Bringing up condom use and using condoms with new sexual partners: Intentional or habitual?

Prevalence and predictors of medicine saving and future prescription medicine sharing: findings from a New Zealand online survey

OBJECTIVES

To assess the prevalence of and factors predicting future prescription medicine sharing behaviours among adults in New Zealand (NZ). The prevalence and predictors of having leftover medicines at home and the relationship between medicine storing and sharing practices were also explored.

METHODS

An online, self-administered survey of a convenience sample of NZ adults was conducted. Logistic regression analysis was used to examine the association between explanatory and outcome variables.

KEY FINDINGS

Two hundred and thirty three participants took part, who were mostly members of patient support groups across NZ. A high prevalence of leftover medicine storing practices (72.4%), future prescription medicine borrowing (72.8%) and lending (68.7%) behaviours was documented. Over half of the participants (57.1%) had never received advice from healthcare providers about the safe disposal of medicines, and 79.7% reported never having received information about risks of medicine sharing from healthcare providers. In multivariate logistic regression analysis, high income, having asthma and having leftover medicines stored at home were found to be positive predictors of future medicine lending or borrowing intentions. Further, high income was a positive predictor of having leftover medicines stored at home. Conversely, those with hypertension would be less likely to lend or borrow medicines.

CONCLUSIONS

The high prevalence of leftover medicine storing practices and future medicine sharing intentions among adults in NZ suggests it may be beneficial to provide patient and public education about appropriate use of prescribed medicines and safe medicine disposal procedures. Further research is needed to elicit effective strategies to reduce leftover medicines and unsafe medicine sharing practices.

Correlates of Young Men's Intention to Discuss Birth Control with Female Partners

CONTEXT

Heterosexually active men who wish to prevent conception, but are not willing to use condoms consistently, need to discuss birth control with female partners. Improving the understanding of correlates of men's intention to have such discussions is one step toward supporting this health-facilitating behavior.

METHODS

A sample of 372 heterosexually active men aged 18-25 were recruited and surveyed online between December 2010 and June 2011. Men answered questions on attitudes toward, norms regarding and self-efficacy about discussing birth control, and about endorsement of two sexual scripts. Multiple regression analyses tested these measures' associations with intention to discuss birth control, controlling for age and relationship status.

RESULTS

Attitudes, norms and self-efficacy were each positively associated with men's intention to discuss birth control, accounting for 34% of variance. The more strongly men endorsed a traditional masculinity sexual script, the less likely they were to intend to discuss birth control (coefficient, -0.2). Endorsement of an alternative, gender-equitable "sex-positive woman" script, which emphasizes sexual pleasure and emotional connection as goals for both partners, had no association with intention.

CONCLUSION

Strategies that merit further exploration as potential supports for men's intention to discuss birth control include improving men's self-efficacy and positive attitudes and norms pertaining to such discussions, and reducing belief in traditionally masculine sexual scripts or transforming them to include discussing birth control. Future research should work both experimentally and longitudinally to document each element of the process that ends with men's full participation in effective contraceptive use.

Predictors of non-condom use intentions by university students in Britain and Greece: The impact of attitudes, time perspective, relationship status, and habit

OBJECTIVE

This study investigated the impact of socio-cognitive factors (attitudes and norms), time perspective (TP), relationship status (RS), and past sexual behaviour on intended non-condom use in 104 Greek and 93 British university undergraduates.

METHOD

Data were obtained by a self-report questionnaire. Data analysis included correlation, regression and ANOVA procedures.

RESULTS

Attitudes were the strongest predictors of non-condom use intentions for participants who had casual relationships or were single (i.e. unstable relationship context), and past behaviour was the strongest predictor of non-condom use intentions for those who perceived themselves to be in an exclusive relationship (i.e. stable relationship context). Past behaviour was the strongest predictorof intended non-condom use in relation to all the variables of this study. TP managed to predict non-condom use intentions and moderate the attitudes-intentions relationship. In terms of temporal influences, participants high in fatalistic TP were strongly inclined not to use condoms, irrespective of their attitudes, but TP did not differ as a function of culture.

CONCLUSIONS

Our data revealed the value of considering the combined effects of relationship status, habit and attitudes, when investigating undergraduate non-condom use intentions and designing interventions. The construct of TP was introduced as a meaningful addition to sexual risk research.

The theory of planned behaviour as a framework for predicting sexual risk behaviour in sub-Saharan African youth: A critical review

Amongst the psychological theories that have been used to help understand why people have unprotected sex, the Theory of Planned Behaviour (TPB: Ajzen 1991) has earned a prominent position. This article is a critical review of 11 peer-reviewed studies conducted in sub-Saharan Africa during 2001 to 2009, which used the TPB as a model of predicting sexual risk behaviour in young people. All the studies revealed the predictive ability of the TPB in urban, rural, and traditional African settings, with R (2) coefficients ranging between 0.14 and 0.67. With data comparing favourably to those obtained in the international literature, these studies indicate that the TPB can be used to study sexual risk intentions and behaviour in sub-Saharan African youth, and question arguments against the theory's use in non-Western settings.

Perceived behavioural control, subjective norms, attitudes and intention to use condom: a longitudinal cross-lagged design

Based on the Theory of Planned Behaviour (TPB), the purpose of this investigation was to examine the directionality of the association among condom use, intention, attitudes, subjective norms and perceived behavioural control. The present study investigated the nature of these relationships using a longitudinal cross-lagged design applied to data from a cohort of 958 randomly selected Italian adults. Using structural equation modelling, two cross-lagged panel analyses revealed reciprocal relationships between intention and attitudes and between intention and condom use. Contrary to expectations, baseline subjective norms and perceived behavioural control did not predict subsequent intention to use condom when controlled for the autoregressive effect of intention at T1 on the same variable at T2. Also, perceived behavioural control at T1 did not influence condom use at T2 after controlling for the effect of baseline intention. The possibility of reciprocity was also tested for all relations and significant results were found. The moderation effect of perceived behavioural control on the relationship between intention and condom use was not significant. The differences in age, gender and partnership status were taken into account in the analyses.

Using growth mixture modeling to identify heterosexual men who reduce their frequency of unprotected sex following a behavioral intervention

Using growth mixture modeling, two 12-month trajectories of unprotected sex were identified in 210 heterosexual men (76 % African American, M(age) = 33.2 years) attending a sexual risk reduction intervention. Risk Reducers (46 %) reported fewer acts of unprotected sex following intervention, whereas Risk Maintainers (54 %) reported continuously high levels of unprotected sex. These groups did not differ with respect to demographic characteristics or intervention type. However, Risk Maintainers were more likely than Risk Reducers to report lifetime sex work, forced sex in the past year, and alcohol use before sex at baseline. They had higher levels of peak alcohol use, poorer condom skills, and scored lower on stage of change for condom use at baseline. Risk Maintainers were also more likely to have steady partners at baseline and less likely to change partner status following intervention. Understanding factors distinguishing these groups can contribute to the development of targeted Risk Reduction interventions.

Identifying the psychosocial correlates of condom use by female sex workers in Hong Kong

This study examined factors affecting condom use by Hong Kong female sex workers when they have sex with their clients and steady partners. Our respondents consisted of 109 active female sex workers, mainly streetwalkers or sex workers who worked in villas. During a 30-minute interview, respondents were interviewed individually and were asked questions regarding their condom use practice. These questions were designed to measure various factors affecting their condom use practice, including attitudes toward condom use, normative pressure, perceived behavioural control, perceived AIDS risks, past condom use behaviour, and future condom use intentions with respect to the two types of partners. Multiple regression analyses reveal that perceived behavioural control is the most important factor associated with these respondents' future condom use across the two types of partners. Perceived AIDS risk is the additional predictor for condom use with clients, while normative pressure is the additional predictor for condom use with steady partners. Past condom use behaviour also provided significant additional prediction for both types of partners, implying the habitual nature of condom use among our respondents. These results have significant implications for designing intervention programmes targeting at increasing condom use by female sex workers in Hong Kong.

Nurses' intention to leave: critically analyse the theory of reasoned action and organizational commitment model

AIM

To systematically analyse the Organizational Commitment model and Theory of Reasoned Action and determine concepts that can better explain nurses' intention to leave their job.

BACKGROUND

The Organizational Commitment model and Theory of Reasoned Action have been proposed and applied to understand intention to leave and turnover behaviour, which are major contributors to nursing shortage. However, the appropriateness of applying these two models in nursing was not analysed.

EVALUATION

Three main criteria of a useful model were used for the analysis: consistency in the use of concepts, testability and predictability.

KEY ISSUES

Both theories use concepts consistently. Concepts in the Theory of Reasoned Action are defined broadly whereas they are operationally defined in the Organizational Commitment model. Predictability of the Theory of Reasoned Action is questionable whereas the Organizational Commitment model can be applied to predict intention to leave. A model was proposed based on this analysis.

CONCLUSIONS

Organizational commitment, intention to leave, work experiences, job characteristics and personal characteristics can be concepts for predicting nurses' intention to leave.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers may consider nurses' personal characteristics and experiences to increase their organizational commitment and enhance their intention to stay. Empirical studies are needed to test and cross-validate the re-synthesized model for nurses' intention to leave their job.

Understanding the association between condom use at first and most recent sexual intercourse: an assessment of normative, calculative, and habitual explanations

The aim of this study was to provide a better understanding of the likely mechanisms underlying regular condom use. In 2009, 1145 sexually active individuals aged 18-65 years were surveyed online, after being recruited via an e-mail message circulated at a large Croatian university and posted on various social networking websites. Participants' mean age was 28.1 years (SD = 8.01). Women constituted a slight majority of the sample (51.6%). The research questions - whether the frequently observed association between condom use at first and most recent sexual intercourse could be best predicted by (a) norm-oriented behavior; (b) calculative decision-making; or (c) habit formation - were tested using multiple logistic regression. Only the calculative and habitual motivational determinants of condom use were significant predictors. Unlike calculative use, which decreased the odds of condoms being used at both occasions, habitual use, as expected, increased the odds of condom use. In addition, the habitual modality of condom use significantly predicted consistent condom use with both casual and steady sexual partners. Age, being in a relationship, and the number of lifetime sexual partners were negatively associated with habitual condom use. The finding that habit plays a substantial role in consistent condom use suggests the need for further exploration of personality and relational factors associated with the initiation of habitual condom use.

The effects of subjective norms on behaviour in the theory of planned behaviour: a meta-analysis

A meta-analysis investigated the effects of perceived injunctive (IN) and descriptive (DN) norms on behaviour (BEH) within the theory of planned behaviour (TPB) in a sample of 196 studies. Two related correlation matrices (pairwise and listwise) were synthesized from the data and used to model the TPB relations with path analyses. Convergent evidence indicated that the relation between DN and BEH was stronger than the relation between IN and BEH. Evidence also suggested a significant direct relation between DN and BEH in the context of TPB. A suppressor effect of IN on DN in its relation with BEH was also noted. Moderator analyses indicated that the DN-BEH relation was stronger when there was more time between measures of cognition and behaviour, when behaviours were not socially approved, more socially motive and more pleasant; results were mixed in the case of the IN-BEH relation. Results imply that IN and DN are conceptually different constructs.

Action-specific cognitions of planned and preparatory behaviors of condom use among Dutch adolescents

Many adolescents fail to use condoms, even when they are motivated to do so. An important reason for their failure to use condoms is that they do not prepare themselves for potential sexual encounters. The present study examined the circumstances under which Dutch adolescents were likely to prepare themselves for condom use (buying and carrying). In a sample of 399 secondary school students, including students with and without sexual experience, it was found that intended condom use was not sufficient to ensure that adolescents plan and prepare for condom use. It was found that having the goal of condom use did not necessarily result in preparatory behavior, such as condom buying and condom carrying. The data showed that action-specific social-cognitive factors of preparatory behavior explained preparatory behavior, beyond the decision to use condoms. This suggests that interventions aimed at promoting condom use should focus not only on condom use itself, but should also motivate and encourage adolescents to buy and carry condoms.

Longitudinal test of a multiple domain model of adolescent condom use

A comprehensive multiple domain model (MDM) to understand condom use in adolescents was proposed and tested using structural equation modeling of data at three time points. The proposed model integrates social psychological theory, demographic and personality factors, social environment, and situational/contextual variables. Adolescents who were sexually active at time 2 (6 months after baseline) and time 3 (1 year after time 2) and completed surveys at all three time points were included in the analyses (N = 511). An iterative process of model testing resulted in a structural equation model that provided a good fit to the data (CFI = .92, RMSEA = .04). Models comparing gender and race as moderators also were calculated and supported the generalizability of the model. Results provide support for an MDM that goes beyond traditional social psychological models for a broader understanding of condom use in adolescents. Implications for further theory testing and safer sexual interventions are discussed.

Change trajectories in women's STD/HIV risk behaviors following intervention

Three 16-month sexual risk-taking trajectories were identified in 287 women in an STD/HIV intervention study. The Risk Eliminator group reported no sex risk following intervention while the Risk Reducer group reported continuous drops over time. The High Risk group reported higher initial risk than the other two and no subsequent changes. The trajectory groups showed no between- or within-group effects of intervention exposure. Trajectory groups were compared on baseline characteristics. No differences were seen in demographics or STD/HIV knowledge. Compared to one or both of the other groups, the High Risk women reported more lifetime partners, recent paying partners, adult rape, and recent substance use. Their steady partners were more likely to be abusive, intoxicated during sex (as were the women themselves), and believed to be non-monogamous. The Risk Eliminator group differed from the other two by being less likely to report a history of childhood sexual abuse.

Why communication is crucial: meta-analysis of the relationship between safer sexual communication and condom use

The purpose of this study was to quantitatively synthesize the growing literature on the relationship between safer sexual communication (SSC) among sexual partners and condom use, and to systematically examine a number of conceptual and methodological moderators of this relationship. Data from 53 articles published in 27 journals met criteria for the study. Fifty-five independent effect sizes coded from samples totaling N=18,529 were meta-analyzed. Results indicate that the mean sample-size weighted effect size of the SSC-condom use relation was r=.22, and a number of conceptual variables were found to moderate this relationship. Specifically, communication about condom use (r=.25) and sexual history (r=.23) had significantly (p<.05) larger effect sizes than communication about safer sex (r=.18). In addition, SSC measures operationalized differently had significantly (p<.05) different effect sizes. From largest to smallest, these were behavioral format (r=.29), intentional format (r=.18), and self-efficacy format (r=.13). Measures that tried to assess persuasion attempts as compared with informational exchanges were not found to have significantly different effect sizes (p>.05). Further, methodological moderators tended to be unrelated to effect size. Implications for the future study of safer sexual communication as well as the importance of emphasizing communication skills in HIV preventive interventions are discussed.

Predictors of condom use self-efficacy in an ethnically diverse university sample

A multitude of factors influence condom use self-efficacy, including age, gender, ethnicity, condom use attitudes and barriers, sexual experience, and partner characteristics. The current study integrated past research by evaluating these factors in a large, ethnically diverse university sample of women and men (N=665). The role of gender on condom use and sexuality variables was assessed across ethnic groups. Hierarchical linear regressions were then calculated to explain levels of condom use self-efficacy using the hypothesized sexual predictors in nonvirgin, sexually active, and recent condom use subsamples. Predictors explained 18-45% of variance in condom use self-efficacy. Findings suggest that a few key variables accounted for the majority of variance in condom use self-efficacy: condom use attitudes, condom use barriers, satisfaction with sexual communication, anticipated number of sexual partners, one-time sexual encounters, and ethnic identity. Significant gender differences emerged in condom use self-efficacy, condom use attitudes, and condom use behaviors. Ethnic differences were found in range of sexual experience and sexual partner characteristics. It is recommended that future studies examining sexual risk behavior incorporate the diverse sexual factors that affect condom use self-efficacy.

Some problems with social cognition models: a pragmatic and conceptual analysis

Empirical articles published between 1997 and 2001 from 4 health psychology journals that tested or applied 1 or more social cognition models (theory of reasoned action, theory of planned behavior, health belief model, and protection motivation theory; N = 47) were scrutinized for their pragmatic and conceptual basis. In terms of their pragmatic basis, these 4 models were useful for guiding research. The analysis of their conceptual basis was less positive. First, these models do not enable the generation of hypotheses because their constructs are unspecific; they therefore cannot be tested. Second, they focus on analytic truths rather than synthetic ones, and the conclusions resulting from their application are often true by definition rather than by observation. Finally, they may create and change both cognitions and behavior rather than describe them.