Development of Condom-Use Self-Efficacy Over 36 Months Among Early Adolescents A Mediation Analysis

Over the last quarter century, substantial progress has been made in effecting purposeful behavioral change to reduce HIV/AIDS risk behaviors (Uniting the World against AIDS [UNAIDS], 2007). A vast literature describing randomized, controlled trials and meta-analyses clearly demonstrates that interventions designed and executed with attention to specific elements (including sound theoretical grounding, specific skills development, and practice in communication and negotiation) can be successful in reducing and preventing sexual risk behaviors (Auerbach, Hayes, & Kandathil, 2006; Johnson, Carey, Marsh, Levin, & Scott-Sheldon, 2003; Kirby, 2002, 2007; Lyles et al., 2007; Mullen, Ramirez, Strouse, Hedges, & Sogolow, 2002; Robin et al., 2004; Ruiz et al., 2000; UNAIDS, 2007). Despite these advances, specific demographic and socio-geographic sub-groups remain at high risk and substantial challenges in maintaining purposeful behavioral change persist. Among those remaining at high risk are adolescents, young adults (Johnson, et al., 2003; Monasch & Mahy, 2006; Stephenson & Obasi, 2004), and individuals in transitional and developing countries (Beyrer, 2007; UNAIDS, 2007). Challenges that have continued to confront behavioral interventionists include inadequate information regarding long-term intervention effects (Chen et al., 2010; Pedlow & Carey, 2003), waning intervention effects over time (Darbes, Kennedy, Peersman, & Zohrabyan, 2002; DiClemente, Salazar, & Crosby, 2007), lack of attention to sustained behavioral changes (Chen, et al., 2010; Coates, Richter, & Caceres, 2008), and the need for interventions that address the changing environmental exposures and responses thereto that occur as children and adolescents mature (Kirby, Laris, & Rolleri, 2007). Effective behavioral interventions require a thorough understanding of the mechanisms by which educational efforts lead to anticipated behavior change. Data from diverse sources indicate that self-efficacy is central in purposeful behavior change (Adih & Alexander, 1999; Johnston-Briggs, Liu, Carter-Pokras, & Barnet, 2008; Wang, Cheng, & Chou, 2009). Self-efficacy refers to beliefs a person has regarding his or her capability to perform a specific task or set of tasks (Bandura, 1997; Ormrod, 2000). Intervention studies demonstrate that levels of self-efficacy for HIV prevention can be enhanced through educational programs (Caceres, Rosasco, Mandel, & Hearst, 1994; Kyrychenko, Kohler, & Sathiakumar, 2006). Furthermore, self-efficacy significantly mediates the effect of educational interventions for adolescents to adapt HIV prevention behavior and to avoid HIV risk behavior (Chen et al., 2009; Chen, et al., 2010; Kalichman et al., 2002) According to Social Cognitive Theory, adolescents with higher levels of self-efficacy regarding an act are more likely to accept challenges and to persevere to overcome difficulties confronted in performing that act (Bandura, Barbaranelli, Caprara, & Pastorelli, 1996, 2001; Bandura, Cioffi, Taylor, & Brouillard, 1988). Further, adolescents with high self-efficacy are also more likely than adolescents with low self-efficacy to devote greater efforts to perform a task for a longer period of time to achieve their goals (Bandura, 1977). In addition, evidence has shown that adolescents with higher levels of self-efficacy are more likely than others to learn and expand their skills, further enhancing their self-efficacy (Schunk, 1990). Indeed, self-efficacy is a prerequisite for the formation of behavioral intentions, the development of action plans, and the initiation of action (Schwarzer, 2008). Data from empirical studies indicate that among adolescents, lower self-efficacy beliefs regarding relevant behaviors significantly predicted a higher number of risk behaviors that are associated with increased likelihood of HIV infection (Holschneider & Alexander, 2003). Both theory and empirical data support the notion that self-efficacy (including self-efficacy regarding condom-use) develops over the course of adolescence in a self-reinforcing fashion. Self-efficacy as a belief can be affected by many intra-personal and inter-personal factors, such as personal mastery experiences (success raises self-efficacy), modeling effect from vicarious experiences (If others can do it, I can do it as well), and social persuasion (I can do it because my teachers say I can) (Bandura, 1997). Higher levels of self-efficacy in early years may facilitate or self-reinforce the development of self-efficacy in subsequent years throughout adolescence. As an adolescent matures, he or she may become increasingly confident about his or her abilities to perform a specific task, including the use of a condom during sex. However, no reported study has examined whether and how self-efficacy itself at an earlier period affects its levels at subsequent periods. If an effect extends across three time points, in addition to a direct impact, is the relationship between the first and the last point statistically mediated by the level of self-efficacy assessed at the mid-point? High levels of condom-use self-efficacy have been linked to protective behaviors against HIV infection among older adolescents and young adults (Basen-Engquist & Parcel, 1992; DiIorio et al., 2001; O’Leary, Jemmott, & Jemmott, 2008). For example, greater condom-use self-efficacy was associated with greater intention to use a condom in a sample of first-year college students (Joffe & Radius, 1993) and higher rates of condom-use among high school students aged 15–19 years (Richard & van der Pligt, 1991). Furthermore, research has shown an increase in condom-use self-efficacy over time in older adolescents (St. Lawrence et al., 1995). However, few studies have examined trends in condom-use self-efficacy in young adolescents. This evidence supports the importance of investigating condom-use self-efficacy beliefs and the development of these beliefs especially among preadolescents who are early in the process of sexual initiation. Using six waves of longitudinal data, in this study, we examine the development of condom-use self-efficacy, including the mediation process of self-efficacy assessed in between two assessments, among an adolescent sample. We hypothesize that (1) condom-use self-efficacy will increase with age; (2) levels of the self-efficacy at an early age (time, e.g., baseline) will be positively associated with levels at subsequent ages (times); (3) furthermore, longitudinal associations across a period 12 months or longer will be mediated through the levels of self-efficacy during the intervening periods. The purpose of the analysis is to document the time course and mediation mechanism of self-efficacy regarding condom-use, and to provide new data enhancing our understanding of the role of self-efficacy and to support HIV prevention interventions for self-efficacy enhancement to increase condom-use.