Identification of Strategies for Promoting Condom Use: A Prospective Analysis of High-Risk African American Female Teens (original) (raw)
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Condom Use among Young African American Men: Implications for Planning Interventions
Journal of Health Disparities Research and Practice, 2015
Condom Use among Young African American Men: Implications for Planning Interventions Condom Use among Young African American Men: Implications for Planning Interventions Sexually transmitted diseases, including HIV, continue to present significant public health problems affecting young people in the United States, especially African Americans. While African Americans make up about 12% of the U.S. population, in 2010 they accounted for 44% of new HIV infections in 2010 and 48% of all persons living with AIDS in 2007. The 2010 data shows that of these new cases, 38% occurred among African American males ages 13-24 years old. Correct condom use remains a challenge in this population and efforts to increase condom use among minority males has been a formidable challenge. This paper reports the results of formative research conducted in order to guide the development of an intervention to increase consistent, effective condom use for young African American males. Methods: Methods: A snowball sampling approach was used to recruit participants. African American males, ages 18-24, who self-reported as sexually active were eligible to participate in one of four focus groups or one of six individual interviews. All study events were conducted at community locations. Each event was audiotaped and notes were taken. Analysis was performed using using NVivo-9. The coding strategy included emic and etic codes and a coding tree was developed which was used to identify themes. Results: Results: A total of 36 African American males between the ages of 18-24 (mean 20.7 years) took part. In general, participants felt condom use was highly influenced by contextual factors including partner interest, partner communication, length of relationship and trust. Condom use was also influenced by a sense of invincibility and being caught up in the moment. Notably, most sexual activity occurred outside of a relationship, most often within the party scene or as quickly arranged hookups. Analysis: Analysis: In order to ensure maximum impact on the development of the intervention, the results from this formative phase were viewed through the Transtheoretical Model of Behavior Change (TTM) and most participants would be described as being in the pre-contemplation or contemplation stages of behavioral change. While all participants expressed some understanding of the risks of unprotected sex, many did not connect risks to consequences. While the data did not indicate that condom use behavior was likely to change in the short-term (less than 6 months), several participants were contemplating making a change. Discussion: Discussion: The snowball sampling approach allowed us to understand the participants' social network and allowed us to consider social influences as well as about individual attitudes and beliefs. In the TTM frame, interventions designed for this population need to include contemplators and pre-contemplators and should focus on modification of cognition, affect and behaviors. Our research also shows that several of the underlying assumptions of TTM are at odds with the framework within which sex often occurs for this population and condom use decisions are highly influenced by the social context. In light of the results, the intervention placed condom use into a health promotion context. It combines group activities and one-on-one interaction. Group activities can impact shared values and beliefs and, thus, the intervention builds social support for behavior changes while addressing individual capacity.
This research study sought to develop, pilot test, and assess a brief male-centered condom promotion program for urban young adult African American males. For study implementation, both qualitative and quantitative research methods were used, and the project was guided by tenets of two common but integrated theoretical frameworks in HIV/sexually transmitted disease (STD) prevention research: the social cognitive theory and the stages of change model. The purpose of the qualitative component was to identify and explore condom-use barriers and facilitators while that of the quantitative component was to identify the prevalence of condom-related behaviors and the feasibility of program administration. After recruitment of study participants from hangout spots and street intercepts, study participants were self-administered a baseline survey regarding their perceived condom-use behaviors prior to random assignment to program conditions (a condom promotion program and an attention-matched comparison condition). In this paper, we report the findings from the analyses of the quantitative baseline survey data. While the occurrence of HIV/STD-related risk behaviors were highly prevalent among this population; importantly, regression analyses revealed that sexual debut, favorable attitudes toward condom use, social or personal connectedness to HIV/STDs, health beliefs, perceived susceptibility, unprotected sexual encounters, and refusal skills were predictive of retrospective (i.e., prior 30 days) condom use while positive reasons (pros) to use condoms, condom-use beliefs, condom-carrying, health belief, unprotected sexual encounters and refusal skills were also predictive of prospective (i.e., future 30 days) condom-use intentions. The implications and limitations of this study are described and recommendations provided for program development.
Measures of Attitudes Toward and Communication about Condom Use
Sexually Transmitted Diseases, 2016
Objective-To construct and test measures of psychosocial mediators that could be used in intervention studies seeking to promote safer sex behavior among young Black men who have sex with men (YBMSM). Methods-YBMSM (N=400), ages 18-29 years, were recruited from an STI clinic, in the Southern U.S. All men had engaged in penile-anal sex with a male as a "top" in the past 6 months. Men completed an audio-computer assisted self-interview and provided specimens used for NAAT testing to detect Chlamydia and gonorrhea. Four measures were constructed and tested for criterion validity (Safer Sex Communication, Condom Turn-Offs, Condom Pleasure Scale, and a single item assessing frequency of condom use discussions before sexual arousal). Results-With the exception of Safer Sex Communication, all of the measures showed criterion validity for both unprotected anal insertive, and unprotected anal receptive sex. With the exception of the Condom Turn-Offs, the three other measures were supported by criterion validity for oral sex. Both the Condom Turn-Offs and Condom Pleasure Scale were significantly related to whether or not men reported multiple partners as a "top" but only the Condom Pleasure Scale was associated with reports of multiple partners as a "bottom." Only the Condom Turn-Offs Scale was positively associated with having been diagnosed with either Chlamydia or gonorrhea.
Predictors of Consistent Condom Use Among Young African American Women
AIDS and Behavior, 2013
The purpose of this study was to determine the predictive value of selected factors to the consistent use of condoms among high-risk young African American women. A clinic-based, prospective, study of 242 young, African-American women (ages 15-21) was conducted. In multivariate analysis, consistent condom use was predicted by having greater perceptions of condom negotiation self-efficacy, lower fear of negotiating condom use, and having communicated with sex partners (during the recall period) about condom use. Relational variables were predictive of consistent condom use among young African American women. STD/HIV preventive interventions should target these factors, perhaps in dyad-level interventions.
Behavioral intervention to increase condom use among high-risk female adolescents
The Journal of Pediatrics, 1996
Objective: To determine whether condom use among high-risk female adolescents could be increased by a behavioral intervention, with the use of infection with Chlamydia trachomatis as a biomarker of condom practices. Design: Prospective, randomized, controlled intervention. Setting: Urban family planning and sexually transmitted disease clinics. Participants: Two hundred nine female adolescents, aged 15 through 19 years, who were treated for C. trachomatis genitourinary infection, were randomly assigned to standard (control) or experimental (behavioral intervention) groups. One hundred twelve subjects returned for follow-up 5 to 7 months after enrollment and comprise the study subjects. Measurements: Subjects completed a multiinstrument questionnaire measuring sexual behavior, condom practices, attitudes and beliefs, cognitive complexity, sociodemographics, and motivation at enrollment and follow-up. Endourethral and endocervical sites were sampled for C. trachomatis. Results: Among the 112 subjects who returned for repeated examination, those who had received the experimental intervention reported increased use of condoms by their sexual partners for protection against sexually transmitted diseases (odds ratio = 2.4; p = 0.02) and for vaginal intercourse (odds ratio = 3.1; p = 0.005) at the 6-month follow-up. Multivariable logistic regression analysis controlling for condom use at enrollment demonstrated that the experimental intervention (odds ratio = 2.8; p = 0.03) and the higher cognitive complexity (odds ratio = 4.6; p = 0.02) independently contributed to greater condom use at follow-up. Despite greater use of condoms among the group who had received the intervention, use remained inconsistent and rates of reinfection with (2. trachomatis were not significantly different (26% vs 17%; p = 0.3). Conclusion: Although a brief behavioral intervention among high-risk female adolescents can increase condom use by their sexual partners, incident infection does not appear to be reduced, because condom use remained inconsistent. (J PEDIATR 1996; 128:288-95)
Public Health Reports, 2001
Objective. The authors used data from a larger study to evaluate the long-term effects of a peer advocate intervention on condom and contraceptive use among HIV-infected women and women at high risk for HIV infection. Methods. HIV-infected women in one study and women at high risk for HIV infection in a second study were selected from the Women and Infants Demonstration Project and assigned to a standard or an enhanced HIV prevention treatment group. The enhanced intervention included support groups and one-on-one contacts with peer advocates tailored to clients' needs. The authors interviewed women at baseline and at 6-, 12- and 18-months, and measured changes in consistency of condom and contraceptive use and in self-efficacy and perceived advantages and disadvantages of condom and contraceptive use. Results. Of HIV-infected women, the enhanced group had improved consistency in condom use, increased perceived advantages of condom use, and increased level of self-efficacy compa...
Predictors of Condom Use in a Multisite Study of High-Risk Youth Living with HIV
AIDS Education and Prevention, 2010
Risky sexual behavior among youth living with HIV (YLH) must be addressed to prevent the spread of the disease. The purpose of the current study was to investigate factors associated with condom use in a multi-site sample of YLH (ages 16-24). Baseline assessments were conducted with 186 YLH using a computer assisted personal interviewing (CAPI) method. Path analysis suggested that condom use was directly predicted by motivational readiness and self-efficacy for safer sex. Interventions that promote self-efficacy and motivational readiness through a variety of mechanisms may be useful in understanding and conceptualizing sexual risk behavior in YLH. However, further predictors must be studied to account for more variance.