Safer Sex Behaviors Research Articles

Seriously Mentally Ill Women’s Safer Sex Behaviors and the Theory of Reasoned Action

Seriously mentally ill women at risk for HIV infection (n = 96) participated in structured interviews assessing sexual and substance-use behavior over a 3-month period. The majority of the women (63.5%) did not use condoms. Consistent with the theory of reasoned action, attitudes toward condom use and perceived social norms about safer sex were associated with safer sex intentions. Supplementing variables from the theory of reasoned action with safer sex self-efficacy explained additional variance in safer sex intentions. Greater safer sex intentions were related to both greater condom use and less frequent unprotected intercourse. In addition, less frequent sex after drug use and a less fatalistic outlook were associated with less frequent unprotected intercourse. Life circumstances specific to this population are particularly important to examine to improve the effectiveness of risk reduction interventions for seriously mentally ill women.

Determinants of Actual Condom Use Among Adolescents in Thailand

This study examined the relationships among attitudes toward condom use, personal characteristics, condom use self-efficacy, and actual condom use among Thai adolescents. Predictors of condom use were also investigated. Bandura's self-efficacy model for safer sexual behavior provided the theoretical framework for this descriptive correlational design. The sample consisted of 270 Thai vocational students aged 18 to 21 years. Multiple regressions were used to estimate the correlates between the independent study variables and condom use among Thai adolescents. Additionally, two open-ended questions regarding attitudes toward premarital sex among males and females in Thai culture were asked. The results showed that self-reported history of alcohol/drug use, attitudes toward condom use, and condom use self-efficacy were related to actual condom use. Results that emerged from the open-ended questions suggested sexual double standards among Thais. This study contributes to strengthening Thai health policy and expanding nursing knowledge about condom use and prevention of sexually transmitted diseases.

HIV Medical Care Provider Practices for Reducing High-Risk Sexual Behavior: Results of a Qualitative Study

A first step in ensuring that HIV-infected persons practice the safer sexual behaviors that reduce disease transmission is to make certain that they receive accurate information about the relationship between sexual risk behaviors and HIV transmission. Health care providers can play a pivotal role in preventing secondary transmission of HIV; federal agencies and professional guidelines encourage providers to counsel HIV-infected patients about safer sex practices and transmission risks, particularly since the health care encounter may be the only time that HIV-infected persons receive information about prevention and risk reduction interventions. Yet research indicates that these opportunities are often missed. Prior to implementing a prevention demonstration project in an urban HIV and STD clinic, we conducted a qualitative investigation with providers, including physicians, nurse practitioners, physician assistants, and nurses. The purpose of this investigation was to examine the current status of prevention education and counseling efforts at the clinic, examine the barriers and facilitators to providing prevention counseling, and identify key areas where providers believed that they needed additional training.

Sexual Behaviour And Condom Use Among Nigerian Soldiers In Ilorin, Kwara State, Nigeria

Background/Objective: Studies have shown that military personnel are aware and knowledgeable about HIV/AIDS and its impact on combat preparedness and efficiency. However, this knowledge did not appear to have translated to reduced risky sexual behaviours. This study, therefore aimed at determining the sexual behaviour and condom use among Nigerian Army personnel in Ilorin, Nigeria. Materials and methods: A descriptive cross-sectional study using a multistage sampling technique to select 400 participants. A pre-tested semi-structured questionnaire was administered. Results: Out of 386 respondents (response rate 96.5%) males constituted 91.2%. Two hundred and seventy two (70.5 %) were married while 42 (15.4%) of the married did not live with their spouses. A significant proportion of the respondents (45.5%), especially those within the age of 18 to 34 years (p=0.000), those who had participated in foreign military operations (p=0.030) and those who did not live with their spouses (p=0.000) engaged in pre/extramarital sexual activities. Regular condom use among the respondents was low. Conclusion/Recommendations: There was a high risky sexual behaviour with irregular condom use among the study population. A continuous information, education and communication on HIV/AIDS to effect safe sex behaviours and regular condom use among this population are recommended. Keywords: Sexual, Behaviour, Condom, Nigerian, Soldiers, Ilorin African Journal of Clinical and Experimental Microbiology Vol. 10 (2) 2009: pp. 128-135

Self-Silencing and Age as Risk Factors for Sexually Acquired HIV in Midlife and Older Women

Objectives. This study explores the contribution of psychosocial factors on sex behaviors of midlife and older women. Methods. A community-based sample of ethnically diverse women (N = 572) between the ages of 50 and 93 completed standardized measures of self-silencing, self-esteem, sensation seeking behavior, HIV-related stigma behavior, sexual assertiveness, and safer sex behaviors. Results. Results from the regression analysis indicated the model significantly predicted safer sex behaviors (p < .001), with self silencing(â = -.115, p < .05) and age (â = .173, p < .001) as significant predictors.Bivariate correlation analysis indicated an inverse correlation between HIV stigma (p < .05) and safer sex behaviors. Discussion. Implications for further study and practice are discussed to include considerations for development of age- and gender-appropriate prevention interventions assisting women with interpersonal processes combined with skills for active involvement in addressing high-risk sex behaviors.

Methods of Promoting Safer Sex Behaviors Utilized by Men Who Have Sex With Male Casual Sex Partners

The purpose of this article is to report results of a qualitative investigation into the methods that HIV-positive men who have sex with men (MSM) use to initiate safer sex with casual sexual partners. In-depth, qualitative interviews were conducted with 57 HIV-positive adult MSM living in a large midwestern city. Using an inductive approach to data analysis, participants revealed a typology of safer sex strategies that can be placed into four primary categorizations: having a nonnegotiable sexual behavior policy, behaviorally controlling the interaction, being verbally direct, and being verbally indirect. Strategies varied by degree of explicitness and partner involvement. Men in this study often employed multiple strategies if their partner was not initially receptive to engaging in safer sex behaviors. The strategies described can be especially beneficial to those working in the area of HIV prevention. Providing MSM a variety of options to initiate safer sex may enhance current prevention efforts.

Frequency of Syphilis Testing in HIV-Infected Patients: More and More Often

OVER THE PAST DECADE, SYPHILIS has resurged in gay men and other men who have sex with men (MSM) in every major metropolitan area in the United States, Europe, and Australia.1 Those increases have been predominantly in HIV-infected MSM driven by the disinhibition in safer sex behavior after the introduction of highly active antiretroviral therapy for HIV infection/ AIDS. Several studies have demonstrated prevalence rates of HIV infection among syphilis cases between 50% and 75%, 2 or 3-fold higher than the prevalence of HIV infection in the general population of MSM.2 Focusing on HIV-infected MSM as the core group in the spread of syphilis might be an efficient and effective means to reduce the continued spread of syphilis and control further increases in incidence. Few studies, however, have measured syphilis incidence in HIV-infected cohorts, and little evidence is available to guide policy makers and clinicians regarding the optimal frequency of syphilis testing. In this issue, Branger et al studied the frequency of syphilis infection from 1994 through 2003 in HIV-infected patients in care in an outpatient clinic in Amsterdam, The Netherlands.3 The authors used 2 epidemiologic methods to estimate the incidence of syphilis in various periods and the proportion of asymptomatic cases. First, the authors measured syphilis prevalence among patients between March 2003 and June 2003. and looked back in time to determine which cases were new. Based on that retrospective analysis, they found an overall incidence between 2000 and 2003 of 2.7 cases per 100 person-years with about one-third asymptomatic. Among MSM that estimate was 4.6 cases per 100 personyears with the same proportion asymptomatic. Second, the authors did a prospective study based on the prevalence results from March 2003 to June 2003 and retested patients 6 months later. The measured syphilis incidence was 3.5 cases per 100 person-years with a little less than one-quarter asymptomatic. Among MSM, that estimate was 6.2 cases per 100 person-years with about the same proportion asymptomatic. The authors concluded that based on the elevated incidence rates and the high proportion of asymptomatic cases at least annual routine screening for syphilis is warranted. Although this study provided evidence to support routine screening, little can be gleaned from the report about the frequency of screening. The optimal frequency of screening would best be ascertained from modeling exercises where, holding other factors constant, the frequency of screening could be varied and one could observe the impact on the modeled incidence of syphilis infection. Fortunately, Wilson et al at the National Center in HIV Epidemiology and Clinical Research recently reported such an exercise at the Australasian Sexual Health Conference in September 2008.4 Using well-described and published parameters of the biology of syphilis transmission, they developed a mathematical model of syphilis transmission in MSM, incorporating sexual mixing networks between those in high or low sexual risk groups. Based on current observations, those groups could be considered as HIV-infected versus HIV-uninfected MSM, respectively. They found a complex relationship among testing coverage, frequency and what they called “synchronicity” of testing (closeness in time of testing within a population) and syphilis incidence. The greater the synchronicity, the larger reduction there was in syphilis incidence. With more than 70% annual coverage in syphilis testing among MSM, syphilis could be eradicated within 10 years. Notably, such a reduction could be equally achieved by screening only 25% of high risk men 2 or 3 times a year. This important study provided additional evidence of the potential population-level benefit of routine and frequent screening in a core group, in this scenario HIVinfected MSM. Currently in San Francisco, I recommend that clinicians obtain a syphilis screening test in HIV-infected patients with every CD4 T cell count or plasma HIV viral load. In clinical practice, those measures are often done every 3 or 4 In the past 12 months, Dr. Klausner has received funding for educational programs from CSI Medical Incorporated supported by King Pharmaceuticals, Inc. Correspondence: Jeffrey D. Klausner, MD, MPH, San Francisco Department of Public Health, STD Prevention and Control Services, Infectious Diseases and Medicine, University of California San Francisco School of Medicine, San Francisco, CA 94103. E-mail: Jeff.Klausner@sfdph.org. Received for publication October 17, 2008, and accepted November 17, 2008. San Francisco Department of Public Health, STD Prevention and Control Services, Infectious Diseases and Medicine, University of California San Francisco School of Medicine, San Francisco, California Sexually Transmitted Diseases, February 2009, Vol. 36, No. 2, p.000–000 DOI: 10.1097/OLQ.0b013e3181960bb7 Copyright © 2008, American Sexually Transmitted Diseases Association All rights reserved.

Test and Tell: Correlates and Consequences of Testing and Disclosure of HIV Status in South Africa (HPTN 043 Project Accept)

As the numbers of HIV-positive diagnoses rise in South Africa, it is important to understand the determinants and consequences of HIV disclosure. Cross-sectional survey from random community samples of men and women in urban and rural South Africa (n = 217 HIV-positive individuals, 89% female). Two thirds of all known HIV-infected adults in these communities had disclosed their status to sexual partner(s). On average, individuals who disclosed were 2 years older, higher in socioeconomic assets, and had known their HIV status 7 months longer than those who had not told their sexual partner(s). The "need for privacy" was the most cited reason (45%) for nondisclosure among those who had never disclosed. People who eventually disclosed their HIV status to sexual partner(s) were significantly more likely to report always or more frequently using condoms, reducing their number of sexual partners, and/or becoming monogamous. Among individuals who disclosed their HIV status, 77% reported increases in social support, with families providing the most support. Disclosure is associated with reports of consequent safer sexual behavior and greater social support. Interventions might be informed by the costs and benefits of disclosure and differences in disclosure to sexual partner vs. to one's social network.

HIV/AIDS preventive self-efficacy, depressive symptoms, and risky sexual behavior in adolescents: A cross-sectional questionnaire survey

Background High incidence rates of HIV/AIDS infections among youth draw attention to the need for emphasizing the reduction of risky sexual behavior, a major contributor to the spread of HIV/AIDS. Few researchers have examined the relationship between self-efficacy for HIV/AIDS preventions, depressive symptoms, and adolescent risky sexual behavior. This insufficient understanding limits nurses’ ability to provide effective programs for reducing adolescents’ risky sexual behaviors. Objectives This study was conducted to investigate the relationships among HIV/AIDS preventive self-efficacy, depressive symptoms, and risky sexual behavior in Taiwanese adolescents. Design A cross-sectional, correlational study. Settings Seven vocational high schools located in a metropolitan area in southern Taiwan. Participants A convenience sample of 16–18-year-old vocational high school Taiwanese adolescents ( n = 734) participated in this study. Methods Several self-administrated questionnaires, including HIV/AIDS Preventive Self-efficacy scale, the Center for Epidemiological Studies–Depression scale, Safe Sex Behavior Questionnaire, and a form for demographic data, were used to collect data. Results Taiwanese adolescents who had higher HIV/AIDS preventive self-efficacy scores had less overall risky sexual behavior. Adolescents who had less depressive symptoms had higher HIV/AIDS preventive self-efficacy. More depressive symptoms were correlated to more risky sexual behavior. Conclusion Improving Taiwanese adolescents’ HIV/AIDS preventive self-efficacy could be useful to reduce risky sexual behaviors in this population. Results of this study may assist nurses in understanding factors related to adolescents HIV/AIDS related risky sexual behavior and its’ preventions. However, future longitudinal studies are needed to clarify whether depressive symptoms is a major influential factor that might interfere with the effectiveness of HIV/AIDS prevention programs.

Sex on premises venue (SOPV) health promotion project in response to sustained increases in HIV notifications

Due to increases in HIV notifications in Queensland, a health promotion outreach project was developed with sex on premises venues (SOPV) in Brisbane. A health promotion officer (HPO) promoted safer sex behaviours among SOPV patrons over 14 months, including providing information, counselling and skills to enhance safer sexual behaviours and providing referrals. Surveys were introduced to facilitate discussions regarding HIV/sexually transmissible infections, testing and safer sex practices. The project demonstrated feasibility within this highly sexualised environment, and was enhanced by careful monitoring and revising the procedure to improve patron/staff responses to the project. The introduction of a survey instrument was a significant contributor to the project's effectiveness, providing opportunities for patrons to discuss a variety of key sexual health issues. This initiative reflected effective partnering between the Health Department, a community HIV/lesbian, gay, bisexual and transgender organisation and private industry. Despite initial difficulties, the presence of a health worker within an SOPV was acceptable to patrons and allowed for brief interventions to be conducted. This project was deemed effective for a limited time period and within certain constraints.

Culturally Competent HIV/AIDS Prevention: Understanding Program Effects on Adolescent Beliefs, Attitudes, and Behaviors

Corazón de Aztlan is a comprehensive and culturally competent adolescent development program for Mexican American and other Hispanic youth intended to prevent risky sexual behavior. Perceptions of Corazón de Aztlan participants on condom use and their implications are presented. Evaluation of HIV/AIDS prevention program effects indicated the program increased accurate knowledge of safer sexual behavior, understanding of peer pressure, negotiation skills involved in having safer sex, sense of vulnerability to HIV/AIDS, and abstinence from sexual activity, but not safer sex among those already sexually active. Contrasting rational decision-making and judgment theoretical models for understanding adolescent high-risk sexual behavior demonstrates the necessity of developing stronger partnerships between families, schools, and the larger community that could be instrumental in the creation of environments that would be more protective of youth. The potential benefits of using peer educator models and culturally competent sex education methods are discussed.

The Law of Communicable Diseases Act and disclosure to sexual partners among HIV-positive youth

In Sweden, human immunodeficiency virus (HIV) is included among the venereal diseases covered by the Law of Communicable Diseases Act. HIV-positive (HIV+) people are required to inform their sexual partners about their infection and adopt safe sex behaviours. However, it is unclear how the law is perceived. This study explores how HIV+ youth in Sweden perceive the law, handle their sexuality and disclose their HIV diagnosis to sexual partners. Ten HIV+ women and men between 17 and 24 years of age were recruited from three different HIV infection clinics. These participants were interviewed in depth. The interviews were tape-recorded, transcribed verbatim and analysed according to a grounded theory approach. The core category—cultured to take responsibility—illuminates the informants' double-edged experiences regarding the law and how they handle disclosure to sexual partners. The legislation implies both support and burden for these HIV+ youth; they feel that they have a great deal of responsibility, sometimes more than they can handle. ‘Switch off lust’, ‘balancing lust, fear and obedience’ and ‘switch off the disease’ are strategies that describe how the informants manage sexuality and disclosure. Young HIV+ people have a difficult time informing partners of their HIV diagnosis and discussing safe sex strategies. These are challenges that health care providers need to take seriously. HIV+ youth need better communication strategies to negotiate safer sex. Staff with extended education on sexuality should be a part of HIV health care.

Predictors of safer sex intentions and protected sex among heterosexual HIV-negative methamphetamine users: an expanded model of the Theory of Planned Behavior

The purpose of this study was to test a version of the Theory of Planned Behavior (TPB) for predicting safe sex behavior in a sample of 228 HIV-negative heterosexual methamphetamine users. We hypothesized that, in addition to TPB constructs, participants’ amount of methamphetamine use and desire to stop unsafe sex behaviors would predict intentions to engage in safer sex behaviors. In turn, we predicted that safer sex intentions would be positively correlated with participants’ percentage of protected sex. Hierarchical linear regression indicated that 48% of the total variance in safer sex intentions was predicted by our model, with less negative attitudes toward safer sex, greater normative beliefs, greater control beliefs, less methamphetamine use, less intent to have sex, and greater desire to stop unsafe sex emerging as significant predictors of greater safer sex intentions. Safer sex intentions were positively associated with future percent protected sex (p<0.05). These findings suggest that, among heterosexual methamphetamine users, the TPB is an excellent model for predicting safer sex practices in this population, as are some additional factors (e.g., methamphetamine use). Effective interventions for increasing safer sex practices in methamphetamine user will likely include constructs from this model with augmentations to help reduce methamphetamine use.

Evaluation of a community-based sexual health intervention for young adult Latino and African-American men

Background Recent research has documented men's unmet need for sexual and reproductive health (SRH) care, a situation which negatively affects their sexual health outcomes as well as those of their partners. This unmet need is due, in part, to men's reluctance to seek health care in general and sexual health care in particular. In this study we evaluated an educational intervention for men designed to promote more positive attitudes toward health care utilization and increase their use of SRH care. The secondary aims of the intervention were to improve men's knowledge about sexually transmitted infections and emergency contraception as well as to promote positive condom attitudes and safer sex behaviors. Methods This study used a non-equivalent control group design with pretest and post-test assessments to evaluate a 3-session SRH educational intervention delivered in small group community settings. A total of 231 men participated in the intervention and completed pretest and post-test assessments, 113 in the intervention and 118 in the control group. To be eligible for the study men had to be aged 18–30, Latino or black and able to participate in an English-language educational program. Study participants were recruited from community-based organizations. Men completed self-administered pretest interviews at study enrollment and a brief telephone interview 3 months later. Results The intervention promoted more positive health care utilization attitudes and modestly improved use of SRH care services. In addition, post-test comparisons indicated that men in the intervention group, when compared to those in the control group, had higher levels of sexual health knowledge, more positive attitudes on one of two condom attitude measures, and fewer sex partners in the past 3 months. No significant intervention effect was observed for the frequency of condom use in general or with casual sex partners. Conclusions This modest success supports the viability and efficacy of delivering sexual health education to young adult men of color in community programs that address men's educational and job-related needs.

The epidemiology of HIV infection among young people aged 15–24 years in southern Africa

To investigate epidemiological patterns and trends of HIV infection and sexual behaviour among young people aged 15-24 years in the nine countries in southern Africa most affected by the HIV epidemic. Data on HIV prevalence among young people in the general population were obtained from national population-based surveys conducted between 2000 and 2007, whereas data on sexual behaviour were obtained from repeat surveys between 1994 and 2007. Linear or exponential regression was used to analyse HIV prevalence trends among young women attending antenatal clinics in recent years. Patterns of HIV infection among young people are similar across the countries included in this analysis. The prevalence of HIV increases after the age of 15 years, more rapidly among women than among men, reaching a peak among women in their twenties and men in their thirties. Between 2000 and 2007 the prevalence of HIV among antenatal clinic attendees was constant in Mozambique and South Africa and declining in Lesotho, Namibia, Swaziland, Zambia, Botswana, Malawi and Zimbabwe, but only reached statistical significance (P < 0.05) in the last three. Changes towards safer sexual behaviour were observed over time among young men and women in the general population in this region. Sexual behaviour changes among young people are encouraging and are associated with declines in HIV prevalence among young antenatal clinic attendees over time. More research is needed to understand the recent changes and the very high prevalence among young women in this region. Interventions aimed at reducing risky behaviour need to be supported and expanded while incorporating new approaches to prevention.

Education and vulnerability: the role of schools in protecting young women and girls from HIV in southern Africa

Education has a potentially important role to play in tackling the spread of HIV, but is there evidence that this potential is realized? This analysis combines the results of previous literature reviews and updates them with the findings of recent randomized controlled trials and a discussion of possible mechanisms for the effect of schooling on vulnerability to HIV infection. There is a growing body of evidence that keeping girls in school reduces their risk of contracting HIV. The relationship between educational attainment and HIV has changed over time, with educational attainment now more likely to be associated with a lower risk of HIV infection than earlier in the epidemic. Educational attainment cannot, however, be isolated from other socioeconomic factors as the cause of HIV risk reduction. The findings of this analysis suggest that the equitable expansion of primary and secondary schooling for girls in southern Africa will help reduce their vulnerability to HIV. Evidence of ineffective HIV prevention education in schools underlines the need for careful evidence-based programme design. Despite the challenges, recent provisional evidence suggests that highly targeted programmes promoting realistic options for young adults may lead to safer sexual behaviour. Targeted education programmes have also been successful in changing students' attitudes to people living with HIV and AIDS, which is associated with testing and treatment decisions. This reduction in stigma may be crucial in encouraging the uptake of voluntary counselling and testing, a central strategy in the control of the epidemic. Expansions of carefully designed and evaluated school-based HIV prevention programmes can help to reduce stigma and have the potential to promote safe sexual behaviour.

Negotiating safe sex among women of Afro-Surinamese and Dutch Antillean descent in the Netherlands

Safe sex negotiation and communication about sexual risks with partners is important for women to ensure sexual risk reduction. This paper describes the results of a survey on safer sex and negotiation behavior, and the correlates of negotiation with partners among 128 women from Surinamese and Dutch Antillean descent in the Netherlands. The key findings are that 50% of the participants had negotiated sexual risk reduction with their partner, yet only 40% of the women who negotiated safer sex actually claimed practicing safe sex. Participants defined safe sex with steady partners primarily as negotiated safety and monogamy, and safe sex with casual partners primarily as condom use. Intentions to negotiate safer sex with steady partners were related to positive attitudes and perceived injunctive norms towards safe sex negotiation, and educational background. Intention to discuss safe sex with casual partners were primarily related to attitudes and perceived self-efficacy. STI/HIV prevention interventions targeting these women should incorporate awareness-raising of safety in different types of relationships, deciding on the appropriateness of relation-specific sexual risk reduction strategies, and building negotiation skills to accomplish the realization of these strategies.

Vulnerability and risk perception in the management of HIV/AIDS: Public priorities in a global pandemic

Understanding the way perception of risk is shaped and constructed is crucial in understanding why it has been so difficult to mitigate the spread of HIV/AIDS. This paper uses the Pressure and Release (PAR) model, used to predict the onset of natural disasters as the conceptual framework. It substitutes vulnerability and risk perception as the trigger factors in the model, in making the case that HIV/AIDS can be characterized as a slow onset disaster. The implications are that vulnerability must be managed and reduced by addressing root causes, dynamic pressures, and unsafe conditions that contribute to the HIV/AIDS pandemic. HIV/AIDS programs must be culturally appropriate and work toward influencing risk perception, while addressing social norms and values that negatively impact vulnerable populations. By impacting cultural and social expectations, individuals will be able to more readily adopt safer sex behaviors. The development of policies and programs addressing the issues in context, as opposed to individual behaviors alone, allows for effective public health intervention. This may have implications for public health measures implemented for combating the spread of HIV/AIDS.

Predicting and explaining transtheoretical model stage transitions in relation to condom‐carrying behaviour

The stages of change component of the transtheoretical model have been applied to safe sex behaviours in cross-sectional analyses, but have not yet been subject to prospective analysis. It was predicted that: (a) cross-sectional analyses would demonstrate good discrimination between the stages of change; (b) prospective analyses would allow for the identification of predictors of stage transitions; and (c) implementation intentions would explain progression from the preparation stage. This study employed an experimental longitudinal design. Participants were randomly assigned to the experimental (implementation intention) or control conditions and completed questionnaires at baseline and at 2-month follow-up. Five hundred and twenty-five adolescents who were broadly representative of the UK population completed questionnaires at baseline and follow-up (N=393) measuring: demographic variables; stage of change; theory of planned behaviour constructs; anticipated regret; and moral norm in relation to condom-carrying behaviour. The experimental condition completed a self-generated implementation intention to carry condoms at the end of the baseline questionnaire. Discriminant function analyses indicated that the stages of change could be accurately discriminated from one another cross-sectionally and that, longitudinally, the measured variables were able to predict transitions between most stages. Implementation intentions caused people to progress from the preparation stage. Transitions between most stages were reliably predicted, thereby providing potential targets for intervention. The brief implementation intention intervention was effective and could easily be utilized and expanded to encompass a broader range of sexual health behaviours.

Parent–Adolescent Sexual Communication: Associations of Condom Use with Condom Discussions

This study investigated the relationship between parent-teen sexual communication, discussion of condoms, and condom use among adolescents in mental health treatment. Adolescents with a history of sexual intercourse and their parents completed questionnaires assessing adolescent sexual risk behavior, sexual communication, and discussion of sexual topics. Greater condom use by adolescents was associated with parent-adolescent condom discussion but was not associated with openness in sexual communication. Seventy-six percent of adolescents reported that parents had discussed condoms with them and these discussions were significantly associated with protected sexual acts. In a logistic regression, accounting for age, gender, race, and psychiatric diagnosis teens that discussed condoms with their parent were more likely to report condom use at last sex. Increasing direct communication about condoms may be an important step in increasing adolescent's safer sex behavior. Mental health disorders and family distress may make such discussions challenging but are not an insurmountable barrier to direct discussions about condoms.