Factors associated with maintenance of regular condom use among single heterosexual adults: a longitudinal study

Efficacy of Human Immunodeficiency Virus/Sexually Transmitted Infection Trial on Condom Use Among Heterosexual Men Patronizing Entertainment Establishments Who Engaged in Casual or Paid Sex in Singapore

BACKGROUND

We assessed the efficacy of a multi-component sexual health promotion program on condom use and human immunodeficiency virus (HIV)/sexually transmitted infection (STI) testing among heterosexual men (HSM) patronizing entertainment establishments who engaged in casual or paid sex in Singapore.

METHODS

This was a quasi-experimental trial with a comparison group using cross-sectional surveys at baseline and 6 months postintervention. A locality patronized by local HSM was assigned the intervention, a comparable and distant area served as the comparison site. Using time location sampling, cross-sectional samples of these men were assessed on sexual behaviors using an anonymous questionnaire at baseline (n = 604) and 6 months postintervention (n = 360) in both groups. The coprimary outcomes were condom use at last vaginal and oral sex with casual partner respectively. Mixed effects Poisson regression model accounting for clustering by establishment was used to compute the adjusted prevalence ratio (aPR) of the outcomes postintervention.

RESULTS

At postintervention, the intervention group was more likely than the comparison group to report condom use at last vaginal (aPR, 1.41; 95% confidence interval [CI], 1.05-1.89) and oral (aPR, 1.70; 95% CI. 1.11-2.61) sex, respectively, with casual partner. Similar findings were found for consistent condom use in the last 6 months for vaginal (aPR, 1.67; 95% CI, 1.13-2.48) and oral (aPR, 1.97; 95% CI, 1.16-3.32) sex, respectively, with casual partner. The HIV/STI testing was not significantly higher in the intervention than the comparison group (aPR, 1.43; 95% CI, 0.98-2.09).

CONCLUSIONS

This trial was effective in promoting condom use with casual partners but not HIV/STI testing among HSM in Singapore.

The Impact of Condom Use Negotiation Self-Efficacy and Partnership Patterns on Consistent Condom Use Among College-Educated Women

This study sought to explore the impact of condom negotiation self-efficacy, interpersonal factors, and sensational factors on condom use behavior among a population of college-educated women with different patterns and types of sexual partner. We administered an online questionnaire capturing sexual behavior, partnership patterns, perceived benefits of and barriers to condom use, and condom use negotiation self-efficacy. A total of 433 women completed the online survey. Perceived sensual, erotic, and interpersonal benefits and barriers to condom use, along with negotiation self-efficacy, were found to be significantly associated with consistent condom use. When compared to respondents reporting only main partners, respondents reporting only casual partners were more likely to use condoms while respondents reporting both main and casual partners were least likely to use condoms. Previous negative experiences with condoms were significantly associated with decreased condom use, while history of sexually transmitted infection diagnosis was not consistently associated with condom use. This study supports the importance of negotiation self-efficacy in promoting condom use; however, building women's self-efficacy is not enough for effective condom use promotion among women. The impact of interpersonal, sensual and erotic factors, as well as the context of different partnership patterns, must be considered in future interventions.

Predicting having condoms available among adolescents: the role of personal norm and enjoyment

OBJECTIVES

Having condoms available has been shown to be an important predictor of condom use. We examined whether or not personal norm and goal enjoyment contribute to predicting having condoms available in the context of cognition specified by the theory of planned behaviour (TPB).

DESIGN

Prospective survey study, with a baseline and follow-up measurement (at 3 months).

METHODS

Data were gathered using an online survey. In total 282 adolescents (mean age = 15.6, 74% female adolescents) completed both questionnaires. At baseline, demographics, sexual experience, condom use, TPB variables, descriptive norm, personal norm, and enjoyment towards having condoms available were measured. At T2 (3 months later) having condoms available was measured. Direct and moderating effects of personal norm and goal enjoyment were examined by means of hierarchical linear regression analyses.

RESULTS

Regression analyses yielded a direct effect of self-efficacy and personal norm on condom availability. In addition, moderation of the intention-behaviour relation by goal enjoyment added to the variance explained. The final model explained approximately 35% of the variance in condom availability.

CONCLUSIONS

Personal norm and goal enjoyment add to the predictive utility of a TPB model of having condoms available and may be useful intervention targets.

STATEMENT OF CONTRIBUTION

What is already known about this subject? Having condoms available is an important prerequisite for actual condom use. The theory of planned behaviour has successfully been applied to explain condom availability behaviour. The theory of planned behaviour has been criticized for not adequately taking into account affective motivation. What does this study add? Personal norm and goal enjoyment add to the predictive utility of the model. Personal norm explains condom availability directly, enjoyment increases intention enactment. Personal norm and goal enjoyment therefore are useful intervention targets.

Reducing sexually-transmitted infection risk in young people with first-episode psychosis

There is emerging evidence that young people with first-episode psychosis are at greater risk of sexually-transmitted infections (STI) than their peers. Theoretical constructs central to behavioural change theories, broadly defined as sexual health-related knowledge, attitudes, and beliefs, have guided most sexual risk-reduction interventions in other at-risk populations. The role of these constructs in the sexual risk behaviour of young people with early psychosis remains unknown. A convenience sample of 67 young people with first-episode psychosis and 48 healthy controls matched on a number of sociodemographic characteristics was recruited. Participants completed a survey assessing their sexual behaviour and sexual health-related knowledge, attitudes, and beliefs. Group differences and the role of these constructs in the condom-use behaviour of these young people were examined. Although some differences emerged, group similarities were prominent. Inconsistent condom use was predicted by clinical status, unemployment, and the absence of peer support for condom use. These results support previous findings that young people with psychosis have greater needs for STI prevention due to increased rates of unprotected sex. Risk-reduction interventions that target peer influence are important. Inquiry into a broader range of psychosocial factors could further our understanding of STI infection risk in early psychosis.

Bridging the intention-behaviour gap: The role of moral norm

This research examined whether intentions aligned with moral norms better predict behaviour compared with intentions aligned with attitudes. Six data sets predicting behaviours in the health domain (smoking, driving over speed limit, applying universal precautions, exercising) were analysed. Moderated regression analysis indicated that participants whose intentions were more aligned with their moral norm were more likely to perform behaviours compared with participants whose intentions were more aligned with their attitude. However, further analysis indicated that this moderation effect was only present when participants construed the behaviour in moral terms. The findings suggest that the theory of planned behaviour should more clearly acknowledge the importance of internalized norms and self-expectations in the development of one's motivation to adopt a given behaviour.

Factors Predictive of Signed Consent for Posthumous Organ Donation

Context

The shortage of organs for transplantation has led public health authorities to invest significant efforts in the promotion of organ donation.

Objective

To identify factors predictive of signed consent for posthumous organ donation by using the theory of planned behavior.

Participants and Design

A random sample of 602 adults completed a questionnaire at baseline, and behavior was self-reported 15 months later.

Results

Logistic regression indicated that intention, perceived behavioral control, moral norm, and past behavior were factors predictive of consent for posthumous organ donation. Participants' perceived behavioral control, past behavior, and moral norm were also predictive of intention to sign, but attitude and perceived barriers were 2 additional determinants. Finally, anticipated regret and knowledge of persons who had made an organ donation were 2 moderators of the intention-behavior relationship.

Conclusion

Overall, the results showed that intention is an important determinant of signing the organ donor's consent sticker and also highlighted that moral consideration and perceived difficulties could be 2 potential avenues for designing interventions.

Application of the theory of planned behaviour to the prediction of objectively assessed breaking of posted speed limits

In two studies the Theory of Planned Behaviour (TPB) including moral norms, anticipated regret and past behaviour was applied to predicting intention to exceed the posted speed limit across different roads and objectively assessed speeding behaviour. All measures except behaviour were taken by self-report questionnaires referring to different driving scenarios. The behaviour measures were based on performance in a simulator (Study 1) or unobtrusive on-road speed camera assessment taken without driver awareness (Study 2) across roads with varying posted speed limits. Results are reported averaged across road types in both studies. In Study 1 (N=83), 82% of the variance in intentions to speed was explained, with attitudes, subjective norms, perceived behavioural control (PBC), moral norms, anticipated regret and past behaviour being significant predictors. A total of 35% of the variance in speed as assessed on a driving simulator was accounted for with intentions, PBC, moral norms and previous accidents being significant predictors. In Study 2 (N=303), 76% of the variance in intentions to speed was explained with attitudes, moral norms, anticipated regret and past behaviour being significant predictors. A total of 17% of the variance in speed as assessed on-road was accounted for with intentions and moral norms being significant. Practical implications of the findings for road safety are discussed.

The role of attitudes and self-efficacy in predicting condom use and purchase intentions

This study examines the condom purchasing and use habits of 256 college students in Norway and English-speaking Canada, and develops a structural equation model to explain condom purchase and use. In the model, intention to purchase condoms is influenced by self-efficacy in condom purchasing, as well as by intention to use condoms. Intention to use condoms is influenced by having a positive attitude toward condom usage and by self-efficacy in persuading a partner to use condoms. The implications for health promotion and social marketing campaigns are discussed.