Factors contributing to the failure to use condoms among students in Zambia.AbstractThis study explored factors that may predict condom 1. condom - The protective plastic bag that accompanies 3.5-inch microfloppy diskettes. Rarely, also used of (paper) disk envelopes. Unlike the write protect tab, the condom (when left on) not only impedes the practice of SEX but has also been shown to have a high failure use among college and high school students in Zambia. Using the Social Cognitive Theory Social Cognitive Theory utilized both in Psychology and Communications posits that portions of an individual's knowledge acquisition can be directly related to observing others within the context of social interactions, experiences, and outside media influences. , this study examined the relationship of drinking behaviors, alcohol-sexual expectations, education level and religion to condom use among 961 students. The results of the study show that condom use was low among both drinkers and non-drinkers. The results also showed that drinkers had higher positive alcohol-sexual expectations than non-drinkers. Furthermore, drinkers had lower negative alcohol-sexual expectations than non-drinkers. A logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. analysis showed that alcohol-sexual expectancies, gender, education, and religion were not significant predictors of condom use among sexually-active students. However, among drinkers, education and positive alcohol-sexual expectancies were significant predictors. Education, positive alcohol-sexual expectations and religion were also significant predictors of condom use among students who engaged in sexual activities after drinking. We conclude that drinking behavior, alcohol-sexual expectations, educational level and religion are associated with lower use of condom. INTRODUCTION The spread of HIV/AIDS HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome and its detrimental det·ri·men·tal adj. Causing damage or harm; injurious. det  ri·men effects are a major
public health and social challenge for Zambia. Young people are learning
about sexual behavior sexual behavior A person's sexual practices–ie, whether he/she engages in heterosexual or homosexual activity. See Sex life, Sexual life. in an environment where an estimated 16.5% of the
adult population is infected in·fect tr.v. in·fect·ed, in·fect·ing, in·fects 1. To contaminate with a pathogenic microorganism or agent. 2. To communicate a pathogen or disease to. 3. To invade and produce infection in. with AIDS (CSO (Chief Security Officer) The person in charge of all staff members who are responsible for promulgating, enforcing and administering security policies for all systems within an enterprise or division. , 2003; UNAIDS UNAIDS Joint United Nations Programme on HIV/AIDS , 2004) and where the most common method of infection is through heterosexual heterosexual /het·ero·sex·u·al/ (-sek´shoo-al) 1. pertaining to, characteristic of, or directed toward the opposite sex. 2. one who is sexually attracted to persons of the opposite sex. behavior (USAID USAID United States Agency for International Development USAID Agencia de los Estados Unidos para el Desarrollo Internacional (Spanish) , 2001). Ten million of over 1 billion youths (ages 1524) world wide are living with HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. . Of the 10 million with HIV, about 63% live sub-Saharan Africa. The UNAIDS (2006) report indicate that the HIV rates among the youth in Zambia has not reduced in recent years with females having higher rates (12.7%) than males (3.8%). HIV Awareness and Prevention Several strategies have been introduced to help reduced the spread of HIV. One among these has been the promotion of the use of latex latex, emulsion of a polymer (e.g., rubber) in water (see colloid). Natural latexes are produced by a number of plants, are usually white in color, and often contain, in addition to rubber, various gums, oils, and waxes. condoms during intercourse. The use of latex condoms during intercourse greatly reduces the risk of HIV infection (CDC See Control Data, century date change and Back Orifice. CDC - Control Data Corporation , 2006). However, evidence from available studies shows inconsistent condom use among young people (Varga, 1997; Agyei & Epema, 1992: Calves calves 1 n. Plural of calf1. calves Noun the plural of calf , 1999). The 2004 Global School Health Survey with sample of 2,257 Zambian students, reported only 11.1% of those who had sex in the previous 12 months used a condom during intercourse. This is despite the fact that 98% of Zambians were aware of HIV/AIDS and its mode of transmission (CSO, 2003). This high awareness level did not translate into preventive behavior: the incidence of HIV/AIDS in Zambia remained among the highest in the sub-Saharan region (UNAIDS, 2006). Factors other than knowledge appear to contribute to the low rates of condom use. The use of alcohol is one particular factor that has been examined in relation risk sexual behavior including failure to use condoms. Although, there is no conclusive evidence CONCLUSIVE EVIDENCE. That which cannot be contradicted by any other evidence,; for example, a record, unless impeached for fraud, is conclusive evidence between the parties. 3 Bouv. Inst. n. 3061-62. on the relationship between alcohol use and risk sexual behavior, examining this relationship may provide useful understanding of the association (LaBrie, Earleywine, & Schiffman, 2005). In this study, we examine the relationship between alcohol use and use of condoms among students in Zambia. We used the Social Cognitive Theory (SCT Sacrococcygeal teratoma (SCT) A tumor occurring at the base of the fetus's tailbone. Mentioned in: Prenatal Surgery ) to examine the association between alcohol drinking behavior, sexual behavior and risky sexual behavior. SCT defines human behavior as a triadic tri·ad n. 1. A group of three. 2. Music A chord of three tones, especially one built on a given root tone plus a major or minor third and a perfect fifth. 3. , dynamic and reciprocal interaction of personal factors (including cognitions), behaviors, and the environment (Bandura ban`dur´a n. 1. A traditional Ukrainian stringed musical instrument shaped like a lute, having many strings. , 1977). The theory posits that behavior is determined by continuous interaction between behavior, personal factors, and the environment. The interaction, also referred to as reciprocal determinism Reciprocal determinism is the theory set forth by psychologist Albert Bandura that a person's behavior both influences and is influenced by personal factors and the social environment. , is a process through which the behavior, personal factors, and the environmental are continuously influencing each other. Examining behavior, personal factors, and environment factors including their interaction may provide a useful framework for understanding health behavior. Social cognitive theory constructs have been used in studies focusing on alcohol (Brown, 1985; Brown, Goldman, Inn, & Anderson, 1985; Innadda, 2002; Wilhelmsen & Laberg, 1994; Oei, & Morawska, 2004; LaBrie, Schiffman, and Earleywine, 2002). These studies have examined behavioral factors such as alcohol use experience and ability to cope with high risk situations for alcohol use. Other studies have examined the cognitive factors Noun 1. cognitive factor - something immaterial (as a circumstance or influence) that contributes to producing a result cognition, knowledge, noesis - the psychological result of perception and learning and reasoning that may shape alcohol-related self-efficacy and outcome expectations. Furthermore, SCT studies on alcohol have examined environmental factors, including the situations and influences that are external to the individual but affect alcohol-related behavioral and cognitive factors. This study examined personal factors, behavior, and environmental factors related to alcohol drinking behavior, sexual behavior, and risky sexual behavior. This study identified and examined a number of factors thought to contribute to the failure to use condoms among students in Zambia. Most current HIV and condom use research based on SCT has limited the measurement of personal factors to knowledge. This project incorporated expectancies into the measure of personal factors. We used logistic regression to examine the relationship between alcohol-sexual expectancies, education, gender, religion, alcohol use, and condom use. Alcohol Use in Zambia In traditional societies alcohol use is typically managed with family and community controls embedded Inserted into. See embedded system. in the local culture. In Zambia changing social, economic, political and technical factors are eroding these indigenous controls. For example, improvements in the roads network has increased the availability of industrially produced alcohol (Colson & Scudder, 1988). Commercially produced alcohol is now readily available to those with money and an increasing proportion of young people have money (Haworth, Mwanalushi & Todd, 1981). Studies of alcohol use among the young people in African countries are quite limited. The few available studies report alcohol use among young people to be prevalent among students in Zambia (Haworth & Nyambe 1980), Zimbabwe (Chambwe, Slade & Dewey, 1983) and Lesotho (Meursing & Morojele, 1989). In these studies males were found to be more likely to drink than females and to drink more. Overall, drinking rates were increasing. Mukuka (2000) found that male youth (no age specified) in Lusaka were frequent customers at places that sold illicit Not permitted or allowed; prohibited; unlawful; as an illicit trade; illicit intercourse. ILLICIT. What is unlawful what is forbidden by the law. Vide Unlawful. 2. alcohol. Relationship of Alcohol Use, Condom Use and Vulnerability to HIV There is an absence of research showing a consistent relationship between drinking behavior and condom use among young people. Most researchers agree that condom use is affected by many factors (Cooper, 2002; Morrison et al, 2003; Fergusson & Lyneskey, 1996; Agyie & Epema, 1992; Glover Glov´er n. 1. One whose trade it is to make or sell gloves. Glover's suture a kind of stitch used in sewing up wounds, in which the thread is drawn alternately through each side from within outward. , et al, 1997). Research among young people in South Africa South Africa, Afrikaans Suid-Afrika, officially Republic of South Africa, republic (2005 est. pop. 44,344,000), 471,442 sq mi (1,221,037 sq km), S Africa. has indicated that condom use is a difficult topic to introduce in conversation, with females reporting a fear that it could lead to negative emotional, physical, or economic consequences (Varga & Makabulo 1996; Wood, Maforah & Jewkes 1998). In Uganda (Agyie & Epema, 1992) and in Cameroon (Calves, 1999), researchers have reported that asking a female partner to accept a condom meant sending her an implicit message that she was unclean or that she was not a serious partner. The potential fear of rejection, despite important health consequences, may reduce condom use, unrelated to other variables like alcohol use. Low condom use among young people could be explained by the high social risks associated with condom use, which outweigh out·weigh tr.v. out·weighed, out·weigh·ing, out·weighs 1. To weigh more than. 2. To be more significant than; exceed in value or importance: The benefits outweigh the risks. the perceived health risks of unprotected intercourse, and any influence of alcohol would be incidental Contingent upon or pertaining to something that is more important; that which is necessary, appertaining to, or depending upon another known as the principal. Under Workers' Compensation statutes, a risk is deemed incidental to employment when it is related to whatever a . No Zambian studies identify a linkage linkage In mechanical engineering, a system of solid, usually metallic, links (bars) connected to two or more other links by pin joints (hinges), sliding joints, or ball-and-socket joints to form a closed chain or a series of closed chains. between alcohol use and HIV/AIDS. Magnani et al (2000) found that among youth in Zambia, alcohol and drug use was a risk factor for having sex, having multiple sexual partners and having more than one partner during the last three months. Magnani et al also found a relationship between alcohol use and condom use. A study of rural residents in Uganda showed a significant association between alcohol use and HIV sero-positivity (Mbulaiteye et al., 2000). Studies in the USA and elsewhere have demonstrated that alcohol consumption increases risky sexual behavior and, therefore, the risk of HIV/AIDS transmission (Agyie & Epema, 1992; Cooper, 2002; Dermen, Cooper & Agocha, 1998; Fergusson & Lyneskey, 1996; Glover, et al, 1997; Justus, Fin & Steinmetz, 2000; McKirnan, Venable, Ostrow, & Hope, 2001; Morrison et al, 2003; Windle, 1997). Research in Uganda and in the USA has shown a relationship between drinking among young people and the likelihood of engaging in sexual intercourse sexual intercourse or coitus or copulation Act in which the male reproductive organ enters the female reproductive tract (see reproductive system). (Kessey, 1996; Birungu, 1995; Hingson, et al, 2003). Studies in Tanzania identified alcohol drinking places like nightclubs and discotheques, which attract young people, as high-risk places for sexual activity (Talle, 1995; Mukiza-Gapere & Ntozi, 1995). Using focus groups and in-depth interviews, Lugalla, et al. (2004), reported that excessive drinking tended to promote high-risk sexual behavior. Others have found that drinkers were more likely to have multiple sexual partners than non-drinkers (La Brie, Schiffman, & Earleywine, 2002; Crowe and George, 1989; Santelli, Robin, et al., 2001; Santelli, Brener, et al., 1998). Studies have demonstrated that people who believe alcohol enhances sexual arousal sexual arousal Horny/horniness, randy/randiness Physiology A state of sexual 'yellow alert' which has a mental component–↑ cortical responsiveness to sensory stimulation, and physical component–↑ penile sensitivity, neural response to stimuli, and performance are more likely to practice risky sexual behavior after drinking (Dermen & Cooper, 2000; Whitaker, Miller and Clark, 2000). Research questions This study describes drinking behavior, sexual activity, alcohol-sexual expectancies, and condom use among a sample of high school and college students in Zambia. We sought to predict condom use from students' education, gender, alcohol-sexual expectancies, and religion. We also explored the likelihood of students not using condoms after drinking. We used the Social Cognitive theory constructs to explore factors that contribute to risk sexual behavior in form of failure to use a condom during sexual intercourse. METHODS Sample Four high schools in Lusaka, Zambia, were selected to represent Zambian high schools. Two of the high schools were co-educational; one was an all-boys school and one an all-girls school. Three colleges were randomly selected to represent the collegeage population. A total of 1,300 students were surveyed, producing 961 (73.9%) usable surveys: 42.4% high school students, 57.6% college students, 57.2% males, and 42.8% females. The instrument The questionnaire was based on the results of focus group discussions, literature describing previous studies, expert advice from Zambian and US based scholars and previously developed questionnaires. There were ten demographic questions, 21 alcohol use questions, a number of which were based on The Alcohol Use Disorder Test (AUDIT) (Babor, de la Fuente De La Fuente is a common surname in the Spanish language meaning of the Source
n. 1. See Sandress. , & Grant, 1992), 12 questions about sexual experience, and 16 alcohol-sexual expectancy A mere hope, based upon no direct provision, promise, or trust. An expectancy is the possibility of receiving a thing, rather than having a vested interest in it. The term has been applied to situations where an individual hopes and expects to receive something, generally questions. The alcohol-sexual expectancy questions were based on the work of Dermen and Cooper (1994) and on information gained from the focus group discussions. Information generated from focus groups was used to reconstruct re·con·struct tr.v. re·con·struct·ed, re·con·struct·ing, re·con·structs 1. To construct again; rebuild. 2. alcohol-sexual expectancy items to reflect the perceptions and language of the students in the discussions. For example, the words sexual experience was used in place of sexual intercourse as students in the focus groups expressed discomfort with the phrase sexual intercourse. While the term sexual experience appears vague, comparison of the results of questions about number of sexual partners and the use of condoms suggests the meaning was clear to questionnaire users. The 16 alcohol-sexual expectancies statements were answered on a 5-point scale in which l=strongly disagree, 2=disagree, 3=neither agree nor disagree, 4=agree, and 5=strongly agree. Through examining the scree plot and total variance explained from factor analysis, two factors were selected. Values greater than 0.6 for each scale are indicative of internal consistency In statistics and research, internal consistency is a measure based on the correlations between different items on the same test (or the same subscale on a larger test). It measures whether several items that propose to measure the same general construct produce similar scores. (Table 1). Five variables had loadings well below the threshold. Only one variable cross load at 0.52 and 0.46. These six variables were dropped from the analysis. Reliability analysis of the fourteen items revealed Cronbach's Alpha Cronbach's  (alpha) has an important use as a measure of the reliability of a psychometric instrument. It was first named as alpha by Cronbach (1951), as he had intended to continue with further instruments. of 0.895.
Data Collection In high schools the questionnaire was administered in classes, in a single sitting, by the first author with assistance from school prefects. In colleges, the lecturers and a student assistant distributed and collected the questionnaires in randomly selected classrooms. Anonymity and confidentiality were assured. The study protocol was approved by the University of Nebraska-Lincoln Institutional Review Board, the Lusaka Regional Headquarters of the Ministry of Education of the Republic of Zambia, and by the deans of the schools that took part. RESULTS Drinking Behavior Among this sample of high school students, 24.2% had consumed alcohol in the last six months and were defined as drinkers (21.9% of the female and 26.1% of the males). Among the college students, 41.0% were drinkers (38.0% of the females and 43.2% of the males). Alcohol included beer, wine, wine coolers, liquor and traditional Zambian drinks such as Mosi Lager, Chibuku, Sheke, and Kachasu. More males than females had consumed alcohol in the last six months but the difference was not statistically significant ([X.sup.2]=2.196 p=.139). Significantly more college students had consumed alcohol than high school students ([X.sup.2]=29.02, p=.000). Sexual Relations sexual relations pl.n. 1. Sexual intercourse. 2. Sexual activity between individuals. Among high school students 14.8% of the females and 22.7% of the males had been sexually active. Among the college students, 52.3% of the females and 62.1% of the males reported being sexually active. Males were significantly more likely to engage in sexual behavior than females ([X.sup.2]= 7.014, p= .05). Risky Sexual Behaviors and Alcohol Use Of the drinkers, 68.7% had engaged in sexual behavior compared to 27.7% of the nondrinkers ([X.sup.2]=148.99, p=.000). Among the sexually active students, in the last six months, 35.0% of the drinkers had more than one sexual partner compared to 14.7% of the nondrinkers ([X.sup.2]= 17.15, p=.000). Among the sexually active students 62.9% of the drinkers failed to use a condom during the last sexual activity compared to 62.5% of the nondrinkers ([X.sup.2]= .008, p=.927). Alcohol-Sexual Expectancies Alcohol-sexual expectancies reflect the attitudes, beliefs, and values that individuals have about alcohol use and sexual behavior. Factor analysis using Principal Component Analysis with Varimax rotation indicated two alcohol-sexual expectancies factors, with one reflecting negative alcohol-sexual expectancies and the other positive alcohol-sexual expectancies (Table 1). Independent t-tests indicated statistically significant differences between drinkers and nondrinkers on both the negative alcohol-sexual expectancies (t = 7.69, p = .000, SD = 1.602) and the positive alcohol-sexual expectancies (t = -8.28, p = .000, SD = 1.334). Group means indicated that nondrinkers had higher average negative alcohol-sexual expectancies (M = 4.06) than drinkers (M = 3.24). Drinkers had higher positive alcohol-sexual expectancies (M = 2.94) than nondrinkers (M = 2.22). Male students reported higher positive alcohol-sexual expectancies (M = 2.576) than females (M = 2.30) (t = 3.35, p = .001). Male students also reported higher negative alcohol-sexual expectancies (M = 3.98) than females (M = 3.51) (t = 4.46, p =.001, SD = 1.493) Students who had engaged in sexual activity had lower negative alcohol-sexual expectancies (M = 3.55) than those who had not (M = 3.95) (t = 3.81, p= .000, SD = 1.556). Students who had engaged in sexual activity also reported higher positive alcohol-sexual expectancies (M = 2.70) than those who had not (M = 2.29) (t = -4.99, p=.000). High school students had higher negative alcohol-sexual expectancies (M = 3.95) than college students (M = 3.66) (t= 2.71, p = .007). There was no significant difference on the positive alcohol-sexual expectancies between high school students (M = 2.43) and college students (M = 2.48). Condom Use Among Sexually-Active Students To further understand condom use among students who had engaged in sexual relationships we used logistic regression to predict condom use from students' education, gender, alcohol-sexual expectancies, religion, and drinking behavior. The regression model was not statistically significant ([X.sup.2] = 8.12, p =. 19). As shown in Table 2, none of the variables in the model were significant predictors of condom use among students who had engaged in sexual activities. Drinking behavior was not a significant predictor of condom use. Condom Use Among Drinkers To explore condom use among drinkers we used logistic regression to predict condom use from student drinkers' education, gender, alcohol-sexual expectancies, and religion. The regression model was statistically significant in predicting condom use ([X.sup.2] = 17.51, p = .000) with classification accuracy of 61.4%. As shown in Table 3, education and positive alcohol-sexual expectancies were significant predictors of condom use among drinkers. The odds of a college or university student not using a condom were more than double those for high school students. The odds of the students with higher positive alcohol-sexual expectancies not using a condom were 22% higher than those of students with lower positive alcohol-sexual expectancies. Failure to Use a Condoms during Sexual Activity After Drinking We also used logistic regression to estimate the likelihood of not using condoms among drinkers during post-drinking sexual relationships from student drinkers' gender, alcohol-sexual expectancies, religion, and the number of sexual partners. The regression model was statistically significant ([X.sup.2] = 91.20, p = .000) with an accuracy classification of 75.4%. As shown in Table 4, education, number of sexual partners, positive alcohol-sexual expectancies, and religion were all significant predictors of not using a condom during post-drinking sexual contact. The odds of college and university students engaging in unprotected sex Unprotected sex refers to any act of sexual intercourse in which the participants use no form of barrier contraception. Sexually transmitted infections Specifically, unprotected sex after drinking were almost four times higher than those for high schools students. The odds of students with multiple sexual partners engaging in unprotected sex after drinking were 3.6 times higher than those for students with one sexual partner. Having higher positive alcohol-sexual expectancies increased students' odds of having unprotected sex after drinking by about one-third. The odds of a Protestant student having unprotected sex after drinking were 65% lower than those of Catholic students. DISCUSSION The use of condoms is an important protection against sexually transmitted diseases Sexually transmitted diseases Infections that are acquired and transmitted by sexual contact. Although virtually any infection may be transmitted during intimate contact, the term sexually transmitted disease is restricted to conditions that are largely . However, this analysis showed that as many as three in every five sexually active students failed to use a condom at least once in the past six months. Both drinkers and nondrinkers were equally likely to fail to use a condom. These results are consistent with others (Morrison et al., 2003; Santelli, Brener, et al., 1998; Santelli, Robin, et al., 2001; Agyei and Epema, 1992; Calves, 1999. The failure of sexually-active students, both drinkers and non-drinkers, to use condoms should not be surprising given the many factors which influence condom use. The development of trust between young people engaged in sexual relationship may reduce the perceived risk of contracting sexually transmitted diseases (Morrison et al, 2003). The risk of fracturing social relationships between young people could also explain the non-use of condoms. Findings in South Africa (Varga, 1997), Uganda (Agyie and Epema, 1992) and in Cameroon (Calves, 1999) support this conclusion. Condom availability, peer norms, adult attitudes toward condom use and sex, and economic conditions may also influence use (MacPhail and Campbell, 2001). Social Cognitive Theory (SCT) is a useful tool in explaining these findings. SCT seeks to explain the interconnection in·ter·con·nect v. in·ter·con·nect·ed, in·ter·con·nect·ing, in·ter·con·nects v.intr. To be connected with each other: The two buildings interconnect. v.tr. between behavior, personal factors and environment. Although this study does not test the interaction between the three constructs, it shows that education, religion, alcohol-sexual expectations, and drinking behavior are associated with failure to use a condom during intercourse among students. Drinkers with higher education higher education Study beyond the level of secondary education. Institutions of higher education include not only colleges and universities but also professional schools in such fields as law, theology, medicine, business, music, and art. were more likely to be sexually active and less likely to use a condom during intercourse. The finding that alcohol use increases risky sexual behavior is consistent with findings by Agyie & Epema, 1992; Cooper, 2002; Dermen, Cooper & Agocha, 1998; Fergusson & Lyneskey, 1996; Glover, et al, 1997; Justus, Fin & Steinmetz, 2000; Mbulaiteye et al., 2000; McKirnan, Venable, Ostrow, & Hope, 2001; Morrison et al, 2003; and Windle, 1997. Drinkers with higher positive alcohol-sexual expectancies were less likely to use condoms, compared to those with lower positive alcohol-sexual expectations. LaBrie, Earlewine, & Schiffman (2005) earlier reported a similar relationship between positive alcohol-sexual expectations and risky behavior, including failure to use a condom. This study found higher positive alcohol-sexual expectancies increased the likelihood of having unprotected sex after drinking. Younger students in this study were less likely to have sex, to drink, and had higher negative alcohol-sexual expectancies. The role of expectancies suggests opportunities for expectancy challenge programs to provide better education for decision-making. Religious influences from parents and siblings siblings npl (formal) → frères et sœurs mpl (de mêmes parents) and religious institutions are largely un-documented and may influence young people's beliefs, values and practice related to alcohol use and condom use. This study found drinkers who were Catholic were more likely to have unprotected sex after drinking. This is one of the few studies that used SCT to examine the association between some behavioral, environmental and personal factors that may be related to condom use among students in Zambia. Most HIV and condom use research based on SCT has limited the measurement of personal factors to knowledge. This project incorporated expectancies into the measure of personal factors. Nevertheless its results are limited in their generalizabilty. It has, however, identified some factors that could affect condom use and reduce HIV/AIDS related risks. More research is needed on the role of parental teaching and behaviors and the role of sibling sibling /sib·ling/ (sib´ling) any of two or more offspring of the same parents; a brother or sister. sib·ling n. teaching and behavior on decisions to use condoms. The social risks of discussions about condom use and ways to improve interpersonal in·ter·per·son·al adj. 1. Of or relating to the interactions between individuals: interpersonal skills. 2. negotiations about condom use need to be understood better. Socio-economic conditions and personal economic crises likely also play an important role on decisions about condom use. Promising interventions, such as targeted brief interventions A Brief intervention is a technique, similar to an intervention, to help reduce alcohol misuse. It work in two ways:
Send all correspondence to Ian M. Newman at: Department of Educational Psychology, University of Nebraska-Lincoln, Box 880345, Lincoln, NE 68588-0345 USA, email: inewman1@unl.edu Authors' note: The full dissertation dis·ser·ta·tion n. A lengthy, formal treatise, especially one written by a candidate for the doctoral degree at a university; a thesis. dissertation Noun 1. on which this article is based is available from the Digital Commons Digital Commons is the world's leading hosted repository platform. This hosted service is licensed by the Berkeley Electronic Press. It is used by associations, consortia, universities and colleges to preserve and showcase their scholarly output. at the University of Nebraska-Lincoln http://0-digitalcommons.unl.edu.library.unl. edu/dissertations/AAI3176794/ REFERENCES Agyei, W. & Epema, E.J. (1992). 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TABLE 1
Alcohol-Sexual Expectancies
Negative Positive
Alcohol-Sexual Alcohol-Sexual
Expectancies Expectancies
If I drink alcohol, I would be more
likely to have sex with a person I
wouldn't have sex with if I were
sober. .83
If I drink alcohol, I would be less
likely to use (ask a partner to use)
a condom. .82
If I drink alcohol, I would be more
likely to do sexual things that I
wouldn't do when I am sober. .80
If I drink alcohol, I would be less
likely to talk with a new sexual
partner about whether they had any
sexually transmitted disease. .80
If I drink alcohol, I would be less
likely to say no to somebody
proposing sex to me or making sexual
advances. .78
If I drink alcohol, I would be less
concerned about whether my partner
has any sexually transmitted disease. .78
If I drink alcohol, I would be less
likely to take preventive measures
before having sex. .78
If I drink alcohol, I would be more
likely to have sex on a first date. .78
If I drink alcohol, I would be less
likely to have protected or safe sex. .73
If I drink alcohol, I would enjoy sex
more than usual. .80
If I drink alcohol, I would be more
sexually responsive. .78
If I drink alcohol, I would feel
closer to a sexual partner .76
If I drink alcohol, I would be a
better lover. .71
If I drink alcohol, I would be less
nervous about sex. .62
Extraction Method: Principal Component Analysis. Rotation Method:
Varimax with Kaiser Normalization.
TABLE 2
Condom use among sexually active students
Wald Odds
Variables [beta] SE [chi square] [rho] Ratio
Education level .077 .247 .078 .780 1.080
Gender .109 .236 .214 .644 1.116
Negative alcohol-sexual .133 .080 2.743 .098 1.142
expectancies
Positive alcohol-sexual .145 .095 2.341 .126 1.156
expectancies
Religion .039 .981
Protestant (Catholic) -.036 .248 .021 .883 .964
Pentecostal (Catholic) -.062 .336 .034 .853 .940
Drinking Behavior -.058 .249 .053 .817 .972
Variables 95% CI
Education level .63-1.846
Gender .702-1.773
Negative alcohol-sexual .976-1.338
expectancies
Positive alcohol-sexual .960-1.391
expectancies
Religion
Protestant (Catholic) .593-1.567
Pentecostal (Catholic) .486-1.816
Drinking Behavior .781-1.241
Note * -2 log likelihood = 489.271; Nagelkerke R2 =.029; Cox & Snell R2
= .021 Education (High school = 0, College/university = 1), Gender
(Female = 0, Male = 1), Religion (Catholic is the reference group),
Drinking behavior (Drinkers = 1, Non-drinkers = 0)
* p <.05
TABLE 3
Condom use among Drinkers
Wald Odds
Variables [beta] SE [chi square] [rho] Ratio
Education level .815 .271 9.073 .003 * 2.260
Gender -.294 .251 1.370 .242 .746
Negative alcohol-sexual -.034 .091 .140 .708 .967
expectancies
Positive alcohol-sexual .195 .098 3.977 .046 * 1.216
expectancies
Religion 1.452 .484
Protestants (Catholics) -.316 .262 1.451 .228 .729
Pentecostals (Catholics) -.176 .371 .225 .636 .839
Variables 95% CI
Education level 1.329-3.841
Gender .456-1.219
Negative alcohol-sexual .809-1.155
expectancies
Positive alcohol-sexual 1.003-1.473
expectancies
Religion
Protestants (Catholics) .436-1.219
Pentecostals (Catholics) .406-1.735
Note * -2 log likelihood = 406.921; Nagelkerke [R.sup.2] = .074; Cox &
Snell [R.sup.2] = .055 Education (High school = 0, College/university =
1), Gender (Female = 0, Male = 1), Religion (Catholic is the reference
group)
* p <.05
TABLE 4
Failure to use condoms after drinking
Wald Odds
Variables [beta] SE [chi square] [rho] Ratio
Education level 1.379 .381 13.086 .000 * 3.970
Gender -.049 .349 .019 .889 .952
Negative alcohol-sexual -.005 .121 .002 .965 .995
expectancies
Positive alcohol-sexual .284 .134 4.488 .034 * 1.329
expectancies
Religion 9.056 .011
Protestant (Catholic) -1.045 .351 8.840 .003 * .352
Pentecostal (Catholic) -.325 .487 .445 .505 .723
Sexual partner 1.271 .216 34.682 .000 * 3.566
Variables 95% CI
Education level 1.881-8.380
Gender .481-1.887
Negative alcohol-sexual .785-1.261
expectancies
Positive alcohol-sexual 1.022-1.729
expectancies
Religion
Protestant (Catholic) .177-.700
Pentecostal (Catholic) .278-1.877
Sexual partner 2.336-5.444
Note -2 log likelihood = 293.219; Nagelkerke R2 = .218; Cox & Snell
R2 = .303 Education (High school = 0, College/university = 1), Gender
(Female = 0, Male = 1), Religion (Catholic is the reference group),
Sexual Partner (Multiple sexual partners = 1, One sexual partner = 0)
* p <.05
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