Effective targeted and community HIV/STD prevention programs

Community interventions and interventions targeting specific groups at risk of STDs/HIV have demonstrated significant impacts on sexual behavior, particularly condom use and safer sex. The scientific evidence suggests the factors that make these interventions particularly effective include the establishment of community, including business and CBO partnerships; maintainance of the intervention post-research funding; and buy-in by the community or target group. The modification of risky normative beliefs through the use of opinion leaders and role models, and through intervention delivery by peer educators, is an important facet of such interventions. Interventions delivered by health professionals, absent a community base, appear to be unsuccessful. Where cultures or subcultures are targeted, the close involvement of such groups in the design and delivery of messages is critical to their success. Diffusion of interventions through existing social networks further extends the intervention into the community and acts to reinforce and maintain changes in peer norms toward safer sexual behavior. The available data confirm that community or medical infrastructure-based interventions are effective in changing sexual behavior and can reach a wider range of the population than face-to-face programs if they incorporate peer educators as role models in modifying norms, and if diffusion of the intervention is integral to the design.     

Digital Peer Interactions Affect Risk Taking in Young Adults

Digital interactions are an increasingly common communication method among young adults, but little is known about whether such remote exchanges influence riskiness. The current study examined whether observing and interacting with, versus simply observing, a digital peer affect risk taking in young adults aged 18–25. Participants who remotely viewed risky behavior by a peer or computer increased risk taking; however, compared to a control condition, only exposure to risk‐encouraging messages from a digital peer resulted in sustained risk‐taking behavior. These findings suggest that short text‐based messages from a risk‐encouraging digital peer can influence risk‐taking behavior in young adults. Given the rapid proliferation of digital communication among this age group, these results highlight a potentially important source of peer influence on risky behavior.     

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.     

Risk behaviors and perceptions of AIDS among street injection drug users

Standardized survey interviews (n = 325) and guided in-depth interviews (n = 22) were conducted with injection drug users (IDUs) in Long Beach, California, to document drug usage and injection patterns, sexual practices, perceived risk of HIV infection, sources of health information, and knowledge and attitudes about AIDS. Most IDUs reported sharing needles (87.9%), and a large minority reported regular sterilization of needles/syringes (40.3%). Lower rates of needle sharing were reported among cocaine users than among heroin and speedball users. HIV seroprevalence was 5.7 percent (11/194). Sexually active female (60.7%) and male (20.5%) IDUs reported exchanging sex for money or drugs. Overall, 48.3 percent of IDUs reported having made changes in their injection practices and one-third reported modifying their sexual behavior in order to avoid HIV infection. Differences in drug use, sexual practices, and drug treatment history were found with regard to gender, ethnicity, age, and type of drug injected. Implications of findings for the development of AIDS risk-reduction programs are presented.     

Family,Peer, and Pubertal Determinants of Dating Involvement Among Adolescents

This study examines the influence of family, peer, and biological contributors to dating involvement among early adolescents (11–14 years of age; n = 244). Further, we assess how parental monitoring may be modified by pubertal maturation and older sibling risky behavior. Data on delinquent peer affiliation, pubertal maturation, parental monitoring, older sibling risky behavior, and dating involvement were gathered through observations and surveys from adolescents, mothers, older siblings, and teachers. Results indicate that lower levels of parental monitoring and higher levels of older sibling risky behavior were related to adolescents' dating involvement through delinquent peer affiliation. Pubertal maturation was directly related to dating involvement for early daters. Findings emphasize the value of examining social and biological factors, in concert, over time.     

Peers' influence and African-American youth in public housing

Drawing from problem behavior theory (PBT), this study investigates whether the relationship between exposure to delinquent peers and delinquent behavior is moderated by peer influences as well as by generalized self-efficacy and an adolescent's attitudes toward deviance. We also explore how gender may influence these relationships. A sample of 401 African-American adolescents living in public housing developments in two large US cities was recruited for this investigation. The preliminary analyses included t-test and bivariate correlations, while our primary analysis included hierarchical regression analysis. The regression analysis included two-way and three-way interaction terms to assess the moderating effects of peer influences, generalized self-efficacy, and attitudes toward deviance as well as gender, respectively. Results indicate that the effects of exposure to delinquent peers depend on peers' influence over adolescents and other factors. Findings provide partial support for PBT and suggest that the relationship between exposure to delinquent peers and delinquent behavior, with regard to minority youth living in urban public housing, merits further investigation. Results have the potential to guide preventative interventions targeting African-American youth living in urban public housing and also inform future inquiries into the lives of such youth.     

Sexual Risk Behavior in Young Adulthood: Broadening the Scope Beyond Early Sexual Initiation

A robust link between early sexual initiation and sexual risk-taking behavior is reported in previous studies. The relationship may not be causal, however, as the effect of common risk factors is often not considered. The current study examined whether early initiation was a key predictor of risky sexual behavior in the 20s and 30s, over and above co-occurring individual and environmental factors. Data were drawn from the Seattle Social Development Project, a longitudinal panel of 808 youth. Early predictors (ages 10 to 15) and sexual risk taking (ages 21 to 24 and 30 to 33) were assessed prospectively. Early sexual initiation (before age 15) was entered into a series of probit regressions that also included family, neighborhood, peer, and individual risk factors. Although a positive bivariate relation between early sexual initiation and sexual risk taking was observed at both ages, the link did not persist when co-occurring risk factors were included. Behavioral disinhibition and antisocial peer influences emerged as the strongest predictors of sexual risk over and above early sexual initiation. These results suggest that early sexual initiation must be considered in the context of common antecedents; public health policy aimed at delaying sexual intercourse alone is unlikely to substantially reduce sexual risk behavior in young adulthood.     

Sexual health programming for vulnerable youth: Improving knowledge,attitudes, and behaviors

PurposeAmong girls in foster care, 48% become pregnant at least once by age 19 (Dworsky & Courtney, 2010). Youth in or at-risk for foster care (YFC) report limited knowledge about, access to, and use of condoms; ambivalent attitudes towards teen parenting; and participation in other risky behaviors. For the current study, we adapted and supplemented an evidence-based sexual health program called SiHLE, using a systematic adaptation framework (ADAPT-ITT, Wingood & DiClemete, 2008), to address the unique and targeted needs of youth living in a temporary shelter due to lack of housing. Youth in this study were either in foster care and awaiting placement, or having serious family problems and were at-risk of entering the foster care system.MethodsThirty-six youth participated in SiHLE-YFC during their stay at a temporary shelter. Four 90-minute sessions focused on increasing sexual health knowledge, improving attitudes towards and self-efficacy of condom use, and developing core skills such as problem-solving and communication.ResultsAs hypothesized, youth showed high satisfaction with the intervention and significant improvement in sexual health knowledge from pre to post. At one-month follow-up, youth continued to show significant improvement in sexual health knowledge, along with a significant reduction in risky sexual behaviors. Though not significant, there were moderate effect sizes for changes in attitudes towards teen pregnancy and condoms. There were no changes in attitudes towards teen parenting.ConclusionTaken together, findings suggest that sexual health education directly targeting the unique needs of YFC may improve sexual health knowledge and behavior, and are discussed in the context of challenges associated with intervention and research with this population.     

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.     

Alcohol Use and Popularity: Social Payoffs From Conforming to Peers' Behavior

Although many economic analyses of adolescents have examined the costs of risky behaviors, few have investigated the gains that young people derive from such actions, particularly in terms of social payoffs for complying with peer behavior. This paper studies the relationship between adolescents' use of alcohol (relative to that of their peers) and popularity at school. We use data from the National Longitudinal Study of Adolescent Health, a rich and nationally representative survey with detailed information on social networks. Our findings suggest that adolescents are socially rewarded for conforming to their peers' alcohol use and penalized (to a lesser degree) for increasing their consumption above that of their peers. Male adolescents are rewarded for keeping up with their peers' drinking and for getting drunk. Female adolescents are rewarded for drinking per se, but not necessarily for keeping up with their peers. The results offer new information on peer influence and have implications for substance abuse interventions at school and in the community.     

Risk and protective factors for problem behaviors among youth in residential care

In accordance with problem behavior theory (PBT), the study examined the contribution of risk and protective factors among high-risk adolescents living in residential care settings (RCSs) to their delinquency, substance abuse, and risky sexual behavior, as well as the inter-correlations between these problem behaviors. The specific study variables were chosen to represent the personal and environmental factors operating on the adolescent. It was hypothesized that higher levels of problem behaviors would be associated with higher levels of sensation-seeking and deviant peer associations (risk factors), and lower levels of future orientation and parental support (protective factors).One hundred and forty seven adolescents (M = 16.03) from seven residential facilities for children with severe emotional and behavioral problems in Israel responded to structured self-report questionnaires.The powerful associations found between the abovementioned risk behaviors suggested a problem behavior syndrome among this group. The risk factors of sensation-seeking and deviant peer associations made the largest contribution to the prediction of problem behaviors beyond any background or protective factors examined. Of the protective factors, only future orientation was found to be significantly associated with problem behaviors: i.e., a more positive future orientation correlated with lower engagement in problem behaviors, an association that increased in strength with age.The apparent existence of a single behavioral syndrome among youth in RCSs and the central contribution to the syndrome of risk factors – in particular, deviant peer associations – points to the need for holistic group interventions addressing multiple risk factors.     

Sexual Education,Gender Ideology,and Youth Sexual Empowerment

Sexual education plays an essential role in preventing unplanned pregnancy and the transmission of sexually transmitted infections (STIs). School-based sexual education programs, in particular, may be well positioned to address social factors that are empirically linked to negative sexual health outcomes, such as traditional social norms surrounding gender and sexuality. However, youth are seldom granted access to sexual education programs that explicitly address these issues. This study presents findings from a pretest–posttest survey of a sexual education program that did. It was designed for eighth graders (N=95) in the context of a school–community collaboration. The study assessed the links between several components of sexual empowerment, including gender ideology, sexual knowledge, and contraceptive beliefs. Findings link participation in the sexual education program to more progressive attitudes toward girls and women, less agreement with hegemonic masculinity ideology, and increases in sexual health and resource knowledge. Structural equation models suggest that traditional attitudes toward women were significantly related to hegemonic masculinity ideology among both boys and girls, which was in turn negatively related to safer contraceptive beliefs.     

Will It Be Silence and Violence or Safety and Prevention for the Next Generation of Gay Youth?

Rates of unprotected anal intercourse and HIV infection are alarmingly high among young gay males. This second wave of infection indicates that traditional models for AIDS education are not working. AIDS educators need to rethink HIV-prevention efforts. Studies consistently find a high level of knowledge about HIV transmission and high levels of commitment to safer sex among gay males, but what accounts for the breakdown between safer sex intentions and practices among them? This article employs social constructionist and queer theoretical assertions that sexuality is socially and culturally produced in complicated and pluralist ways. The analysis examines how risky sexual situations shape young gay males' sexualities by exploring two examples selected to represent, alternatively, models of safer sexual and unsafe sexual trajectories. Implications for HIV prevention practices and policies are discussed.     

Adolescents Prefer More Immediate Rewards When in the Presence of their Peers

Adolescents take more risks in the presence of their peers, but the mechanism through which peer presence affects risky decision‐making is unknown. We propose that the presence of peers increases the salience of the immediate rewards of a risky choice. The current study examined the effect of peer presence on reward sensitivity in a sample of 100 late adolescents ages 18 through 20 (M=18.5) using a delay discounting task, which assesses an individual's preference for immediate versus delayed rewards. Participants were randomly assigned to complete the task alone or with 2 same‐age, same‐sex peers observing. Consistent with our prediction, adolescents demonstrated a greater preference for immediate rewards when with their peers than when alone. Heightened risk taking by adolescents in the company of their friends may be due in part to the effect that being with one's peers has on reward sensitivity.     

Relative Efficacy of a Pregnancy,Sexually Transmitted Infection,or Human Immunodeficiency Virus Prevention–Focused Intervention on Changing Sexual Risk Behavior Among Young Adults

Abstract

Objectives: Despite findings suggesting that young adults are more concerned about experiencing an unplanned pregnancy or contracting a sexually transmitted infection (STI) than becoming human immunodeficiency virus (HIV) infected, no empirical work has investigated whether the specific focus of an intervention may be more or less efficacious at changing sexual behavior. Participants: Participants were 198 college students randomized to 1 of 4 conditions: pregnancy intervention, STI intervention, HIV intervention, or a control condition during 2008–2009. Methods: The authors compared the efficacy of 3 theory-based, sexual risk–reduction interventions that were exactly the same except for an exclusive focus on preventing pregnancy, STI, or HIV. Condom use and risky sexual behavior were assessed at baseline and 4-week and 8-week follow-up. Results: Participants exposed to the pregnancy or STI interventions reported greater condom use and less risky sexual behavior than those exposed to the HIV intervention. Conclusions: The focus of sexual risk–reduction interventions may lead to differential behavior change among young adults.     

The Social Construction of Romantic Relationships in Adolescence: Examining the Role of Peer Networks,Gender, and Race*

Romantic activity is a social psychological phenomenon. Gender, race, and peer networks are key contexts for understanding the social construction of this behavior as gender‐ and race‐based norms structure feelings and behaviors that define “appropriate” romantic activity and peer networks serve as incubators of this activity. With a nationally representative sample of adolescents (N= 8510) drawn from the National Longitudinal Study of Adolescent Health, this study explored the linkages among peer networks, conceptions of idealized romantic relationships and actual romantic relationships, and the ways in which gender and race moderate these associations. Several characteristics of peer networks predicted adolescent attitudes about romantic behaviors as well as actual romantic behavior. Moreover, the linkages among peer networks, romantic attitudes, and romantic behaviors varied by race.     

Predictors of safer sex on the college campus: a social cognitive theory analysis.

In April and May 1989, the authors surveyed a sample of students enrolled on four college campuses in New Jersey (N = 923) concerning their HIV transmission-related behavior, knowledge, and a variety of conceptual variables taken primarily from social cognitive theory that were thought to be potentially predictive of safer sexual behavior. Analyses of sexually active, unmarried students' responses indicated that men expected more negative outcomes of condom use and were more likely to have sexual intercourse while under the influence of alcohol or other drugs, whereas women reported higher perceived self-efficacy to practice safer sex. Regression analyses indicated that, among the factors assessed, stronger perceptions of self-efficacy to engage in safer behavior, expecting fewer negative outcomes of condom use, and less frequency of sex in conjunction with alcohol or other drug use significantly predicted safer sexual behavior. Enhanced self-efficacy to discuss personal history with a new partner was associated with a greater number of risky encounters. Implications of these findings for intervention efforts with students are discussed.     

Is risky sex rational?

Consideration of a simple model of sexual decision‐making suggests that many individuals who engage in risky sexual practices do so for “rational” reasons. Within a framework of subjective values and perceptions, risky sex may be rational in the sense that the benefits derived from sexual expression outweigh the threat of loss from AIDS. One implication of this conceptualization is that in order to understand risky behavior, primary consideration must be accorded the perceptions, attitudes, and desires of the individual.     

Peer and family influences on adolescent anger expression and the acceptance of cross-gender aggression

Past research has examined the relative impact of family and peers on adolescent behavior, but very little research has examined it in relation to youth dating violence. Eight hundred and sixty-five adolescents, primarily urban Latino youth, completed self-administered surveys at school. Multivariate analyses indicated that exposure to prior family violence was not significantly associated with adolescents' aggressive expression of anger or their acceptance of cross-gender aggression. However, current conflict--either family or peer--was associated with adolescent behavior and attitudes, with the exception that current peer conflict was not significantly associated with adolescents' acceptance of male on female aggression. Parental monitoring and attachment were not found to be moderators of these relationships. Implications for dating violence interventions and future directions for research are explored.     

A critique of progress in adolescent smoking prevention

Researchers have developed a number of programs for preventing adolescent smoking. This critique evaluated a cross-section of 12 of these programs. The majority demonstrated short-term effectiveness in reducing the onset of smoking. The studies stressed three common themes: information about smoking's physiological and social effects, skills to cope with peer and advertising pressures, and the modification of attitudes. Despite many positive outcomes in reducing smoking, the studies did not clearly establish whether the interventions did so by imparting coping skills or by modifying attitudes. This leaves in doubt the exact processes that influence smoking behavior. Carbon monoxide and thiocyanate analyses have not been established as alternatives to self-report, as these methods prove unreliable with adolescent populations. Due to the lack of longitudinal studies, the long-term effectiveness of these interventions remains undetermined.