Eleni L. Tolma

Examining the Theory of Planned Behavior and the Construct of Self-Efficacy to Predict Mammography Intention:

This article examines the applicability of the Theory of Planned Behavior (TPB) with the addition of the selfefficacy construct in the understanding of the motivation to obtain an initial screeningmammogramamong Cypriot women. The study sample consisted of 293women aged 40 to 65 years, asymptomatic of breast cancer, and with no previous mammography experience. The study took place at the General Hospital of Nicosia in Cyprus. The results of the study provided support of the TPB with the addition of self-efficacy in an international setting. Self-efficacy was the strongest predictor of intention. Other predictors of intention included educational level, time of last clinical breast examination, and age. The study also provided some empirical support of the distinction between self-efficacy and perceived behavioral control. Researchers may want to include self-efficacy in addition to the TPB and other demographic characteristics in future applications to more fully explain behavioral outcomes.

Cognitive motivations associated with screening mammography in Cyprus

BACKGROUND This study examined the relationship between cognitive motivations, demographic characteristics, related preventive health behaviors, and intention to obtain a first screening mammogram among Greek Cypriot women. METHODS This cross-sectional study took place at the outpatient clinics of the General Hospital of Nicosia during the fall of 1999. The participants were 293 women asymptomatic of breast cancer and with no previous mammographic experience. The Theory of Planned Behavior in conjunction with the construct of self-efficacy was used in the development of the questionnaire. The assessment also included demographic information, practice of other preventive health behaviors, and knowledge of breast cancer screening. RESULTS Self-efficacy was the most significant determinant of initial screening mammography, followed by normative beliefs associated with the physician, family and close friends, and perceived behavioral control beliefs related to barriers to obtaining a mammogram. Educational level, time of last clinical breast examination, and status of breast self-examination were also strongly implicated in the explanation of initial screening mammography. CONCLUSIONS Insights into specific salient motivational cognitions and certain demographic characteristics or related preventive health behaviors are crucial to the development and implementation of effective intervention strategies.

School-Related Assets and Youth Risk Behaviors: Alcohol Consumption and Sexual Activity

BACKGROUND Two risk behaviors, alcohol consumption and early initiation of sexual intercourse (ISI), can have devastating consequences for youth. The purpose of this study was to determine the association of school connectedness and school-related behaviors (eg, academic performance, skipping school, getting into trouble at school) with these 2 risk behaviors. METHODS The Youth Asset Survey (YAS) was administered to 1117 youth/parent pairs in their homes using Computer-Assisted Personal/Self-Interviewing (CAPI/CASI). The YAS measures 17 youth assets and risk behaviors including alcohol consumption and sexual activity. RESULTS The mean age of the sample was 14.3 years; 53% were female; and 70% were from 2-parent homes. Five school-related behaviors were positively associated with no ISI. Four school-related behaviors were positively associated with reporting no alcohol consumption in the past 30 days, including the School Connectedness asset (only among 12- to 13-year-olds), not skipping school (only among non-Hispanic Caucasians), staying out of trouble, and paying attention. CONCLUSIONS School is very much a part of the lives of youth and therefore the relationship they have with their school experience is important and may influence their involvement in risk behaviors. Feeling connected to school is a positive asset that can protect youth from such risky behaviors as sexual initiation and alcohol consumption.

Youth Assets and Sexual Risk Behavior: Differences Between Male and Female Adolescents:

Youth internal assets and external resources are protective factors that can help youth avoid potentially harmful behaviors. This study investigates how the relationship between youth assets or resources and two sexual risk behaviors (ever had sex and birth control use) varied by gender. Data were collected through in-home interviews from parent—adolescent dyads, including 1,219 females and 1,116 males. Important differences exist between male and female adolescents. Females with the nonparental role models or the family communication resource were more likely to report never having had sexual intercourse than were females without the resources. Among males, the aspirations for the future and responsible choices assets were associated with never having had sexual intercourse. Males and females had two assets or resources in common that were protective of never having had sex: peer role models and use of time (religion). Considering which youth assets and resources are more likely to positively influence sexual behaviors of males and females may be important when planning prevention programs with youth.

A Longitudinal Study of Youth Assets, Neighborhood Conditions, and Youth Sexual Behaviors

PURPOSE To prospectively determine whether individual, family, and community assets help youth to delay initiation of sexual intercourse (ISI); and for youth who do initiate intercourse, to use birth control and avoid pregnancy. The potential influence of neighborhood conditions was also investigated. METHODS The Youth Asset Study was a 4-year longitudinal study involving 1,089 youth (mean age = 14.2 years, standard deviation = 1.6; 53% female; 40% white, 28% Hispanic, 23% African American, 9% other race) and their parents. Participants were living in randomly selected census tracts. We accomplished recruitment via door-to-door canvassing. We interviewed one youth and one parent from each household annually. We assessed 17 youth assets (e.g., responsible choices, family communication) believed to influence behavior at multiple levels via in-person interviews methodology. Trained raters who conducted annual windshield tours assessed neighborhood conditions. RESULTS Cox proportional hazard or marginal logistic regression modeling indicated that 11 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for ISI; seven assets (e.g., educational aspirations for the future, responsible choices) were significantly associated with increased use of birth control at last sex; and 10 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for pregnancy. Total asset score was significantly associated with all three outcomes. Positive neighborhood conditions were significantly associated with increased birth control use, but not with ISI or pregnancy. CONCLUSIONS Programming to strengthen youth assets may be a promising strategy for reducing youth sexual risk behaviors.

Reliability and validity of the youth asset survey: an update.

Purpose. Improve and expand an existing youth asset scale. Design. Consisted of seven steps: (1) review of poorer-performing items and constructs, (2) literature review for relevant new asset constructs/items, (3) review of revised instrument by panel of experts, (4) qualitative review through focus group research, (5) pilot-test of instrument, (6) evaluation of the performance of the instrument in a longitudinal study, and (7) conduct of test-retest analysis. Subjects/Setting. Youth (N = 1111) recruited through canvassing of randomly selected census tracts and blocks. Measures. Youth Asset Survey (YAS). Analysis. Factor analysis was conducted on 50% of the baseline data and repeated on the second half of the baseline data. Correlations were computed for the test-retest analysis. Results. Following modifications to the YAS based upon qualitative research, the survey was administered to youth (mean age, 14.3years; 53% female; 39% white, 28% Hispanic, 23% African-American, 9% other). Cronbach α = .55–.92. A majority (27 of 34) of α ≥ .65. All items loaded on one construct at α ≥ .40. The final results yielded 17 constructs assessed via 61 items. Spearman correlations and intraclass correlations ranged from .60 to .82 and .58 to .87, respectively. Conclusion. The results generally suggest that the expanded YAS is a reliable and valid measure of assets.

Youth Assets and Delayed Coitarche Across Developmental Age Groups

Cross-sectional studies suggest that assets are associated with youth abstinence, but whether these relationships are constant across developmental age groups has not been shown. Data for this study were obtained from two independent datasets collected across a 2-year period using in-person, in-home interviews of youth (52% female; 44% Caucasian, 23% Hispanic, 23% African-American, 10% other) and their parents (N = 2163 youth/parent pairs). Eighty-eight percent of teens aged 12-14 and 58% of teens aged 15-17 reported no sexual intercourse. Individual logistic regression models for assets and abstinence found 5 youth assets with significant adjusted odds ratios for both age groups: Non-Parental Adult Role models; Family Communication; Use of Time (Religion); Responsible Choices; and Peer Role Models. Community Involvement was associated with abstinence for young teens only and Aspirations for the Future and Good Health Practices only for middle teens. These findings can inform policies and programs targeting youth sexual decision-making.

The predictive influence of family and neighborhood assets on fighting and weapon carrying from mid- to late adolescence.

Using a developmental, social–ecological approach to understand the etiology of health-risk behavior and inform primary prevention efforts, we assess the predictive effects of family and neighborhood social processes on youth physical fighting and weapon carrying. Specifically, we focus on relationships among youth and their parents, family communication, parental monitoring, as well as sense of community and neighborhood informal social control, support, concerns, and disorder. This study advances knowledge through its investigation of family and neighborhood structural factors and social processes together, employment of longitudinal models that estimate effects over adolescent development, and use of self-report and observational measures. Data from 1,093 youth/parent pairs were analyzed from the Youth Assets Study using a Generalized Estimating Equation approach; family and neighborhood assets and risks were analyzed as time varying and lagged. Similar family assets affected physical fighting and weapon carrying, whereas different neighborhood social processes influenced the two forms of youth violence. Study findings have implications for the primary prevention of youth violence, including the use of family-based approaches that build relationships and parental monitoring skills and community-level change approaches that promote informal social control and reduce neighborhood concerns about safety.

Youth Assets and Sexual Abstinence in Native American Youth

Compared with youth of other races/ethnicities, Native American youth (ages 15–19 years) are more likely to have participated in sexual intercourse, thus placing them at greater risk for sexually transmitted diseases (STDs) and unintended pregnancies. This studys purpose was to investigate relationships among protective factors (assets) and sexual intercourse in a Native American youth population. Data were collected from Native American youth and their parents (N=126 youth/parent pairs) living in randomly-selected households using in-person, in-home interview methods. Nine youth assets were the independent variables and never had sexual intercourse was the dependent variable. Data were analyzed using logistic regression. One significant (p<.05) asset main effect and one asset by youth age interaction were found. Youth with the Non-Parental Adult Role Models asset were 3.8 times more likely to have never had sex compared with youth without the asset. Further study of the influence of protective factors among Native American youth is warranted.

Parental youth assets and sexual activity: differences by race/ethnicity.

OBJECTIVES To examine how the relationship between parental-related youth assets and youth sexual activity differed by race/ethnicity. METHODS A random sample of 976 youth and their parents living in a Midwestern city participated in the study. Multivariate logistic regression analyses were conducted for 3 major ethnic groups controlling for the other demographics. RESULTS Parental monitoring had the strongest association with sexual abstinence for all 3 ethnic/racial groups. Family communication and relationship with mother were also important for white and black youth respectively. CONCLUSIONS Parental youth assets, especially parental monitoring, can be important in the decision to delay sexual intercourse.