Theories of reasoned action and planned behavior as models of condom use: a meta-analysis

Individual and environmental protective factors for risky sexual behavior among homeless youth: an exploration of gender differences

The goal of the current study was to identify potential individual and environmental protective factors for sex risk behavior among homeless youth. We explored gender differences in the prediction of unprotected sex and number of sex partners. Data were collected from 192 sexually active, homeless youth who were 14-21 years old. High rates of sex risk behavior were reported. Significant gender differences were found in STD rates with 19% of females and 2% of males reporting an STD diagnosis during the previous three months. Findings indicated that positive expectations for the future were associated with fewer sex partners for both genders, whereas decision making skills predicted a lower percentage of unprotected sex for males and fewer sex partners for females. For females, univariate analyses indicated that self-esteem and having a natural mentor may reduce the likelihood of unprotected sex, whereas multivariate analysis indicated that being employed or in school may play a protective role with respect to number of sex partners.

Predictors of early first sexual intercourse among adolescents in Cape Town, South Africa

Early coital debut is a risk factor for HIV. In this paper we investigate the predictors of young adolescents' transition to first intercourse using a social cognition theoretical framework. The analyses reported here were based on a longitudinal study of 2,360 students in the schools allocated to the control arm of a cluster-randomized controlled trial to investigate the effect of a school-based HIV prevention programme among Grade 8 students in Cape Town. Structural equation modelling was performed with Mplus version 3.11. Of the 1440 students who were virgins at baseline, 1,144 remained virgins 15 months later and 296 (20.6%) reported having had their first sexual intercourse. Transition to first sexual intercourse was more likely among males than females, among older students and among students with a lower socio-economic status. Transition to first sexual intercourse was significantly associated with intentions to have sexual intercourse, poor self-efficacy to negotiate delayed sex and intimate partner violence. The model predicted 35% of the variance in intentions and 16% of the variance in transition. These findings indicate some of the factors that influence young adolescent's transition to first intercourse and that need to be addressed when designing effective interventions.

The effects of subjective norms on behaviour in the theory of planned behaviour: a meta-analysis

A meta-analysis investigated the effects of perceived injunctive (IN) and descriptive (DN) norms on behaviour (BEH) within the theory of planned behaviour (TPB) in a sample of 196 studies. Two related correlation matrices (pairwise and listwise) were synthesized from the data and used to model the TPB relations with path analyses. Convergent evidence indicated that the relation between DN and BEH was stronger than the relation between IN and BEH. Evidence also suggested a significant direct relation between DN and BEH in the context of TPB. A suppressor effect of IN on DN in its relation with BEH was also noted. Moderator analyses indicated that the DN-BEH relation was stronger when there was more time between measures of cognition and behaviour, when behaviours were not socially approved, more socially motive and more pleasant; results were mixed in the case of the IN-BEH relation. Results imply that IN and DN are conceptually different constructs.

Predicting and explaining transtheoretical model stage transitions in relation to condom-carrying behaviour

OBJECTIVES

The stages of change component of the transtheoretical model have been applied to safe sex behaviours in cross-sectional analyses, but have not yet been subject to prospective analysis. It was predicted that: (a) cross-sectional analyses would demonstrate good discrimination between the stages of change; (b) prospective analyses would allow for the identification of predictors of stage transitions; and (c) implementation intentions would explain progression from the preparation stage.

DESIGN

This study employed an experimental longitudinal design. Participants were randomly assigned to the experimental (implementation intention) or control conditions and completed questionnaires at baseline and at 2-month follow-up.

METHODS

Five hundred and twenty-five adolescents who were broadly representative of the UK population completed questionnaires at baseline and follow-up (N=393) measuring: demographic variables; stage of change; theory of planned behaviour constructs; anticipated regret; and moral norm in relation to condom-carrying behaviour. The experimental condition completed a self-generated implementation intention to carry condoms at the end of the baseline questionnaire.

RESULTS

Discriminant function analyses indicated that the stages of change could be accurately discriminated from one another cross-sectionally and that, longitudinally, the measured variables were able to predict transitions between most stages. Implementation intentions caused people to progress from the preparation stage.

CONCLUSIONS

Transitions between most stages were reliably predicted, thereby providing potential targets for intervention. The brief implementation intention intervention was effective and could easily be utilized and expanded to encompass a broader range of sexual health behaviours.

Self-reported and P3 event-related potential evaluations of condoms: does what we say match how we feel?

Research consistently reveals positive self-reported condom evaluations, yet such evaluations often do not predict condom use. Whereas positive self-reports likely reflect social norms regarding prevention of diseases and pregnancy, psychophysiological measures might better assess spontaneous condom evaluations. Here, participants completed a visual oddball task in which condoms and alcoholic beverages were infrequent targets among neutral, positive, and negative context images. Although self-reported condom evaluations were very positive, condom images presented in a negative context produced a smaller P3 than condom images presented in a neutral or positive context, suggesting that spontaneous condom evaluations were more negative than positive. The P3 elicited by alcohol images indicated positive evaluations. The findings underscore the multifaceted nature of evaluations and point to the utility of ERPs for assessing health-related attitudes.

Acceptability and use of sexual barrier products and lubricants among HIV-seropositive Zambian men

This study assessed the acceptability and preference for sexual barrier and lubricant products among men in Zambia following trial and long-term use. It also examined the role of men's preferences as facilitators or impediments to product use for HIV transmission reduction within the Zambian context. HIV-seropositive and -serodiscordant couples were recruited from HIV voluntary counseling and testing centers in Lusaka between 2003 and 2006; 66% of those approached agreed to participate. HIV seropositive male participants participated in a product exposure group intervention (n = 155). Participants were provided with male and female condoms and vaginal lubricants (Astroglide [BioFilm, Inc., Vista, CA] & KY gels [Johnson & Johnson, Langhorne, PA], Lubrin suppositories [Kendwood Therapuetics, Fairfield, NJ]) over three sessions; assessments were conducted at baseline, monthly over 6 months and at 12 months. At baseline, the majority of men reported no previous exposure to lubricant products or female condoms and high (79%) levels of consistent male condom use in the last 7 days. Female condom use increased during the intervention, and male condom use increased at 6 months and was maintained over 12 months. The basis for decisions regarding lubricant use following product exposure was most influenced by a preference for communicating with partners; participant preference for lubricant products was distributed between all three products. Results illustrate the importance of development of a variety of products for prevention of HIV transmission and of inclusion of male partners in interventions to increase sexual barrier product use to facilitate barrier acceptability and use in Zambia.

Predicting hypothetical willingness to participate (WTP) in a future phase III HIV vaccine trial among high-risk adolescents

The present study sought to determine whether the Theory of Planned Behaviour predicted stated hypothetical willingness to participate (WTP) in future Phase III HIV vaccine trials among South African adolescents. Hierarchical logistic regression analyses showed that The Theory of Planned Behaviour (TPB) significantly predicted WTP. Of all the predictors, Subjective norms significantly predicted WTP (OR = 1.19, 95% C.I. = 1.06-1.34). A stepwise logistic regression analysis revealed that Subjective Norms (OR = 1.19, 95% C.I. = 1.07-1.34) and Attitude towards participation in an HIV vaccine trial (OR = 1.32, 95% C.I. = 1.00-1.74) were significant predictors of WTP. The addition of Knowledge of HIV vaccines and HIV vaccine trials, Perceived self-risk of HIV infection, Health-promoting behaviours and Attitudes towards HIV/AIDS yielded non-significant results. These findings provide support for the Theory of Reasoned Action (TRA) and suggest that psychosocial factors may play an important role in WTP in Phase III HIV vaccine trials among adolescents.

A reasoned action approach to health promotion

This article describes the integrative model of behavioral prediction (IM), the latest formulation of a reasoned action approach. The IM attempts to identify a limited set of variables that can account for a considerable proportion of the variance in any given behavior. More specifically, consistent with the original theory of reasoned action, the IM assumes that intentions are the immediate antecedents of behavior, but in addition, the IM recognizes that environmental factors and skills and abilities can moderate the intention-behavior relationship. Similar to the theory of planned behavior, the IM also assumes that intentions are a function of attitudes, perceived normative pressure and self-efficacy, but it views perceived normative pressure as a function of descriptive as well as of injunctive (i.e., subjective) norms. After describing the theory and addressing some of the criticisms directed at a reasoned action approach, the paper illustrates how the theory can be applied to understanding and changing health related behaviors.

Beyond the most willing audiences: a meta-intervention to increase exposure to HIV-prevention programs by vulnerable populations

OBJECTIVE

Enrollment in HIV-prevention interventions is more likely when the audience has safer rather than riskier HIV-relevant behavior. Thus, a meta-intervention was designed to increase participation by an audience of infrequent condom users in Florida.

DESIGN

Participants (N = 400) were randomly assigned to 1 of 4 conditions varying the introduction to a counseling program. In the experimental condition, participants were told that the intervention gave participants options but might not change their behavior. In a standard-introduction condition, participants were told that the program was highly effective at changing participants' behaviors. There was also an information-control group containing a description of the program, and a no-information-control group solely containing an invitation.

MAIN OUTCOME MEASURES

The outcome measure was actual participation in the offered counseling.

RESULTS

Findings indicated that the experimental introduction was the most successful at yielding participation in the counseling program when the audience had low intentions to use condoms in the future.

CONCLUSION

Intervention introductions countering participants' resistance to change increase participation in HIV-prevention counseling among reluctant clients. Other meta-interventions may be explored to systematically augment the effectiveness of evidence-based health-promotion interventions.

Health professionals' attitudes towards suicide prevention initiatives

Preventing suicide can depend upon the ability of a range of different health professionals to make accurate suicide risk assessments and treatment plans. The attitudes that clinicians hold towards suicide prevention initiatives may influence their suicide risk assessment and management skills. This study measures a group of non-mental health professionals' attitude towards suicide prevention initiatives. Health professionals that had attended suicide prevention education showed significantly more positive attitudes towards suicide prevention initiatives. The findings in this study further support the effectiveness of educating non-mental health professionals in suicide risk awareness and management.

Theory of planned behavior and multivitamin supplement use in Caucasian college females

The objective of this study was to identify predictors of the use of multivitamin supplements (MVS) among Caucasian college females utilizing the Theory of Planned Behavior (TPB). Variables of the TPB and the self-reported use of multivitamin supplements were measured by two separate surveys within 1 week with a convenience sample of 96 Caucasian college student females. Two attitudinal beliefs and one control belief significantly predicted behavioral intention to use multivitamin. A belief that taking multivitamin supplements helps to feel and look good was the most important predictor of the use of multivitamin supplements. EDITORS' STRATEGIC IMPLICATIONS: Findings from this study, although in need of replication, suggest that prevention campaigns would be more successful if messages used to reach these females were consistent with perceived beliefs regarding benefits of using MVS. More broadly, TPB appears to offer a useful framework for understanding or predicting behavior based on psychological constructs theorized to influence behavior.

Epidemiologic and behavioral characterization of knowledge of condom use and modeling among military personnel

How accurately condoms are being used vary across populations and knowledge of the factors determining its proper use remains unclear. Knowledge of such differentials and determinants would aid in evaluating the contributions of condom use to HIV epidemic reduction. Baseline data from the Situationally Focused Individual HIV/AIDS intervention to promote HIV protective behavior among 2,213 Nigerian Military Personnel were analyzed. Educational status as a predictor variable was assessed using univariable and multivariable logistic regression model. Compared to those with less than high school education, those with high school and some college education were two times more likely to demonstrate knowledge of condom use and modeling, prevalence odds ratio (POR), 2.32, 95% Confidence Interval (CI) = 1.60-3.37. After adjustment for the relevant covariates, higher education attainment was associated with nonsignificant 62% increase in knowledge and modeling, POR, 1.62, 95% CI = 0.78-3.38. This study is indicative of low knowledge of condom use and modeling among the Nigerian military personnel; as well as a direct correlation between education attainment and knowledge of condom use and modeling.

Predictors of intention to practice safer sex among Korean college students

This study examined the efficacy of the Theory of Planned Behavior (TpB) among Korean college students on intentions of condom use. A cross-sectional, correlational design was conducted with an exploratory survey method. Young men and women aged 18-25 were recruited from a university in Seoul, Korea using a flyer and self-referral. Students completed a background and sexual behavior questionnaire, a parent-adolescent communication scale, and instruments derived from the TpB. Age, parent-adolescent communication, and perceived risk of sexual behavior were added to the model as potential determinants of intention of condom use. All the TpB components significantly predicted intention of condom use for young men, but only condom attitude and condom efficacy significantly predicted intention of condom use for young women. Age and quality of parent-adolescent communication indirectly affected the intention of condom use; however, perceived risk of sexual behavior did not predict intention of condom use, nor was it affected by age. Older students had a higher condom efficacy and a higher perceived peer norm of condom use. The quality of parent-adolescent communication significantly predicted a higher condom efficacy for young men, but not women.

Perceptions of sexual partner safety

BACKGROUND

Many individuals select sexual partners based on assumed partner STI/HIV safety, yet few studies have investigated how these assumptions are formed. The objective of this research was to determine the extent to which partner safety beliefs were used to evaluate partner safety, and whether these beliefs influenced perceptions of personal STI/HIV risk.

METHODS

Participants (n = 317) recruited from an STI clinic completed a structured self-report questionnaire. A Partner Safety Beliefs Scale (PSBS) was developed to determine the factors that most influenced perceived partner safety. Exploratory factor analysis showed that a single factor accounted for 46% of the variance in the PSBS; with an internal consistency of 0.92. Linear regression was used to determine factors predictive of perceived personal STI/HIV risk.

RESULTS

Participants endorsed statements indicating that knowing or trusting a sexual partner influences their beliefs about their partner's safety. Linear regression analysis indicated that education, income, number of sexual partners, and PSBS scores were significant predictors of perceived personal STI/HIV risk.

CONCLUSIONS

The results of this study indicate that many individuals are relying on partner attributes and relationship characteristics when assessing the STI/HIV status of a sexual partner, and that this reliance is associated with a decreased perception of personal STI/HIV risk. Prevention campaigns need to acknowledge that people are likely to evaluate sexual partners whom they know and trust as safe. Dispelling erroneous beliefs about the ability to select safe partners is needed to promote safer sexual behavior.

Today I'll use a condom, but who knows about tomorrow: a daily process study of variability in predictors of condom use

OBJECTIVE

Most models of health behavior change applied to condom use behavior have focused on individual differences in theoretical constructs to explain condom use or nonuse, while ignoring the possibility that day-to-day within-person changes in these constructs may contribute to understanding behavior. The goal of the present study was to investigate day-to-day variability in condom use attitudes, self-efficacy, and behavioral intentions and assess the utility of this variability in predicting the likelihood of condom use each day.

DESIGN

A 30-day Web-based structured daily diary was used to collect daily reports of sexual behaviors and data on theoretical predictors of condom use behavior from sexually active college students (N = 116).

MAIN OUTCOME MEASURES

The authors investigated whether condom use attitudes, self-efficacy, and behavioral intentions vary day to day; whether this within-person variability predicts condom use behavior; and whether negative affective states explain this variability.

RESULTS AND CONCLUSIONS

Within-person variability was found for each of the constructs. Within-person day-to-day changes in behavioral intentions and attitudes predicted the instances in which an individual used a condom and daily negative affect partially explained within-person day-to-day changes in behavioral intentions and self-efficacy. Implications for models of health behavior change and for behavior change interventions are discussed.

Enhancing prediction of inhalant abuse risk in samples of early adolescents: a secondary analysis

The theory of reasoned action (TRA) was used to estimate adolescents' vulnerability to inhalant abuse, operationalized by intentions to use or avoid inhalants. The model correctly differentiated 78% of all respondents (N=596). A second analysis highlighted variables that discriminated properly identified from misclassified youth. False positives, those defined as being at-risk, but who repudiated inhalants, were significantly less likely than their at-risk peers to have used inhalants; they used inhalants and marijuana less frequently; were monitored more closely by parents; and were less rebellious (all p<.05). False negatives, defined as not at-risk, but who had not unequivocally rejected inhalants, were significantly more likely than their similarly classed peers to have used inhalants and marijuana, and to have used both more frequently; also, they were less highly acculturated. This study reaffirmed the utility of the TRA and underscored factors that might improve classification accuracy. This approach may facilitate prevention efforts, and may be extrapolated to any context in which risk categorization is used as a basis for prevention or amelioration.

Correlates of safe sex behaviour among low-educated adolescents of different ethnic origin in Antwerp, Belgium

BACKGROUND

Several reports suggest that low educated adolescents of ethnic minority origin are at a higher risk of acquiring a sexually transmitted infection (STI) than autochthonous teens. On the other hand, focus group research with young Moroccan boys revealed a positive attitude towards condom use; they claim to use a condom even more frequently than their Belgian peers. The aim of this study is to document the behavioural, educational and social correlates that influence the use of condoms among low educated adolescents of different origin.

METHOD

Data from 378 questionnaires completed by 253 native Belgian and 125 ethnic minority adolescents, mostly Moslems, were analysed with the statistic software: SPSS. Results were interpreted according to the behavioural science ASE model (Attitude, Social influences, self-Efficacy).

RESULTS

Native boys discuss sexual items more frequently with their parents and sexual partner, while boys in the other group address their questions more frequently to teachers, pharmacists and doctors. In both groups the most important correlate of safe sex intention and behaviour is the self-efficacy variable 'both partners taking the initiative with regard to condom use'. This correlate refers to communication skills. Parental support and quality of general communication about sexuality with the parents are very important for both groups. A positive attitude of peers influences the intention of condom use in both groups.

CONCLUSION

There is no significant difference in sexual activity and safe sex behaviour between native boys and young males of ethnic minority. Self efficacy (correct condom use and taking the initiative) is the most prominent predictor of safe sex behaviour in both groups.

An assessment of the relationship between condom labels and HIV-related beliefs and intentions

The aim of this article is to examine the impact of the FDA's proposed condom package labeling on HIV-related beliefs about condom effectiveness, on intentions to recommend condoms for friends to use, and intentions to use condoms. Using a nationally representative survey we randomized 1,194 adults ages 18-65 years into one of three condom label conditions: the current label on condom packaging; a label with the proposed FDA language; and a label with CDC language on condom effectiveness. In short, there are no significant differences between the proposed FDA label and the current label on HIV-related beliefs and intentions. In contrast, from an HIV prevention perspective, the CDC condom language appears to offer a better alternative to the current condom label for unmarried populations.

Health Psychology: the Search for Pathways between Behavior and Health

This review of the current status of theoretically based behavioral research for chronic illness management makes the following points: (a) Behavioral interventions have demonstrated effectiveness for improving health outcomes using biomedical indicators, (b) current interventions are too costly and time consuming to be used in clinical and community settings, (c) translation of the conceptual models generated from studies of the problem-solving processes underlying self-management and the relationship of these processes to the self system and cultural and institutional contexts suggest new avenues for developing effective and efficient cognitive-behavioral interventions, and (d) it is proposed that integration of the conceptual developments in self-management with new approaches to the design of clinical trials can generate tailored, behavioral interventions that will improve quality of care.

Using the theory of planned behaviour to understand the motivation to learn about HIV/AIDS prevention among adolescents in Tigray, Ethiopia

Various studies indicate that school- or university-based HIV prevention curricula can reduce the prevalence of sexual risk behaviour among adolescent youth in Sub-Saharan Africa. However, effective HIV/AIDS prevention education may be problematic, if the needs of youth are not served adequately. To date, little attention has been given to the motivation of youth to learn about HIV/AIDS and about their preferences for HIV/AIDS curriculum design options. The aim of this study was to get insight into the determinants of the motivation of youth to learn about HIV/AIDS prevention and to assess their curriculum design preferences. Students from a university in Tigray, Ethiopia, filled out a structured questionnaire, which assessed demographics, variables that according to the Theory of Planned Behaviour are related to the motivation to learn, and their preferences for independent, carrier and integrated HIV/AIDS curriculum designs. On average, participants were highly motivated to learn about HIV/AIDS. Motivation to learn was primarily related to social norms and was not related to self-efficacy to discuss HIV/AIDS in class. The often discussed reluctance to discuss sexuality and condom use in curricula in Sub-Saharan Africa, seems to be more related to existing negative social norms, than to lack of self-efficacy. Participants revealed a high preference for the independent, carrier and integrated curriculum design options. However, students with a higher motivation to learn about HIV/AIDS were more attracted to the independent course design.

'Searching for a "generalized social agent" to predict Namibians' intentions to prevent sexual transmission of HIV

Debate surrounds the definition, measurement and utility of subjective norms (theory of reasoned action, Fishbein & Ajzen, 1975; Ajzen & Fishbein, 1980). Scholars propose alternative concepts including descriptive norms and injunctive norms (Cialdini et al., 1990), enabling factors and social embeddedness (e.g. Barrera, 1986), and betweenness to others in a network (Wasserman & Faust, 1994) to explain social influences on willingness to perform a behaviour. This study explores the relative utility and comparability of different social concepts in understanding Namibians' intentions (n=1200) to abstain from sex or to be faithful to one sexual partner. Neither subjective norms nor the five other concepts consistently predict either intentions, although they account for 21% of variance in intentions to abstain and 24% of intentions to have one sexual partner in one region. Conflicting relationships between injunctive and subjective norms exist; stigma surrounding HIV prevention provides some explanation. Campaigns designed to alter norms may benefit from altering stigma simultaneously.

Acceptability of microbicidal surrogates among Zambian women

OBJECTIVES AND GOAL

This study assessed the acceptability after the use of vaginal lubricants as surrogates for microbicides among women in Zambia and the role of cultural factors as facilitators or impediments to their potential use for HIV risk reduction within the Zambian context.

STUDY DESIGN

HIV seronegative women (N = 301) recruited from the University Teaching Hospital HIV Voluntary Counseling and Testing Center were randomized into group, individual, or enhanced usual care arms. Participants attended pre- and post-HIV test counseling, followed by a 3-session, 2-hour once-a-month intervention introducing them to vaginal lubricants (2 types of gels, suppositories) in addition to male and female condoms. Supplies were offered at months 4 and 5; assessments were at baseline, 6, and 12 months.

RESULTS

At baseline, the majority of women reported minimal previous exposure to vaginal products and low levels of condom use. Participants' use of products was influenced by product characteristics and perceived partner acceptability; the majority of participants preferred drier products and suppository delivery systems. The basis for decisions regarding vaginal product acceptability changed over time and followed product exposure, and was greatly influenced by perceptions of partner acceptability.

CONCLUSION

Results illustrate the influence of male partners on Zambian seronegative women's preferences for microbicidal products, and the change in preferred characteristics over time.

An investigation of a personal norm of condom-use responsibility among African American crack cocaine smokers

The purpose of this study was to investigate the unique contribution of a personal norm of condom-use responsibility to the formation of intentions to use male condoms during vaginal sex. Data were collected from 402 male and 157 female heterosexual African American crack cocaine smokers in Houston, Texas, US. Two structural equation models of the intention to use a condom with the last sex partner were estimated. One model included measures of condom-use attitudes, subjective norms and condom-use self-efficacy. A second model included these three measures and a fourth measure of a personal norm of condom-use responsibility. Separate models were estimated for men and women. The addition of a personal norm of condom-use responsibility provided a significantly better fit to the data than did models including only outcome expectations, subjective norms and self-efficacy. Results also showed distinctly different underlying cognitive structures of condom-use intention for men and women. A personal norm of condom-use responsibility had a strong direct effect on men's intentions to use condoms with the last sex partner. Other variables appeared to have no direct effect on men's intentions. Women's intentions were strongly influenced by a personal norm and social subjective norms. Situational self-efficacy and outcome expectations had weaker, yet significant, effects on women's intentions. Given the strong effect of personal norms on men's intentions to use condoms, further research should be undertaken.

Testing a model of contraception use behavior among sexually active female adolescents in Taiwan

The purpose of this cross-sectional study was to test a model of contraception use among sexually active Taiwanese female adolescents, using structural equation modeling. Anonymous questionnaires were distributed to 404 female adolescents who had had sexual intercourse in the previous 3 months. A model was produced in which past contraception use, self-efficacy for contraception use, and decisional balance for using contraception had significant direct effects on current contraception use. Social influences had not only significant direct effects on self-efficacy and on decisional balance, but also a significant indirect effect on current contraception use. These findings provide a reference for the development of contraceptive intervention programs for sexually active female adolescents in Taiwan.

Correlates of parents' reports of acceptability of human papilloma virus vaccination for their school-aged children

Background: Routine human papilloma virus (HPV) vaccination for 12–13-year-old girls will be introduced in the UK from September 2008. The aim of the present study was to identify correlates of parents’ anticipated uptake of HPV vaccination for their sons and daughters. Methods: Self-administered questionnaires were completed by 353 parents of school-aged children living in Brighton and Hove (England). The main outcome measure was anticipated acceptance of HPV vaccination for children. Putative predictors of acceptance of HPV vaccination included general attitudes toward vaccination, beliefs about the impact on adolescent sexual behaviour of vaccines against sexually transmissible infections, and knowledge of HPV and cervical cancer. Results: Multivariate regression revealed that greater perceived benefits of HPV vaccination, greater general belief in the protection offered by vaccination, and greater support for adolescent sexual health services explained substantial proportions of the variance in HPV vaccine acceptability for both sons and daughters. For both sons and daughters, the most important correlate of vaccine acceptability was general belief in the protection offered by vaccination: this variable explained 40–50% of variance. Acceptability of vaccination appeared to improve following the provision of brief information about the links between HPV and cervical cancer and the proposed introduction of HPV vaccination. Conclusions: Uptake of HPV vaccination may be maximised by: improving attitudes toward the safety and efficacy of childhood vaccinations; countering concerns that provision of sexual health services for young people will encourage promiscuous or unsafe sexual behaviour; and improving knowledge about the role of HPV in cervical cancer aetiology.

Parent-adolescent relationship education (PARE): program delivery to reduce risks for adolescent pregnancy and STDs

The first author recruited parent-adolescent dyads (N = 192) into after-school prevention education groups at middle schools in southeast Texas. This author placed participants in either (1) an Interactive Program (IP) in which they roleplayed, practiced resistance skills, and held parent-child discussions or (2) an Attention Control Program (ACP) that used the same curriculum but was delivered in a traditional, didactic format. Questionnaires administered at the beginning and end of the 4-session program and again after booster sessions in 3 subsequent semesters provided measures of social controls (eg, communication with parents) and self controls (eg, protection against risk) on the youths' sexual health behaviors. Linear mixed models adjusted for gender, age, and ethnicity showed that the IP, in comparison with the ACP, achieved significant gains in social control by increasing parental rules about having sex and other risky behaviors and also enhanced students' self-control by increasing their knowledge about prevention and enhancing resistance responses when pressured to have sex.

Effectiveness of “Dangerous Decibels,” a School-Based Hearing Loss Prevention Program

Purpose

To evaluate the effectiveness of the “Dangerous Decibels” educational program in increasing students' knowledge and positively changing their attitudes and intended behaviors related to hearing and hearing loss prevention.

Method

Baseline questionnaires were completed by 478 4th-grade students and 550 7th-grade students. Approximately half of the students in each grade received a 35-min interactive classroom presentation on hearing and hearing loss prevention. The remaining students served as comparison groups. Students who received the curriculum filled out questionnaires immediately after the presentation. All students filled out follow-up questionnaires 3 months after baseline.

Results

Fourth-grade students who participated in the Dangerous Decibels presentation exhibited significant improvements in knowledge and attitudes related to hearing and hearing loss prevention. These improvements were maintained 3 months after the presentation. Seventh-grade students also experienced long-term improvements in their knowledge base. However, attitudes and intended behaviors in 7th graders returned to baseline levels 3 months postpresentation.

Conclusion

The Dangerous Decibels hearing loss prevention program was effective at producing long-term improvements in the knowledge base of 4th- and 7th-grade students. Future studies should include components on peer pressure and should incorporate repeated, multimodality interventions to increase the likelihood of long-term improvement in adolescents.

Willingness to use microbicides varies by race/ethnicity, experience with prevention products, and partner type

OBJECTIVE

To investigate women's willingness to use vaginal microbicides to reduce/prevent HIV infection, using measures grounded in the individual, behavioral, and social contexts of sex.

DESIGN

A cross-sectional study that enrolled a sample (N = 531) of 18-55 year old Latina, African-American, and White women in the U.S. between October, 2004, and July, 2005.

MAIN OUTCOME MEASURES

Willingness to use microbicides and individual- and context-related variables (e.g., demographics, relationship status).

RESULTS

Exploratory and confirmatory factor analyses supported a one-dimensional, 8-item scale, with high internal consistency (alpha = .91). Subgroup analyses within the Latina (n = 166), African- American (n = 193), and White sub-samples (n = 172) also supported a unidimensional scale with strong internal validity and high reliability. Race/ethnicity as a contextual factor, a woman's history of using prevention products, and the nature of the sexual partnership were predictive of willingness to use microbicides (R = .41). That is, women with greater frequencies of condom use, a history of spermicide use, and non-main sexual partners had higher predicted Willingness to Use Microbicides scale scores, while White women had lower predicted scores.

CONCLUSION

The Willingness to Use Microbicides scale serves as the first psychometrically validated measure of factors related to microbicide acceptability. Developing and implementing psychometrically validated and contextualized microbicide acceptability measures, in an effort to understand microbicide users and circumstances of use, is crucial to both clinical trials and future intervention studies.