Contraceptive and Condom Use Adoption and Maintenance: A Stage Paradigm Approach

The Transtheoretical Model of Behavior Change was examined for its applicability to contraceptive and condom use adoption and maintenance using N = 248 heterosexually active college-age men and women. The model posits that individuals do not go directly from old behaviors to new behaviors, but progress through a sequence of stages: precontemplation, contemplation, preparation, action, and maintenance. The stages of change offer a temporal dimension that provides information regarding when a particular shift in attitudes, intentions, and behavior may occur. The model also postulates a set of constructs that act as sensitive intervening or outcome variables—the pros and cons of change and self-efficacy. The results demonstrated that individuals were furthest along in the stages of change for general contraceptive use, followed closely by condom use with other (e.g., casual) partners, and then condom use with main partners. Although no sex differences were found for the stages for the three separate contraceptive behaviors, males and females differed on the pros and cons and levels of self-efficacy when engaging in intercourse with the two types of partners. MANOVA/ANOVA results indicated that the relationship between stages and other constructs follows predicted patterns suggesting that the transtheoretical model may provide a useful framework or paradigm for understanding contraceptive and condom use behavior

Relationships of Stigma and Shame to Gonorrhea and HIV Screening

Objectives. The purpose of this study was to assess the relationships between stigma and shame associated with seeking treatment for sexually transmitted diseases (STDs) and undergoing testing for gonorrhea and HIV. Methods. Participants were 847 males and 1126 females (mean age: 24.9 years) in 7 cities. Two scales assessed STD-related stigma and STD-related shame. Results. Rates of stigma and shame were higher among participants without a gonorrhea test in the past year and among those without an HIV test. Sex, age, health service use, previous suspicion of gonorrhea, and low levels of stigma were independently associated with gonorrhea testing. Age, enrollment site, use of health services, gonorrhea testing, and low levels of stigma were independently associated with HIV testing. Conclusions. Shame is part of the experience of seeking STD-related care, but stigma may be a more powerful barrier to obtaining such care

International genome-wide meta-analysis identifies new primary biliary cirrhosis risk loci and targetable pathogenic pathways.

Primary biliary cirrhosis (PBC) is a classical autoimmune liver disease for which effective immunomodulatory therapy is lacking. Here we perform meta-analyses of discovery data sets from genome-wide association studies of European subjects (n=2,764 cases and 10,475 controls) followed by validation genotyping in an independent cohort (n=3,716 cases and 4,261 controls). We discover and validate six previously unknown risk loci for PBC (Pcombined<5 × 10(-8)) and used pathway analysis to identify JAK-STAT/IL12/IL27 signalling and cytokine-cytokine pathways, for which relevant therapies exist

Prediction of adherence using the Transtheoretical model: Implications for pharmacy care practice

Practical and theoretically derived intervention techniques are needed to improve adherence with prescription medications. Recently, there has been increased attention on the potential applicability of the Transtheoretical Model of Change (TTM) to intervening on medication adherence. This paper compares the predictive ability of the constructs of the TTM to static predictors (i.e., demographics and sexual history characteristics) in the area of adherence with oral contraceptives, a daily medication. Three hundred and six pill users from two community samples responded to an anonymous questionnaire regarding pill use and the TTM constructs. Hierarchical multiple regressions indicated that demographic and sexual history variables did not add significantly to the prediction of adherence based on the TTM constructs. Moreover, stage of adherence emerged as a strong and significant predictor and the model constructs accounted for a large proportion of the variance in nonadherence. The ability of the TTM\u27s constructs to predict nonadherence is of particular importance given that this research addressed a difficult question by restricting the range of prediction to current pill users and not including individuals who had discontinued pill use. Discontinuation is presumably easier to predict because it is the most extreme form of nonadherence. Implications for individualizing interventions within pharmacy practice to improve adherence with OC and other prescription medications are discussed

Condom Use Assertiveness and the Stages of Change With Main and Other Partners

A measure assessing an individual\u27s ability to assert the use of condoms was developed using, N= 248, heterosexually active college men and women. Both principal component analysis (PCA) and structural equation modeling (SEM) procedures were performed. External validity for the assertion for condom use measure was established by integrating the measure with the stages of change dimension from the transtheoretical model of behavior change. The transtheoretical model posits that both the cessation of high‐risk behaviors and the acquisition of health behaviors involve the progression through five stages of change: precontemplation, contemplation, preparation, action, and maintenance. The results indicated that individuals were further along in the stages of change for using condoms with a casual partner, as compared to a steady partner. The degree to which assertive condom use behavior was engaged in was related to an individual\u27s stage of readiness for using condoms with the two types of partners. The utility of stage‐matched intervention strategies, as opposed to the action‐oriented approaches to modify high‐risk sexual behavior, is discussed. Copyright © 1993, Wiley Blackwell. All rights reserve

Condom use adoption and continuation: A transtheoretical approach

The use of latex condoms can reduce the risks of sexually transmitted diseases (STDs), including the human immunodeficiency virus (HIV) that can lead to the acquired immunodeficiency syndrome (AIDS). Yet, most intervention programs have demonstrated little effect on overall condom use. The major limitation of many traditional behavioral change programs is that they are based on an action paradigm which implicitly or explicitly views behavior change as a dramatic and discrete movement (e.g. going from \u27never\u27 using condoms to \u27always\u27 using condoms). The Transtheoretical Model of Change (TMC) offers an alternative conceptualization of the structure of change, a stage paradigm, that defines behavior change as an incremental process through a series of stages. This paper offers a summary of how measures and models of condom use based on the TMC have been developed and continue to be refined, offers some preliminary findings with diverse populations, and describes intervention applications of a stage paradigm approach to condom use adoption and continuation

Assessing the Stages of Change and Decision-Making for Contraceptive Use for the Prevention of Pregnancy, Sexually Transmitted Diseases, and Acquired Immunodeficiency Syndrome

A synergistic approach was taken to examine contraceptive use adoption for two related behaviors: pregnancy prevention and the prevention of sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). One hundred twenty-three young adults responded to questionnaire items based on two constructs from the Transtheoretical Model of Change, the Stages of Change and Decisional Balance, as well as other pertinent variables. In Phase 1, two Decisional Balance measures were developed: One for the prevention of pregnancy and one for disease prevention. Final versions of both measures consisted of two 10-item scales: one representing the positive aspects (PROS) and one representing the negative aspects (CONS) of contraceptive and condom use. In Phase 2, the same individuals were staged for both pregnancy and disease prevention according to their readiness to change for contraceptive and condom use. MANOVAs and ANOVAs indicated that the PROS and CONS for both measures were related to stage of change for both contraceptive and condom use. Results from this pilot study were consistent with prior applications of the Transtheoretical Model to the cessation of such problem behaviors as smoking and to the adoption of positive health behaviors such as exercise acquisition. © 1993, Sage Publications. All rights reserved

The Theory of Reasoned Action and Intention to Seek Cancer Information

Objectives : To evaluate the applicability of the theory of reasoned action to explain men\u27s intentions to seek prostate cancer information. Methods : Three hundred randomly selected African American men participated in telephone interviews. Correlational and regression analyses were conducted to examine relationships among measures. Results : All relationships were significant in regression analyses. Attitudes and subjective norm were significantly related to intentions. Indirect measures of beliefs derived from elicitation research were associated with direct measures of attitude and subjective norms. Conclusions : The data are sufficiently clear to support the applicability of the theory for this behavioral domain with African American men and suggest several important areas for future research

HIV Risk in Women: A Multifaceted Model

A comprehensive model was designed to predict risky, HIV‐related sex in women from a set of behavioral, interpersonal, and psychoattitudinal measures. Survey measures were administered to two university samples of 234 and 263 women. Three sets of dependent measures assessed Partner‐Related HIV Risk, Unprotected Vaginal Intercourse, and Anal Intercourse. There were three multifaceted sets of independent variables that involved 12 factors. The first set, behavioral risk, involved (a) Social Substance Use, (b) Hard Substance Use, (c) Foreplay Sexual Experience, and (d) Advanced Sexual Experience. The second set, interpersonal risk, examined (a) Victimization, (b) Anticipated Partner Reaction, (c) Birth Control Sexual Assertiveness, (d) Refusal Sexual Assertiveness, and (e) Initiation Sexual Assertiveness. The third set, psychoattitudinal risk, involved (a) Psychosocial Functioning, (b) Psychosexual Attitudes, and (c) Self‐Efficacy for AIDS Prevention. Substantial variance was explained using structural modeling methods, with the strongest prediction involving behavioral and interpersonal HIV risk factors. Psychoattitudinal factors were less central, although still important. The results supported and extended previous findings and suggested that the biggest HIV risk factors for women include: greater social substance use, greater sexual experience, anticipated or actual victimization, low assertiveness about requesting birth control, overly positive psychosocial attitudes, negative attitudes about sexuality, and less self‐efficacy about avoiding HIV risk. Copyright © 1993, Wiley Blackwell. All rights reserve