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Predicting Condom Use Behavior in Sexually Active Adolescents

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Predicting Condom Use Behavior in Sexually Active Adolescents PREDICTING CONDOM USE BEHAVIOR IN SEXUALLY ACTIVE ADOLESCENTS: APPLICATION OF THE HEALTH BELIEF MODEL AND DEVELOPMENTAL ASSETS FRAMEWORK by HOLLI M. SLATER Presented to the Faculty of the Graduate School of The University of Texas at Arlington in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY THE UNIVERSITY OF TEXAS AT ARLINGTON May 2015 Copyright © by Holli M. Slater 2015 All Rights Reserved ii Acknowledgements My path to completing this PhD has been long, but rewarding. I am forever grateful to the many incredible people in my life who helped me along the way so that I was able to reach this incredible milestone. First and foremost, Diane Mitschke, my mentor, colleague, and friend. Thank you for gently nudging and eventually pushing me to finish. Your constant encouragement inspired me to never give up. It was because of you that I made it through this final push. Thank you to each of my committee members: Regina Praetorius, the first person to encourage me to pursue a PhD; Maria Scannapieco, the first person to encourage me to use this data; Larry Watson, for your support along the way; Sharon Homan, for talking through numerous ideas until we found something that would work; and finally, Mike Killian, who came on halfway through this process and spent endless hours answering question…after question…after question. There are a lot of words written here. I appreciate all of you for reading each and every one of them and providing me with valuable feedback. I am a stronger researcher because of all of you. I am grateful to Arlington Independent School District and the Office of Adolescent Health (OAH) for supporting this study. My work as an evaluator during my doctoral studies has helped me better define my career path, allowed me to develop a strong skillset, and become an expert researcher in the process. This study is a small part of the amazing work that continues to be done through OAH funding with innovative grantees like Arlington ISD. Thank you to my dear friends and family. I could not have done this without having each of you stepping in when I needed you and providing me with unconditional support. I am so thankful to know that while I was working away, my sweet boy was in the care of such loving people or that a pep talk was just a phone call away. A special thanks to my dear friend Kathy, who flew in from Georgia at a moment’s notice to help out, checked in daily to offer words of encouragement, and spent countless hours listening to me talk through dissertation ideas. Mary, my mother-in-law, who brought over dinner and snacks regularly and was always available to help with childcare. Hollis and Louisa, my amazing parents, I definitely could not have done this without you. You have always been my loudest cheerleaders, offering unending support and iii encouragement. I am truly thankful to have such amazing people in my life and for unlimited minutes on my phone plan. Thank you for listening to hours of research jargon, frustrations, and stress-filled rants and always ending the conversation with “I know you can do this! Now, go work!” Alan, my life partner, thank you for being an amazing single parent during the past few months and ensuring the hidden stash of chocolate was always well stocked. I am happy to have had you by my side during this long journey. Lastly, my sweet Emmett, thank you for finally sleeping through the night in the final weeks before my paper was submitted. I hope you continue to be inquisitive as you grow and enjoy flipping through statistics books just as much when you are older as you do now. Note: This publication was supported by Grant Number TP2AH000011 from the U.S. Health and Human Services (HHS) Office of Adolescent Health. Its contents are solely the responsibility of the author and do not necessarily represent the official views of the Office of Adolescent Health or HHS. April 21, 2015 iv Abstract PREDICTING CONDOM USE BEHAVIOR IN SEXUALLY ACTIVE ADOLESCENTS: APPLICATION OF THE HEALTH BELIEF MODEL AND DEVELOPMENTAL ASSETS FRAMEWORK Holli M. Slater, PhD The University of Texas at Arlington, 2015 Supervising Professor: Diane B. Mitschke A significant amount of progress has been made over the past decade to reduce the impact of risky sexual behavior among adolescents; however, rates of unwanted pregnancy and contraction of sexually transmitted infections remain high. Finding ways to mitigate the consequences of risky sexual behavior continues to be a focus of many working with adolescents engaging in risky behavior. This study performed a secondary analysis of data collected during a 5-year evaluation of a teen pregnancy program targeting youth ages 17-19 who were at high risk for dropping out of high school. The goals of this study were two fold: 1) Test the applicability of the Health Belief Model (HBM) for assessing both adolescent intentions to use condoms and condom use behavior, and 2) Assess the moderating effect of the Developmental Assets framework on the relationship between condom use intentions and behavior. Guided by the Health Belief Model framework, factor analyses were conducted to identify the model that best fit the data. This resulted in six factors comprised of 26 items that reflected different aspects v of the HBM and predicted 63% of the variance in the model. This was followed by ordinal and logistic regressions to detect the relationship between each of the identified factors and condom use intentions, as well as between each of the identified factors and condom use behavior. The results demonstrated that Partner Efficacy, Interpersonal Barriers – Partner Trust, Structural Barriers – Accessibility, Benefits, and Physical Barriers – Comfort significantly predicted intentions to use condoms. Susceptibility was the only factor that did not produce a significant result for intentions to use condoms. Interpersonal Barriers – Partner Trust, Structural Barriers – Accessibility, and Physical Barriers – Comfort significantly predicted a positive relationship between the factor and condom use behavior. Susceptibility was found to have a significant negative relationship between susceptibility and condom use behavior, while Partner Efficacy and Benefits failed to produce significant results. Ultimately, participants who reported greater intentions to use condoms were more than twice as likely to report using a condom in the past three months. Overall developmental assets scores did not significantly demonstrate a moderating effect on the relationship between intentions and behavior. These findings confirm that the Health Belief Model in the originally hypothesized form did not fit well for this sample; however, the newly identified model demonstrated a stronger fit for this population. The development of a new model guided by the HBM may be more applicable when assessing condom use intentions with academically at-risk adolescents. While some of the factors exhibited limitations, revisions to items, inclusion of new items, and removal of weaker items may lead to an improved model and should be explored. Further examination into the role of the developmental assets should also be assessed. Implications of this study’s findings for social work policy, practice and future research are discussed. vi Table of Contents Acknowledgements ............................................................................................................ iii Abstract ............................................................................................................................... v List of Illustrations ............................................................................................................ xiii List of Tables .................................................................................................................... xiv Chapter 1 Introduction ........................................................................................................ 1 Steps to Address Pregnancy and STIs Among Youth .................................................... 2 School Based Programs ............................................................................................ 4 After School or Community Based Programs ............................................................ 6 Clinic Based Programs ............................................................................................... 8 Specialized Setting Programs .................................................................................. 10 Risky Sexual Behavior and Outcomes ......................................................................... 11 Unwanted Teen Pregnancy ...................................................................................... 12 Educational Impacts of Teen Pregnancy ............................................................. 13 Economic Impacts of Teen Pregnancy ................................................................ 13 Health Impacts of Teen Pregnancy ...................................................................... 14 Developmental Impacts of Teen Pregnancy ........................................................ 15 Rates of Teen Pregnancy - Scope of the Problem .............................................. 15 Sexually Transmitted Infections (STIs) .................................................................... 16 Health Impacts of Sexually Transmitted Infections .............................................. 17 Economic Impacts of Sexually Transmitted Infections ........................................
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