Test of a brief theory of planned behaviour-based intervention to promote adolescent safe sex intentions

Psychosocial Determinants of Sleep Behavior and Healthy Sleep Among Adolescents: A Two-Wave Panel Study

To date, it remains unknown which psychosocial determinants identified by several leading behavior change theories are associated with different sleep parameters among adolescents. Therefore, this study investigates whether changes in knowledge about healthy sleep, attitude toward healthy sleep and going to bed on time, self-efficacy to engage in healthy sleep behavior, perceived parental and peer norms, perceived barriers (e.g., worrying, fear of missing out), and perceived support (e.g., bedtime rules, encouragement) related to healthy sleep are associated with changes in adolescents' sleep duration on school days and free days and sleep quality over a period of 1 year. Two-wave data of 1648 Flemish adolescents (mean age = 15.01, SD = 0.65, 46.3% female) were analyzed using linear models. Increased levels of parental social support, positive attitude towards and perceived advantages of healthy sleep, norm-knowledge, and perceived peer behavior were associated with sleep duration, with parental social support having the strongest association. Increased levels of perceived barriers were associated with decreased levels of sleep quality parameters, and increased levels of self-efficacy, positive attitude, and parental modeling were associated with improved sleep quality parameters, with perceived barriers having the strongest association. The current results indicate that behavior change theories are useful in the context of adolescent sleep behavior and suggest that perceived parental support (i.e., bedtime rules) and perceived barriers are most strongly associated with adolescents' sleep duration and/or quality.

Bystander intervention among secondary school pupils: Testing an augmented Prototype Willingness Model

This study augmented the Prototype Willingness Model (PWM) to assess reactive and deliberative decision-making underpinning bystander intervention in gender-based violence contexts. There were 2079 participants (50% male, 49% female, and 1% unreported), aged 11-15 years old (M = 12.32, SD = 0.91), attending 19 secondary schools across Scotland. Participants self-reported the augmented PWM variables, then their intervention behaviour approximately 1 month later. Path analyses mostly supported the predicted relationships between positive and negative bidimensional attitudes, subjective norms, prototype perceptions, perceived behavioural control, and self-efficacy on intentions and willingness. Willingness predicted positive (speaking with a teacher) and negative (doing nothing) intervention in less serious violence. Self-efficacy predicted negative intervention in more serious violence. Subjective norms positively moderated the attitudes-intentions relationship. Overall, the results suggested that reactive (willingness) more so than deliberative (intention) decision-making account for intervention when young people witness gender-based violence. Additionally, the findings highlight the complexity of bystander intervention decision-making, where adding control perceptions, bidimensional attitudes, and moderators have independent contributions. Furthermore, self-comparison to the typical bystander who positively intervenes (prototype perceptions) was the strongest predictor of intentions and willingness, highlighting in a novel way the importance of image and group membership on decision-making.

The unappreciated relevance of auxiliary assumptions for evaluating theory-based interventions in health psychology

The use of theory in health behavior change interventions has been recently questioned with mixed results found for theory-based intervention effectiveness. But theory testing in intervention depends on not only theoretical assumptions, but on auxiliary assumptions too. Specifically, auxiliary assumptions are required to traverse the distance from nonobservational terms in theories and observational terms at the level of the empirical hypotheses in interventions. We believe intervention failures are often due to flaws in auxiliary assumptions rather than assumptions at the theoretical level. We use the theory of planned behavior to illustrate how the consideration of these auxiliary assumptions is important to appraise the effectiveness of interventions informed by theory. We hope that bringing attention to the importance of auxiliary assumptions provides a more nuanced and accurate appraisal of theory utility.

Factors Associated with Condom Use Behaviour Among Young University Students

Abstract As the rates of sexually transmitted infections among Brazilian youth rise, college students present with low rates of condom use. Understanding which factors affect preventive behaviours may assist in promoting them. This study aimed to test the Theory of Planned Behaviour (TPB) as a model of condom use behaviour among young university students. Data on sexual behaviour, TPB, and personality variables were collected online with 343 sexually active students aged between 18 and 29. Seventy participants also provided follow-up data after 30 days. Structural equation models and ordinal regressions were used to analyse the effects of TPB variables on condom use behaviour. Attitude was the main predictor of behavioural intention in the cross-sectional and longitudinal models. Being in a relationship and lower age at sexual debut were also associated with less frequent condom use behaviour in the cross-sectional analysis. Behavioural intention and perceived control were associated with condom use behaviour.

Safe-Sex Behavioral Intention of Chinese College Students: Examining the Effect of Sexual Knowledge Using the Theory of Planned Behavior

Numerous contemporary studies have examined safe sexual behavior among college students. In China, families are reluctant to discuss sexual behavior, thus understanding and exploring the sexual knowledge of college students and the promotion of safe sexual behavior is essential. On the basis of the theory of planned behavior (TPB), a cognitive behavioral theory that is widely used to predict human social behavior, we conducted an in-depth investigation of the factors influencing the sexual behavioral intentions of Chinese college students. We referenced the relevant literature to develop a TPB-based model for analyzing differences in sexual knowledge. Our statistical analysis revealed the following: (1) subjective norms and behavior control are key variables that influence the safe sexual behavior of college students; (2) attitudes and safe-sex behavioral intentions are influential in groups with extensive sexual knowledge; (3) behavioral control and subjective norms influence the differences in the comparative sexual knowledge of students. On the basis of the present results, we propose research recommendations and directions for the development of sex education in China.

Environmental Management in the Peri-urban Region: Psychological and Contextual Factors Influencing Private Land Conservation Actions

Peri-urban areas, defined as the region between urban and rural settlements, are heterogeneous, dynamic regions experiencing rapid land use change in cities around the world. Ongoing development and land use change has resulted in the fragmentation, degradation and loss of natural assets, threatening biodiversity, and ecosystems within the peri-urban region. With much of this land privately owned, the actions of landholders have considerable opportunity to deliver environmental outcomes, yet an understanding of this diverse group of landholders is challenging. Through a survey of landholders (N = 184) in Australian peri-urban regions we sought to understand motivations and barriers to engagement in environmental management. Factors influencing willingness to engage in environmental management included perceived personal capacity to act, feeling that actions were helpful, and community participation. We discuss how engagement strategies could incorporate these findings by focussing on improving capacity and environmental knowledge with hands on, face-to-face extension activities, encouraging simple actions, and fostering greater community interaction.

Safe Sexual Behavior Intentions among College Students: The Construction of an Extended Theory of Planned Behavior

Sexual health education is an essential part of quality-oriented education for college students. It aims to help these students to acquire knowledge of sexual physiology, sexual psychology, and sexual social norms that is consistent with the maturity of the students. Along with college students’attitudes toward sex, their perceptions regarding sexual behavior have also undergone profound changes. The importance of safe sexual behavior, sexual taboos, and sexual autonomy are gaining increasing attention as Chinese society is becoming more open. For college students who have just reached adulthood and have full autonomy of themselves, however, are they really going to have sexual behavior without careful consideration? Or is it something they have planned to do in the first place? To answer the above questions, this study was conducted to understand the relationship between college students’ attitudes toward sex, subjective norms, and behavioral control of their sexual behavior intentions by applying the Theory of Planned Behavior. In this study, 460 valid questionnaires were collected from Chinese college students and analyzed with partial least squares structural equation modeling (PLS-SEM). This study analyzes the relationship of multiple factors, including those influencing college students’ sexual behavior intentions. Meanwhile, it also compares the differences in factors affecting sexual behavior intentions between college students with or without sexual experience and those of different genders. Based on the results of the study, it was found that, first, subjective norms and perceived behavioral control of college students had a significant effect on safe sexual behavior intentions, while attitudes did not have a significant effect on safe sexual behavior intentions. Second, the gender and sexual experience of college students had a significant effect on safe sexual behavior intentions. Third, non-sexually experienced college students were more likely to be influenced by external factors. Relevant future research suggestions will be proposed based on the results of this study. Finally, this study helps to provide substantive suggestions for enhancing safe sexual behavior among college students in the context of universal higher education, as well as strengthening the self-protection of college students and providing practical advice for the development of sex education in China.

The Validity of the Theory of Planned Behaviour for Understanding People's Beliefs and Intentions toward Reusing Medicines

Background: many factors can impact a person’s behaviour. When the behaviour is subject to prediction, these factors can include, for example, the perceived advantages and disadvantages of performing the behaviour, normative beliefs, and whether the behaviour is thought to be achievable. This paper examines intentions to engage in medicines reuse, i.e., to accept medicines that are returned unused to a pharmacy to be reused. The paper aims to outline the validity of the Theory of Planned Behaviour (TPB) for understanding people’s intentions to engage in medicines reuse by examining this against other long-standing health-related psychological theories of behavioural change. Thus, the Health Belief Model (HBM), Protection Motivation Theory (PMT), Trans-Theoretical Model of Health Behaviour Change (TTM/SoC), Theory of Reasoned Action (TRA), and TPB are examined for their application in the study of medicines reuse. Discussion: the HBM, PMT, TTM/SoC, TRA, and TPB were assessed for their relevance to examining medicines reuse as a behaviour. The validity of the TPB was justified for the development of a Medication Reuse Questionnaire (MRQ) to explore people’s beliefs and intention toward reusing medicines. Conclusion: TPB has been widely used inside and outside of health-related research and it was found to have more accurately defined constructs, making it helpful in studying medicines reuse behaviour.

Attention-Deficit/Hyperactivity Disorder Symptoms Are Associated with Greater Delay Discounting of Condom-Protected Sex and Money

Attention-deficit/hyperactivity disorder (ADHD) is associated with increased risk of detrimental life outcomes. Recent research also indicates that ADHD is associated with sexual risk behavior, such as unprotected sex. Some risky sexual behaviors may be driven, in part, by preference for immediate rewards, referred to as delay discounting, which is prominent in etiological models of ADHD. Therefore, the present study examined the effect of delay on preference for both monetary and sexual outcomes in adults with many ADHD symptoms (both on and off medication) and with fewer ADHD symptoms. Online participants (N = 275; n = 161 males, n = 114 females) completed a monetary delay discounting task, assessing preference for smaller sooner versus larger delayed hypothetical money, and the Sexual Delay Discounting Task, assessing preference for condom use in hypothetical casual sex scenarios based on delay until condom availability. Those with greater ADHD symptoms discounted delayed monetary outcomes as well as delayed condom-protected sex (i.e., preferred sooner money rewards and immediate unprotected sex) significantly more than those with fewer symptoms; however, no effect of current medication use was found across monetary or sexual delay discounting among those with greater ADHD symptoms. This study is the first to demonstrate the relation between ADHD symptoms and reduced condom-use likelihood. Increased discounting of delayed condom-protected sex might constitute one mechanism of risky sexual behavior among individuals with ADHD symptoms. Interventions geared toward increasing condom use in situations in which condoms may otherwise be unavailable, may mitigate risky sexual behaviors and their associated harms in this population.

Reasons Lesbian and Bisexual Adolescent Girls Have or Might Have Sex with Females or Males: Implications for Discordance between Sexual Identity and Behaviors and for Prevention of Pregnancy and STIs

We examined reasons lesbian and bisexual adolescent girls have sex or, if sexually inexperienced, might have sex with girls or boys, and the role of internalized homonegativity in these relations and among lesbians. Girls were recruited online and classified as lesbian (n = 129) or bisexual (n = 193); the classification was validated. Love and pleasure were common reasons for having sex with girls, although more lesbian girls (LG) than bisexual girls (BG) endorsed love. BG, relative to LG, had sex with girls because they were curious or wanted to verify their sexual identity. Love and pleasure were motives for having sex with boys for BG. They were common reasons for potentially having sex with either sex among sexually inexperienced girls, but both were more likely for BG than LG for sex with boys. Internalized homonegativity did not mediate the relation between sexual identity and reasons for sex, but LG just with male partners were more homonegative than LG just with female partners. The findings indicate that LG and BG should not be combined into a single group, provide insights into the discordance between sexual identity and behaviors, and have implications for reducing risk for pregnancy and sexually transmitted infections among sexual minority girls.

Safe sexual behaviors intention among female youth: The construction on extended theory of planned behavior

AIM

To examine female youth's intentions for safe sex with the relationship partners based on the extended theory of planned behaviour (TPB) model and explore the direct and indirect impact of parent-child communication about sex, peer interaction related to sexual issues, and exposure to sexually explicit materials on female youth's safe sexual behaviour intentions.

DESIGN

A non-experimental, cross-sectional research design.

METHODS

A convenience sampling was employed for data collection and 731 female youth aged 15-24 years old were recruited in 2013-2014. An anonymous, self-report structured questionnaire was used as a research instrument to collect participants' basic information and measure the internal and additional variables in the extended TPB model.

RESULTS

The extended TPB model explained 42-45% of the total variance. Perceived behavioural control (PBC) and subjective norms had a positive effect on female youth's intentions for contraceptive use, condom use, and dual use with relationship partner; PBC was found to have the greatest influence. Among the additional variables in the extended TPB model, more parent-child communication about sex was found to lead to more positive dual use intentions. More peer interaction related to sexual issues was found to lead to less dual use intentions.

CONCLUSIONS

To improve female youth's sexual health, the priorities are to reinforce their PBC and subjective norms and enhance parent-child communication about sex. Future efforts should strengthen sex education in families and schools and shape a social environment that facilitates safe sex.

IMPACT

The extended TPB model can successfully predict female youth's safe sexual behaviour intentions. Empowering female youth to establish a sense of subjectivity and awareness of being a mature individual with physical autonomy, is importance for their sexual health.

Why U.S. Consumers Buy Sustainable Cotton Made Collegiate Apparel? A Study of the Key Determinants

U.S. collegiate apparel is a $4 billion market in which cotton and polyester made by conventional production methods account for 85% of materials used. Sustainable cotton made collegiate apparel offers a new opportunity for cotton made by novel and sustainable production methods to enter and replace conventional cotton and polyester for environmental protection and sustainable business development. This study aimed to provide insights on why U.S. consumers buy sustainable cotton made collegiate apparel and help understand the emerging trend of sustainable cotton apparel. Building on the Theory of Planned Behavior, an enhanced research model of consumer intent to purchase sustainable cotton made collegiate apparel (SCCA) is proposed. 225 eligible survey responses were gathered for data analysis and hypothesis testing. Attitude, subjective norms, perceived consumer effectiveness, and environmental knowledge positively influences U.S. consumers’ purchase intentions toward SCCA while the effect of perceived behavioral control is insignificant. Furthermore, consumer environmental knowledge positively moderates the relationship between U.S. consumers’ attitude and their purchase intentions. There are no significant differences between age groups, genders, education levels, or income levels among U.S. consumers in regards to their purchase intentions. The proposed research model exhibits a good explanatory power, accounting for 47.3% of the variance in U.S. consumers’ purchase intentions toward SCCA.

The association between perceived injunctive norms toward corporal punishment, parenting support, and risk for child physical abuse

The use of corporal punishment (CP) is a strong risk factor for many poor outcomes for children including child maltreatment. The use of CP occurs within social contexts which are important to understand. Although it is known that perceived social norms regarding CP are related to its use, the specific role that a mother's primary support person plays in influencing attitudes toward and use of CP remains unknown. The current study assessed linkages between maternal perceived social support in parenting and perceived injunctive norms of CP from her primary source of support, with maternal attitudes toward and use of CP. Survey data were collected from female primary caregivers (N = 436) of children age 2 to 7 years (mean age = 3.7) enrolled in Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics in Southeastern Louisiana. Most frequently, the biological father of the child (37.9%) and the maternal grandmother of the child (24.2%) were identified as the participant's primary source of social support in parenting. Perceived injunctive norms of this support person toward CP use were significantly and positively associated with attitudes toward, AOR = 5.97, 95% CI = [4.04, 8.82], and use of CP, AOR = 3.77, 95% CI = [2.55, 5.59]. However, perceived social support was not associated with these outcomes and also did not moderate these associations. Findings suggest that efforts to reduce maternal risk for child physical abuse and use of CP must include the mother's primary source of social support if they are to be successful.

Interventions to reduce risk for sexually transmitted infections in adolescents: A meta-analysis of trials, 2008-2016

BACKGROUND

Numerous studies have evaluated the efficacy of interventions to reduce risk for sexually transmitted infections in adolescents in recent years, but their global effects remain unknown since 2008, the last date of a comprehensive review of prior studies.

AIMS

This study aims at evaluating the efficacy of interventions to promote sexual health, reduce STIs and unplanned pregnancies targeted to adolescents available after 2008; and analyzing the moderators of their global efficacy.

METHODS

We searched electronic databases and manual searches of some journals focused on STIs in May 2016. The studies evaluated the efficacy of interventions to reduce sexual risk in adolescents (age range: 11-19) anywhere in the world. Effect size of the relevant outcomes for sexual risk was calculated for every study. Analyses incorporated random-effect assumptions for each outcome. The homogeneity in the results was examined with the I2 statistic and its associated 95% confident interval.

RESULTS

Data from 63 studies (59,795 participants) were analyzed for behavioral and non-behavioral outcomes. In the short term, interventions had a positive impact in sexual health-related knowledge (Hedges'g = 1.01), attitudes (g = 0.29), self-efficacy toward condom use (g = 0.22), intention to refuse sex (g = 0.56), condom use intention (g = 0.46), and condom use (g = 0.38). In the medium term, positive effects observed at the short-term were maintained, although effect size significantly decreased in all variables. In the long term, interventions improved condom use (g = 0.47). Moderators of the efficacy are discussed.

CONCLUSIONS

Sexual health promotion interventions are effective to promote sexual health through increasing condom use. Effects on non-behavioral variables tend to decrease over time, while condom use increased in the long-term. Interventions should focus on the long-term efficacy, especially in behavioral and biological measures.

College Students' Intent to Intervene when a Peer is Engaging in Nonmedical Use of Prescription Stimulants: An Application of the Theory of Planned Behavior

BACKGROUND

This study examined college students' communication surrounding nonmedical use of prescription stimulants (NPS).

OBJECTIVE

Using a hypothetical scenario, the researchers employed the Theory of Planned Behavior (TPB) to investigate the relationship of students' attitudes, perceived subjective norms, and perceived behavioral control with their intent to intervene on behalf of a friend who is engaging in NPS.

METHODS

College students (N = 163) at a small, Southwestern university in the United States completed anonymous web- based surveys, reporting on their attitudes, subjective norms, perceived behavioral control, and behavioral intention in the Spring of 2015. Self-reports of perceived knowledge of prescription stimulants were also collected as a control variable.

RESULTS

Results of structural equation modeling support the utility of TPB in this context; participants' attitudes and subjective norms were significant predictors of behavioral intent. Perceived behavioral control was not a significant predictor. Conclusions and Importance: Based on these findings, several recommendations are offered for both researchers and practitioners who might consider a bystander intervention to address the growing NPS epidemic on college campuses.

Photo-sharing social media for eHealth: analysing perceived message effectiveness of sexual health information on Instagram

Health professionals increasingly use social media to communicate health information, but it is unknown how visual message presentation on these platforms affects message reception. This study used an experiment to analyse how young adults (n = 839) perceive sexual health messages on Instagram. Participants were exposed to one of four conditions based on visual message presentation. Messages with embedded health content had the highest perceived message effectiveness ratings. Additionally, message sensation value, attitudes and systematic information processing were significant predictors of perceived message effectiveness. Implications for visual message design for electronic health are discussed.

Development of a Theoretically Grounded, Web-Based Intervention to Reduce Adolescent Driver Inattention

Motor vehicle crashes are the leading cause of adolescent death. Inattention to the roadway contributes to crash risk and often results from distractions, such as cell phone calls, texting, and peer passengers. We report on the development of a web-based intervention based on the Theory of Planned Behavior that aims to reduce adolescent driver inattention ( Let's Choose Ourselves). In Phase I, we collected qualitative and quantitative data on adolescents' attitudes, perceived behavioral control, and subjective norms about driver inattention through focus groups with newly licensed adolescent drivers. In Phase II, we developed the content in an e-learning delivery system, performed beta- and pilot testing, and made refinements. In Phase III, we conducted a randomized controlled trial to evaluate feasibility. The development of Let's Choose Ourselves provides information for school nurses regarding intervention development strategies as well as promotion of safe adolescent driving by reducing driver inattention.

How Effective are Behavior Change Interventions Based on the Theory of Planned Behavior?

Abstract. The theory of planned behavior (TPB) is a prominent framework for predicting and explaining behavior in a variety of domains. The theory is also increasingly being used as a framework for conducting behavior change interventions. In this meta-analysis, we identified 82 papers reporting results of 123 interventions in a variety of disciplines. Our analysis confirmed the effectiveness of TPB-based interventions, with a mean effect size of .50 for changes in behavior and effect sizes ranging from .14 to .68 for changes in antecedent variables (behavioral, normative, and control beliefs, attitude, subjective norm, perceived behavioral control, and intention). Further analyses revealed that the interventions’ effectiveness varied for the diverse behavior change methods. In addition, interventions conducted in public and with groups were more successful than interventions in private locations or focusing on individuals. Finally, we identified gender and education as well as behavioral domain as moderators of the interventions’ effectiveness.

A pilot randomised test of a self-affirmation implementation intention intervention to reduce dietary salt intake

Self-affirmation may reduce defensive processing towards health messages. We tested the effects of a self-affirmation implementation intentional intervention with regard to salt risk message acceptance, estimates of daily-recommended intake and self-reported intake. Participants ( n = 65) who consumed over 6 g/day of salt were randomised into three conditions: self-affirmation, self-affirming implementation intention and control. Participants attended the laboratory and completed a 2-week follow-up. There was no effect of the condition on message acceptance, salt estimation and 2-week salt intake. Across conditions, 2-week salt intake was reduced. We found no evidence for either intervention with regard to salt risk message acceptance and behaviour change.

Teen Drivers' Perceptions of Inattention and Cell Phone Use While Driving

OBJECTIVE

Inattention to the roadway, including cell phone use while driving (cell phone calls, sending and reading texts, mobile app use, and Internet use), is a critical problem for teen drivers and increases risk for crashes. Effective behavioral interventions for teens are needed in order to decrease teen driver inattention related to cell phone use while driving. However, teens' perceptions of mobile device use while driving is a necessary component for theoretically driven behavior change interventions. The purpose of this study was to describe teen drivers' perceptions of cell phone use while driving in order to inform future interventions to reduce risky driving.

METHODS

We conducted 7 focus groups with a total of 30 teen drivers, ages 16-18, licensed for ≤ 1 year in Pennsylvania. The focus group interview guide and analysis were based on the Theory of Planned Behavior, identifying the attitudes, perceived behavioral control, and norms about inattention to the roadway. Directed descriptive content analysis was used to analyze the focus group interviews. All focus groups were coded by 2 research team members and discrepancies were reconciled. Themes were developed based on the data.

RESULTS

Teens had a mean age of 17.39 (SD = 0.52), mean length of licensure of 173.7 days (SD = 109.2; range 4-364), were 50% male and predominately white (90%) and non-Hispanic (97%). From the focus group data, 3 major themes emerged: (1) Recognizing the danger but still engaging; (2) Considering context; and (3) Formulating safer behaviors that might reduce risk. Despite recognizing that handheld cell phone use, texting, and social media app use are dangerous and distracting while driving, teens and their peers often engaged in these behaviors. Teens described how the context of the situation contributed to whether a teen would place or answer a call, write or respond to a text, or use a social media app. Teens identified ways in which they controlled their behaviors, although some still drew attention away from the roadway.

CONCLUSIONS

Cell phone use while driving is a contributor to motor vehicle crashes in teens, and effective interventions to decrease risks are needed. Teens viewed some types of cell phone use as unsafe and describe methods in which they control their behaviors. However, some of their methods still take attention off the primary task of driving. Teens could benefit from behavior change interventions that propose strategies to promote focused attention on the roadway at all times during the driving trip.

Identification and characterization of adolescents' sexual boundaries

PURPOSE

Adolescents' decisions to have sex may be based on a priori boundaries placed on sex. This study addresses: (1) to what extent adolescents set vaginal sexual boundaries; (2) the types of sexual boundaries most and least likely to be endorsed; and (3) to what extent sexual boundaries vary by sex, race/ethnicity, and sexual experience.

METHODS

A cross-sectional study of 518 students attending 10th grade. Survey measures queried about demographics, ever having sex, and existence of sexual boundaries (e.g., being in love, having an attractive partner) that must be in place before having vaginal sex.

RESULTS

The most frequently endorsed boundaries were maturity, commitment, trust, love, and marriage. These boundaries were more frequently endorsed than having a safer-sex method. Compared with females, males were more likely to choose boundaries based on partner attractiveness (p < .001) and avoiding trouble (p < .04). Compared with Asians and Pacific Islanders, whites were more likely to endorse wanting to be a certain age to have sex (p < .01 and p < .05, respectively); Asians and Pacific Islanders were more likely to choose sexual boundaries based on marriage (p's < .05). Adolescents who were sexually experienced were more likely than inexperienced adolescents to endorse boundaries related to relationship characteristics and partner attractiveness (OR = 2.5), and less likely to endorse boundaries related to feeling mature (OR = .34) and waiting until marriage (OR = .34).

CONCLUSIONS

Identifying adolescents' sexual boundaries should help healthcare professionals better understand under what circumstances adolescents are more or less likely to have sex; and this information should ultimately inform the development of new interventions.

Examining the prospective effects of making a virginity pledge among males across their 4 years of college

OBJECTIVES

The authors examined prospective associations of making a virginity pledge on sexual behaviors among male college students.

PARTICIPANTS

A sample of 795 males was followed for 4 years (2008, 2009, 2010, 2011), with response rates ranging from 72% to 82% across the follow-up years.

METHODS

Males were surveyed at the end of each of their 4 years in college about sexual behavior activities and other risky behaviors.

RESULTS

Multivariate regression analyses indicated that males who made private virginity pledges were significantly more likely to remain abstinent across all 4 years of college and have fewer sexual partners at the end of their third and fourth years of college, even after controlling for age, race, high-risk drinking, impulsivity, and religiosity. Making a pledge was not related to condom use.

CONCLUSION

Findings suggest that abstinence-based messages alone are not sufficient yet should be included as part of comprehensive sex education programs.

Evidence that changes in social cognitions predict changes in self-reported driver behavior: Causal analyses of two-wave panel data

Previous research on the theory of planned behavior (TPB) is characterized by cross-sectional tests of the model's proposed causal relationships. In the absence of effective experimental techniques for changing the TPB's cognitive antecedents, the present research aimed to provide a stronger non-experimental test of the model, using causal analyses of two-wave panel data. Two studies of driver behavior were conducted in which naturally occurring within-participant changes in TPB constructs were measured over time, and used to predict corresponding within-participant changes in both intentions and behavior. A two-wave panel design was used in both studies. Study 1 had a one-month gap between baseline and follow-up. At both waves, a convenience sample comprising predominantly university students (N=135) completed questionnaire measures of all TPB cognitions and behavior (compliance with speed limits in urban areas). Cross-lagged multiple regressions and bootstrapping procedures for testing multiple mediators supported all of the relationships proposed by the TPB. These findings were extended in study 2 using a large, non-student sample of speed limit offenders (N=1149), a six-month gap between baseline and follow-up, and a larger number of cognitive antecedents. Participants completed postal questionnaires at both waves to measure all cognitions proposed by the two-component TPB, along with moral norm, anticipated regret, self-identity and speeding on urban roads, country roads, and fast dual carriageways or motorways. Changes in instrumental and affective attitude, descriptive norm, self-efficacy, moral norm, anticipated regret and self-identity predicted changes in intention to speed. Changes in intention and self-efficacy predicted behavior-change. Injunctive norm and perceived controllability did not predict intention or behavior-change. Additionally, direct (unhypothesized) relationships with behavior were found for affective attitude, descriptive norm and anticipated regret. The implications of the findings for theory and the development of effective behavior-change interventions are discussed.

The role of attitude functions, efficacy, anticipated emotions, and relationship status on college students' condom use intentions

Conducted from the reasoned action perspective, previous research related to condom use generally included a limited number of variables and treated attitudes and self-efficacy as unidimensional constructs. Informed by attitude functions theory and health literature on condom use and anticipated emotions, this project aims to provide a more detailed understanding of college students' intentions to use condoms during sexual intercourse. Results show that relationship status moderated the relationships between several psychological variables and condom use intentions. For female college students negative anticipated emotions were a stronger predictor of condom use intentions for those in monogamous relationships for three months or longer than for those in other relationships or not in a relationship. On the other hand, subjective norms were a stronger predictor of intentions for those in other types of relationship or not in a relationship than for those in a monogamous relationship for three months or longer. For male participants, sexual sensation was a more important, negative predictor of condom use intentions among those in monogamous relationships for three months or longer (versus other relationship status or not in a relationship). Both theoretical and practical implications are discussed.

An interdisciplinary knowledge translation intervention in long-term care: study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial

BACKGROUND

Knowledge translation (KT) research in long-term care (LTC) is still in its early stages. This protocol describes the evaluation of a multifaceted, interdisciplinary KT intervention aimed at integrating evidence-based osteoporosis and fracture prevention strategies into LTC care processes.

METHODS AND DESIGN

The Vitamin D and Osteoporosis Study (ViDOS) is underway in 40 LTC homes (n = 19 intervention, n = 21 control) across Ontario, Canada. The primary objectives of this study are to assess the feasibility of delivering the KT intervention, and clinically, to increase the percent of LTC residents prescribed ≥800 IU of vitamin D daily. Eligibility criteria are LTC homes that are serviced by our partner pharmacy provider and have more than one prescribing physician. The target audience within each LTC home is the Professional Advisory Committee (PAC), an interdisciplinary team who meets quarterly. The key elements of the intervention are three interactive educational sessions led by an expert opinion leader, action planning using a quality improvement cycle, audit and feedback reports, nominated internal champions, and reminders/point-of-care tools. Control homes do not receive any intervention, however both intervention and control homes received educational materials as part of the Ontario Osteoporosis Strategy. Primary outcomes are feasibility measures (recruitment, retention, attendance at educational sessions, action plan items identified and initiated, internal champions identified, performance reports provided and reviewed), and vitamin D (≥800 IU/daily) prescribing at 6 and 12 months. Secondary outcomes include the proportion of residents prescribed calcium supplements and osteoporosis medications, and falls and fractures. Qualitative methods will examine the experience of the LTC team with the KT intervention. Homes are centrally randomized to intervention and control groups in blocks of variable size using a computer generated allocation sequence. Randomization is stratified by home size and profit/nonprofit status. Prescribing data retrieval and analysis are performed by blinded personnel.

DISCUSSION

Our study will contribute to an improved understanding of the feasibility and acceptability of a multifaceted intervention aimed at translating knowledge to LTC practitioners. Lessons learned from this study will be valuable in guiding future research and understanding the complexities of translating knowledge in LTC.

Predicting university undergraduates' binge-drinking behavior: a comparative test of the one- and two-component theories of planned behavior

This study provides a comparative test of the one- and two-component theories of planned behavior (TPB) in the context of university undergraduates' binge-drinking. Participants (N=120) self-completed questionnaire measures of all TPB constructs at time 1 and subsequent binge-drinking at time 2 (two-weeks later). The data were analyzed using a combination of path analyses and bootstrapping procedures. Both models accounted for a substantial proportion of the variation in behavior. However, the two-component TPB provided a significantly better fit to the data, with the total direct and indirect effects accounting for 90% of the variance. Intention was the only direct predictor of behavior. Instrumental attitude, affective attitude and self-efficacy had indirect effects. Although health interventions could usefully target these cognitive antecedents, simulation analyses, modeling the effects of cognition change on behavior, showed that only large-sized (0.8 SD) changes to affective attitude, or moderate-sized changes to all of these cognitions in combination were sufficient to reduce binge-drinking.