Multidimensional Condom Attitudes Scale Research Articles

Support for Texting-Based Condom Negotiation Among Forcibly Displaced Adolescents in the Slums of Kampala, Uganda: Cross-sectional Validation of the Condom Use Negotiated Experiences Through Technology Scale.

BackgroundPromoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg, sexting) may increase adolescents’ confidence in discussing sexual health issues and negotiating condom use. However, limited evidence exists describing validated measures for text-based condom negotiation in the literature.ObjectiveThis study helps fill this gap by adapting and examining the psychometric properties of a condom use experience through technology (condom use negotiated experiences through technology [CuNET]) scale.MethodsUsing peer network sampling, 242 forcibly displaced adolescents (aged 16-19 years) living in Kampala’s slums were recruited for participation between January and March 2018. A subscale (embarrassment to negotiate condom use) of the Multidimensional Condom Attitudes Scale was adapted to incorporate sexting, yielding CuNET. Participants were randomly assigned to calibration and validation subsamples to conduct exploratory and confirmatory factor analyses to establish and validate the scale. CuNET measured participants’ support levels for texting-based condom negotiation via sexting based on gender, and multivariable logistic regression was used to explore its associations with sexual health outcomes (recent consistent condom use, access to sexual and reproductive health services, and lifetime sexually transmitted infection testing).ResultsThe one-factor CuNET with the validation sample was valid (χ24=5.3; P=.26; root mean square error of approximation=0.05, 90% CI 0.00-0.16; comparative fit index=0.99; Tucker-Lewis index=0.99; standardized root mean square residual=0.006), and reliability (Cronbach α=.98). Adolescent girls showed significantly lower levels of support for using sexting to negotiate condom use (mean 13.60, SE 0.70 vs mean 21.48, SE 1.23; P=.001). In multivariable analyses, a 1-point increase in the CuNET score was associated with increased odds of recent consistent condom use (adjusted odds ratio [aOR] 1.73, 95% CI 1.24-2.41) but not with access to sexual and reproductive health services (aOR 1.51, 95% CI 0.99-2.30) or lifetime sexually transmitted infection testing (aOR 0.90, 95% CI 0.64-1.26).ConclusionsThe unidimensional CuNET scale is valid and reliable for forcibly displaced adolescents living in slums in Kampala, gender-sensitive, and relevant for predicting consistent condom use among urban displaced and refugee adolescents. Further development of this scale will enable a better understanding of how adolescents use digital tools for condom negotiation.

An Interactive Web-Based Sexual Health Literacy Program for Safe Sex Practice for Female Chinese University Students: Multicenter Randomized Controlled Trial.

BackgroundSexual health concerns among young adults worldwide help to motivate preventative practices against sexually transmitted infections. To foster better sexual health, sexual health literacy must be enhanced. Little research has been conducted on the impact of gender power dynamics on sexual health, such as sexual coercion, even though the prevalence of sexual coercion remains high in China.ObjectiveThis study describes the development and systematic evaluation of a web-based sexual health literacy intervention called “Smart Girlfriend” for female Chinese university students.MethodsA multicenter randomized controlled trial was conducted with 781 female university students at 5 universities with dormitories in Hong Kong. Inclusion criteria were used to select unmarried, female, Chinese university students who were ≥18 years old and had not received a sexual health intervention in the past 12 months. Participants were randomly assigned to 2 groups: one group received an interactive web-based sexual health literacy intervention and the other group received a single webpage of online information about condom use. The intervention content was based on the Health Belief Model and the Continuum of Conflict and Control theory. The primary outcome was self-reported consistency of condom use with every partner at 3-month and 6-month follow-up assessments, analyzed using zero/one inflated beta (ZOIB) regression. The secondary outcome was an appraisal of the knowledge, attitudes, norms, and self-efficacy of condom use using the 25-item Multidimensional Condom Attitudes Scale (MCAS). The intention to treat was applied in analyses.ResultsOf 1503 individuals that were screened, 781 (52%) were randomized into 2 groups. The retention rates at the 3-month and 6-month follow-ups were 92% and 91%, respectively. Most participants were born locally (536/746, 72%), and 18% (134/746) self-reported as a sexual minority. ZOIB results regarding the consistency of condom use were not significant [model 1: odds ratio (OR) 2.25 with a 95% credible interval (CrI) of 0.84-6.36; model 2: OR 8.03 (95% CrI 0.22-330.31); model 3: OR 1.21 (95% CrI 0.78-1.86)]. Consistency in the intervention group was 5% higher (95% CI −1.90 to 11.63) than the control group at the 3-month follow-up, and 1% higher (95% CI −5.81 to 8·02) at the 6-month follow-up. MCAS scores at the 3-month follow-up were significantly higher in the intervention group (mean 122.51, SD 15.97) than the control group (mean 119.86, SD 15.85; P=.02).ConclusionsAn interactive web-based sexual health literacy program did not significantly increase the consistency of condom use compared to a single webpage of condom use information; however, it did temporarily improve knowledge, attitudes, norms, and self-efficacy regarding condom use. Future revisions of this intervention should be personalized and delivered with a proactive approach.Trial RegistrationClinicalTrials.gov NCT03695679; https://clinicaltrials.gov/ct2/show/NCT03695679

A Moderated Mediation Analysis of Condom Negotiation and Sexual Orientation on the Relationship Between Sexual Coercion and Condom Use in Chinese Young Women: Cross-Sectional Study.

BackgroundThe high prevalence of sexual coercion against young women has become a significant public health issue in China and other regions around the world. Young women are also especially vulnerable to engage in inconsistent condom use because of low sexual control. Although the relationship between sexual coercion and condom use has been widely demonstrated, the mechanism of this relationship is still unclear.ObjectiveThe objective of this study was to test condom negotiation as a mediator of the relationship between sexual coercion and condom use in young Chinese women and to investigate whether sexual orientation is a moderator.MethodsData were collected using web-based questionnaires and a total of 402 young Chinese women were included in the analysis. Sexual coercion was measured using a subscale of the Revised Conflict Tactics Scales and condom negotiation was measured using a subscale of the UCLA Multidimensional Condom Attitudes Scale. Sexual orientation was assessed using an item adopted from a previous study and condom use was calculated by the total number of times condoms were used divided by the total number of times sexual intercourse was engaged in during the past 3 months. Moderated mediation analyses were conducted with sexual coercion as the independent variable, condom use consistency as the dependent variable, condom negotiation as the mediator variable, and sexual orientation as a moderator.ResultsThe moderated mediation analysis indicated that the relationship between sexual coercion and condom use was significantly mediated by condom negotiation and moderated by sexual orientation. The indirect effect of condom negotiation was significant in heterosexual women (indirect effect: –0.80, 95% boot CI –1.67 to –0.36) but not in sexual minority women (indirect effect: –0.33, 95% boot CI –0.86 to 0.31).ConclusionsThe results showed that sexual orientation meaningfully affects the relationship between sexual coercion and condom negotiation. The difference in the mechanism of the relation between sexual coercion and sexual behaviors in heterosexual and sexual minority women should be considered for future research and interventions aimed at mitigating the adverse effects of sexual coercion.

The use of the Multidimensional Condom Attitude Scale in Chinese young adults

BackgroundAttitude towards condom use is an important predictor of consistent condom use. However, this topic is an understudied area in Chinese populations, and no validated Chinese instrument is available to capture condom attitude. To fill this research gap, the present study aimed to evaluate the psychometric properties of the University of California, Los Angeles (UCLA) Multidimensional Condom Attitudes Scale (MCAS) and assessed the attitudes towards condom use amongst Chinese adults aged 18–29 years old.MethodsIn this cross-sectional study, a total of 500 people aged 18–29 years old were randomly recruited in Hong Kong. The primary outcome was the attitude towards condom use as measured by the UCLA MCAS. Factor structure, internal construct validity, known-group validity and internal consistency were assessed.ResultsInstead of the five-factor structure designed by the original developers of the MCAS questionnaire, this study proposed a novel six-factor scale: (1) Reliability and Effectiveness, (2) Excitement, (3) Displeasure, (4) Identity Stigma, (5) Embarrassment about Negotiation and (6) Embarrassment about Purchase. The internal construct validity and reliability of the new scale were high. The revised MCAS could differentiate between subgroups, including gender, sexual orientation and sexual experience. In terms of attitudes, over 40% of the participants believed that condoms are not reliable, though the vast majority of the sample did not perceive any stigma related to condom use. In addition, more than half (55.4%) of the respondents felt embarrassed to be seen when buying condoms while a quarter (25.8%) felt uncomfortable buying condoms at all.ConclusionsOverall, the psychometric analysis found that attitude to condom use is culturally specific. The study also highlighted the need for more public health campaigns and interventions to help people cope with the embarrassment of purchasing condoms.

Spanish Translation, Adaptation, and Validation of the Multidimensional Condom Attitudes Scale with Young Colombian Men and Women.

Infection by HIV/AIDS or other STIs and unplanned pregnancies are sexual health problems of considerable impact around the world. Condoms are the only method that prevents all those risks, and attitudes toward the use of condoms are among the best predictors of their consistent use. The purpose of the present study was to translate, adapt, and validate a Spanish-language version of the Multidimensional Condom Attitudes Scale (MCAS) using a sample of young people from Colombia. A total of 1441 young people between the ages of 18 and 26 years responded to a web-based survey conducted between January 2018 and February 2018. The dimensionality of the scale was explored and confirmed to replicate the original five-factor structure (alphas ranged from .65 to .86). Criterion validity was adequate. Women had more positive attitudes toward identity stigma associated with condom use, while men had more positive attitudes toward reliability and effectiveness of condoms and were less embarrassed with condom negotiation and use. The Spanish-language MCAS is suitable for measuring condom-related attitudes among Colombian youth. Future research is needed to validate the Spanish version of the MCAS with other Spanish-speaking populations.

Psychometric Properties of the Condom Use Self-Efficacy Scale among Young Colombians.

(1) Background: This study evaluated the psychometric properties of the Condom Use Self-Efficacy Scale among Colombian youth. (2) Method: A total of 2873 men and women between 18 and 26 years old (M = 21.45, SD = 2.26) took part in this study. All participants answered a socio-demographic survey, the Condom Use Self-Efficacy Scale, the UCLA Multidimensional Condom Attitudes Scale, The Condom Use Errors and Problems Scale, and the Sexual Assertiveness Scale. Sampling was web-based, and the survey was distributed via Facebook. (3) Results: The Condom Use Self-Efficacy Scale demonstrated adequate reliability (ordinal α ranged = 0.76 to 0.92). Exploratory and confirmatory factor analysis suggested a four-factor structure with an explained variance of 69%. This dimensionality was also invariant across gender. Moreover, positive attitudes toward condom use were significantly associated with appropriation and assertiveness. Two dimensions (appropriation and partner disapproval) showed significant gender differences. (4) Conclusions: The Spanish–Colombian version of the Condom Use Self-Efficacy Scale is a psychometrically adequate instrument to measure perceived condom use self-efficacy. This scale can be used in both research and professional settings to measure self-efficacy at using condoms in young people.

Condom Use Errors and Problems in a Sample of Young Colombian Adults

ABSTRACT Condom effectiveness can be reduced by a number of problems and errors that take place during use. The purpose of the present study was to translate and adapt the Condom Use Errors and Problems Survey (CUES) into Spanish and to use it for testing the prevalence of these issues in a sample of young Colombian adults. A total of 775 people (414 women and 361 men) between 18 and 26 years of age participated in the study. Participants completed the following questionnaires online: Condom Use Errors and Problems Survey, Sexual Opinion Survey, Sexual Assertiveness Scale, Multidimensional Condom Attitudes Scale, a sociodemographic and sexual history questionnaire, plus two questions concerning condom-associated erectile problems. Results showed significant differences in the prevalence of condom use errors/problems associated with gender, sexual orientation, and whether the participant had a stable sexual partner. The occurrence of problems/errors ranged from 9.4% to 69.5%. Except for certain specific practices, observations were similar to those of studies performed in North America. Results indicate that the present linguistic adaptation of the CUES for its use in Colombian Spanish-speaking populations is an effective instrument to assess problems and errors associated with the use of male condoms.

Factor structure and gender stability in the multidimensional condom attitudes scale.

Sexually transmitted infections continue to trouble the United States and can be attenuated through increased condom use. Attitudes about condoms are an important multidimensional factor that can affect sexual health choices and have been successfully measured using the Multidimensional Condom Attitudes Scale (MCAS). Such attitudes have the potential to vary between men and women, yet little work has been undertaken to identify if the MCAS accurately captures attitudes without being influenced by underlying gender biases. We examined the factor structure and gender invariance on the MCAS using confirmatory factor analysis and item response theory, within-subscale differential item functioning analyses. More than 770 participants provided data via the Internet. Results of differential item functioning analyses identified three items as differentially functioning between the genders, and removal of these items is recommended. Findings confirmed the previously hypothesized multidimensional nature of condom attitudes and the five-factor structure of the MCAS even after the removal of the three problematic items. In general, comparisons across genders using the MCAS seem reasonable from a methodological standpoint. Results are discussed in terms of improving sexual health research and interventions.

Safer Sex as the Bolder Choice: Testosterone Is Positively Correlated with Safer Sex Behaviorally Relevant Attitudes in Young Men

Higher testosterone (T) is tied to risk-taking, especially in financial domains but also in health domains relevant to acquiring sexually transmitted infections (STIs). However, safer sex constructs could themselves carry the possibility of "social risk" due to sexual stigma or embarrassment, or could involve boldness or confidence because they could represent status displays of frequent sexual activity. To determine how T and behaviorally relevant attitudes about sexual risk-taking are linked, to better understand biopsychosocial aspects of sexual health related to STIs. In 78 first-year male college students, we examined correlations between salivary T and behaviorally relevant safer sex attitudes assessed via questionnaires. T, via saliva; safer sex attitudes, via a composite and the University of California, Los Angeles Multidimensional Condom Attitudes Scale (MCAS). Higher T was significantly correlated with higher scores on the following: safer sex likelihood composite, r(73)=0.33, P=0.003; the MCAS safer sex resilience, r(32)=0.36, P=0.037; and the MCAS condom purchase comfort, r(32)=0.37, P=0.031. Associations between T and safer sex likelihood and resilience were still robust after controlling for potential confounds, though the association between T and purchase comfort diminished to a trend. Higher T was positively linked with safer sex attitudes, especially those most closely tied to STI risk avoidance. Thus, future research and interventions for STI prevention should address the possibility that safer sex may be paradoxically perceived as a "bold" or "risky" choice even as it decreases STI risk.

The Ucla Multidimensional Condom Attitudes Scale: Validity in a Sample of Low-Acculturated Hispanic Women

Condom use can prevent unintended pregnancy, HIV infection, and other sexually transmitted diseases. Unfortunately, scales assessing attitudes toward condom use have not been validated in Hispanic samples. Low-acculturated Hispanic women (N = 291) completed the University of California, Los Angeles (UCLA) Multidimensional Condom Attitudes Scale (MCAS). The MCAS contains five subscales: Reliability and Effectiveness, Pleasure, Identity Stigma, Embarrassment About Negotiation and Use, and Embarrassment About Purchase. Confirmatory factor analysis was used to evaluate the factor loadings of the questionnaire items on the five factors. The model fit and factor structure were similar to results originally obtained with a college student sample. Higher education was associated with higher scores on Pleasure and lower scores on Identity Stigma, whereas financial strain was associated with higher scores on Embarrassment About Negotiation and Use and Embarrassment About Purchase. Results suggest that the MCAS can be used to assess condom attitudes among low-acculturated Hispanic women.

The UCLA Multidimensional Condom Attitudes Scale: Documenting the complex determinants of condom use in college students.

This article describes the development and validation of the UCLA Multidimensional Condom Attitudes Scale (MCAS). The relationships between the MCAS and gender, sexual experience, intentions to use a condom, and past condom use were assessed. The MCAS has five distinct factors: (a) Reliability and Effectiveness of condoms, (b) the sexual Pleasure associated with condom use, (c) the stigma attached to persons who use condoms (Identity Stigma), (d) the Embarrassment About Negotiation and Use of condoms, and (e) the Embarrassment About the Purchase of condoms. The results strongly suggest that condom attitudes are multidimensional and thus cannot meaningfully be summed to a single global score. Results further indicate that men and women hold very different attitudes toward condoms. Implications of scale multidimensionality and directions for future research are discussed.

The UCLA Multidimensional Condom Attitudes Scale: Documenting the complex determinants of condom use in college students.

The UCLA Multidimensional Condom Attitudes Scale: Documenting the complex determinants of condom use in college students.