Effects of a brief, theory-based STD-prevention program for female college students

Correlates and effects of information, motivation and behavioral skills on primary sexual abstinence among female university students in Ethiopia: a cross-sectional study

BACKGROUND

The burden of sexually transmitted infections (STIs) and unintended pregnancies continue to pose significant public health challenges, disproportionately affecting young women. The information-motivation-behavioral (IMB) skills model is useful for understanding risky and safe sexual behavior. However, while the IMB models have been used primarly to understand and promote HIV prevention with condom use behavior, there is limtted research using the IMB model to understand and promote safer sexual dual-protection behaviors, such as abstinence, to address the risk of both STI/HIV and unwanted pregnancy among youth in Ethiopia. This study aimed to fill this gap by applying the IMB model to assess the correlates and effects of information, motivation, and behavioral skills on primary sexual abstinence among female university students in Ethiopia.

METHODS

A cross-sectional study was conducted with a sample of 1,020 female university students at Mattu University between May and June 2023. Data were collected using a self-administered questionnaire and analyzed using SPSS version 23. Descriptive statistics were used to summarize the percentage distribution of participants by their sociodemographic characteristics and levels of HIV risk reduction/dual protection information, motivation, behavioral skills, and risky and safer sexual behaviors. Bivariate and multivariate analyses were conducted using structural equation modeling (SEM) with AMOS 23 to examine the correlations and effects of information, motivation, and behavioral skills on primary sexual abstinence.

RESULTS

Of 1,020 participants, 624 (61.2%) reported having practiced primary sexual abstinence.Multivariate analyses showed that primary sexual abstinence was significantly predicted by motivation (β = 0.34, P < 0.001), behavioral skills (β = 0.24, P < 0.001) and information (β = 0.11, P < 0.001) after controlling for the effects of other confounding variables. Overall, approximately 28% of the variance in primary sexual abstinence was explained by the IMB model constructs.

CONCLUSIONS

The findings indicate that the IMB model is a useful tool for identifying powerful determinants of sexual abstinence, which has potential implications for interventions aimed at enhancing specific information, motivation, and behavioral skills to promote sexual abstinence and reduce the risk of HIV/STI and unintended pregnancy among youth in settings with high HIV burdens.

University-based behavioral interventions to promote safer sex practices: A systematic review and meta-analysis

OBJECTIVE

This study aims to critically review the characteristics and effectiveness of university-based intervention to promote safer sex practice.

PARTICIPANTS AND METHODS

The published studies were selected from 5 databases with the publication year restricted between 1974 and 2018. The data were then pooled using a random-effect meta-analysis.

RESULTS

A total of 41 studies with 10,144 participants were included from 5,253 potentially relevant citations. Compared with minimal intervention, those people who participated in the intervention reported a statistically significant increase in the frequency of condom use (SMD 0.61; 95%CI 0.46-0.77, I2 = 9%). There was an insignificant change after the intervention (SMD 0.34; 95%CI -0.04-0.72, I2 = 72%) in communication with sexual partners and the heterogeneity existed in diversity of sessions of the intervention.

CONCLUSION

Behavioral interventions can significantly increase in the frequency of condom use but not in communication with sexual partners. A standardized measurement is a necessary consideration for future studies.

Knowledge of Palestinian women about cervical cancer warning signs: a national cross- sectional study

Background

Timely presentation and diagnosis of cervical cancer (CC) are crucial to decrease its mortality especially in low- and middle-income countries like Palestine. This study aimed to evaluate the knowledge of Palestinian women about CC warning signs and determine the factors associated with good knowledge.

Methods

This was a national cross-sectional study conducted between July 2019 and March 2020 in Palestine. Stratified convenience sampling was used to recruit adult women from hospitals, primary healthcare centers, and public spaces of 11 governorates. A translated-into-Arabic version of the validated CC awareness measure (CeCAM) was used to assess women’s knowledge of 12 CC warning signs.

Results

Of 8086 approached, 7223 participants completed the CeCAM (response rate = 89.3%). A total of 7058 questionnaires were included in the analysis: 2655 from the Gaza Strip and 4403 from the West Bank and Jerusalem (WBJ). The median age [interquartile range] for all participants was 34.0 [24.0, 42.0] years. Participants recruited from the WBJ were older, getting higher monthly income, and having more chronic diseases than those recruited from the Gaza Strip.

The most frequently identified warning sign was ‘vaginal bleeding after menopause’ (n = 5028, 71.2%) followed by ‘extreme generalized fatigue’ (n = 4601, 65.2%) and ‘unexplained weight loss’ (n = 4578, 64.9%). Only 1934 participants (27.4%) demonstrated good knowledge of CC warning signs. Participants from the Gaza Strip were slightly more likely than participants from the WBJ to have a good level of knowledge. Factors associated with having good knowledge included having a bachelor or postgraduate degree, being married, divorced, or widowed as well as knowing someone with cancer.

Conclusion

The overall awareness of CC warning signs was low. Educational interventions are needed to increase Palestinian women’s awareness of CC warning signs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11792-8.

Knowledge and testing preferences for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis infections among female undergraduate students

Objective: Our goal was to evaluate knowledge and testing preferences for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) infections.Participants: We surveyed female undergraduates attending the University of California, Los Angeles, in May 2017.Methods: Using an online survey, we collected demographic information and information on 793 participants' health care seeking behavior, sexual activity, sexually transmitted infection (STI) knowledge, and STI screening preferences. We used conjoint analysis to evaluate testing preferences of hypothetical STI tests.Results: On knowledge questions of CT and NG infections, 193 (27.7%) participants scored >80% correct. Cost had the largest impact on willingness to use a hypothetical STI test, accounting for 41.5% of preference, followed by specimen type (17.4%), and location of testing (16.4%).Conclusions: Knowledge regarding STIs was low. Educational programs implemented through the university health center might increase testing rates. A free, urine-based, home STI test may be desirable for undergraduate females.

HIV Knowledge of Middle Eastern and North Africans 18-35 Residing in the U.S.: A Cross Sectional Study

The current body of literature on the HIV knowledge related to young adult Middle Eastern and North African (MENA) individuals residing in the United States is substantially underdeveloped. As the number of MENA individuals residing in the US continues to rise, there remains a need for research investigating the levels of general HIV knowledge for this unique group. An exploratory cross-sectional design was used for an anonymous online survey of MENA adults ages 18-35 (n = 198) residing in the United States concerning their levels of HIV knowledge. Results showed that less than fifty percent (46.40%) of the sample reported adequate knowledge of HIV transmission and prevention methods. Multiple regression analyses indicate that prior sexual health education, prior HIV testing, a four-year college degree and identification as a Muslim predicted higher HIV knowledge. These findings may assist with the development of MENA specific HIV prevention and education programs.

Assessing How Gender, Relationship Status, and Item Wording Influence Cues Used by College Students to Decline Different Sexual Behaviors

Researchers rarely examine college students' event-level refusals and how refusals may change based on sexual behavior, gender, or relationship status. As such, we assessed how sexual behavior and demographic characteristics influence cues students use to decline sexual activity. As an exploratory aim, we examined the influence of item wording (such as reading the words, not willing/non-consent vs. refusal) on how students reported declining sexual activity. A sample of 615 college students from Canada and the U.S. completed a survey; students were randomly assigned to one of two conditions that manipulated item wording (not willing/non-consent vs. refusal). Students were then prompted with four open-ended questions that asked how they refused/communicated non-consent for four sexual behaviors. An inductive coding procedure was used and five overarching themes emerged. Three themes included explicit and implicit verbal cues and two themes included explicit and implicit non-verbal cues. Wording condition (i.e., not willing/non-consent v. refusal) did not influence the types of cues reported by students. Refusal communication varied by sexual behavior and relationship status but not gender. Sexual assault prevention initiatives should include more information about the variety of refusal cues used by college students in their programming, as many of these cues are currently absent.

HIV Prevention in Rural Appalachian Jails: Implications for Re-entry Risk Reduction Among Women Who Use Drugs

Rural women are at risk for health consequences (such as HIV) associated with substance misuse, but targeted interventions are limited for this population. Jails provide an underutilized opportunity for outreach to high-risk women in rural Appalachian communities. Rural women were randomized to either the NIDA Standard education intervention (n = 201) or the NIDA Standard plus motivational interviewing (MI-HIV; n = 199) while in jail. Outcomes focused on HIV risk behaviors 3 months post-release from jail. Decreases in HIV risk behaviors were observed at follow-up across conditions. Although participants in the MI-HIV group showed reductions in outcomes compared to the NIDA Standard group (OR = 0.82-0.93), these estimates did not reach significance (p values > .57). HIV education interventions can be associated with risk-reduction behaviors. These findings support the need for increased access to prevention education in criminal justice venues, particularly in rural communities.

Game Plan: Development of a Web App Designed to Help Men Who Have Sex With Men Reduce Their HIV Risk and Alcohol Use

Background

Men who have sex with men (MSM) are at high risk for HIV, and alcohol use is a major risk factor for HIV infection. Internet-facilitated brief interventions have been shown to reduce alcohol use and HIV-risk behavior in other at-risk populations, but have so far incorporated limited content and have not been tested among MSM.

Objective

This manuscript describes Game Plan, an interactive, tablet-optimized web application designed to help heavy drinking, high-risk MSM consider reducing their alcohol use and sexual risk behavior. In this paper, we discuss the rationale, goals, and flow for each of Game Plan’s components, which were modelled after common in-person and web-based brief motivational interventions for these behaviors.

Methods

The development of Game Plan was informed by a thorough user-focused design research process that included (1) audits of existing interventions, (2) focus groups with stakeholders and (3) intended users (high-risk, heavy drinking MSM), and (4) usability testing. The aesthetic, features, and content of the app were designed iteratively throughout this process

Results

The fully-functional Game Plan app provides (1) specific and personal feedback to users about their level of risk, (2) exercises to help prompt users to reflect on whether their current behavior aligns with other important life goals and values, and for those open to change, (3) exercises to help users understand factors that contribute to risk, and (4) a change planning module. In general, this flow was constructed to roughly align with the two phases described in early accounts of motivational interviewing (MI): (1) Content intended to elicit intrinsic motivation for change, and when/if sufficient motivation is present, (2) content intended to translate that motivation into specific goals and plans for change. This sequence first focuses on the user’s HIV risk behavior, followed by their alcohol use and the connection between the two. The app’s overall aesthetic (eg, branding, color palettes, icons/graphics) and its onboarding sequence was also designed to align with the “spirit” of MI by conveying respect for autonomy, open-mindedness (ie, avoiding judgment), and empathy.

Conclusions

Should future research support its efficacy in facilitating behavior change, Game Plan could represent a wide-reaching and scalable tool that is well-suited for use in settings where delivering evidence-based, in-person interventions would be difficult or cost-prohibitive.

Multiple brief interventions in police custody: The MuBIC randomized controlled study for primary prevention in police custody. Protocol and preliminary results of a feasibility study in the Paris metropolitan area, France

BACKGROUND

The 15- to 35-year-old population has little contact with the health care system and is exposed to risk factors. Several studies demonstrated the feasibility of brief interventions (BIs) in different settings, e.g., in addiction medicine during police custody, where arrestees are entitled to a medical examination. Approximately 700,000 individuals are detained in police custody in France annually, and custody is an opportunity for young people to be medically examined. The characteristics of the detainees and previous experience with BIs suggest that custody is an opportunity to contribute to primary prevention. We propose to investigate the feasibility of such a contribution.

OBJECTIVES

The aim of this article is to present a study protocol and some preliminary results. The primary research objective is to assess the feasibility of performing brief interventions without a specific topic in police custody settings in arrestees aged 15-35 years. The secondary research objectives include i) testing four strategies for engaging in BIs that maximize the chances of success of the BI; ii) identifying the determinants that can orient the practitioner's choice to use a specific strategy over another one; and iii) analysing the differences between individuals who engage in BIs and those who do not and, in those who do engage, the determinants of success of the intervention.

METHODS

A two-step randomized and prospective study: i) randomization of eligible patients into 4 groups of 500 patients each; analysis of the response rates for each strategy; performance of the BI; and analyses of the associated factors and ii) a real-life, full-scale phase study evaluating the effectiveness of BIs performance of the BI; and analyses of the interventions. Analyses of the determinants of a positive response to BI, of success and of the topic of intervention will be conducted.

EXPECTED RESULTS

The rates of BI performed, rates of success, and characteristics associated with response and with success are the main expected results. Additionally, the development and assessment of filter questions and an improved BI dedicated to primary prevention for police custody settings will be attained.

Beyond "Just Saying No": A Preliminary Evaluation of Strategies College Students Use to Refuse Sexual Activity

Preventing sexual assault is a core goal for universities as prevalence rates of sexual assault remain high, particularly among college students. A key mechanism thought to decrease rates of sexual assault is teaching college students how to give clear, explicit, verbal refusals. However, there is a paucity of research regarding how college students refuse sex. Thus, the purpose of this study was to understand different behavioral strategies college students would use to refuse sex. A sample of 773 heterosexual college students (523 women, 250 men) were recruited from two large southern universities in the USA to complete a survey on sexual communication. Thirty-eight items assessing verbal and behavioral cues that college students would use to refuse vaginal-penile sex were written based on previous, formative research. Items were assessed by the research team through an exploratory factor analyses, followed by a confirmatory factor analysis (CFA). The results yielded a three-factor structure: direct nonverbal refusals, direct verbal refusals, and indirect nonverbal refusals; CFA results suggested a good fit index for the model. Two independent sample t tests were conducted to examine differences in refusal cues across gender and relationship status; significant differences in refusals emerged for both. The three-factor structure depicting refusal cues was similar to previous work depicting cues college students use to communicate sexual consent; such information could inform sexual assault prevention programming.

Single-Session Behavioral Interventions for Sexual Risk Reduction: A Meta-Analysis

BACKGROUND

Evidence-based, single-session STI/HIV interventions to reduce sexual risk taking are potentially effective options for implementation in resource-limited settings and may solve problems associated with poor participant retention.

PURPOSE

The purpose of the study is to estimate the efficacy of single-session, behavioral interventions in reducing unprotected sex or increasing condom use.

METHODS

Data sources were searched through April 2013 producing 67 single-session interventions (52 unique reports; N = 20,039) that included outcomes on condom use and/or unprotected sex.

RESULTS

Overall, participants in single-session interventions reduced sexual risk taking relative to control groups (d ₊  = 0.19, 95 % CI = 0.11, 0.27). Within-group effects of the interventions were larger than the between-groups effects when compared to controls.

CONCLUSIONS

Brief, targeted single-session sexual risk reduction interventions demonstrate a small but significant effect and should be prioritized.

A Peer-Led, Social Media-Delivered, Safer Sex Intervention for Chinese College Students: Randomized Controlled Trial

Background

The peer-led, social media-delivered intervention is an emerging method in sexual health promotion. However, no research has yet investigated its effectiveness as compared with other online channels or in an Asian population.

Objective

The objective of this study is to compare a peer-led, social media-delivered, safer sex intervention with a sexual health website. Both conditions target Chinese college students in Hong Kong.

Methods

A randomized controlled trial was conducted with a peer-led, safer sex Facebook group as the intervention and an existing online sexual health website as the control. The intervention materials were developed with peer input and followed the information-motivation-behavioral skills model; the intervention was moderated by peer educators. The participants filled out the online questionnaires before and after the 6-week intervention period. Outcome evaluations included safer sex attitudes, behavioral skills, and behaviors, while process evaluation focused on online experience, online-visiting frequency, and online engagement. The effect of online-visiting frequency and online engagement on outcome variables was investigated.

Results

Of 196 eligible participants—100 in the control group and 96 in the intervention group—who joined the study, 2 (1.0%) control participants joined the Facebook group and 24 of the remaining 194 participants (12.4%) were lost to follow-up. For the process evaluation, participants in the intervention group reported more satisfying online experiences (P<.001) and a higher level of online-visiting frequency (P<.001). They also had more positive comments when compared with the control group. For outcome evaluation, within-group analysis showed significant improvement in condom use attitude (P=.02) and behavioral skills (P<.001) in the intervention group, but not in the control group. No significant between-group difference was found. After adjusting for demographic data, increased online-visiting frequency was associated with better contraceptive use behavioral intention (P=.05), better behavioral skills (P=.02), and more frequent condom use (P=.04).

Conclusions

A peer-led, social media-delivered, safer sex intervention was found to be feasible and effective in improving attitudes toward condom use and behavioral skills, but was not significantly more effective than a website. Future research may focus on the long-term effectiveness and cost-effectiveness of this popular method, as well as the potential cultural differences of using social media between different countries.

Trial Registration

Chinese Clinical Trial Registry (ChiCTR): ChiCTR-IOR-16009495; http://www.chictr.org.cn/showprojen.aspx?proj=16234 (Archived by WebCite at http://www.webcitation.org/6s0Fc2L9T)

An Integrated HIV Risk Reduction Intervention for Women with a History of Intimate Partner Violence: Pilot Test Results

There are few HIV risk reduction interventions to meet the unique needs of women who experience intimate partner violence (IPV). This pilot study tested the feasibility, safety, and preliminary effects of an integrated IPV-sexual risk reduction intervention for abused women. Fifty-five women were randomized to the supporting positive and healthy relationships (SUPPORT) intervention (n = 27) or to a control group (n = 28). Assessments were conducted pre- and post-intervention and at 3-month follow-up. Post-intervention, SUPPORT participants showed a significant decrease in frequency of unprotected sex and an increase in safer sex communications with steady and other sexual partners. Compared to the control group, SUPPORT participants reported a higher number of safer sex conversations with their steady partner at the 3-month follow-up, and fewer episodes of IPV at both assessments in comparison to baseline. They showed improvements in sexual relationship power at both follow-ups and in several hypothesized antecedents of HIV-risk behavior. These encouraging preliminary findings suggest the need for a larger clinical trial.

Feasibility and acceptability of a web-based HIV/STD prevention program for adolescent girls targeting sexual communication skills

Adolescent girls are at substantial risk of sexually transmitted diseases including HIV. To reduce these risks, we developed Health Education And Relationship Training (HEART), a web-based intervention focused on developing sexual assertiveness skills and enhancing sexual decision-making. This study assessed the feasibility and acceptability of this new program and examined if perceived acceptability varied according to participant ethnicity, sexual orientation or sexual activity status. Participants were part of a randomized controlled trial of 222 10th-grade girls (Mage = 15.26). The current analyses included those in the intervention condition (n = 107; 36% white, 27% black and 29% Hispanic). HEART took approximately 45 min to complete and was feasible to administer in a school-based setting. Participants found the program highly acceptable: 95% liked the program and learned from the program, 88% would recommend the program to a friend and 94% plan to use what they learned in the future. The primary acceptability results did not vary by the ethnicity, sexual orientation or sexual activity status of participants, suggesting broad appeal. Results indicate that this new online program is a promising method to reach and engage adolescents in sexual health education.

A brief information-motivation-behavioral skills intervention to promote human papillomavirus vaccination among college-aged women

Background

Human papillomavirus (HPV) is prevalent among college-aged women. Although HPV vaccines decrease women’s risk for cervical cancer, the vaccination rates remain inadequate.

Objective

This study explored the utility of an information–motivation–behavioral skills (IMB) intervention in promoting HPV vaccination knowledge, motivation, and intentions among college-aged women.

Methods

In Spring/Fall 2012, 62 participants were randomly assigned to a single-session intervention or attention control and were assessed baseline, post-intervention, and at 1 month.

Results

The participants demonstrated adequate baseline vaccine knowledge, low HPV/cancer knowledge, and ambivalence about the vaccination. Post-intervention, the IMB arm demonstrated increased HPV/cancer and vaccination knowledge, motivation, and intentions. There were no group differences in vaccination at 1 month; however, the odds of wanting to get vaccinated increased sevenfold in the IMB arm.

Conclusion

These results provide preliminary support for an IMB-based intervention in increasing vaccination knowledge, motivation, and intentions among at-risk women. Future research examining the efficacy of longer trials with larger, diverse populations is warranted.

ProjectHeartforGirls.com: Development of a Web-Based HIV/STD Prevention Program for Adolescent Girls Emphasizing Sexual Communication Skills

This article describes the development of ProjectHeartforGirls.com , an interactive web-based program designed to improve sexual communication skills and reduce the risk of HIV/STDs among adolescent girls, a population at heightened risk for negative sexual health outcomes (Centers for Disease Control and Prevention, 2013). Although sexual communication is a critical predictor of safer sex among teens, there are few online interventions that target these skills as a central program component. We developed ProjectHeartforGirls.com to fill this gap. Program development involved (1) identifying the target population (ethnically diverse high school girls), (2) clarifying the theoretical foundation (Reasoned Action Model), (3) conducting formative qualitative research (n = 25 girls), (4) drafting initial program content, (5) receiving ongoing feedback from a teen advisory board (n = 5 girls), (6) programming online content, and (7) conducting usability testing (n = 6 girls). These steps are described along with the final intervention product, which is currently being evaluated in a randomized controlled trial.

Brief interventions to prevent sexually transmitted infections suitable for in-service use: A systematic review

BACKGROUND

Sexually transmitted infections (STIs) are more common in young people and men who have sex with men (MSM) and effective in-service interventions are needed.

METHODS

A systematic review of randomized controlled trials (RCTs) of waiting-room-delivered, self-delivered and brief healthcare-provider-delivered interventions designed to reduce STIs, increase use of home-based STI testing, or reduce STI-risk behavior was conducted. Six databases were searched between January 2000 and October 2014.

RESULTS

17,916 articles were screened. 23 RCTs of interventions for young people met our inclusion criteria. Significant STI reductions were found in four RCTs of interventions using brief one-to-one counselling (2 RCTs), video (1 RCT) and a STI home-testing kit (1 RCT). Increase in STI test uptake was found in five studies using video (1 RCT), one-to-one counselling (1 RCT), home test kit (2 RCTs) and a web-based intervention (1 RCT). Reduction in STI-risk behavior was found in seven RCTs of interventions using digital online (web-based) and offline (computer software) (3 RCTs), printed materials (1 RCT) and video (3 RCTs). Ten RCTs of interventions for MSM met our inclusion criteria. Three tested for STI reductions but none found significant differences between intervention and control groups. Increased STI test uptake was found in two studies using brief one-to-one counselling (1 RCT) and an online web-based intervention (1 RCT). Reduction in STI-risk behavior was found in six studies using digital online (web-based) interventions (4 RCTs) and brief one-to-one counselling (2 RCTs).

CONCLUSION

A small number of interventions which could be used, or adapted for use, in sexual health clinics were found to be effective in reducing STIs among young people and in promoting self-reported STI-risk behavior change in MSM.

Perceptions of Black College Women on Barriers to HIV-Risk Reduction and Their HIV Prevention Intervention Needs

HIV prevention interventions can help college students engage in safe sexual behaviors. We used the Information, Motivation, Behavioral Skills model to frame four focus group discussions with Black women (n = 32) attending a historically Black college/university or a traditional university to understand their HIV prevention needs. Participants wanted clear information about sexually transmitted infections/HIV and access to contraception. Motivators for practicing safe sex were related to cultural and religious expectations, desire to avoid pregnancy, and conscious efforts to defy racial stereotypes. Barriers to practicing safe sex included issues of accountability, stigma associated with accessing HIV testing/prevention services, and media influences. We found general consensus about the need to develop skill-building HIV prevention interventions focused on communication skills, condom negotiation, access to services, and empowerment. We offer insight into culture- and age-appropriate HIV prevention for Black college women to guide the development of future interventions.

Group Interventions for Patients with Cancer and HIV Disease: Part I: Effects on Psychosocial and Functional Outcomes at Different Phases of Illness

Group interventions for individuals facing cancer or HIV disease have drawn considerable attention among researchers and clinicians over the past 20 years. There is growing evidence that group services may be helpful, but which interventions are most effective for participants at which phases in the trajectory of disease has been less clear. Moreover, professionals working in different intervention settings (e.g., primary prevention vs. clinical care) and different disease sites (cancer vs. HIV disease) often have little awareness of relevant advances in other fields. Efforts to integrate findings in the literature may accelerate research and advance the standard of clinical care. The current article, the first in a series of four special reports, critically evaluates the efficacy of group interventions led by professional or trained facilitators for individuals confronted by cancer or HIV, across the spectrum of illness from elevated risk through advanced disease. We examine psychosocial and functional outcomes for different interventions directed toward different patient subgroups, trace common themes, highlight limitations, and offer recommendations for further research.

Web-based intervention to change perceived norms of college student alcohol use and sexual behavior on spring break

The purpose of the present study was to evaluate an adapted web-based multi-component personalized feedback intervention to reduce college student alcohol use and risky sexual behavior during Spring Break. This is one of the first interventions focused on Spring Break alcohol use and related sexual behavior. Personalized feedback intervention components addressed intentions, expected consequences, norms, motivations, protective behavioral strategies, and pacts with friends. Participants were college students (N=263; 55% women) between the ages of 18 and 21 who planned to go on a Spring Break trip with their friends. Effects were not significant in reducing alcohol use or sexual behavior during Spring Break or some of the proposed intervention mechanisms. However, consistent results showed that the intervention succeeded in reducing perceived social norms for Spring Break drinking and sexual behavior. Findings suggest that changing norms alone is not sufficient for changing risk behavior during this event and alternative strategies are needed to impact other putative mediators.

Randomized controlled trial of a web-delivered personalized normative feedback intervention to reduce alcohol-related risky sexual behavior among college students

OBJECTIVE

The purpose of this study was to evaluate the efficacy of personalized normative feedback (PNF) on college student alcohol-related risky sexual behavior (RSB).

METHOD

In a randomized controlled trial, 480 (57.6% female) sexually active college students were stratified by gender and level of drinking and randomly assigned to an alcohol-only intervention, an alcohol-related RSB-only intervention, a combined alcohol and alcohol-related RSB intervention, or control. All assessment and intervention procedures were Web-based.

RESULTS

Results indicated a significant reduction in drinking outcomes for the alcohol only and the combined alcohol and alcohol-related RSB interventions relative to control. Findings further demonstrated a significant reduction in alcohol-related RSB outcomes for the alcohol-related RSB only and the combined alcohol and alcohol-related RSB interventions relative to control. There were no significant intervention effects on alcohol-related negative consequences. These findings demonstrate that the combined alcohol and alcohol-related RSB intervention was the only intervention successful at reducing both drinking and alcohol-related RSB outcomes relative to control. There were no significant differences when comparing the combined alcohol and alcohol-related RSB intervention to the alcohol-only intervention or the alcohol-related RSB-only intervention. Finally, results suggested that the intervention effects on high-risk behaviors were mediated by reductions in descriptive normative perceptions.

CONCLUSIONS

These findings demonstrate that PNF specific to drinking in sexual situations was needed to reduce alcohol-related RSB. Furthermore, this study highlights the potential utility of a brief intervention that can be delivered via the Internet to reduce high-risk drinking and alcohol-related RSB among college students.

Parental information, motivation, and adherence behaviors among children with sickle cell disease

BACKGROUND

Identification of psychosocial correlates of health care utilization has become an important strategy in improving clinical care. The objective of the study was to examine the fit of the Information-Motivation-Behavioral Skills (IMB) model, applied to health care utilization among children with sickle cell disease (SCD).

PROCEDURE

Participants were parents of 150 children, ages 1-17 years, receiving care in a sickle cell center. Parents completed questionnaires assessing information, motivation, adherence behaviors, and other factors with respect to SCD management. Data regarding health care utilization in the previous 12 months were obtained from parent report and electronic medical records. Stepwise multiple regression analysis was conducted to determine associations between IMB factors and health care use.

RESULTS

Parents rated highly in the domains of information, motivation, and adherence behaviors for managing their child's SCD. Children of parents reporting higher satisfaction with social supports had higher odds (OR 1.49, 95% CI 1.03-2.15) of two or more routine hematology visits in the previous 12 months. Neither information nor adherence behavior was associated with urgent or routine care use. Among other variables measured, high parental illness-related stress and child health status reported as fair/poor were the strongest predictors of urgent care use while private insurance type was the strongest predictor of routine care use.

CONCLUSIONS

Among IMB factors, social support was associated with routine health care utilization. Social support and parental illness-related stress may serve as important, modifiable targets in interventions to allocate needed resources to families and reduce unnecessary medical care.

HIV information and behavioral skills moderate the effects of relationship type and substance use on HIV risk behaviors among African American youth

The HIV/AIDS epidemic is disproportionately impacting young African Americans. Efforts to understand and address risk factors for unprotected sex in this population are critical in improving prevention efforts. Situational risk factors, such as relationship type and substance use before sex, are in need of further study. This study explored how established cognitive predictors of risky sexual behavior moderated the association between situational factors and unprotected sex among low-income, African American adolescents. The largest main effect on the number of unprotected sex acts was classifying the relationship as serious (event rate ratio=10.18); other significant main effects were alcohol use before sex, participant age, behavioral skills, and level of motivation. HIV information moderated the effect of partner age difference, motivation moderated the effects of partner age difference and drug use before sex, and behavioral skills moderated the effects of alcohol and drug use before sex. This novel, partnership-level approach provides insight into the complex interactions of situational and cognitive factors in sexual risk taking.

Reducing sexual risk behavior in adolescent girls: results from a randomized controlled trial

PURPOSE

Teenage girls in low-income urban settings are at an elevated risk for HIV, sexually transmitted infections, and unintended pregnancies. The purpose of this study was to evaluate the efficacy of a sexual risk-reduction (SRR) intervention, supplemented with postintervention booster sessions, targeting low-income, urban, sexually active teenage girls.

METHOD

Randomized controlled trial in which sexually active urban adolescent girls (n = 738) recruited in a midsize northeastern U.S. city were randomized to a theory-based SRR intervention or to a structurally equivalent health promotion control group. Assessments and behavioral data were collected using audio computer-assisted self-interview at baseline, then at 3, 6, and 12 months postintervention. Both interventions included four small-group sessions and two booster sessions.

RESULTS

Relative to girls in the control group, girls receiving the SRR intervention were more likely to be sexually abstinent; if sexually active, they showed decreases in (a) total episodes of vaginal sex at all follow-ups, (b) number of unprotected vaginal sex acts at 3 and 12 months, and (c) total number of sex partners at 6 months. Medical record audits for girls recruited from a clinical setting (n = 322) documented a 50% reduction in positive pregnancy tests at 12 months.

CONCLUSIONS

Theory-based behavioral interventions tailored to adolescent girls can help to reduce sexual risk and may also reduce unintended pregnancies. Although sexually active at enrollment, many of the girls receiving the intervention were more likely to practice secondary abstinence. Continued refinement of SRR interventions for girls is needed to ensure they are feasible, appealing, and effective.

A brief, peer-led HIV prevention program for college students in Bangkok, Thailand

STUDY OBJECTIVE

To test the effectiveness of a brief theory-based HIV prevention program led by peers among college students.

DESIGN

A quasi-experimental research using a pretest-posttest nonequivalent control group design with 2-mo follow-up.

SETTING

A university in Bangkok.

PARTICIPANTS

For peer leaders, 70 undergrad students taking health sexuality course were invited to participate in the study. Then, a convenience sample of undergraduate students was recruited through peer leaders, 226 for experimental group and 209 for control group.

MAIN OUTCOME MEASURES

Information, motivation, behavioral skills, and AIDS/STIs preventive behaviors.

RESULTS

The study revealed that a Brief, Peer-Led HIV Prevention Program significantly increased knowledge of preventive behaviors (β = 2.67, P < .000), motivated participants to have a better attitude toward preventive behaviors (β = -5.26, P < .000), better subjective norms (β = -1.54, P < .000), and greater intentions to practice preventive behavior (β = -1.38, P < .000). The program also significantly decreased perceived difficulty of AIDS/STIs preventive behaviors (β = 2.38, P < .000) and increased perceived effectiveness at AIDS/STIs preventive behavior (β = -3.03, P < .000). However, it did not significantly increase AIDS/STIs preventive behaviors (β = 2.13, P > .05).

CONCLUSION

Findings of this study provide initial evidence as to how theoretical variables were operated to effectively increase knowledge, change motivation, and behavioral skills of AIDS/STIs preventive behavior among Thai college students. More research is needed to further test the effectiveness of the program on AIDS/STIs preventive behaviors among college students.

Effectiveness of a condom use educational program developed on the basis of the Information-Motivation-Behavioral Skills model

AIM

To assess a condom use educational program developed using the Information-Motivation-Behavioral Skills (IMB) model to enable Japanese young people to use condoms.

METHODS

The program was implemented in two sessions of approximately 90 min each over a 2 day period. The participants underwent the program in small same-sex groups. The study participants were divided into the intervention group (n=94) and the control group (n=186). Knowledge relating to HIV/sexually-transmitted diseases (STDs), attitudes towards contraception and sex, the risk perceptions of pregnancy and HIV/STD infection, anticipated reaction to proposed condom use, self-efficacy of condom use, and sexual behaviors were assessed. Data were obtained at baseline, immediately after the program, and 1 and 3 months after the program or baseline survey.

RESULTS

Intervention group participants with experience of sexual intercourse (n=14) had significantly higher scores for knowledge relating to HIV/STDs, self-efficacy of condom use, and relief/confusion associated with condom use than the control group (n=13) at the 1 and 3 month surveys. Intervention group participants with no experience of sexual intercourse (n=14) had significantly higher scores for knowledge relating to HIV/STDs and self-efficacy of condom use, and significantly lower scores for condom avoidance, than the control group (n=116). Condom use behavior was not changed in either group.

CONCLUSION

The program used in this study did not promote condom use, but it increased knowledge relating to HIV/STDs and self-efficacy of condom use and reduced resistance to condom use.

Predicting condom use using the Information-Motivation-Behavioral Skills (IMB) model: a multivariate latent growth curve analysis

BACKGROUND

The Information-Motivation-Behavioral Skills (IMB) model often guides sexual risk reduction programs even though no studies have examined covariation in the theory's constructs in a dynamic fashion with longitudinal data.

PURPOSE

Using new developments in latent growth modeling, we explore how changes in information, motivation, and behavioral skills over 9 months relate to changes in condom use among STD clinic patients.

METHODS

Participants (N = 1281, 50% female, 66% African American) completed measures of IMB constructs at three time points. We used parallel process latent growth modeling to examine associations among intercepts and slopes of IMB constructs.

RESULTS

Initial levels of motivation, behavioral skills, and condom use were all positively associated, with behavioral skills partially mediating associations between motivation and condom use. Changes over time in behavioral skills positively related to changes in condom use.

CONCLUSIONS

Results support the key role of behavioral skills in sexual risk reduction, suggesting these skills should be targeted in HIV prevention interventions.

F.O.R.E.play: the utility of brief sexual health interventions among college students

OBJECTIVES

The authors aimed to determine the most effective brief sexual health intervention for college students, while also evaluating students' preferences for learning about sexual health, in order to develop a university program.

METHODS

A total of 302 students enrolled in an introductory college course participated and were randomly assigned to 1 of 3 brief interventions during a regularly scheduled class and completed pre- and postsurveys assessing knowledge, motivation to use condoms, and condom self-efficacy.

RESULTS

Findings indicated that having an actual person in charge of the learning process resulted in higher knowledge gains and highlighted a student preference for discussion-based learning, viewing pictures of sexually transmitted infections, and hearing real-life experiences about the consequences of unsafe sex.

CONCLUSIONS

These findings will be used to tailor a future intervention targeting college students for use with freshmen students at this university.

Relative efficacy of a pregnancy, sexually transmitted infection, or human immunodeficiency virus prevention-focused intervention on changing sexual risk behavior among young adults

OBJECTIVES

Despite findings suggesting that young adults are more concerned about experiencing an unplanned pregnancy or contracting a sexually transmitted infection (STI) than becoming human immunodeficiency virus (HIV) infected, no empirical work has investigated whether the specific focus of an intervention may be more or less efficacious at changing sexual behavior.

PARTICIPANTS

Participants were 198 college students randomized to 1 of 4 conditions: pregnancy intervention, STI intervention, HIV intervention, or a control condition during 2008-2009.

METHODS

The authors compared the efficacy of 3 theory-based, sexual risk-reduction interventions that were exactly the same except for an exclusive focus on preventing pregnancy, STI, or HIV. Condom use and risky sexual behavior were assessed at baseline and 4-week and 8-week follow-up.

RESULTS

Participants exposed to the pregnancy or STI interventions reported greater condom use and less risky sexual behavior than those exposed to the HIV intervention.

CONCLUSIONS

The focus of sexual risk-reduction interventions may lead to differential behavior change among young adults.

Randomized controlled trial of brief interventions to reduce college students' drinking and risky sex

The present study tested the proposition that an intervention to reduce alcohol use among college students will also reduce their risky sexual behavior. In a randomized controlled trial, 154 heavy-drinking, predominantly White, heterosexual college students at behavioral risk for infection with HIV and other sexually transmitted diseases were assigned to receive no intervention or a two-session, in-person, motivational interviewing-based intervention focused on (a) reducing alcohol risk behavior, (b) reducing HIV risk behavior, or (c) reducing both alcohol and HIV risk behavior. Three-month retrospective assessments of alcohol use and sexual behavior were conducted at intake and at 3-, 6-, 9-, 12-, and 15-month follow-up appointments. During follow-up, participants who received the single-focus alcohol risk-reduction intervention drank less frequently and consumed fewer drinks per drinking day as compared with no-intervention control participants, but did not differ from control participants in their frequency of intercourse without a condom or number of sexual partners. Participants who received the single-focus HIV risk-reduction intervention evidenced fewer unprotected sex events during follow-up, as compared with control participants. The number of sexual partners reported during follow-up did not differ by condition. Effects of the interventions did not vary significantly over time and were not moderated by participant gender. Results suggest that intervening to reduce alcohol use may not reduce risky sexual behavior among nonminority college students, but that a brief motivational intervention targeting HIV risk behavior may have utility for reducing the frequency of unprotected sex in this population.

Interventions for encouraging sexual behaviours intended to prevent cervical cancer

BACKGROUND

Human papillomavirus (HPV) is the key risk factor for cervical cancer. Continuing high rates of HPV and other sexually transmitted infections (STIs) in young people demonstrate the need for effective behavioural interventions.

OBJECTIVES

To assess the effectiveness of behavioural interventions for young women to encourage safer sexual behaviours to prevent transmission of STIs (including HPV) and cervical cancer.

SEARCH STRATEGY

Systematic literature searches were performed on the following databases: Cochrane Central Register of Controlled Trials (CENTRAL Issue 4, 2009) Cochrane Gynaecological Cancer Review Group (CGCRG) Specialised Register, MEDLINE, EMBASE, CINAHL, PsychINFO, Social Science Citation Index and Trials Register of Promoting Health Interventions (TRoPHI) up to the end of 2009. All references were screened for inclusion against selection criteria.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of behavioural interventions for young women up to the age of 25 years that included, amongst other things, information provision about the transmission and prevention of STIs. Trials had to measure behavioural outcomes (e.g. condom use) and/or biological outcomes (e.g. incidence of STIs, cervical cancer).

DATA COLLECTION AND ANALYSIS

A narrative synthesis was conducted. Meta-analysis was not considered appropriate due to heterogeneity between the interventions and trial populations.

MAIN RESULTS

A total of 5271 references were screened and of these 23 RCTs met the inclusion criteria. Most were conducted in the USA and in health-care clinics (e.g. family planning).The majority of interventions provided information about STIs and taught safer sex skills (e.g. communication), occasionally supplemented with provision of resources (e.g. free sexual health services). They were heterogeneous in duration, contact time, provider, behavioural aims and outcomes. A variety of STIs were addressed including HIV and chlamydia. None of the trials explicitly mentioned HPV or cervical cancer prevention.Statistically significant effects for behavioural outcomes (e.g. increasing condom use) were common, though not universal and varied according to the type of outcome. There were no statistically significant effects of abstaining from or reducing sexual activity. There were few statistically significant effects on biological (STI) outcomes. Considerable uncertainty exists in the risk of bias due to incomplete or ambiguous reporting.

AUTHORS' CONCLUSIONS

Behavioural interventions for young women which aim to promote sexual behaviours protective of STI transmission can be effective, primarily at encouraging condom use. Future evaluations should include a greater focus on HPV and its link to cervical cancer, with long-term follow-up to assess impact on behaviour change, rates of HPV infection and progression to cervical cancer. Studies should use an RCT design where possible with integral process evaluation and cost-effectiveness analysis where appropriate. Given the predominance of USA studies in this systematic review evaluations conducted in other countries would be particularly useful.

An Experience of Peer Education Model among Medical Science University Students in Iran

BACKGROUND

The purpose of this study was to evaluate the effectiveness of peer education among university students for reproductive health promotion based on researchers' experiences.

METHODS

This interventional study was conducted in Qazvin University of Medical Science during 2002 to 2004 through stakeholders' partnership and selection of 24 volunteer students according to their knowledge, interest, communication skills. Capacity building was performed through holding an interactive reproductive health coarse contained marital health, illegal abortion, family planning, STI/AIDS, communication and counseling skills. Trained peer educators have introduced to other student and present education and counseling formally and informally. A post interventional study was conducted after 9 months in order to find its effectiveness.

RESULTS

In our experience Stakeholders' partnership in community interventional programs led to the best expected availability of better health through ownership and adopting policies. In present study, the proper determined criteria for selection of peer educators and clear understood expectations of the peer educators' role were very important in health promotional program. Although peer education was acceptable program for university students, more support and supervising for peer groups are needed. The students believed that the power point of peer education and counseling related to same age groups sympathy, confident, well behaved, cheerful, and kind-hearted and peer educators awareness.

CONCLUSION

Universities are appropriate real world for experience a friendly youth program and then disseminate it to other young communities. There seems peer education is effective strategy for reproductive health promotion and reinforce positive behaviors in youth.

Are we going to close social gaps in HIV? Likely effects of behavioral HIV-prevention interventions on health disparities

Although experimental behavioral interventions to prevent HIV are generally designed to correct undesirable epidemiological trends, it is presently unknown whether the resulting body of behavioral interventions is adequate to correct the social disparities in HIV-prevalence and incidence present in the United States. Two large, diverse-population meta-analytic databases were reanalyzed to estimate potential perpetuation and change in demographic and behavioral gaps as a result of introducing the available behavioral interventions advocating condom use. This review suggested that, if uniformly applied across populations, the analyzed set of experimental (i.e. under testing) interventions is well poised to correct the higher prevalence and incidence among males (vs. females) and African-Americans and Latinos (vs. other groups), but ill poised to correct the higher prevalence and incidence among younger (vs. older) people, as well as men who have sex with men, injection-drug users, and multiple partner heterosexuals (vs. other behavioral groups). Importantly, when the characteristics of the interventions most efficacious for each population were included in the analyses of behavior change, results replicated with three exceptions. Specifically, after accounting for interactions of intervention and facilitator features with characteristics of the recipient population (e.g. gender), there was no behavior change bias for men who have sex with men, younger individuals changed their behavior more than older individuals, and African-Americans changed their behavior less than other groups.

Using the information-motivation behavioral model to predict sexual behavior among underserved minority youth

BACKGROUND

Testing, refining, and tailoring theoretical approaches that are hypothesized to reduce sexual risk behaviors among adolescent subpopulations is an important task. Relatively little is known about the relationship between components of the information-motivation-behavior (IMB) model and sexual behaviors among underage minority youth. Using the IMB model, this study examines predictors of risky sexual behavior among underserved Hispanic and African-American youth.

METHODS

This cross-sectional study was conducted with a sample of 380 youths aged 11-17 years recruited in Los Angeles, California, and utilized latent variable models to examine interrelationships and predictive relations among IMB model variables associated with risky sexual behavior.

RESULTS

Sixty percent of the participants aged 15-17 and 1 out of 10 participants aged 11-12 reported prior sexual intercourse. Of the sexually active, more than half reported having unprotected sex and 11% had sexual intercourse with 4 or more partners. Results of the structural equation model indicated that older age and attitudes against sexual activities had significant, direct impacts on risky sexual behaviors. Behavioral refusal skills, positioned as an intervening variable, also significantly predicted less risky sex. Knowledge, attitudes against sexual activities, and perceived peer pressure against sexual behavior predicted sexual refusal skills. Additionally, there were significant indirect effects on risky sexual behavior mediated through behavioral refusal skills.

CONCLUSION

A large number of disadvantaged minority urban youth are engaged in risky sexual behaviors. Intervention programs, particularly those targeting preadolescents, should focus on building long-lasting behavioral skills that emphasize the reduction of peer pressure and normative influences on risky sexual behaviors. Components of the IMB model clearly have a role in the design of efficacious interventions.

Subjective life expectancy and health behaviors among STD clinic patients

OBJECTIVES

To examine whether people who expect to live longer engage in healthier behaviors relative to people who expect to live shorter lives.

METHODS

Patients (994 black Americans, 373 white Americans) from a publicly funded clinic estimated their expected survival age and reported their health behaviors (alcohol, tobacco, and drug use; sexual behaviors; physical activity; and sleep).

RESULTS

Subjective life expectancy (SLE) was a significant predictor of health behavior for both men and women. Race moderated the SLE-health behavior relation but only for alcohol and tobacco use.

CONCLUSIONS

Future research should explore the potential health benefits of shifting SLE from a more limited to an expansive perspective.

Preliminary findings from a brief, peer-led safer sex intervention for college students living in residence halls

The purpose of this study was to evaluate a single-session peer-led safer sex intervention, based on the Information-Motivation-Behavioral Skills theoretical model, for college students residing in campus residence halls. Participants (N = 108) were assigned to either an hour long control or 5-module intervention session. Compared to the control condition, the intervention increased participants' information and women's subjective norms about preventative behavior. Both the control and intervention sessions increased intentions to perform preventative behaviors (e.g., keep condoms available). These preliminary results suggest that this intervention is promising for increasing constructs associated with safer sexual behavior and could easily be implemented by residence hall staff.

Measurement of sexual risk taking among college students

Current measures of sexual risk taking are either too narrowly focused to be used with college students or do not have adequate psychometric properties. The goal of the current study was to develop a broad and psychometrically sound measure of sexual risk taking. A total of 613 undergraduate students (302 men, 311 women) at a mid-sized Midwestern university in the U.S. were surveyed to develop and gather reliability and validity information on a new measure of sexual risk, the Sexual Risk Survey (SRS). The measure was found to be multifactorial with five factors. The measure was found to have good internal consistency and test-retest reliability. The SRS also demonstrated evidence of convergent and concurrent validity by its relationships with reported number of sexual partners and history of infidelity as well as measures of sensation seeking, sexual desire, substance use, sexual excitation and inhibition, and sexual health consequences. Social desirability was not found to be related to sexual risk taking scores and threat of sexual disclosure was only weakly related. An investigation of sex differences revealed that men reported greater intentions to engage in sexual risk behaviors and greater overall sexual risk taking behavior compared to women. The SRS provides researchers with a valid and comprehensive measure of sexual risk taking that can be used to clarify inconsistent findings in the literature and to assess outcome in programs designed to prevent and reduce sexual risk behaviors among college students.

Repeat HIV testing and HIV transmission risk behaviors among sexually transmitted infection clinic patients

HIV testing and counseling expends considerable HIV prevention resources and offers great opportunities for HIV risk reduction. Individuals who are at risk for HIV and have not been HIV tested are the focus of current targeted testing campaigns and yet persons who are repeatedly tested for HIV often continue engaging in high-risk practices. This study examined HIV testing, risk behaviors, and other medical diagnostic testing practices of men (N = 231) and women (N = 86) attending an inner-city sexually transmitted infections (STI) clinic. Results showed that 75 (23%) participants had not yet been tested for HIV, 45 (14%) had been tested once, and 197 (63%) had been tested two or more times. Patients that had not been tested and those who were repeatedly tested were similar in their risk behaviors; both demonstrated significantly greater risks for HIV than persons tested just once, although repeat testers were more likely to have had a past STI. HIV testing history was minimally associated with other medical testing and health protective practices, such as testicular self-examination, mammography, and having had PAP tests. Results support targeting high-risk untested persons for HIV testing and suggest an urgent need for interventions to reduce risk behaviors among STI clinic patients who repeatedly test for HIV.

Evaluating a two-step approach to sexual risk reduction in a publicly-funded STI clinic: rationale, design, and baseline data from the Health Improvement Project-Rochester (HIP-R)

BACKGROUND

Sexually transmitted infection (STI) clinics provide an opportune setting for HIV prevention efforts. This randomized controlled trial evaluated a unique, two-step approach to sexual risk reduction at a publicly-funded STI clinic.

METHODS

During an initial visit, patients completed an audio-computer assisted self-interview (ACASI), were randomized to and received one of two brief interventions, obtained medical care, and completed a post-assessment. Next, two-thirds of the patients were assigned to attend an intensive sexual risk reduction workshop. At 3, 6, and 12 months, patients completed additional ACASIs and provided urine specimens to assess behavior change and incident STIs.

RESULTS

During a 28-month interval, 5613 patients were screened, 2691 were eligible, and 1483 consented to participate and were randomized; the modal reason for declining was lack of time (82%). Consenting patients included 688 women and 795 men; 64% of participants were African-American. The sample was low-income, with 57% reporting an annual income of less than $15,000; most participants (62%) had a high school education or less, and 51% were unemployed. Sexual risk behavior was common, as indicated by multiple sexual partners (mean=32.8, lifetime; mean=2.8, past 3 months), unprotected sex (mean=17.3 episodes, past 3 months), and prior STIs (mean=3.3, lifetime; 23% at baseline). Bivariate analyses confirmed our prediction that HIV-related motivation and behavioral skills would be related to current sexual risk behavior. All patients received a brief intervention; patient satisfaction ratings were uniformly high for both interventions (all means >or=3.7 on 4-point scales). Fifty-six percent of invited patients attended the intensive workshop, and attendance did not differ as a function of brief intervention. Patient satisfaction ratings were also uniformly positive for the workshop interventions (all means >or=3.6). Return to follow-up assessments exceeded 70%.

CONCLUSIONS

Results demonstrate that implementing an HIV preventive program in a busy, public clinic is feasible and well-accepted by patients. Ongoing evaluation will determine if the interventions reduce sexual risk behavior and lower incident STIs.

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

OBJECTIVE

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

DESIGN

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSION

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

Health behavior and college students: does Greek affiliation matter?

The college years offer an opportunity for new experiences, personal freedom, and identity development; however, this period is also noted for the emergence of risky health behaviors that place college students at risk for health problems. Affiliation with on-campus organizations such as fraternities or sororities may increase a students' risk given the rituals and socially endorsed behaviors associated with Greek organizations. In this study, we examined alcohol and drug use, smoking, sexual behavior, eating, physical activity, and sleeping in 1,595 college students (n = 265 Greek members, n = 1,330 non-Greek members). Results show Greek members engaged in more risky health behaviors (e.g., alcohol use, cigarette smoking, sexual partners, and sex under the influence of alcohol or drugs) than non-Greek members. Greek and non-Greek members did not differ in condom use, unprotected sex, eating, and physical activity behaviors. Implications for prevention and intervention strategies among Greek members are discussed.

Who participates in which health promotion programs? A meta-analysis of motivations underlying enrollment and retention in HIV-prevention interventions

This meta-analysis examines whether exposure to HIV-prevention interventions follows self-validation or risk-reduction motives. The dependent measures used in the study were enrolling in an HIV-prevention program and completing the program. Results indicated that first samples with low prior condom use were less likely to enroll than samples with high prior condom use. Second, samples with high knowledge were less likely to stay in an intervention than were those with low knowledge. Third, samples with medium levels of motivation to use condoms and condom use were more likely to complete an intervention than were those with low or high levels. Importantly, those patterns were sensitive to the interventions' inclusions of information-, motivation-, and behavioral-skills strategies. The influence of characteristics of participants, the intervention, and the recruit procedure are reported.

Development and psychometric evaluation of a self-administered questionnaire to measure knowledge of sexually transmitted diseases

This research developed and evaluated a brief but comprehensive measure of knowledge about sexually transmitted diseases (STDs) for use in research and applied settings. Questionnaire construction involved a review of empirical precedents as well as qualitative work with STD experts (n = 6) and the target population (n = 40). Eighty-five items were piloted (n = 50) and tested (n = 391) with college students. Item- and test-level analyses identified items that were eliminated to shorten the questionnaire. Factor analyses revealed a two-factor model of STD knowledge, including a Cause/Cure factor and a General Knowledge factor. Six supplemental items were added to the final questionnaire for their public health value and resulted in the 27-item STD-Knowledge Questionnaire (STD-KQ). The STD-KQ demonstrated internal consistency (alpha = .86) and test-retest reliability (r = .88) over a brief period. Evidence for the validity of the STD-KQ was obtained through a comparison with a validated HIV knowledge questionnaire (Carey & Schroder, 2002); treatment outcome sensitivity was obtained in response to an educational program. Use of the STD-KQ will enable researchers and health educators to identify knowledge deficits, measure knowledge for theory testing, evaluate risk reduction programs, and assess treatment response in research and applied settings.

The need for sexual health information: perceptions and desires of young adults

PURPOSE

To ascertain young adults perceptions of previously received sexual health information and describe what types of information they would like to receive.

STUDY DESIGN AND METHODS

In individual interviews, 55 young adults were asked questions regarding their perceptions of previously received sexual health information as well as their interests in receiving future information. Content analysis was used to categorize responses and identify categories.

RESULTS

The majority of participants remember receiving information about sexually transmitted infections (STIs) primarily from classes in middle and high school. Less than half remembered receiving information about contraception or how to prevent STIs. The majority of participants did not feel that (or were uncertain about whether) past information influenced their current sexual practices. Of those who felt past education influenced them in changing sexual practices, an increase in awareness of their risk was the category most often cited. One-third of the participants responded that a culture of abstinence in the US explained why current educational programs failed. When asked to describe an ideal sexual health program, the most common answers were wanting a comfortable, "not scared" person to teach them more "nitty-gritty" information about STIs with "more details," what they could do to protect themselves, "how to get birth control," and "how the reproductive system works."

CLINICAL IMPLICATIONS

Young adults have specific needs and interests when it comes to sexual health information. Research is necessary to see if development of specific interventions requested by young adults would result in higher levels of recall and ability to avoid dangerous sexual practices.