Health belief and self-efficacy models: their utility in explaining college student condom use.

This investigation tested the ability of the Health Belief Model (HBM), dimensions of self-efficacy, various behavioral variables (i.e., number of sex partners in the past 12 months, frequency of drunkenness during sexual intercourse, and number of diagnosed sexually transmitted diseases), and demographic measures to distinguish between three condom user groups (i.e., nonusers, sporadic users, and consistent users). The usable sample consisted of 366 college students, ages 18 to 24. The study operationalized the following HBM components: perceived susceptibility, perceived benefits, and perceived barriers. The multidimensional Condom Use Self-Efficacy Scale (CUSES) was also used in this investigation. Results from a discriminant analysis indicated that sporadic users were best distinguished from both consistent and nonusers by number of sex partners in the past year, frequency of drunkenness during sexual intercourse, perceived susceptibility to HIV/AIDS and other STDs, and a self-efficacy factor labeled Assertive. The sporadic users had significantly more sex partners, were drunk more often when engaging in sexual intercourse, perceived themselves as more susceptible to HIV/AIDS and other STDs, and were less confident in their ability to discuss and insist on condom use with a partner. It was also discovered that each condom user group was best defined by different subsets of discriminating variables. Implications of these findings for campus-based prevention programs and future research are discussed.

PIP: The ability of the health belief model and self-efficacy concept to discriminate among three condom use groups--nonusers, sporadic users, and consistent users--was assessed in a sample of 366 sexually active college students 18-24 years of age. The mean number of sex partners in the 12 months preceding the survey was 2.2. The students could be classified as follows: nonusers, 70 (19%); sporadic users (defined as having more total sex partners in the preceding year than partners with whom a condom was always used), 157 (43%); and consistent users, 107 (29%), Principal components factor analyses of the health belief model constructs indicated that perceived benefits, perceived barriers, and perceived susceptibility are multidimensional. In univariate analyses, statistically significant differences across condom use groups were found for the following measures: perceived susceptibility of partner, perceived susceptibility of self, assertiveness, partner disapproval of condoms, intoxicants, number of sex partners, and inebriation during sexual intercourse. When a multiple discriminant function analysis was conducted with these variables, they failed to differentiate significantly between nonusers and consistent users but did distinguish sporadic users. Sporadic condom users perceived themselves and their partners as at highest risk of acquired immunodeficiency syndrome and other sexually transmitted diseases, had the largest number of sex partners in the past year, reported more inebriation during sexual intercourse, and were less confident in their ability to negotiate condom use with a partner than their counterparts in the other two use groups. Out of the variable subsets, the health belief model was best at identifying sporadic users, behavioral variables were most pertinent for nonusers, and the self-efficacy measure was most relevant in the case of consistent use.

A review of PCP abuse trends and perceptions.

A critical review of epidemiologic literature on the abuse of phencyclidine (PCP) suggests that current perceptions by the public and among members of the health professions and drug treatment communities about abuse of the drug are distorted. Epidemiologic data indicate that PCP abuse is not widespread in the United States, nor is its abuse prevalent among adolescents. Its abuse has become concentrated among post-high school age, black males in a limited number of cities, especially Washington, DC. The degree of PCP abuse in a metropolitan area may be related to the availability and cost of other, more highly coveted drugs, such as crack cocaine.

The social context of drinking scales: construct validation and relationship to indicants of abuse in an adolescent population.

A series of items that measure the social context of alcohol consumption among adolescents was administered in a questionnaire survey to over 1,300 high school students. Emerging from a factor analysis were five factors which suggested that drinking occurs in the following social contexts: drinking for social facilitation where adults are not present, drinking at school or during school-related activities, drinking for stress control, drinking for conformity or to be part of a group, and drinking under parental supervision at home. Scales based on these factors appeared to be reliable, free from social desirability bias, and able to discriminate problem drinkers from nonproblem drinkers. The most important of these factors was drinking for social facilitation that is not restrained by the presence of adults. These findings reinforce the validity of examining the social context of drinking (which involves situational as well as motivational reasons for drinking) to uncover important etiological contributors of alcohol abuse in an adolescent population.

A test of the perceived norms model to explain drinking patterns among university student athletes.

The author tested the ability of perceived drinking norms to discriminate among drinking patterns in a sample of National Collegiate Athletic Association (NCAA) Division I student athletes. He used an anonymous questionnaire to assess 297 athletes, representing 18 teams, at a public university in the Midwest. Alcohol use patterns showed considerable variation, with many athletes (37.1%) abstaining during their season of competition. A discriminant function analysis revealed that higher levels of alcohol involvement are disproportionately found among athletes who began drinking regularly at an early age. Perceived drinking norms were less important in the discrimination of student athlete drinker groups. Women and those with higher grade point averages were somewhat more likely to refrain from in-season drinking than other survey respondents.

Adolescent perceptions of college student drinking.

OBJECTIVE: To extend knowledge about perceived drinking norms by assessing perceptions of college student drinking in a sample of 7th- to 12th-graders. METHODS: Anonymous questionnaire was administered to 2,017 adolescents in two Ohio school districts. RESULTS: By seventh grade, 89.6% of the students had formed normative perceptions of collegiate drinking. A canonical correlation analysis revealed that perceptions of collegiate drinking have substantial, independent relationships not only with alcohol use intensity and drinking onset, but also with indicators of tobacco and other drug use as well. CONCLUSIONS: Exaggerated perceptions of college student drinking are psychosocial markers of substance use in 7th- to 12th-graders.

Dimensions of self-efficacy among three distinct groups of condom users.

Condom use self-efficacy can be defined as expectations about one's ability to use condoms under a variety of circumstances. This investigation examined the factor structure of the Condom Use Self-Efficacy Scale (CUSES) in an 18- to 23-year-old college population (N = 339) and tested the ability of the factors to distinguish among three groups of condom users (nonusers, sporadic users, and ritualistic users). Emerging from a principal components analysis were four reliable factors labeled Mechanics, Partner's Disapproval, Assertive, and Intoxicants. Results from a discriminant analysis indicated that sporadic users were best distinguished from ritualistic users by number of sex partners, use of intoxicants, and intensity of alcohol use. The sporadic users had more sex partners, were less confident of their ability to use condoms when intoxicated, and were heavier drinkers than were the ritualistic users. Nonusers were best distinguished from ritualistic users by the factor labeled Assertive. Nonusers were significantly less confident in their ability to discuss condoms and to insist on their use with a sexual partner. Implications of the findings for improving campus-based programs to prevent the spread of human immunodeficiency virus infection and sexually transmitted diseases are discussed.

PIP: During January-June, 1992, 339 students, 18-23 years old, at the State University of New York in Brockport completed a 79-item questionnaire designed to assess sexual behavior and alcohol use. Researchers aimed to test the factor structure of the Condom Use Self-Efficacy Scale (CUSES), which comprised 28 items in the questionnaire, and the ability of self-efficacy, high risk behavior, and demographic factors to differentiate among consistent condom users, sporadic users, and nonusers. Sporadic users had significantly more sexual partners in the last 12 months than did consistent users (3.64 vs. 1.92; p .005). This may be because sporadic users were more likely to use alcohol (CUSES score: 9.09 vs. 7.81; p .05) and to lack confidence in their ability to use condoms when intoxicated (8.5 vs. 9.73; p .005) than were consistent users. Alcohol use had a consistent, positive correlation with number of sexual partners (p .01), indicating the need for college health education programs that promote condom use to address alcohol abuse. Nonusers were less likely to be confident of their ability to demand that their sexual partner use a condom than were consistent users (9.36 vs. 10.58; p .005). They were also more likely to fear partner's disapproval than consistent users (16.46 vs. 17.73; p .05), but this was a more moderate difference than assertiveness. Thus, nonusers tended to be insecure in their abilities to discuss and insist on condom use and to negotiate and resolve any conflict about condom use. Consistent users had better communication skills about intimate subjects than did nonusers. Any health education program promoting safer sexual practices needs to address communication and improvement of relationship skills. These findings also suggest that campus programs cannot be limited to mechanics of condom use, and that role playing would provide students opportunities to practice skills in relationships, communication, and conflict resolution.

Balancing risks and benefits of deception in assessing genetic screening utilization.

OBJECTIVE: To advocate that research using intentional deception is sometimes appropriate. METHODS: A deception paradigm created to assess utilization of genetic screening for alcoholism susceptibility is reviewed in the context of competing ethical obligations and objections to the procedure. CONCLUSIONS: The paradigm is ethically defensible, it generates useful knowledge about future utilization of alcoholism screening by college students, and it exposes participants to no more than minimal risk. The use of deception to address questions related to predictive genetic screening will require investigators to balance protection of participants with the need to advance knowledge.

Application of a bogus testing procedure to determine college students' utilization of genetic screening for alcoholism.

A convenience sample of 181 college students took part in a quasi-experimental study that tested the use of genetic screening for alcoholism--a test that does not yet exist. A questionnaire was administered before and after the students viewed a presentation that accurately explained genetic susceptibility to alcoholism but misled them by offering "a newly available" test. Alcohol-related variables were assessed before the presentation. Test-seeking intention and reasons for and against testing were assessed after the presentation. Regression analysis found that being Caucasian, female, and somewhat older than traditional college age, and having a history of early drunkenness were significant predictors of testing intention. During the week following data collection, only 7 participants (4%) attempted to schedule a test. Implications of these findings and the ethical issues related to predictive screening for alcoholism in the college population are discussed.

The relationship of adolescent perceptions of peer norms and parent involvement to cigarette and alcohol use.

This investigation assessed the relative influence of peer norms and parental involvement on adolescent cigarette and alcohol use. An anonymous questionnaire was administered to 2,017 seventh- to 12th-grade students in two Ohio public school districts. Cigarette and alcohol use rates in the sample were comparable to those found in national probability surveys. Results indicated that the relative balance of peer-parent influences did not differ across grade level. At all grade levels, perceived peer norms had substantially greater correlations with cigarette and alcohol use than did measures of perceived parental involvement. The findings are interpreted from an efficiency perspective. Optimal use of prevention resources suggest that programming for seventh- to 12th-graders should focus on shaping the perceptions of peer smoking and drinking practices rather than on parent interventions. Social norms marketing or other forms of normative education should be tested in this population.

Relationships between expectancies and adolescent dieting behaviors.

Dieting expectancies are cognitive variables pertaining to anticipated outcomes individuals expect to obtain from dieting to lose weight. This investigation examined the factor structure of dieting expectancies in an adolescent population, age 10-18, and tested the ability of factors to distinguish among types of dieter, diet pill user, and vomiter groups. Emerging from a principal components analysis were five reliable expectancy factors: Social Confidence, Social Approval, Self-Worth, Positive Performance, and Negative Consequences. Results indicate dieting expectancies and gender are important in distinguishing among adolescents who engage in different dieting practices. Gender and Self-Worth were particularly important in distinguishing frequent dieters from nondieters. Social Approval was best at separating frequent dieters from occasional dieters, diet pills users from nonusers, and vomiters from nonvomiters.

Social context, sensation seeking, and teen-age alcohol abuse.

An anonymous questionnaire was administered to more than 1,200 seventh to 12th grade students in four rural public schools in western New York State. The questionnaire measured alcohol use, the social contexts of drinking, and the personality trait known as "sensation seeking." A majority (57%) were drinkers, and discriminant function analyses were performed on their scores on these measures to determine if they could distinguish between different levels of alcohol use intensity, alcohol-impaired driving, and riding with an impaired driver. Results indicated social context measure were effective in distinguishing among levels on each indicant of abuse. In particular, high-intensity drinkers, impaired drivers, and riders of impaired drivers were more likely to drink in a context of social facilitation, stress control, and defiance of school and adult authority. The drinking context of peer acceptance was important only in distinguishing teen-agers who ride with drunk drivers from those who do not. Overall, the sensation seeking trait was of moderate importance in distinguishing among different alcohol abuse practices. Implications of these findings for assessment as well as school-based prevention programs are discussed.

Occupational low back disability: effective strategies for reducing lost work time.

1. The important variables related to lost work time in this study are: back diagnosis (lumbar disc displacement), history of back surgery, job satisfaction, and employee reluctance to report low back pain to supervisor. 2. The findings support the complexity of low back disability. Lost work time related to low back pain must be managed using a "holistic" approach by addressing all dimensions of a person (physical, emotional, and environmental). 3. To minimize low back disability, occupational health providers should be part of a community task force with representatives from other disciplines who can plan and develop low back disability guidelines and standards of care.

Social context, perceived norms and drinking behavior in young people.

An anonymous questionnaire was administered to 1,283 middle school/high school students and 930 college students. The students responded to instruments assessing social context of drinking, perceived norms of drinking, alcohol use intensity, and frequencies of impaired driving (DWI) and riding with an impaired driver (RWID). Canonical correlation analyses revealed that in middle school/high school students, there are discernable patterns of association between social context, perceived norm and alcohol abuse measures. Drinking intensity for self was closely related to several social context variables and perceptions of close friends' drinking intensity, whereas RWID and DWI frequencies for self were most strongly associated with different perceived norm variables. Among college students, findings from a canonical analysis showed that both social context and perceived norm variables were related to drinking intensity, though there were not multiple patterns of association among subsets of variables. Overall, the findings indicate that alcohol consumption has linkages to both social context and perceived norms. In contrast, DWI and RWID are closely related only to normative influences.

The art and science of scale development in health education research.

This conceptually-based article focuses on the value of the complementary or integrative use of qualitative and quantitative research methods in health education research. Specifically, the article describes a model for developing measurement scales using both qualitative and quantitative techniques. The qualitative methods of open-ended interviews and focus groups are used to develop questionnaire items. Quantitative methods (e.g. factor analysis) are used to test and refine questionnaire subscales. A discussion of reliability and scale validation is offered along with illustrative examples from recent health education research.

Social context and sensation seeking: gender differences in college student drinking motivations.

An anonymous questionnaire was administered to students at two universities. The questionnaire contained the Social Context of Drinking Scales, the Sensation Seeking Scale, and measures of alcohol use intensity, frequency of alcohol-impaired driving, as well as frequency of riding with an impaired driver. The results revealed significant gender differences in the social context of drinking as well as sensation seeking. High intensity drinkers of each gender were more likely to drink in a context of Social Facilitation and score higher on the sensation seeking subscale--Disinhibition. High intensity men drinkers were more likely to drink in a context of Sex Seeking, whereas high intensity women drinkers tended to drink in a context of Emotional Pain. In general, the Social Context of Drinking Scales were superior to the Sensation Seeking Scales at being able to discriminate high from low intensity drinkers. The implications for targeted prevention programs on college campuses are discussed.