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

Dismantling the theory of planned behavior: evaluating the relative effectiveness of attempts to uniquely change attitudes, norms, and perceived behavioral control

The current study compares the effectiveness of interventions that attempted to uniquely influence hypothesized determinants of behavior in the Theory of Planned Behavior versus some optimal combination of constructs (three constructs vs. four) to increase condom use among intentions and behavior college students. 317 participants (Mage = 19.31; SDage = 1.31; 53.3% female; 74.1% Caucasian) were randomly assigned to one of seven computer-based interventions. Interventions were designed using the Theory of Planned Behavior as the guiding theoretical framework. 196 (61.8%) completed behavioral follow-up assessments 3-month later. We found that the four construct intervention was marginally better at changing intentions (estimate = - .06, SE = .03, p = .06), but the single construct interventions were more strongly related to risky sexual behavior at follow-up (estimate = .04, SE = .02, p = .05). This study suggests that these constructs may work together synergistically to produce change (ClinicalTrials.gov Number NCT# 02855489).

Using Media Literacy Education for Adolescent Sexual Health Promotion in Middle School: Randomized Control Trial of Media Aware

This study examined the short-term efficacy of Media Aware, a classroom-based media literacy education (MLE) program for improving adolescents' sexual health outcomes. In a randomized control trial, schools were randomly assigned to the intervention (N = 5 schools) or health promotion control (N = 4 schools) group. Students completed questionnaires at pretest (N = 880 students) and immediate posttest (N = 926 students). The Media Aware program had a significant favorable impact on adolescent outcomes related to sexual health, including increased self-efficacy and intentions to use contraception, if they were to engage in sexual activity; enhanced positive attitudes, self-efficacy, and intentions to communicate about sexual health; decreased acceptance of dating violence and strict gender roles; and increased sexual health knowledge. Program effects were also found for media-related outcomes, including enhanced media deconstruction skills and increased media skepticism. Media deconstruction skills mediated the program's impact on students' intentions to communicate with a medical professional about sexual health issues. This study provides support for the use of MLE with adolescents to promote sexual health.

Sexual compulsivity and its relationship with condomless sex among unmarried female migrant workers in Shanghai, China: a cross-sectional study

Background

Individuals with high sexual compulsivity are preoccupied with their sexual desire to such an extent that it interferes with their normal daily life and can inhibit self-control. Previous studies have found a close association between sexual compulsivity and condomless sex among different populations; however, no studies have investigated this among unmarried female migrant workers in China. This study aimed to validate the Sexual Compulsivity Scale (SCS) for appropriate use and examine the association between sexual compulsivity and condomless sex in this target population.

Methods

In 2015, we recruited 1325 unmarried female migrant workers in Shanghai, China. Information about sociodemographics, sexual compulsivity, and condomless sex were collected using a structured questionnaire. Exploratory factor analysis and reliability analysis were performed to validate the Chinese version of the SCS. Multiple logistic regression analyses were used to examine the association between sexual compulsivity and condomless sex.

Results

The prevalence of condomless sex in the previous 6 months was 66.8% among all participants. The SCS was proven internally consistent for the overall scale (Cronbach’s α = 0.89), and two factors, Social Disruptiveness (Cronbach’s α = 0.87) and Perceived Self-Control (Cronbach’s α = 0.84), were extracted. With mean total score of 18.25 (standard deviation = 4.94) after adjusting for significant sociodemographic factors, the SCS total scores (adjusted odds ratio [AOR] = 1.04, 95% confidence interval [CI] = 1.02–1.07) and two subscale scores (AOR = 1.07, 95% CI = 1.02–1.13; AOR = 1.06, 95% CI = 1.02–1.10) were all related to inconsistent condom use with partners in the previous 6 months.

Conclusions

The Chinese version of the SCS was found to be well adaptable for use among unmarried Chinese female migrant workers and a potential predictor for condomless sex. In addition to safe sex interventions, counselling on managing sexually compulsivity should also be provided in this population.

Strength of Implementation Intentions to Use Condoms Among Men Who Have Sex with Men

Although pre-exposure prophylaxis (PrEP) use is increasing among men who have sex with men (MSM), condoms remain key to HIV prevention. Implementation intentions-which link a behavioral action plan with a situation or cue-may predict condom use. The Strength of Implementation Intentions Scale (SIIS), which assesses condom use implementation intentions, has not been evaluated among MSM. A structural model tested whether the SIIS mediated the relationship between condom use intentions and condomless sex acts among 266 sexually-active MSM (56% White, 26% Black, 15% Latino, M_age = 32.54). After controlling for PrEP use, HIV-status, and demographics (χ²(107) = 140.06, CFI = 0.98, TLI = 0.97, RMSEA = 0.03), the SIIS fully mediated the relationship between condom use intentions and condomless sex acts. The SIIS can serve as a fidelity check for interventions, a mediator in theoretical models, and future studies should incorporate implementation intentions into HIV prevention interventions for MSM.

Maternal grand multiparity and intention to use modern contraceptives in Nigeria

BACKGROUND

Grand multiparity and low contraceptive prevalence are dominant among Nigerian women. These elevate the risk of unintended pregnancies, high-risk fertility and adverse maternal and child health outcomes among women in the country, particularly grand multiparous women. Studies have examined predictors of intention to use modern contraceptives among women of reproductive age. However, these studies did not ascertain the extent to which grand multiparity is associated with intention to use modern contraceptives. This study examined association between grand multiparity and intention to use modern contraceptives in Nigeria.

METHODS

The study pooled data from 2003 to 2013 Nigeria Demographic and Health Surveys. The weighted sample size analysed was 34,302 women. The outcome variable was intention to use contraceptive. The main explanatory variable was parity with specific attention to grand multiparity. Unadjusted multinomial logistic regression coefficients were used to examine association between specific explanatory or control variables and intention to use contraceptives while the adjusted multinomial logistic regression was applied to further examine associated factors of intention to use contraceptives relative to being uncertain about future contraceptive use. Four multinomial logistic regression models were fitted using Stata 14.

RESULTS

More than half of respondents do not intend to use contraceptives, while less than one-fifth of respondents intend to use contraceptives in the future. Across the four fitted models, the relative risks of intention to use compared with being uncertain about future contraceptive use were significantly lower among grand multiparous women. Results further revealed pregnancy termination, fertility planning status, exposure to mass media family planning messages, knowledge of modern contraceptives, ideal family size, remarriage, household power relations, and maternal education as other key factors influencing expected risk of intention to use contraceptives relative to being uncertain about future contraceptive use.

CONCLUSION

Maternal grand multiparity is significantly associated with intention to use contraceptives among women in Nigeria. The development of a specific population and health programme to target grand multiparous women is imperative in the country. Such programme could be integrated into existing national family planning programme through specific contraceptive education, counselling and information for high parous women.

The Theory of Planned Behavior to Predict Protective Behavioral Intentions against PM2.5 in Parents of Young Children from Urban and Rural Beijing, China

Smog and air pollution have fast become significant environmental problems and are attributed to rapid global industrialization and urbanization. Emissions of fine particulate matter with an aerodynamic diameter of ≤2.5 μm (PM2.5) increase smog and air pollution, with strong impacts on human health. Children are particularly vulnerable. While increasing studies are being conducted on the behaviors leading to PM2.5 toxicity from the perspective of environmental toxicants, there is a lack of research on factors influencing anti-PM2.5 behavioral intentions. Thus, this study aims to narrow this gap by adapting the theory of planned behavior framework to investigate the effects of attitude, subjective norms, and perceived behavioral control on protective behavioral intentions against PM2.5. In total, 1277 online questionnaires were collected from parents of young children living in urban and rural areas of Beijing, and the data was analyzed using correlation, regression, and path analyses. Results revealed that there were significant differences between parents from urban and rural areas in terms of attitude (t = 4.727 > 1.96, p < 0.001), subjective norms (t = 5.529 > 1.96, p < 0.001), perceived behavioral control (t = 6.155 > 1.96, p < 0.001), and anti-PM2.5 behavioral intentions (t = 6.838 > 1.96, p < 0.001). Path analysis revealed that parents from urban and rural areas had different behavioral intention paths. For urban parents, the findings indicated that subjective norms (β = 0.73, t = 21.84 > 3.29) and perceived behavioral control (γ = 0.22, t = 6.12 > 3.29) had direct impacts on anti-PM2.5 behavioral intentions. In contrast, the attitudes (γ = 0.39, t = 3.74 > 3.29) and subjective norms (β = 0.60, t = 8.55 > 3.29) of rural parents were found to directly influence anti-PM2.5 behavioral intentions.

Theory-Based Behavioral Intervention Increases Mother-Son Communication About Sexual Risk Reduction Among Inner-City African-Americans

PURPOSE

African-American adolescent males are at increased risk for HIV, yet there are few sexual risk-reduction interventions targeting this population. Interventions that include mothers can influence parentingbehaviors and in turn, reduce risky behaviors in adolescents. This study tests the efficacy of the Mother-Son Health Promotion Project at increasing mother-son communication about sexual risk reduction.

METHODS

African-American mothers with their sons (ages 10-15 years) residing in public housing in Philadelphia, Pennsylvania were randomized into a HIV/sexually transmitted infections risk-reduction intervention consisting of 16 1-hour modules or an attention-matched health-promotion control intervention.Mothers and sons completed surveys pre-intervention, immediately postintervention, and at 3-, 6-, 12-, 18- and 24-months postintervention.

RESULTS

Of 525 mother-son dyads, 366 (69.7%) completed the 24-months postintervention follow-up survey. Generalized-estimating-equations models using both mothers' and sons' reports revealed that over 24 months, mothers and sons in the HIV/sexually transmitted infections risk-reduction intervention were more likely to communicate about sexual health, including sexual intercourse, birth control, HIV/AIDS prevention, and condoms. Intervention efficacy was found to weaken over time.

CONCLUSIONS

This culturally grounded, theory-based intervention was efficacious in increasing mother-son communication about sexual risk reduction. The work highlights the value of the intervention toincrease parental protective factors, including communication by mothers, to decrease HIV risk behaviors of African-American adolescent males.

The Intention of Men Who Have Sex With Men to Participate in Voluntary Counseling and HIV Testing and Access Free Condoms in Indonesia

This study aimed to identify factors that influenced the intention of men who have sex with men (MSM) to participate in voluntary counseling and HIV testing (VCT) and in accessing free condoms. A qualitative inquiry using one-on-one in-depth interviews was conducted with MSM participants who were recruited using a purposive sampling technique. Data analysis was guided by a framework analysis for qualitative data by Ritchie and Spencer, and the Theory of Planned Behavior (TPB) framework was used to analyze the data. The findings were grouped into three themes-namely, (a) attitude encompassing knowledge about HIV/AIDS and HIV/AIDS services and the belief about the positive outcomes of the services; (b) subjective norms including support from MSM peers and family members and motivation to comply with the support; and (c) perceived behavioral control, which is associated with resource availability and having confidence and positive intention to participate in VCT and willingness to access free condoms. Findings indicated that personal, community, and structural factors were predictors to intention to accessing services. Interventions targeting large numbers of MSM population and further studies to understand what needs to be done by nongovernmental organizations and governmental institutions to halt the spread of HIV infections among MSM populations and increase their intention to use HIV/AIDS services are also recommended.

Predicting Condom Use among Undergraduate Students Based on the Theory of Planned Behaviour, Coquimbo, Chile, 2016

Background: Sexually transmitted infections and pregnancy in adolescents are acknowledged public health problems in many countries. Although it is known that the proper use of condoms allows avoiding these health problems, their use in Chile is still limited, for unknown reasons. Objective: Based on planned behavioural theory, the aim was to validate a behaviour model regarding condom use by measuring the influence of the variables that predict this use among Chilean university students. Methods: A cross-sectional descriptive study was carried out in October 2016 among 151 Chilean university students belonging to the health and engineering areas. The information was collected through a self-administered survey. The sample was divided into two groups: stable and not stable relationships. Partial least squares (PLS) regression was used for the analysis. Results: It was possible to explain the condom use of the students by 57%. The attitude was the main variable related to the intention of using condoms, together with the perceived behavioural control. Additionally, there are statistically significant differences in the variables that predict condom use among students with stable relations compared to those without a stable relationship. Conclusions: The planned behavioural theory is useful for predicting condom use behaviour when students have a stable partner.

Understanding barriers to specialty substance abuse treatment among Latinos

BACKGROUND

National studies have documented that Latinos are less likely to use specialty substance abuse treatment (e.g., rehabilitation programs, in/out-patient services) than other racial/ethnic groups. Disparities in treatment utilization are particularly pronounced between Latinos and Whites. Few national studies have explicitly examined barriers to treatment by race/ethnicity, and current results are inconclusive. The purpose of this study was to gain a better understanding of barriers to specialty substance abuse treatment among Latinos.

METHODS

In 2017-2018, in-depth qualitative interviews were conducted with 54 White, Black, and Latino participants who met eligibility criteria for a recent substance use disorder. Participants were recruited via online ads and screened for eligibility through an online survey. Interview questions were grounded in the Theory of Planned Behavior (TBP): Participants were asked about treatment-related barriers in the domains of attitudes, subjective norms, and perceived control. Interviews were transcribed verbatim and coded by two independent coders. Barriers were compared across all interviews and by race/ethnicity.

RESULTS

Latinos were significantly more likely to report attitudinal and subjective norm barriers than their White and Black counterparts. Within the attitudes domain, results suggested that Latinos largely avoided specialty treatment due to barriers stemming from cultural factors, perceived treatment efficacy, recovery goals, and perceived treatment need. In the area of subjective norms, stigma and perceived lack of social support from family were more pervasive among Latinos' narratives. Lastly, in terms of perceived control, a minority of Latinos reported logistical barriers to treatment.

CONCLUSION

Specialty substance abuse treatment services have been found to be effective regardless of race/ethnicity. Understanding why Latinos use specialty treatment at low rates is key to reducing existing racial/ethnic disparities related to substance abuse. This study identified several malleable barriers that interventions can target to increase Latinos' utilization of treatment. These barriers may also be key to explaining Latino-White disparities in treatment utilization.

Gambling and the Reasoned Action Model: Predicting Past Behavior, Intentions, and Future Behavior

Gambling is a serious concern for society because it is highly addictive and is associated with a myriad of negative outcomes. The current study applied the Reasoned Action Model (RAM) to understand and predict gambling intentions and behavior. Although prior studies have taken a reasoned action approach to understand gambling, no prior study has fully applied the RAM or used the RAM to predict future gambling. Across two studies the RAM was used to predict intentions to gamble, past gambling behavior, and future gambling behavior. In study 1 the model significantly predicted intentions and past behavior in both a college student and Amazon Mechanical Turk sample. In study 2 the model predicted future gambling behavior, measured 2 weeks after initial measurement of the RAM constructs. This study stands as the first to show the utility of the RAM in predicting future gambling behavior. Across both studies, attitudes and perceived normative pressure were the strongest predictors of intentions to gamble. These findings provide increased understanding of gambling and inform the development of gambling interventions based on the RAM.

Exploring psychosocial predictors of STI testing in University students

Background

To explore university students’ Sexually Transmitted Infection (STI) testing knowledge, psychosocial and demographic predictors of past STI testing behaviour, intentions to have an STI test, and high risk sexual behaviour, to inform interventions promoting STI testing in this population.

Methods

A cross-sectional, quantitative online survey was conducted in March 2016, recruiting university students from North East Scotland via an all-student email. The anonymous questionnaire assessed student demographics (e.g. sex, ethnicity, age), STI testing behaviours, sexual risk behaviours, knowledge and five psychological constructs thought to be predictive of STI testing from theory and past research: attitudes, perceived susceptibility to STIs, social norms, social fear and self-efficacy.

Results

The sample contained 1294 sexually active students (response rate 10%) aged 18–63, mean age = 23.61 (SD 6.39), 888 (69%) were female. Amongst participants, knowledge of STIs and testing was relatively high, and students held generally favourable attitudes. 52% reported ever having an STI test, 13% intended to have one in the next month; 16% reported unprotected sex with more than one ‘casual’ partner in the last six months. Being female, older, a postgraduate, longer UK residence, STI knowledge, perceived susceptibility, subjective norms, attitudes and self-efficacy all positively predicted past STI testing behaviour (p < 0.01). Perceived susceptibility to STIs and social norms positively predicted intentions to have an STI test in the next month (p  < 0.05); perceived susceptibility also predicted past high-risk sexual behaviour (p < 0.01).

Conclusions

Several psychosocial predictors of past STI testing, of high-risk sexual behaviour and future STI intentions were identified. Health promotion STI testing interventions could focus on male students and target knowledge, attitude change, and increasing perceived susceptibility to STIs, social norms and self-efficacy towards STI-testing.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5587-2) contains supplementary material, which is available to authorized users.

Intention to Enact and Enactment of Gatekeeper Behaviors for Suicide Prevention: an Application of the Theory of Planned Behavior

Gatekeeper training for suicide prevention was evaluated on a college campus to examine the impact of training on gatekeeper enactment of behaviors in support of suicide prevention and identify predictors of enactment of gatekeeper behaviors. Trained gatekeepers (N = 216) displayed greater perceived knowledge and self-efficacy for suicide prevention and reported higher rates of self-reported actual gatekeeper behaviors, including inquiring about suicidal ideation and referring for mental health treatment when they encountered someone in distress, compared to their untrained counterparts (N = 169). Consistent with the Theory of Planned Behavior, SEM results indicated that attitudes, self-efficacy, and perceived knowledge explained intentions to engage in gatekeeper behaviors, accounting for 59% of the variance in intentions to inquire about suicidal ideation and supporting the role of attitudes and perceived behavioral control in intentions to act. These intentions explained self-reported actual gatekeeper behaviors among participants who encountered someone in distress, with each one-point increase in intention associated with nearly twice the likelihood of both inquiring about suicidal ideation and referring someone for mental health care. On the other hand, self-reported situational barriers were associated with a decreased likelihood of referral behavior, indicating the role of actual behavioral control over volitional actions. Findings support the value of gatekeeper training for promoting factors that influence the likelihood of action on behalf of suicide prevention.

The Utility of Measuring Intentions to Use Best Practices: A Longitudinal Study Among Teachers Supporting Students With Autism

BACKGROUND

School-based interventions can result in profound social, behavioral, and academic improvement for students with autism, but teachers rarely implement them. It is important to understand why this occurs and use this information to increase the use of evidence-based practices. Toward this goal, 2 proof-of-construct studies demonstrate the theoretical and methodological advantages of measuring behavioral intentions to use specific practices.

METHODS

Two observational studies enrolled public school teachers who work with students with autism. The studies measure the strength of teachers' intentions to use each of 4 different evidence-based practices, assess variability in intentions, and test whether intentions predict future teacher behavior.

RESULTS

In adjusted analyses, intentions to use a specific evidence-based practice were strongly associated with subsequent use (adjusted odds ratio = 5.2). The proportion of teachers who reported strong intentions varied from a low of 33% to a high of 66%, depending on the practice.

CONCLUSIONS

The findings illustrate that the strength of intentions, which varies depending on the specific practice, can predict implementation. More generally, the studies demonstrate how measures of intention can aid efforts to identify implementation barriers. The approach taken can be applied to study implementation of any practices designed to improve student health.

Sexual Self-Efficacy and Gender: A Review of Condom Use and Sexual Negotiation Among Young Men and Women in Sub-Saharan Africa

Sexual self-efficacy (SSE), one's perceived control of or confidence in the ability to perform a given sexual outcome, predicts sexual behavior; however, important questions remain regarding whether gender modifies observed associations. In a comprehensive review of peer-reviewed HIV-prevention literature focusing on youth (ages 10 to 25) in sub-Saharan Africa, we measured and assessed the influence of SSE on condom use and sexual refusal, overall and by gender. Our results, after reviewing 63 publications, show that SSE is inconsistently measured. Most studies measured condom use self-efficacy (CUSE) (96.8%) and/or sexual refusal self-efficacy (SRSE) (63.5%). On average, young men had higher CUSE than young women, while young women had higher SRSE than young men. While cross-sectional studies reported an association between high SSE and sexual behaviors, this association was not observed in interventions, particularly among young women who face a disproportionate risk of HIV acquisition. In all, 25% of intervention studies demonstrated that fostering CUSE increased condom use among young men only, and one of two studies demonstrated that higher SRSE led to reduced frequency of sexual activity for both men and women. Future research and HIV-prevention interventions must be gender targeted, consider improving CUSE for young men, and move beyond limited individual-level sexual behavior change frameworks.

An integrated model of condom use in Sub-Saharan African youth: A meta-analysis

OBJECTIVE

We tested an integrated social-cognitive model derived from multiple theories of the determinants of young people's condom use in Sub-Saharan Africa. The model comprised seven social-cognitive antecedents of condom use: Attitudes, norms, control, risk perceptions, barriers, intentions, and previous condom use.

METHOD

We conducted a systematic search of studies including effects between at least one model construct and intended or actual condom use in young people from sub-Saharan African countries. Fifty-five studies comprising 72 independent data sets were included and subjected to random-effects meta-analysis. Demographic and methodological variables were coded as moderators. Hypotheses of the integrated model were tested using meta-analytic structural equation modeling.

RESULTS

The meta-analysis revealed significant nontrivial sample-weighted correlations among most model constructs. Moderator analyses revealed differences in six correlations for studies that included a formative research component relative to studies that did not. There was little evidence of systematic moderation of relations among model constructs by other candidate moderators. Meta-analytic structural equation models revealed significant direct effects of attitudes, norms, and control on condom use intentions, and of intention, control, and barriers on condom use. Including past condom use increased explained variance in condom use intentions and behavior but did not attenuate model effects. There were also significant indirect effects of attitudes, norms, and control on condom use through intentions.

CONCLUSIONS

Findings provide preliminary evidence to support the integrated condom use model in sub-Saharan African youth. The model provides guidance on potential targets for improving the effectiveness of condom promotion interventions. (PsycINFO Database Record

InfoSec Process Action Model (IPAM)

While much of the extant InfoSec research relies on single assessment models that predict intent to act, this article proposes a multi-stage InfoSec Process Action Model (IPAM) that can positively change individual InfoSec behavior. We believe that this model will allow InfoSec researchers to focus more directly on the process that leads to action and develop better interventions that address problematic security behaviors. Building on successful healthcare efforts that resulted in smoking cessation, regular exercise, and a healthier diet, among others, IPAM is a hybrid predictive process approach to behavioral InfoSec improvement. IPAM formulates the motivational antecedents of intent as separate from the volitional drivers of behavior. Singular fear appeals often seen in InfoSec research are replaced by more nuanced treatments appropriately differentiated to support behavioral change as part of a process; phase-appropriate measures of self-efficacy are employed to more precisely assess the likelihood that a participant will act on good intentions; and decisional balance assessment of pro and con perceptions is monitored over time. These notions better align InfoSec research with both leading security practice and successful comparators in healthcare. We believe IPAM can both help InfoSec research models better explain actual behavior and better inform practical security behavior improvement initiatives.

Preventing tobacco in vocational high schools: study protocol for a randomized controlled trial of P2P, a peer to peer and theory planned behavior-based program

BACKGROUND

In France, the issue of youth smoking remains a major challenge for public health. School failure, socio-economic and socio-cultural backgrounds influence the initiation and maintenance of smoking behavior in adolescents. Vocational students are at particularly high risk of using psychoactive substances, including tobacco. One of the most important factors is the environment, whether family, friends or peers. Therefore, peer education has a positive potential to change smoking behavior of adolescents. It has also been demonstrated that the Theory of Planned Behavior (TPB) has yielded the best prediction of intentions and behavior, in several health domains, including on tobacco. However, it is usually confined to the measurement of processes by which interventions change behavior, rather than to the development of these interventions. The objective of this paper is to describe the protocol for a randomized controlled trial of a peer intervention based on the TPB on a highly exposed young population.

METHODS/DESIGNS

This is a cluster randomized controlled trial comparing an intervention group to a control group, randomized into clusters (professional schools and classes) and stratified in three departments (Hérault, Aude and Gard) in the Languedoc-Roussillon region. The primary issue is the prevalence of daily smoking at 24 months, defined by a daily tobacco use of at least 1 cigarette, validated by CO levels in exhaled air. The primary hypothesis is that intervention will lead to decrease the daily smoking prevalence of 10% between the intervention group and the control group during a 2-year follow-up.

DISCUSSION

The results from this trial will provide evidence on the effectiveness of an innovative peer-to-peer intervention based on the TPB.

TRIAL REGISTRATION

ISRCTN: 37336035 , Retrospectively registered 11/12/2015.

Fidelity Moderates the Association Between Negative Condom Attitudes and Outcome Behavior in an Evidence-Based Sexual Risk Reduction Intervention for Female Sex Workers

BACKGROUND

Intervention fidelity and participant-level variables, such as negative attitudes towards condoms, are important variables to consider in the successful implementation of evidence-based HIV prevention interventions. Mujer Segura is an intervention that has been shown to be efficacious at reducing condomless sex for female sex workers (FSWs) in Mexico [1].

PURPOSE

We examined main effects of fidelity, negative condom attitudes, and their interaction on the effectiveness of the Mujer Segura intervention at reducing condomless sex at intervention follow-up.

METHODS

Of the FSWs recruited from 13 cities across Mexico, 528 participated in the Mujer Segura intervention. We measured negative condom attitudes at baseline (comprising of beliefs and outcome evaluations) and condomless sex with clients at baseline and 6-month follow-up. Fidelity was measured by a fidelity checklist completed by independent raters; the sum of potentially 43 total elements completed by the counselor constituted fidelity.

RESULTS

Complete fidelity was found in only 15.1% (n = 73) of sessions. There was no significant main effect of intervention fidelity on condomless sex with clients at follow-up. There was a significant and positive main effect of negative condom attitudes and a significant two-way interaction. At lower levels of fidelity, negative condom attitudes predicted greater condomless sex acts, whereas at higher levels of fidelity, the effect of condom attitudes became weaker. The results also indicated that the interaction between negative condom attitudes and fidelity were driven primarily by negative condom beliefs, as opposed to negative condom outcome evaluations.

CONCLUSIONS

Ensuring treatment fidelity in an HIV prevention intervention is particularly important when participants have negative attitudes towards condoms.

Development and evaluation of a blended educational programme for general practitioners' trainers to stimulate proactive HIV testing

Background

In the Netherlands, a substantial proportion of newly diagnosed HIV patients present late for care, therefore, we investigated the effectiveness of a blended educational programme for trainers of GPs designed to stimulate proactive HIV testing.

Methods

GP trainers at the Academic Medical Center in Amsterdam were invited to participate in a two days training programme incorporating evidence-based practice guidelines and multiple teaching strategies, including interactive lectures, discussion groups, e-learning and quality improvement targets. The GP trainers completed questionnaires before and after the programme to evaluate the effect of the programme. We also used six-monthly cumulative laboratory data from 2010 to 2015 to compare the participating GPs’ HIV tests to the general trend in testing among non-participating GPs.

Results

150 GP trainers attended the first session, and 74 completed the questionnaires for both sessions. GPs median score on achieving their quality improvement targets was high and the quality of the programme highly appreciated. Between 2010 and 2013, the mean annual number of laboratory-documented HIV tests decreased by 9.1% in the 624 GPs in the control group, and by 13.0% for 11 GPs in the intervention group. After the programme, the annual decreases were 2.3% and 1.8%, respectively. Before the programme, the GPs in the intervention group had 50% more laboratory-documented HIV tests than GPs in the control group. After the programme, GPs in the intervention group had twice as many laboratory-documented HIV tests as the controls.

Conclusions

We provided a detailed description of a programme based on educational and clinical evidence. We could not retrieve laboratory-documented HIV testing data for the majority of GPs in both the intervention and control groups. Therefore, the limited results should be interpreted with caution as our findings may not be representative of all participants. The blended educational programme appears to have stabilized – at a higher level – the initially stronger downward trend in testing for 11 GPs undergoing the intervention, indicating that the programme may have had an impact on their HIV testing behaviour.

Electronic supplementary material

The online version of this article (10.1186/s12875-018-0723-8) contains supplementary material, which is available to authorized users.

Perceived behavioral control as a potential precursor of walking three times a week: Patient's perspectives

Background

Behavior change theories can identify people’s main motivations to engage in recommended health practices and thus provide better tools to design interventions, particularly human centered design interventions.

Objectives

This study had two objectives: (a) to identify salient beliefs about walking three times a week for 30 minutes nonstop among patients with hypertension in a low-resource setting and, (b) to measure the relationships among intentions, attitudes, perceived social pressure and perceived behavioral control about this behavior.

Methods

Face-to-face interviews with 34 people living with hypertension were conducted in September-October 2011 in Lima, Peru, and data analysis was performed in 2015. The Reasoned Action Approach was used to study the people’s decisions to walk. We elicited people’s salient beliefs and measured the theoretical constructs associated with this behavior.

Results

Results pointed at salient key behavioral, normative and control beliefs. In particular, perceived behavioral control appeared as an important determinant of walking and a small set of control beliefs were identified as potential targets of health communication campaigns, including (not) having someone to walk with, having work or responsibilities, or having no time.

Conclusions

This theory-based study with a focus on end-users provides elements to inform the design of an intervention that would motivate people living with hypertension to walk on a regular basis in low-resource settings.

Cross-country Association of Press Freedom and LGBT freedom with prevalence of persons living with HIV: implication for global strategy against HIV/AIDS

BACKGROUND

Human behaviors are affected by attitudes and beliefs, which in turn are shaped by higher-level values to which we have ascribed. In this study, we explore the relationship between two higher-level values, press freedom and LGBT freedom, and HIV infection with national data at the population level.

METHODS

Data were the number of persons living with HIV (PLWH, n = 35,468,911) for 148 countries during 2011-15, press freedom index (PFI) determined by the Reporters Without Borders, and LGBT freedom index (LGBT-FI) based on laws regulating same-sex relationships and expression. PLWH prevalence (1/1000), PFI and LGBT-FI were mapped first. Multiple regression was thus used to associate the logarithm of PLWH prevalence with PFI, LGBT-FI and PFI × LGBT-FI interaction, controlling for per capita GDP and weighted by population size.

RESULTS

Global prevalence of PLWH during 2011-15 was 0.51 per 1000 population. The prevalence showed a geographic pattern moving from high at the south and west ends of the world map to low at the north and east. Both PFI and LGBT-FI were positively associated with PLWH prevalence with a negative interaction between the two.

CONCLUSIONS

More people are infected with HIV in countries with higher press freedom and higher LGBT freedom. Furthermore, press freedom can attenuate the positive association between levels of LGBT freedom and risk of HIV infection. This study demonstrated the urgency for and provided data supporting further research to investigate potential cultural and socioecological mechanisms underpinning the complex relationship among press freedom, LGBT freedom and HIV infection, with data collected at the individual level.

Advantages to Using Social-Behavioral Models of Medication Adherence in Research and Practice

Achieving and sustaining high levels of adherence to medication regimens is essential to improving health outcomes, but continues to be a challenge for a sizable proportion of patients. Decades of research suggests that medication adherence is determined by a complex constellation of factors. Social-behavioral science research has focused on creating frameworks that identify which contextual, personal, social, or drug-related factors appear to most influence adherence. Comprehensive models of adherence propose specific structural relationships between these factors that can be used to plan for, implement, and monitor programs that seek to optimize adherence. The use of social-behavioral models offers multiple advantages in both practice and research environments; however, the breadth and depth of these models can deter many from engaging in this important exercise. To promote the use of social-behavioral frameworks and models of adherence, we provide a brief overview of the advantages in using a social-behavioral lens in adherence work, a sampling of models used in HIV medication adherence research that have high generalizability to other conditions, and practical guidance for grounding adherence promotion strategies in evidence informed by social-behavioral science research.

The interplay between feelings and beliefs about condoms as predictors of their use

OBJECTIVE

Negative feelings about condoms are a key barrier to their use. Using the behavioural affective associations model, we examined the joint effects of affective associations and cognitive beliefs about condoms on condom use.

DESIGN

In Study 1 (N = 97), students completed measures of their affective associations and cognitive beliefs about sex and condoms, sexual activity and condom use. In Study 2 (N = 171), a measure of behavioural intentions and condom selection task were added.

MAIN OUTCOME MEASURES

Condom use measured in Study 1 as (1) current condom use, and (2) willingness to use condoms; in Study 2 as: (1) behavioural intentions, (2) number of condoms selected.

RESULTS

Affective associations with sex and condoms were behaviour-specific, were directly associated with the respective behaviour, and mediated the relations of cognitive beliefs to behaviour, ps < .05. In Study 2, affective associations were associated with behavioural intentions and the number of condoms selected, ps < .05; cognitive beliefs were indirectly associated with these outcomes through affective associations, indirect effects: ps < .05.

CONCLUSIONS

Affective associations are a behaviour-specific and proximal predictor of condom use, mediating the effect of cognitive beliefs, suggesting they may be a particularly viable intervention target.

Identification of Key Beliefs Explaining Male Circumcision Motivation Among Adolescent Boys in Zimbabwe: Targets for Behavior Change Communication

Male circumcision (MC) significantly reduces HIV acquisition among men, leading WHO/UNAIDS to recommend high HIV and low MC prevalence countries circumcise 80% of adolescents and men age 15-49. Despite significant investment to increase MC capacity only 27% of the goal has been achieved in Zimbabwe. To increase adoption, research to create evidence-based messages is greatly needed. The Integrated Behavioral Model (IBM) was used to investigate factors affecting MC motivation among adolescents. Based on qualitative elicitation study results a survey was designed and administered to a representative sample of 802 adolescent boys aged 13-17 in two urban and two rural areas in Zimbabwe. Multiple regression analysis found all six IBM constructs (2 attitude, 2 social influence, 2 personal agency) significantly explained MC intention (R2 = 0.55). Stepwise regression analysis of beliefs underlying each IBM belief-based construct found 9 behavioral, 6 injunctive norm, 2 descriptive norm, 5 efficacy, and 8 control beliefs significantly explained MC intention. A final stepwise regression of all the significant IBM construct beliefs identified 12 key beliefs best explaining intention. Similar analyses were carried out with subgroups of adolescents by urban-rural and age. Different sets of behavioral, normative, efficacy, and control beliefs were significant for each sub-group. This study demonstrates the application of theory-driven research to identify evidence-based targets for the design of effective MC messages for interventions to increase adolescents' motivation. Incorporating these findings into communication campaigns is likely to improve demand for MC.

HealthyhornsTXT: A Text-Messaging Program to Promote College Student Health and Wellness

Objective: Text-messaging interventions positively affect health behaviors, but their use on college campuses has been limited. Text messaging serves as a relatively affordable way to communicate with large audiences and is one of the preferred modes of communication for young adults. This study examined the feasibility and acceptability of a campus-wide, health text–messaging program. Participants: The subscriber pool consisted of approximately 6,000 undergraduate students from a large, southern university. From that pool, 1,095 participants (64% female; 41% White) completed a posttest survey. Method: Text messages covered a range of health topics and information about campus resources. Research was conducted from August through December 2015. Process data were collected throughout the semester; participants’ attitudes were assessed via an online survey at the program’s conclusion. Results: Students demonstrated engagement with the messages throughout the semester as evidenced by replies to text-back keywords and clicks on website links embedded within messages. Messages about sleep, stress management, and hydration were considered most relevant. The majority of participants (61%) reported increased awareness regarding their health. Conclusions: Text-messaging interventions are a feasible strategy to improve college student health.

Motivational power of future time perspective: Meta-analyses in education, work, and health

Future time perspective (FTP) may predict individual attitudes and behaviors. However, FTP research includes different FTP conceptualizations and outcomes which hinder generalizing its findings. To solve the inconsistencies in FTP research and generalize the magnitude of FTP as a driver of motivation and behavior, we conducted the first systematical synthesis of FTP relationships in three crucial life domains. Our meta-analyses of FTP studies in education (k = 28), work (k = 17), and health (k = 32) involved N = 31,558 participants, and used a conceptual model for grouping FTP constructs. To address different outcome types, we applied the Theory of Planned Behavior when coding the studies. FTP relationships with outcomes were small-to-medium, were generalizable across domains, and were strongest when the FTP construct included a mixture of cognition, behavioral intention, and affect and, in education, when the FTP measure was domain specific rather than general. There were cross-cultural differences in FTP-outcome relationships. The strength of the FTP-outcome types relationship varied for attitudes, perceived behavioral control, behavioral intention, and behaviors. The lowest effect sizes were found for FTP predicting actual behaviors in education, work, and health and between FTP and health attitudes. Theoretical implications of the findings and future research directions are discussed.

Predicting Condom Use: A Comparison of the Theory of Reasoned Action, the Theory of Planned Behavior and an Extended Model of TPB

ABSTRACT It was our goal to give a contribution to the prediction of condom use using socio-cognitive models, comparing classic theories to an extended model. A cross-sectional study was conducted using a questionnaire of self-reported measures. From the students who agreed to participate in the study, 140 were eligible for the full study. A confirmatory analysis was used to assess the predictive value of the researched model. The model tested had slightly better fit indexes and predictive value than classic Theories of Reasoned Action and Planned Behaviour. Although the results found, discussion continues to understand the gap between intention and behaviour, as further investigation is necessary to fully understand the reasons for condom use inconsistency.

A Latent Class Analysis of Seroadaptation Among Gay and Bisexual Men

Initial research into seroadaptive strategies suggests that, individually, they are potentially effective behavioral methods to reduce risk of HIV transmission. Combining strategies, therefore, has the potential to increase risk reduction. The aim of this study was to determine how gay and bisexual men (GBM) combine strategies. To this end, a total of 774 sexually active GBM, aged ≥16 years, in Metro Vancouver, Canada, were recruited. Grouped by self-reported HIV status, latent class analysis of self-reported condom use, strategic positioning, anal sex avoidance, serosorting, viral-load sorting, and withdrawal were conducted. Multinomial logistical regression identified explanatory variables of class membership (i.e., sensation seeking, treatment optimism, sexual altruism, relationship status, number of partners, anal sex preference). Four latent classes were identified: Condom Users, Multiple Prevention Users, Viral-Load Sorters, and Serosorters. The majority of HIV-negative/unknown men (72 %) and a large proportion of HIV-positive men (42 %) belonged to the Condom Users class. Class membership was associated with age, relationship status, treatment optimism, sexual altruism, sensation seeking, number of recent male anal sex partners, and recent condomless anal sex with a serodiscordant or unknown-status partner. Understanding these distinct patterns allows for tailored interventions addressing GBM's sexual health needs.

Why Interventions to Influence Adolescent Behavior Often Fail but Could Succeed

We provide a developmental perspective on two related issues: (a) why traditional preventative school-based interventions work reasonably well for children but less so for middle adolescents and (b) why some alternative approaches to interventions show promise for middle adolescents. We propose the hypothesis that traditional interventions fail when they do not align with adolescents' enhanced desire to feel respected and be accorded status; however, interventions that do align with this desire can motivate internalized, positive behavior change. We review examples of promising interventions that (a) directly harness the desire for status and respect, (b) provide adolescents with more respectful treatment from adults, or (c) lessen the negative influence of threats to status and respect. These examples are in the domains of unhealthy snacking, middle school discipline, and high school aggression. Discussion centers on implications for basic developmental science and for improvements to youth policy and practice.

What's the harm? Alcohol and marijuana use and perceived risks of unprotected sex among adolescents and young adults

The link between substance use and risky sexual behavior, particularly unprotected sex, among adolescents and young adults has been well established in the literature; however, less is known regarding how different patterns and types of substance use differentially relate to unprotected sex and perceived risks of unprotected sex. The current study examined perceived risks and unprotected sex among adolescents and young adults, and examined whether marijuana use, alcohol use, and dual marijuana and alcohol use were differentially linked to unprotected sex and perceived risks of unprotected sex.

METHOD

A sample of N=144 adolescents and young adults (Mage=18.77, SDage=3.4, range: 12-25) completed self-report questionnaires regarding past month substance use, unprotected sex, and perceived risks of having unprotected sex.

RESULTS

In a hierarchical logistic regression, only alcohol use was related to having unprotected sex at last intercourse (b=0.25, p<0.001). The second multinomial logistic regression showed that the interaction of alcohol and marijuana use was significantly related to lower levels of perceived risk of unprotected sex (moderate risk: b=0.06, p=0.04, OR=1.07; no/slight risk: b=0.07, p=0.03).

CONCLUSION

While dual marijuana and alcohol use was related to lower perceived risk of unprotected sex, only alcohol use only was associated with a higher likelihood of unprotected sex.

Meta-Analysis of the Reasoned Action Approach (RAA) to Understanding Health Behaviors

Background

Reasoned action approach (RAA) includes subcomponents of attitude (experiential/instrumental), perceived norm (injunctive/descriptive), and perceived behavioral control (capacity/autonomy) to predict intention and behavior.

Purpose

To provide a meta-analysis of the RAA for health behaviors focusing on comparing the pairs of RAA subcomponents and differences between health protection and health-risk behaviors.

Methods

The present research reports a meta-analysis of correlational tests of RAA subcomponents, examination of moderators, and combined effects of subcomponents on intention and behavior. Regressions were used to predict intention and behavior based on data from studies measuring all variables.

Results

Capacity and experiential attitude had large, and other constructs had small-medium-sized correlations with intention; all constructs except autonomy were significant independent predictors of intention in regressions. Intention, capacity, and experiential attitude had medium-large, and other constructs had small-medium-sized correlations with behavior; intention, capacity, experiential attitude, and descriptive norm were significant independent predictors of behavior in regressions.

Conclusions

The RAA subcomponents have utility in predicting and understanding health behaviors.

Rethinking HIV-prevention for school-going young people based on current behaviour patterns

The aim of the research was to gain increased knowledge regarding the sexual risk behaviour of school-going young people in South Africa after two decades of HIV-education in schools, to contribute to the development of improved HIV prevention strategies. In collaboration with the Department of Education, a sample of 5305 learners (between 10 and 18 years in Grades 5-12) from high-risk communities were identified. They completed a survey that assessed self-reported sexual risk behaviour and variables that potentially underlie sexual risk, such as attitudes towards preventive behaviour, perceived social norms and self-efficacy (based on the theory of planned behaviour [TPB]) and social factors like caregiver relationships and gender norms (based on the social ecological theory). Lifetime sex was reported by 49.4% of boys and 30.5% of girls in Grades 8-12, while 56% of the sexually active young people reported consistent condom use. Accurate knowledge about HIV transmission was low (37.8%). Regression analysis showed that risk behaviour was more prominent among older male youths, who perceived social norms as encouraging sexual activity, who use alcohol excessively, and who have negative attitudes towards abstinence. Perceived traditional community gender norms and negative relationships with caregivers were also associated with sexual risk behaviour. This research showed that the TPB can be used in planning HIV prevention interventions for young people. It also revealed that HIV-prevention strategies should focus beyond educating the individual, to address community factors such as improving caregiver relationships, the culture of substance abuse, peer group norms and inequality in community gender norms. These community processes influence young people's behaviour and need to be addressed to allow the youth to make healthy behavioural choices.

The importance of actual use in defining and measuring innovative behaviour: Comparison of e-book reader users and non-users

This study introduces the concept of personal innovative behaviour and demonstrates its validity in the context of e-book reader adoption and use. Personal innovative behaviour, unlike measures of consumer innovativeness, amalgamates decisions about product adoption with reports of the product’s actual use. Quantitative methodology was used, and probability proportional stratified sampling technique was used to obtain the proportionate sample. Items to measure personal innovative behaviour for e-book readers were included in a questionnaire distributed to students at a Malaysian university. Of the 386 participants, 79% used the e-book reader, half of them for academic purposes. Confirmatory factor analysis using Amos tested the concept of personal innovative behaviour for both users and non-users. The results indicated that the underlying dimensions, (intended Adoption Behaviour and actual Use Behaviour), could be measured and combined in a structural model only for users, i.e. innovators. Good model fit confirmed the validity and reliability of the framework. The redefined construct and scale validation will be helpful to researchers to measure the individual personal behaviour in terms of their final decision to adopt and actual usage of the novel product. The personal innovative behaviour scale presented here can be used by researchers and practitioners to measure adoption and use of personal information products and devices. The two dimensional conceptualization of personal innovative behaviour (intended Adoption Behaviour and actual Use Behaviour) reconciles similarities and differences between the decision and action variables in innovation diffusion theory and the technology acceptance model.

An application of the Health Action Process Approach model to oral hygiene behaviour and dental plaque in adolescents with fixed orthodontic appliances

BACKGROUND

The Health Action Process Approach (HAPA) model addresses health behaviours, but it has never been applied to model adolescents' oral hygiene behaviour during fixed orthodontic treatment.

AIM

This study aimed to apply the HAPA model to explain adolescents' oral hygiene behaviour and dental plaque during orthodontic treatment with fixed appliances.

METHODS

In this cross-sectional study, 116 adolescents with fixed appliances from an orthodontic clinic situated in Almere (the Netherlands) completed a questionnaire assessing oral health behaviours and the psychosocial factors of the HAPA model. Linear regression analyses were performed to examine the factors associated with dental plaque, toothbrushing, and the use of a proxy brush.

RESULTS

Stepwise regression analysis showed that lower amounts of plaque were significantly associated with higher frequency of the use of a proxy brush (R² = 45%), higher intention of the use of a proxy brush (R² = 5%), female gender (R² = 2%), and older age (R² = 2%). The multiple regression analyses revealed that higher action self-efficacy, intention, maintenance self-efficacy, and a higher education were significantly associated with the use of a proxy brush (R² = 45%).

CONCLUSION

Decreased levels of dental plaque are mainly associated with increased use of a proxy brush that is subsequently associated with a higher intention and self-efficacy to use the proxy brush.

Modeling Beliefs, Attitudes, and Intentions of Condom Use Among Secondary School Students in Kenya

As in other parts of sub-Saharan Africa, youth in Kenya report low rates of condom use. Although several studies have explored reasons for the low condom use among Kenyan youth, not many have established linkages between lack of use and normative beliefs and attitudes around condoms. Using the Theory of Planned Behavior (TPB), this article examined whether beliefs and attitudes around condoms influenced intentions and actual condom use. Data for the study were restricted to 1453 sexually active youth during the last school break. Path analysis was used to examine the relationship between the TPB constructs and condom use among Kenyan youth. Results indicated a direct relationship between attitudes and condom use for male respondents and an indirect relationship between these two variables for females. Both males and females who expressed greater intentions to use condoms were significantly more likely to report they used condoms consistently. Also, male and female youth with higher perceived behavioral control were significantly more likely to have used condoms consistently. Males with friends who used condoms were significantly more likely to use condoms consistently. The findings suggest the importance of examining young people's attitudes toward condoms-in particular, those deeply rooted in misconceptions that serve to discourage safer sexual behaviors.

Condom use negotiation among high school adolescents in Ghana: the role of gender

Gender has a profound effect on the sexual risk preventive intentions and behaviour of young people. However, little is known about the role of gender on condom use negotiation among adolescents in Ghana. This study explored gender differences in condom use negotiation among school-going adolescents in Ghana. Participants ( n = 684) completed self-report measures based on attitudes towards condom use, subjective norms regarding condom use, perceived behavioural control over condom use, intentions to use condoms, and on actual condom use behaviour. Results revealed statistically significant differences in condom use by gender. Specifically, attitudes towards condom use were more favourable among male students than they were among female students. Male students perceived slightly greater control over condom use than did female students. Moreover, male students reported slightly more condom-protected sexual behaviour than did female students. These results highlight the usefulness of designing gender-specific sexual risk reduction programmes among high school adolescents in Ghana.

Video Game Intervention for Sexual Risk Reduction in Minority Adolescents: Randomized Controlled Trial

Background

Human immunodeficiency virus (HIV) disproportionately impacts minority youth. Interventions to decrease HIV sexual risk are needed.

Objective

We hypothesized that an engaging theory-based digital health intervention in the form of an interactive video game would improve sexual health outcomes in adolescents.

Methods

Participants aged 11 to 14 years from 12 community afterschool, school, and summer programs were randomized 1:1 to play up to 16 hours of an experimental video game or control video games over 6 weeks. Assessments were conducted at 6 weeks and at 3, 6, and 12 months. Primary outcome was delay of initiation of vaginal/anal intercourse. Secondary outcomes included sexual health attitudes, knowledge, and intentions. We examined outcomes by gender and age.

Results

A total of 333 participants were randomized to play the intervention (n=166) or control games (n=167): 295 (88.6%) were racial/ethnic minorities, 177 (53.2%) were boys, and the mean age was 12.9 (1.1) years. At 12 months, for the 258 (84.6%) participants with available data, 94.6% (122/129) in the intervention group versus 95.4% (123/129) in the control group delayed initiation of intercourse (relative risk=0.99, 95% CI 0.94-1.05, P=.77). Over 12 months, the intervention group demonstrated improved sexual health attitudes overall compared to the control group (least squares means [LS means] difference 0.37, 95% CI 0.01-0.72, P=.04). This improvement was observed in boys (LS means difference 0.67, P=.008), but not girls (LS means difference 0.06, P=.81), and in younger (LS means difference 0.71, P=.005), but not older participants (LS means difference 0.03, P=.92). The intervention group also demonstrated increased sexual health knowledge overall (LS means difference 1.13, 95% CI 0.64-1.61, P<.001), in girls (LS means difference 1.16, P=.001), boys (LS means difference 1.10, P=.001), younger (LS means difference 1.18, P=.001), and older (LS means difference=1.08, P=.002) participants. There were no differences in intentions to delay the initiation of intercourse between the two groups (LS means difference 0.10, P=.56).

Conclusions

An interactive video game intervention improves sexual health attitudes and knowledge in minority adolescents for at least 12 months.

Trial Registration

Clinicaltrials.gov NCT01666496; https://clinicaltrials.gov/ct2/show/NCT01666496 (Archived by WebCite at http://www.webcitation.org/6syumc9C0).

The Short-term Effects of a Cyberbullying Prevention Intervention for Parents of Middle School Students

This study experimentally evaluated the short-term effects of the Arizona Attorney General's cybersafety promotion presentation, a key component of which is cyberbullying prevention. Fifty-one parents of children attending a middle school in the southwestern United States participated in the study. Results reveal parents who viewed the presentation believed their children to be more susceptible to cyberbullying, and indicated that they were more likely to talk to their children about saving evidence, not retaliating, and telling an adult compared to parents who had not viewed the presentation. The theoretical and practical implications of these results are discussed.