Loretta Sweet Jemmott

Increasing condom-use intentions among sexually active black adolescent women.

Whether a social cognitive theory AIDS prevention intervention would increase intentions to use condoms among 109 sexually active inner-city black female adolescents was tested. Analyses revealed that the women scored higher in intentions to use condoms, AIDS knowledge, outcome expectancies regarding condom use, and self-efficacy to use condoms after the intervention than before the intervention. Although increased self-efficacy and more favorable outcome expectancies regarding the effects of condoms on sexual enjoyment and sexual partners support for condom use were significantly related to increased condom-use intentions, increases in general AIDS knowledge and specific prevention-related beliefs were not.

Reducing HIV risk-associated sexual behavior among African American adolescents: Testing the generality of intervention effects.

This randomized controlled trial tested the effects of a theory-based culture-sensitive HIV risk-reduction intervention among 496 inner-city African American adolescents (mean age = 13 years) and examined the generality of its effects as a function of the facilitators race and gender and the gender composition of the intervention group. Adolescents who received the HIV risk-reduction intervention expressed more favorable behavioral beliefs about condoms, greater self-efficacy, and stronger condom-use intentions postintervention than did those who received a control intervention on other health issues. Six-month follow-up data collected on 93% of the adolescents revealed that those who received the HIV risk-reduction intervention reported less HIV risk-associated sexual behavior, including unprotected coitus, than did their counterparts in the control condition. Self-reported sexual behavior and changes in self-reported behavior were unrelated to scores on a standard measure of social desirability response bias. There was strong evidence for the generality of intervention effects. Moderator analyses testing eight specific interaction hypotheses and correlational analyses indicated that the effects of the HIV risk-reduction intervention did not vary as a function of the facilitators race or gender, participants gender, or the gender composition of the intervention group.

Effects on sexual risk behavior and STD rate of brief HIV/STD prevention interventions for African American women in primary care settings.

OBJECTIVES We tested the efficacy of brief HIV/sexually transmitted disease (STD) risk-reduction interventions for African American women in primary care settings. METHODS In a randomized controlled trial, 564 African American women recruited at a Newark, NJ, inner-city womens health clinic were assigned to a 20-minute one-on-one HIV/STD behavioral skill-building intervention, 200-minute group HIV/STD behavioral skill-building intervention, 20-minute one-on-one HIV/STD information intervention, 200-minute group HIV/STD information intervention, or 200-minute health intervention control group. Primary outcomes were self-reported sexual behaviors in the previous 3 months; secondary outcome was STD incidence. RESULTS At 12-month follow-up, participants in the skill-building interventions reported less unprotected sexual intercourse than did participants in the information interventions (Cohens d [d]=0.23, P=.02), reported a greater proportion of protected sexual intercourse than did information intervention participants (d=0.21, P=.05) and control participants (d=0.24, P=.03), and were less likely to test positive for an STD than were control participants (d=0.20, P=.03). CONCLUSIONS This study suggests that brief single-session, one-on-one or group skill-building interventions may reduce HIV/STD risk behaviors and STD morbidity among inner-city African American women in primary care settings.

Predictors of sexual intercourse and condom use intentions among Spanish-dominant Latino youth: a test of the planned behavior theory.

BackgroundSpanish-dominant Latino youth represent a growing yet underserved segment of the U.S. population, especially in terms of protection from sexually transmitted HIV infection. There is evidence to suggest that this subgroup engages in both risk and protective behaviors that may be different from the behaviors of English-dominant Latino youth. ObjectiveTo examine theoretical predictors (attitude, subjective norm, behavioral beliefs, normative beliefs, control beliefs) of sexual intercourse and condom use with a sample of Spanish-dominant Latino youth. MethodsParticipants in this study were part of a larger randomized controlled intervention designed to reduce the risk of sexually transmitted HIV among Latino youth. This article is based on preintervention data from 141 Spanish-speaking Latino adolescents (77 girls and 64 boys) who completed a Spanish version of the questionnaire. ResultsMultiple regression analyses showed significant effects of attitudes, perceived partner approval, self-pride, and parental pride on intentions to engage in sexual intercourse. Attitudes, intentions to engage in sex in the next 3 months, self-pride, parental pride, goals, and partner approval predicted sexual intercourse in the preceding 3 months. Attitudes, subjective norms, self-efficacy, partner and parental approval, and impulse control beliefs were significant predictors of intentions to use condoms. ConclusionsThis study represents initial efforts to address the needs of Spanish-dominant Latino youth. The identification of salient beliefs that may predict sexual risk and protective behavior are relevant to the design of culturally and linguistically effective interventions.

Mediation Analysis of an Effective Sexual Risk-Reduction Intervention for Women : The Importance of Self-Efficacy

OBJECTIVE Sister-to-Sister: The Black Womens Health Project is a skill-building HIV/STD risk-reduction intervention for African American women that had significant effects in reducing self-reported sexual risk behavior and biologically confirmed sexually transmitted disease (STD) incidence. The present analyses were conducted to identify which theory-based factors that were addressed in the intervention accounted for its success. DESIGN The data were collected in the context of a randomized, 5-group intervention trial with assessments at baseline and at 3, 6, and 12 months following the intervention. A mediation analysis was conducted with condom use at last sex, self-reported 12 months after the intervention, as the outcome variable. Mediators were also measured at the 12-month follow-up. MAIN OUTCOME MEASURES Mediators were derived from social cognitive theory: condom use knowledge, hedonistic beliefs regarding effects of condom use, expected sex partner reactions to condom requests, sex partner approval of condom use, self-efficacy for impulse control, self-efficacy for carrying condoms, and self-efficacy to achieve consistent condom use with partner. RESULTS The intervention significantly improved all potential mediators except condom use knowledge (p = .15), hedonistic beliefs (p = .08), and self-efficacy for impulse control (p = .20). Analyses testing each mediator separately revealed that expected partner reaction, partner approval of condom use, self-efficacy for condom carrying, and self-efficacy for condom use were significant mediators. When they were entered into a multivariate mediation analysis, however, only self-efficacy for condom use was significant (p = .001). CONCLUSION These results highlight the importance of self-efficacy in explaining the effects of skill-building sexual risk-reduction interventions on womens use of condoms. Self-efficacy was more important than characteristics of male partners.

HIV Behavioral Interventions for Adolescents in Community Settings

Adolescence is a period of the life cycle characterized by biological, psychological, and social changes and transitions. There is growing concern that for many young people it is also a time of risks associated with sexual involvement. Adolescent pregnancy is a national concern, and far too many adolescents contract sexually transmitted infections, including infection with the human immunodeficiency virus (HIV)—the cause of acquired immunodeficiency syndrome (AIDS). In this chapter, we review research aimed at identifying effective interventions to reduce the risk of sexually transmitted HIV infections among adolescents in community settings.

Effectiveness of an HIV/STD Risk-Reduction Intervention for Adolescents When Implemented by Community-Based Organizations: A Cluster-Randomized Controlled Trial

OBJECTIVES We evaluated the effectiveness of an HIV/STD risk-reduction intervention when implemented by community-based organizations (CBOs). METHODS In a cluster-randomized controlled trial, 86 CBOs that served African American adolescents aged 13 to 18 years were randomized to implement either an HIV/STD risk-reduction intervention whose efficacy has been demonstrated or a health-promotion control intervention. CBOs agreed to implement 6 intervention groups, a random half of which completed 3-, 6-, and 12-month follow-up assessments. The primary outcome was consistent condom use in the 3 months prior to each follow-up assessment, averaged over the follow-up assessments. RESULTS Participants were 1707 adolescents, 863 in HIV/STD-intervention CBOs and 844 in control-intervention CBOs. HIV/STD-intervention participants were more likely to report consistent condom use (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.06, 1.84) than were control-intervention participants. HIV/STD-intervention participants also reported a greater proportion of condom-protected intercourse (beta = 0.06; 95% CI = 0.00, 0.12) than did the control group. CONCLUSIONS This is the first large, randomized intervention trial to demonstrate that CBOs can successfully implement an HIV/STD risk-reduction intervention whose efficacy has been established.

Theory of planned behaviour predictors of intention to use condoms among Xhosa adolescents in South Africa.

Abstract HIV/AIDS is taking a heavy toll on South African youth. Reducing their risk for HIV requires an understanding of the determinants of their HIV risk behaviours that are amendable to intervention-induced change. This study draws upon the theory of planned behaviour to identify the modifiable determinants of the intention to use condoms among Xhosa-speaking South African adolescents. The participants were 390 Xhosa-speaking 6th grade students (mean age = 12.1 years) in public schools in the township of Mdantsane, South Africa who completed an anonymous questionnaire. Multiple regression revealed that attitude and perceived behavioural control were significantly related to the intention to use condoms, whereas subjective norm was not, controlling for sexual experience, gender, and language preference. Consistent with this were additional analyses using beliefs as predictors: Hedonistic behavioural beliefs and control beliefs about condom-use negotiation and technical skills predicted intention, whereas normative beliefs did not. The theory of planned behaviour may be a useful model of condom use among Xhosa-speaking South African adolescents. An emphasis on beliefs about the adverse effects of condom use on sexual enjoyment, the ability to negotiate condom use, and the ability to use condoms correctly might improve the efficacy of HIV/STD interventions for such adolescents.

Sexual Knowledge, Attitudes, and Risky Sexual Behavior among Inner-City Black Male Adolescents

Sexual knowledge, attitudes toward sex and contraception, contraception use, and sexual behavior were examined among 200 Black male inner-city junior and senior high school students who completed an anonymous questionnaire. Virtually all of the students (97%) reported having had coitus at least once. Most (78%o) reported not using any contraceptive during initial coitus, and a majority (54%) reported not using one during their most recent coitus. Multivariate multiple regression analyses revealed that students with greater sexual knowledge and more positive attitudes toward contraception were more likely to report using contraception than were other students. Students with more liberal sexual attitudes reported greater sexual activity, including a higher frequency of, and number of female partners for, coitus and fellatio. Among students who reported involvement in a steady romantic relationship, relatively liberal sexual attitudes were associated with self-reports of a sexual relationship with a woman besides their girlfriend.

Family Structure, Parental Strictness, and Sexual Behavior among Inner-City Black Male Adolescents

Family structure, parental strictness, and sexual behavior were examined among 200 Black male adolescents who completed an anonymous questionnaire. Adolescents who lived with both of their parents reported using condoms more consistently in the past year and were less likely to report fathering a pregnancy as compared with adolescents who did not live with both of their parents. Parental strictness was related to sexual behavior, but the relation differed depending on whether the perceived strictness of the mother or the father was examined. Adolescents who perceived that their mothers were more strict than did other adolescents reported less frequent coitus and with fewer women. Adolescents who perceived that their fathers were more strict than did other adolescents reported using condoms more consistently in the past year.