Safer sex in a digital world: A Web-based motivational enhancement intervention to increase condom use among college women

ABSTRACT

Objective: This study is a randomized trial of a Web-based intervention to increase condom use among college women. Participants: From October 2012 to March 2013, N = 422 completed baseline questionnaires and intervention procedures. n = 216 completed 3-month follow-up. Methods: Participants completed a decisional balance exercise examining their sex acts over the past 3 months and wrote an essay encouraging young girls to use condoms. All procedures were conducted online. Results: The intervention improved intentions to use and attitudes towards condoms for 3 subscales of condom attitudes. Attitudes following the intervention significantly predicted condom use at 3-month follow-up, and this relationship was mediated by condom intentions immediately post intervention. The relationship between intentions and condom use was moderated by group. Conclusions: The intervention improved condom attitudes and intentions immediately post intervention, and immediately post intervention intentions had a greater impact on condom use at 3-month follow-up among those in the condom intervention compared with those in the control group.     

Encouraging Safer Sex: Mediating and Moderating Effects on Condom Use Among Italian Girls

ABSTRACT

Objectives: The present study investigated the effects of condom availability, peer norms, and negotiation self-efficacy on girls’ perception of male condom use. Methods: Participants were presented with a vignette in which condom availability, peer norms, and negotiation self-efficacy were manipulated. Results: Condom availability and peer norms interacted in determining condom use, such that protected sex was more likely when a condom was available and when peer norms approved, rather than disapproved, of condom use. The effect of peer norms on condom use was mediated by intentions to use a condom and communication between partners about condom use. Condom communication, identified as a direct antecedent of condom use, was influenced by negotiation self-efficacy. Conclusions: These results suggest that interventions aimed at reducing risky sexual behavior should not only make condoms available but also address key psychosocial variables, such as peer norms. Condom communication should be taken into account as well, considering that it can be affected directly by negotiation self-efficacy and can be affected indirectly by peer norms.     

Lights,camera, condoms! Assessing college men's attitudes toward condom use in pornography

ABSTRACT

Objective: Investigate male college students' attitudes toward actors' use of condoms in pornography. Participants: Two hundred thirteen undergraduate males attending a large, state-supported midwestern university in the fall semester, 2012. Methods: Using a Web-based procedure, participants completed questionnaires assessing their pornography use, sexual history characteristics, and their attitudes toward condom use by adult performers. Results: Factor analysis of the 11-item condom use attitudes questionnaire supported 2 distinct subscales: Condom Supportive Attitudes and Condom Critical Attitudes. Although participants typically agreed with statements supportive of condom use and generally disagreed with statements critical of condom use in pornography, gay men had significantly higher condom supportive subscale scores than did heterosexual men. Neither subscale was correlated with weekly viewing of pornography. Conclusions: Although some producers of adult films argue that actors wearing condoms will displease many viewers, current findings suggest that young men express support for use of condoms by pornographic film actors.     

Relationship intentions,race, and gender: Student differences in condom use during hookups involving vaginal sex

Abstract

Objective: To examine the relationship between race, gender, and pre-hookup relationship intentions and college students’ participation in condomless vaginal sex. Participants: 3,315 Black and White college students who participated in the Online College Social Life Survey (OCSLS). Methods: Secondary data analysis of the OCSLS using Chi-square and multiple logistic regression analyses. Results: The model revealed that students who did not want a relationship with their hookup partners and students unsure of their relationship intentions were more likely to use condoms during their last vaginal hookup. Further, White and Female students were less likely to have used condoms during their last vaginal hookup.

Conclusions: White and female students, as well as students desiring romantic relationships with hookup partners may be at risk for sexually transmitted infections (STIs) due to decreased condom use. However, more research is needed to explore the factors driving STI disparities facing Black students despite higher condom use.     

Women's Perceptions of Alcohol-Related Sexual Disinhibition: Personality and Sexually-Related Alcohol Expectancies

ABSTRACT

Scales assessing attitude toward condoms typically focus on their use for a specific context or outcome (sexually transmitted diseases/HIV prevention or pregnancy prevention) and not the characteristics of a condom itself. To assess the psychometrics of the Multi-Factor Attitude toward Condoms Scale, data from 1,832 U.S. men were analyzed. Internal consistency was acceptable (α= .816) with three factors accounting for 61.44% of the variance (affective, perceived effectiveness, and manageability). Additional validity assessments demonstrated construct validity for this new attitude toward condoms scale that focuses on the properties of the condom and not a specific behavioral or outcome-focused context.     

Condom Use Completeness,Perceptions, and Sexual Quality at Most Recent Sexual Event: Results from a U.S. Nationally Representative Probability Sample

Abstract

Objectives: To explore perceptions of condoms associated with complete use and evaluate relationships between condom perceptions, condom use, and sexual quality.

Methods: Using data from a U. S. nationally representative probability sample, we assessed individuals’ condom use perceptions and related characteristics of their most recent sexual event through bivariate and regression analyses (n?=?234).

Results: Most participants reported complete condom use and neutral or positive perceptions of condoms. Though incomplete use was associated with orgasm among women, arousal and pleasure did not differ by gender or duration of condom use.

Conclusions: We found no evidence that delayed application or early condom removal increased sexual arousal or pleasure, which may help sexual health promotion interventions address negative cultural ideas about condoms.     

Explaining Condom Use Disparity Among Black and Hispanic Female Adolescents

The study examined condom use among 204 Black and Hispanic female adolescents who attended family planning clinics. Partner attitude, partner communication, parental communication and social support measures were used in a multinomial logistic regression model to predict condom use at last intercourse. The results indicated that adolescents who perceived that their partners had a positive attitude toward condom use were 1.37 times more likely to report condom use compared to those whose partners did not have a positive attitude. Additionally, adolescents who reported communicating with partners about condoms were .37 times more likely to use condoms compared to those who did not communicate with their partners. These findings suggest that increasing condom use among female adolescents will require addressing primarily partner factors. Male partners must also be included in interventions to increase condom use.     

Condom Use,Condom Refusal,and Substituted Sexual Behaviors Among Youth at Higher and Lower Risk for HIV Infection

ABSTRACT

The purpose of this study was to describe sexual behaviors that youth substitute for protected intercourse when a partner refuses to use a condom or a condom is not used. Participants included: (a) 120 adolescents (mean age 17.2 years) undergoing substance abuse treatment and (b) 171 university students (mean age 21.3 years). The treatment sample reported significantly higher levels of discrete risk factors for HIV exposure. While only a small proportion of each sample experienced outright refusals by partners to use condoms, the majority of participants in each sample used condoms inconsistently with main partners. The university sample reported more substituted behaviors (lower risk and total) when partners did not want to use condoms. Yet, substantial proportions of participants in each sample engaged in unprotected intercourse. Implications for social work and health promotion efforts directed toward youth at risk for HIV/STD exposures are discussed.     

Safer Sex and the Health Belief Model

Abstract

The goal of the present study was to build on the Health Belief Model (HBM) by adding predictors of late adolescent safer sex behavior: perceptions of peer norms for sexual behavior, and sexual attitudes that emerge from socialization. Sexually active, late adolescent college students (N = 154, 62.3% female; mean age 20.8 years, 76% European American) participated in the study. Predictors from the original HBM included perceived vulnerability, condom use self-efficacy, and attitudes about condoms. In addition, peer norms for condom use and sexual behavior, general sexual attitudes, and endorsement of the sexual double standard were included as predictors of safer sex behavior. Attitudes about condoms, perceived vulnerability, condom use self-efficacy, and the sexual double standard emerged as significant correlates of condom use. General sexual attitudes and the sexual double standard were significantly correlated with alcohol use before or during sex. With the addition of these variables, the regression models accounted for 28% of the variance in condom use, and 14% of the variance in alcohol use before or during sex.     

Preparing for Male Condom Use: The Importance of Volitional Predictors

Objectives: Intention is not sufficient to actually use condoms, as self-regulatory processes are needed to translate motivation into action. This study has focused on the role of preparatory behaviors as a proximal predictor of condom use and examined how they contribute to the self-regulatory processes proposed by the health action process approach model. Methods: An on-screen longitudinal study was conducted with 3 measurement points 2 weeks apart. The participants were young men aged 18 to 25 years old (N = 203) recruited from vocational training centers. Outcome expectancies, perceived self-efficacy, intention, action planning, coping planning, volitional self-efficacy, preparatory behaviors, and condom use were assessed by self-report. A structural equation analysis was used to test a series of 3 nested models, with all parameters estimated by bootstrapping. Results: The model proposed that the included preparatory behaviors provided the best fit to the data. Preparatory behaviors were the most proximal predictors of condom use, and mediation occurred in a sequential manner with preparatory behaviors preceding the volitional variables, action and coping planning, and volitional self-efficacy. Conclusions: To bridge the intention–behavior gap, preparatory behaviors play a mediating role, demonstrating how they work in conjunction with other volitional variables such as planning and self-efficacy in the translation of behavioral intentions into actual condom use.     

Condom Use in Heavy Drinking College Students: The Importance of Always Using Condoms

Abstract

Objective: The authors examined whether alcohol use decreased condom use. Participants: The subjects were heavy-drinking students on 5 different college campuses. Methods: A face-to-face interview, administered between November of 2004 and February of 2007, gathered information about condom use, alcohol use, and other behaviors. Multivariate logistic regression was used to assess predictors of condom use. Results: Of the 1715 participants, 64% reported that they did not always use condoms. Male students who drank heavily were less likely to always use condoms (adjusted odds ratio [AOR] 0.61). Participants with more sexual partners used condoms less when drinking (AOR 1.93 for men, 1.45 for women). Conclusions: Many students do not use condoms consistently, especially those who drink heavily or have multiple sexual partners. Clinicians at student health need to encourage all students to use condoms every time they have intercourse.     

Determinants Influencing Male Condom use Among University Students in Portugal

ABSTRACT. A self-administered questionnaire was carried out among university students in Portugal, with the aim to examine determinants influencing male condom use, according to the information–motivation–behavioral skills model (J. Fisher & Fisher, 1992). Students’ levels of information, motivation, and behavioral skills regarding preventive sexual behavior (male condom use) were ascertained and were used to determine their association with condom use among 880 male and 1,807 female students aged 18 to 35 years old. Although 86.9% of respondents indicated that they used a condom during their first sexual intercourse, only 32.8% used a condom always during sexual intercourse in the last 12 months. Most young people, especially women, had a good level of information regarding HIV/AIDS transmission/prevention. They also showed reasonable positive attitudes and had positive subjective norms and intentions toward HIV/AIDS preventive behaviors. Men presented a higher perceived difficulty and a lower perceived effectiveness of HIV/AIDS preventive behavior, therefore reporting higher risk acceptance. A path analysis revealed that preventive sexual behavior did not depend directly on information level but on motivation and behavioral skills (especially among men). Information about HIV prevention/transmission was not significantly associated with condom use. The finding that motivation and behavioral skills were the strongest determinants of condom use suggested that these may be important factors in effective sexually transmitted infection-prevention programs.     

Examining interactions within the theory of planned behavior in the prediction of intentions to engage in cannabis-related driving behaviors

Abstract

Objective: As marijuana use becomes more available to college students through increasing legal reform, this paper seeks to examine intentions for driving under the influence of cannabis (DUIC) and riding with a high driver (RWHD) through the lens of the theory of planned behavior (TPB) and assess potential interactions between personal attitudes, subjective norms, perceived behavioral control (PBC), and sex. Participants: Undergraduate college students (N?=?311) completed online surveys in September, 2013. Method: Participants self-reported their attitudes toward DUIC, subjective norms, PBC, past DUIC and RWHD, and intentions to DUIC and RWHD. Results: Participants’ attitudes toward DUIC, subjective norms, and PBC were strongly associated with intentions to DUIC and RWHD bivariately. In regression models, attitudes and PBC were both positively and significantly related to intentions to DUIC and RWHD. Conclusions: DUIC and RWHD are concerns for college populations. Targeting personal attitudes and perceived behavioral control via interventions may reduce these behaviors.     

Knowledge,attitudes, and behavior related to condom use and STDs in a high risk population

Since the mid‐1980s, the incidence of sexually transmitted diseases (STDs) among Blacks has increased dramatically nationwide, particularly in Philadelphia and other major urban areas. One approach to this public health problem is to prevent the further transmission of disease through the use of condoms during sexual activity. To provide a basis for condom‐promotion programs within a high risk Black urban community, we explored condom use behavior and the relationship between condom use and variables related to demographic characteristics, knowledge, attitudes, perceived risk and concern about STDs, and STD history. A household survey was conducted of a stratified, quota sample of 925 male and female adolescent and adult residents in North and West Philadelphia. These areas have the highest rate of STDs in the city and among the highest rates in the country. The survey revealed a trichotomy among respondents with respect to condom use: approximately one‐third of the sample used condoms consistently; one‐third used them intermittently, and one‐third never used condoms. Consistent condom users tended to use condoms with both steady and casual partners; less frequent condom users tended to use condoms with partners who could be considered higher risk: new partners and casual partners. Although condom use rates did not vary as a function of age among males, women under age 20 were far more likely to use condoms than were other female age groups. Knowledge about STDs and prevention was not found to predict condom use. Negative attitudes toward condoms were related to non‐use, with the exception of women who used condoms in perceived high risk situations despite negative attitudes.     

Expectancies specific to condom use mediate the alcohol and sexual risk relationship

The present study tested the role of alcohol expectancies for condom use in mediating the alcohol and risky sex relationship. Expectancies for condom use are specific anticipations for alcohol's effect on one's ability to use a condom. College students (N = 563) reported on beliefs, intentions and actual sexual and drinking behavior. Among the sexually active, alcohol was directly related to future intention to use a condom in drinking situations for men, but not for women. In the men, alcohol expectancies for condom use mediated the relationship between drinking and condom intention. Beliefs that alcohol negatively impacts one's ability to use condoms were associated with more drinking and lower intentions to use a condom. These expectancies may help explain how alcohol affects risky sex in men. Gender differences and implications are discussed.     

A Novel,Self-guided,Home-Based Intervention to Improve Condom Use Among Young Men Who Have Sex With Men

Abstract

Objective: This pilot study tested the efficacy of a brief, novel, theory-driven, self-guided, home-based intervention designed to promote condom use among young men who have sex with men (YMSM). Participants: Thirty YMSM were recruited from a large public US midwestern university during spring of 2012. Methods: The intervention was tested using a repeated measures design with the primary follow-up assessment occurring 6 weeks after enrollment. Results: Forty-five percent of men reported a reduced frequency of unprotected insertive penile–anal intercourse in the past 30 days compared with baseline (p = .01). Consistency of condom use improved (p = .013), as did motivation to use condoms correctly, condom use self-efficacy, and condom attitudes. All participants indicated that they were glad they participated, would recommend the program, and that overall, they had liked the program. Conclusions: This pilot study supports an expanded trial of this intervention with MSM at high-risk of acquiring human immunodeficiency virus/sexually transmitted infections (HIV/STIs).     

Stage-Based Computer-Delivered Interventions to Increase Condom Use in Young Men

ABSTRACT

Objectives: The aim is to examine whether adopting or increasing condom use can be influenced by psychological treatment targeting both motivational and volitional aspects, when these components are matched to the characteristics of the recipients. Method: In a randomized controlled trial, 159 heterosexual young men (intervention groups, n = 113; control condition, n = 46) were exposed to 2 computer-delivered intervention arms, 1 targeting nonintenders (n = 36; motivational intervention arm) and the other targeting intenders (n = 77; volitional intervention arm). Intention and condom use were assessed through self-report questions at 3 points in time, each 2 weeks apart. Motivational intervention involved screen content requesting decisional balance for condom use and focus on past success to trigger self-efficacy. Volitional intervention encouraged the formation of specific if-then plans, where participants were required to choose and write about the most favourable situations by means of reflection on when, where, and how to carry them out, and of thinking about strategies for obstacles that might hinder condom use. Results: Experimental nonintenders obtained higher levels of condom use intention two weeks and one month later and of reported condom use one month later than control nonintenders. Experimental intenders reported an increase in condom use in comparison with control intenders one month later. Conclusions: At a 30-day follow-up, treatment was shown to have helped nonintenders to first increase their condom use intentions and later condom use, and intenders to improve condom use behavior. A stage-based computer-delivered intervention design including motivational and volitional treatment appears to be suitable for improving condom use motivation as well as behavior after a 1-month period.     

The State of the Union: Sexual Health Disparities in a National Sample of US College Students

Abstract

Objective: To examine sexual health disparities between blacks and whites in a national sample of US college students. Participants and Method Summary: Analyses utilized secondary data from 44,165 nonmarried undergraduates (aged 18–24; M = 20.1) responding to the Spring 2007 American College Health Association–National College Health Assessment; 64% were female and 94.7% were white. Results: Whites reported more experience in oral and anal sex, were less likely to use condoms for oral, anal, and vaginal sex, and less likely to have been tested for HIV (human immunodeficiency virus) compared with blacks. However, blacks reported more sex partners, lower use of hormonal contraceptives, and higher rates of adverse sexual health outcomes, such as sexually transmitted infections (STIs) and unintended pregnancy. Sexual behaviors and outcomes also varied across gender. Conclusions: This study highlights a need to increase access to hormonal contraceptives and early STI screening/treatment among blacks, improve HIV testing among whites, and increase condom use promotion for all students.     

Using Fear to Encourage Safer Sex

Rogers' (1983) Protection Motivation Theory (PMT) was used as a basis for generating an STD information intervention to encourage positive attitudes toward safer sex practices. PMT identified four components that influence intentions to engage in adaptive behaviors to avoid disease and bodily injury, including (a) perceived severity, (b) perceived vulnerability, (c) responseeff~cacy, and (d) self-efficacy. The effect of severity and response-efficacy messages on safer sex attitudes and intentions of college students was examined in the present study. Those who were exposed to photographs of diseased human genitals (high severity) and messages that presented condoms as effective for reducing STD risk (high responseefficacy) were expected to score highest on percaved STD severity and perceived condom-efficacy. This group was also expected to report the most positive attitudes toward condoms and STD prevention, and the strongest intentions to use condoms in future sexual episodes. The high severity condition produced the strongest perception of STD severity, but the messages about condoms produced no differences in perceived responseefficacy. No differences in attitudinal measures were found, but those exposed to consistent severity and efficacy messages reported greatest intentions to engage in safer sex.