Alexandra Morales

Predicting condom use in adolescents: a test of three socio-cognitive models using a structural equation modeling approach

BackgroundThe theory of planned behavior (TPB), socio-cognitive model (SCM), and information-motivation-behavioral skills (IMB) model are effective in predicting condom use. However, the adequacy of these three theoretical models in predicting the frequency of condom use (FCU) among young people has not been compared. This cross-sectional study tested the applicability and suitability of these three models in predicting the FCU, and analyzed the relationships among the postulated constructs.MethodsSexually experienced adolescents (n = 410) aged 13–18 completed a survey assessing the TPB, SCM, and IMB model constructs. Participants were students recruited from 18 high schools, randomly selected from the north, south, east, and southeast of Spain. A structural equation modelling (SEM) analysis was applied to test TPB, SCM and IBM and constructs relationships of each model using R.ResultsThe results of SEM demonstrated that behavioral skills predict behavior via motivation as hypothesized by the IMB model, but not directly via knowledge about condom use and sexually transmitted infections (STIs). Cognitive factors, such knowledge about condom use and STIs as well as condom use self-efficacy, directly predicted the FCU when modeled as per the SCM. According to the TPB, condom use intention was the best predictor of the FCU, and condom use intention was predicted by attitudes toward condom use and subjective norms related to condom use, but perceived control was not directly or indirectly related to the FCU. Based on the data, the TPB becomes the best-fit model for predicting the FCU among young people compared to the SCM and IMB model.ConclusionsFrom a statistical perspective, the TPB seems to be the most suitable model for predicting the FCU among young people compared to the other models. Overall, key direct predictors of the FCU in adolescents included condom use intention, behavioral skills and cognitive factors, such as STIs knowledge and condom use self-efficacy. The next step should be to test integrative models that include personal, contextual, environmental, and social factors.

Sexual behaviour under the influence of alcohol among Spanish adolescents

Este trabajo tiene como objetivo comparar el comportamiento sexual y los factores protectores y de riesgo entre adolescentes que mantienen relaciones sexuales bajo la influencia del alcohol y los que no lo hacen, y determinar los factores predictores de la combinacion sexo y drogas. Se analizaron las diferencias entre estos dos grupos en comportamiento sexual, actitud hacia el VIH, norma subjetiva y conocimientos sobre el VIH. Mediante medidas de autoinforme fueron evaluados 1216 adolescentes espanoles entre 14 y 18 anos (M = 15.92, DT = .76), fueron seleccionados 297 por ser sexualmente activos. De estos, 117 informaron haber mantenido relaciones sexuales bajo la influencia del alcohol en los ultimos seis meses (51% fueron chicas). Los adolescentes que combinaron sexo y alcohol se implicaron en mayor medida en sexo vaginal, sexo oral y sexo anal respecto a los que no lo hicieron. Haber mantenido relaciones sexuales bajo la influencia del alcohol en los ultimos seis meses se relaciono con una actitud negativa hacia el uso del condon cuando existen obstaculos para su uso y menor uso consistente del preservativo. No hubo diferencias en el conocimiento sobre el VIH entre ambos grupos. Los adolescentes que combinaron sexo y alcohol presentaron en mayor medida caracteristicas asociadas con el riesgo sexual. Las medidas preventivas deben atender a las caracteristicas particulares de este grupo de riesgo. Se requiere mayor evidencia de los efectos del alcohol sobre el comportamiento sexual.

Validación de una escala de conocimiento sobre el VIH y otras infecciones de transmisión sexual en población adolescente

Resumen Objetivo El objetivo de esta investigación es analizar la fiabilidad y validez de un cuestionario que evalúe de forma específica el conocimiento sobre el VIH y otras infecciones de transmisión sexual en una muestra de adolescentes españoles. Diseño Estudio descriptivo transversal para la validación de un cuestionario. Emplazamiento 17 centros escolares de cinco provincias españolas. Participantes 1.570 adolescentes entre los 13 y los 17 años escolarizados en institutos. Intervenciones Se estableció un banco de 40 ítems relativos a conocimiento sobre VIH y otras infecciones de transmisión sexual. Este banco fue sometido a un juicio de expertos, para detectar posibles errores. Seguidamente, se administró a un grupo piloto, con las mismas características sociodemográficas de la muestra, para garantizar la comprensión. Mediciones principales Análisis de ítems, consistencia interna, test-retest y análisis factorial exploratorio Resultados Cinco factores explicaban el 46% de la varianza total: conocimiento general sobre el VIH, del preservativo como método protector, de las vías de transmisión del VIH, de las medidas de prevención del VIH y sobre otras infecciones de transmisión sexual. La fiabilidad oscila desde 0,66 hasta 0,88. La correlación test-retest fue de 0,59. Existen diferencias de conocimientos en función del sexo. Conclusiones Estos factores tienen una adecuada consistencia interna y una correlación test-retest aceptable. A nivel teórico encajan adecuadamente respecto al contenido de los ítems. Entre los factores se observa una relación moderada, lo que indica que el tener un elevado grado de conocimiento respecto a un aspecto, no garantiza el tener conocimiento general elevado. El disponer de un cuestionario para evaluar el conocimiento de las infecciones de transmisión sexual es de gran ayuda para evaluar programas preventivos.OBJECTIVE The objective of this research is to determine the validity and reliability of a questionnaire designed to specifically assess the knowledge of HIV and other sexually transmitted infections in a Spanish adolescent population. DESIGN Cross-sectional study for the validation of a questionnaire. LOCATION A total of 17 schools in five Spanish provinces. PARTICIPANTS A total of 1,570 adolescent schoolchildren between 13 and 17 years old. INTERVENTION A pool of 40 items relating to knowledge about HIV and other sexually transmitted infections was established. This pool was analyzed by an expert panel. It was then administered to a pilot group with the same demographic characteristics of the sample, to ensure comprehension. MAIN MEASUREMENT Item analysis, internal consistency, test/retest and exploratory factorial analysis. RESULTS A factor analysis was performed, in which five factors that explained 46% of the total variance were retained: general knowledge about HIV, condom as a protective method, routes of HIV transmission, the prevention of HIV, and other sexually transmitted infections. Reliability measures ranged from 0.66 to 0.88. The test-retest correlation was 0.59. There were gender differences in the knowledge of infections. CONCLUSIONS These factors have adequate internal consistency and acceptable test-retest correlation. Theoretically, these factors fit properly with the content of the items. The factors have a moderate relationship, indicating that a high degree of knowledge about an aspect, but not a guarantee of general knowledge. The availability of a questionnaire to assess knowledge of sexually transmitted infections is helpful to evaluate prevention programs.

Sexual risk behaviors increasing among adolescents over time: comparison of two cohorts in Spain

Despite advances in treatment and prevention, HIV/AIDS remains a serious health and social problem. This studys objective is to examine sexual behavior, levels of knowledge, and attitudes toward HIV/AIDS between two cohorts in Spanish adolescents, and to analyze gender differences in these cohorts. Participants were 2132 adolescents between 15 and 18 years of age: 1222 in 2006 (43.2% boys) and 910 in 2012 (54.1% boys). The results indicate lower HIV knowledge and less favorable attitudes about HIV/AIDS in the 2012 cohort. In addition, adolescents from the 2012 cohort had their first sexual intercourse at an earlier age and have more sexual partners than those from the 2006 cohort. Compared to boys, girls engage in fewer risky behaviors, although they did not use condoms with their stable partner; girls tended to use condom less when they were in a stable relationship than boys. This study confirms the insufficiency of prevention campaigns as well as the need to improve the impact from programs that promote healthy sexual habits. Assuming comparability of cohorts, this study suggests increased risk of HIV/AIDS over time.

The short-term impact of peers as co-facilitators of an HIV prevention programme for adolescents: A cluster randomised controlled trial

Abstract Background There is no consensus concerning the most effective type of facilitator to promote healthy sexual behaviours in interventions targeting adolescents. Objectives To evaluate the facilitators effect on the implementation of the COMPAS programme (Spanish acronym for Skills for Adolescents with Healthy Sexuality), a school-based HIV prevention protocol. Methods Participants were 832 Spanish scholars aged 14 to 18. Fifteen schools were randomly assigned to one of the three following schemes: COMPAS delivered by experts only; the same programme administered by experts and peers; or a control group, not exposed to any intervention. Results The experts achieved an improvement in HIV knowledge and attitudes towards HIV and condom use; however, experts associated to peers only succeeded in increasing HIV knowledge. The effect size of the changes indicated a greater positive change in the programme when applied by experts than by experts and peers. Conclusions The participation of peers as co-facilitators did not increase the efficacy of a programme delivered by experts to Spanish adolescents. Education delivered by experts was the most effective modality for reducing sexual risk. COMPAS is the only Spanish programme targeting the promotion of safer sex behaviours in adolescents whose efficacy has been evaluated with different health agents in Spain. Chinese Abstract 摘 要 背景 关于促进青少年健康性行为干预措施的最为有效的促进因素尚未达成共识。 目的 为了评估COMPAS计划（青少年健康性行为相关技能的西班牙语首字母缩写）实施中促进因素的作用，该计划是一项以学校为基础的HIV预防方案。 方法 参加者是832名年龄在14至18岁的西班牙学生。以下三种方案中的任一种被随机分配给15所学校：仅由专家给予COMPAS;由专家和同龄学生给予相同的课程；对照组不采取任何干预措施。 结果 专家组的学生在HIV相关知识和对待HIV及使用避孕套的态度方面有改善；而专家联合同龄学生组只在增进HIV知识方面有提高。这种变化的大小说明专家组比专家联合同龄学生组有更显著的影响。 结论 同龄学生参与计划作为共促进因素并不增加给予西班牙青少年课程专家组的有效性。COMPAS是西班牙唯一一项针对青少年实施的促进其较安全性行为的计划，其有效性由不同西班牙健康代理机构评估。

Riesgo sexual en adolescentes según la edad de debut sexual

In Spain young people have their first sexual intercourse at an earlier age than in other countries; however, little is known about the relationship between age of sexual debut and sexual behavior in this population. Sexual practices and methods of protection are analyzed depending on the age of sexual debut among Spanish adolescents who are sexually experienced (N = 351). The mean age was 15.9 years (SD = .75, range: 14-18). Three groups were formed according to the age of sexual debut reported: early sexual debut (earlier than 15 years), average (15 years) and late (later than 15 years). The early sexual debut group reported further mutual masturbation, vaginal intercourse and oral sex with a higher number of sexual partners than the rest. Condom use at first intercourse, percentage of use and consistent condom use was significantly lower in the early sexual debut group compared to the others. Sexual debut before 15 years old was associated with increased risk of sexual infections, deficit in condom use and increased sexual exposure. The findings of this study suggest that the age of sexual debut has implications for the sexual health in young people.

Nicotine Dependence as a Mediator of Project EX’s Effects to Reduce Tobacco Use in Scholars

In Spain, 44% of 14–18-year-olds have smoked, and 12.5% have smoked cigarettes in the last 30 days. Nicotine is one of the most addictive substances, and can lead to serious addiction in adulthood with adverse consequences to one’s health. School plays a relevant role in health promotion and preventing risk behaviors such as tobacco consumption. Despite the fact that some school-based tobacco cessation and prevention interventions prove to be effective for their purposes, there is a lack of understanding as to why these programs succeed or fail. This longitudinal study aims to test the nicotine dependence (ND) as a mediator of Project EX’s effect – a tobacco-use cessation program developed for high school youth to reduce tobacco consumption in scholars. Six high schools located in the Mediterranean coast were randomized for the participation of the program (Spanish version of Project EX) or a waiting-list group with baseline, immediate-posttest, and 12-month follow-up assessments. At baseline, 1,546 adolescents aged 14–21 years old (mean age: 15.28; SD = 1.20; 46% were women) were evaluated by self-administered tests on tobacco consumption and ND. A biomarker of smoke inhalation – a measurement of exhaled carbon monoxide (ECM) – was used. Participants who were smokers (N = 501; 32%) were selected for this study. Mediation analyses were conducted using the PROCESS v2.12 macro for Windows. The significant criterion was p ≤ 0.05, and 5,000 samples were used for bias-corrected bootstrap confidence intervals. Results indicated that Project EX indirectly decreased the number of cigarettes smoked in the last month, the number of cigarettes smoked within the last 7 days, the number of daily cigarettes, and ECM level at 12-month follow up through decreasing the level of ND in the short-term. This is the first Spanish study that explores ND as a mediator of the long-term efficacy of Project EX to reduce tobacco consumption in adolescents. Results suggest that interventions that reduce ND at short-term are more likely to be successful to decrease tobacco use at long-term.

Short Health Anxiety Inventory: Factor structure and psychometric properties in Spanish adolescents:

The Short Health Anxiety Inventory is a common screening tool for assessing health anxiety among adolescents; however, its psychometric properties and internal structure have not been evaluated within a Spanish-speaking population. The goodness of fit of four models of the latent structure of the Short Health Anxiety Inventory was tested by using confirmatory factor analysis in a sample of 832 Spanish secondary school adolescents. Based on these results, the reliability of the original two-factor model was tested. Differences in health anxiety by gender and age were also examined. The results support use of the Spanish version of the Short Health Anxiety Inventory by researchers and clinicians among Spanish adolescents.

Two-Year Follow-Up of a Sexual Health Promotion Program for Spanish Adolescents.

The aim is to evaluate the effects of the Competencias para adolescentes con una sexualidad saludable (COMPAS) program and compare them with an evidence-based program (¡Cuídate!) and a control group (CG). Eighteen public high schools were randomly assigned to one of the three experimental conditions. Initially, 1,563 Spanish adolescents between 14 and 16 years of age participated, and 24 months after their implementation, 635 of them completed a survey. Self-report measures collected data on sexual behavior, knowledge, attitudes, intention, sexual risk perception, and perceived norm. Compared to the CG, COMPAS increased the level of knowledge about sexually transmitted infections and improved the attitudes toward people living with human immunodeficiency virus at the 2-year follow-up. Neither intervention had a long-term impact on behavioral variables. Results suggest that COMPAS has a comparable impact to the other intervention on the variables predicting consistent condom use. Reinforcing the messages and skills that have the greatest impact on condom use and adding booster sessions following program completion as strategies to maintain long-term effects are necessary.

Validation of the short version of the Cognitive Emotion Regulation Questionnaire for Spanish children

This study aimed to validate a short version of the Cognitive Emotion Regulation Questionnaire for Spanish kids (CERQ-Sk) based on the 18-item version available for adults. A sample of 654 children aged 7–12 years completed the CERQ-Sk and tests for depression and anxiety measures. Confirmatory factor analysis supported the 18-item version and the original nine-factor structure, which includes self-blame, acceptance, rumination, positive refocusing, refocus on planning, positive reappraisal, putting into perspective, catastrophizing, and other-blame (comparative fit index = .99, Tucker–Lewis index = .98, root mean square error of approximation = .02). Internal consistency was adequate (ordinal α = .80), and the eight-week stability of this version was moderate (intraclass correlation = .69). Criterion validity was supported by correlations among self-blame, rumination, and catastrophizing (positive) and among positive reappraisal and depression and anxiety symptoms (negative). Results suggest that the short version of the CERQ-Sk is a valid and reliable instrument for assessing these cognitive emotion regulation strategies during the middle childhood developmental period. Clinicians and researchers will benefit from this briefer acceptable version when time is not available for the 36-item version. This study offers preliminary results for the first short version of the CERQ for children.