Determinants of Condom Use Among High-Risk Heterosexual Adults: A Test of the Theory of Reasoned Action1

Structural equation modeling test of the pre-intentional phase of the health action process approach (HAPA) model on condom use intention among senior high school students in Tianjin, China

Based on the Theory of Health Action Process Approach (HAPA) Model, this study aimed to investigate factors associated with condom use intention in Chinese adolescents.In 2017, we conducted a cross-sectional study using stratified cluster, convenience sampling method to assess condom use intention among senior high school students in Tianjin, China. One thousand eighty two senior high school students were anonymously surveyed through self-administered questionnaires. Structural equation modelling was used to assess the pre-intentional phase of HAPA model.Among the participants, 41.5% (449/1082) were male, 54.1% (585/1082) were female, 4.4% (48/1082) were gender-deficient. The average age was 16.7 years. The final pre-intentional phase of HAPA model was acceptable (CFI = 0.95; GFI = 0.94; RMSEA = 0.06). Action self-efficacy (r = 0.60) had a strong direct effect on condom use intention.The pre-intentional phase of HAPA model is valid to assess condom use intention among Chinese senior high school students. The pre-intention phase of the HAPA model could be applied to guide AIDS health educations of students, and further research is needed to evaluate the effect.

Do Difficulties Regulating Positive Emotions Contribute to Risky Sexual Behavior? A Path Analysis

Within the U.S., risky sexual behavior (RSB) is the primary mode of HIV transmission. The role of emotion dysregulation in RSB has received growing attention over the past decade. However, this literature has been limited in its focus on emotion dysregulation stemming from negative (but not positive) emotions. The goal of the current study was to extend research by examining the relative and unique contributions of dimensions of difficulties regulating positive emotions (i.e., nonacceptance of positive emotions [Accept], difficulties controlling impulsive behaviors when experiencing positive emotions [Impulse], and difficulties engaging in goal-directed behaviors when experiencing positive emotions [Goals]) to RSB. Participants were 386 trauma-exposed individuals recruited from Amazon's MTurk (M age = 35.85 years; 57.5% female; 76.4% White). At the bivariate level, dimensions of difficulties regulating positive emotions were significantly positively associated with sexual risk taking with uncommitted partners, impulsive sex behaviors, and intent to engage in risky sexual behaviors (with the exception of Goals to sexual risk taking with uncommitted partners), and significantly negatively associated with risky sex acts. Regarding the unique contributions of difficulties regulating positive emotions to RSB, (1) Accept was significantly positively associated with impulsive sexual behaviors and intent to engage in risky sexual behaviors; (2) Impulse was significantly positively associated with risky anal sex acts; and (3) Goals was significantly negatively associated with risky anal sex acts. Findings suggest the potential utility of targeting difficulties regulating positive emotions in treatments aimed at reducing RSB.

Male Condom Use by Type of Relationship following an HIV Intervention among Women Who Use Illegal Drugs

Predictors of increased male condom use are investigated following a recent, gender-specific HIV intervention among African-American women. Data were analyzed from 138 women (aged 18 to 59), recruited from inner-city Atlanta (Georgia, U.S.) neighborhoods. Predictors of condom use with steady and casual paying partners were examined separately. Increased condom use with steady partners was associated with drug-using status, intervention assignment, sexual relationship characteristics, age at first condom use, and HIV testing history. Condom use with casual paying partners was associated with having sex while high and the frequency of crack cocaine use. Personalized norms regarding condom use were not salient factors in predicting increased rates of condom use with either partner type. Findings indicate the continued need to consider sex in the context of drug use, and reveal the importance of measuring such influences and all antecedents of condom use separately for steady versus casual sexual relationships.

The Attainment of Important Health Goals Throughout Adulthood: An Integration of the Theory of Planned Behavior and Aspects of Social Support

This research integrates the Theory of Planned Behavior (TPB) with aspects of social support and explores the utility of variables within each model in predicting the attainment of important health goals. Incorporating an idiographic methodology, 290 respondents ranging in age from 27 to 87 years were administered a postal survey and completed a brief follow-up telephone survey months later. The postal survey included measures of respondent's most important health goals, attitudes, motivation to comply with subjective norms, control beliefs, behavioral intention, and plan-of-action for attaining the health goal, as well as aspects of social support. The follow-up telephone survey inquired into respondents' successful goal attainment and health. Results indicate association, between TPB components and aspects of social support. Further, the emotional and instrumental support provided by a family member or friend and size of social support network were found to be unique predictors of health goal attainment after controlling for TPB components. The importance of personalized goals and social support in designing health interventions for older adults is discussed.

Predicting Intended and Self-perceived Sugar Restriction among Tanzanian Students using the Theory of Planned Behavior

This study examines the applicability and sufficiency of the Theory of Planned Behavior (TPB) in predicting intention and self-perceived behavior with respect to avoiding between-meal intake of sugared snacks and drinks. One thousand one hundred and twenty-three Tanzanian students (mean age 26.4 years) completed self-administered questionnaires designed to measure the components of the TPB during May–July, 1999. Self-perceived sugar consumption was obtained in a subsample of respondents ( n = 228) four weeks later. The TPB provided a significant prediction of intention ( R2= 0.44), with attitude (= 0.25), subjective norms (= 0.28) and perceived behavioral control (= 0.35) significant, and subsequent behavior ( R2 = 0.15, with intention (= 0.25) and perceived behavioral control (= 0.18) significant. Frequency of past behavior explained a significant, albeit small, amount of additional variance in intention (1 percent) and behavior (4 percent). The results indicate that the TPB is applicable to the prediction of food choice-related intention and behavior among young adult students living in a non-occidental setting.

Predicting Intended Condom Use among Tanzanian Students using the Theory of Planned Behaviour

This study examined whether perceived behavioural control predicted the intention to use condoms at next sexual intercourse above the components of the theory of reasoned action, as well as the sufficiency of the theory of planned behaviour (TPB) as a theory of intention among Tanzanian adolescents. Five hundred and twenty-eight students who were sexually active, from seven secondary schools in Arusha, Northern Tanzania, completed a questionnaire designed to measure the components of the TPB. Behavioural intentions were significantly predictable from attitudes (.11), subjective norms (.22) and perceived behavioural control (.48). The inclusion of past behaviour into the regression equation increased R(2) only marginally (2 percent) but significantly, suggesting that the TPB provides a fairly accurate explanation of intention to use condoms among Tanzanian adolescents. The implications of this finding in relation to theoretical and practical issues are discussed.

Predictors of hooking up sexual behaviors and emotional reactions among U.S. college students

The present study examined factors associated with engaging in oral and vaginal sex and condom use during the most recent hookup, a term that refers to a range of physically intimate behaviors outside of a committed relationship, among college students. In addition, this research aimed to evaluate factors associated with experiencing positive and negative affect resulting from the most recent hookup. A random sample (N = 1,468) of undergraduates (56.4% female) completed a Web-based survey that was comprised of measures of drinking and sexual behavior. Participants (n = 824; 56.1%) who indicated they had ever hooked up were included in data analysis. Findings indicated that sex, partner type, alcohol use, attitudes towards hooking up, and attitudes towards sexual activity during hookups explained significant variance for oral sex, vaginal sex, condom use, and positive and negative affect related to the most recent hookup experience. Clinical implications regarding the role of situational stressors, such as the impact on affect following a hookup, and ways to reduce risks associated with stressors are discussed.

Understanding behavioral intent to participate in shared decision-making in medically uncertain situations

OBJECTIVE

This article describes the process undertaken to identify and validate behavioral and normative beliefs and behavioral intent based on the Theory of Reasoned Action (TRA) and applied to men between the ages of 45 and 70 in the context of their participation in shared decision-making (SDM) in medically uncertain situations. This article also discusses the preliminary results of the aforementioned processes and explores potential future uses of this information that may facilitate greater understanding, efficiency and effectiveness of clinician-patient consultations.

MATERIALS AND METHODS

Twenty-five male subjects from the Philadelphia community participated in this study. Individual semi-structure patient interviews were conducted until data saturation was reached. Based on their review of the patient interview transcripts, researchers conducted a qualitative content analysis to identify prevalent themes and, subsequently, create a category framework. Qualitative indicators were used to evaluate respondents' experiences, beliefs, and behavioral intent relative to participation in shared decision-making during medical uncertainty.

RESULTS

Based on the themes uncovered through the content analysis, a category framework was developed to facilitate understanding and increase the accuracy of predictions related to an individual's behavioral intent to participate in shared decision-making in medical uncertainty. The emerged themes included past experience with medical uncertainty, individual personality, and the relationship between the patient and his physician. The resulting three main framework categories include 1) an individual's Foundation for the concept of medical uncertainty, 2) how the individual Copes with medical uncertainty, and 3) the individual's Behavioral Intent to seek information and participate in shared decision-making during times of medically uncertain situations.

DISCUSSION

The theme of Coping (with uncertainty) emerged as a particularly critical behavior/characteristic amongst the subjects. By understanding a subject's disposition with regard to coping, researchers were better able to make connections between a subject's prior experiences, their knowledge seeking activities, and their intent to participate in SDM. Despite having information and social support, the subjects still had to cope with the idea of uncertainty before determining how to proceed with regard to shared decision-making. In addition, the coping category reinforced the importance of information seeking behaviors and preferences for shared decision-making.

CONCLUSIONS

This study applies and extends the field of behavioral and health informatics to assist medical practice and decision-making in situations of medical uncertainty. More specifically, this study led to the development of a category framework that facilitates the identification of an individual's needs and motivational factors with regard to their intent to participate in shared decision-making in situations of medical uncertainty.

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.

Le tabou, un concept peu exploré en marketing

Malgré l'importance des tabous dans les sociétés contemporaines et leur influence sur la consommation, le concept de tabou reste peu exploré en marketing. Partant des approches anthropologique, sociologique et psychanalytique, cet article met en avant cinq caractéristiques définitoires du tabou qui viennent éclairer et enrichir les travaux antérieurs en marketing relevant de la question du tabou. Il propose des perspectives de recherche relatives à l'influence des caractéristiques des tabous sur le comportement du consommateur et sa perception par les individus tout en insistant sur la prudence mais aussi la créativité méthodologiques nécessaires dans L'étude de cet objet de recherche.

The application of the theory of reasoned action to school nurses’ behaviour

The aim of this paper was to ascertain how valuable the Theory of Reasoned Action (TRA) would be in the prediction of the sexual health education behaviour of school nurses. The current government in the United Kingdom has made a commitment to reducing the high rates of teenage conceptions and sexually transmitted infections and emphasise an increased public health role for school nurses. However, there appears to be no research to suggest that school nurses are the most appropriate healthcare professionals to competently assist with sexual health education in schools. In accordance with the TRA, a questionnaire was designed to measure the intention, attitude, subjective norm and behaviour of the group being surveyed. The purpose-designed questionnaire was distributed to all school nurses in a large geographical area in the United Kingdom. All 46 participants who responded were female (as there are currently no male school nurses in the United Kingdom). No demographic data were obtained as it is believed that the components of the model incorporate all information needed. The major components of the model accounted for 43% of the variance in intention and 46% of the variance in behaviour. Results suggest that the model has good predictive utility in this area and could usefully be employed in interventions with school nurses with the aim of modifying their behaviour. This is the first time the TRA has been used in this context, and it has provided some important information regarding school nurse’s intentions to practise in sexual health.

Predictors of Condom Use Among Israeli Soldiers

Only a small percentage of young people aged 18 to 20 years use condoms regularly. Thus, the younger population has an increased risk of contracting sexually transmitted diseases. This study examines the underlying determinants of condom use among soldiers based on the theory of planned behavior as well as the influence of soldiers’ social circumstances and prior sexual experience. A correlational design using an exploratory survey method was used. Participants were sampled in a convenience sample of 113 male soldiers from the Israel defense forces. A total of 70.1% of soldiers use condoms in their first sexual experience, however, this percentage subsequently decreases. The study indicates that soldiers are not familiar with the risks of frequent oral and anal sex. Behavioral intentions and self-control are significant predictors of condom use. Condom use among soldiers from one-parent families was lower than among soldiers from two-parent families. The theory of planned behavior seems to be a helpful method of predicting condom use among soldiers. Accordingly, efforts should be channeled at attempts to generate changes in soldiers’ views of condom use, intensifying normative pressures operated by their social milieu, and increasing their self-control in the use of condoms.

Future HIV vaccine acceptability among young adults in South Africa

Developing and disseminating a preventive HIV vaccine is a primary scientific and public health objective. However, little is known about HIV vaccine acceptability in the high-prevalence setting of South Africa- where young adults are likely to be targeted in early dissemination efforts. This study reports on six focus groups ( n = 42) conducted in 2007 with South Africans aged 18 to 24 years. A deductive framework approach is used to identify key motivators and barriers to future HIV vaccine uptake. Participants identify HIV testing, HIV stigma, mistrust of the health care system, and concerns about sexual disinhibition as barriers to vaccine uptake. For women, family members and friends are strong motivators for vaccine uptake, whereas men are more likely to see vaccines as an opportunity to stop using HIV prevention strategies such as condoms and partner reduction. Implications of these findings for developing HIV vaccine dissemination strategies and policy in South Africa are discussed.

Predicting preparatory behaviours for condom use in female undergraduate students: a one-year follow-up study

The objective of this study is to investigate whether the Theory of Planned Behaviour (i.e. attitude, subjective norm, perceived behavioural control and intention), fluctuations in motivation over time, and variables from the Prototype-Willingness Model (i.e. behavioural expectation and behavioural willingness to have unprotected sex) predict preparatory behaviours for condom use. Sixty-two female undergraduates completed baseline and one-year follow-up questionnaires. Having condoms at home and carrying condoms were predicted by behavioural willingness to have unsafe sex at baseline. Having bought condoms was predicted by the behavioural expectation to use condoms with new partners at baseline. Intention and fluctuations in motivation did not emerge as significant predictors of preparatory actions. Female undergraduates, who are more willing to have unprotected sex under risk-conducive circumstances, are also less likely to prepare adequately for condom use, and thereby increase their chances of encountering such situations. Overall, the findings are in support of the Prototype-Willingness Model.

A practitioner's guide to persuasion: an overview of 15 selected persuasion theories, models and frameworks

OBJECTIVE

To provide a brief overview of 15 selected persuasion theories and models, and to present examples of their use in health communication research.

RESULTS

The theories are categorized as message effects models, attitude-behavior approaches, cognitive processing theories and models, consistency theories, inoculation theory, and functional approaches.

CONCLUSIONS

As it is often the intent of a practitioner to shape, reinforce, or change a patient's behavior, familiarity with theories of persuasion may lead to the development of novel communication approaches with existing patients.

PRACTICE IMPLICATIONS

This article serves as an introductory primer to theories of persuasion with applications to health communication research. Understanding key constructs and general formulations of persuasive theories may allow practitioners to employ useful theoretical frameworks when interacting with patients.

Factor structure of the Condoms Barriers Scale with a sample of men at high risk for HIV

This study assesses the psychometric properties of the Condom Barriers Scale (CBS), an instrument originally designed to measure women's perceptions and attitudes regarding male condom use, with a sample of men at high risk for human immunodeficiency virus (HIV). Participants include 590 male patients in drug abuse treatment involved in a gender-specific HIV prevention intervention for teaching safer sex skills. Second-order confirmatory factor analysis generally supported the underlying four-factor subscale structure of the CBS. However, exploratory factor analysis revealed a few specific discrepancies in the factor structure between men and women. Internal consistency and test-retest reliability estimates were moderate to high in value. CBS scores correlated with use of condoms for men with high-risk sexual partners, supporting criterion-related validity. Overall, the analysis indicates that the CBS is a potentially valid and reliable instrument and has utility for assessing barriers to condom use with men, but may need some item content modifications to allow appropriate assessment of gender differences and comparisons across studies.

An investigation of a personal norm of condom-use responsibility among African American crack cocaine smokers

The purpose of this study was to investigate the unique contribution of a personal norm of condom-use responsibility to the formation of intentions to use male condoms during vaginal sex. Data were collected from 402 male and 157 female heterosexual African American crack cocaine smokers in Houston, Texas, US. Two structural equation models of the intention to use a condom with the last sex partner were estimated. One model included measures of condom-use attitudes, subjective norms and condom-use self-efficacy. A second model included these three measures and a fourth measure of a personal norm of condom-use responsibility. Separate models were estimated for men and women. The addition of a personal norm of condom-use responsibility provided a significantly better fit to the data than did models including only outcome expectations, subjective norms and self-efficacy. Results also showed distinctly different underlying cognitive structures of condom-use intention for men and women. A personal norm of condom-use responsibility had a strong direct effect on men's intentions to use condoms with the last sex partner. Other variables appeared to have no direct effect on men's intentions. Women's intentions were strongly influenced by a personal norm and social subjective norms. Situational self-efficacy and outcome expectations had weaker, yet significant, effects on women's intentions. Given the strong effect of personal norms on men's intentions to use condoms, further research should be undertaken.

Drinking and condom use: results from an event-based daily diary

Although it is often assumed that drinking alcohol interferes with condom use, most studies on this topic do not meet the conditions required for causal interpretation. We examined the association of drinking to condom use using data from diaries of alcohol use and sexual encounters, collected over 8 weeks from college students and clients of a sexually transmitted disease clinic. This method establishes the temporal relationships between drinking and condom use and controls for individual differences by using a within-subjects analysis. Multilevel models that predicted condom use from alcohol use before the sexual encounter, partner type, and the use of other contraception showed that drinking before sex was unrelated to condom use. These results do not support the persistent notion that alcohol causes people to engage in sexual risk that they would avoid when sober; instead, people tend to follow their usual pattern of condom use, regardless of alcohol use.

A conceptual model of women's condom use intentions: Integrating intrapersonal and relationship factors

We developed and tested a multifaceted model of condom use intentions with cross-sectional data from 435 heterosexual women at risk for HIV/STIs. In addition to traditional intrapersonal variables drawn from established models of HIV prevention (e.g. attitudes, norms, self-efficacy), the present study examined the role of relationship factors and dynamics (i.e. relationship commitment, duration, condom use and pregnancy prevention decision-making) in shaping condom use intentions. In some cases, relationship variables were directly associated with condom use intentions. In other cases their effects on condom use intentions were mediated by intrapersonal constructs. The final model accounted for 66% of the variance in condom use intentions and confirmed the importance of integrating intrapersonal variables and relationship characteristics and dynamics in understanding women's intentions to use condoms. These results offer important insights for the design of interventions directed at promoting condom use among young women at risk for HIV/STIs and underscore the need to design prevention programs that address relationship characteristics and dynamics.

Predictors of sexual risk behaviors among adolescent mothers in a human immunodeficiency virus prevention program

PURPOSE

The purpose of this study was to determine the following: (1) whether adolescent mothers in a human immunodeficiency virus (HIV) prevention program had significantly greater perceived self-efficacy and perceived behavioral control to use condoms, and more favorable outcome expectancies and subjective norms regarding condom use than those in a health education control group, 3 months after intervention; and (2) the impact of the 3-month postintervention theoretical variables on intentions to use condoms at 3 months and sexual risk behaviors at 6 months.

METHODS

Structural equation modeling with latent variables was used to assess the influence of theoretical variables and treatment condition using data from 496 participants (78% Latinas, 18% African-Americans) who completed questionnaires at baseline and at 3- and 6-month follow-up evaluations.

RESULTS

Substantial improvements were shown by both groups, with a slight advantage for the HIV prevention group, on all theoretical variables between pretest and the follow-up evaluations. In the predictive model, the intervention group reported significantly fewer sex partners. By using intentions to use condoms as a mediator, greater self-efficacy, hedonistic beliefs, positive subjective norms, and less unprotected sex predicted intentions to use condoms, which, in turn, predicted less unprotected sex. Lower subjective norms modestly predicted multiple partners. Significant indirect paths mediated through intentions to use condoms were observed.

CONCLUSIONS

These data support a relationship among several constructs from social cognitive theory and the theory of reasoned action, and subsequent sexual risk behaviors. HIV-prevention programs for adolescent mothers should be designed to include these theoretical constructs and to address contextual factors influencing their lives.

Are HIV/AIDS conspiracy beliefs a barrier to HIV prevention among African Americans?

OBJECTIVES

This study examined endorsement of HIV/AIDS conspiracy beliefs and their relations to consistent condom use and condom attitudes among African Americans.

METHODS

We conducted a telephone survey with a random sample of 500 African Americans aged 15 to 44 years and living in the contiguous United States.

RESULTS

A significant proportion of respondents endorsed HIV/AIDS conspiracy beliefs. Among men, stronger conspiracy beliefs were significantly associated with more negative condom attitudes and inconsistent condom use independent of selected sociode-mographic characteristics, partner variables, sexually transmitted disease history, perceived risk, and psychosocial factors. In secondary follow-up analyses, men's attitudes about condom use partially mediated the effects of HIV/AIDS conspiracy beliefs on condom use behavior.

CONCLUSIONS

HIV/AIDS conspiracy beliefs are a barrier to HIV prevention among African Americans and may represent a facet of negative attitudes about condoms among black men. To counter such beliefs, government and public health entities need to work toward obtaining the trust of black communities by addressing current discrimination within the health care system as well as by acknowledging the origin of conspiracy beliefs in the context of historical discrimination.

Influences of social power and normative support on condom use decisions: a research synthesis

A meta-analysis of 58 studies involving 30,270 participants examined how study population and methodological characteristics influence the associations among norms, control perceptions, attitudes, intentions and behaviour in the area of condom use. Findings indicated that control perceptions generally correlated more strongly among members of societal groups that lack power, including female, younger individuals, ethnic-minorities and people with lower educational levels. Furthermore, norms generally had stronger influences among younger individuals and among people who have greater access to informational social support, including males, ethnic majorities and people with higher levels of education. These findings are discussed in the context of HIV prevention efforts.

Partner influence on noncondom use: gender and ethnic differences

This study investigates gender and ethnicity differences in the experience of not using a condom due to a partner s influence (unwanted noncondom use). Analysis of 247 anonymous questionnaires from students at urban community college campuses revealed that 46.7% had experienced unwanted noncondom use since age 16, and 37% had experienced unwanted noncondom use with their current or most recent partner. Males and females reported equal levels of unwanted noncondom use. However, African-American and Latino participants reported higher levels of unwanted noncondom use than Whites. The findings indicate that females, males, and people from ethnic groups at high risk for HIV infection need support to carry out their safer sex intentions.

Methodological challenges in research on sexual risk behavior: I. Item content, scaling, and data analytical options

Investigation of sexual behavior involves many challenges, including how to assess sexual behavior and how to analyze the resulting data. Sexual behavior can be assessed using absolute frequency measures (also known as counts) or with relative frequency measures (e.g., rating scales that range from never to always). We discuss these 2 assessment approaches in the context of research on HIV risk behavior. We conclude that these 2 approaches yield nonredundant information and, more important, that only data yielding information about the absolute frequency of risk behavior have the potential to serve as valid indicators of HIV contraction risk. However, analyses of count data may be challenging because of non-normal distributions with many outliers. Therefore, we identify new and powerful data analytical solutions that have been developed recently to analyze count data and discuss limitations of a commonly applied method (viz., analysis of covariance using baseline scores as covariates).

Need for intimacy in relationships and motives for sex as determinants of adolescent condom use

PURPOSE

To investigate the extent to which need for intimacy in relationships and motives for sex are capable of distinguishing between adolescents who always have protected sex and adolescents who do not, with reference to both steady and casual relationships.

METHODS

Seven-hundred-and-one adolescents (424 males and 277 females) aged 15 to 23 years filled out a questionnaire assessing determinants of sexual behavior and various outcome behaviors, such as having casual sex and condom use.

RESULTS

Two-thirds of the participants (470) were sexually experienced. Discriminant functions using constructs of the Theory of Planned Behavior (attitude, subjective norm, self-efficacy), as well as the need for intimacy in relationships and motives for sex, were found to distinguish significantly between adolescents who always had protected sexual intercourse and adolescents who did not. This was valid both for sex within steady and within casual relationships. Besides a positive attitude and high perceived subjective norms, protected sex with a steady partner was characterized by low scores on the scale for the motive for sex to express love, and on the scale for the need for intimacy in relationships. Consistent condom use with casual partners was related to high self-efficacy, attitude, and perceived subjective norms, as well as a greater need for intimacy in relationships. Gender differences emerged with respects to determinants of (un)safe sex with casual partner(s), in that for males the variables of the Theory of Planned Behavior were most important in distinguishing those who had unsafe casual sex from those who had safe casual sex. For females, on the other hand, the variables concerning the meaning attached to having sex or to the relationship within which sex occurs seemed to be of more significance in explaining (un)safe sex with casual partner(s). However, owing to small subsamples, caution is warranted when interpreting these differences.

CONCLUSIONS

In adolescence, the factors which influence the decision to have (un)protected sex depend on the kind of relationship that exists between the partners. In addition, the goals which adolescents pursue with regard to their relationships and with regard to having sex fulfill an important role in the decision-making process whether to use condoms.

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

OBJECTIVE

The aims of this study were to describe behavioural and psychosocial characteristics of single heterosexuals towards regular condom use, and to identify factors associated with the maintenance of this behaviour over time.

METHOD

A cohort of 179 single heterosexual adults (83 men and 96 women, mean age: 32 years) was followed over a period of 2 years. The data were collected, by phone interviews, at baseline and 1 and 2 years later. The phone numbers were generated using a random digit strategy.

RESULTS

The following changes were observed: over time fewer people were sexually active, but those who were, reported more often having had more than one sexual partner. No significant change was observed regarding condom use. The psychosocial variables remained stable during the study period. To have a favourable intention was the main factor associated with maintenance of condom use. Having had a STD, personal normative beliefs and positive attitude were also associated with regular condom use.

DISCUSSION

Promotion strategies should highlight the importance of acting as a responsible person, reinforce the advantages of using condoms, and select strategies that favour the implementation of intention of using condoms.

Heterosexually active men's beliefs about methods for preventing sexually transmitted diseases

CONTEXT

Most research on heterosexual transmission of HIV and other sexually transmitted diseases (STDs) has focused on women. However, heterosexual transmission of STDs cannot be prevented without a better understanding of men's, as well as women's, sexual beliefs and behaviors.

METHODS

Heterosexually active men's beliefs about four methods of STD prevention--abstinence, mutual monogamy, use of male condoms and use of female condoms--were elicited through open-ended interviews. A survey based on these responses was administered to a random sample of 486 heterosexually active men, and scores were calculated to examine their beliefs about each behavior. Additional analyses explored how these beliefs were related to men's characteristics and to their actual behavior.

RESULTS

The men held both positive and negative beliefs about the outcomes of using each method and thought that their partners, close friends, health care providers, family members and, to some extent, friends at church had opinions about whether they should use each method. Multiple regression analyses showed that the men's beliefs were related to their marital status and, to some extent, their race or ethnicity and education. Beliefs about the outcomes of practicing abstinence, practicing mutual monogamy and using male condoms with steady partners were significantly related to these behaviors; beliefs about whether they had support for practicing monogamy or using male condoms with steady partners were significant predictors of doing so.

CONCLUSIONS

Encouraging safer-sex practices among heterosexually active men will require addressing their beliefs and perceived norms about alternative methods of preventing STDs.

Expectancies specific to condom use mediate the alcohol and sexual risk relationship

The present study tested the role of alcohol expectancies for condom use in mediating the alcohol and risky sex relationship. Expectancies for condom use are specific anticipations for alcohol's effect on one's ability to use a condom. College students (N = 563) reported on beliefs, intentions and actual sexual and drinking behavior. Among the sexually active, alcohol was directly related to future intention to use a condom in drinking situations for men, but not for women. In the men, alcohol expectancies for condom use mediated the relationship between drinking and condom intention. Beliefs that alcohol negatively impacts one's ability to use condoms were associated with more drinking and lower intentions to use a condom. These expectancies may help explain how alcohol affects risky sex in men. Gender differences and implications are discussed.

The relation between beliefs about drug treatments for HIV and sexual risk behavior in gay and bisexual men

This study examined the relation between gay and bisexual men's (N = 575) beliefs about highly active antiretroviral therapy (HAART) and other HIV-related beliefs, intentions, and risk behaviors. Confirmatory factor analysis verified three belief factors: the extent to which HAART improves health among HIV-infected individuals, decreases the risk of HIV transmission, and is complicated and of limited efficacy. Men who endorsed the belief that HAART decreases HIV transmission risk expressed lower intentions to use condoms for anal sex and were more likely to have engaged in unprotected anal intercourse with a casual partner HIV-negative men who believed that HAART decreases transmission risk also perceived themselves to be more susceptible to HIV infection. Statistical evidence indicated that perceptions of susceptibility partially mediate the relation between sexual risk behavior and beliefs about HAART suggesting that beliefs may result from, rather than cause, increased risk behavior.

Psycho-social determinants for sexual partner referral in Uganda: quantitative results

The purpose of this study was to investigate the factors influencing sexual partner referral using the Attitude-Social influence self-Efficacy model as a guiding theoretical framework. The data was collected in an interview survey with 236 women and 190 men attending a sexually transmitted disease clinic in Kampala, Uganda. Intention, attitude, subjective norm, self-efficacy, and past behaviour in relation to partner referral as well as partner type were collected at time 1. At time 2 (1 month later), sexual partner referral was assessed. Intention, self-efficacy, and previous behaviour predicted partner referral for women whereas intention, partner type and previous behaviour predicted partner referral for men. For the women the strongest predictors for intention were self-efficacy followed by attitude and partner type. For the men the strongest predictor was attitude followed by partner type and self-efficacy. Social influence was a better predictor of intention for women than for men. An analysis of underlying cognitive beliefs discriminating those who referred and those who did not refer the sexual partner showed that attitudinal beliefs were the most important for men whereas self-efficacy beliefs were the most important for women. The targeting of the gender-based discriminatory beliefs in intervention may improve compliance with sexual partner referral.

Relationship between sexual partners influences rates and correlates of condom use

A common finding in studies of heterosexual young adults is that condom use is more likely with casual partners than with regular partners. However, few studies have examined whether correlates of condom use differ with different partners. In this study, 103 heterosexual men and women completed a condom use diary for a period of up to 6 months. Condom use during sexual encounters with regular partners was mainly determined by established patterns of behavior. In contrast, condom use with casual partners was determined by the interaction between the sexual partners during the encounter, and was not influenced by the attitudes and beliefs of the individual. These differences have implications for interventions. They suggest that condom use with casual partners may be increased by furnishing young adults with skills and confidence for negotiating condom use. For young adults in regular relationships, we must ensure that routine patterns of condom use are appropriate for the levels of risk to which the partners are exposed.

Crack smokers' intention to use condoms with loved partners: intervention development using the theory of reasoned action, condom beliefs, and processes of change

Prevalence rates of HIV infection acquired through heterosexual contacts have risen steadily since 1982. Crack cocaine smokers are at particular risk of HIV infection due to heterosexual exposure. HIV risk reduction interventions seeking to increase condom use among drug users have met with minimal success, and there is a need for interventions to be strongly grounded in psychosocial models of behaviour change. This study presents the results of an investigation of predictors of intention to use condoms and related therapy processes among heterosexual drug users. Data were analyzed from 586 crack smokers recruited in Washington, DC, Miami, Florida, and Collier County, Florida who reported having both primary and casual sex partners. Participants responded to items derived from the theory of reasoned action, the theory of planned behaviour and the transtheoretical model of change. Condom use beliefs and therapy processes used to initiate and maintain condom use were assessed. Outcome expectancies and normative beliefs were the strongest predictors of intention to use condoms with a primary sexual partner. In turn, beliefs that condoms inhibit sexual romance and decrease sexual pleasure strongly predicted outcome expectancies. Therapy processes found to be associated with these constructs included: self-liberation, counter conditioning and stimulus control/reinforcement. Results suggest that HIV risk reduction interventions using a group format and targeting condom beliefs related to sexual romance and pleasure will decrease negative outcome expectancies about condom use. Also, reinforcing attempts to use condoms with intimate partners should increase positive outcome expectancies and intention to initiate or maintain condoms with a primary sexual partner.

Condom use among US students: the importance of confidence in normative and attitudinal perceptions

The author performed a study among U.S. undergraduates to test an earlier conclusion (D. Trafimow, 1994) that confidence in the correctness of one's perceptions of normative pressure to use a condom influences the correspondence between those perceptions and the intentions actually to perform the behavior. Consistent with previous findings (Trafimow), the participants' perceptions of normative pressure strongly predicted their intentions to use condoms only under conditions of extreme normative confidence. Otherwise, their attitudes were better predictors of their intentions to use condoms. In addition, 2 other variables (attitudinal confidence and perceived behavioral control) were found to be unimportant predictors of intentions. Results of a 2nd study suggest that behaviors performed by sexual partners and knowing the sexual partners affected the participants' normative confidence.

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

To examine how well the theories of reasoned action and planned behavior predict condom use, the authors synthesized 96 data sets (N = 22,594) containing associations between the models' key variables. Consistent with the theory of reasoned action's predictions, (a) condom use was related to intentions (weighted mean r. = .45), (b) intentions were based on attitudes (r. = .58) and subjective norms (r. = .39), and (c) attitudes were associated with behavioral beliefs (r. = .56) and norms were associated with normative beliefs (r. = .46). Consistent with the theory of planned behavior's predictions, perceived behavioral control was related to condom use intentions (r. = .45) and condom use (r. = .25), but in contrast to the theory, it did not contribute significantly to condom use. The strength of these associations, however, was influenced by the consideration of past behavior. Implications of these results for HIV prevention efforts are discussed.