School-based,randomised controlled trial of an evidence-based condom promotion leaflet

A condom use promotion leaflet was designed for use with older teenagers in schools. The text targeted a series of cognitive and behavioural antecedents of condom use identified in the literature. Given previous evidence that motivational incentives can enhance the effectiveness of health promotion leaflets, the leaflet was presented in conjunction with a quiz and prize draw. Students were randomly assigned to either the intervention condition or a (no leaflet or incentive) control condition. Measures were taken immediately, pre-intervention and 4 weeks later from 404 students. The 20-min intervention successfully promoted six of the eight measured cognitions, namely (1) attitude towards using condoms with a new partner (2) attitude towards using condoms with a steady partner (3) normative beliefs in relation to preparatory actions (4) self-efficacy in relation to both preparatory actions and (5) condom use (6) intention to use condoms, as well as three measured preparatory actions, that is, purchasing condoms, carrying condoms and discussing condom use. The intervention did not increase condom use with steady or new partners but power to test intervention impact on condom use was curtailed.     

Sexually Explicit Media and Sexual Risk Behavior in a Sample of Men Who Have Sex with Men in Norway

The aim of this study was to explore the association between the consumption of sexually explicit media (SEM) depicting condom and non-condom use and HIV/STI-related sexual risk behavior among men who have sex with men (MSM) in Norway. We also explored whether the association between SEM consumption and STI-related sexual risk behavior is mediated by men’s sexual self-esteem and/or condom use self-efficacy. A cross-sectional online survey study was carried out in Norway in 2012. The final sample comprised 529 MSM in Norway. There was a bivariate association between the use of SEM picturing condom use and less STI-related sexual risk behavior. Further, the association between SEM consumption and sexual risk behavior was mediated by condom use self-efficacy. However, SEM did not influence sexual risk behavior via sexual self-esteem. The results offer important cross-cultural validation of recent comparative data from the US and may be used to promote HIV/STI prevention, in the sense that the actors in SEM may serve as role models in managing condom use in sexual contexts.     

Improving condom use intentions and behavior by changing perceived partner norms: an evaluation of condom promotion videos for college students.

OBJECTIVE: To examine the effectiveness of 2 condom promotion videotapes on self-efficacy, intentions, and behavior. DESIGN: Two hundred twenty college students completed social-cognitive and behavioral measures and were then randomly assigned to receive one of two 30-min condom promotion videotapes (male or female student presenters) or to a wait-list control condition. Participants who watched 1 of the videotapes completed immediate posttest measures, and 85% of participants completed a 4-month follow-up. MAIN OUTCOME MEASURES: Self-efficacy for condom use, intentions to use condoms, use of condom during last sex, and consistent condom use over the last month. RESULTS: Participants who received either video reported greater self-efficacy to refuse to have unprotected sex and intentions than controls at follow-up. Individuals who received either video were more likely than controls to report using a condom during last sex with a regular partner, and those who watched the female presenter were more likely to report consistent condom use. CONCLUSION: Participants benefited in terms of self-efficacy and intentions from receiving either video, but both men and women benefited more in terms of condom use behavior from receiving the female video. Future research is needed to determine whether opposite-sex speaker videos could be beneficial with a larger (and more sexually active) sample and whether these effects are maintained over time.     

Role of relationship context in influencing college students' responsiveness to HIV prevention videos.

This research examined the effectiveness of different HIV prevention videos for students as a function of whether they were in a dating relationship. Two hundred two college students completed pretest measures and were randomly assigned to watch one of three 42-min videos (communication skills, technical skills, combined skills). Posttest and 3-month follow-up data indicated that receiving the technical skills video was associated with greater self-efficacy for condom use across several different dimensions. However, students who received the combined skills video and were not currently in a dating relationship had the greatest proportion of protected acts of intercourse. These findings suggest that video-based interventions can be an effective way of decreasing risky sexual behavior, and that HIV prevention messages that focus on both technical and communication skills are the most successful in leading to behavioral change.     

Transtheoretical model and condom use in HIV-positive youths.

The purpose of the study is to test constructs of the Transtheoretical Model for predicting unprotected intercourse in HIV-positive youths (ages 16-25 years). Questionnaires and interviews about sexual behavior, stage of change, self-efficacy, substance use, emotional distress, and social support were obtained from 60 HIV-positive youths. Path analysis, with standard errors determined by methods appropriate to small samples, suggested that self-efficacy completely mediated the relationship between stage of change and unprotected intercourse acts. Social support specific to reducing risk was associated with increased self-efficacy. Emotional distress and low general social support were not associated with decreased condom use. The path between substance use and decreased condom use approached significance. Results highlight the potential of prevention interventions that simultaneously boost self-efficacy and social support specific to practicing safer sex as well as those that reduce substance use.     

Predictors of Condom Use in Mexican Migrant Laborers

The purpose of this study was to explore predictors of condom use with occasional sex partners and regular sex partners, as well as carrying condoms in a new high-risk group for HIV infection, Mexican migrant laborers. This study extends previous findings by (1) exploring additional predictors not previously examined, (2) utilizing a large sample of male and female Mexican migrant laborers, (3) carefully controlling for the effects of various demographic and lifestyle variables related to condom use, and (4) assessing the interactive effects of gender on predictors of condom use. Snowball sampling was used to survey 501 adult Mexican migrant laborers. Results revealed that condom use with occasional sex partners was predicted by carrying condoms and condom self-efficacy and that women were more likely to use condoms with occasional partners when both men and women knew someone with HIV/AIDS. Condom use with regular sex partners was predicted by procondom social norms, less negative attitudes toward condoms, not knowing someone with HIV/AIDS, and condom self-efficacy. Carrying condoms was predicted by procondom social norms, less negative attitudes toward condoms, condom self-efficacy, worry about contracting HIV/AIDS, and women were more likely than men to carry condoms when both men and women were married. Understanding these findings, future research directions, and implications for condom promotion strategies with Mexican migrant laborers are discussed.     

Today I'll use a condom, but who knows about tomorrow: a daily process study of variability in predictors of condom use

OBJECTIVE: Most models of health behavior change applied to condom use behavior have focused on individual differences in theoretical constructs to explain condom use or nonuse, while ignoring the possibility that day-to-day within-person changes in these constructs may contribute to understanding behavior. The goal of the present study was to investigate day-to-day variability in condom use attitudes, self-efficacy, and behavioral intentions and assess the utility of this variability in predicting the likelihood of condom use each day. DESIGN: A 30-day Web-based structured daily diary was used to collect daily reports of sexual behaviors and data on theoretical predictors of condom use behavior from sexually active college students (N = 116). MAIN OUTCOME MEASURES: The authors investigated whether condom use attitudes, self-efficacy, and behavioral intentions vary day to day; whether this within-person variability predicts condom use behavior; and whether negative affective states explain this variability. RESULTS AND CONCLUSIONS: Within-person variability was found for each of the constructs. Within-person day-to-day changes in behavioral intentions and attitudes predicted the instances in which an individual used a condom and daily negative affect partially explained within-person day-to-day changes in behavioral intentions and self-efficacy. Implications for models of health behavior change and for behavior change interventions are discussed.     

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

The research presents tests of traditional and augmented versions of Fishbein and Ajzen's Theory of Reasoned Action (TRA), applied to condom use among adult clients of a sexually transmitted disease clinic. In a longitudinal survey, predictor variables suggested by Ajzen and Fishbein (1980), plus gender and condom use self-efficacy, were measured at Time 1. Condom use at Time 2, 3 months later, was regressed onto these variables. The traditional TRA worked well to predict condom use intentions and behavior. Support was also found for inclusion of gender and self-efficacy in the prediction of intention to use condoms, but not behavior. Implications for interventions to increase condom use among those at high risk for AIDS and other STDs are discussed.     

Integration of five health behaviour models: common strengths and unique contributions to understanding condom use

The purpose of this research was to select from the health belief model (HBM), theories of reasoned action (TRA) and planned behaviour (TPB), information-motivation-behavioural skills model (IMB) and social cognitive theory (SCT) the strongest longitudinal predictors of women's condom use and to combine these constructs into a single integrated model of condom use. The integrated model was evaluated for prediction of condom use among young women who had steady versus casual partners. At Time 1, all constructs of the five models and condom use were assessed in an initial and a replication sample (n?=?193, n?=?161). Condom use reassessed 8 weeks later (Time 2) served as the main outcome. Information from IMB, perceived susceptibility, benefits, and barriers from HBM, self-efficacy and self-evaluative expectancies from SCT, and partner norm and attitudes from TPB served as indirect or direct predictors of condom use. All paths replicated across samples. Direct predictors of behaviour varied with relationship status: self-efficacy significantly predicted condom use for women with casual partners, while attitude and partner norm predicted for those with steady partners. Integrated psychosocial models, rich in constructs and relationships drawn from multiple theories of behaviour, may provide a more complete characterisation of health protective behaviour.     

The relationship between psychosocial factors and condom use among African-American adolescents

The present investigation explored the relationship between psychosocial factors and condom use by African-American adolescents. Two hundred twenty-nine males, aged 14 to 19 years, responded to a health behavior survey that gathered information on demographics, HIV knowledge, perceived certainty of future condom use, present and past use of condoms, and intention to use condoms in the next six months. Several psychological variables, including sexual self-efficacy and self-esteem, were also measured. It was found that the majority of participants were sexually active by age 13, had four or more lifetime sexual partners, and were using condoms regularly. Multiple linear regression analysis indicated that sexual self-efficacy predicted perceived certainty of condom use. In addition, self-esteem and sexual self-efficacy predicted intention to use condoms. These findings highlight the need to develop HIV prevention curricula for African-American male adolescents that not only emphasize the potential risks associated with having multiple sexual partners, but also include components to enhance self-worth and sexual self-efficacy.     

Integration of five health behaviour models: Common strengths and unique contributions to understanding condom use

The purpose of this research was to select from the health belief model (HBM), theories of reasoned action (TRA) and planned behaviour (TPB), information–motivation–behavioural skills model (IMB) and social cognitive theory (SCT) the strongest longitudinal predictors of women's condom use and to combine these constructs into a single integrated model of condom use. The integrated model was evaluated for prediction of condom use among young women who had steady versus casual partners. At Time 1, all constructs of the five models and condom use were assessed in an initial and a replication sample (n?=?193, n?=?161). Condom use reassessed 8 weeks later (Time 2) served as the main outcome. Information from IMB, perceived susceptibility, benefits, and barriers from HBM, self-efficacy and self-evaluative expectancies from SCT, and partner norm and attitudes from TPB served as indirect or direct predictors of condom use. All paths replicated across samples. Direct predictors of behaviour varied with relationship status: self-efficacy significantly predicted condom use for women with casual partners, while attitude and partner norm predicted for those with steady partners. Integrated psychosocial models, rich in constructs and relationships drawn from multiple theories of behaviour, may provide a more complete characterisation of health protective behaviour.     

Perceived Pros and Cons of Condom Use as Predictors of its Consistent Use with a Heterosexual Romantic Partner Among Young Adults

The present research examines the pros and cons of condom use as predictors of consistent condom use with a heterosexual romantic partner. Data from 619 undergraduate students (35.1 % males; mean of age?=?20.31) were collected using a voluntary and anonymous self-report survey. The pros and cons predicted consistent condom use during the last month among females, whereas only the pros were predictive of consistent condom use in men. Similarly, only the feelings of safety predicted consistent condom use among men. However, the reduction of pleasure for women, the side-effects of other contraceptive methods, the difficulty in asking for condom use when they were also using the pill and the fact that condom use interrupts and cools off foreplay were also predictors among women. Besides the superiority of the pros over the cons, in general, the present research identifies a number of important pros and cons that should be used to encourage condom use.     

Relationship commitment and its implications for unprotected sex among impoverished women living in shelters and low-income housing in Los Angeles County.

OBJECTIVE: To examine how relationship commitment among impoverished women is associated with their frequency of unprotected sex. DESIGN: Cross-sectional analyses were conducted on survey data from a probability sample of 445 women initially sampled from shelters and low-income housing in Los Angeles County. MAIN OUTCOME MEASURE: Frequency of unprotected sex in a typical month was derived as the product of 2 items: how often the woman had sex with her partner in a typical month and how often a male condom was used. RESULTS: For both sheltered and housed women, relationship commitment predicted more frequent engagement in unprotected sex with their partner, even after controlling for the type of relationship (primary vs. casual). However, this association could not be accounted for by perceived partner monogamy, ability to refuse unwanted sex, perceived HIV susceptibility, and condom use self-efficacy. Among housed women only, never asking the partner to use a condom partially accounted for more frequent engagement in unprotected sex among women with stronger relationship commitment. CONCLUSION: Results emphasize the importance of relationship commitment issues in HIV prevention interventions with impoverished women, and the need for a better understanding of relationship commitment and its influence on condom use in this population.     

Moderation and Mediation of HIV-Prevention Interventions: Relationship Status,Intentions, and Condom Use Among College Students1

This study examined the effects of 2 HIV prevention interventions on condom use and mediators of condom use. College students were randomly assigned to a control condition or an intervention (communication skills or technical skills). Those who received either intervention had greater condom use self-efficacy, more positive condom use attitudes, and stronger intentions to use condoms than did controls. Furthermore, 3-month follow-up data revealed that students in either intervention who were not in a steady dating relationship reported more consistent condom use than did those in the control condition, whereas students who were in either intervention and in a relationship reported somewhat less consistent condom use than did those in the control condition. Analyses suggested that effects of the interventions on condom use were mediated by increased intentions to use condoms.     

Correlates and predictors of HIV risk among inner-city African American female teenagers

OBJECTIVE DESIGN: For human immunodeficiency virus (HIV)-related prevention initiatives to be most effective, they should be broad-based and incorporate multiple domains of influence. This study tested how several ecodevelopmental domains influenced HIV-risk related attitudes and behaviors in a community sample of African American female teens (N = 242). MAIN OUTCOME MEASURES: Outcome measures were number of partners, frequency of intercourse, number of pregnancies, abstinence/condom use, HIV/AIDS-related attitudes and behaviors, and HIV testing. RESULTS: Structural Equation Modeling revealed many direct paths from ecodvelopmental domains to risky sexual behaviors. The findings include having more partners was associated with parental alcohol-related problems, more drug use, and a younger age at first intercourse. More frequent intercourse was associated with less cultural pride and more drug use. More pregnancies were related to a younger age at first intercourse and parental alcohol problems. HIV testing was associated with having experienced sexual abuse, an older age at first intercourse, and stronger self-efficacy. CONCLUSIONS: Prevention programs that focus on risk reduction could expand their focus beyond sexual behavior to include a broad-range of psychosocial domains that are associated with HIV-risk. The effectiveness of prevention programs should be monitored carefully for appropriateness in different ethnic groups.     

Factors affecting behaviors that address HIV risk among senior secondary school pupils in South Africa.

The purpose of this study was to identify factors affecting HIV risk reduction among senior secondary school pupils in South Africa. The sample included 460 Grade 12, Secondary School pupils whose ages ranged from 16 to 30 years (M = 19.7 yr., SD = 2.5) and who were chosen at random from the total Grade 12 population throughout one region in the Northern Province of South Africa. Measures were of sexual behavior and condom use, knowledge about correct condom use, intention of condom use, behavioral norms, attitudes, normative beliefs, and subjective norms about condoms, HIV/AIDS vulnerability (likelihood to get it) and severity of the illness in the country, and condom use self-efficacy. Bivariate analysis gave positive significant relations among normative beliefs, subjective norms, and attitudes towards condom use as well as HIV/AIDS vulnerability and HIV risk behavior. Regression analysis indicated that for boys, younger age at first vaginal intercourse, less intention for condom use, and HIV/AIDS vulnerability were predictive for HIV/AIDS risk behavior and explained 39% of the variance. It is suggested that these predictors should be included in intervention programs for HIV prevention.     

Self-Efficacy to Use Condoms in Unmarried Latino Adults

Measures of self-efficacy to use condoms can clarify the barriers to condom use Latinos encounter. A 20-item scale, that differed slightly for men and women, and was based on extensive elicitation interviews, was used in a random digit dial household survey of 1,600 unmarried Latino adults in 10 states with large Latino populations. Self-efficacy was related to condom use for both men and women. Factor analyses revealed five correlated factors: Regular Partner, Impulse Control, Partner Resistance, STD Thoughts, and Condom Discussion. Both men and women reported lowest self-efficacy for impulse control and using condoms with a regular partner. Less-educated men and women had lower self-efficacy to discuss condoms, to manage partner resistance, to use condoms with a regular partner, and to control impulses, but there were few other demographic differences in self-efficacy. The scale can be helpful in the design and evaluation of HIV prevention.     

Factors shaping condom use among South African university students: a thematic analysis

This study aimed to investigate contextual influences on condom use by South African university students. Twenty one-to-one, semi-structured interviews were conducted with male and female South African undergraduates. The data were thematically analysed. Results revealed that condom use was transient and often unrelated to disease prevention. Condom use was impeded by closer perceived intimacy, gender dynamics, and social stigma against proposing use of condoms in a presumably committed relationship. Public health policies regarding condom, pill and injection pricing / promotion, and religious toleration also hampered condom use, by encouraging a preference over hormonal contraception or proscribing contraceptive measures altogether. The results provide a basis for considering the impact of immediate and wider social contexts on condom use, as proposed by socio-ecological models of HIV risk behaviour.     

Risk Propensity,Self-Regulation,and Entrepreneurial Intention: Empirical Evidence from China

Drawing on a self-regulation perspective, we develop and test a theoretical model linking risk propensity to entrepreneurial intention through the mechanisms of entrepreneurial self-efficacy and regulatory focus. Using survey data collected from a sample of 210 employees and managers in China, the results indicated that entrepreneurial self-efficacy and promotion focus (but not prevention focus) are positively associated with entrepreneurial intention. Furthermore, these two self-regulatory mechanisms partially mediate the relationship between risk propensity and entrepreneurial intention. Implications for entrepreneurship research and practice are offered.