To guide acquired immunodeficiency syndrome (AIDS) prevention program planning, 181 tenth grade students residing in or near an AIDS epicenter completed a survey measuring past year involvement in sexual intercourse and condom use, beliefs about self-efficacy for AIDS preventive behaviors, and beliefs about susceptibility to and severity of AIDS, and outcome efficacy of AIDS preventive actions. A degree of uncertainty existed for all areas of self-efficacy surveyed: refusing sexual intercourse under a variety of circumstances, questioning sex partners about past risky behaviors, and correct and consistent condom use. Students were most uncertain of their ability to refuse sex with a desirable partner, under pressure, or after drinking alcohol or using marijuana; to purchase condoms, or use them consistently after drinking alcohol or using marijuana; and to question partners about past homosexual history. Those students with lower self-efficacy for refusing sex were twice as likely to have had sexual intercourse. Similarly, those students with lower self-efficacy for correct, consistent condom use were five times less likely to have used condoms consistently. These associations remained even after adjusting for the influence of other AIDS-related beliefs. Implications of these findings focus on exploiting the link between self-efficacy and behavior by building a prevention program that emphasizes skills-building rather than the traditional knowledge-only approach.
PIP: 181 10th-grade students from 3 New York City and 3 Rockland county high schools were surveyed on beliefs about self-efficacy for AIDS prevention behaviors, susceptibility and severity of AIDS, and past year sexual intercourse and condom use in spring 1989. 3 logistic regression models were run to test whether past year involvement in sexual intercourse was linked to perceived self-efficacy for refusing sex, and to self-efficacy for correct, consistent condom use. The students averaged 15.5 years of age. 33% had engaged in sexual intercourse in the last year; 33% of these said they used condoms every time. Students perceiving themselves to be less efficacious in refusing sex were twice as likely to have engaged in coitus. Those feeling less able to use condoms were 5 times as likely to have used them every time. The proportion stating that they were "very sure" that they could perform 22 AIDS prevention behaviors ranged from 15.6% (for refusing to have sex with a prior partner) to 65.5% (for getting money to buy condoms). Girls were more sure than boys that they could refuse sex and say no when drinking or using marijuana. Boys were more sure that they could buy condoms and use them correctly. New York City residents were more sure that they could refuse sex after alcohol and question potential partners about homosexual history than were Rockland County residents. A main finding of the analysis was the weakness in self-efficacy for refusing sex in the face of social pressures, especially a desirable partner, or after using alcohol or drugs. Another finding was the increased likelihood of risk-taking behavior in the presence of decreased self-efficacy, even when controlling for knowledge and attitudes toward AIDS. As in several previous studies, knowledge alone has little effect on implementation of risk-reduction strategies. Adolescents need to develop social skills of communication, negotiation and personal control in sexual situations. The implications of these results were discussed at length. Self-efficacy can be taught by performance attainment, vicarious experiences of observing others, verbal persuasion, and physiological states that act as cues, through modeling (e.g., with videos), practicing (role-playing), and reinforcing the behavior. Models should have the same age, gender, vernacular, and ethnicity as the students. It is suggested that students be taught to use condoms with props and to be consumer-wise in purchasing condoms by showing them brands, types, expiration dates, and prices. Practical teaching of strategies is more time-consuming than providing mere factual knowledge, but will be of much more value to teens, especially those in AIDS epicenters.