Prevention Science [PREV] PP996-prev-473913 September 26, 2003 17:52 Style ﬁle version Nov. 04, 2000
Prevention Science, Vol. 4, No. 4, December 2003 (
Identification of Strategies for Promoting Condom Use:
A Prospective Analysis of High-Risk African
American Female Teens
Richard A. Crosby,
Ralph J. DiClemente,
Gina M. Wingood,
Laura F. Salazar,
Susan L. Davies,
and M. Kim Oh
Condom promotion strategies for adolescents typically include provision of STD/HIV-
associated knowledge, fostering favorable attitudes toward condom use, promoting positive
peer norms regarding condom use, improving condom-related communication skills and self-
efﬁcacy, and overcoming barriers to condom use. The purpose of this study was to identify
which of these constructs were prospectively associated with condom use among a high-risk
sample of African American adolescent females reporting sexual activity with a steady male
partner. Adolescents, 14–18 years old, were recruited from schools and health clinics. Ado-
lescents completed an in-depth survey and interview at baseline and again 6 months later.
Analyses were limited to adolescents with steady partners who reported sexual activity be-
tween the baseline and 6-month follow-up assessment periods (N = 179). At baseline, ﬁve-scale
measures and a single-item measure were used to assess predictive constructs. At follow-up,
adolescents were asked about their frequency of condom use over various periods of recall.
Multivariate models were created to control for the confounding inﬂuence of pregnancy sta-
tus. The ﬁndings were remarkably distinct. The evidence strongly supported the predictive
role of perceived barriers toward condom use and peer norms. The measure of sexual com-
munication achieved signiﬁcance for two of the six assessed outcomes. Alternatively, mea-
sures of attitudes toward condom use, condom negotiation self-efﬁcacy, and knowledge about
STD/HIV-prevention were consistently nonsigniﬁcant. The ﬁndings suggest that to improve
effectiveness of individual-level STD/HIV prevention programs, designed for this population,
program emphasis should be on reducing barriers to condom use, teaching partner communi-
cation skills, and fostering positive peer norms relevant to condom use.
KEY WORDS: African American; adolescents; STD; HIV; sexual behaviors; condoms.
Department of Behavioral Sciences and Health Education,
Rollins School of Public Health, Atlanta, Georgia.
Emory Center for AIDS Research, Atlanta, Georgia.
Department of Pediatrics, Division of Infectious Diseases, Univer-
sity School of Medicine, Epidemiology, and Immunology, Atlanta,
Department of Pediatrics, School of Medicine, University of
Department of Health Behavior, School of Public Health, Univer-
sity of Alabama, Birmingham.
Correspondence should be directed to Richard A. Crosby, Rollins
School of Public Health, Department of Behavioral Sciences and
Health Education, Room 542, 1518 Clifton Road, NE, Atlanta,
Georgia 30322; e-mail: firstname.lastname@example.org.
Sexually transmitted diseases (STDs), including
infection with the human immunodeﬁciency virus
(HIV), have reached epidemic proportions among
African American adolescents (Centers for Disease
Control and Prevention [CDC] 1999a,b; Eng & But-
ler 1997). Within this population, females have been
disproportionately affected by these intersecting epi-
demics, particularly in the southern United States
(Bunnell et al., 1999; CDC 1999b, Eng & Butler 1997).
Because the sequelae of STD infection in females are
especially problematic and costly, prevention efforts
for this population are a priority (Berman & Hein
1999; Bolan et al., 1999; Eng & Butler, 1997).
2003 Society for Prevention Research