Factor structure and gender stability in the multidimensional condom attitudes scale

Promoting Adolescent Healthy Relationships (The About Us Program): Protocol for a Randomized Clinical Trial

BACKGROUND

Romantic relationships play a critical role in adolescent development, and by middle adolescence, most young people have been involved in at least one romantic relationship, a context in which most sexual interactions occur. Research suggests adolescents lack positive models and skills related to building healthy relationships.

OBJECTIVE

This project aims to test the impact of an innovative healthy relationships intervention, called About Us, implemented in school-based health centers (SBHCs) in California in a randomized controlled trial.

METHODS

About Us is being tested using a 7-site, 2-group, parallel randomized controlled trial with a treatment versus control allocation ratio of 3:2 to assess the impact of the intervention relative to the standard of care among adolescents aged 14 to 18 years. Adolescents with active parental consent provide study assent at each of the 3 survey time points: baseline, 3 months postintervention, and 9 months postintervention. A stratified randomization procedure was used to ensure balance in key covariates and screening criteria across intervention groups. Through benchmark intent-to-treat analyses, we will examine the primary outcome of this study-the impact of About Us relative to the standard of care 9 months following the end of the intervention on the prevalence of vaginal or anal sex without condoms in the past 3 months. The secondary outcomes are four-fold: what is the impact of About Us relative to the standard of care 3 and 9 months following the end of the intervention, on (1) the prevalence of abstinence from vaginal or anal sex in the past 3 months, (2) composite scores of relationship communication and positive conflict resolution among participants involved in a relationship at baseline, (3) the prevalence of SBHC service use or information receipt in the past 3 months, and (4) composite scores of condom use intentions and attitudes regarding condoms and other birth control? Additionally, as part of our sensitivity analyses, two additional analyses will be implemented: modified intent-to-treat and complete case analysis.

RESULTS

This project (ClinicalTrials.gov #NCT03736876) was funded in 2016 through the Family Youth Services Bureau as part of the Personal Responsibility Education Innovative Strategies program. Baseline data collection took place between February 2018 and March 2020, yielding a total of 5 cohorts and 533 study participants: 316 assigned to treatment and 217 assigned to control. Ongoing follow-up data collection continued through May 2021.

CONCLUSIONS

About Us draws on developmental science to create a contextually and developmentally relevant program that addresses motivation and emotional influences in sexual decision-making. The intervention was designed for implementation within SBHCs, an understudied venue for relationship and sexual health promotion interventions. Unfortunately, COVID-19 pandemic restrictions led to school closures, interrupting ongoing programming, and in-person follow-up data collection, which has affected study attrition.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03736876; https://clinicaltrials.gov/ct2/show/NCT03736876.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/30499.

Spanish Translation, Adaptation, and Validation of the Multidimensional Condom Attitudes Scale with Young Colombian Men and Women

Infection by HIV/AIDS or other STIs and unplanned pregnancies are sexual health problems of considerable impact around the world. Condoms are the only method that prevents all those risks, and attitudes toward the use of condoms are among the best predictors of their consistent use. The purpose of the present study was to translate, adapt, and validate a Spanish-language version of the Multidimensional Condom Attitudes Scale (MCAS) using a sample of young people from Colombia. A total of 1441 young people between the ages of 18 and 26 years responded to a web-based survey conducted between January 2018 and February 2018. The dimensionality of the scale was explored and confirmed to replicate the original five-factor structure (alphas ranged from .65 to .86). Criterion validity was adequate. Women had more positive attitudes toward identity stigma associated with condom use, while men had more positive attitudes toward reliability and effectiveness of condoms and were less embarrassed with condom negotiation and use. The Spanish-language MCAS is suitable for measuring condom-related attitudes among Colombian youth. Future research is needed to validate the Spanish version of the MCAS with other Spanish-speaking populations.

The use of the Multidimensional Condom Attitude Scale in Chinese young adults

Background

Attitude towards condom use is an important predictor of consistent condom use. However, this topic is an understudied area in Chinese populations, and no validated Chinese instrument is available to capture condom attitude. To fill this research gap, the present study aimed to evaluate the psychometric properties of the University of California, Los Angeles (UCLA) Multidimensional Condom Attitudes Scale (MCAS) and assessed the attitudes towards condom use amongst Chinese adults aged 18–29 years old.

Methods

In this cross-sectional study, a total of 500 people aged 18–29 years old were randomly recruited in Hong Kong. The primary outcome was the attitude towards condom use as measured by the UCLA MCAS. Factor structure, internal construct validity, known-group validity and internal consistency were assessed.

Results

Instead of the five-factor structure designed by the original developers of the MCAS questionnaire, this study proposed a novel six-factor scale: (1) Reliability and Effectiveness, (2) Excitement, (3) Displeasure, (4) Identity Stigma, (5) Embarrassment about Negotiation and (6) Embarrassment about Purchase. The internal construct validity and reliability of the new scale were high. The revised MCAS could differentiate between subgroups, including gender, sexual orientation and sexual experience. In terms of attitudes, over 40% of the participants believed that condoms are not reliable, though the vast majority of the sample did not perceive any stigma related to condom use. In addition, more than half (55.4%) of the respondents felt embarrassed to be seen when buying condoms while a quarter (25.8%) felt uncomfortable buying condoms at all.

Conclusions

Overall, the psychometric analysis found that attitude to condom use is culturally specific. The study also highlighted the need for more public health campaigns and interventions to help people cope with the embarrassment of purchasing condoms.

Feasibility of a Mobile Messaging-Enhanced Brief Intervention for High Risk Heavy Drinking MSM: A Pre-Pilot Study

The purpose of this project was to assess the feasibility of an in-person session + mobile messaging intervention approach to reduce heavy drinking and condomless anal intercourse among heavy drinking men who have sex with men at high risk for HIV. Participant (n = 8) engagement rates, retention and satisfaction ratings were used to measure feasibility and acceptability of the 4-week intervention. Paired t-tests were used to assess additional secondary outcomes. Results support the feasibility and acceptability of this novel treatment approach among this population. Pre-post intervention effect sizes on alcohol, sex risk and process variable secondary outcomes are discussed.

Portuguese Version of the HIV-Related Attitudes Scale (HIV-AS) for Adolescents

Abstract. The HIV-related Attitudes Scale (HIV-AS) is a brief, valid, and reliable instrument, widely used in Spain. Because of the high risk of HIV in adolescents in Portugal and the scarcity of multidimensional measures to assess attitudes toward HIV-related aspects, reliable and valid instruments are essential for understanding sexual risk behaviors in this population. The aim of this study was to adapt and validate the Spanish version of the HIV-AS into Portuguese. Factor structure, internal consistency, temporal stability, and measurement equivalence with the Spanish version were examined. Analyses were conducted based on a sample of 1,618 adolescents aged 15–18 years (Portugal N = 624, and Spain N = 994). This study confirmed the four-factor structure of HIV-AS, including attitudes toward obstacles to safe sex, HIV testing, condom use, and people living with HIV/AIDS. Reliability was excellent (α = .82) and temporal stability was moderate ( r = .51). Results provided good initial support for the invariance at a strict level for Portuguese and Spanish samples. The Portuguese version of the HIV-AS is a valid and reliable tool for assessing relevant dimensions of attitudes toward HIV-related aspects in adolescents. Future research is needed to consolidate these findings and to generalize them to other populations and countries.