Predictors of condom use in sexually active adolescents

Evaluation of a Brief Online Sexual Health Program for Adolescents: A Randomized Controlled Trial

Adolescents are at increased risk of acquiring sexually transmitted infections (STIs) and experiencing unintended pregnancy. In particular, adolescents from marginalized communities experience significant sexual health disparities compared to their more advantaged peers. Digital sexual health programs, such as HEART (Health Education and Relationship Training), may be effective in reducing these risks and addressing these disparities. HEART is a web-based intervention focused on the promotion of positive sexual health outcomes, such as sexual decision-making skills, sexual communication skills, sexual health knowledge, and sexual norms and attitudes. The current study evaluates the efficacy of HEART, and examines whether effects were moderated by gender, socioeconomic status (SES), race, English as a second language, and sexual orientation to ensure the program is effective for diverse groups of adolescents. Participants were 457 high school students (Meanage=15.06, 59% girls, 35% White, 78% heterosexual, 54% receive free or reduced-price lunch). Students were randomized to HEART or an attention matched control and assessed at pretest and immediate posttest. HEART was effective in increasing sexual assertiveness, sexual communication intentions, HIV/STI knowledge, condom attitudes, and safer sex self-efficacy compared to the control condition. There were no significant interactions by gender, SES, race, English as a second language, or sexual orientation, suggesting the program worked equally well for all groups of youth. The findings of this study suggest that HEART may be a promising avenue for the promotion of positive sexual health outcomes for diverse groups of youth.

Media, Trust in Government, and Risk Perception of COVID-19 in the Early Stage of Epidemic: An Analysis Based on Moderating Effect

Previous research has revealed that environmental, social, and cultural factors affect people's risk perception of COVID-19, especially the influence of media and trust, while the dynamics of how they affect it is still not clear. Through the analysis of online survey data, this article shows that there are two opposed paths of action. Trust in the government will enhance people's confidence in controlling COVID-19. It then moderates and decreases the effects of people's level and frequency of concernon the risk perception (both cognition and worries) of COVID-19, on the contrary, obtaining information from unofficial channels also moderates and increases the effects of the people's level and frequency of concern on the second dimension (worries) of risk perception of COVID-19 rather than the first dimension (cognition). These conclusions have important policy implications for the control of the COVID-19 epidemic all over the world.

Evaluation of an Online Sexual Health Program among Adolescent Girls with Emotional and Behavioral Difficulties

OBJECTIVES

Adolescent girls with emotional and behavioral difficulties (EBDs) have a heightened risk of negative sexual health, including HIV, other sexually transmitted infections (STIs), and unplanned pregnancy. Few evidence-based sexual health interventions are available for adolescent girls with EBDs. This study tested the feasibility, acceptability, and efficacy of a brief, online sexual health program called HEART (Health Education and Relationship Training).

METHODS

Forty-seven participants (M-age = 15.79; SD = 1.71; 62% Black, 23% Hispanic) recruited from community-based organizations in the southeastern U.S. were compared to a non-equivalent comparison group who received an attention-matched intervention.

RESULTS

Findings support the feasibility of participant recruitment and program administration in community-based settings. Participants completed HEART in 44 minutes and experienced few technological difficulties. HEART was highly acceptable: most participants liked, learned from, and were engaged with the program. Further, 92% would recommend HEART to a friend and 98% would use what they learned in the future. At posttest, intervention participants had significantly higher communication intentions, communication skills, STI/HIV knowledge, sexual self-efficacy, condom attitudes, and condom norms than the comparison group (ps < .003; effect size ds = .38-1.65). Significant improvement in condom intentions was observed when comparing pretest to posttest scores among intervention participants only, t(46) = -3.21, d = 0.47.

CONCLUSIONS

Findings support the feasibility, acceptability, and efficacy of HEART among adolescent girls with EBDs in community-based settings. This study also addresses the growing need for research into the transferability of sexual health interventions to facilitate evidence-based decision-making about program dissemination and implementation.

Feasibility, Acceptability, and Preliminary Efficacy of a Brief Online Sexual Health Program for Adolescents

This study evaluated the feasibility, acceptability, and preliminary efficacy of a 45-minute interactive, online sexual health program for adolescents, called Health Education and Relationship Training (HEART). The program was originally developed and evaluated among adolescent girls (HEART for Girls); the current project describes and evaluates a new version of the program that was adapted for boys and girls. Participants were 226 high school students (mean age = 16.3; 58% girls; 46% White; 79% heterosexual). Students were randomized to HEART or an attention-matched control and assessed at pre-test and immediate post-test. Overall, the program was feasible to administer in a school setting and youth found the program highly acceptable (83% liked the program, 87% learned new things, and 93% would use program content in the future). At post-test, students who completed HEART demonstrated improvements on every outcome we examined: sexual communication intentions, condom use intentions, HIV/STD knowledge, condom attitudes, condom norms, self-efficacy to practice safer sex, and sexual assertiveness compared to control participants (effect size ds = .23 to 1.27). Interactions by gender and sexual orientation revealed the program was equally acceptable and worked equally well for boys and girls and for heterosexual and sexual minority youth. We propose several avenues to further adapt and tailor HEART given its promise in promoting adolescent sexual health.

The Impact of Pre-Exposure Prophylaxis on Sexual Communication and Sexual Behavior of Urban Gay and Bisexual Men

Pre-exposure prophylaxis (PrEP) has altered the public health landscape for gay, bisexual, and other men who have sex with men (GBM) by significantly increasing protection against HIV infection. Early epidemiologic data showed GBM generally used PrEP as prescribed, i.e., as an additional protective tool over and above barrier protection, although subsequent reports have been equivocal. Irrespective of population-level trends, some GBM appear to have reevaluated their HIV risk tolerance and changed their interactions with sex partners. Scant published data have focused on factors that influence PrEP-using GBM's decisions about sexual behavior-including condom use as well as sex with HIV-positive partners-and sexual communication practices. Thus, in this study, we investigated those research concerns qualitatively via content analysis of individual interviews conducted with 103 GBM in New York City (M age 32.5 years, 50% White, 64% on PrEP > 6 months). Emergent themes reflect (1) participants' strong HIV knowledge; (2) changing GBM community norms about condom use on PrEP; (3) increased focus on risk tolerance with individual differences in post-PrEP condom use; (4) appreciation for routine sexually transmitted infection (STI) screening in PrEP care concomitant with some STI knowledge deficits; (5) decreased stigma concerning, and greater comfort with, HIV-positive sex partners; and (6) increased confidence discussing HIV status and condom use preferences with partners. Findings have implications for future research as well as for clinical practice, such as enhanced STI education and provider-initiated discussions about risk compensation, serosorting, and sexual communication skills.

Texting 4 Sexual Health: Improving Attitudes, Intention, and Behavior Among American Indian and Alaska Native Youth

PURPOSE

To design and test the effectiveness of a text messaging intervention to promote condom use and STI/HIV testing among American Indian and Alaska Native youth.

METHOD

A total of 408 study participants, 15 to 24 years old, were recruited, consented, surveyed, were sent intervention messages, and were incentivized via text message over a 9-month period. Complete pre- and postsurvey data were collected from 192 participants using SMS short codes. A mixed-effects logistic regression model was used to analyze before-after change in responses assessing sexual health knowledge, attitude, self-efficacy, intention, and behavior.

RESULTS

Participants' condom use attitude, condom use behavior, and STI/HIV testing intention improved after the intervention ( p < .05). Frequent condom use increased from 30% to 42% and was retained by participants at least 3 months postintervention, and the intervention improved participants' intention to get tested for STI/HIV after changing sexual partners, increasing from 46% to 58% postintervention.

CONCLUSIONS

Given the widespread use of cell phones by youth, text-based interventions may offer a feasible and effective tool to promote condom use and STI/HIV testing.

Predictors of Sexual Behavior among out-of-School Adolescents in Nigeria

Purpose:

To examine the influence of specific demographic and socio-cognitive variables on reported condom use among out-of-school adolescents in Nigeria.

Methods:

A cross-sectional study on a community-based sample of 1698 sexually active out-of school adolescents in Oyo state, Nigeria. Data were collected using a non-validated questionnaire administered by an interviewer.

Results:

Nine percent of the sexually-active adolescents reported condom use during sexual intercourse in the past year. Findings of logistic regression showed that adolescents with adequate self-efficacy were seven times more likely to use condom. A two-fold increase in condom use was found in adolescents who value parents' opinion on condom use.

Conclusion:

Results suggest self-efficacy and parents' influence affect condom use among Nigerian adolescents.

Risk and Rationality in Adolescent Decision Making

Crime, smoking, drug use, alcoholism, reckless driving, and many other unhealthy patterns of behavior that play out over a lifetime often debut during adolescence. Avoiding risks or buying time can set a different lifetime pattern. Changing unhealthy behaviors in adolescence would have a broad impact on society, reducing the burdens of disease, injury, human suffering, and associated economic costs. Any program designed to prevent or change such risky behaviors should be founded on a clear idea of what is normative (what behaviors, ideally, should the program foster?), descriptive (how are adolescents making decisions in the absence of the program?), and prescriptive (which practices can realistically move adolescent decisions closer to the normative ideal?). Normatively, decision processes should be evaluated for coherence (is the thinking process nonsensical, illogical, or self-contradictory?) and correspondence (are the outcomes of the decisions positive?). Behaviors that promote positive physical and mental health outcomes in modern society can be at odds with those selected for by evolution (e.g., early procreation). Healthy behaviors may also conflict with a decision maker's goals. Adolescents' goals are more likely to maximize immediate pleasure, and strict decision analysis implies that many kinds of unhealthy behavior, such as drinking and drug use, could be deemed rational. However, based on data showing developmental changes in goals, it is important for policy to promote positive long-term outcomes rather than adolescents' short-term goals. Developmental data also suggest that greater risk aversion is generally adaptive, and that decision processes that support this aversion are more advanced than those that support risk taking.

A key question is whether adolescents are developmentally competent to make decisions about risks. In principle, barring temptations with high rewards and individual differences that reduce self-control (i.e., under ideal conditions), adolescents are capable of rational decision making to achieve their goals. In practice, much depends on the particular situation in which a decision is made. In the heat of passion, in the presence of peers, on the spur of the moment, in unfamiliar situations, when trading off risks and benefits favors bad long-term outcomes, and when behavioral inhibition is required for good outcomes, adolescents are likely to reason more poorly than adults do. Brain maturation in adolescence is incomplete. Impulsivity, sensation seeking, thrill seeking, depression, and other individual differences also contribute to risk taking that resists standard risk-reduction interventions, although some conditions such as depression can be effectively treated with other approaches.

Major explanatory models of risky decision making can be roughly divided into (a) those, including health-belief models and the theory of planned behavior, that adhere to a “rational” behavioral decision-making framework that stresses deliberate, quantitative trading off of risks and benefits; and (b) those that emphasize nondeliberative reaction to the perceived gists or prototypes in the immediate decision environment. (A gist is a fuzzy mental representation of the general meaning of information or experience; a prototype is a mental representation of a standard or typical example of a category.) Although perceived risks and especially benefits predict behavioral intentions and risk-taking behavior, behavioral willingness is an even better predictor of susceptibility to risk taking—and has unique explanatory power—because adolescents are willing to do riskier things than they either intend or expect to do. Dual-process models, such as the prototype/willingness model and fuzzy-trace theory, identify two divergent paths to risk taking: a reasoned and a reactive route. Such models explain apparent contradictions in the literature, including different causes of risk taking for different individuals. Interventions to reduce risk taking must take into account the different causes of such behavior if they are to be effective. Longitudinal and experimental research are needed to disentangle opposing causal processes—particularly, those that produce positive versus negative relations between risk perceptions and behaviors.

Counterintuitive findings that must be accommodated by any adequate theory of risk taking include the following: (a) Despite conventional wisdom, adolescents do not perceive themselves to be invulnerable, and perceived vulnerability declines with increasing age; (b) although the object of many interventions is to enhance the accuracy of risk perceptions, adolescents typically overestimate important risks, such as HIV and lung cancer; (c) despite increasing competence in reasoning, some biases in judgment and decision making grow with age, producing more “irrational” violations of coherence among adults than among adolescents and younger children. The latter occurs because of a known developmental increase in gist processing with age. One implication of these findings is that traditional interventions stressing accurate risk perceptions are apt to be ineffective or backfire because young people already feel vulnerable and overestimate their risk. In addition, research shows that experience is not a good teacher for children and younger adolescents, because they tend to learn little from negative outcomes (favoring the use of effective deterrents, such as monitoring and supervision), although learning from experience improves considerably with age. Experience in the absence of negative consequences may increase feelings of invulnerability and thus explain the decrease in risk perceptions from early to late adolescence, as exploration increases. Finally, novel interventions that discourage deliberate weighing of risks and benefits by adolescents may ultimately prove more effective and enduring. Mature adults apparently resist taking risks not out of any conscious deliberation or choice, but because they intuitively grasp the gists of risky situations, retrieve appropriate risk-avoidant values, and never proceed down the slippery slope of actually contemplating tradeoffs between risks and benefits.

"Condoms are the standard, right?": Exploratory study of the reasons for using condoms by Black American emerging adult women

Condoms are considered a highly effective form of sexually transmitted infection prevention for heterosexual sex. Black American women (BAW) have been and are at elevated risk for heterosexual exposure to human immunodeficiency virus (HIV) because they have been and continue to be less likely to negotiate condom use with a partner that supports them financially. However, BAW who have made tremendous educational gains may still encounter challenges regarding the distribution of power that can affect condom use and negotiation. The purpose of this exploratory study was to examine the reasons that highly educated, emerging, adult BAW reported for using condoms. One hundred twenty-seven emerging adult BAW (ages 18-29 years) completed a mixed-methods online survey during the spring of 2013 (January-May). Approximately 80% of the women were in college or college graduates. They had a high rate of previous HIV testing (68.5%). Through the use of an interpretive paradigm and grounded theory, three themes emerged regarding the reasons that the participants in this sample used condoms as their primary form of protection: (1) the reliable "standard," (2) pregnancy prevention, and (3) cost effective and "easily accessible." Findings are discussed in terms of their public health significance for this seemingly lower-risk population.

The Hawke's Bay Condom Card Scheme: a qualitative study of the views of service providers on increased, discreet access for youth to free condoms

OBJECTIVES

The incidence of sexually transmitted infections and unplanned pregnancies in adolescence is of concern. The Hawke's Bay District Health Board, New Zealand, set up a pilot condom card scheme ('the Scheme') to allow 13- to 24-year-olds, deemed suitable for the Scheme, to access free condoms from pharmacies on presentation of a Condom Card. Our study explored the views of service providers of a pilot Condom Card Scheme.

METHODS

Qualitative interviews were conducted with 17 service providers (nurses, pharmacists, pharmacy staff) between February and April 2013.

KEY FINDINGS

Our findings showed that the Scheme was viewed positively by service providers, who indicated almost universal support for the Scheme to continue. However, participants noted a perceived lack of advertising, low number of sites for collection of condoms, lack of flexibility of the Scheme's criteria relating to who could access the scheme and issues with some pharmacy service providers, all of which led to a number of recommendations for improving the Scheme.

CONCLUSIONS

The views of service providers indicate broad support for the continuation of the Scheme. Canvassing young people's suggestions for improving the Scheme is also essential.

A Systematic Review and Meta-analysis of Interventions for Sexual Health Promotion Involving Serious Digital Games

OBJECTIVE

Serious games may be effective in promoting sexual health behavior. Their confidential nature may encourage users to discuss sensitive sexuality topics. Furthermore, they can tailor messages to the individual's needs and may be intrinsically motivating. This meta-analysis investigates the effectiveness of interventions for sexual health promotion that use serious games.

MATERIALS AND METHODS

A database search was conducted in PubMed, Web of Science, CINAHL, and PsycINFO for publications before the end of July 2013. Serious digital games studies measuring effects on behavior or its determinants, using a control condition, allowing the calculation of an effect size (Hedges' g, random-effects model) were included.

RESULTS

Seven game studies for sexual health promotion were included. These showed positive effects on determinants (g=0.242; 95 percent confidence interval, 0.129, 0.356), albeit of small effect size. The effects on behavior, measured in only two studies, were not significant (g=0.456; 95 percent confidence interval, -0.649, 1.561). Most games did not use many game features that are considered to be immersive or enhancing flow. Instead, there was a strong reliance on pure gamification features, such as rewards and feedback.

CONCLUSIONS

The effectiveness of the next generation of games may be enhanced by building on the behavioral change and educational gaming literatures (e.g., using role-play and simulation game formats, individual tailoring, offering adaptation in the difficulty of the challenge, and amount and timing of the feedback). There is a need for studies with rigorous evaluations of game effectiveness, longer-term follow-up, and using measures of behavior rather than merely their determinants.

A meta-analytic review of the relationship between adolescent risky sexual behavior and impulsivity across gender, age, and race

BACKGROUND

Impulsivity is frequently included as a risk factor in models of adolescent sexual risk-taking; however, findings on the magnitude of association between impulsivity and risky sexual behavior are variable across studies. The aims of the current meta-analysis were to examine (1) how specific impulsivity traits relate to specific risky sexual behaviors in adolescents, and (2) how the impulsivity-risky sex relationship might differ across gender, age, and race.

METHOD

Eighty-one studies were meta-analyzed using a random effects model to examine the overall impulsivity-risky sex relationship and relationships among specific impulsivity traits and risky sexual behaviors.

RESULTS

Overall, results revealed a significant, yet small, association between impulsivity and adolescent risky sexual behavior (r=0.19, p<0.001) that did not differ across impulsivity trait. A pattern of stronger effects was associated with risky sexual behaviors as compared to negative outcomes related to these behaviors. Gender moderated the overall relationship (β=0.22, p=0.04), such that effect sizes were significantly larger in samples with more females. Age, race, study design, and sample type did not moderate the relationship, although there was a pattern suggesting smaller effects for adolescents in juvenile detention settings.

CONCLUSIONS

Adolescent samples with more females showed a larger impulsivity-risky sex relationship, suggesting that impulsivity may be a more important risk factor for risky sex among adolescent females. Research and treatment should consider gender differences when investigating the role of impulsivity in adolescent sexual risk-taking.

A Meta-Analysis of the Relations Between Three Types of Peer Norms and Adolescent Sexual Behavior

The aim of the present meta-analysis was to investigate the associations between three types of peer norms-descriptive norms (peer sexual behaviors), injunctive norms (peer sexual attitudes), and peer pressure to have sex-and two adolescent sexual behavior outcomes (sexual activity and sexual risk behavior). Adolescent sexual activity was more strongly associated with descriptive norms (ESrfixed=.40) than with injunctive norms (ESrfixed=.22) or peer pressure (ESrfixed=.10). Compared with the sexual activity outcome, the effect size for descriptive norms (peer sexual risk behavior) for sexual risk behavior was smaller (ESrfixed=.11). Age, gender, peer type, and socio-cultural context significantly moderated these associations. Additional analyses of longitudinal studies suggested that selection effects were stronger than socialization effects. These findings offer empirical support for the conceptual distinction between three types of peer norms and hold important implications for theory, research, and intervention strategies.

How Gendered Attitudes Relate to Women's and Men's Sexual Behaviors and Beliefs

This study examines associations between endorsement of a sexual double standard, gender role attitudes, and sexual behaviors and beliefs. First year university students in the northeastern United States (N = 434; 52 % female; 33 % Black, 29 % Latino, 39 % White; ages 17-19) participated during their first year of college. Endorsement of a sexual double standard was associated with more conventionally gender-stereotyped sexual behaviors and beliefs, specifically, more sexual partners and fewer perceived barriers to condom use for young men, and more perceived barriers to condom use for young women. Women who were more conventional about men's roles in society tended to use condoms less, whereas women who were more conventional about women's roles tended to use condoms more. Men who were more conventional about men's roles tended to have fewer sexual partners. Findings suggest the importance of examining gender's role in sexual behaviors and beliefs by assessing multiple gendered attitudes, rather than simply considering biological sex.

It's Your Game…Keep It Real: can innovative public health prevention research thrive within a comparative effectiveness research framework?

The federal comparative effectiveness research (CER) initiative is designed to evaluate best practices in health care settings where they can be disseminated for immediate benefit to patients. The CER strategic framework comprises four categories (research, human and scientific capital, data infrastructure, and dissemination) with three crosscutting themes (conditions, patient populations, and types of intervention). The challenge for the field of public health has been accommodating the CER framework within prevention research. Applying a medicine-based, research-to-practice CER approach to public health prevention research has raised concerns regarding definitions of acceptable evidence (an evidence challenge), effective intervention dissemination within heterogeneous communities (a dissemination and implementation challenge), and rewards for best practice at the cost of other promising but high-risk approaches (an innovation challenge). Herein, a dynamic operationalization of the CER framework is described that is compatible with the development, evaluation, and dissemination of innovative public health prevention interventions. An effective HIV, STI, and pregnancy prevention program, It's Your Game…Keep It Real, provides a case study of this application, providing support that the CER framework can compatibly coexist with innovative, community-based public health prevention research.

Sensation seeking and impulsivity: combined associations with risky sexual behavior in a large sample of young adults

Although prior studies have shown that sensation seeking and impulsive decision-making are related to sexual risk-taking, it is still unclear whether these personality traits operate independently or synergistically. The purpose of this study was to elucidate the joint contribution of these personality traits to HIV and sexually transmitted disease (STD) risk behaviors using data from a large sample of sexually active young adults (N = 2,386). Regression modeling indicated that both sensation seeking and impulsive decision-making were consistently associated with sexual risk behaviors across 11 risk-related outcomes. Results further indicated that sensation seeking and impulsive decision-making operated synergistically with respect to the outcome variables of sex acts using drugs, acts with a partner using alcohol, and acts with a partner using drugs. In contrast to this, sensation seeking and impulsive decision-making operated independently with respect to the other sexual risk outcomes. Theoretical implications, as well as implications for HIV/STD prevention among high sensation seekers and impulsive decision-makers, are discussed.

Sexually-transmitted Infections and Unintended Pregnancy: A Longitudinal Analysis of Risk Transmission through Friends and Attitudes

Data from 1087 adolescent participants in three waves of the National Longitudinal Study of Adolescent Health was used to examine the effects of peer selection and socialization processes in adolescence on later reports of sexually-transmitted infections (STI) and unintended pregnancies. Friends' attitudes and behavior were assessed with friends' reports. Among males, there was evidence for selection effects on STI diagnoses and socialization effects on reports of unintended pregnancy, both involving friends' attitudes. Among females, there was evidence for long-term effects of both socialization and selection processes involving same-sex friends' attitudes. Discussion focuses on the importance of peer and individual attitudes as potential intervention targets.

Factors influencing condom use among women in Ghana: an HIV/AIDS perspective

Although in Ghana information on HIV infection and prevention, both in terms of quality and quantity, has increased considerably within the past few years, available literature indicates that behaviour change is yet to correspond with the amount of information and education provided. The objective of this study is to examine factors that influence condom use among women in Ghana in the context of HIV/AIDS prevalence. Data for this study are from the 2003 Ghana Demographic and Health Surveys (GDHS) and the study population (N=5 691) was analysed using logistic regression with the Health Belief Model (HBM) as an explanatory tool. The outcome variable for this study is condom use during last sexual intercourse. The HBM identifies perception of HIV/AIDS risks, awareness of its seriousness, knowledge about prevention, and confidence in condom use as predictors of safe sexual activity. Results show that the proportion of women reporting use of condoms remains tremendously low, in both the rural and urban areas. In the urban areas, only 15% of women reported having sex with condom during their last intercourse, whereas in the rural areas the proportion is even lower (10%). However, multivariate analyses based on the HBM components show that speaking with a partner about how to avoid AIDS (Odds Ratio = 1.63) and perceived benefits of using condoms (Odds Ratio = 1.54) are notable factors that predict condom use. Overall, the study points out that with the exception of perceived severity, the HBM can be applied to understand condom use among the study population. It will be important to emphasise all components of the HBM and empower women with condom negotiation skills.

Character as a predictor of reproductive health outcomes for youth: a systematic review

To review research examining the influence of character on adolescent sexual and reproductive health (ASRH). We defined character as comprising two positive youth development constructs: prosocial norms and spirituality. We conducted a systematic review of behavioral research published from 1985 through 2007 that examined the association between two character constructs (prosocial norms and spirituality) and ASRH outcomes. We coded results as showing a protective association, risk association, or no association, and as longitudinal, or cross-sectional. We considered consistent associations from at least two longitudinal studies for a given outcome to be sufficient evidence for a protective or risk association. There is sufficient evidence to indicate that prosocial norms and spirituality can be protective factors for some ASRH outcomes including intention to have sex, early sex or ever having sex, contraceptive and condom use, frequency of sex, and pregnancy. The generalizability of findings by age, race/ethnicity, and gender was unclear. Findings suggest that some character sub-constructs are associated with a reduced likelihood of several adverse ASRH outcomes and with an increased likelihood of using contraceptives and intending to use condoms. Further research is needed to better understand mixed results and results showing some character sub-constructs, such as religious affiliation, to be associated with adverse ASRH outcomes.

Sex and drugs: the correlations of injecting drug users' risk perception and behavioral patterns

A low-level blood-borne virus infection exists among Hungary's injecting drug users (IDUs). Assessing the relationship between risk perception and risk behaviors is necessary in order to predict future drug-injecting trends. During 1999 -and 2000, 197 IDUs were interviewed in Budapest using the Risk Assessment Questionnaire developed by the National Institute on Drug Abuse. Certain IDUs perceived high risks but did not act accordingly. High-risk perception of sexual behavior correlates with high-risk perception of drug use, which should be taken into consideration when planning intervention strategies targeting IDUs. Additional research with a larger sample is needed to explain our results in more detail. The study's limitations have been noted.

Associations between health screening questions and sexual risk behaviors in adolescent female clinic patients: identifying a brief question format to yield critical information

This study examines the ability of brief screening questions to identify adolescent girls at high risk for sexually transmitted infections and teen pregnancy. Participants included 103 sexually active 13-year-old to 17-year-old girls recruited from adolescent clinics who (1) were identified as at risk for negative sexual health outcomes through responses to an 8-item Health Screening Survey, and (2) returned to clinic within 2 weeks to complete a self-report survey about sexual risk behaviors and contraceptive use. Analyses examined relationships between girls' total screening scores, individual screening survey items, and 5 self-reported sexual risk behaviors. Higher screening scores correlated with lower levels of refusing unprotected sex and less consistent condom use (P < .05 and P < .01, respectively). High-risk responses to 2 screening items were associated with all 5 sexual risk behaviors. Findings suggest useful questions in routine clinical screening of sexually active adolescent girls to identify those at high levels of sexual risk.

HIV testing among at-risk adolescents and young adults: a prospective analysis of a community sample

PURPOSE

Little is known about predictors of human immunodeficiency virus (HIV) testing among sexually active adolescents, who account for a large proportion of new HIV infections. This study sought to determine predictors of HIV testing among a large community-based sample of adolescents in three cities who had recent unprotected sexual intercourse.

METHODS

Sexually active adolescents (N = 1222) completed baseline and 3-month assessments of sexual behavior, substance use and HIV testing behaviors as part of a larger, multi-site, brief HIV prevention program.

RESULTS

Approximately half of the adolescents reported having previously been tested for HIV, and of those one third were tested in the next 3 months without a specific intervention. Adolescents who received HIV testing were more likely at baseline to have ever been tested, to have a STI diagnosis, to have not used substances during sex and to have been assertive about condom use with a partner.

CONCLUSIONS

Health care models encouraging more widespread, universal testing may be an important public health initiative to curb the spread of HIV. Regular HIV screenings provide an opportunity to enhance awareness of behavioral risk and HIV status, as well as provide opportunities for early detection and care.

Peer selection and socialization effects on adolescent intercourse without a condom and attitudes about the costs of sex

This study investigated peer selection and socialization effects on sexual behavior and attitudes using 1,350 15- to 18-year-old students participating in two waves of the National Longitudinal Study of Adolescent Health. Regarding socialization effects, friends' intercourse without condoms predicted later individual intercourse without condoms positively. Friends' attitudes about the costs of sex predicted later individual attitudes positively and intercourse without condoms negatively. The latter relation was stronger for females than for males. Regarding selection effects, individual attitudes predicted later friends' attitudes positively, but the strength of this effect varied by ethnicity. The results suggest that adolescents socialize friends to have similar sexual attitudes and behavior but tend to select friends based on similar attitudes rather than similar behaviors.

Association between condom use at sexual debut and subsequent sexual trajectories: a longitudinal study using biomarkers

OBJECTIVES

We compared subsequent sexual behaviors and risk of sexually transmitted infections among adolescents who did and did not use a condom at their sexual debut.

METHODS

We derived data from the National Longitudinal Study of Adolescent Health, which followed a sample of 4018 sexually active adolescents between 1994 and 2002. During waves I, II, and III of the study, data on sexual behavior were gathered, and at wave III urine specimens were collected to test for sexually transmitted infections.

RESULTS

Among interviewed adolescents, those who reported condom use at their debut were more likely than those who did not use condoms at their debut to report condom use at their most recent intercourse (on average 6.8 years after sexual debut), and they were only half as likely to test positive for chlamydia or gonorrhea (adjusted odds ratio=0.50; 95% confidence interval=0.26, 0.95). Reported lifetime numbers of sexual partners did not differ between the 2 groups.

CONCLUSIONS

Adolescents who use condoms at their sexual debut do not report more sexual partners, are more likely to engage in subsequent protective behaviors, and experience fewer sexually transmitted infections than do adolescents who do not use condoms at their sexual debut.

Injecting equipment sharing and perception of HIV and hepatitis risk among injecting drug users in Budapest

In central European states, rates of HIV among injection drug users (IDUs) have been low although Hepatitis C (HCV) infection is widespread. The goal of our study was to assess HIV infection, risk perceptions and injecting equipment sharing among IDUs in Budapest, Hungary. Altogether 150 IDUs were interviewed (121 structured interviews between 1999 and 2000 and 29 ethnographic interviews between 2003 and 2004). The majority of them injected heroin (52% and 79%) and many injected amphetamines (51% and 35%). One person tested positive for HIV. Two thirds (68%) shared injecting equipment (syringes, cookers and filters). Some participants said they shared syringes because they were not carrying them for fear of police harassment and that they reused filters as a backup drug supply. In multivariate analysis, sharing of injecting equipment was associated with higher perceived susceptibility to HIV/AIDS, lower self-efficacy for sterile equipment use, higher motivation to comply with peer pressure to use dirty injecting equipment and with having a criminal record. The high levels of injecting risk-behaviors found in this study are a cause for serious concern. Interventions for HIV-prevention need to address not only sharing syringes but also sharing and reusing of other injecting equipment and drug filters.

Creating Mechanisms for Meaningful Collaboration Between Members of Urban Communities and University-Based HIV Prevention Researchers

This article provides a description of a Community/University Collaborative Board, a formalized partnership between representatives from an inner-city community and university-based researchers. This Collaborative Board oversees a number of research projects focused on designing, delivering and testing family-based HIV prevention and mental health focused programs to elementary and junior high school age youth and their families. The Collaborative Board consists of urban parents, school staff members, representatives from community-based agencies and university-based researchers. One research project, the CHAMP (Collaborative HIV prevention and Adolescent Mental health Project) Family Program Study, an urban, family-based HIV prevention project will be used to illustrate how the Collaborative Board oversees a community-based research study. The process of establishing a Collaborative Board, recruiting members and developing subcommittees is described within this article. Examples of specific issues addressed by the Collaborative Board within its subcommittees, Implementation, Finance, Welcome, Research, Grant writing, Curriculum, and Leadership, are detailed in this article along with lessons learned.

AIDS health beliefs and intention for sexual abstinence among male adolescent students in Kathmandu, Nepal: a test of perceived severity and susceptibility

OBJECTIVES

In Nepal, male adolescent students are at high risk for infection with human immunodeficiency virus (HIV) because of their risky sexual behaviours. This study examined whether two subscales of the Health Belief Model (HBM), perceived severity and perceived susceptibility, are associated with abstinence intention among Nepalese male adolescent students for HIV/acquired immunodeficiency syndrome (AIDS) prevention.

STUDY DESIGN AND METHODS

A school-based study was conducted at a single school located in central Kathmandu from July to August 2002. Participants included 183 male students in Grades 9-12 aged 14-19 years. Anonymous self-reported questionnaires were used, and Zagumny's AIDS Health Belief Scale was adopted as a measure of perceived severity and perceived susceptibility.

RESULTS

Over half of the students (53%) strongly agreed with abstinence intention. Students with higher levels of perceived severity strongly agreed with abstinence intention [crude odds ratio 1.86, 95% confidence interval (CI) 1.02-3.38; adjusted odds ratio 1.94, 95% CI 1.05-3.58], but those with higher levels of perceived susceptibility did not. Moreover, age-stratified analysis showed that a high level of perceived susceptibility tended to decrease strong abstinence intention among students aged 16-19 years.

CONCLUSIONS

Perceived severity enhanced abstinence intention. The interpretations of perceived susceptibility need further examination through a longitudinal study among students aged 16-19 years. Furthermore, future research is needed to assess the effect of HIV/AIDS education on HIV/AIDS prevention strategies using perceived severity as a motivational tool to help persuade Nepalese male students to abstain from sexual intercourse.

Depressive symptoms as a predictor of sexual risk among African American adolescents and young adults

PURPOSE

To understand the prospective relationship between depressive symptoms and sexual risk behavior among a community sample of African American adolescents.

METHODS

African American adolescents (n = 415) who participated in a larger multi-site human immunodeficiency virus (HIV) prevention program provided baseline data on demographics, psychosocial context and depressive symptoms. At six-month follow-up, data were collected regarding sexual activity in the past 90 days. Multivariate logistic regression was conducted to determine the prospective relationship between depressive symptoms and proportion of condom use while controlling for relevant demographic and contextual factors.

RESULTS

The odds that African American adolescents who reported depressive symptoms at baseline would report inconsistent condom use at six-month follow-up was approximately four times greater than that of their peers who did not report depressive symptoms. Older adolescents and females were less likely to use condoms consistently and certain contextual factors, such as less pleasurable expectations about condom use, and living with a partner also heightened HIV/STI risk.

CONCLUSIONS

Clinicians should assess for depression symptoms in African American adolescent patients as an indicator of future sexual risk. Prevention interventions that address depressed mood could have a significant impact on later HIV/STI sexual risk behaviors. Further research is needed to understand the effect of depressive symptoms on sexual risk among adolescents of other race/ethnicities and to examine the potential cultural forces that affect this relationship.

Interventions and Patterns of Risk in Adolescent HIV/AIDS Prevention

Mid-way through the third decade of experience in preventing HIV/AIDS among adolescents, behavioral interventions and outcomes for high risk subgroups have generated evidence extremely instructive for navigating future priorities in reducing transmission risk behavior. Youth who abuse alcohol or drugs, who are detained or incarcerated, or have mental health co-morbidity such as externalizing disorders, represent the most significant challenge to current and future efforts to control the epidemic among the adolescent population. Although there is no unambiguous, standard intervention approach with adolescents, patterns of risks and outcomes with these subgroups are instructive in the critical priority of creating more sustainable gains with our HIV prevention resources. This article provides a synthesis of the evidence with these subgroups, discusses important limitations and difficulties in the current intervention science and highlights promising directions for the next generation of effort in reducing adolescent HIV-related sexual risk behavior. Because individual-level interventions have had only modest effects, a key current emphasis within the field is to develop multilevel interventions with a more ecological or contextual focus. We review various pragmatic responses that acknowledge this priority and the debt owed to individual-level intervention work with adolescents.

Applying a transtheoretical behavioral change model to HIV/STD and pregnancy prevention in adolescent clinics

PURPOSE

To evaluate the application of a transtheoretical model (TTM) of behavioral change to adolescent reproductive health counseling.

METHODS

Family planning counselors in Boston Metro school-based and community health centers used a TTM for pregnancy and human immunodeficiency virus/sexually transmitted disease (HIV/STD) prevention. Data were collected from September 2000 through December 2001. Bivariate analyses using chi-square statistics and multivariate analyses using logistic regression were performed to identify the differences between stage of change (SOC) groups and the predictive variables for SOC movement.

RESULTS

Data on 539 sexually experienced clients were examined. Site, client's gender, race, proximity of sexual activity, sexual partner status, level of partner support, and target behavior were significantly associated with initial SOC for both pregnancy and disease prevention (p < .01). For clients meeting stage movement analysis criteria (n = 86 for pregnancy prevention; 128 for disease prevention), there was suggestive evidence that older ones were more likely to move forward for both pregnancy and disease prevention (p = .08 and p = .07, respectively) between their first and second visits. For disease prevention, those initially in the precontemplation/contemplation stages were more likely than those in the action/maintenance stages to be forward movers (odds ratio = 3.89, p = .06). Counselors/supervisors reported that the TTM helped structure an integrated message and increased client engagement.

CONCLUSIONS

Efforts to prevent teen pregnancy and HIV/STDs should acknowledge the roles of partner support and age in SOC. Adolescents in preparation may need specific skill-building for behavioral change. Overall, TTM represents a promising approach to promoting integrated pregnancy and disease prevention in family planning counseling.

Youths and HIV/AIDS: psychiatry's role in a changing epidemic

OBJECTIVE

To review the past 10 years of published research on human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the United States, including psychosocial and psychiatric risk factors, epidemiology, biology, neurocognitive and psychiatric sequelae, disclosure issues, prevention strategies, and biological and behavioral treatments.

METHOD

Researchers reviewed the English-language literature with a focus on child and adolescent risk factors associated with HIV/AIDS, prevention, and treatment.

RESULTS

Substantial scientific advances have occurred over the past two decades leading to decreased morbidity and mortality in the United States from AIDS-related opportunistic infections. At the same time, rates of HIV infection are increasing in teenagers, young women, and minorities, and growing numbers of youths are living with an infected family member. Understanding HIV risk behavior requires a broad theoretical framework. Comprehensive HIV prevention programs have led to reduced risk behavior among HIV-affected youths and teens at risk of infection. Biological and behavioral treatments of HIV infection continue to evolve and have led to longer life span, improved quality of life, and fewer psychiatric problems.

CONCLUSIONS

HIV/AIDS has significant mental health implications, and psychiatry can play a critical role in curbing the epidemic. With minimal effort, mental health professionals can adapt and apply the strategies that they use to treat psychiatric symptoms to prevent HIV transmission behaviors.

Evaluation of behavioral measures of risk taking propensity with inner city adolescents

The current study examined the utility of behavioral measures of risk-taking propensity in the assessment of self-reported real-world risk-taking behaviors using a sample of 51 high-school-aged inner-city adolescents. Results indicated that performance on one behavioral measure, the balloon analogue risk task, accounted for unique variance in self-reported delinquency/safety risk behaviors as well as substance use risk behaviors, above and beyond that provided with demographics and self-report measures of risk-related constructs (i.e., impulsivity and sensation seeking). These results are discussed in relation to the potential utility of using a multimethod assessment approach for better understanding risk-taking vulnerability among adolescents.

Is Condom Use Habit Forming?

OBJECTIVE

The objective of this study was to assess whether using a condom at adolescent sexual debut is associated with an increased likelihood of subsequent condom use.

STUDY DESIGN

A nationally representative sample was used, including 4024 sexually active adolescents (12-18 years) from the National Longitudinal Study of Adolescent Health. Logistic regression was used to model the association of condom use at sexual debut on condom use at most recent sex (mean interval, 23 months).

RESULTS

Condom use at adolescent sexual debut was associated with a twofold increased likelihood of condom use during most recent sex (odds ratio, 2.28; 95% confidence interval, 1.91-2.73).

CONCLUSIONS

Among adolescents, early condom use is associated with an increased likelihood of subsequent condom use.

Family-level impact of the CHAMP Family Program: a community collaborative effort to support urban families and reduce youth HIV risk exposure

This article presents family-level results from an ongoing study examining the impact of the CHAMP (Chicago HIV prevention and Adolescent Mental health Project) Family Program, a family-based HIV preventative intervention meant to reduce the amount of time spent in situations of sexual possibility and delay initiation of sexual activity for urban youth in the 4th and 5th grades living in neighborhoods with high rates of HIV infection. The CHAMP Family Program has been developed, delivered, and overseen by a collaborative partnership, consisting of community parents, school staff, community-based agency representatives, and university-based researchers. Design of the program was informed by input from this collaborative partnership, child developmental theory of sexual risk, and empirical data gathered from the targeted community. This article presents findings that suggest CHAMP Family Program impact on family communication, family decision-making, and family-level influences hypothesized to be related to later adolescent HIV risk. Implications for future family-based HIV prevention research are discussed here.

Condom availability programs in Massachusetts high schools: relationships with condom use and sexual behavior

OBJECTIVES

This study assessed relationships between condom availability programs accompanied by community discussion and involvement and adolescent sexual practices.

METHODS

Sexual practice and condom use differences were assessed in a representative sample of 4166 adolescents enrolled in high schools with and without condom availability programs.

RESULTS

Adolescents in schools where condoms were available were more likely to receive condom use instruction and less likely to report lifetime or recent sexual intercourse. Sexually active adolescents in those schools were twice as likely to use condoms, but less likely to use other contraceptive methods, during their most recent sexual encounter.

CONCLUSIONS

The strategy of making condoms available, an indication of socioenvironmental support for condom use, may improve HIV prevention practices.

Prevention of type 2 diabetes in young people: a theoretical perspective

Type 2 diabetes in youth is an increasing public health concern, especially in certain minority populations. The current paper consists of four sections. First, we establish the significance of the problem by presenting an overview of epidemiological and physiological evidence. Second, we discuss behavioral issues relevant to the prevention of type 2 diabetes in youth. Third, a qualitative review of existing prevention interventions specific to type 2 diabetes in youth is presented. Results suggest that modest improvements in social cognitive, dietary, and exercise outcomes are possible with diabetes intervention studies, although beneficial changes are difficult to sustain over the long term. Although theoretical frameworks are not always explicit, most studies have utilized elements of the social cognitive theory. Less attention has been paid to sociocultural and community organization variables. Finally, the paper discusses issues of risk definition and intervention sustainability, and presents a comprehensive, theoretically diverse model for the prevention of type 2 diabetes in youth. In summary, we suggest that theories of the natural history and pathophysiology of type 2 diabetes are important to identify modifiable risk factors, while theories of behavioral change are essential to modify the risk factors identified. The combination of sound physiological and behavioral theories should form the basis of prevention intervention design. In addition, an ecologic approach that takes into consideration the dynamic interactions of personal, social, and environmental factors would best promote the long-term adoption of healthful behaviors in a supportive, meaningful, and personally enjoyable context.

Evaluation of a comprehensive AIDS education curriculum in Hungary--the role of good educators

The aim of this research was to evaluate a school-based AIDS education programme in Eastern Europe. Four evaluation segments were undertaken: process and outcome evaluations of the training of AIDS educators and of the educational activities for students. While most AIDS education curricula focus on the content of the education, our findings demonstrate that other aspects--including the characteristics of those educators who appear to be most effective, the way in which education is affected by teachers' attitudes, and the cultural implications of transferring programmes from one country to another--also need to be considered, especially in international environments.

Effective contraceptive counseling with adolescents in a nurse-based setting

Nurses serve a critical role in working with adolescents on reproductive health issues. Nurses must be knowledgeable and comfortable with providing counseling on contraceptive choices and decision making in order to meet the important goal of helping teens prevent unintended pregnancies.

Sexual activity and condom use among Eastern European adolescents--the Study of Hungarian Adolescent Risk Behaviours

While rates of HIV and STD infection in Eastern Europe are increasing rapidly, little is known about sexual behaviour, including condom use, among Eastern European youths. The Study of Hungarian Adolescent Risk Behaviours was designed to assess the knowledge, attitudes, and behaviours of adolescents studying in secondary schools in Budapest, Hungary. Students (n =3486) in a random sample of public secondary schools completed a self-administered questionnaire, including measures of sexual activity and condom use. Thirty-eight percent of students reported ever having had vaginal intercourse. Condom use by those reporting having had sex in the past five weeks was classified as consistent/every time (40%); irregular (25.6%); and none (34.3%). Multivariate analysis revealed positive opinions about condoms, fear of AIDS, and initiation of condom use by both partners to predict more frequent condom use. Implications for targeted AIDS/STD education and prevention among adolescents are discussed.

Correlates of HIV risk among Ecuadorian adolescents

The purpose of this study was to examine the relationship of HIV knowledge, demographics, and psychosocial factors with HIV risk behavior among high school students (N = 805) in urban and rural regions of Ecuador. Forty-three percent of the participants reported being sexually experienced. Of the sexually experienced participants, 50% reported never using condoms for intercourse, and 70% did not use condoms at last intercourse. A small minority of the sample felt that they were at risk for contracting HIV (18.5%). Educational aspirations past high school and residence in an urban area were significantly associated with decreased HIV risk (condom use at last intercourse and abstinence). High self-efficacy for condom use and strong refusal skills to unsafe sex were also significantly associated with decreased HIV risk. Consistent with prior research, the participants that reported their peers were sexually experienced were significantly more likely to have had sex. The discussion focuses on the use of interventions and education for promoting safer sexual behavior among Ecuadorian adolescents.

The POWER campaign for promotion of female and male condoms: audience research and campaign development

In this study, we conducted and content analyzed 12 focus groups with women aged 15-25 living in inner city Denver as a process of audience research to develop a male and female condom promotion campaign. We recruited 89 women from school and community sites in central Denver neighborhoods to discuss their knowledge, attitudes, and practices regarding both male and female condoms, then solicited opinions about how to increase knowledge about and familiarity with female condoms, increase positive attitudes toward both male and female condoms, and how to increase access to and use of both male and female condoms. Opinions on these topics drove the development of a targeted media campaign promoting condom use in this population. We report here on the general findings from focus groups and provide details about the campaign the participants helped to develop.

Where do adolescents get their condoms?

PURPOSE

To determine where adolescents obtain their condoms; the availability and accessibility of condoms; condom availability in relationship to different sexually transmitted disease (STD) rates; and the availability of safer sex information in places where condoms are sold.

METHODS

We conducted a random digit-dialed telephone survey of 259 14-19-year-old adolescents in Monroe County, New York. Self-reported health services use, knowledge and use of confidential services, and where adolescents obtained or intended to obtain condoms were assessed. Research assistants visited all retail establishments in five areas of similar population size with gonorrhea rates from 887 to 12,427 per 100,000 adolescents to assess how available and accessible condoms were in each store. Perceived access and actual condom availability and accessibility were compared using Chi-square and Student's t-tests.

RESULTS

Trained interviewers dialed 11,800 numbers in 1993, identifying 4449 (40%) households among 11,065 numbers reached successfully. Of these, 393 (8.8%) had eligible adolescents and 259 (66%) completed interviews. Most adolescents reported obtaining, or planning to obtain, condoms in stores rather than from free health care settings. Adolescents who have used condoms more often reported having obtained them without cost than having purchased them. Condoms were available at 101 (83%) of 122 stores identified. All drug stores and 75% of supermarkets sold condoms and displayed them openly. Most small grocery stores also sold condoms (92%), but were less likely to openly display them. No stores displayed or provided safer sex information. Areas with higher STD rates had more stores (p <.01), and more stores that sold condoms (p <.01). There was no difference in condom cost by area.

CONCLUSIONS

Many adolescents obtain their condoms in retail stores. Condom accessibility varied by store type and area STD rate. Increasing condom visibility in private grocery stores may increase the accessibility of condoms to adolescents in areas with highest STD rates.

HIV testing among young adults and older adolescents in the setting of acute substance abuse treatment

OBJECTIVES

To examine the feasibility and acceptance of HIV testing among youth in acute substance abuse treatment.

METHODS

Youth, aged 18 to 25 years old, in state-funded inpatient detoxification completed a confidential demographic/risk behavior questionnaire, and were offered a choice of no testing, serum-based testing, or oral fluid (Orasure, Epitope, Inc., Beaverton, OR, U.S.A.) HIV testing.

RESULTS

In all, 74% of 204 participants accepted HIV testing. In a multivariate model, female gender (odds ratio [OR], 0.32; 95% confidence interval [CI] 0.14-0.74) and having been recently tested (OR, 0.11; 95% CI, 0.05-0.26) were independently associated with refusing testing. Recent sexual activity (OR, 5.4; 95% CI, 1.5-20.4), recent use of methamphetamines (speed) or a combination of cocaine and heroin (speedball) (OR, 3.8; 95% CI, 1.6-9.0), and a recent perceived risk for HIV (OR, 4.6; 95% CI, 1.9-10.9) were independently associated with test acceptance. Thus, 150 of 150 (100%) chose the Orasure test. Overall, 64.6% (97 of 150) of those tested received their results, but among participants requiring a follow-up appointment to learn test results, only 9.2% (8 of 87) returned.

CONCLUSIONS

HIV testing is feasible and acceptable in this population. All patients preferred Orasure testing to a serum enzyme-linked immunosorbent assay (ELISA). Most youth tested in detoxification will only learn their results if they are provided during treatment. Rapid HIV testing with same-day results could improve follow-up rates.

Adolescent sexual risk behavior: a multi-system perspective

Adolescents are at high risk for a number of negative health consequences associated with early and unsafe sexual activity, including infection with human immunodeficiency virus, other sexually transmitted diseases, and unintended pregnancy. As a result, researchers have attempted to identify those factors that influence adolescent sexual risk behavior so that meaningful prevention and intervention programs may be developed. We propose that research efforts so far have been hampered by the adoption of models and perspectives that are narrow and do not adequately capture the complexity associated with the adolescent sexual experience. In this article, we review the recent literature (i.e., 1990-1999) pertaining to the correlates of adolescent sexual risk-taking, and organize the findings into a multisystemic perspective. Factors from the self, family, and extrafamilial systems of influence are discussed. We also consider several methodological problems that limit the literature's current scope, and consider implications of the adoption of a multisystemic framework for future research endeavors. We conclude with a discussion of the implications of the available research for practitioners working to reduce sexual risk behavior among adolescents.

The relationship of perceived risk to condom use: why results are inconsistent

Studies of the relationship between perceived risk and condom use among young adults show contradictory results. This article examines some reasons why the relationship appears to be inconsistent. One source of inconclusive results within and across studies appears to be the fact that perceived risk is both a “cause” and an “effect” of condom use. Measures of perceived risk rarely specify the context for responding and can therefore be interpreted in varying ways. Implications for both researchers and social marketing practitioners are discussed.