Health beliefs and teenage condom use: a prospective study

The authors investigated the extent to which Health Belief Model (HBM) measures can be used to predict subsequent sexual activity and consistency of condom use among teenagers, especially those who report having new sex partners. Results from a longitudinal survey of sex behavior and HIV-relevant cognitions among 258 sexually active 16 and 18 year olds in Dundee, Scotland, are reported. Participants responded to a confidential postal questionnaire on their demographic characteristics, previous sexual experience, prior condom use, beliefs specified by the HBM, peer norms regarding condom use, and condom use intentions. Measures of sexual behavior and condom use consistency were then included in a follow-up questionnaire 1 year later. Demographic and HBM measures, as determined through discriminant analysis, did not account for significant proportions of variance in the consistency of condom use or mediate the effects of prior sexual experience or demographic measures. The respondents who reported more frequent sexual intercourse were less likely to use condoms consistently while those who had used condoms previously reported more consistent use. Female respondents were less likely than the young men to follow through upon their intentions to consistently use condoms.     

Using the Theory of Planned Behavior to Predict Intention to Use Condoms Among Male and Female Injecting Drug Users

This study tested the utility of the theory of planned behavior (TPB) for understanding and predicting condom use intentions among male and female injecting drug users (IDUs). Interviews were conducted with 405 male and 315 female sexually active IDUs. Participants indicated their intentions to use condoms with main and nonmain sexual partners as well as attitudes, social norms, partner norms, and perceived behavioral control relevant to condom use with each partner type. The TPB accounted for 36 to 48% of the variance in intentions to use condoms. Intentions were related to attitudes, regardless of partner type. Partner norms were related to intentions to use condoms with main partners (men and women) and nonmain partners (men only). Social norms did not predict intentions, regardless of partner type. Perceived behavioral control was related to intentions to use condoms with main partners (men and women) and nonmain partners (women only). The findings are interpreted in light of the roles of cooperation, intimacy, and concern about self-protection.     

Romantic Ideals,Fear of Negative Implications,and the Practice of Safe Sex1

The present study examined how young heterosexuals’ beliefs about the power of condom use to destroy their romantic ideals and to lead to negative implications affected both their intentions and their actual behavior of using and discussing the use of condoms with sexual partners. The extra predictive power gained from considering these beliefs, in addition to subjects’ beliefs concerning whether condoms reduced their risk of contracting HIV, was examined within the context of Fishbein and Ajzen's (1975) theory of reasoned action. One-hundred-and-two sexually active heterosexual students participated in the study. At the first wave of data collection, beliefs concerning the potential of condoms to reduce risk, to destroy romance, and to lead to negative implications were assessed, as were norms and intentions. Measures of actual behavior were obtained three months later for both regular and casual/new partners. The results of the study indicated that norms and beliefs concerning the risk-reduction effects of condom use were the primary predictors of intentions to use condoms. Subjects’ beliefs concerning whether condoms destroyed their romantic ideals or led to negative implications did not influence their intentions with casual/new partners, although emotional concerns played a minor role in determining intentions with regular partners. In contrast, these emotional concerns had a major impact in determining actual behavior for all partner types. Although intentions partially predicted behavior, beliefs about reducing risk, destroying romance and fear of negative implications had strong and direct influences on behavior, especially in the case of casual/new partners. Additional analyses revealed gender differences in the determinants of behavior. Females, in contrast to males, were less able to act in accord with their attitudes about using condoms to reduce their risk of contracting HIV, and were also less able to act in conformity with their subjective norms with less well-known partners. Although both males and females were similarly affected by more emotional concerns with new and/or casual partners, gender differences occurred in how these emotional factors affected behavior with regular partners. Implications of the finding that behavior is determined to a large extent by more emotional concerns that are not factored in ahead of time when formulating intent are discussed.     

Safe and Unsafe Sexual Intentions and Behavior: The Effects of Norms and Attitudes1

A study of 85 heterosexual men, 85 heterosexual women, and 82 homosexual men was undertaken to examine the variables that influence intentions to engage in different sexual practices and actual sexual behavior. On the basis of Fishbein and Ajzen's (1975) theory of reasoned action, it was predicted that the strength of intentions would be related to whether behavior was in accord with intentions. Consistent with expectations, the strength of intention to engage in six different sexual practices (e. g., vaginal intercourse, anal intercourse, oral sex) and the three strategies that modify the risk of HIV transmission (sex with an exclusive partner, sex wearing a condom, and looking for a new partner) predicted actual behavior. Second, it was proposed that attitudes toward one's sexual practices and norms would be related to intentions to engage in safe sex. To reflect differential levels in the safety of behavioral intentions, five safety intention groups were formed: (a) nonpenetrative sex, (b) penetrative sex in an exclusive relationship with a condom, (c) penetrative sex in an exclusive relationship without a condom, (d) penetrative sex in a nonexclusive relationship with a condom, and (e) penetrative sex in a nonexclusive relationship without a condom. Norms, rather than attitudes, distinguished the five safety intention groups. the groups intending to engage in safe sex (nonpenetrative sex or penetrative sex with a condom) perceived lower levels of social approval for their sexual practices than the noncondom groups. Additional analyses showed that past behavior had a stabilizing effect on the intention-behavior relationship, but only for the nonpenetrative and noncondom safety intention groups.     

Links between sex-related expectations about alcohol, heavy episodic drinking and sexual risk among young men in a shantytown in Lima, Peru

CONTEXT: Alcohol use is frequently identified as a contributor to risky sexual behaviors; however, research results are mixed. Given the conflicting evidence, researchers have focused on other factors, such as expectations about alcohol's effects that might help explain the relationship of alcohol use and risky sexual behaviors. METHODS: Cross-sectional data from 312 sexually experienced males aged 18-30 in a shantytown in Lima, Peru, were used in logistic regression models to identify associations of heavy episodic drinking and sex-related expectations about alcohol with sexual risk behaviors. RESULTS: Heavy episodic drinking was associated with having had two or more sexual partners and having had sex with a casual partner in the past year (odds ratios, 2.8 and 2.5, respectively). After controlling for alcohol consumption, sex-related expectations about alcohol were associated with these high-risk sexual behaviors, as well as with not using a condom at last sex (1.2) and not using a condom at last sex with a casual partner (1.3). CONCLUSION: Beliefs about the effect of alcohol on sexual performance could help explain links between alcohol consumption and risky sexual behavior not completely accounted for by the pharmacological effects of alcohol.     

The prediction of safe sex behaviour: The role of intentions,attitudes, norms and control beliefs

Abstract

The present study was designed to examine the utility of the theory of reasoned action (Fishbein and Azjen, 1975) in relation to people's propensity to engage in a range of different safe sex strategies, including engaging in an exclusive sexual relationship, avoiding casual sex, and asking sexual partners about their previous sexual and IV drug use history. It was proposed that the intention to engage in a particular safe sex practice would be influenced by the person's attitude towards engaging in the practice, as well as his or her perception of the extent to which others thought they should do so (subjective norm), while behavioural intentions were proposed to predict actual behaviour. The study was also designed to examine whether, after control of the effects of the components of the theory of reasoned action, the person's generalised control beliefs would explain any additional variance in either behavioural intentions or actual behaviour. One hundred and two sexually active heterosexual students participated in the study. At the first wave of data collection, subjects completed measures of intentions, attitudes, and norms appropriate to each of the different behaviours. Measures of actual behaviour were obtained at follow-tip (three months after first period of data collection). The results of the study indicated that attitudes and norms predicted intentions for avoiding casual sex and asking sexual partners about their previous sexual and IV drug use history, while intentions predicted actual behaviour for all three safe sex strategies. Although there were no significant main effects of control beliefs on intentions or behaviour, subjects with internal control beliefs were more likely than their counterparts with external control beliefs to behave in accordance with their intentions to engage in an exclusive sexual relationship and ask sexual partners about their previous sexual and IV drug use history. Additional analyses revealed that the levels and determinants of intentions and actual behaviour were, in general, similar for males and females.     

Self-conscious emotions and self-regulation in the promotion of condom use

Two prospective studies examined the self-regulatory role of anticipated negative self-conscious emotions (ANSCE) in the theory of planned behavior. In Study 1, 147 undergraduates reported condom attitudes, perceived norms, self-efficacy, ANSCE (shame and guilt) should they not use condoms, and intentions to use condoms during the coming 6 weeks. At a 6-week follow-up, ANSCE predicted condom use intentions and behavior and partially mediated the effect of attitudes and norms on both. Study 2 experimentally tested the social nature of self-consciousness in ANSCE; 61 female undergraduates read a scenario priming the private-self or social-self or were assigned to a no-scenario control. They reported condom attitudes, perceived control, ANSCE, condom use intentions, and a 6-week follow-up. ANSCE again predicted condom use intentions. A test of moderated mediation indicated that ANSCE influenced condom intentions more in the social-self condition than in the control condition. Implications of these findings are discussed.     

Alcohol Consumption and the Theory of Planned Behavior: An Examination of the Cognitive Mediation of Past Behaviorid

This study examined the predictive power of the theory of planned behavior (TPB) in explaining alcohol consumption in 3 prospective samples of students ( Ns = 178. 176. and 159). Generally, the TPB performed well. with attitudes, subjective norms and perceived behavioral control (PBC) explaining between 28% and 46% of the variability in intentions. Intentions and PBC explained between 12% and 50% of the variability in behavior. Measures of self-identity as a "drinker" and past behavior contributed to predictions of intentions over and above the contribution of attitudes. subjective norms. and PBC. Measures of past behavior but not self-identity consistently contributed to predictions of behavior over and above the contributions from intentions and PBC. The direct relationship between past behavior and intention and between past behavior and behavior (independent of the TPB variables or self-identity) could not be attributed to common method variance.     

Condom use in steady and casual sexual relationships: Planning, preparation and willingness to take risks among adolescents

Condom use within steady and casual sexual relationships was examined among 14-16 year old Dutch adolescents from secondary school (N?=?140). It was hypothesised that among adolescents sex and subsequently condom use with casual sex partners is less likely to be considered in advance, more context-dependent and less habitual; whereas the opposite is true for steady relationships. Therefore, preparatory behaviours (buying and carrying condoms and communicating about condom use) were expected to mediate the intention-behaviour relation in the context of steady relationships, but not in the context of casual sex. Results confirmed that condom use with steady sex partners was explained by preparatory behaviours, habits, and to some extent, behavioural willingness, and that preparatory behaviours mediated the intention-behaviour relationship. Condom use with casual sex partners was predicted by risk willingness and intentions, without any mediation by preparatory behaviours. The results indicate that it is essential to increase awareness among adolescents that unexpected sexual situations may occur and to train them to take preparatory actions.     

Impact of alcohol on sexual decision making: Intentions to have unprotected sex

The impact of alcohol on intentions to have sex with a new partner and the antecedents of intentions were investigated in three studies (N = 139, 60, and 218, respectively). In all three studies, respondents were intoxicated or not intoxicated with alcohol and completed measures based on the Theory of Planned Behaviour in relation to having sex whilst imagining him- or her-self in the scenario. The scenario described unprotected sex between two individuals not in an existing relationship. Consistently across studies, intoxication had a significant effect on intentions for men but not for women. Also consistently across studies, affective attitudes were significantly stronger determinants of intentions for women than for men. Alcohol intoxication consistently moderated the impact of affective attitudes on intentions in women but not men, with greater intoxication associated with stronger impacts (Studies 1, 2, and 3). Implications for understanding the impacts of alcohol intoxication on sexual decision making in men and women are discussed.     

Improving Predictions of Condom Behavioral Intentions With Partner-Specific Measures of Risk Perception

Inconsistent findings regarding the predictive validity of perceptions of risk for a sexually transmitted disease (STD) and HIV may be related to the use of nonspecific measures. The objective of this study was to determine whether more specific measures of perceptions of risk for SI Ds and HIV are associated with intentions to use a condom. We interviewed 490 male and female adolescents, 14 to 19 years old, from a free municipal STD clinic. Controlling for whether a condom was used at last sex, the association between perceptions of risk for an STD and HIV with a casual sex partner and intentions to use a condom with a casual sex partner was significant (β_HIV= 14, p < .01, and β_STD=.20, p < .01), as was the association between perceptions of risk for an STD and HIV with a main sex partner and intentions to use a condom with a main sex partner (β_HIV= .31, p <.001, and β_STD= .32, p < .001). This supports the continued inclusion of this construct in models of sexual and other health-related behaviors.     

Determinants of intentions to practise safe sex among 16–25 year-olds

This study aimed at predicting intentions to avoid casual sex and to use condoms, through self-efficacy, attitudes, optimistic bias in perceived risk, knowledge and past sexual risk behaviour. To this end, a mixed-sex sample of high school and university students between 16 and 25 years completed questionnaires at two points in time. Intentions to avoid casual sex were predicted positively by the attitude towards avoiding casual sex and assertiveness in sexual relationships, and negatively by communication about sex. The intention to use condoms was predicted positively by the perceived benefits of condom use, and negatively by past sexual risk behaviour and fatalism. Gender and sexual experience were found to have a moderating influence, implying that AIDS education should use different messages for these target groups. Since the results show that condom use is quite a powerful habit and that sexually non-active subjects had more positive intentions towards safe sex, AIDS education should start at a young age in order to establish safe sex habits from the beginning. © 1997 John Wiley & Sons, Ltd.     

Sensation seeking, impulsive decision-making, and risky sex: implications for risk-taking and design of interventions

In an HIV prevention study, 2949 ninth-grade students in 17 high schools in two Midwestern U.S. cities were administered scales measuring sensation seeking and impulsive decision-making and their separate and combined relationships to a number of indicators of sexual risk-taking. Measures of sexual risk-taking included intentions to have sex, ever had sex, number of lifetime sexual partners, been pregnant or caused a pregnancy, used a condom, used marijuana, had unwanted sex when drunk, had unwanted sex under pressure, said no to sex, used alcohol or partner used alcohol before sex. Strong associations were observed between each of the measures and sexual risk-taking for most of the indicators. Strongest associations were found among sexually active students high on both sensation seeking and impulsive decision-making and weakest associations among students low on both measures. Implications for design of interventions in health campaigns are discussed.     

The Theory of Reasoned Action and the Role of External Factors on Heterosexual Men's Monogamy and Condom Use1

Although the majority of prevention efforts have focused on women, reduction of heterosexual transmission of STDs also requires interventions for men, necessitating understanding of men's safer sex decision making. In a random sample of 486 heterosexually active men, the theory of reasoned action (TRA) was used to predict intentions to use condoms with casual partners, as well as 2 steady‐partner safer sex behaviors: mutual monogamy and condom use. The basic TRA model fit the data well. Expanded models identified the mediated (via attitudes, social norms, and self‐efficacy) and, for some, direct effects on intentions and behavior of selected intrapersonal, interpersonal, and sociocultural variables. Results suggest that the role of external variables might vary depending on the behaviors in question.     

Examining normative pressure in the theory of planned behaviour: Impact of gender and passengers on intentions to break the speed limit

This research examined the impact of passenger-type on young people’s responses to a driving scenario about speeding. In the scenarios, the presence, and gender of the passenger were systematically varied. A total of 162 respondents (83 females, 79 males) completed questionnaires containing measures from the Theory of Planned Behaviour (TPB) and additional variables after reading each of two scenarios. The TPB provided good predictions of intention to speed (45% explained variance) with all TPB variables plus moral norms and past behaviour significant. Males compared to females reported significantly greater normative pressure to speed, less control over not speeding, and less moral norms not to speed. Normative pressure was a stronger predictor of intentions for men compared to women when driving alone. Normative pressure was a stronger predictor of intentions when the passenger was male.     

Examining normative pressure in the theory of planned behaviour: Impact of gender and passengers on intentions to break the speed limit

This research examined the impact of passenger-type on young people’s responses to a driving scenario about speeding. In the scenarios, the presence, and gender of the passenger were systematically varied. A total of 162 respondents (83 females, 79 males) completed questionnaires containing measures from the Theory of Planned Behaviour (TPB) and additional variables after reading each of two scenarios. The TPB provided good predictions of intention to speed (45% explained variance) with all TPB variables plus moral norms and past behaviour significant. Males compared to females reported significantly greater normative pressure to speed, less control over not speeding, and less moral norms not to speed. Normative pressure was a stronger predictor of intentions for men compared to women when driving alone. Normative pressure was a stronger predictor of intentions when the passenger was male.     

A test of theory of planned behavior in Korea: participation in alcohol-related social gatherings

Two studies are reported using the theory of planned behavior (TPB) to predict and explain joining and not joining alcohol-related social gatherings among Korean undergraduates in various engineering majors. Specifically, considering that the attitudinal component of TPB is behavioral-outcome-based, the current study investigated whether the outcomes of engaging in a behavior and of not engaging in a behavior would similarly predict intentions to engage in a behavior and intentions to not engage in a behavior. The current study also examined whether intentions to engage and intentions to not engage would be significantly related to self-reported behavior a week later. Participants in Study 1 reported TPB components (attitudes toward behavior, subjective norms, perceived behavioral control, and behavioral intentions) concerning joining alcohol-related social gatherings. Participants in Study 2 reported TPB components concerning not joining alcohol-related social gatherings. Additionally, a week later, the participants in both studies reported their participation in alcohol-related social gatherings from the past week. Generally, the results showed that the TPB components were significantly associated with undergraduates' intentions to join and intentions to not join. Specifically, conversation-related attitudes and senior-junior relationship-related attitudes were significantly related to intentions to join, and only group-related attitudes were significantly related to intentions to not join. Intentions to join and intentions to not join were not significantly related to self-reported behavior of joining alcohol-related social gatherings a week later. The findings from the current research provide some evidence that joining or not joining alcohol-related social gatherings may not be mere behavioral opposites, predictable by the presence or absence of the same behavioral outcomes. These two aspects of the behavior may require assessment of different behavioral outcomes or different assessments of the same behavioral outcomes.     

Studying, Practicing, and Mastering: A Test of the Model of Goal-Directed Behavior (MGB) in the Software Learning Domain

The present study tested the model of goal-directed behavior (MGB). The model proposes that behavioral intentions to perform instrumental behaviors are primarily motivated by desires to perform the acts. In turn, desires mediate the effects of attitudes, subjective norms, perceived control, and anticipated emotions on intentions. Construct validity for MGB variables is assessed, and the predictive utility of the MGB is compared with that of the theory of planned behavior (TPB). College students ( N = 102) provided measures for MGB and TPB variables while participating in a training program to use statistical software. We focused on two goal-related instrumental behaviors: studying handbooks and practicing with the package. The results show that the MGB accounts for a greater proportion of variance in intentions and instrumental behaviors than does TPB. Although desires mediate most of the effects of other predictors on intentions to perform the instrumental behaviors, it is proposed that when the behavior is normatively relevant, or when self-efficacy appraisals play a major role, subjective norms and perceived behavioral control may directly affect intentions.     

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

Abstract

A prospective study of 94 Dutch adults who have casual sexual partners examined whether two important aspects of safe sex, namely bringing up condom use (BCU) and actual condom use (ACU) are intentional or habitual. For each of these aspects, a model based on the Theory of Planned Behaviour (TPB: Ajzen, 1991) was pitted against a similar model that was extended with a path from past to later BCU and ACU, respectively. The results suggest that bringing up the issue of condom use was equally predicted by intentions and past BCU. However, among people with casual partners, using condoms - and more importantly not using condoms - was especially predicted by past ACU, suggesting a strong habitual component. These results are discussed in terms of their implications for safe sex education and the use of theories in safe sex promotion campaigns.