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

Developing an Inclusive Model of Young Heterosexual and Sexual Minority Women's Sexual Decision-Making

Efforts to improve sexual health outcomes among young cisgender women require in-depth understanding of how women with diverse sexual identities make decisions about their sexual health. We conducted semi-structured interviews with 31 young cisgender women with diverse sexual identities and histories (age range 18-29 (M = 23.32); 81% White; 29% bisexual, 26% heterosexual, 16% lesbian, 13% queer, 10% pansexual, 3% gay, 3% demisexual) about their decision-making surrounding sexual risk reduction. By conducting thematic analysis, we found that, regardless of partner sex or gender, women adapted sexual health strategies based on how much commitment, trust, and communication existed in their relationships. Because heteronormative structural influences limited access to information and safer sex options, women had to rely on trust and communication more with other women and partners with vaginas, compared to men and partners with penises. Women did not consider safer sex strategies with partners with vaginas (e.g. hand washing) risk-reduction techniques; instead, they considered them general hygiene or a way to take care of a partner. We propose that an inclusive model of young women's sexual decision-making should: (a) highlight the influence of relationships; (b) frame prevention in terms of overall health instead of pregnancy and STIs; and (c) acknowledge that structural factors, such as heteronormativity and sex-negativity, constrain women's decisions.

Dual decision-making routes for COVID-19 and influenza vaccines uptake in parents: A mixed-methods study

OBJECTIVE

Parental decision-making for children's uptake of a relatively novel vaccine and a more common vaccine could involve different processes. This study aimed to compare the psychological processes and the relative importance of psychological factors influencing parental decision-making for children's seasonal influenza vaccination (SIV) and COVID-19 vaccination.

DESIGN AND METHODS

We adopted mixed-methods approach. Study 1 was a qualitative study involving 29 parents to explore and compare their decision-making processes for children's SIV and COVID-19 vaccination. In Study 2, data from 632 parents were collected longitudinally; then, machine learning was used to quantify the relative importance of factors identified in Study 1 that were relevant to parents' decision-making for childhood vaccination decisions. Alluvial plots were used to compare the predictability of parents' baseline intention for follow-up children's SIV and COVID-19 vaccination.

RESULTS

Study 1 revealed that parents used the influenza vaccine as an anchor to assess the COVID-19 vaccine's risks. Decision-making for children's SIV was habitual and rule-based, while for COVID-19 vaccination, it involved more deliberation influenced by negative situational cues like negative news and anecdotal experiences. Study 2 further found that, for COVID-19 vaccination, situation-varying factors including distressed emotional states and affective response to news were significant. While for SIV, past-year vaccination behaviour was a more important factor. Baseline intention reliably predicted children's SIV but not COVID-19 vaccination.

CONCLUSIONS

The convergence of qualitative and quantitative data highlighted the distinct decision-making strategies for these two vaccines. Targeting key factors in parental decisions can enhance the effectiveness of future vaccination campaigns.

Explicating college students' COVID-19 prevention behaviors: Integrating information seeking and response efficacy into the reasoned action approach

Objective: This study investigated correlations between college students' intentions to adopt COVID-19 prevention behaviors (i.e., handwashing, mask wearing, and social distancing) and their attitudes, perceived norms, perceived efficacy, and information seeking. Participants: Students (N = 326) from a large Midwestern university recruited via simple random sampling. Methods: Using a cross-sectional survey from mid-March to April 2021, structural equation modeling assessed intentions across behaviors. Results: Attitudes and perceived self-efficacy were variably associated with intentions. Perceived injunctive norms were linked to intention across all behaviors. Response efficacy was associated only with social distancing intentions. Information seeking was tied to attitudes, perceived injunctive norms, and perceived response efficacy, across all behaviors. Conclusions: Information seeking affected how college students evaluate prevention behaviors, emphasizing the importance of disseminating accessible and accurate health information in this context. The findings also highlight the need for future interventions to tailor to the unique barriers and motivators for different prevention behaviors.

Different Classes of HIV-Preventive Behavioral Intention Among Youths Vulnerable to HIV Acquisition

The HIV incidence rate continues to increase among youth, especially among young men who have sex with men (YMSM) and young transgender women (YTW). To date, behavioral intention has often been viewed as the likelihood of engaging in prevention behaviors and emphasized as a key antecedent for condom use, disclosure of serostatus, and PrEP use among people living with HIV. In addition, individuals with different sociodemographic factors may have varying degrees of HIV prevention intention, which is a critical knowledge needed to identify facilitators and barriers to HIV prevention intention. This is a secondary data analysis of baseline data from a randomized controlled trial (RCT) (N = 488). This study aimed to identify distinct, latent classes of HIV prevention intention among youth vulnerable to HIV acquisition and to understand the sociodemographic and contextual factors associated with each latent class. Latent class analysis was conducted to identify meaningful latent classes of youths based on HIV prevention intention. Class 1: "High condomless sex, low serosorting, low PrEP intention," Class 2: "High condomless sex, high serosorting, low PrEP intention," Class 3: "Moderate condom use, serosorting, low PrEP intention," and Class 4: "Moderate condom use, high serosorting, moderate PrEP intention" were identified. Significant differences were found in age, sexual orientation, level of education, current employment status, annual household income, housing/living arrangement, and relationship status. Overall, YMSM and YTW without a recent history of HIV testing or PrEP use may have particularly low intentions for HIV prevention, and therefore may be at higher risk for HIV infection.

Progress on theory of planned behavior research: advances in research synthesis and agenda for future research

The theory of planned behavior is a social cognition theory that has been widely applied to identify the psychological determinants of intentions and behavior in health contexts. Our 2015 meta-analysis of theory applications in chronic illness contributed to a burgeoning evidence base comprising syntheses supporting theory predictions in health behavior. In this review, we identify limitations of prior meta-analyses of theory applications in health behavior and highlight salient evidence gaps, summarize how recent meta-analyses of the theory have addressed some of the limitations, outline outstanding research questions, and suggest future research syntheses, including those currently in progress, to resolve them. We point to recent and ongoing meta-analyses addressing theory hypotheses and assumptions not tested in previous syntheses, such as perceived behavioral control moderating effects and indirect effects of environmental (e.g., sociostructural variables) and intrapersonal (e.g., personality traits) determinants on health behavior mediated by theory constructs. We also highlight meta-analyses examining behavioral effects of constructs representing extended processes (e.g., habit, implicit cognition) in the context of the theory. Further, we summarize recent meta-analyses addressing directional and causal inferences in theory effects, including meta-analyses of longitudinal studies and experimental and intervention research. We also highlight attempts to test the mechanisms of action of interventions based on the theory including the change meta-analysis method and mediation analyses. We conclude by summarizing the advances that recent meta-analyses of the theory have made to the evidence base of health behavior determinants and interventions and highlighting suggestions for meta-analyses that will further progress the evidence base.

Evaluating the home-based intervention strategy (HIS-UK) to reduce new chlamydia infection among young men aged 16-25 years by promoting correct and consistent condom use: findings from a randomised controlled trial

BACKGROUND

Correct and consistent condom use is the most effective method to reduce transmission of sexually transmitted infections (STIs).

OBJECTIVE

To compare the HIS-UK intervention to usual condom information and distribution care for effect on chlamydia test positivity.

METHODS

Trial design A 3-parallel arm randomised controlled trial (1:1:1 allocation, two intervention arms vs. control). Randomisation using permuted blocks of varying lengths, with stratification by site, ethnicity and sexual-partnering risk. Repeated measures design with monthly follow-up to six months post-randomisation. Setting Sexual health services in seven NHS Trusts and one university medical centre. Telephone and video consultations, online and in participants' homes in England, UK. Participants Target sample of 2231 men and people with penises, aged 16-25, at risk of STIs. Intervention HIS-UK delivered (1) face-to-face by health professionals (proHIS) or (2) digitally (eHIS). Two-weeks self-practice and experimentation using the HIS-UK condom kit. Primary health outcome Chlamydia test positivity by six-months. Secondary outcomes Frequency of unprotected sexual intercourse, reported condom use errors and problems, attitudes and use experience. Analyses Chlamydia test positivity by six months analysed by logistic regression. Secondary outcomes analysed using linear mixed effects models with fixed effects and a random effect for the repeated measures, and generalised estimating equations with a logit link, adjusting for fixed effects and specifying an autoregressive-1 correlation structure.

RESULTS

Seven hundred twenty-five participants (proHIS:241, eHIS:243, control:241) randomised. 575 participants completed all baseline activities, 189 (32.9%) reached six-months post-randomisation. The absolute difference in chlamydia test positivity between arms was -4.9 percentage points at six months (7.9% HIS-UK, 12.8% control). The odds of chlamydia test positivity during follow-up were 55% lower for HIS-UK participants (p=.261). HIS-UK showed a positive impact on recent condom use over time (p<.001). Significant reductions in condom errors and problems among HIS-UK participants were observed (p=.035). Lubricant use increased among HIS-UK participants, with evidence of an intervention-by-time interaction (p=.051), and a decline in poor condom fit and feel reports, but without intervention effect.

CONCLUSIONS

This study provides valuable insights into the potential of HIS-UK to enhance sexual health practices among at-risk populations at-risk of STI transmission.

TRIAL REGISTRATION

ISRCTN registration: 11400820 (23/10/2019).

A Media Literacy Education Approach to Sexual Health Promotion: Immediate Effects of Media Aware on the Sexual Health Cognitions of Young Adult Community College Students

This study evaluates the efficacy of Media Aware, a comprehensive sex education program with a media literacy education approach, for improving sexual health cognitions among 1139 U.S. community college students (ages 18-19) from 23 campuses. Students were randomized to condition (intervention or delayed-intervention control) and completed pretest and posttest questionnaires. Several main effects of the intervention were found at posttest, including reduced perceived realism of media messages, positive attitudes about risky sex, and descriptive normative beliefs about unprotected and risky sexual activity, and increased self-efficacy to use dental dams. Gender and pretest levels moderated some intervention effects. Women in the intervention group reported less identification with media messages compared to women in the control group. Students in the intervention group who reported lower pretest levels of self-efficacy to use dental dams and to refuse unprotected sex had higher posttest levels on those outcomes as compared with the control group. Students in the intervention group who reported higher pretest levels of normative beliefs about risky sexual activity had lower posttest levels on those outcomes as compared with the control group. Results suggest that Media Aware is a promising method to improve the sexual health of young adults attending community college.

Promoters and Barriers of Vaccine Hesitancy

This systematic review explores the psychological antecedents of Vaccine Hesitancy, a significant determinant of vaccination behavior. Following PRISMA guidelines, an extensive search was conducted starting from 1673 papers and resulting in 48 publications from various databases. The review identifies psychological factors, specifically cognitive, personality, experiential, and social factors contributing to hesitancy. Cognitive factors include health literacy, conspiracy beliefs, trust, and perceived risk. Personality traits such as extraversion, openness, and psychological capital impact hesitancy, while psychopathy increases it. Personal experiences, like perceived stress and racial discrimination, indirectly affect hesitancy. Social factors, including social relationships and norms, play a significant role in reducing hesitancy. Tailored interventions addressing these factors can enhance vaccine acceptance.

Contextualized Experiences and Predictors of Condom Use in a Flemish Population: A Mixed Methods Study

This study aims to address the gap in understanding condom use (CU) behavior in Flanders (the Dutch-speaking community in Belgium) by applying a mixed methods approach, integrating both quantitative and qualitative data. Utilizing a large-scale survey of over 14,000 participants and 11 in-depth interviews, the study explores key factors influencing CU, including (amongst others) relationship status, attitudes toward condoms, and STI testing. Quantitative findings highlight significant predictors such as the type of partner (casual vs. steady), STI testing behaviors, and negative attitudes toward condoms. Qualitative insights further reveal personal experiences that complicate CU decisions, such as the disruption of sexual flow and emotional dynamics within relationships. These findings underscore the complexity of CU behavior, showing that practical barriers (e.g., discomfort, fit) and personal beliefs play pivotal roles. The study concludes that targeted public health interventions could focus on improving condom accessibility and addressing both practical and emotional factors. Recommendations for sexual health education include promoting communication around CU and enhancing condom experimentation and fit. These findings contribute valuable insights into enhancing sexual health outcomes through more nuanced, contextualized approaches to condom use.

Associations of Implicit and Explicit Sexual Double Standard Endorsement and Sexual Assertiveness with Sexual and Interactional Competence in Emerging Adults

In this study, among emerging adults, we investigated the interrelationships of explicit and implicit measures of sexual assertiveness (SA) and sexual double standard endorsement (SDS) on the one hand, and different aspects of sexual and interactional competence (SAIC) on the other hand, using Partial Least Squares Path Modeling (PLS-PM) of cross-sectional data. Participants were 159 sexually active, heterosexual individuals in the Netherlands between 18 and 25 years. No exclusion criteria were used. The Sexual Competence and Interaction Competence in Youth and lifetime number of sexual partners were used to measure SAIC. Explicit SA was measured using the Hurlbert Index of Sexual Assertiveness, while Explicit SDS was assessed using the Scale for the Assessment of Sexual Standards in Youth. Two implicit association tests were performed to measure implicit SA and SDS. Participants accessed these computerized reaction time tasks via a secure online data collection platform. Results showed a strong association between the latent factors of sexual attitudes and SAIC. Greater SA and lower SDS were associated with a greater competence level. No gender effects were found.

Allowing time for 8+ hours of sleep: identification and validation of important beliefs using the reasoned action approach

Introduction

The present studies advance research using the Reasoned Action Approach to understand sleep behavior. Identification of the modal salient beliefs that individuals hold regarding their sleep habits is necessary to understand the attitudes, perceived normative pressure, and perceived behavioral control (PBC) that individuals hold.

Methods

Belief elicitation (Study 1) and follow-up validation (Study 2) studies of undergraduates at a Midwestern USA university were conducted to identify readily accessible and important beliefs regarding allowing time for 8+ hours of sleep each night.

Results

Important attitude relevant beliefs included positive effects on mood, thinking, health, and productivity. Important normative beliefs were perceived injunctive pressure from family, health professionals, and significant others. Because of the strong influence of PBC on intentions/behavior, most important were control beliefs about the need for good time management.

Discussion

The present studies increased our understanding why many individuals do not allow time to obtain adequate sleep. Identification of the beliefs that distinguish between those who intend to allow time for adequate sleep and those who do not is a necessary step toward the design of effective interventions to improve sleep duration. The results indicate that a focus on increasing time management skills and PBC may be an effective approach for sleep interventions.

Preventive behavior intention for a viral outbreak among college students: The case of Mpox

OBJECTIVE

Examine college students' behavior intention to reduce viral outbreak transmission in the context of Mpox, and what preventive messaging strategies would be most effective in future transmissible disease outbreaks based on the Reasoned Action Approach (RAA).

PARTICIPANTS

Undergraduates at a mid-Atlantic U.S. University.

METHODS

An online survey (n = 266) conducted at the height of the recent Mpox outbreak in the U.S., asked about five target behaviors to reduce Mpox transmission, including RAA determinants for each behavior.

RESULTS

Highest intention was safe sex practices, lowest were vaccination and sexual abstinence, and sharing dishes and fabrics were in between. RAA determinants differed by target behavior, although attitudes were significantly positively associated with intention for all five behaviors.

CONCLUSIONS

College students are potentially open to preventative behaviors to reduce viral transmission during an outbreak. However, specific target behavior matters and messaging should focus on differing RAA determinants depending on target behavior.

Health-promotion interventions targeting multiple behaviors: A meta-analytic review of general and behavior-specific processes of change

Although health-promotion interventions that recommend changes across multiple behavioral domains are a newer alternative to single-behavior interventions, their general efficacy and their mechanisms of change have not been fully ascertained. This comprehensive meta-analysis (6,878 effect sizes from 803 independent samples from 364 research reports, N = 186,729 participants) examined the association between the number of behavioral recommendations in multiple-behavior interventions and behavioral and clinical change across eight domains (i.e., diet, smoking, exercise, HIV [Human Immunodeficiency Virus] prevention, HIV testing, HIV treatment, alcohol use, and substance use). Results showed a positive, linear effect of the number of behavioral recommendations associated with behavioral and clinical change across all domains, although approximately 87% of the samples included between 0 and 4 behavioral recommendations. This linear relation was mediated by improvements in the psychological well-being of intervention recipients and, in several domains (i.e., HIV, alcohol use, and drug use), suggested behavioral cuing. However, changes in information, motivation, and behavioral skills did not mediate the impact of the number of recommendations on behavioral and clinical change. The implications of these findings for theory and future intervention design are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pilot randomized controlled trial using the theory of planned behavior to promote sexual consent of undergraduates in Greek-letter organizations

OBJECTIVE

Sexual assault is prevalent among undergraduates in Greek-letter organizations (GLO). Prevention efforts promote sexual consent, though few explicitly employ theoretical constructs known to positively influence behavior. This study evaluated theory-informed educational posters promoting sexual consent seeking.

PARTICIPANTS

Forty undergraduate GLO students (20 female, 20 male) were recruited through in-person, email, and social media solicitation. Data collection was completed March-November 2019 during the spring and fall semesters.

METHODS

A double-blind randomized controlled trial was conducted. Intervention participants viewed theory-informed educational posters promoting sexual consent.

RESULTS

The intervention group demonstrated more favorable consent intention (p = .024; η2 = 0.131) and consent subjective norms (p = .040; η2 = 0.109). Intervention group males showed a greater improvement in one of four consent attitudes (p = .045; η2 = 0.211).

CONCLUSIONS

Brief exposures to theory-informed messaging may help to improve subjective norms and behavioral intent to seek sexual consent among undergraduate GLO members.

Applying the theory of planned behaviour to understand mental health professionals' intentions to work using a human rights-based approach in acute inpatient settings

BACKGROUND

There has been a shift to implement human rights-based approaches in acute mental health care due to increasing concerns around quality of care. National Health Service (NHS) Trusts have a legal duty to uphold a person's human rights, therefore it is important to understand what any barriers might be. Using psychological theory may help to develop this understanding.

AIM

To test whether the theory of planned behaviour can be an effective model in understanding mental health professionals' intentions to work using a human rights-based approach.

METHOD

Participants were recruited from two NHS Trusts in the North West of England. A cross-sectional, survey design was used to examine mental health professionals' intentions to use human rights-based approaches.

RESULTS

Multiple regression analyses were performed on the theory of planned behaviour constructs showing that attitude and subjective norm significantly predicted intention. Perceived behavioural control did not add any significant variance, nor any demographic variables.

CONCLUSION

There could be factors outside of the individual clinician's control to fully work within a human rights-based framework on acute mental health wards. The theory of planned behaviour offers some understanding, however further development work into measuring human rights outcomes on acute mental health wards is needed.

Effectiveness of Social Media-Based Intervention in Intention Change of Adolescents for Promoting Sexual Health Behavior in Western Terai of Nepal

BACKGROUND

Sexually transmitted infections (STIs) in adolescents are among the major public health challenges that have to be prevented in time. Traditional education falls short of reach; social media offers accessible ways. However, there is no research on such an issue in Nepal. Accordingly, this study was conducted to assess the effectiveness of a social media-based health education intervention in changing the intention of promoting sexual health among adolescents in Nepal. Study Design: A quasi-experimental study.

METHODS

A total of 160 adolescent students aged 14-19 years old from four purposively selected schools were evenly divided into intervention and non-intervention groups. Sampling and data collection were performed between May and June 2023. Data were collected through self-administered questionnaires for pretest and posttest evaluation. The intervention was delivered and followed up through a Facebook Messenger group. The obtained data were managed and analyzed using SPSS 21, with a significance level of 5%.

RESULTS

Social media-based health education interventions played a significant role in promoting the sexual health behavior of adolescents. The adolescents' knowledge and attitude scores on STIs increased from 2.33 to 4.62 and from 21.87 to 26.30. In addition, their scores on subjective norms, perceived behavioral control, and intentions in promoting sexual behavior increased from 13.93 to 17.59, from 19.96 to 25.40, and from 13.07 to 18.06, respectively, which were statistically significant.

CONCLUSION

The utilization of social media platforms such as Facebook Messenger groups is an effective medium for delivering health educational messages. Hence, increasing social media-based health education is a cost-effective intervention for promoting the health and sexual behaviors of adolescents.

Profile of gym-goers who do not use performance-enhancement substances

Introduction

Currently the use of prohibited performance-enhancing substances (PES) in fitness and gym settings is a public health concern as adverse health consequences are emerging. Understanding the characteristics of gym-goers who do not use these substances could lead to an important complement to the ongoing research about risk factors for PES use. The aim of this study was to identify the profile of PES non-use in gym-goers.

Methods

In total, 453 gym-goers (mean age = 35.64 years; SD = 13.08 - measure of central tendency location and measure of absolute dispersion, respectively) completed an online survey assessing sociodemographic factors, exercise characteristics, gym modalities, peers, social influence, attitudes, subjective norms, beliefs, intentions, and self-reported use of PES.

Results

Decision Trees showed that being a woman, training less frequently, not practicing bodybuilding and having a negative intention to consume PES were identified as characteristics of non-users of PES.

Discussion

These results may support evidence-based anti-doping interventions to prevent abusive use of PES in the fitness context.

Uncertain and Anxiously Searching for Answers: The Roles of Negative HealthCare Experiences and Medical Mistrust in Intentions to Seek Information from Online Spaces

While online sources of information, like support groups and wellness influencers, can be beneficial for those seeking additional information about their health conditions, these sources can also contain detrimental information. As misinformation and even conspiracies like QAnon proliferate in wellness discourse, particularly in online support groups and on the accounts of wellness influencers, it becomes increasingly important to understand what may contribute to individuals seeking information from these sources. Based on uncertainty in illness theory and the theory of motivated information management, we conducted a cross-sectional survey (N = 544) to test the role of negative health-care experiences and medical mistrust in uncertainty and information seeking from online support groups and wellness influencers across those with chronic and acute health concerns. Results indicated that negative health-care experiences had an indirect effect on information seeking from both online support groups and wellness influencers. This indirect effect, however, operated through uncertainty anxiety but not uncertainty discrepancy. For those with chronic conditions, the indirect effect also included medical mistrust. Implications and future extensions of the results are discussed.

Adolescents' pornography viewing frequency and its relationship with condom attitudes

Background This study examined adolescent pornography viewing and its' relationship with condom attitudes. Methods Data were from 457 adolescents aged 13-18years old who completed an online survey assessing pornography viewing frequency and condom attitudes. Results Many adolescents in our sample had viewed pornography in the past year (n =188, 41%), with pornography viewing frequency being higher among older adolescents (P =0.02), those who have had sex in the past year (P =0.001), and those who identified as White (P =0.01), LGB+ (P =0.05), and male (P =0.001). Adolescents who viewed pornography more frequently had more negative condom attitudes (r =-0.18, P Conclusions A substantial proportion of adolescents in our sample viewed pornography and those who view more frequently had more negative condom attitudes. Results indicate a need for experimental studies examining this relationship and interventions addressing pornography literacy among adolescents.

From Information Seeking and Scanning to the Practice of Healthy Habits: A Longitudinal Test of the Integrative Model of Behavioral Prediction in the Context of Fruit and Vegetable Consumption

Fruit and vegetable intake is essential for health, but global adherence to recommended levels remains insufficient. Health information exposure positively influences consumption, yet the underlying mechanisms are not fully understood. This study aims to explore the relationships between information seeking and scanning, attitudes, norms, perceived behavioral control (PBC), intentions, and fruit and vegetable intake, following the main tenets of the Integrative Model of Behavioral Prediction (IM). Data were collected through face-to-face surveys in Santiago, Chile, with a representative sample of individuals aged 25 and older in two waves. Findings revealed that intentions in Wave 1 predicted fruit and vegetable consumption in Wave 2, with positive associations between attitudes, norms, PBC, and intentions. Information seeking was positively associated with attitudes, norms, and PBC, and it had indirect effects on fruit and vegetable consumption through attitudes, norms, PBC, and intentions. Information scanning did not show significant indirect effects on fruit and vegetable consumption, even though the path between scanning and attitudes was significant. The study provides support for the IM and highlights the importance of information seeking in promoting fruit and vegetable consumption through its influence on attitudes, norms, and PBC. The findings have practical implications for health campaigns, educational programs, healthcare interactions, and public policies targeting healthier dietary habits.

The rules of mature sex: Sexual scripts and the global challenge of rising STIs

Sexual health continues to be a socially complex problem globally with rising rates of sexually transmitted infections (STIs) despite extensive government and health marketing initiatives. In particular, STIs are rising at a greater rate in mature consumers than any other age group with the main reason cited as lack of condom use. The rules around condom use are based on sexual scripts or internalised guidelines and thus a key step in developing social marketing initiatives to increase condom use and address this global challenge is identifying the sexual scripts that motivate and inhibit condom use by mature consumers. Using sexual script theory, this research involves interviews with 24 mature single heterosexual Australian consumers to identify the sexual scripts that can be leveraged in health marketing to address the grand challenge of increasing mature consumer participation in protective sexual health behaviours.

A Mixed-Methods Approach to Develop a Combined Model of U.S. College Student Alcohol-Associated Condomless Sex

Unhealthy alcohol use and sexually transmitted infections (STIs) are significant public health concerns for US college students. Because alcohol use and condomless sex often co-occur in this population, alcohol-associated condomless sex has been identified as a behavioral intervention target. Existing theoretical frameworks have not garnered sufficient empirical support to serve as the foundation for interventions. The primary goal of the current study was to use a mixed-methods approach to develop a model of college student alcohol-associated condomless sex that combines elements from well-established health behavior theories. In Aim 1, multilevel modeling was used to predict condomless vaginal sex in a sample of heterosexual college student drinkers (N = 53). Aim 2 consisted of in-depth interviews (n = 18) to gather perceptions about the role of alcohol in sexual activity and identify supplemental constructs omitted from theories in Aim 1. The multilevel model explained a significant proportion of variance in condomless vaginal sex at the between- and within-person level. Themes derived from the in-depth interviews identified complementary elements of condom use decision-making. Findings from both aims were synthesized to construct a combined model of alcohol-associated condomless sex. This model can be further refined and ultimately serve as the foundation of an alcohol-STI prevention-intervention.

Interventions Promoting Condom Use Among Youth: A Systematic Review

In many European and other high-income, Western countries, condom use has been decreasing among youth. A variety of promotional strategies to increase condom use exists. Our systematic review aimed to identify effective elements in interventions aimed at increasing condom use in youth. We searched databases (2010-2021) for intervention studies promoting condom use among youth in Western, high-income countries. The primary outcome was condom use; the secondary outcome was sexually transmitted infection (STI) diagnoses. Effectiveness per intervention was defined based on the percentage of comparisons that showed significant increases in condom use and significant decreases in STIs. We compared the effectiveness of interventions for different participant-, intervention- and methodological characteristics. We included 74 papers describing 85 interventions in the review. Overall, the median intervention effectiveness was 33.3% (interquartile range = 0%-66.7%) for condom use and 0% (interquartile range = 0%-100%) for STI diagnoses. Intervention effectiveness for condom use was significantly higher in interventions tailored towards females and males specifically, compared with interventions applied to both sexes combined. Our findings show the difficulty in designing effective interventions to increase condom use among youth. Interventions aimed at either females or males were more effective in increasing condom use.

Salient beliefs related to secondary distribution of COVID-19 self-test kits within social networks

Background

Widespread access to testing is critical to public health efforts to control the COVID-19 pandemic. Secondary distribution of COVID-19 self-test kits, where an individual distributes test kits to others in their social networks, is a potential strategy to improve access to testing. In this qualitative study, we identified salient beliefs about distributing and accepting COVID-19 self-test kits within one's social network, as well as ordering COVID-19 self-test kits from the government.

Methods

We recruited 61 participants from a randomized controlled trial (NCT04797858) in Philadelphia, Pennsylvania to elicit beliefs about (1) distributing COVID-19 self-test kits within one's social network, (2) receiving test kits from social contacts, and (3) ordering self-test kits from the government. Using validated, open-ended question stems, we identified the most common set of beliefs underlying attitudes, perceived norms (or social referents), and perceived behavioral control (or self-efficacy) toward each of these behaviors.

Results

Twenty-seven out of 30 (90%) of participants who received self-test kits reported distributing the kits to social contacts. These participants described altruistic beliefs about giving others access to testing, and felt approval from family members, friends, and others in their social networks. When receiving test kits from social network contacts, participants described advantages of test kit convenience, but some voiced concern about test kit tampering and confusing instructions. Participants also described perceived logistic barriers to distributing and receiving self-test kits, such as delivering or transporting test kits, or finding time to meet. Participants who ordered test kits from the government also described increased convenience of test access, but described different logistic barriers such as delays in test kit delivery, or not receiving test kits at all.

Conclusion

In comparison with government-ordered test kits, the secondary distribution of COVID-19 self-test kits raised unique concerns about test kit quality and instructions, as well as distinctive logistic barriers related to distributing self-test kits to network contacts, which were not raised for test kits ordered from the government. This study demonstrates that beliefs may vary depending on the type of testing behavior, and behavioral interventions may benefit from developing messages tailored to specific testing strategies.

A Serious Video Game Targeting HIV Testing and Counseling: A Randomized Controlled Trial

PURPOSE

Adolescents are the age group that is least likely to know their HIV status and may unknowingly transmit the virus to others. A randomized controlled trial was conducted to evaluate the impact of the original video game intervention, PlayTest!, on behavioral antecedents for HIV testing and counseling (HTC).

METHODS

Participants (N = 287 adolescents) were recruited between 2018 and 2020 and were 48% female, aged 14-18 years (mean age = 15.4 years), and 76% racial minorities. Participants were randomized 1:1 and assigned to either play PlayTest! or a set of control games, ∼one session per week for an hour per session over 4-6 weeks (gameplay) after school. The primary outcome measure was participants' attitudes around HTC at 6 months, with intentions, knowledge, self-efficacy, and behaviors assessed as secondary outcomes.

RESULTS

Two hundred and ninety-six participants were enrolled/randomized; nine were withdrawn due to incomplete parental consent forms, leaving 287 participants: 145 were randomized to PlayTest! and 142 to the control condition. Mixed between-within subjects ANOVAs assessed the impact of the study conditions on outcomes. Improvements were seen in the PlayTest! group in HTC attitudes (p < .001), intentions (p < .001), knowledge (p < .001), and self-efficacy (p = .002) at all time-points. At 6 months, for those who had access to HTC (N = 134; prior to COVID-19) and for those who did not have access to HTC (N = 261; during COVID-19), there were no differences in self-reported HTC between the two groups (p = .289 and p = .074, respectively).

DISCUSSION

PlayTest! impacted important behavioral antecedents related to HTC and has the potential to broadly increase HTC rates in adolescents.

Pre-exposure prophylaxis access, uptake and usage by young people: a systematic review of barriers and facilitators

Background

Young people's sexual health decision-making, including decisions to access and adhere to HIV prevention strategies such as Pre-Exposure Prophylaxis (PrEP), are influenced by a range of internal and external factors. Synthesizing these factors is essential to guide the development of youth-focused PrEP health promotion strategies to contribute to international goals of ending HIV transmission.

Objective

To understand the individual, interpersonal, sociocultural and systemic barriers and facilitators to PrEP access, uptake and use experienced by young people 24 years and younger.

Design

A systematic review that adhered to the Preferred Reporting Items of Systematic Review and Meta-Analysis Protocols.

Data Sources and Methods

Eight databases (PubMed, Scopus, Cochrane, Medline, CINAHL, JBI, EMBASE, Web of Science) were systematically searched using terms related to young people, HIV and PrEP use. A narrative synthesis approach was used to delineate key barriers and facilitators to PrEP access, uptake and use.

Results

Of 11,273 returned articles, 32 met the eligibility criteria for inclusion: 18 from the United States, 10 from African nations and two from Brazil. Barriers and facilitators to PrEP access, uptake and use experienced by young people were identified across intrapersonal, interpersonal, community and systems levels. These factors are described under four overarching themes that relate to knowledge, side effects and perceptions of risk; attitudes and perceptions of family and partners; community attitudes and stigma; and negative healthcare provider experiences and difficulties navigating complex costly healthcare systems.

Conclusion

Findings suggest individual-level factors need consideration alongside the impacts of healthcare systems and broader systemic sociocultural structures within young people's relationships when developing PrEP health promotion strategies and services. Without considering these wider external implications to access, uptake and use of PrEP, global targets towards the elimination of HIV transmission will likely remain out of reach.

Registration

This review was registered with Prospero (CRD42022296550).

Influence of social and psychological factors on smartphone usage during the COVID-19 pandemic

Objective

This study investigates the influence of psychological factors-specifically affective and cognitive risk perceptions, social distancing attitudes, subjective norms, and cabin fever syndrome-on smartphone usage intensity during the COVID-19 pandemic, with a particular focus on university students.

Methods

Utilizing a cross-sectional survey design, data were collected from 314 university students from South Korea and Vietnam. Structural equation modeling was employed to analyze the relationships between the psychological constructs and their impact on smartphone usage.

Results

The analysis confirms that both affective and cognitive risk perceptions significantly influence attitudes towards social distancing. Furthermore, these social distancing attitudes are found to significantly affect cabin fever syndrome, suggesting that positive attitudes towards social distancing are closely associated with higher reports of cabin fever. Notably, cabin fever syndrome emerges as a significant predictor of increased smartphone usage, underscoring its role as a mediator between prolonged isolation and digital engagement. Additionally, subjective norms are also shown to significantly influence smartphone usage intensity, highlighting the impact of social expectations on digital behaviors during the pandemic.

Conclusion

The study highlights the complex interplay between psychological distress induced by social restrictions and increased reliance on digital technology for social connectivity. These insights suggest that mental health interventions and digital literacy programs tailored to university students' needs can be effective in managing the negative impacts of prolonged social isolation.

Applying the SOR framework to mitigate single-use plastic tableware consumption and why does it work? Solving the dissonance with an extended SOR framework

Although plastic pollution is a critical environmental issue worldwide and household consumption of single-use plastic tableware (SUPT) is a growing concern, research on the determinants of SUPT use is deficient. In light of the prevalent and frequent use of SUPT, the far-reaching nature of its consumption, and its distinctive health concerns, compounded by the lack of dedicated regulations, this article sheds light on the SUPT problem and strives to minimize SUPT consumption. The Stimulus-Organism-Response (SOR) framework has been extensively applied in various contexts but not yet in the context of household SUPT consumption. In this study, we aim to fill the lacuna by examining the motives behind SUPT consumption using two online questionnaires in two Western countries that are known for relatively high domestic SUPT consumption: Israel (Study 1, n = 408) and the USA (Study 2, n = 295). Our findings indicate that personal attitudes toward the plastic problem ("organism" in the SOR taxonomy) mediate the relation between plastic health problem awareness ("stimulus") and SUPT consumption ("response"). Moreover, we identified perceived behavioral control (PBC) as a significant predictor of behavior when behavior is not under volitional control (i.e., an action against the individual's self-interest), as in the SUPT context. Therefore, we propose expanding the SOR framework with the organism comprising attitude and PBC, thus supporting the dissonance theory (double mediation). We suggest that modifying personal attitudes toward the plastic problem by enhancing plastic health problem awareness may strengthen PBC and reduce SUPT consumption. Overall, this study deepens our understanding of SUPT consumption by highlighting the importance of attitude and PBC as mechanisms that link awareness to sustainable behavior.

Understanding Psychosocial Determinants of PrEP Uptake Among Cisgender Women Experiencing Heightened HIV Risk: Implications for Multi-Level Communication Intervention

Pre-exposure prophylaxis (PrEP) is a highly effective daily pill that decreases the likelihood of HIV acquisition by up to 92% among individuals at risk for HIV. PrEP can be discretely used, autonomously controlled, and in place at the time of risk exposure, making it an especially promising method for HIV prevention for cisgender women (CGW). But, PrEP is underutilized by CGW relative to the demonstrable need. We apply the Integrative Model of Behavioral Prediction to identify the critical psychosocial factors that shape CGW's intentions to use PrEP and their relevant underlying beliefs. We surveyed (N = 294) community- and clinic-recruited PrEP eligible CGW to understand the relative importance of attitudes, norms, and efficacy in shaping PrEP intentions. We utilized structural equation modeling to identify the relevant paths. We inspected the summary statistics in relation to three message three selection criteria. We identified beliefs that demonstrated (1) an association with intention, (2) substantial room to move the population, (3) practicality as a target for change through communication intervention. Results show that PrEP awareness was low. When women learned about PrEP, they voiced positive intentions to use it. There were significant and positive direct effects of SE (0.316***), attitudes (0.201**), and subjective norms (0.249***) on intention to initiate PrEP. We illustrate the strategic identification of beliefs within the relevant paths using the 3 belief selection criteria. We also discuss implications for social and structural communication interventions to support women's HIV prevention.

Infodemic Management for Social and Behavior Change: Youth Mobilization for Combating Disinformation During COVID-19

This study discusses an undergraduate elective university course as a notable case for youth mobilization in combatting misinformation during COVID-19 with positive social and behavior change outcomes of an indicative nature. Remote modality of the civic engagement course entailed students' voluntary work at partnering with society organizations specialized in new media technologies. Students' engagement with the civil society organizations' three different research and implementation projects as a form of voluntary work enabled them to mobilize in accordance with a vital dimension of infodemic management, namely engagement of communities to take positive action. Results derived from a mixed model research present that individual change observed on the students' knowledge, attitudes and practices as well as social change objectives of partnering institutions and the course are modestly positive, suggesting replication of adapted course design and implementation in relevant contexts.

Predicting COVID-19 and Influenza Vaccination Confidence and Uptake in the United States

This study investigates and compares the predictors of COVID-19 and influenza vaccination confidence and uptake in the U.S. Vaccine hesitancy is defined as the reluctance or refusal (i.e., less than 100% behavioral intention) to vaccinate despite the availability of effective and safe vaccines. Vaccine hesitancy is a major obstacle in the fight against infectious diseases such as COVID-19 and influenza. Predictors of vaccination intention are identified using the reasoned action approach and the integrated behavioral model. Data from two national samples (N = 1131 for COVID-19 and N = 1126 for influenza) were collected from U.S. Qualtrics panels. Tobit regression models were estimated to predict percentage increases in vaccination intention (i.e., confidence) and the probability of vaccination uptake (i.e., intention reaching 100%). The results provided evidence for the reasoned approach and the IBM model and showed that the predictors followed different patterns for COVID-19 and influenza. The implications for intervention strategies and message designs were discussed.

Intention to Initiate HIV Pre-exposure Prophylaxis Among Cisgender Women in a High HIV Prevalence U.S. City

OBJECTIVE

Our objective was to identify the individual, interpersonal, community, health-system, and structural factors that influence HIV pre-exposure prophylaxis (PrEP) initiation among cisgender women seeking sexual and reproductive health care in a high HIV prevalence community to inform future clinic-based PrEP interventions.

METHODS

We collected anonymous, tablet-based questionnaires from a convenience sample of cisgender women in family planning and sexual health clinics in the District of Columbia. The survey used the lens of the socio-ecological model to measure individual, interpersonal, community, institutional, and structural factors surrounding intention to initiate PrEP. The survey queried demographics, behavioral exposure to HIV, perceived risk of HIV acquisition, a priori awareness of PrEP, intention to initiate PrEP, and factors influencing intention to initiate PrEP.

RESULTS

A total of 1437 cisgender women completed the survey. By socio-ecological level, intention to initiate PrEP was associated with positive attitudes toward PrEP (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.13-2.15) and higher self-efficacy (OR, 1.32; 95% CI, 1.02-1.72) on the individual level, perceived future utilization of PrEP among peers and low fear of shame/stigma (OR, 1.65; 95% CI, 1.33-2.04) on the community level, and having discussed PrEP with a provider (OR. 2.39; 95% CI, 1.20-4.75) on the institutional level.

CONCLUSION

Our findings highlight the importance of multilevel, clinic-based interventions for cisgender women, which promote sex-positive and preventive PrEP messaging, peer navigation to destigmatize PrEP, and education and support for women's health medical providers in the provision of PrEP services for cisgender women.

Testing the influence of harm reduction messages on health risk attitudes, injunctive norms and perceived behavioral control

BACKGROUND

E-cigarettes can potentially be a harm reduction pathway for adults who smoke and who are seeking to make the complete switch from cigarettes. However, often people who smoke believe that e-cigarettes are just as damaging as cigarettes to their health. From a harm reduction perspective, the key question is whether providing information about the reduced toxicant intake of e-cigarettes, compared to cigarettes, could influence their perceptions and whether there are certain message features that might further support this transition.

METHODS

In this experiment (n = 305), we test whether a harm reduction (reduced toxicant intake, complete switch) message will influence the health risk attitudes, injunctive norms and perceived behavioral control of people who smoke, compared to those who do not view a message and whether including a "smoking cue" within the message influences their response.

RESULTS

Results indicate that those who viewed the harm reduction message with a smoking cue had lower health risk attitudes than those who did not view a message (p = 0.025) and higher injunctive norms than those who viewed the message without a smoking cue (p = 0.006).

CONCLUSIONS

These findings demonstrate that a harm reduction message with a smoking cue can influence the perceptions of adults who smoke, lowering health risk attitudes and increasing injunctive norms.

Increasing early infant male circumcision uptake in Zambia: Like father like son

Voluntary Medical Male Circumcision (VMMC) is an effective strategy for HIV prevention in areas with high prevalence of, and risk for, HIV. More than 361,000 male neonates are born each year in Zambia, many of whom could be eligible for Early-Infant Medical Circumcision (EIMC). Building on successful implementation strategies utilized in our Spear & Shield program, this pilot study, "Like Father, Like Son" (LFLS), evaluated the feasibility and acceptability of offering combined EIMC and VMMC services and couple-level behavioral interventions. A total of N = 702 pregnant women and their male partners (n = 351 couples) were recruited and enrolled. Couples were assessed twice pre-birth, 2 weeks post birth, and 6 months post birth. Expectant mothers were an average of 15.05 weeks pregnant (SD = 8.83). Thirty-nine pregnancies did not result in a live birth (11%), 14 couples withdrew from the study or were lost to follow-up prior to delivery (4%), and 148 babies were born female (42%), leaving 150 couples with a male infant in the analytic sample (43%). The LFLS study achieved significantly higher EIMC rates (35%) in comparison with previously observed EIMC study rates in Zambia (11%), and significantly higher than hypothetical comparison rates up to 30%. Relative to baseline rates, odds of VMMC among couples' older sons increased by 31% at post-intervention and by 90% at two-weeks following birth. Overall, this pilot study found the LFLS intervention to be feasible, acceptable, and effective in doubling the rate of EIMC in comparison with a previous longitudinal study in Zambia. Future research should consider a family-centric approach to promotion of male circumcision for infants and adolescents. LFLS may be effective in promoting father-son "bonding" by MC status; a bond that may be a bridge to increase both EIMC and VMMC uptake in newborns and couples' older sons and is a novel leverage point for promotion of this HIV prevention strategy.

Delay Discounting and Sexual Decision-Making: Understanding Condom Use Behavior Among U.S. College Students

Condoms provide protection against sexually transmitted diseases; however, condomless sex remains common among college students and intentions to use condoms do not consistently translate into condom use. This study tested which indicator of condom use intentions from a delay discounting paradigm of condom-protected sex best accounted for variance in condom use behavior. The sample consisted of 187 sexually active college students (51.9% female) who completed measures of condom use during vaginal and anal sex over the past three months and a decision-making paradigm regarding condom intentions with hypothetical sexual partners. In separate models, condom behavior was regressed on one of three indicators of condom intentions: initial intentions to use a condom, delay discounting of condom-protected sex, and overall area under the curve across all trials. Results showed that delay discounting of condom-protected sex best accounted for variance in absolute frequency of condomless sex, whereas initial intentions to use a condom best accounted for variance in relative proportion of condomless sex. Future research directions and implications for interventions are discussed.

Sending, receiving, and nonconsensually sharing nude or near-nude images by youth

INTRODUCTION

There is growing evidence about the prevalence of sending, receiving, or resharing nude images by youth (sexting). Less is known about the demographic, technology use, and social context correlates of sexting. Using logistic regression, we looked at predictors of sexting behaviors in minors.

METHODS

Participants were a market panel sample of 394 youths aged 9-12 and 602 youths aged 13-17 (M_age  = 13.5, SD = 2.50, 60.3% females) recruited for an anonymous online survey in the United States. The survey comprised questions about demographic characteristics, sexting behaviors, technology use, attitudes, and perceived norms. The four outcomes were sending nude or near-nude images or videos (images), receiving images sent without the depicted person's knowledge, nonconsensually resharing images, or having one's own images nonconsensually reshared.

RESULTS

Regression analyses showed gender, gender/sexual minority status, use of dating apps and particular online platforms, self-sharing and resharing attitudes, and friend norms predicted sending images. Age, resharing attitudes, and friend norms all predicted receiving nude images of other youths. Household income, geographic location, some online platforms, resharing attitudes, and friend norms all predicted nonconsensual resharing of nudes. Age, use of encrypted apps, and friend norms predicted having one's own image nonconsensually reshared.

CONCLUSIONS

We partially replicated prior research by finding associations between age and gender. Further, we identified technology use factors including the use of dating apps and particular platforms. Attitudes about sexting and perceived friend norms were robust across sexting behaviors, suggesting these factors are potentially important for intervention.

Predicting behavioral intentions for unsafe off-highway vehicle use

INTRODUCTION

Hundreds of adults are killed or injured each year while operating off-highway vehicles. Four common risk-taking behaviors were identified on off-highway vehicles in the literature and examined intention to engage in such behaviors within the context of the Theory of Planned Behavior.

METHOD

One hundred and sixty-one adults completed measures of experience on off-highway vehicles and injury exposure followed by a self-report created according to the predictive structure of the Theory of Planned Behavior. Behavioral intentions to engage in the four common injury risk behaviors on off-highway vehicles were predicted.

RESULTS

Similar to research on other risk behaviors, perceived behavioral control and attitudes emerged as consistently significant predictors. Subjective norms, the number of vehicles operated, and injury exposure showed varying relationships to the four injury risk behaviors. Results are discussed in the context of similar studies, intrapersonal predictors of injury risk behaviors, and with regard to implications for injury prevention efforts.

Using theory of reasoned action to reduce high-risk sexual behaviors among patients with HPV: A randomized controlled trial

BACKGROUND

Sexually transmitted diseases are a major health problem in all countries. Human papillomavirus (HPV) infection is the most common viral sexually transmitted disease in both genders. High-risk sexual behaviors (HRSBs) are among the major risk factors for HPV infection. Lack of knowledge can contribute to HRSBs and hence, education can potentially reduce HRSB risk. This is a study using theory of reasoned action to reduce the high-risk sexual behaviors among patients with HPV.

MATERIALS AND METHODS

This study was a two-grouped, randomized, controlled trial. The educational program was developed based on the results of a survey into the most important components of the theory of reasoned action contributing to HRSBs among 100 patients recruited from Razi hospital, Tehran, Iran. Then, 110 patients from the same hospital were consecutively recruited and randomly allocated to a control (n = 55) and an intervention (n = 55) group. Then, each participant in the intervention group was provided with the developed educational program. Their counterparts in the control group solely received routine care services. Three months after the first educational session, HRSBs were reassessed in both groups. Data were analyzed via the SPSS software (v. 21.0).

RESULTS

After the intervention, the mean score of HRSBs significantly decreased in the intervention group (P < 0.001) but did not significantly change in the control group (P = 0.70). The post-test mean score of HRSBs in the intervention group was significantly less than the control group (P = 0.015).

CONCLUSION

Education based on the theory of reasoned action is effective in significantly reducing HRSBs. Nurses can develop and use educational interventions based on this theory to reduce HRSBs and HPV infection.

Predicting Risky Sexual Behavior Among College Students Through Machine Learning Approaches: Cross-sectional Analysis of Individual Data From 1264 Universities in 31 Provinces in China

BACKGROUND

Risky sexual behavior (RSB), the most direct risk factor for sexually transmitted infections (STIs), is common among college students. Thus, identifying relevant risk factors and predicting RSB are important to intervene and prevent RSB among college students.

OBJECTIVE

We aim to establish a predictive model for RSB among college students to facilitate timely intervention and the prevention of RSB to help limit STI contraction.

METHODS

We included a total of 8794 heterosexual Chinese students who self-reported engaging in sexual intercourse from November 2019 to February 2020. We identified RSB among those students and attributed it to 4 dimensions: whether contraception was used, whether the contraceptive method was safe, whether students engaged in casual sex or sex with multiple partners, and integrated RSB (which combined the first 3 dimensions). Overall, 126 predictors were included in this study, including demographic characteristics, daily habits, physical and mental health, relationship status, sexual knowledge, sexual education, sexual attitude, and previous sexual experience. For each type of RSB, we compared 8 machine learning (ML) models: multiple logistic regression (MLR), naive Bayes (BYS), linear discriminant analysis (LDA), random forest (RF), gradient boosting machine (GBM), extreme gradient boosting (XGBoost), deep learning (DL), and the ensemble model. The optimal model for both RSB prediction and risk factor identification was selected based on a set of validation indicators. An MLR model was applied to investigate the association between RSB and identified risk factors through ML methods.

RESULTS

In total, 5328 (60.59%) students were found to have previously engaged in RSB. Among them, 3682 (41.87%) did not use contraception every time they had sexual intercourse, 3602 (40.96%) had previously used an ineffective or unsafe contraceptive method, and 1157 (13.16%) had engaged in casual sex or sex with multiple partners. XGBoost achieved the optimal predictive performance on all 4 types of RSB, with the area under the receiver operator characteristic curve (AUROC) reaching 0.78, 0.72, 0.94, and 0.80 for contraceptive use, safe contraceptive method use, engagement in casual sex or with multiple partners, and integrated RSB, respectively. By ensuring the stability of various validation indicators, the 12 most predictive variables were then selected using XGBoost, including the participants' relationship status, sexual knowledge, sexual attitude, and previous sexual experience. Through MLR, RSB was found to be significantly associated with less sexual knowledge, more liberal sexual attitudes, single relationship status, and increased sexual experience.

CONCLUSIONS

RSB is prevalent among college students. The XGBoost model is an effective approach to predict RSB and identify corresponding risk factors. This study presented an opportunity to promote sexual and reproductive health through ML models, which can help targeted interventions aimed at different subgroups and the precise surveillance and prevention of RSB among college students through risk probability prediction.

A Meta-Analytical Assessment of the Effect of Deontological Evaluations and Teleological Evaluations on Ethical Judgments/Intentions

Deontological and teleological evaluations are widely utilized in the context of consumer decision-making. Despite their use, the differential effect of these distinct types of evaluations, and the conditions under which they hold, remains an unresolved issue. Thus, we conduct a meta-analysis of 316 effect sizes, from 53 research articles, to evaluate the extent to which deontological and teleological evaluations influence ethical judgments and intentions, and under what circumstances the influence occurs. The effect is explored across three categories of moderators: (1) contextual elements of the ethical issue, (2) stakeholders, and (3) methodological characteristics of primary studies. We find that the overall effect of deontological evaluations on ethical judgments and intentions is stronger than for teleological evaluations; however, the magnitude of the effect is contingent on several moderators. Deontological evaluations are weaker in offline consumer contexts and stronger when there are financial implications of the ethical issue. Conversely, the effect of teleological evaluations is relatively stable across ethical consumer contexts. Teleological evaluations are stronger from a utilitarian perspective than from an egoist one. Furthermore, the effect of deontological evaluations is weaker, but the effect for teleological evaluations is stronger, when the decision-maker has a personal relationship (as compared to an organizational relationship) with the victim of the unethical act. Findings validate the effect of both deontological and teleological evaluations on ethical judgments and intentions and highlight their importance in consumers' ethical decision-making. Implications for developing programs to prevent consumer unethical behavior are discussed.

Examining behavioural intention towards organ donation in Hong Kong

Although many people report favourable attitudes towards organ donation, Hong Kong has one of the lowest rates of organ donation globally. The present study examined behavioural intention towards organ donation. A convenience sample of 225 Hong Kong Chinese adults (118 = female) aged 18-82 years were recruited to an online survey. Behavioural intention, attitudes, subjective norms, self-efficacy, knowledge and altruism were examined. ANOVA was conducted to examine key differences based on behavioural intention, regression then examined predictors of behavioural intention to donate before exploratory analysis examined the mediating role of subjective norms on the relationship between self-efficacy and behavioural intention. Findings revealed over one third (38%) of respondents were actively registered as organ donors. Women were significantly more likely to be registered as organ donors. Subjective norms and self-efficacy were strong predictors of behavioural intention to donate, and subjective norms significantly mediated the relationship between self-efficacy and behavioural intention to donate.

Longitudinal Associations Among Adolescents' Sexual Attitudes, Beliefs, and Behaviors

Youth sex and relationship education programs aim to improve adolescent well-being by changing their knowledge, beliefs, and attitudes regarding sex and their health. However, there is a gap in existing research linking these cognitive targets to relevant behaviors, and a particular dearth of data on links with sexual behaviors. The current study tested longitudinal links between cognitive factors related to sex (attitudes about sex, normative beliefs, risk-avoidant intentions, and confidence in refusal skills) and outcomes of sexual behaviors (recent sexual encounters, number of sexual partners, and frequency of condom use). Data were drawn from three waves of data from a panel study of US high-school students and were analyzed using cross-lagged structural equation modeling. We hypothesized direct, reciprocal links between intentions and behaviors, but this hypothesis was not supported. Instead, more conservative attitudes about sex emerged as the most consistent prospective predictor of fewer sexual encounters and sexual partners, though with small effect sizes (βs = - .08 to - .131, ps < .05). Further, bidirectional interrelationships were observed among several of the cognitive and behavioral variables over time. These results highlight attitudes about sex as a potentially useful intervention target, but also suggest that sex and relationship education curricula and evaluations should consider multiple pathways of links between cognition and behavior. Continued research is needed on causal links between adolescents' sexual attitudes, knowledge, intentions, and behavior.

Applying the Theory of Planned Behavior to predict community pharmacists' intention to provide diabetes care

BACKGROUND

The role of the pharmacist has changed from dispensing medicines, to working with other healthcare professionals to assure appropriate medication therapy management. This study assessed community pharmacists' intention regarding diabetes care based on the theory of planned behavior (TPB) in Alexandria, Egypt.

METHODS

A sample of 385 community pharmacies with one index per site (one pharmacist per pharmacy) was recruited in the sample using a multistage random sampling technique. This cross-sectional survey was performed using a self-administered questionnaire that measured the constructs of TPB. A structural equation model was used to identify specific factors that most contribute to and predict pharmacists' intention to provide diabetes care.

RESULTS

The sample included 385 pharmacies, approximately half of them (51.4%) were males and the majority of them (94%) had a bachelor's degree in pharmaceutical sciences. Intention was significantly correlated with attitude, subjective norm and perceived behavioral control. "Regular screening for complications can improve quality of life for diabetic patients" (β = 1.131) was the most specific factor motivating pharmacists to perform diabetes care, while "some physicians do not appreciate pharmacists' involvement in diabetic care" was the most specific factor that negatively influenced intention of pharmacists to provide diabetes care (β = 4.283).

CONCLUSION

Community pharmacists demonstrated a positive attitude, perceived significant approval from others and felt able to intervene in diabetes care. However, lack of physician collaboration was a specific hindering factor for pharmacists' practice of diabetes care.

Assessing the impact of pre-test education on patient knowledge, perceptions, and expectations of pharmacogenomic testing to guide antidepressant use

Pharmacogenomic (PGx) testing is an increasingly utilized technology that offers the potential for precision drug selection to treat depression. Though PGx-guided therapy is associated with increased rates of remission of depression symptoms, for many patients, treatment will not change based on PGx testing results. Lack of consensus guidelines for pre-test counseling may hinder the communication of PGx testing limitations, and patients often have high expectations for test outcomes. To explore this issue, we created and evaluated the impact of a pre-test education video for patients with depression. Individuals in the education group (n = 198) viewed this brief video about PGx testing prior to completing a survey that explored knowledge, perception, and expectations of PGx testing developed using a theoretical framework to measure intention to test. Individuals in the survey-only group (n = 189) completed the same survey but were not provided with any PGx educational materials. Analyses demonstrate efficacy of the video in improving knowledge of PGx. The education group also reported more positive attitudes and greater perceived control over pursuing PGx testing compared to the survey-only group. Further analyses identified significant differences in expectations, attitudes, and intention to pursue PGx testing based on number of previous medication trials. Path analyses identified the best model for predicting PGx testing intention, specifically that social norms and ease of testing have a strong positive association, and knowledge has a strong negative association with patients' intentions to test across the full sample, the education group, and the survey-only group. The findings of this study serve as a foundation for future tailored educational initiatives in the PGx testing space.

Defining and evaluating the Hawthorne effect in primary care, a systematic review and meta-analysis

In 2015, we conducted a randomized controlled trial (RCT) in primary care to evaluate if posters and pamphlets dispensed in general practice waiting rooms enhanced vaccination uptake for seasonal influenza. Unexpectedly, vaccination uptake rose in both arms of the RCT whereas public health data indicated a decrease. We wondered if the design of the trial had led to a Hawthorne effect (HE). Searching the literature, we noticed that the definition of the HE was unclear if stated. Our objectives were to refine a definition of the HE for primary care, to evaluate its size, and to draw consequences for primary care research. We designed a Preferred Reporting Items for Systematic reviews and Meta-Analyses review and meta-analysis between January 2012 and March 2022. We included original reports defining the HE and reports measuring it without setting limitations. Definitions of the HE were collected and summarized. Main published outcomes were extracted and measures were analyzed to evaluate odds ratios (ORs) in primary care. The search led to 180 records, reduced on review to 74 for definition and 15 for quantification. Our definition of HE is "an aware or unconscious complex behavior change in a study environment, related to the complex interaction of four biases affecting the study subjects and investigators: selection bias, commitment and congruence bias, conformity and social desirability bias and observation and measurement bias." Its size varies in time and depends on the education and professional position of the investigators and subjects, the study environment, and the outcome. There are overlap areas between the HE, placebo effect, and regression to the mean. In binary outcomes, the overall OR of the HE computed in primary care was 1.41 (95% CI: [1.13; 1.75]; I 2 = 97%), but the significance of the HE disappears in well-designed studies. We conclude that the HE results from a complex system of interacting phenomena and appears to some degree in all experimental research, but its size can considerably be reduced by refining study designs.

Examining the relationships between trust in providers and information, mistrust, and COVID-19 vaccine concerns, necessity, and intentions

To facilitate maximum uptake of the COVID-19 vaccine, the roles of medical trust and mistrust of healthcare professionals must be examined. Previous work suggests that trust and mistrust may have differential impacts on vaccination intention via vaccine necessity and concerns. Multigroup structural equation modeling was utilized to test whether vaccine necessity and concerns mediated the associations between trust in providers and health information, mistrust of providers, and willingness to get the COVID-19 vaccine. The model was found to be invariant across Black and White respondents. Trust in providers and trust in healthcare information exerted indirect effects on intentions through vaccine necessity, while mistrust of providers exerted indirect effects through vaccine concerns. Unlike previous work, the forms of trust did not influence vaccine concerns. The findings have implications for future communication efforts from healthcare professionals and health messengers.

Religious affiliation and philosophical and moral beliefs about vaccines: A longitudinal study

How do religious affiliation and beliefs shape vaccine attitudes and behaviors? This study examined the associations of attitudes and behaviors relevant to the flu, measles-mumps-rubella (MMR), and human-papillomavirus (HPV) vaccines with religious affiliations, as well as philosophical, spiritual, and moral beliefs. Respondents were 3005 adults from a probability-based, four-wave panel survey in the United States. Longitudinal structural equation modeling examined how religious affiliations and philosophical/moral beliefs shaped attitudes toward vaccines and actual vaccination. Stronger philosophical beliefs predicted more negative attitudes toward each vaccine and stronger moral beliefs more negative attitudes toward the HPV vaccine. Negative vaccine attitudes then predicted weaker intentions to encourage others to vaccinate and lower probability of receiving a vaccine. Theoretical and public health messaging implications are discussed.

National trends and disparate access to formal and informal sex education among youth involved with the child welfare system in the USA

This study aimed to understand whether youth involved with the child welfare system in the USA are receiving formal and informal sex education. Data come from the Second National Survey of Child and Adolescent Wellbeing, a nationally representative sample of children and adolescents in contact with child protective services. Participants included young people (n=1093, aged 11-21) involved with the child welfare system. Participants reported whether they had received formal sex education about a) abstinence only; b) contraceptives/condoms only; c) abstinence and contraceptives/condoms; or d) none. They also reported whether they knew where to access family planning services. We examined the prevalence of sex education experiences and differences in sex education access and knowledge based on participants' pregnancy history and sociodemographic characteristics. Only half (49%) of participants had received any form of formal sex education. Pregnant youth were less likely to have received any sex education compared to non-pregnant youth (p=.045). 72% of adolescents who had received sex education about contraceptives/condoms reported knowing where to access family planning services compared to only 46% of adolescents who had not received sex education about contraceptives/condoms (p=.014). There is a pressing need for comprehensive sex education among young people involved with the child welfare system in the USA.

Public Space Behaviors and Intentions: The Role of Gender through the Window of Culture, Case of Kerman

Urban public spaces are the spatial nexus of social interactions, activities, and expressions. Society manifests itself within these spaces through different lenses such as cultures and norms. The framework and restrictions related to gender-based behavior play a central role in the discourse about inclusivity and equity in urban public spaces when viewed through these lenses. There is, however, a gap in the literature that addresses how culture and gender influence public space behaviors and intentions within a traditional and modern cultural framework. The current study tests whether culture correlates with public space behavior on a neighborhood scale. A comparative study was conducted between two distinct neighborhoods in the city of Kerman, Iran. The two cases were selected due to their significant differences in how women use and interact with urban space. The effects of gender differences and perceived constraints on how residents manifest their behavior in public spaces were investigated. The study further investigated whether gender has a significant relationship with the level of appropriateness of certain public space behaviors and the intention to pursue them. The findings indicate significant cultural differences in both behavioral practice and behavioral intentions among the respondents. Furthermore, in traditional neighborhoods, the findings support significant gender-dependent differences in public space behavior, even though this gap is not apparent regarding intentions toward public space behaviors. The findings show a significantly greater disparity between traditional and modern districts in women’s perceived behavioral restrictions on personal expression.

Personal Social Networks and Relapses in Women With Substance Dependence: Application of the Theory of Planned Behavior

OBJECTIVE

Establishing positive network resources and rebuilding drug free networks are key components of recovery process for women with substance use disorder (SUDs). Theory of planned behavior (TPB) posits that behaviors are determined by behavioral intentions, which are determined by three factors: attitude toward the behavior, perceived behavioral control, and subjective norms. The current study applied TPB to examine whether women's personal social network characteristics (as subjective norms) were related to intentions towards, and/or a substance use relapse using prospective research design.

METHODS

Longitudinal data from 300 American women with SUD who received treatment at three county-funded, women-only intensive treatment programs was utilized for the current study.

RESULTS

Bayesian estimation path analyses indicated that attitude and abstinence self-efficacy at intake were not related to intention at the 6-month follow-up, but abstinence self-efficacy was directly related to substance use relapse by 12 months. Personal social network characteristics, number of treatment related persons in personal social network and sobriety support were significantly associated with intention at 6 months. The interaction between the numbers of treatment related persons and density was found on intention, suggesting that density strengthens the relationship between treatment related persons in network and intention. Intention to use substance was associated with relapse to substance use behavior.

CONCLUSION

Our findings support that personal social network characteristics can be considered as subjective norms in the TPB model. Personal social network interventions focusing on rebuilding consistent social norms against drug-using behaviors may decrease intention to use substance, which will lead to abstinence.