The Relationship Between Psychosocial Factors And Condom Use Among African-American Adolescents

Adolescence, Fall, 2000 by Rose M. Colon, Dawn Elise Wiatrek, Richard I. Evans

ABSTRACT

The present investigation explored the relationship between psychosocial factors and condom use by African-American adolescents. Two hundred twenty-nine males, aged 14 to 19 years, responded to a health behavior survey that gathered information on demographics, HTV knowledge, perceived certainty of future condom use, present and past use of condoms, and intention to use condoms in the next six months. Several psychological variables, including sexual self-efficacy and self-esteem, were also measured. It was found that the majority of participants were sexually active by age 13, had four or more lifetime sexual partners, and were using condoms regularly. Multiple linear regression analysis indicated that sexual self-efficacy predicted perceived certainty of condom use. In addition, self-esteem and sexual self-efficacy predicted intention to use condoms. These findings highlight the need to develop HIV prevention curricula for African-American male adolescents that not only emphasize the potential risks associa ted with having multiple sexual partners, but also include components to enhance self-worth and sexual self-efficacy.

INTRODUCTION

Although the incidence of AIDS is decreasing in the U.S., according to the Centers for Disease Control (CDC) heterosexual transmission continues to rise among men (CDC, 1998). In addition, various ethnic groups differ in regard to the rate at which they contract HIV (CDC, 1992, 1996, 1997). Among the new cases of AIDS between 1995 and 1996 that were attributable to heterosexual transmission, the greatest relative increase occurred among African-American males (CDC, 1997). In particular, urban African-American male adolescents have been found to be at a disproportionately higher risk of contracting HIV as compared with male adolescents of other ethnicities (CDC, 1992, 1996, 1997). Further, the CDC (1998) has reported that although African-American males in grades 9-12 have higher levels of condom use, they are also more likely than adolescents from other ethnic groups to have had sexual intercourse before the age of 13 and to have had more than four sexual partners, both of which are considered to be major ris k factors for HIV infection.

In order to develop effective interventions to decrease the spread of HIV among African-American adolescents, it is important to determine which factors impact their sexual decision making. To date, relatively few studies have attempted to determine the role of psychosocial mediators in minority adolescents' sexual decision making.

Inconsistent Condom Use and HIV Knowledge

Although abstinence is the surest way to avoid HIV infection, many adolescents choose to be sexually active (Jemmott, Jemmott, & Fong, 1998; Kaemingk & Bootzin, 1990). The consistent use of condoms during sexual intercourse has been recognized as one of the most effective ways to prevent HIV/AIDS infection (Cates, 1991), consequently inconsistent condom use poses a risk. Shafer et al. (1993), examining the relationship between risk behaviors and sexually transmitted diseases among adolescent male detainees, found that three factors put these adolescents at risk: multiple sexual partners, alcohol consumption, and inconsistent condom use. Further, Hingson, Strunin, Berlin, and Heeren (1990) found that only 34% of the 16- to 19-year-old males they surveyed reported consistent condom use.

Research has revealed that even when adolescents possess HIV prevention knowledge, they do not always use condoms consistently (Belgrave et al., 1993; Brown, DiClemente & Park, 1992; Kaemingk & Bootzin, 1990; Kasen et al., 1992). For example, learning that unprotected sexual intercourse is the major route of HIV transmission may result in only minimal change in adolescents' risky sexual behaviors. Consequently, factors other than knowledge may be having a greater impact on adolescents' sexual behavior (Jemmott, 1996; Damond, Breuer & Pharr, 1993).

Self Efficacy and Sexual Decision Making

Explanations for the inconsistent use of condoms among adolescents include negative attitudes toward condoms (Jemmott, 1996; Hebert, Bernard, De Man, & Farrar, 1989; Bruce, Shrum, Trefethen, & Slovik, 1990), negative social influences (Evans, Getz, & Raines, 1991, 1992), low self-esteem (Keeling, 1987), and lack of personal efficacy (Brafford & Beck, 1991). Of these, self-efficacy--the belief that one can execute a desired behavior (Bandura, 1977)--has been found to be one of the most consistent predictors of condom use (Wulfert & Wan, 1993). Kasen, Vaughan, and Walter (1992) have developed instruments to assess adolescents' self-efficacy levels for condom use, refusing sexual intercourse, and questioning potential sexual partners. Other researchers have developed more global measures of sexual self-efficacy (Rosenthal et al., 1991). Measures of adolescent sexual self-efficacy (in particular, items that assess condom use in various situations) have been found to be related to intention to use condoms in the f uture (Kasen et al., 1992; Kaemingk & Bootzin, 1990; Wulfert & Wan, 1993); however, most of the studies were conducted with predominantly Anglo populations.