
self respect as well as respect for others in interpersonal relationships. Components of the
program include 19 projects varying in time, geographical location in the region, amount of
clients, depth, and duration. This program uses the socio-ecological intervention involving inter-
agency action and policy analysis. The intervention hoped to reduce health risk via behavioral
change on an individual level. When the trials of interventions aiming to reduce unwanted
pregnancy were evaluated, little effect was shown, but this creates a conflict because ‘evidence
of no effect’ could possible also mean it is there but very small, or because methods were flawed.
Critique. A strength of this program is that is had multiple projects to use as
interventions and study the data collected from each one. It was also tailored for its target
population well. A weakness is that the trial highlights the possibility of bias towards low-impact
interventions because they were included in the review.
Main Points.
● Self-audits were run quarterly from each project to record progress, activity, and
quantitative impact in reaching project milestones
● The evaluation consisted of 19 complement projects of varying lengths
● After the conclusion of the program, there was little evidence of effect, indicating
a different approach is necessary.
Intervention #3
Hillis, S. D., Nakashima, A., Amsterdam, L., Pfister, J., Vaughn, M., Addiss, D., Marchbanks,
P. A.,Owens, L. M., & Davis, J. P. (1995). The impact of comprehensive chlamydia
prevention program in Wisconsin. Family Planning Perspectives, 27(3), 108-111. doi:
10.2307/2136107 or http://www.jstor.org/stable/2136107

25
Project Overview. The purpose of Comprehensive Chlamydia Prevention Program in
Wisconsin (CCPPW) was to reduce incidence and prevalence of the infection as well as
complications that arise when it goes untreated. This was accomplished by encouraging
collaboration of public and private healthcare providers, procuring governmental funding,
making low-cost testing available in centralized laboratories, bolstering selective screening in
family planning clinics as well as encouraging screening for everyone in the largest STD clinics,
providing data systems that may identify people with the highest risk, and assess the intervention
efficacy. The intervention addressed mostly environmental level determinants. The analysis
compares trends in reporting C. trachomatis infection in men and women to how many
laboratory tests come out positive since the commencement of CCPPW. It also compares the
incidence of females with the infection to the rate of pelvic inflammatory disease (PID) and
ectopic pregnancies.
The program compared four data systems for analysis. The Wisconsin Sexually
Transmitted Disease Surveillance System (WSTDSS) includes all positive tests for C.
trachomatis. The Wisconsin State Laboratory of Hygiene Information System (WSLHIS)
provides information regarding age, gender, county, the type of test performed, the type of
administered test, and the result. The Milwaukee City Health Department Bureau of Laboratories
(MCHDBL) is the largest testing facility in the state and includes how many tests were
performed, the type and result of the test, and the gender of the individual. The Hospital
Discharge Summary (HDS) provides information regarding admittance of women for PID and
ectopic pregnancies between 1982 and 1991. The criteria of included information in the analysis
varied for each database. All men and women between the ages of 10 and 55 were included from
WSTDSS, the total tests performed from WSLHIS and MCHDBL, and women between the ages

26
of 15 and 44 regarding the HDS. The varied data collections from each database encompassed
information from 1982-1991 because of the scope of the analysis. Following the implementation
of CCPPW in 1985, an observed reduction in incidence, prevalence, and complications of the
infection were seen. Trends in prevalence showed an increase from 1985-1987 but stabilized in
groups of women 20 years or older as well as men 25 years or older. Rates rose among the
younger population and peaked in 1990. There was a 40% decrease in incidence. Rates in
complications like PID and ectopic pregnancy complications decreased by 54%. These figures
indicate the program was successful.
Critique. A strength of this trial is that data is collected from multiple sectors allowing
for a more all-encompassing study regarding the information observed. A weakness is that in this
trial, all females were tested whereas only symptomatic males were tested, making it possible
that this data is skewed. This also makes it impossible to make conclusions regarding disease
occurrence between all men and women, since not all men are tested.
Main Points.
● The program analysis was made up of four different databases from the state of
Wisconsin to study statewide incidence and prevalence of C. trachomatis
● The evaluation of the program was based on reported rates of infection and
complications over a period of 4 years (1987-1991)
● After the program was established, four of the five evaluated indicators saw a
marked decline, indicating the prevention program was highly effective
Conclusion
These intervention strategies are important for the improved sexual health of our nation
based on its success. The programs reviewed are also important for improved design of

27
SHECAW. Maintenance of sexual health relies on a number of behavioral and lifestyle factors
based on the data from each of these programs. In order to properly utilize the information
presented here for SHECAW, the strengths and weaknesses must be taken into consideration to
expand and improve the strategies used. Taking past knowledge and success into consideration
will promote the development of a more efficacious new program.
Project Description
Introduction
Sexual Health Education for College-Aged Women (SHECAW) will address risky sexual
behavior, aiming to improve sexual health in women via screening and preventative measures.
The target population is approximately 100 college-aged women 18-22 years old of any race or
ethnicity. The program will be based at the University of Pennsylvania’s Women’s Center,
located at 3642 Locust Walk, Philadelphia, PA 19104. The participants of this program will
complete 12 weekly educational sessions facilitated by various teaching methods. The program
as a whole will occur over a 12-month period. Participants will be provided with a
comprehensive education about C. trachomatis screening and measures to prevent the spread of
the disease.
SHECAW will be supported by the Health Belief Model. This widely used behavior
change model states an individual will change if they the adverse condition can be avoided, their
action will result in the avoidance of that condition, and that if they choose to engage in this
behavior they will be successful. This program will highlight C. trachomatis as a negative health
outcome and avoidance of risky sexual behavior will effectively prevent the contraction of this
disease (Resource Center for Adolescent Pregnancy Prevention, 2016).

28
Once this program is completed, participants should know how sexually transmitted
diseases (STDs) are transmitted, the ways in which they can protect themselves from this
transmission, how to get treated should they become exposed or have an existing case, and
provide social support to reduce stigma among the group as well as the community.
Conclusively, the intervention will encourage the initiation or continued utilization of barrier
contraception, regular screenings, retain accurate knowledge to propagate to peers, and
ultimately reduce incidence and prevalence among the participants.
Program Framework and Structure
Program Preparation Activities. In order for the program to be properly facilitated and
prepped, the following steps are necessary. Approval from the Penn Women’s Center (PWC) is
required for a venue in which to hold the program sessions. Following this, staff for the program
must be interviewed and hired to facilitate to program. Materials will need to be ordered to begin
recruitment and workshop preparation. Flyers will be created and distributed throughout campus
as well as affixed to bulletins to draw in participants. The design of the program activities must
be commenced and finalized before the first cohort.
Overview of Program Structure. The participants of SHECAW will be present for 12
weekly sessions facilitated by a combination of the health educator, peer educators, nurse
practitioner, and psychologist. The health educator will be the primary facilitator of the lessons.
Two cohorts of 50 participants each will partake in the intervention activities. The class sessions
will take place on Monday evenings for 90 minutes each. The health educator will distribute an
outline for the objectives and activities of the day so participants can begin thinking about the
subject, know what to expect, and be able to review the content on their own time outside of
class. A sign-in sheet will be distributed to measure attendance. A combination of intrapersonal

29
and interpersonal activities will be conducted so each session will vary based on the plan for that
period. This intervention is similar to the Comprehensive Chlamydia Prevention Program in that
it encourages participants to get screened in order to reduce incidence and prevalence and it has
been shown that this program was highly successful (Hillis, Nakashima, Amsterdam, Pfister,
Vaughn, Addiss, Marchbanks, Owens, & Davis, 1995).
Program Materials, Equipment, and Facilities. Flyers and posters must be created to
distribute in order to recruit participants at the start of the program. T-shirts and drawstring bags
will also be used as promotional material and must be ordered. Various office supplies are
needed such as pens, pencils, markers, and index cards to be used during class sessions. Journals
for each participant must be ordered to distribute during session 1 of each cohort. Two anatomy
models must be ordered to be used during session 3 by the nurse practitioner as well as a
speculum as part of the demonstration. Condoms will be handed out during this presentation so
they should be ordered as well. Brochures will be used during session 8 about campus health
services. Blankets with the program acronym (SHECAW) will be ordered to be used as prizes
during educational games to encourage participation during sessions 5 and 11. A flipchart will be
used during group discussion in sessions 9 and 11. All educational sessions will require a
desktop computer and a projector with a screen. Laptops will be provided to staff members as
needed for sessions they facilitate. Desks will be provided for staff members to use. Chairs for
participants to utilize during class sessions will be required. Classroom, office, and storage space
will be provided by PWC.
Program Staffing. This intervention will require a full-time Program Director and CHES
Health Educator, a psychologist, nurse practitioner, and two peer educators. The program
director will ensure the smooth collaboration and facilitation of all staff and class sessions. The

30
CHES health educator is responsible for designing all educational program activities as well as
instructing or assisting in each session. A psychologist will assist in two sessions but will mostly
serve as a contact of support for emotional or psychological concerns participants have during
cohort periods. The nurse practitioner will also assist in two sessions but will serve as a resource
for medical information and screening for the participants. The peer educators will be the
primary facilitators for session 4 with assistance from the health educator and will assist the
health educator during other sessions. They will also serve as additional points of contact
regarding participants’ questions regarding the program.
Table 2－Project Timeline
Activity Jan Feb Mar April May Jun July Aug Sep Oct Nov Dec
PWC
Approval 𝛷
Hire Staff 𝛷 𝛷
Order
Materials 𝛷
Train Staff 𝛷 𝛷
Distribute
Flyers 𝛷 𝛷 𝛷 𝛷
Recruit
Participants 𝛷 𝛷 𝛷 𝛷 𝛷
Program
Activity
Design
𝛷 𝛷 𝛷
SHECAW
Program
Cohort 1 𝛷 𝛷 𝛷
Cohort 2 𝛷 𝛷 𝛷

31
Staff
Quality
Meeting
𝛷 𝛷 𝛷 𝛷 𝛷 𝛷 𝛷 𝛷
Evaluation
of Program 𝛷 𝛷 𝛷 𝛷 𝛷 𝛷 𝛷 𝛷
Follow-up 𝛷 𝛷 𝛷 𝛷 𝛷
Program Activities
The health problem SHECAW addresses Chlamydia trachomatis in women ages 18-22.
The focus of this program addresses two health behaviors: risky sexual behavior and STD
screening. The table below highlights predisposing, reinforcing, and enabling factors pertaining
to these target health behaviors.
Table 3－Factors for the Target Health Behaviors
Target Behavior Intrapersonal
Program Components
(Predisposing Factors
Being Addressed)
Interpersonal
Program Components
(Reinforcing Factors
Being Addressed)
Community Program
Components
(Enabling Factors
Being Addressed)
Risky Sexual Behavior ● Low self-efficacy in
ability to properly
use protection
● Receiving
inaccurate
information from
peers about sexual
health
● Nonchalance from
peers about sexual
health risk
behaviors
● Friends who do not
use proper
protection during
intercourse
● Students think
condoms are too
expensive
STD Screening ● Lack of knowledge
of STIs and their
transmission
● Perceived personal
unsusceptibility to
STIs
● Sexually active
peers do not get
screened
● Low perceived
social support after
confirmed STI
contraction
● Limited access to
campus health
services
Intrapersonal Program Components. The predisposing factors associated with
intrapersonal program components deal with a combination of low self-efficacy regarding use of
protection, inaccurate information about sexual health, lack of knowledge about STIs and STI

32
transmission, and a perceived unsusceptibility to contracting STIs. In order for a successful
behavior change and subsequent program success, participants must gain confidence in their
ability to use protection, correct any misinformation about the health issue, learn more about
STIs, know the means of STI transmission, and become knowledgeable about how susceptible
they are to contracting STIs should they choose to engage in risky sexual behavior. The health
educator will have to take these ideas into consideration during the design of the lesson plan.
Sessions 2 through 5 should effectively cover these factors via different teaching methods and
subjects. Lessons, activities, and other details about each session can be found in table 4.
Interpersonal Program Components. The reinforcing factors associated with
interpersonal program components address nonchalant attitudes from peers about health risks
and friends who do not use proper protection during intercourse. Session 4 covers the general
attitudes of the participants in that cohort and can be evaluated by the health educator once
brainstorming papers are collected. Peers who do not use protection during intercourse can be
identified in 1 and 4 and can be rectified in sessions 7 and 9. Reinforcing factors also highlight
peers who do not get screened if they are sexually active, which will be rectified when all
participants are required to make an appointment with the nurse practitioner in session 8. Low
perceived support from peers deals with a combination of sessions including 4-6 and 9. The
lessons and activities in these classes will improve participant’s views and knowledge as well as
encourage a communal support system.
Community Program Components. The enabling factors for this program are that
condoms are too expensive for college students to want to buy them and they have limited access
to campus health services for various individual reasons. Condoms will be provided to students
for free in session 3 to address the issue of cost. Session 3 also talks about campus health

33
services that students can utilize. Brochures will be handed out in this class with the information
so participants can take it with them. Overall this session will aid in perceived barriers to
changing behavior for participants.
Table 4－Session Content, Lessons, and Activities
Session Content, Facilitator(s), & Material Lesson & Activities
1 Evaluation
Facilitator(s):
Health Educator
Peer Educators (observe)
Materials:
Journals, tests, pencils
Lesson: Introduction of staff to students.
Activity: Survey of the overall knowledge of the
participants regarding Chlamydia trachomatis with
an assessment of sexualrisk behaviors.
Icebreakers following test to increase familiarity
and camaraderie among classmates. Journals will
be distributed to students at the end of class.
2 What is Chlamydia trachomatis?
Facilitator(s):
Health Educator
Peer Educators (observe)
Materials:
Prepared index cards,glitter
Lesson: Epidemiology, definition, symptoms, risk
factors,transmission, adverse health effects
Activity: Students will be given an index card with
a C, A, BC, or U. Students with a C on their card
will have glitter put on their hands, they are
representative of people with C. trachomatis.
Students with an A on their card are representative
of abstinence. Students with a BC on their card
will represent people who choose barrier
contraception during sexual activity. Students with
a U represent people who are unprotected during
intercourse. All students, except for cards with an
A, will then go around the room shaking hands
with multiple people for a few minutes. At the end,
students with glitter on their hand will be asked to
stand. This will show students how connections
with any number of partners may expose them to
STI/Ds and will stress the importance of screening
even if barrier contraception is used because
exposure is still possible.
3 Testing, Treatment and Prevention
Facilitator(s):
Health Educator
Nurse Practitioner
Materials:
Anatomy models, PAP & STD
test kit, condoms, speculum
Lesson: Lecture on various testing procedures,the
way the infection is treated,prophylaxis.
Activity: Condoms will be handed out to students.
Nurse Practitioner will demonstrate an STD test on
a model for the class and questions about different
procedures can be answered.

34
4 Attitudes, Norms, and Gender Roles
Facilitator(s):
Peer Educators
Health Educator
Materials:
Quiz, pencils
Lesson: Class will begin with a quiz based on
material from past two informational sessions.
Peer educators will lead this discussion with the
help of the Health Educator to speak to students in
relation to attitudes pertaining to sexuality as well
as perceived expectations from family, friends,
peers,and society regarding sexual behavior and
assigned roles as females.
Activity: Participants will break off into groups
and discuss personal beliefs and attitudes towards
sex, contraception use, and behavior. One group
member will write down ideas and papers will be
collected by Health Educator.
5 Myths and Stereotypes
Facilitator(s):
Health Educator
Materials:
1 blanket embroidered with
SHECAW acronym
Lesson: Common misconceptions about sex,
STDs, and contraception will be discussed.
Activity: Online Kahoot quiz with mobile devices
to gauge understanding of facts and myths
surrounding the topics learned that period.
Participant with the highest score will receive a
blanket as a prize.
6 Sexual Communication and Decision-
Making
Facilitator(s):
Psychologist
Health Educator
Materials:
No special materials
Lesson: A psychologist will visit to discuss
barriers to proper communication with sexual
partners and how to overcome them, methods of
talking about STDs with potential new partners,
strategies to make healthy decisions when
engaging in sexual behavior.
Activity: Students will be given time to reflect and
write in their journals about instances when they
felt they did not have the skills to properly
communicate/decide and how they can do that
differently in the future. They may also write
about positive experiences to reinforce that
behavior. Should this be difficult for any
participant, students have the option of speaking
individually with the psychologist.
7 Behavior Change
Facilitator(s):
Health Educator
Psychologist
Materials:
Lesson: Approaches to thinking about and
implementing individual behavior change will be
discussed. Methods of how to make healthy
behaviors into habits will be taught.
Activity: Students will write in their journals
sexually healthy habits they would like to initiate
or maintain and write why they are important to
their overall physical and mental health. Students
will have the opportunity to speak with the
psychologist regarding ways to personally

35
encourage self efficacy,habit forming and
discussing any issues they may be having
regarding content.
8 Campus Services
Facilitator(s):
Health Educator
Nurse Practitioner
Materials:
Informational brochures
Lesson: Information regarding campus student
health services will be given out and any questions
can be answered.
Activity: Students will make an appointment to get
a free STD screening with Nurse Practitioner.
9 Social Support
Facilitator(s):
Health Educator
Materials:
Flipchart, markers
Lesson: Highlight the importance of peer and
familial support in maintaining healthy sexual
behaviors.
Activity: Journaling for some time about
individual perceptions of support systems. Small
group discussion on thoughts, feelings, and ideas
derived from lecture.
10 PersonalStatement
Facilitator(s):
Health Educator
Materials:
Lesson: Explain the final assignment and answer
questions regarding expectations for final
reflection.
Activity: Students will begin in class an
anonymous reflection paper on things they have
learned and ways they have changed during the
intervention.
11 Review
Facilitator(s):
Health Educator
Materials:
Flipchart, markers, 13 blankets
embroidered with SHECAW
acronym
Lesson: Participants will turn in anonymous
statements at the beginning of the period. Content
and ideas from sessions will be reviewed for post
evaluation.
Activity: Students will be split into four groups. A
team leader will be appointed for each. Students
will then participate in a jeopardy game with
knowledge about various program subjects. The
team that wins each get a blanket as a prize..
12 Evaluation
Facilitator(s):
Health Educator
Peer Educators
Materials:
Test, pencils
Lesson: Closing statements.
Activity: Post test of participants knowledge and
behaviors.
Conclusion
Sexual Health Education for College-Aged Women intends to reduce the risk of C.
trachomatis in women ages 18-22 by educating them on information regarding methods to

36
change their behavior to become more self-efficacious about dealing with their own sexual
health. The target behaviors highlight risky sexual behavior and STD screening and the various
activities implemented in the program will address the predisposing, enabling, and reinforcing
factors associated with the continuation or initiation of these, respectively. The participants are
expected to increase their rates of C. trachomatis screening in order to reduce incidence as well
as learn about disease complications (Hillis, Nakashima, Amsterdam, Pfister, Vaughn, Addiss,
Marchbanks, Owens, & Davis, 1995).
Mission Statement
The goal of this public health intervention is to provide education and a safe, open
learning environment to at risk college-aged women, 18-22, for preventable STDs like
Chlamydia trachomatis. SHECAW aims to impart proper knowledge and care for individuals as
well as provide a supportive network in which participants feel free to communicate and learn.
Goals
1. Significantly reduce incidence and prevalence of infection among the target
population.
2. Increase awareness about the disease.
Process Objectives
1. By the end of the sixth month, 100 women ages 18-22 will be enrolled in the
SHECAW program.
2. After six months, 50% of participants will have received the education and
training via class sessions.
3. By the end of the third month, all staff will have received training in program
instruction and implementation.

37
Outcome Objectives
1. One year after the end of the program, there will be at least a 65% increase in the
number of college-aged women getting tested for C. trachomatis as well as other
STDs.
2. One year after participating in SHECAW, 75% of participants will report they are
continuing to use barrier contraception methods such as condoms to reduce the
spread of C. trachomatis.
Conclusion
The goals and objectives set forth in the SHECAW program will prevent further
transmission of Chlamydia trachomatis in college-aged women and their counterparts following
the completion of this program as strategies and provided protection are implemented.
Marketing Plan
Introduction
The overall goals of this intervention are to reduce new cases of C. trachomatis in the
target population, create a judgement free support network, and ensure the participants leave the
program with a better understanding of STD transmission as a means of prevention. In
cultivating a marketing plan, the social tendencies of the target population were taken into
consideration during the research and development phase of creating the materials. The hope is
to not only get the information out to students but to also get them excited and eager about the
program. In order to recruit an appropriately diverse target sample size, messages to promote the
program that are culturally relevant will be utilized.
Marketing Strategies

38
In order to effectively promote the intervention program, appropriate marketing strategies
must be used. For marketing and promotion of SHECAW, existing university services will be
contacted and utilized, social media campaigns will be created, flyers and posters will be
distributed throughout campus, WQHS radio will be contacted to place an ad, and university
listserv will be used in order to send a message to its students who qualify to participate as well
as the general student body.
Community Mobilization. The Program Director’s role in this step is crucial in the
success of this marketing strategy. As a means of engaging the main stakeholders in the
community that have the most reach to students, the Program Director will meet with associates
from each campus center listed above to discuss the rationale of the program. Its relevance to the
target population will be established to ensure the centers involved are in accordance with the
program goals. Posters and flyers will be used in each of these locations to advertise the
necessary information to become involved as a participant. UPenn’s student health services will
also be involved in a similar sense. The Penn Women’s Center is a central community partner in
this intervention. All promotional print materials will be utilized in this location and will also
rely on the members who work in the center to provide information word of mouth. This is why
it is important for the Program Director to speak with each community stakeholder so that the
correct information is given out. Student may also sign up in this location. UPenn’s Student
Health Services will function similarly. The physicians, nurse practitioners, and nurses as well as
administrative staff will know the information to refer students to the program.
Posters and Flyers. The University of Pennsylvania (UPenn) is a large campus with
many walkable areas utilized heavily by students on a daily basis. Located at various point on
campus are outdoor bulletins in which promotional flyers and posters will be adhered with

39
information about how to get involved with the program. These materials can also be displayed
on the bulletin boards located in each building as well as the dormitories on campus. The flyers
displayed on the bulletins around campus as well as in campus buildings and dorms with display
the title of the marketing material and the title of the program. It will ask the reader the criteria
instead of listing it as a means of grabbing their attention. For example, the top of the flyer will
say “Are you female?” and “Are you between the ages of 18 & 22?” and so on, leading down to
where and when the program will take place as well as the social media platforms. This will be
able to reach more people should they overlook other means of advertisement.
Social Media. A social media campaign will be launched on Facebook, Twitter,
Instagram, and Twitter as a useful marketing platform for a far reaching audience. Social media
in this instance will focus mainly on reaching as many people as possible. A public Facebook
group will be created with coinciding twitter and instagram pages. The Facebook page will have
informational posts and photos from the instagram page linked to it. The Facebook page will
serve as a public reminder of deadlines as well as a forum that people can ask questions. Twitter
will focus on these aspects as well but will be a more brevity because of character limits and act
as another medium for questions. The instagram page will hopefully serve as a vehicle for more
people who would respond well to visuals.
WQHS Radio. UPenn has its own radio station that is run by students, broadcasted online
called WQHS. This station is 24 hours a day, 7 days a week so running an advertisement on this
medium would be quite effective in reaching the target audience. The radio advertisement
broadcasted on WQHS will begin with a statistic about chlamydia as well as how harmful it
could be to one’s body. It will then state that the STD is mostly asymptomatic. It will go on to
describe the program by stating the target population, when it begins, and how students can

40
register. The broadcast will emphasize information available from the listserv as well as social
media outlets. This will be appropriate to the target audience as it describes them and may pique
their interest in finding out more about the intervention.
UPenn Listserv. The same flyer posted around campus will be attached to an email sent
out via the university listserv to every student along with additional information on who to
contact for more information.
Conclusion
These strategies are created to pique the interest and encourage the enrollment of as many
eligible participants as possible. The materials cater to a variety of inclinations, including visual
and auditory. Paper materials ensure greater reach outside of the realm of technology. Social
media appeals to the target population and their cohorts. Involving community centers allows
participants to listen to and assures proper reception of information. Information regarding the
program available on different mediums allows for a better reach to the target population. The
different approaches will ensure that the reception of the program is sufficient to admit an
adequate amount of eligible individuals.
Evaluation Plan
Process Objectives
➼By the end of the third month, all staff members will have received training in program
instruction and implementation.
Staff training will take place in February and March after all faculty has been hired.
Faculty will have to demonstrate a clear understanding of the program goals, procedures, and
material. This will show the number of staff qualified to facilitate the program measured by
testing prior to training and at the end before the first cohort takes place.

41
➼By the end of the sixth month, 100 women ages 18-22 will be enrolled in the SHECAW
program.
Faculty will evaluate registration applications as well as signed Informed Consent forms
to assess the number of eligible enrolled participants. This will confirm that participants know
the procedures, benefits, and purpose of the intervention program. The signature will also let the
program director know the participant is aware they are free to leave the program should they not
wish to continue in activities. This will be measured by the amount of complete and signed
applications the program director receives and the total number of these applications will
determine the number of participants.
➼After six months, at least 50% of participants will have received the education and training via
class sessions.
A sign-in sheet will be passed around at the start of each session for participants to record
their name as a measure of class attendance. It will be the health educator’s responsibility to
make sure everyone has signed the sheet when they arrive to class or before they leave.
Impact Objectives
➼After eight months, participants will have seen a healthcare provider to screen for STDs.
In order to ensure this objective is successful, participants will make an appointment with
the nurse practitioner during session 8. This will depend on attendance to the sessions for
screening assurance. The nurse practitioner will do an evaluation of each participant and
determine is necessary as well as encourage the participants to continue to seek care by
providing resources.
➼After 3 workshops, participants will be able to identify the ways in which C. trachomatis is
transmitted, treated, and prevention measures.

42
The health educator will distribute a multiple choices quiz at the start of session 4 to
assess what participants have retained from the previous classes. The amount of quizzes
completed with an adequate score will determine whether or not this objective is successful.
➼By the end of the program, there will be a 75% in the number of women who report engaging
in less risky sexual behavior.
There are two ways in which this objective can be evaluated. Participants are assigned a
reflection paper/personal statement in session 10 and will submit it anonymously in session 11.
Staff will read each response There is also a post evaluation administered in session 12 that can
be compared to the baseline examination. Either method will yield data regarding the program
efficacy in reducing risky sexual behavior.
Outcome Objectives
➼One year after the end of the program, there will be at least a 65% increase in the number of
college-aged women getting tested for C. trachomatis as well as other STDs.
Staff will send each participant an email with a survey about whether they have received
testing in the past year or not. The responses to this email will be calculated in order to determine
percentage of screening for C. trachomatis among women who participated in the program.
➼One year after participating in SHECAW, 75% of participants will report they are continuing
to use barrier contraception methods such as condoms to reduce the spread of C. trachomatis.
Participants will be sent a survey via email to follow up on their sexual behavior habits
and continuity of sexual risk reduction measures. The percentage will be calculated by staff
when they receive responses to this email.
Quality Assurances

43
In order to adequately assure the quality of SHECAW, assessment measures will be
taken. All promotional material will be the same to ensure equivalency in the reception of
information by potential participants. Staff will be trained similarly, with specifications
regarding their role in the program. The Health Educator for SHECAW must be a Certified
Health Educator Specialist (CHES) from the National Commission for Health Education
Credentialing. Inc. These individuals take an exam to test their ability and knowledge in several
areas of responsibility and become a CHES upon passing. These areas require that the individual
have the skills to plan, implement, and even evaluate health materials. They will serve as a
reliable and credible resource throughout the program. (National Commission for Health
Education Credentialing Inc., 2016). This thoroughly trained professional will know the
appropriate tools needed to teach a variety of audiences.
The Health Educator will also work alongside the Program Director to develop
appropriate policies for classroom conduct among participants and staff. This will include rules
for students acting accordingly when participating in interpersonal group settings in which
discussion is the focus. The rules will also set precedence for confidentiality between members
and those outside of the program. The health educator will design educational sessions to be used
in both cohorts to ensure that all participating individuals are getting the same material and
information. Staff will convene to discuss expectations and to answer any questions prior to the
first session. These meetings will occur once a month during the program as well to ensure all
faculty are on the right track.
Human Subjects Assurances
The comfort and safety of participants is paramount to the success of the program;
without it a major program goal of a support network will flounder. In order to protect

44
participants, an Informed Consent form will be preliminary disbursed and collected as part of the
registration process. This form will be in plain, understandable language. It will explain the steps
and purpose of the program, benefits, policies enforced to ensure individual safety both in and
out of the program sessions, as well as procedures to ensure individual rights as a participant.
Individuals will not be able to participate in the sessions until the signed form is returned to the
Program Director with the rest of the registration material. Should issues regarding the
withdrawal of a person from the program arise, these materials may be referenced as well.
An additional measure employed to protect the individuals participating will be faculty
background checks. This will occur prior to staff being hired to facilitate the program to ensure
the quality of the persons involved in the program. Should staff not pass the background check or
refuse to comply with one, they will not be hired. Furthermore, national certifications may be
required for certain roles such as the Health Educator, who must be certified in health education
as mentioned in the prior section. A candidate who is not a Certified Health Education Specialist
will not be considered for the position of Health Educator in this program.
All information regarding these assurances will be collected by the Program Director.
Once received, only the Program Director will have access to this particular information for
further review. A file for every participant and staff member will be created and stored in a
locked storage armoire located in the faculty office space to which the Program Director holds
the key. It is the responsibility of the Program Director to ensure this closet is closed and locked
at all times and that they do not permit another member of the staff access for any reason.
Conclusion
Proper evaluation is vital in determining the success of any program. The measures, data,
and methods described in this section will effectively assess how efficacious project SHECAW

45
is. Quality assurances and human subjects assurances are important to note in order to ensure the
program is as safe and comfortable as it is successful. The measures described will support a
safe, ethical, and productive intervention program for staff and participants.
Budget and Justification
Direct Costs
I. Personnel
A. Salaries FTE Cost
Position
Project Director 1.0 $50,000
Health Educator 1.0 $32,000
B. Benefits @ 35% $28,700
Total Personnel $110,700
C. Consultants and Contractual Services
Psychologist: 5 hrs/wk @ $100/hr x 24 wks. $12,000
Nurse Practitioner: 3 hrs/wk. @ $90/hr x 24 wks. $6,480
Peer Educators (2): 2 hrs/wk. @ $15/hr x 24 wks. $1,440
Total Consultant/Contractual Services $19,920
II. Non-Personnel
A. Consumable Supplies
Office Supplies $775
Photocopying
1,500 copies @ $.10 each $150
Educational Materials

46
105 journals @ $1 each $105
150 brochures @ $.30 each $45
1 flipchart @ $30 each $30
2 Female Reproductive System Anatomy Models @ $200 each $400
440 Condoms @ $.10 each $44
Promotional Materials
150 T-shirts @ $10 each $1,500
150 Drawstring bags @ $.50 each $75
30 Embroidered Blankets @ $29.50 each $885
5 Posters @ $15 each $75
Test Kit Materials for Nurse Practitioner
500 count PAP test kit 1 @ $500 $500
105 Speculums @ $4 each $420
102 STD Diagnostic Tests @ $13 each $1,326
Total Consumable Supplies Costs $6,330
B. Travel
50 miles a week for faculty @ $.28 a mile x 45 wks. $630
Parking $300
Total Travel Costs $930
C. Equipment
1 Computer @ $800 each $800
5 Laptops @ $300 each $1,500
In-Kind:

47
1 Projector @ $1,000 each $1,000
1 Projector Screen @ $130 each $130
3 Desks @ $150 each $450
51 Chairs @ $25 each $1,275
1 Storage Closet @ $500 $500
Total Equipment Costs $2,300
Total In-Kind Equipment Costs $1,975
III. Location
D. Space Rental
In-Kind:
Women’s Center Space [3 hrs/wk @ $75/hr x 24 wks.] $5,400
In-Kind: Women’s Center Office Space [$100/wk x 24 wks.] $2,400
Total Location Costs $0
Total In-Kind Location Costs $7,800
E. Other Costs
6 Background Checks @ $50 $300
Telephone/Highspeed Internet [$75/month x 12 months] $900
Computer Software [one time expense] $330
Liability [$125/wk x 44 wks.] $5,500
Property [$100/wk x 52 wks.] $5,200
Total Other Costs $12,230
Total Direct Costs $152,460
Indirect Costs @ 30% $45,738

48
Total Program Costs $198,198
Total In-Kind Contributions $9,775
Justification
Direct Costs
I. Personnel
A. Salaries
1. Program Director: The Program Director of SHECAW will have a Master’s Degree in
Public Health, preferably with a concentration in Social and Behavioral Science or close
equivalent. The program director will facilitate meetings with staff to ensure sessions are
running as planned and material is being covered in a timely manner. The program
director also has the responsibility of interviewing and hiring all other faculty in this
program. The program director is also responsible for ensuring all participant files are
complete and kept confidential. All of their time will be spent on the planning and
implementation of program activities. Total amount requested: $50,000 a year.
2. Health Educator: The health educator will have a minimum of a Bachelor’s Degree in
Public Health and will be a Certified Health Education Specialist (CHES) by the National
Commission for Health Education Credentialing, Inc. The job of the Health Educator is
to design lesson plans appropriate for multiple intelligences through various teaching
methods. The Health Educator will be present and facilitating for 100% of the sessions.
Total amount requested: $32,000 a year.
B. Fringe Benefits

49
The fringe benefits were calculated at 35%. This will cover basic health insurance, employee
benefits, vacation or sick leave, as well as other expenses that may come up during the program.
Total amount requested: $28,700.
Total Personnel Costs $110,700
Consultants and Contractual Services
1. Psychologist: A licensed professional will be hired to talk with participants in an
individual setting. The psychologist will also assist in teaching two sessions regarding
behavioral changes and proper communication strategies. The weeks in which the classes
are facilitated by the psychologist will serve as part of their required hours. This
individual will work five hours a week for 24 weeks. Hourly rate will be $100. Total
amount requested: $12,000.
2. Nurse Practitioner: A qualified Nurse Practitioner will provide the health screenings
needed to assess the effectiveness of the program and also facilitate two portions of the
program. Any health question will be directed to this individual. The NP will screen all of
the participants as well. Hourly rate will be $90. This professional is needed for three
hours for 24 weeks. Total amount requested: $6,480.
3. Peer Educators: The peer educators will be selected by the program director who are
familiar with the health issue. They will preferably be Public Health Graduate students
from UPenn. Their presence will help market this program in a way that is relatable to the
community. These individuals will have a say in exactly what content goes into the
development of marketing and classroom materials to make them more culturally
appropriate. They will work two hours a week for 24 weeks. The hourly pay is $15. Total
amount requested: $1,440.

50
Total Consultants and Contractual Services Costs $19,920
II. Non-Personnel
A. Consumable Supplies
Office Supplies: For this program, various writing utensils are needed, including
pens, pencils, and markers. This also includes paper, staples, folders, ink, index
cards, and anything else that could come up as an expense for the faculty of the
program. Total amount requested: $775.
Photocopying: A reprographics service will be needed to provide copies of all in
class worksheets, tests, quizzes, or outlines. Total amount requested: $150.
Educational Materials
Journals: Each participant will receive their own journal to log their behavior during the
program. These will be required for successful completion. A few extra are factored into
the amount to account for loss. Total amount requested $105.
Brochures: During a session regarding where a participants can access health care on
campus, informational brochures will be passed out. 150 are required so there are some
extra after giving them to all of the participants. Total amount requested: $45.
Flipchart: A flipchart will be used during class sessions to facilitate discussion and
brainstorm in front of a room in a way that allows instructors to save the written
information about what students are talking about.. Total amount requested: $30.
Anatomy Models: These models are required for the Nurse Practitioner to lead a
discussion and demonstration on PAP/STD tests in front of the class. Two models are
required to show the reproductive tract from different angles. Each are $200. Total
amount requested: $400.

51
Condoms: Condoms will be handed out to participants during the same lecture the
anatomy models are used. They will encourage use after discussing prevention measures.
200 are required at $.21 each. Total amount requested: $44.
Promotional Materials
T-shirts, Drawstring Bags, and Blankets: These products will be used as incentive for
the successful registration and participation in the program. This will require 150 of the t-
shirts and drawstring bags at $10 and $1, respectively. The embroidered blankets are
$29.50 each and 20 are required. Total amount requested: $2,535.
Posters: These will be an important component in the marketing strategies. Five of these
24” x 36” will be required to hang around campus. Total amount requested: $75.
Test Kit Materials for Nurse Practitioner
PAP Test Kit: This test kit is a 500 count to perform PAP test on women. This is
required for the Nurse Practitioner to provide screening kit is $500.
Disposable Speculum: These instruments will be used to assist in performing the PAP
test. Extra are accounted for to be used in lecture. Each speculum costs $4. Total amount
requested: $420.
STD Diagnostic: This cost is the approximate cost of each laboratory examination of the
PAP tests. It is $13 per participant. Total amount requested: $1,326.
Total Consumable Supplies Costs $6,330
B. Travel
This expense is calculated by the approximate number of miles all the staff will
have to travel to come into work during the intervention program. Parking

52
expenses are also reimbursed to each faculty member. Total amount requested:
$930
Total Travel Costs $930
C. Equipment
Computer: A desktop computer will be required to store the most important
information collected during the program. The cost of this device is $800. A total
of four laptops will also be needed to provide each faculty with a means of
recording pertinent information when they do not have access to the desktop
computer. Total amount requested: $2,000.
Projector: This is required to properly facilitate all lecture sessions via media the
health educator designs for the program. This will be provided in-kind as it is
already installed in a classroom of PWC. Total amount requested: $1,000.
Projector Screen: The screen is also required to properly facilitate all lecture
sessions via media the health educator designs for the program. This will be
provided in-kind as it is already installed in a classroom of PWC. Total amount
requested: $130.
Classroom Furniture: The desks will be used by the faculty as a workspace and
one will also house the main computer. Each desk will cost $150. The chairs will
be used by participants during class sessions to provide a comfortable learning
environment. Each chair is $25. The storage closet will be used to store files while
class is not in session and also journals of participants should they wish to leave
them. This closet must have a lock in which the program director has a key to.
The cost of the closet/armoire is $500. Total requested amount: $2,225

53
Total Equipment Costs $2,300
Total In-Kind Equipment Costs $1,975
III. Location
D. In-Kind Space Rental
Classroom/Women’s Center: This space will be required in order to meet for
activities or class sessions during the program. This will be rented for three hours
a week at $75 an hour for 24 weeks. Total amount requested: $5,400
Office Space: This space is required for planning of the program in the early
stages, storage of participant information in the locked closet, storage of
promotional material before it is distributed and any extra material, and a place in
which the program director can work on making sure the program continues to
run smoothly. Total amount requested: $2,400.
Total Location Costs $0
Total In-Kind Location Costs $7,800
E. Other Costs
Background Checks: Each staff member once hired must undergo a background
check. This is $50 per person, which will cost $300. Total requested amount:
$300.
Internet: This package will be needed to give faculty members access to the
internet and also ensure that the staff members can communicate via electronic
sources. This service is $75 a month for 11 months. Total requested amount:
$825.

54
Computer Software: The desktop computer will need Microsoft office in order to
faculty to effectively record data and other information about the program. This is
a one time expense in which the software can then be installed into the computer.
Total requested amount: $330.
Liability Coverage: The project requires this type of insurance in the event that
someone is physically injured while on the program premises. This will cost $125
a week for weeks. Total requested amount: $5,625
Property Insurance: SHECAW requires property insurance to cover the facilities
provided by the University of Pennsylvania. Should any property or in-kind
material be damaged at any time in the duration of the program, the insurance will
cover the cost. Property insurance is $100 a week for 45 weeks. Total requested
amount: $4,500.
Total Other Costs $12,230
Total Direct Costs $152,460
Indirect Costs
Indirect costs are created to reimburse The University of Pennsylvania Women’s Center.
This aims to cover any excess costs that may come up in the duration of SHECAW. The rate is
30% of the total direct cost.
Total Indirect Costs $45,738
Total Cost for Project SHECAW $198,198
Conclusion
Sexually transmitted disease, especially C. trachomatis, is a substantial issue within the
college population of the United States but women carry the greatest burden of disease. There are

55
powerful implications in creating programs that work toward education, screening, and treatment
of cases, especially ones that exist currently in this target population. The analysis and
intervention program presented here suggests helpful primary and secondary prevention
measures but also provides a means of treatment. This proposal has explored aspects of this topic
in order to develop an approach that is appropriate to the target audience.

56
References
Bébéar, C., & Barbeyrac, B. (2009). Genital Chlamydia trachomatis infections.
Clinical Microbiology and Infection. Retrieved December 2, 2015, from
http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2008.02647.x/full
Better Health Channel. (2011). Salpingitis. Sexually Transmitted Infections. Retrieved December
2, 2015 from
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/salpingitis
Carder, C., Mercey, D., & Benn, P. (2006). Chlamydia trachomatis. Retrieved December 2,
2015,
from http://www-ncbi-nlm-nih-gov.libproxy.temple.edu/pmc/articles/PMC2563901/
?tool=pmcentrez
CDC. (2015[A]). Chlamydia. 2014 Sexually Transmitted Diseases Surveillance. Retrieved
December 2, 2015, from http://www.cdc.gov/std/stats14/chlamydia.htm
CDC. (2015[B]). Chlamydia - CDC fact sheet (detailed). Chlamydia. Retrieved December 2,
2015, from http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm
CDC. (2015[C]). Chlamydia Treatment and Care. Chlamydia. Retrieved December 2, 2015, from
http://www.cdc.gov/std/chlamydia/treatment.htm
Cornell University. (2015). Binary fission and other forms of reproduction in bacteria.
Department of Microbiology. Retrieved December 2, 2015 from
https://micro.cornell.edu/research/epulopiscium/binary-fission-and-other-forms-
reproduction-bacteria

57
Ferrer, R. (1998). Lymphadenopathy: Differential diagnosis and evaluation. American
Family Physician. Retrieved December 2, 2015, from
http://www.aafp.org/afp/1998/1015/p1313.html
Garcia, J., Reiber, C., Massey, S., & Merriwether, A. (2012). Sexual hookup culture: A review.
Retrieved December 2, 2015, from http://psycnet.apa.org/journals/gpr/16/2/161/
Gaydos, C. (2013). Chlamydia trachomatis. In Women & Health (Second ed., pp. 445-459).
Baltimore, Maryland: Academic Press.
Gewirtzman, A., Bobrick, L., Conner, K., & Tyring, S. (2011). Epidemiology of Sexually
Transmitted Infections. In Sexually Transmitted Infections and Sexually Transmitted
Diseases (pp. 13-34). Houston, TX: Springer Berlin Heidelberg. http://link.springer.com.
libproxy.temple.edu/chapter/10.1007/978-3-642-14663-3_2
Green, E., & Murphy, E. (2014). Health Belief Model. In The Wiley Blackwell Encyclopedia of
Health, Illness, Behavior, and Society. John Wiley & Sons. Retrieved December 3, 2015
from http://onlinelibrary.wiley.com/doi/10.1002/9781118410868.wbehibs410/
abstract;jsessionid=B89030BD7F2645F6B6B5FD57B07F3D01.f02t03?
Hillis, S. D., Nakashima, A., Amsterdam, L., Pfister, J., Vaughn, M., Addiss, D., Marchbanks, P.
A.,Owens, L. M., & Davis, J. P. (1995). The impact of comprehensive chlamydia
prevention program in Wisconsin. Family Planning Perspectives, 27(3), 108-111. doi:
10.2307/2136107 or http://www.jstor.org/stable/2136107
Home of Health. (2010). Retrieved December 2, 2015, from http://www.aviva.co.uk/health-
insurance/home-of-health/medical-centre/medical-encyclopedia/entry/bartholinitis/
Labhart, F., Graham, K., Wells, S., & Kuntsche, E. (2012). Drinking before going to licensed

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