University of Southern California Dissertations and Theses

Values and their relationships to HIV-related behavior, attitudes, and social norms

(USC Thesis Other)

Values and their relationships to HIV-related behavior, attitudes, and social norms

PDF

Download a page range

Download transcript

Copy asset link

Request this asset

Transcript (if available)

Content INFORMATION TO USERS This manuscript has been reproduced from the microfilm master. UMI films the text directly from the original or copy submitted. Thus, some thesis and dissertation copies are in typewriter face, while others may be from any type of computer printer. The quality of this reproduction is dependent upon the quality of the copy submitted. Broken or indistinct print, colored or poor quality illustrations and photographs, print bleedthrough, substandard margins, and improper alignment can adversely afreet reproduction. In the unlikely event that the author did not send UMI a complete manuscript and there are missing pages, these will be noted. Also, if unauthorized copyright material had to be removed, a note will indicate the deletion. Oversize materials (e.g., maps, drawings, charts) are reproduced by sectioning the original, beginning at the upper left-hand comer and continuing from left to right in equal sections with small overlaps. Each original is also photographed in one exposure and is included in reduced form at the back of the book. Photographs included in the original manuscript have been reproduced xerographically in this copy. Higher quality 6” x 9” black and white photographic prints are available for any photographs or illustrations appearing in this copy for an additional charge. Contact UMI directly to order. UMI A Bell & Howell Information Company 300 North Zeeb Road, Ann Arbor MI 48106-1346 USA 313/761-4700 800/521-0600 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. VALUES AMD THEIR RELATIONSHIP TO HIV-RELATED BEHAVIOR, ATTITUDES, AMD SOCIAL NORMS by Robert A. Chemoff A Thesis Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree MASTER OF ARTS (Clinical Psychology) December 1996 Copyright 1996 Robert A. Chemoff Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. UMI Number: 1383586 UMI Microform 1383586 Copyright 1997, by UMI Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. UMI 300 North Zeeb Road Ann Arbor, MI 48103 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. UNIVERSITY OF SOUTHERN CALIFORNIA THE GRADUATE SCHOOL UNIVERSITY PARK LOS ANGELES. CALIFORNIA 90007 This thesis, written by Robert Alan Chemoff under the direction of h.is.— Thesis Committee, and approved by a ll its members, has been pre sented to and accepted by the Dean of The Graduate School, in partial fulfillm ent of the requirements fo r the degree of Master of Arts Date December 17, 1996 THESIS COMMITTEE Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. TABLE 07 CONTENTS Page ABSTRACT INTRODUCTION 1 Background 2 Values 7 Value Survey 9 Value Self-Confrontation 10 Hypotheses 15 METHOD 17 Participants 17 Materials 20 Procedure 25 RESULTS 27 Reliability 27 Descriptive Data 29 DISCUSSION 42 Theoretical Implications 42 Limitations 45 Practical Applications 50 Summary and Conclusions 54 REFERENCES 56 APPENDICES 75 A VALUE SURVEY 76 B SELF-ADMINISTERED QUESTIONNAIRE 84 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. LIST OF TABLES TABLE 1 2 3 4 5 Descriptive Data on Number of Sex Partners and Consistency of Condom Use Descriptive Data on Values, Attitudes, and Social Norms Medians and Mean Ranks for "An Exciting Life" as a Function of HIV Risk Behavior Medians and Mean Ranks for "An Exciting Life11 as a Function of Attitudes and Social Norms Multiple Regression Analyses Showing Variance in HIV Risk Behavior (Number of Sex Partners and % of Condom Use - Vaginal Intercouse) Accounted for by Values, Attitudes, and Social Norms PAGE 65 66 67 70 71 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. LI8T OF FIGURES FIGURE PAGE Frequency distribution for number of sex partners. 72 Median rankings of "An Exciting Life" depending on number of sex partners. 73 Median rankings of "An Exciting Life" depending on number of sex partners and percentage of condom use (vaginal intercourse). 74 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ABSTRACT The value priorities, attitudes, and social norms of individuals reporting high risk HIV-related sexual behavior were hypothesized to differ significantly from those reporting low to moderate risk behavior. The Rokeach Value Survey and a 93-item questionnaire were administered to 761 late adolescent and young adult college students. Using Kruskal-Wallis one-way ANOVA, analyses revealed significant differences (p < .005). High risk individuals gave higher rankings to the values An Exciting Life and lower rankings to Wisdom. Mature Love, and Loving. High risk individuals also expressed greater support for pro-risk HIV-related attitudes and social norms. The value self-confrontation paradigm (Rokeach, 1973) is discussed as a possible AIDS prevention strategy. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 1 VALUES AMD THEIR RELATIONSHIP TO HIV-RELATED BEHAVIOR, ATTITUDES, AND SOCIAL NORMS Introduction Late adolescents and young adults continue to engage in sexual behaviors that put them at risk for contracting the human immunodeficiency virus (HIV). The prevailing belief in the HTV prevention literature is that the development of effective prevention strategies requires a comprehensive understanding of the factors that underlie HIV risk behavior. The factors receiving the most attention in the literature have been attitudes and social norms supportive of HIV risk behavior. Scant attention has been paid to the possible role that general, overarching values may play as determinants of high risk behavior. The present study examined the connection between values and HIV risk behavior, and the interconnections among values, attitudes, and social norms. I hypothesized that preferences for certain values would be associated with engagement in high risk behavior and endorsement of attitudes and social norms supportive of high risk behavior. The data from the study supported these Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 2 predictions, although not without limitations and qualifications. The results of this study have various implications for HIV prevention and education strategies. They suggest why some prevention efforts have been less than successful among those most at risk. They also point toward some possible new directions for the development of interventions— notably, value self-confrontation, a procedure that aims to effect behavior change by targeting and challenging value priorities. Background Although late adolescents and young adults represent a relatively small percentage of the total number of diagnosed cases of acquired immune deficiency syndrome (AIDS) and HIV infection in the United States (Centers for Disease Control, 1995), they account for one of the fastest growing categories of HIV and AIDS cases among the general population (Walter, Vaughn, Gladis, Rogin, Kasen, & Cohall, 1993). According to the Centers for Disease Control, between June 1994 and June 1995, males between the ages of 20 and 24 accounted for 14% of all cases of HIV infection among males. During the same period, females in the same age group accounted for 17% of HIV infection cases among females (Centers for Disease Control, 1995). Despite Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 3 increased awareness of how HIV is transmitted, the majority of sexually active adolescents and young adults continue to engage in some form of unprotected sexual activity, and the numbers appear to be increasing (DiClemente & Peterson, 1994; Hein, 1992). Compared with other subgroups, young people may be especially vulnerable to the risks of HIV infection. They are more prone to believing in their invulnerability to HIV infection despite engaging in high risk behavior (Bowler, Sheon, D'Angelo, & Vermund, 1992). They are more likely to embrace risk-taking as a value and eschew "neurotic overconcem" with matters of personal health (Metzler, Noell, & Biglan, 1992; Strunin, 1991; Fisher, 1988). Their decisions are more likely to be based on immediate needs them future consequences (Gardner & Herman, 1990; Brooks-Gunn, Boyer, & Hein, 1988). Many are apt to perceive themselves as unable to prevent infection, negotiate condom use, or discuss their sexual histories with potential partners (Bowler et al., 1992). Consequently, young people pose a special challenge when it comes to the development of effective AIDS prevention strategies. The depth of the challenge has not deterred researchers from developing interventions designed to stem the spread of AIDS among young people. These interventions Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 4 have tended to incorporate some combination of three particular strategies (Fisher & Fisher, 1993; Fisher, Misovich, & Fisher, 1992; Fisher & Fisher, 1992; Fisher, 1988). The first is the dissemination of information. School educational programs that teach the basic facts about how HIV infection is transmitted and prevented are an example of this strategy (e.g., Kirby & DiClemente, 1994). The second strategy is the development of behavioral skills. Instruction on how to negotiate condom use and other assertiveness techniques are an illustration of this strategy (e.g., Moore, Harrison, & Doll, 1994). The third strategy focuses on motivation to change. This usually involves an exploration of attitudes, norms, beliefs, and intentions that underlie and maintain risky behavior (e.g., Fishbein, Middlestadt, & Hitchcock, 1994). As a prevention strategy, the dissemination of knowledge has had limited success. Awareness of how HIV infection is transmitted and prevented has increased significantly among adolescents and young adults over the past decade (Hein, 1992; DiClemente, 1990). Nevertheless, AIDS researchers have consistently found that knowledge of HIV transmission and risk reduction strategies are not by themselves sufficient to motivate the adoption and maintenance of AIDS preventive behaviors. By itself, Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 5 dissemination of knowledge has been an ineffective strategy (DiClemente, 1991; Catania, Kegeles, & Coates, 1990). Instruction in behavioral skills that promote AIDS preventive behaviors has proved somewhat more effective. Interventions that include instruction in condom use, communication with partners, assertion training, and negotiation of safer sex have all been found to be effective to some degree (Fisher & Fisher, 1993; Rotheram-Borus, Koopman, Haignere, & Davies, 1991; Franzini, Sideman, Dexter, & Elder, 1990). Yet, the behavioral skills aspect of AIDS prevention strategies has been limited in at least two respects. Studies that have measured the effectiveness of behavioral skills training have usually been part of an overall intervention strategy of which behavioral skills training was only one component (Rotheram-borus et al., 1991). When skills training is combined with HIV education and discussion of attitudes, norms, and beliefs, it becomes difficult to assess the particular contribution of skills training toward behavior change. Moreover, an intervention that teaches AIDS preventive behavioral skills is of limited use if motivation to implement and practice such skills is lacking. Interest in the motivational aspect of AIDS prevention has intensified in recent years. Numerous researchers have Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. sought a better understanding of the underlying determinants of HIV risk behavior (Auerbach, Wypijewska, & Brodie, 1994). Two major determinants that have garnered a great deal of attention are attitudes and social norms. Researchers have explored a wide range of attitudes and beliefs associated with high risk sexual behavior. These have included attitudes toward sexuality and condom use (e.g., Baffi, Schroeder, Redican, & McCluskey, 1989), attitudes toward safe sex practices (Catania, Dolcini, Coates, Kegeles, Greenblatt, & Puckett, 1989), attitudes about the perceived threat of AIDS (Rotheram-Borus & Koopman, 1991), beliefs about one's susceptibility to HIV infection (Rosenstock, Strecher, & Becker, 1994), and beliefs about one's self-efficacy to act in a safe manner (Bandura, 1994; Bandura, 1992). Social norms have also been the object of much research in the AIDS prevention area. Social norms have long been recognized as having a significant influence over individual behavior in general (Ajzen & Fishbein, 1980). In the particular case of sexual behavior, the social network has been recognized as having a significant effect on the behavior patterns of its members (Laumann, Gagnon, Michael, & Michaels, 1994). Social norms have been found to be one of the strongest predictors of HIV risk behavior (DiClemente, 1993; DiClemente, 1992; Fisher & Misovich, Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 7 1990; Flora & Thoresen, 1988). Pro-risk social norms have been found to be significantly associated with HIV risk behavior among male and female American university students (Winslow, Franzini, & Hwang, 1992; Catania et al., 1989), Dutch secondary school students (Schaalma, Kok, & Peters, 1993), and minority high school students (Walter et al., 1993). Similarly, pro-prevention social norms have been found to predict AIDS preventive behaviors (Schaalma et al., 1993). What researchers have not devoted much attention to in the AIDS prevention field is an examination of the more general, overarching values that argued)ly underlie the attitudes and social norms associated with HIV risk behavior. Rarely have researchers examined the possible contribution of core, central values to the individual's choices of behaviors, beliefs, and social networks. It is these relationships— the connection between values and HIV risk behavior, and the connection between values and HIV- related attitudes and social norms— that are the focus of the present study. Values The concept of values used in this study is that developed by Milton Rokeach (1973). In this conception, values are seen as superordinate, guiding principles in Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 8 people's lives which direct and shape their attitudes, beliefs, and behavior choices. They are relatively enduring and stable across a variety of situations and contexts. In addition, they are relatively limited in number and can be ranked in order of personal importance. Rokeach's view of values bears some resemblance to the concept of individual goals. Similar to Rokeach's view that values are guiding principles around which behavioral choices are made, Cantor and Fleeson (1995) speak of goals as serving to organize behavior and lend coherence and concrete form to the choices people make in their daily lives. Read and Miller (1989) refer to goals as encompassing a wide range of personal needs, including abstract needs such as truth or justice. This, too, is reminiscent of Rokeach's view that values represent abstract concepts which are important guiding principles in people's lives. Despite these similarities, Rokeach's concept of values is quite distinct from the concept of goals. In the Rokeach view, values are general, abstract principles that guide and organize one's attitudes, beliefs, and behaviors. Goals, on the other hand, are concrete, specific age- graded life tasks toward which a person's actions and experiences are oriented. Depending on a person's stage of life, goals may include such life tasks as graduating from Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. college, embarking on a career, developing a relationship, or starting a family (Cantor & Fleeson, 1995; Read 6 Miller, 1989). To be sure, values influence the choice of life tasks that are pursued and their relative priority in a person's life. But values are not themselves identical with the pursuit of these life tasks. Goals may imply or reflect values, but they are not necessarily themselves values. Value Survey Rokeach developed the Value Survey as an instrument for measuring value priorities (Rokeach, 1973). In any of its various forms, the Value Survey presents a list of values and asks the individual to rank each one in order of relative importance as a guiding principle in his or her life. The end result represents an organized hierarchy of value priorities. A number of researchers have used the Value Survey to study the value priorities of people who engage in behaviors adverse to their health. The underlying assumption of these studies has been that the value priorities of persons engaging in unhealthy behaviors will differ significantly from the value priorities of the general population. Toler (1975) administered the Value Survey to male alcoholics and drug users and compared the Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 10 results to a group of males from the general population who had also taken the Value Survey. Toler (1975) found that male alcoholics and drug users tended to give higher rankings to the value called An Exciting Life than nonalcoholics and non-drug users. Conroy (1979) used the Value Survey in a smoking cessation program and found that those who quit smoking tended to rank the value Self-Discipline more highly them those who persisted in smoking. Smokers ranked the value Broadminded more highly than quitters. Schwartz and Inbar-Saban (1988) used the Value Survey in connection with a weight loss program and found that successful dieters tended to rank Wisdom more highly them overeaters, whereas overeaters tended to rernk Happiness more highly them Wisdom. These studies suggest that persons engaging in behaviors adverse to their health do tend to endorse a significantly different set of value priorities than persons engaging in healthier behaviors. Value Self-Confrontation If values are related to behavioral choices, might it be that changes in value priorities can lead to concomitant behavior change? Rokeach and his colleagues put this question to the test by developing and applying an experimental procedure for effecting change in both value Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 11 priorities and actual behavior (Ball-Rokeach, Rokeach, & Grube, 1984; Rokeach, 1973). Known as value self-confrontation, the paradigm involves the implementation of three distinct phases. In the first phase, subjects are randomly assigned to an experimental or control condition and asked to complete the Value Survey. In the second phase, subjects in the experimental (but not the control) condition are "confronted" with data describing how previous groups of subjects, who have also taken the Value Survey, have ranked the particular values of interest. Subjects are asked to compare their value rankings to those of the prior subjects. In the third and final phase, all subjects complete the Value Survey a second time. Comparisons between the first and second administrations of the Value Survey are made to see if any changes in value priorities have taken place. Months later, targeted behaviors are monitored and measured. If behavior change occurs among the subj ects who have been through the value self- confrontation procedure to a significantly different degree than the control group, the difference is arguably attributable to the value self-confrontation procedure. Rokeach (1973) demonstrated empirically that value self-confrontation could be used to induce both value and behavioral change. In one such study, groups of college Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. students completed the Value Survey. Subjects in the experimental condition were presented with data showing that many of their peers, who had previously taken the Value Survey, had ranked the value Freedom higher than the value Ecrualitv. It was suggested to subjects that those who ranked Freedom higher than Equality appeared to value their own personal rights over the rights of others. When the Value Survey was administered a second time, students in the value self-confrontation condition tended to elevate their ranking of Equality and lower their ranking of Freedom to a significantly greater degree than students in the control condition. Many months later, anonymous mailings requesting donations to various civil rights organizations were sent to students who had participated in both the experimental and control conditions. Students who had been through the value self-confrontation procedure were significantly more likely to make donations to these organizations theui students from the control condition. The value self-confrontation procedure had arguably effected not only changes in value priorities, but concomitant behavior change as well. (See also Ball-Rokeach et al., 1984, in which a similar procedure was used to effect value and behavior change involving concern over the environment.) Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 13 The rationale behind the value self-confrontation procedure lies in the potentially disquieting experience of comparing one's own value priorities with those of one'se of one's peers. The theory is that comparing one's value rankings to those of one's peers can have the effect of challenging and threatening one's self-concept, producing am internal monologue along the following lines: "I value X very highly, but most of my peers apparently don't. What does that say about me?" This challenge to the self-concept produces a sense of self-dissatisfaction. In an effort to reduce self-dissatisfaction, the individual is motivated to alter his or her value rankings to be more in accord with those of the desired reference group (i.e., the peer group). The resulting change in value priorities arguably leads to concomitant change in actual behavior (Ball-Rokeach et al., 1984; Rokeach, 1973). The value self-confrontation paradigm has been used successfully to target and change various health risk behaviors. Schwartz and Inbar-Saban (1988) used it as part of a diet program to promote weight loss. Subjects in a weight loss program completed the Value Survey and were then presented with data informing them that successful dieters had ranked Wisdom as a more important value to them them Happiness. while unsuccessful dieters had ranked Happiness over Wisdom. Subjects were invited to compare Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. their own values with those of successful and unsuccessful dieters. When the Value Survey was administered a second time, subjects changed their rankings of wisdom and Happiness to be more consistent with those of the preferred reference group— successful dieters. Additionally, these subjects actually lost more weight them controls, who had not been through the value self-confrontation treatment condition. Value self-confrontation was used in a similar fashion to induce smoking cessation (Conroy, 1979). Subjects who were exposed to the value self-confrontation procedure were significantly more likely to reduce smoking than those who had not. One of the main purposes of the present study was to explore the viability of using value self-confrontation as an intervention for effecting change in high risk sexual behavior. In order for value self-confrontation even to be considered a viable HIV prevention strategy, it would first need to be shown that the value priorities of persons engaging in high risk sexual behavior differed significantly from those engaging in low risk sexual behavior. Only then would it be possible to "confront" high risk individuals with their own value priorities in comparison with those of low risk individuals. Theoretically, the discrepancy between these two sets of value priorities could then be used to produce a sense of Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 15 self-dissatisfaction among those at high risk, encouraging them to reconsider their value priorities and creating the possibility for concomitant behavior change. Hypotheses Thus, in the interest of exploring whether value self confrontation could be a viable candidate as an AIDS prevention intervention, the present study was designed to test whether high risk adolescents and young adults possessed significantly different value priorities from those reporting low or moderate risk sexual behavior. Although I found no study that had tested this hypothesis, there was some empirical basis for believing that the value priorities of these two populations would be significantly different (Davison & Neale, 1994). In a study similar to this one, Rokeach (1973) examined the value priorities of hippies— a subpopulation of young adults known for their nontraditional sexual behavior patterns and liberal sexual attitudes and norms. In comparison to the general population, hippies ranked hedonistic values favoring short-term gratification, such as Pleasure and An Exciting Life, significantly higher on the Value Survey than nonhippies. Hippies also ranked values favoring delayed gratification, such as Responsible and Self-Control led, significantly lower than nonhippies. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 16 Hypothesis I; Values and Behavior. In a similar vein, I expected those reporting high risk behavior to prefer values favoring short-term needs over those values favoring long-term interests. More specifically, I predicted that subjects reporting behaviors associated with increased risk of HIV infection, such as multiple partners, inconsistent condom use, and alcohol and drug use in conjunction with sexual activity, would give significantly higher rankings on the Value Survey to such hedonistic, short-term oriented values as Pleasure. An Exciting Life, and Happiness. I also predicted that these subjects would give significantly lower rankings on the Value Survey to values favoring long term interests and delayed gratification, such as Wisdom. Responsible. Self-Controlled. and Health. Hypothesis II: Values. Attitudes, and Social Norms. In addition to predicting a connection between values and behavior, I expected to find associations between values, attitudes, and norms. I predicted that participants endorsing pro-risk attitudes, such as aversion to condom use or support for casual sex, would tend to give higher rankings on the Value Survey to the cluster of values favoring short-term gratification (e.g., Pleasure. An Exciting Life! and lower rankings to the cluster of values favoring long-term interests (e.g., Wisdom. Health). I Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 17 also predicted that subjects whose peers tended to support and engage in high risk behavior would give higher rankings to the cluster of values favoring short-term needs and lower rankings to the values favoring long-term interests. Hypothesis III: Variance in Behavior Accounted for bv Values. Attitudes, and Social Norms. The last hypothesis of the study was that values would account for more variance in HIV risk behavior than either attitudes or social norms. I predicted that in a multiple regression analysis comparing the relative contributions of values, attitudes, and social norms, values would prove to be a better predictor of HIV risk behavior. I also predicted that when values were removed from the multiple regression analysis, the total amount of variance accounted for in HIV risk behavior would be significantly reduced. This would be consistent with Rokeach's notion that values are a superordinate construct under which attitudes, and arguably social norms, are subsumed. METHOD Participants The participants in the study were 761 predominantly late adolescent and young adult undergraduates from the Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. University of Southern California (53.5% female, 46.5% male). The only requirement for participating in the study was an adequate ability to read English. Most participants were drawn from the USC Psychology Department Human Subjects Pool or from various undergraduate psychology courses (e.g., Introductory Psychology, Abnormal Psychology, Human Sexuality). These subjects received course credit for volunteering in the study. Additional male subjects were recruited from seven USC fraternities when it appeared that insufficient numbers of male subjects were volunteering for the study. These subjects represented 23.3% of the total sample. Compensation was paid to each fraternity that participated in the study in the amount of $5.00 per volunteer. Participants ranged in age from 17 to 47 (M = 21, SD = 3.5). Most subjects were U.S. citizens, but about 11% of the sample was comprised of citizens from 34 different countries. The most represented region of the world among non-U.S. participants was Asia and the Pacific, followed by the Americas, Europe and the former Soviet Union, the Middle East, and Africa. The sample was quite diverse in terms of racial and ethnic background. A bare majority of subjects identified as White, not of Hispanic Origin (53.7%). All other participants identified as Asian or Pacific Islander (20%), Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Hispanic (11%), "Other" (7.9%), Black, not of Hispanic Origin (6.4%), and American Indian or Alaskan Native (.8%). Among subjects identifying as "Other," over half described themselves as having a mixed racial background (e.g., Asian/Hispanic), mixed ethnic background (e.g., Italian/Portuguese), or mixed racial and ethnic background (e.g., Mexican/Black). Another segment of participants identifying as "Other" described themselves by reference to a specific ethnic background, such as Armenian, Iranian, or Filipino. A smaller group of participants identifying as "Other" described themselves by reference to a group name other than those listed in the Questionnaire (e.g., Latino, Caucasian, Chicana). Sexual orientation was measured according to three dimensions: sexual attraction, sexual behavior, and self- identification. Participants were asked to whom they were sexually attracted. The vast majority reported sexual attraction to the opposite sex exclusively (93.3%), with 4.2% reporting sexual attraction to both sexes, and 2.2% reporting sexual attraction to the same sex exclusively. The vast majority also reported having sex partners of the opposite sex exclusively (75.8%), while 1.8% reported having sex partners of the same sex exclusively and 1.6% Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 20 reported having both male and female sex partners.1 Finally, as to self-identification, participants described themselves as heterosexual (93.4%), bisexual (2.8%), homosexual (2.1%), "Don't know" (1.1%), or "Something else" (.3%). Haiteriais Participants completed two paper-and-pencil, self- report instruments designed to measure values, attitudes, and HIV risk behaviors. Values were measured with a modified version of the Rokeach Value Survey (Appendix A). The Value Survey contained a total of 36 values in two separate lists. One list contained 18 "terminal values "- -Rokeach's term for desired end states of existence (e.g., Wisdom. Mature Lovel. Another list contained 18 "instrumental values"— Rokeach's term for personal attributes or traits necessary for achieving desired end states of existence (e.g., Independent. Responsible). Within each of these lists, the values were presented in alphabetical order. Subjects were asked to rate the 1 It should be noted that about 20% of the sample was abstinent. Thus, the numbers of subjects reporting sex partners were clearly lower than the numbers of subjects reporting sexual attraction and self-identification, which were questions virtually all subjects could answer. 2 The value Health was substituted in place of Salvation in the list of terminal values. It was felt that Health was more relevant to the issues being examined in this study than Salvation. Health has been used in at least one published version of the Value Survey (Mueller, 1984) . Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. importance of each value as a guiding principle in their lives. Ratings were made on a 9-point Likert scale, ranging from Minor importance (1) to Vitally important (9). The Value Survey also contained a separate section in which participants were asked to rank certain values in order of personal importance to them. A list of 10 terminal values believed to have some relationship with HIV risk behavior was presented in alphabetical order, ranging from An Exciting Life to Wisdom. Participants were asked to rank these values from Most important (1) to Least important (10). A separate list of 7 instrumental values also believed to be associated with HIV risk behavior was presented in alphabetical order, ranging from Broadminded to Self-Controlled. Subjects ranked these values in order of importance from Most important (1) to Least important (7). Attitudes, norms, and HIV risk behavior were measured with a 93-item Self-Administered Questionnaire (Appendix B). Items in the Questionnaire were either written by the author or based upon questions used in Laumann et al. (1994), Brown, DiClemente, and Beausoleil (1992), Winslow et al. (1992), Brown, DiClemente, and Reynolds (1991), Rotheram-Borus and Koopman (1991), Shulkin, Mayer, Wessel, de Moor, Elder, and Franzini (1991), Kelly, St. Lawrence, Brasfield, Lemke, Amidei, and Roffman (1990), Baldwin and Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 22 Baldwin (1988), or Catania, Kegeles, and Coates (1988). The Questionnaire was submitted to a focus group for testing in order to make sure the wording of the items was clear and understandable. The Questionnaire contained 16 items pertaining to HIV risk behaviors engaged in by subj ects over the previous 12- month period. These items included questions on abstinence, monogamy, vaginal and anal intercourse, condom use, oral sex, number of sex partners, frequency of intercourse, and use of alcohol, marijuana, or drugs in conjunction with sexual activity. These items were intended to tap into behaviors known to increase the likelihood of HIV infection (e.g., multiple partners, inconsistent condom use) or decrease the likelihood of HIV infection (e.g., abstinence, monogamy)(Laumann et al., 1994; Auerbach, Wypijewska, & Brodie, 1994). Once the study was underway, additional behavior items were added that pertained to condom use with primary and secondary partners. I noticed that more than a few participants who said they were in a monogamous relationship" over the past 12 months— strictly defined in the Questionnaire as a romantic or sexual relationship with one and only one partner— also reported having multiple sex partners. Six items were added to the Questionnaire asking whether participants had one “ primary partner," whether Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 23 they also had other secondary partners," and how often they used condoms during intercourse with their primary and secondary partners. A subgroup of 522 participants were presented with these items. The Questionnaire contained 24 items on HIV-related attitudes. These items were presented as declarative statements (e.g., "You should always use a condom if you have sex with a new person"), and participants were asked to rate their level of agreement with each statement on a 9-point Likert scale ranging from Totally disagree (1) to Totally aoree (9) . Half of the statements were worded so that agreement with the statement would indicate endorsement of pro-prevention attitudes (e.g., "It's too risky to sleep around with a lot of people1'), while the other half were worded so that agreement would indicate endorsement of pro-risk attitudes (e.g., "It's OK to practice unsafe sex once in a while"). These items tapped into six different categories of attitudes, including attitudes toward condom use (5 items), safer sex practices (5 items), casual sex and monogamy (8 items), abstention (2 items), alcohol and drug use in conjunction with sex (2 items), and discussion of safer sex practices with one's partner (2 items). The Questionnaire also contained 35 items pertaining to social norms. Twenty-three of these items tapped into Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 24 perceived peer norms, that is, the thoughts, beliefs, or feelings about HIV risk behavior that participants' believed were generally and widely held by the majority of their social network (e.g., "Most of my close friends think it's OK to practice unsafe sex once in awhile"). The remaining 12 items tapped into perceived peer behavior, that is, the participants' perceptions about the HIV risk behaviors which in their opinion were generally and widely practiced by the majority of their peer group (e.g., "Most of my close friends seldom use condoms when they have sex with a new partner") . As in the case of the attitude items, the social norm items were phrased as declarative statements, and subjects were asked to rate their level of agreement with each statement on the same 9-point Likert scale. These items were also counterbalanced so that agreement would indicate either pro-prevention or pro-risk social norms. The social norm items tapped into the same six categories as the attitude items, including condom use (7 items), safer sex practices (6 items), casual sex and monogamy (13 items), abstention (3 items), alcohol and drug use in conjunction with sex (3 items), and discussion of safer sex practices with one's partner (3 items). The Questionnaire begem with four demographic questions, followed by a randomly ordered block of 33 items pertaining to attitudes and social norms. A block of items Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 25 pertaining to HIV risk behaviors was presented, followed by another randomly ordered block of 31 attitude and social norm items. The Questionnaire ended with a final set of 6 behavior items. In addition, three items were included in the Questionnaire designed to detect possible random responses (e.g., "I have never been in a store"). Measures recommended by Catania, Gibson, Chitwood, and Coates (1990) to increase the probability of obtaining honest and accurate self-reports were incorporated into the instructions for the Questionnaire. Participants were told the study was intended to expand our understanding of how to deal with the AIDS epidemic. They were informed their responses would be anonymous and confidential, and that they were free to leave at anytime if they felt uncomfortable with any of the questions. At the end of the Questionnaire, participants were given the option of having their answers eliminated from the study altogether if they so chose. To ensure that all subjects had the same understanding of the terms used in the Questionnaire, key words such as "safer sex," "unsafe sex11 and "sexual activity" were clearly defined and explained. Procedure The Value Survey and Questionnaire were administered to a total of 772 participants. Nine participants were Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 26 eliminated from the study for giving contradictory or random responses on the Questionnaire. Two were eliminated because they they did not want their answers used in the study. Only the responses of the remaining 761 participants were used in the analyses. The Value Survey and Questionnaire were administered to groups of participants of varying sizes over the course of about five months. In each group, instructions were given both orally and in writing. The participants completed and returned the test instruments as directed. There were no prescribed time limits within which the participants had to complete them. The treatment of all participants was in accordance with the ethical standards of the APA. To increase the probability that subjects would answer all questions as honestly as possible, efforts were made to ensure the privacy of each participant. No names or other identifying marks were permitted to appear on any of the test instruments. When completed and returned, the Value Survey and Questionnaire were placed in plain, unmarked manila envelopes by each participant. I was available to answer any questions about the study that subjects may have had. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 27 RESULTS Reliability Test-retest reliabilities for both the Value Survey and Questionnaire were measured. I administered these instruments to a subgroup of 60 participants (35 female, 25 male) and readministered the same instruments to the same 60 participants three weeks later. For the Value Survey, separate correlations were obtained for the 10 terminal 3 values and six instrumental values. When measured by the Pearson product-moment coefficient, test-retest reliabilities for the 10 terminal values ranged from .54 to .71, with a median and mean of .62. For instrumental values, test-retest reliabilities were lower, ranging from .43 to .70, with a median of .48 and a mean of .54. Test-retest reliability was also measured using Kendall's tau, with somewhat lower results. For terminal values, test-retest reliabilities ranged from .37 to .57, with a median of .49 and a mean of .48. For 3 The value called Capable was excluded from the analysis for having no significant test-retest correlation. Only the 16 values ranked ordinally on the Value Survey were used in the analyses. The 36 values which subjects had rated on a 9-point Likert scale did not show as much range and variance as the ordinally ranked values. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 28 instrumental values, the range was between .33 to .59, with a median of .42 and a mean of .44. Test-retest correlations were also obtained for the behavior, attitude, and social norm items on the Questionnaire. For the items pertaining to HIV-related sexual behaviors, correlations were uniformly high. For categorical behavior items (e.g., yes/no items), chi-square coefficients were obtained. Values ranged from 26.7 to 179.39, with a median of 104.57, indicating high test- retest reliability. High test-retest correlations were also obtained for two non-categorical behavior items— number of sexual partners (r = .91) and frequency of intercourse (r = .81). For the attitude and social norm items on the Questionnaire, test-retest reliability was fair. Pearson correlations for the attitude items ranged between .26 and .87, with a median of .63. Pearson correlations for the social norm items ranged from .28 to .80, with a median of .58. In contrast to test-retest reliability, internal reliability for the attitude and social norm items was high. Cronbach's alpha was used with the data from all 761 participants to measure internal reliability. Attitudes towards condom use, safer sex practices, casual sex, monogamy, abstinence, and alcohol and drug use, were drawn Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 29 from 21 items on the Questionnaire and combined together to form a single factor called "Attitudes." The Attitudes factor showed high internal consistency (a = .87). Twenty- six Questionnaire items were combined together to form another factor called ''Social Norms.'' These items tapped into subjects' beliefs about the attitudes and behaviors of their peers in regard to condom use, safer sex practices, casual sex, monogamy, abstinence, and alcohol and drug use. Like Attitudes, The Social Norms factor showed high internal consistency (a = .92). Descriptive Data HIV Risk Behavior. Participants reported sexual behaviors at all levels of the risk continuum. Abstinence from all interpersonal sexual activity was reported by 151 subjects, or 19.8%, of the entire sample. Of these, 45.7% reported not wanting to have sex yet, 31.8% reported wanting to have sex but not yet having found the right partner, and 22.5% reported abstaining for some "other reason," with religious grounds or the desire to wait until marriage being the most commonly cited reasons. The remaining 80.2% of the sample reported being sexually active over the previous 12-month period. Vaginal and anal intercourse were reported by 66.2% and 10.9% of Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 30 the sample, respectively. Of the subjects reporting anal intercourse, 90% said it had occurred with a partner of the opposite sex. Frequency of intercourse ranged from zero to 600 occurrences over the previous 12 month period (M = 42.9; 5% trimmed mean = 30.9; SD = 75.6). Oral sex was reported by 70.3% of the sample. Figure 1 shows the highly skewed frequency distribution for the number of sex partners reported by subj ects over the past 12 months (M = 3; 5% trimmed mean = 1.8; SD = 13.3). Number of partners ranged from 0 to 300. About 36% of the sample reported having only one sex partner, while 42.8% reported having two or more. Subjects with seven or more partners accounted for about 6% of the sample. Table 1 presents data on number of partners and condom use. About 26% of the sample reported a combination of vaginal intercourse, multiple partners, and less them 100% condom use. Another 4.9% of the sample reported a combination of anal intercourse, multiple partners, and less than 100% condom use. A number of participants reported alcohol, marijuana, or drug use as an accompaniment to sex. About 16% of the sample reported using alcohol in conjunction with 50-100% of their sexual activity. Of these subjects, most (59%) reported using condoms less than 100% of the time. Six Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 31 percent of the sample reported using marijuana or drugs in conjunction with 50-100% of their sexual activity, and the majority of these subjects (63%) reported less them 100% condom use. Out of the subgroup of 522 participants who were asked about primary emd secondary partners, 14.2% reported engaging in sexual activity with both a primary partner emd one or more secondary partners. Among this group, most (62.2%) reported less than 100% condom use with both the primary emd secondary partners. Values. Attitudes, and Social Norms. Table 2 shows the mediem rankings for the 17 values presented on the Value Survey emd remked by subjects in order of importance. Happiness was the highest ranked terminal value overall, followed by Health and Self-Respect. The lowest remked terminal values were An Exciting Life emd Pleasure. Table 2 also presents descriptive statistics for Attitudes emd Social Norms. An Attitude score for each subject was determined by taking a mean score for the 21 Attitude items on the Questionnaire. The scale for these scores remged between 1 and 9, with low scores indicating strong support for pro-prevention attitudes, and high scores indicating strong support for pro-risk attitudes. The mean Attitude score for the entire sample was fairly Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 32 low (J4 = 3.32, SD = 1.22), suggesting an overall propensity towards pro-prevention attitudes. A Social Norms score was determined by taking the mean score for the 26 Social Norms items on the Questionnaire. The scale for these scores also ranged from l to 9, with low scores indicating pro-prevention social norms, and high scores indicating pro-risk social norms. The Social Norms mean for the entire sample (M = 4.61, SD = 1.36) was somewhat higher than the Attitude mean score, and about midway between pro-risk and pro-prevention. Hypothesis I: Values and Behavior. As predicted, subjects who reported high risk sexual behavior did in fact report significantly different value rankings on the Rokeach Value Survey than subjects reporting low to moderate risk behavior. Support for this hypothesis was found across a number of different behaviors and for several different values. In particular, high risk behaviors were associated with significantly higher rankings of the terminal value called An Exciting Life, significantly lower rankings of the terminal values called Wisdom and Mature Love, and significantly lower rankings of the instrumental value called Loving. Of all the values in the Value Survey, the one most closely associated with high risk behavior was An Exciting Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 33 Life. Subjects' median rankings of An Exciting Life are shown in Table 3 in relation to eight HIV risk behaviors. For each behavior, subjects were divided into groups depending on the level of risk they reported. Table 3 presents the criteria for each group within the eight behavior categories. Groups are presented in ascending order, from least risky to most risky. For each behavior category, the median rankings of An Exciting Life among the different risk groups were compared to one another. The Kruskal-Wallis one-way analysis of variance (ANOVA) was used to determine whether, for each behavior category, the median rankings of the various risk groups were significantly different. The Kruskal-Wallis test was selected because of the ordinal and continuous nature of the value data emd because all comparisons involved more than two groups. In addition to the eight HIV risk behaviors listed in Table 3, the median rankings for An Exciting Life were also analyzed for two other behaviors, making a total of 10 pairwise comparisons between An Exciting Life and various HIV risk behaviors. Out of the 10 pairwise comparisons, eight yielded significant results, which are described in Table 3. To control for possible Type I error, a Bonferroni correction procedure was applied to these analyses. Significant Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 34 findings were reported only where the significance level was below .005. Subj ects with many sex partners ranked An Exciting Life significantly higher them subjects reporting few sex partners. As shown in Table 3, sub j ects were divided into seven groups on the basis of number of sex partners, from zero partners to 10 or more partners. Median value remkings for each of the seven groups were compared using Kruskal-Wallis. As shown in Figure 2, subjects reporting two or fewer partners ranked An Exciting Life as the eighth most important terminal value in their lives out of the 10 values presented to them. By contrast, subjects reporting 10 or more partners ranked An Exciting Life as the fourth most important terminal value in their lives. This difference was significant, H(6) = 31.73, p < .0001. Comparisons were made between value rankings of An Exciting Life and reported condom use. Subjects were divided into five groups depending on the level of condom use during vaginal intercourse, from 0% condom use to 100% condom use. No significant differences were found in the value rankings of An Exciting Life among these five groups. The same comparison was made for condom use during anal intercourse. Again no significant differences were found in value rankings, regardless of whether subjects never used a condom or always used a condom. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 35 Although level of condom use by itself failed to reveal any significant differences in the way subjects remked An Exciting Life, condom use in combination with number of sex partners did reveal significant differences. For this comparison, subjects were divided into nine groups on the basis of risk level, ranging from abstinent (Group 1) at the low risk end, to seven or more partners and less them 100% condom use during vaginal intercourse (Group 9) at the high risk end, as shown in Table 3. Figure 3 shows that subjects in Groups 1 through 7 (e.g., those reporting abstinence, no intercourse, 100% condom use, or relatively few partners with less than 100% condom use) gave An Exciting Life a relatively low ranking on the Value Survey. Subjects in Groups 8 and 9 (e.g., those reporting five or more partners with less than 100% condom use) gave An Exciting Life a significantly higher ranking, H(8) = 31.98, p < .0001. A similar result was found for a number of partners in combination with condom use during anal intercourse. As shown in Table 3, subjects reporting two or more partners with less them 100% condom use during anal intercourse gave significantly higher rankings to An Exciting Life than any other group of subjects, H(4) = 21.17, e < -001. Subjects reporting several other risky behaviors also ranked An Exciting Life significantly higher than other Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 36 sub j ects. An Exciting Life was ranked significantly higher by subjects reporting alcohol use in conjunction with all or most of their sexual activity, H(4) = 42.36, p < .0001. Subjects reporting marijuana or drug use in conjunction with all or most of their sexual activity also remked An Exciting Life significantly higher them other subjects fi(4) = 16.74, p < .005. Subjects reporting less than 100% condom use with both primary and secondary partners also ranked An Exciting Life significantly higher than sub j ects reporting either abstinence or intercourse with only one primary partner, H(4) = 22.65, p < .0001. Subjects reporting high risk behaviors ranked three other values in significantly different ways than other subjects. As predicted, the value Wisdom was ranked significantly lower by high risk subjects, albeit only for two behaviors. Subjects reporting multiple partners and less than 100% condom use ranked Wisdom significantly lower them other subjects, H(4) = 15.53, p < .005. Subjects reporting less them 100% condom use with primary and secondary partners also gave Wisdom significantly lower rankings than other subjects, H(4) = 18.88, p < .001. I failed to predict that the values Mature Love emd Loving would be remked differently by high risk subjects. Loving was ranked significantly lower by sub j ects reporting seven or more sex partners, H(6) = 21.95, p < .005. Mature Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 37 Love was remked significantly lower by subjects reporting seven or more partners and less than 100% condom use during vaginal intercourse, H(8) = 22.17, p < .005. Also contrary to my expectations, high risk subjects ranked Pleasure. Happiness. Health. Broadminded. Independent. Responsible, and Self-Controlled no differently them low risk subjects. Hypothesis II: Values. Attitudes, and Norms. As expected, subjects who endorsed pro-risk attitudes gave significantly different value rankings than subjects endorsing pro-prevention attitudes. As shown in Table 4, subjects were divided into six groups on the basis of their mean Attitude score, ranging from the most pro-prevention (Group 1, M < 2) to the most pro-risk (Group 6, M £ 6). Value rankings of the six groups were compared using the Kruskal-Wallis one-way ANOVA. Subjects with the strongest support for pro-risk attitudes gave significantly higher rankings to the values An Exciting Life. H(5) =77.72, p < .0001, and Pleasure. H(5) =34.36, p < .0001. They also gave significantly lower rankings to the values Loving. H(5) = 17.34, p < .005, and Wisdom. H(5) = 14.22, p < .05. Subjects reporting pro-risk social norms also gave significantly different value rankings than subjects reporting pro-prevention social norms. Subjects were Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 38 divided into six groups (as shown in Table 4) on the basis of their mean Social Norms score, ranging from the most pro-prevention (Group 1, M < 3) to the most pro-risk (Group 6, M > 7). Subjects with the highest mean scores on Social Norms— indicating strongly pro-risk social norms— gave significantly higher rankings to the values An Exciting Life. H(5) * 43.18, p < .0001, and Pleasure. H(5) = 14.31, E < .05. Hypothesis III: Variance in Behavior Accounted for bv Values. Attitudes, and Social Norms. The hypothesis that values would account for more variance in HIV risk behavior than either attitudes or social norms was not supported by the results. Multiple regression analyses revealed that the amount of variance in HIV risk behavior accounted for by values was relatively modest. Far more variance was accounted for by Attitudes emd Social Norms them by values. Thus, the prediction that values would account for more variemce in HIV risk behavior was not confirmed. Before running the analyses, I tested whether the assumptions of linear multiple regression were met. The HIV risk behavior chosen as the dependent measure for these analyses was "Number of Sex Partners and % of Condom Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 39 Use (Vaginal Intercourse) " as described in Table 3. This variable was chosen because its distribution satisfied the assumptions of linearity, normality, emd homoscedasticity. Among the predictor variables, Attitudes and Social Norms satisfied all assumptions. Values, however, only partially satisfied the assumptions. The four values chosen for the analyses were An Exciting Life. Mature Love. Loving, emd Wisdom, since these values revealed the most significant associations with HIV risk behavior in pairwise comparisons. For all values, homoscedasticity was acceptable. Residuals were nearly normally distributed for Mature Love and Loving, but were not normally distributed for An Exciting Life and Wisdom. The linearity assumption was not met for any of the four values. No transformation of any of these variables succeeded in producing transformed variables that came closer to meeting the assumptions for multiple regression. In fact, the transformations did more harm than good. One other limitation of the values data must be mentioned. Linear multiple regression presupposes the use of continuous interval data. The behavior, attitude, emd social norm data were continuous emd interval. The values data, on the other hand, were ordinal. The use of em ordinal variable as a predictor in a multiple regression analysis did not strictly satisfy the assumptions of Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 40 multiple regression. Still, one of the primary purposes of the study was to see how much variance in HIV risk behavior could be attributed to values. In the interest of seeing whether values could account for any variance in behavior, the use of an ordinal variable in a multiple regression analysis was deemed worth the possible risk of a reduction in power. In addition to testing whether the assumptions of linear multiple regression had been met, I also checked for multicollinearity among the predictor variables. Correlations among the predictors were quite low, ranging between -.32 and .68, with a median of -.03. The highest correlation among the predictors was between Attitudes and Social Norms (r = .68), but this correlation was not high enough to indicate a multicollinearity problem. With these limitations in mind, three stepwise multiple regression analyses were conducted. In the first regression analysis, behavior was regressed on values. Table 5 presents the results. The four values together explained a modest, though statistically significant, 2 amount of risk behavior, £- = .07, E(4, 695) = 12.04, p < .0001. As shown in Table 5, each value by itself accounted for a very small amount of variance, the most being An Exciting Life accounting for 3% of the unique variance. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 41 In the second regression analysis, behavior was regressed on Attitudes emd Social Norms. Far more variance was accounted for by these two predictors than by values, ^ = .27, Z(2, 738) = 136.22, p < .0001. As between Attitudes emd Social Norms, Attitudes uniquely explained far more variemce in behavior than Social Norms (i.e., 10% explained as compared with 1%). In the third and final regression emalysis, behavior was regressed on values, Attitudes, emd Social Norms. Contrary to my prediction that values would account for more variemce in behavior than would Attitudes or Social Norms, values actually accounted for only a small eunount of variemce. When values were added into the equation along 2 with Attitudes emd Social Norms, total R~ increased from 2 .27 to .28. The increase in R- was small, but significant (p < .0001) . However, another consequence of the addition of values to Attitudes and Social Norms was that the beta weights for An Exciting Life. Mature Love, emd Loving were rendered nonsignificant. The beta weight for Wisdom remained significant (t = 2.39, p < .05), but Wisdom accounted for only a small amount of the unique variance (1%). Thus, on the one hand, Attitudes and Social Norms accounted for significantly more variance in behavior in comparison with values. On the other hand, values did account for a small eunount of variance in behavior over and Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 42 above that which was accounted for by Attitudes and Social Norms alone. DISCUSSION Theoretical Implications Late adolescents and young adults who engage in the highest levels of risky sexual behavior appear to possess a different set of value priorities in comparison to those at low or moderate risk. High risk individuals appear more inclined toward values favoring immediate gratification (e.g., An Exciting Life) . and less inclined toward values favoring delayed gratification (e.g., Wisdom. Mature Love). They appear more likely to express negative attitudes toward abstinence, monogamy, and condom use, and more likely to express positive attitudes toward casual sex and the use of alcohol or drugs with sex. Additionally, high risk individuals are more likely to report membership in social networks supportive of pro-risk attitudes and behaviors. These results are not surprising in light of past studies that have found connections between value priorities and health risk behaviors. Just as alcoholics, drug users, and smokers have been found to possess value priorities different from those of the general population Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 43 (Toler, 1975; Conroy, 1979), so the value priorities of high risk individuals appear to differ significantly from those of others. It cannot be inferred from this study that the preference for hedonistic values actually causes the adoption of risky sexual behaviors. It may be that those who engage in high risk behavior are simply more attracted to hedonistic values. Alternatively, it may be that high risk behavior is rationalized by the endorsement of certain consistent values. Whichever the case may be, it can be inferred that a connection exists between values and HIV risk behavior. One can also infer that connections exist between values and attitudes. Attitudes supportive of risky behavior appear to be correlated with values supportive of excitement, stimulation, and pleasure. This finding is consistent with the view that values are superordinate, organizing principles under which specific attitudes can be subsumed (Rokeach, 1973). Again, it is not clear whether hedonistic values cause the adoption of pro-risk attitudes, or whether people who endorse pro-risk attitudes happen to be attracted to hedonistic values. Further research would be needed to tease out such causal relationships. In light of the connection between values and attitudes, it is not unexpected to find a connection Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 44 between values and social norms. We know that social networks can have a significant influence on sexual behaviors and attitudes, as indeed social networks can influence a wide range of social behaviors (Laumann et al., 1994). It should come as no surprise, then, that people who report membership in social networks that endorse and engage in high risk behavior should also express a preference for values consistent with excitement, stimulation, and pleasure. The findings from this study lend additional support to the theory that high risk sexual behavior may simply be but one expression of an overall penchant for risk-taking. It has been shown that various risk behaviors often co occur among the same people. Correlations have been found between high risk sexual behavior on the one hand, and cigarette smoking, alcohol and marijuana use, antisocial behavior, and academic difficulties on the other hand (Metzler et al., 1992; Biglam et al., 1990). Preference for pro-risk, HIV-related attitudes has also been shown to be strongly associated with attitudes supportive of risk- taking in general (Brown et al., 1992). Metzler et al. (1992) have suggested that the clustering of such attitudes and behaviors indicates the existence of an underlying propensity toward risk-taking. The findings from the present study, which establish connections between values Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 45 that, emphasize excitement and stimulation, high risk sexual behavior, and risk-supportive attitudes and social norms, all serve to £umish additional evidence for the existence of a risk-taking construct. It is perhaps somewhat encouraging that the highest at risk represent a relatively small percentage of the larger population of late adolescents and young adults. The participants in the study who reported relatively low risk behaviors (e.g., abstinence, monogamy, consistent condom use with multiple partners) actually represented a substantial proportion of the sample (about 65%). Efforts to prevent the spread of AIDS through widespread education campaigns over the past decade or more have arguably increased the prevalence of AIDS preventive behaviors among the young. The number of participants reporting the highest levels of HIV risk behavior accounted for only about five to seven percent of the sample, depending on the specific behavior. Still, while these individuals may represent only a minority, when generalized to the broader population of late adolescents and young adults, they represent sizable numbers of people at risk. Limitations Test-retest reliability of Value Survey. The test- retest reliability of the Value Survey was only moderate. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 46 The median test-retest reliability for the 10 terminal values measured in this study was .62 using Pearson's £ and .49 using Kendall's tau. These results were comparable to the test-retest reliability found by Rokeach (1973) for the full list of 18 terminal values, in which the average product-moment reliability was around .65. For the six instrumental values measured in this study, test-retest reliabilities were lower (median £ = .57, median Kendall's tau = .42). These results were also comparable to those found by Rokeach (1973) for the full list of 18 instrumental values, in which the average product-moment reliability was around .60. The moderate test-retest reliability of the Value Survey seems at odds with the theory that values are relatively stable and enduring. If values are truly stable and enduring, one would expect the test-retest reliability of the values data to be fairly high. At least two explanations for this result appear warranted. First, it could be argued that the test-retest reliability coefficients for the Value Survey are perfectly acceptable for the kind of instrument that it is. Each value is measured by a single numerical ordinal ranking. It would not be reasonable to expect two single ordinal rankings made over the space of three weeks to be highly stable. A second response is that the Value Survey did, Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 47 after all, yield significant results. Whatever flaws in reliability may be inherent in the Value Survey, significant differences were found in the value preferences of high risk individuals as compared with others. The fact that the Value Survey with its moderate reliability was still able to produce significant results suggests that the phenomenon of value differences between high and low risk individuals is a real, measurable phenomenon. Given the low alpha levels of many of the significant findings (e.g., £ < .0001), the likelihood that these results are a case of Type I error is extremely low. Small effect size. Although significant differences appear to exist between high and low risk individuals on the basis of value priorities, the size of the effect appears to be small. Values accounted for only a relatively modest amount of the variance in HIV risk behavior among subjects in the study. Values also accounted for less variance in behavior than did attitudes and social norms. The theory that values are a superordinate construct under which attitudes and norms are subsumed would suggest that values should have more explanatory power than attitudes and norms, but this turned out not to be the case. Why might this be? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 48 One possibility is that HIV-related attitudes and social norms are simply more closely related to HIV risk behavior and are therefore better predictors than abstract values. It has been argued that the best predictors of behavior are the most directly related to the specific behavior in question (Ajzen & Fishbein, 1980). Perhaps values have too indirect and nonspecific a relationship with high risk behavior to be powerful predictors. Alternatively, perhaps it is logical that values should explain only a small amount of variance. Value priorities did not significantly differ among the participants in this study except among the five to seven percent minority who reported the highest levels of HIV risk behavior. It may make perfect sense for values to account for only a small amount of variance, since only a minority possesses significantly different value priorities. Those who accord higher priority to hedonistic values are in fact the population of greatest interest when it comes to AIDS prevention, since these are the people most at risk. So while the amount of variance explained may be small, the variance explained may pertain to the most important segment of the population as far as prevention efforts are concerned. Still another explanation for this result may be explained by possible weaknesses in the Value Survey as a Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. measurement tool. Unlike the measures for attitudes and social norms used in this study (which were based on dozens of questionnaire items with high internal consistency), the Value Survey is, after all, essentially a single item measure. The relative importance of each value is determined by one ordinal score. It may simply be that this measure is not sensitive enough to detect subtle differences among those who report varying levels of risk behavior. Further research is needed to see if other value measures do a better job of explaining more variance. Finally, the small amount of variance accounted for by values may be partly attributable to the fact that the values data failed to meet all of the assumptions for linear multiple regression. As mentioned earlier, the values data were problematic on two counts: first, they failed to meet the assumptions of linearity and normality, and second, they were ordinal rather than continuous interval data. We would expect a reduction in the ability of the values data to account for variance. Nevertheless, values did account for a significant amount of variance over and above attitudes and social norms, even with the imperfections and limitations inherent in the values data. Values did contribute something significant to our understanding of HIV risk behavior that could not be explained by attitudes and social norms alone. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 50 Methodological problems. Brief mention should be made of other methodological problems with the study. Like most sexual behavior research, this study was based largely on self-report data, with all the problems that implies (Catania et al., 1990). The veracity of responses to questionnaire items could not be independently verified. There were no guarantees against responses that were dishonest or random, or motivated by social desirability, or simply inaccurate due to faulty recollection. It is hoped that the incorporation of the procedural controls described in the Method section helped minimize some of these problems. Practical Applications The practical applications of this study are two-fold. First, the results offer some insight into why traditional AIDS prevention strategies have had difficulty in persuading high risk individuals to modify their behavior. Second, the study points the way toward a possible new direction in which to develop prevention interventions. Conventional prevention efforts typically encourage behavior change by appealing to long-term interests. Some programs argue that using condoms or having fewer sex partners may compromise spontaneity and pleasure in the short-run, but that the costs are outweighed by the long- Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 51 term benefits of increased longevity, health, and safety. Other programs emphasize the long-term benefits of monogamy and love over the short-term benefits of casual sex with multiple partners (Kirby & DiClemente, 1994). The people most at risk for HIV infection are the least likely to be persuaded by these messages. Appeals to health and safety are apt to conflict with the orientation towards excitement, stimulation, and risk-taking with which many high risk individuals identify. The stress placed on monogamy and love is not likely to appeal to the high at risk when the message taps into value priorities of lesser importance to them. High risk individuals are likely to dismiss messages that directly conflict with their values. We have seen that the value priorities of high risk individuals are different from those of others. How might this information be used to effectuate actual behavior change? One approach might be to develop an intervention strategy which, instead of ignoring these differences in value priorities, meets them head on. Value self confrontation may be one such strategy. Applied to am HIV prevention context, value self- confrontation would entail several steps. Subjects would be selected who, on the basis of self-report data, had engaged in a pattern of relatively high risk behavior over the last several months. Subjects would be randomly Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 52 assigned to an experimental or control condition. Baseline behavior would be measured over the next month or so for both groups of subjects, preferably with the use of diaries so that behavior could be recorded at or near the time it occurred instead of recollected months later. Subjects in both groups would be asked to complete the Value Survey. For subjects in the experimental group only, a summary of data taken from this study would be presented. They would be told that their fellow peers had previously taken the Value Survey, that the vast majority of them had ranked the value An Exciting Life very low in importance— in fact the lowest in importance of all the values in the survey— and that most had ranked the values Wisdom. Mature Love, and Loving quite high. They would also be told that people who had regularly engaged in high risk sexual behavior had ranked An Exciting Life quite high in importance, and had also ranked Wisdom. Mature Love, and Loving quite low in importance. An interpretation of these data would be offered to the effect that high risk individuals apparently regard the pursuit of excitement and stimulation as far more important than tenderness, intimacy, or maturity. These subj ects would also be informed that the vast majority of their peers engaged in relatively low risk behavior, and that only a relatively small minority engaged in high risk behavior. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 53 After this procedure, the Value Survey would be administered again to both groups. Both groups would continue to record their sexual conduct over the course of several more months. The results of the two administrations of the Value Survey would be examined to see if any changes had occurred in the value rankings of the four targeted values. If more change scores occurred in the experimental group than the control group, it could be inferred that the change was due to the self confrontation procedure. More importantly, if more AIDS preventive behaviors were reported by the experimental group them by the control group, the difference could arguably be attributed to the value self-confrontation procedure. For individuals who identify strongly as risk-takers emd are not at all concerned about the risks their behavior entails, this procedure would not likely have any effect. But for those who engage in high risk behavior and are concerned about the risks to which they are exposed, this procedure has potential for effecting behavior change. The theory is that by "confronting" high risk individuals with data about the value priorites and behavior of their peers, a sense of self-dissatisfaction is produced among those who find the comparison of themselves to their peers unfavorable and challenging to their self-concept. In an Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 54 effort to reduce their self-dissatisfaction, these individuals are motivated to reconsider their value priorities and change their behavior to be more in accord with pro-prevention norms. Value self-confrontation has not yet been tried as an AIDS risk reduction strategy, but it is well worth exploring. The strategy of producing behavior change by focusing on discrepancies between behavior and self-concept has been used with some success by Baker and Dixon (1991), who have applied motivational interviewing techniques, originally developed to address alcohol and drug addiction, to the problem of HIV risk reduction. Preliminary indications are that engendering self-dissatisfaction by focusing on discrepancies between the individual's behavior on the one hand, and self-concept on the other, may be a promising approach to AIDS prevention. Summary and Conclusions The present study examined whether the values, attitudes, and social norms of late adolescents and young adults reporting high risk sexual behavior would differ significantly from those reporting low to moderate risk behavior. I found that significant differences did exist. High risk individuals appeared to value excitement more highly, while according lesser importance to wisdom and Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 55 love. They were more likely to express negative attitudes towards abstinence, condom use, safer sex, and monogamy, and more likely to express positive attitudes towards casual sex, and alcohol or drug use in conjunction with sex. They also appeared more likely to belong to peer groups who shared similar attitudes towards HIV prevention and risk behavior. These findings suggest that high risk individuals have a general inclination towards risk-taking and sensation-seeking. The difference in value priorities, while significant, is somewhat limited in effect size. Values accounted for far less variance in HIV risk behavior than did attitudes or social norms. Nevertheless, the study remains meaningful. It offers some insight into why conventional AIDS prevention programs have had trouble appealing to high risk individuals. It also suggests that the value self confrontation paradigm (Rokeach, 1973) may well be an appropriate and promising technique worth exploring as a possible risk reduction strategy. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 56 REFERENCES Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall. Auerbach, J. D., Wypijewska, C., & Brodie, H. K. H. (Eds.). (1994). AIDS and behavior; An integrated approach. Washington, DC: National Academy Press. Baffi, C. R., Schroeder, K. K., Redican, K. J., & McCluskey, L. (1989). Factors influencing selected heterosexual male college students' condom use. Journal of American College Health. 38. 137-141. Baker, A., & Dixon, J. (1991). Motivational interviewing for HIV risk reduction. In Miller, W. R., & Rollnick, S. (Eds.), Motivational interviewing: Preparing people to change addictive behavior (pp. 293-302) . New York: The Guilford Press. Baldwin, J. D., & Baldwin, J. I. (1988). Factors affecting AIDS-related sexual risk-taking behavior among college students. The Journal of Sex Research. 25(2), 181-196. Ball-Rokeach, S., Rokeach, M., & Grube, J. W. (1984). The great American values test: Influencing belief through television. New York: The Free Press. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 57 Bandura, A. (1994). Social cognitive theory and exercise of control over HIV infection. In DiClemente, R. J., & Peterson, J. L. (Eds.), Preventing AIDS: Theories and methods of behavioral interventions (pp. 25-59). Hew York: Plenum Press. Bandura, A. (1992). A social cognitive approach to the exercise of control over AIDS infection. In DiClemente, R. J. (Ed.), Adolescents and AIDS: A generation in jeopardy (pp. 89-117). Newbury Park, CA: Sage Publications. Bowler, S., Sheon, A. R., D'Angelo, L. J., & Vermund, S. H. (1992). HIV and AIDS among adolescents in the United States: Increasing risk in the 1990s. Journal of Adolescence. 15(4), 345-371. Brooks-Gunn, J., Boyer, C. B., & Hein, K. (1988). Preventing HIV infection and AIDS in children and adolescents. American Psychologist. 43.(11) , 958-964. Brown, L. K., DiClemente, R. J., Beausoleil, N. I. (1992). Comparison of human immunodeficiency virus related knowledge, attitudes, intentions, and behaviors among sexually active and abstinent young adolescents. Journal of Adolescent Health. 13, 140-145. Brown, L. K., DiClemente, R. J., & Reynolds, L. A. (1991). HIV prevention for adolescents: Utility of the health belief model. AIDS Education and Prevention. 3.(1), 50-59. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 58 Cantor, N., & Fleeson, W. (1994). Social intelligence and intelligent goal pursuit: A cognitive slice of motivation. In Dienstbier, R., & Spaulding, W. D. (Eds.), Intecrrative views of motivation, cognition, and emotion: Volume 41 of the Nebraska symposium on motivation (pp. 125- 179). Lincoln: University of Nebraska Press. Catania, J. A., Gibson, D. R., Chitwood, D. D., & Coates, T. J. (1990) . Methodological problems in AIDS behavioral research: Influences on measurement error and participation bias in studies of sexual behavior. Psychological Bulletin. 108(3), 339-362. Catania, J. A., Kegeles, S. M., & Coates, T. J. (1990). Towards an understanding of risk behavior: An AIDS risk reduction model (ARRM) . Health Education Quarterly. 17(1), 53-72. Catania, J. A., Dolcini, M. M., Coates, T. J., Kegeles, S. M., Greenblatt, R. M., & Puckett, S. (1989). Predictors of condom use and multiple partnered sex among sexually-active adolescent women: Implications for AIDS-related health interventions. The Journal of Sex Research. 16(4), 514-524. Catania, J. A., Kegeles, S. M., & Coates, T. J. (1988). Psychosocial measures for studies of AIDS risk behavior. Technical report to the World Health Organization. Center for AIDS Prevention Studies, Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 59 University of California, San Francisco. [Furnished by first author.] Centers for Disease Control and Prevention. (1995). HIV/AIDS surveillance report. 7(1). Atlanta, GA: U. S. Department of Health and Human Services. Conroy, W. J. (1979) . Human values, smoking behavior, and public health programs. In Rokeach, M. (Ed.), Understanding human values: Individual and societal (pp. 199- 209). New York: The Free Press. Davison, G. C., & Neale, J. M. (1994). Abnormal psychology (6th ed.). New York: John Wiley & Sons. DiClemente, R. J., & Peterson, J. L. (1994). Changing HIV/AIDS risk behaviors: The role of behavioral interventions. In DiClemente, R. J., & Peterson, J. L. (Eds.), Preventing AIDS: Theories and methods of behavioral interventions (pp. 1-4). New York: Plenum Press. DiClemente, R. J. (1993) . Confronting the challenge of AIDS among adolescents: Directions for future research. Journal of Adolescent Research. 8.(2), 156-166. DiClemente, R. J. (1992) . Psychological determinants of condom use among adolescents. In DiClemente, R. J. (Ed.), Adolescents and AIDS: A generation in jeopardy (pp. 35-60). Newbury Park, CA: Sage Publications. DiClemente, R. J. (1991) . Predictors of HIV-preventive sexual behavior in a high-risk adolescent population: The Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 60 influence of perceived peer norms and sexual communication on incarcerated adolescents' consistent use of condoms. Journal of Adolescent Health. 12.(5), 385-390. DiClemente, R. J. (1990). Adolescents and AIDS: Current research, prevention strategies, and policy implications. In Temoshok, L., & Baum, A. (Eds.), Psychological perspectives on AIDS: Etiolocrv. prevention, and treatment (pp. 51-64). Hillsdale, NJ: Lawrence Erlbaum Associates. Fishbein, M., Hiddlestadt, S. E., & Hitchcock, P. J. (1994). Using information to change sexually transmitted disease-related behaviors: An analysis based on the theory of reasoned action. In DiClemente, R. J., & Peterson, J. L. (Eds.), Preventing AIDS: Theories and methods of behavioral interventions (pp. 61-78). New York: Plenum Press. Fisher, W. A., & Fisher, J. D. (1993). A general social psychological model for changing AIDS risk behavior. In Pryor, J. B., & Reeder, G. D. (Eds.), The social psychology of HIV infection (pp. 127-153). Hillsdale, NJ: Lawrence Erlbaum Associates. Fisher, J. D., & Fisher, W. A. (1992). Changing AIDS-risk behavior. Psychological Bulletin. 111(3), 455-474. Fisher, J. D., Misovich, S. J., & Fisher, W. A. (1992). Impact of perceived social norms on adolescents' Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 61 AIDS-risk behavior and prevention. In DiClemente, R. J. (Ed.), Adolescents and AIDS: A generation in ieooardv (pp. 118—136). Newbury Park, CA: Sage Publications. Fisher, J. D., & Misovich, S. J. (1990). Social influence and AIDS-preventive behavior. In Edwards, J., Tindale, R. S., Heath, L., & Posavac, E. J. (Eds.), Social influence processes and prevention (pp. 42-70). New York: Plenum Press. Fisher, J. D. (1988). Possible effects of reference group-based social influence on AIDS-risk behavior and AIDS prevention. American Psychologist. 43(11), 914-920. Flora, J. A., & Thoresen, C. E. (1988). Reducing the risk of AIDS in adolescents. American Psychologist. 43(11), 965-970. Franzini, L. R., Sideman, L. M., Dexter, K. E., & Elder, J. P. (1990) . Promoting AIDS risk reduction via behavioral training. AIDS Education and Prevention. 2.(4) , 313-321. Gardner, W., & Herman, J. (1990). Adolescents' AIDS risk-taking: A rational choice perspective. In Gardner, W., Millstein, S. G., & Wilcox, B. L. (Eds.), Adolescents in the AIDS epidemic (pp. 17-34). San Francisco: Jossey-Bass. Hein, K. (1992). Adolescents at risk for HIV infection. In DiClemente, R. J. (Ed.), Adolescents and Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 62 AIDS: A generation in ieopardv (pp. 4-17). Newbury Park, CA: Sage Publications. Kelly, J. A., St. Lawrence, J. S., Brasfield, T. L., Lemke, A., Amidei, T., & Roffman, E. (1990). Psychological factors that predict AIDS high-risk versus AIDS precautionary behavior. Journal of Consulting and Clinical Psychology. 5,8 (1), 117-120. Kirby, D., & DiClemente, R. J. (1994). School-based interventions to prevent unprotected sex and HIV among adolescents. In DiClemente, R. J., & Peterson, J. L. (Eds.), Preventing AIDS: Theories and methods of behavioral interventions (pp. 117-139). New York: Plenum Press. Laumann, E. 0., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago: University of Chicago Press. Metzler, C. W., Noell, J., & Biglan, A. (1992). The validation of a construct of high-risk sexual behavior in heterosexual adolescents. Journal of Adolescent Research. 2(2), 233-249. Moore, J. S., Harrison, J. S., & Doll, L. S. (1994). Interventions for sexually active, heterosexual women in the United States. In DiClemente, R. J., & Peterson, J. L. (Eds.), Preventing AIDS: Theories and methods of behavioral interventions (pp. 243-265). New York: Plenum Press. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 63 Mueller, D. J. (1984). Rokeach value survey. In Keyser, D. J., & Sweet land, R. C. (Eds.), Test critiques (Vol. 1). Kansas City, MO: Test Corp. of America. Read, S. J., & Miller, L. C. (1989). Inter personalism: Toward a goal-based theory of persons in relationships. In Pervin, L. (Ed.), Goal concepts in personality and social psychology (pp. 413-472). Hillsdale, N. J.: Erlbaum. Rokeach, M. (1973). The nature of human values. New York: The Free Press. Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1994). The health belief model and HIV risk behavior change. In DiClemente, R. J., & Peterson, J. L. (Eds.), Preventing AIDS: Theories and methods of behavioral interventions (pp. 5-24). New York: Plenum Press. Rotheram-Borus, M. J., & Koopman, C. (1991). Sexual risk behavior, AIDS knowledge, and beliefs about AIDS among predominantly minority gay and bisexual male adolescents. AIDS Education and Prevention. 3.(4), 305-312. Rotheram-Borus, M. J., Koopman, C., Haignere, C., & Davies, M. (1991). Reducing HIV sexual risk behaviors among runaway adolescents. Journal of the American Medical Association. 266(9)/ 1237-1241. Schaalma, H., Kok, G., & Peters, L. (1993). Determinants of consistent condom use by adolescents: The Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 64 impact of experience of sexual intercourse. Health Education Research. 8.(2), 255-269. Schwartz, S. H., & Inbar-Saban, N. (1988). Value self-confrontation as a method to aid in weight loss. Journal of Personality and Social Psychology. 54(3), 396-404. Shulkin, J. J., Mayer, J. A., Wessel, L. G., de Moor, C., Elder, J. P., & Franz ini, L. R. (1991). Effects of a peer-led AIDS intervention with university students. College Health. 40, 75- 79. Strunin, L. (1991). Adolescents' perceptions of risk for HIV infection: Implications for future research. Social Science Medicine. 32.(2), 221-228. Toler, C. (1975) . The personal values of alcoholics and addicts. Journal of Clinical Psychology. 31(3). 554-557. Walter, H. J., Vaughan, R. D., Gladis, M. M., Ragin, D. F., Kasen, S., & Cohall, A. T. (1993). Factors associated with AIDS-related behavioral intentions among high school students in an AIDS epicenter. Health Education Quarterly. 20(3), 409-420. Winslow, R. W., Franzini, L. R., & Hwang, J. (1992). Perceived peer norms, casual sex, and AIDS risk prevention. Journal of Applied Social Psychology. 22(23), 1809-1827. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 65 Table 1 Descriptive Data on Nrnnho-r of sex Partners and Consistency of Condom Use n 1 Vaginal Intercourse 100% condom use with 1 or more partners 124 16.3 1 partner, less than 100% condom use 170 22.3 Multiple partners, less than 100% condom use 201 26.4 Anal Intercourse 100% condom use with 1 or more partners 22 2.9 1 partner, less them 100% condom use 24 3.2 Multiple partners, less than 100% condom use 37 4.9 Note. Percentages are based on the entire sample of 761 participants. Subjects not included in these data either were abstinent from all interpersonal sexual activity, or did engage in interpersonal sexual activity that did not include vaginal or anal intercourse. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 66 Table 2 Descriptive Data on Values. Attitudes, and Social Norms Median Mean SD Terminal Values Happiness 3 Health 4 Self-Respect 4 Friendship 5 Mature Love 5 A Sense of Accomplishment 6 Freedom 6 Wisdom 7 An Exciting Life 8 Pleasure 8 Instrumental Values Independent 3 Loving 3 Responsible 3 Broadminded 4 Self-Controlled 5 Obedient 7 Capable — Attitudes 3.32 1.22 Social Norms 4.61 1.36 Note. Medians are presented in ascending order of importance based on value rankings by the entire sample. Terminal values were ranked on an ordinal scale from 1 (Least Important) to 10 (Most Important). Instrumental values were ranked from 1 (Least Import aunt) to 7 (Most Important). Attitudes and social norms were measured according to a 9-point Likert scale, with low numbers (e.g., 1) indicating endorsement of pro-prevention attitudes and social norms, and high numbers (e.g., 9) indicating endorsement of pro-risk attitudes and social norms. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 67 Table 3 Medians and Mean Ranks for "An Exciting Life” as a Function of H i y . . . Ris f c , . Beh^V - iP - E n Median Mean Rank nuuiuBi ui gcA raiuiVAo Group 1: 0 partners 148 8 400.76 Group 2: 1 partner 259 8 383.56 Group 3: 2 partners 107 8 358.69 Group 4: 3 partners 74 7 316.26 Group 5: 4-6 partners 90 7 320.15 Group 6: 7-9 partners 18 6 253.58 Group 7: 10+ partners Number of Sex Partners and % of Condom Use fVaainal Intercourse) 23 4 218.43 Group 1: Abstinent 147 8 395.25 Group 2: No intercourse 88 8 373.84 Group 3: 100% condom use, 1 or more partners 120 7 337.65 Group 4: 1 partner, condom use < 100% 159 8 378.26 Group 5: 2 partners, condom use < 100% 61 7 319.66 Group 6: 3 partners, condom use < 100% 43 8 318.29 Group 7: 4 partners, condom use < 100% 34 7 303.99 Group 8: 5-6 partners, condom use < 100% 32 6 306.56 Group 9: 7+ partners, condom use < 100% 21 4 184.38 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 68 Table 3 (Continued) n Median Mean Rank Winnber of Sex Partners and % of Condom Use (Anal Intercourse) Group 1: Abstinent Group 2: No intercourse Group 3: 100% condom use, 1 or more partners Group 4: 1 partner, condom use < 100% Group 5: 2+ partners, condom use < 100% 147 8 174.13 88 8 164.49 22 8 148.84 23 7 134.65 36 5 101.19 % of Time Alcohol Used in Conjunction with Sex Group 1: 0% Group 2: 25% or less Group 3: 50% Group 4: 75% Group 5: 100% % of Time Alcohol Used and % of Condom Use (Vaginal Intercourse) 196 9 343.57 257 7 273.04 77 6 237.31 29 6 196.93 15 5 235.27 Group 1: Alcohol used 0-25%, 100% condom use 88 7.5 239.52 Group 2: Alcohol used 0-25%, condom use < 100% 270 8 233.09 Group 3: Alcohol used 50-100%, 100% condom use 24 5 165.17 Group 4: Alcohol used 50-100%, condom use < 100% 61 6 170.00 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 69 Table 3 (Continued) n Median Mean Rank % of Time Mariiuana or Drugs Used in Coniunction with Sex Group 1: 0% 407 8 299.20 Group 2: 25% or less 116 7 278.22 Group 3: 50% 29 5 206.02 Group 4: 75% 18 5 200.72 Group 5: 100% % of Time Mariiuana or Drugs Used and % of Condom Use (Vaginal Intercourse) 2 4 121.50 Group 1: 0-25% drug use, 100% condom use 110 7.5 247.66 Group 2: 0-25% drug use, condom use < 100% 319 8 238.82 Group 3: 50-100% drug use, 100% condom use 9 2 96.28 Group 4: 50-100% drug use, condom use < 100% Condom Use with Primarv & Secondarv Partners 31 6 191.08 Group 1: 0 partners 148 8 342.59 Group 2: 1 partner 259 8 327.73 Group 3: multiple partners, no primary partner 140 7 266.70 Group 4: primary & secondary partners, 100% condom use with either or both 28 7.5 310.88 Group 5: primary & secondary partners, condom use < 100% with both 45 6 241.81 Note. For all behaviors, groups are listed in ascending order from least risky to most risky. High median and mean rank scores indicate that "An Exciting Life" has been given a low ranking by that group. Low scores indicate a high ranking. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 70 Table 4 Medians and Mean Ranks for "An Exciting Life'1 as a Function of Attitudes and Social Norms n Median Mean Rank Attitudes Group 1: M £ 2 114 9 438.72 Group 2: 2 < M £ 3 205 8 408.32 Group 3: 3 < M £ 4 196 8 378.32 Group 4: 4 < M £ 5 135 6 279.67 Group 5: 5 < M £ 6 60 6 244.02 Group 6: M > 6 15 4 193.90 Social Norms Group 1: M £ 3 97 9 448.88 Group 2: 3 < M 4 160 8 402.98 Group 3: 4 < M i S 5 171 8 363.08 Group 4: 5 < M £ 6 175 7 328.19 Group 5: 6 < M £ 7 106 6 300.54 Group 6: M > 7 16 5.5 236.31 Note. Group membership is based on mean scores on Attitudes and Social Norms, as indicated. Low mean scores indicate pro prevention attitudes and socials norms, while high mean scores indicate pro-risk. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 71 Table 5 Multiple Regression Analyses Showing Variance in Hiy Risk Behavior fNumber of Sex Partners and % of Condom Use - Vaainal Intercourse! Accounted for bv Values. Attitudes, and Social Norms Proportion of Unique Variance First multiple rearession . 07d An Exciting Life -.17* .03 Mature Love -.09a .01 Loving *14b .02 Wisdom .12 .01 Second multiple rearession .27d Attitudes ,42b .10 Social Norms . 13 .01 Third multiple, regression • t o 0 0 p. An Exciting Life -.01 .00 Mature Love -.01 .00 Loving .03 .00 Wisdom .08a .01 Attitudes *42b .09 Social Norms . 12 .01 a£ < .05 b£ < .01 5 < -o°i dp < .0001 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Frequency 72 -—l* - -~* frequency <iis—nbution for number of ssx Dartners. 300- Number of Sex Partners Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Median Rank 73 Figure 2. Median. ranJcings of "an Exciting Life" depending on number of sex partners. Low Importance High Importance 3 T Low Risk High Risk Number of Sex Partners Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Median Rank Figure _3. Median rankings of "An Exciting Life" depending on number of sex partners and percentage of condom use (vaginal intercourse) . Low Importance ®T I 1 . 0 0- ZM 1 0 0 4 X» 1 0 0 1 0 0 £oo 1 0 0 T : Low Risk High Risk G roup N um ber Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. APPENDIX A 75 No. VALUE SURVEY Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. INSTRUCTIONS On the next page are 18 values listed in alphabetical order. Your task is to rate how each one of them is important to YOU, as guiding principles in YOUR life. You will rate each one according to the following scale: 1 — Minor importance 2 3 = Somewhat important 4 5 = Moderately important 6 7 = Strong importance 8 9 = Vitally important Study the list carefully and give a numerical rating to each value. Work slowly and think carefully. If you change your mind, feel free to change your answers. The end result should truly show how you really feel. PLEASE TURN THE PAGE AND BEGIN Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 77 3 A COMFORTABLE LIFE (a prosperous life) c ( 0 ( D - C o o E ° - 2 E o Q. £ w O c C Q -C © E o CO c f l j *c o Q. E © a s o E a j u c ( 0 ~ o Q. E a i c o h_ 3 5 c m • c o a. E 1 2 3 8 9 AN EXCITING LIFE (a stimulating, active life) A SENSE OF ACCOMPLISHMENT (lasting contribution) A WORLD AT PEACE (free of war and conflict) A WORLD OF BEAUTY (beauty of nature and the arts) EQUALITY (brother/sisterhood, equal opportunity for all) FAMILY SECURITY (taking care of loved ones) FREEDOM (independence, free choice) HAPPINESS (contentedness) HEALTH (free of disease and illness) INNER HARMONY (freedom from inner conflict) 2 3 4 5 6 7 8 9 2 3 4 5 6 7 8 9 2 3 4 5 6 7 8 9 2 3 4 5 6 7 8 9 2 3 4 5 6 7 8 9 2 3 4 5 6 7 8 9 2 3 4 5 6 7 8 9 2 3 4 5 6 7 8 9 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 PLEASE TURN THE PAGE AND CONTINUE. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 78 4 MATURE LOVE (sexual and spiritual intimacy) NATIONAL SECURITY (protection from attack) PLEASURE (an enjoyable, leisurely life) SELF-RESPECT (self-esteem) SOCIAL RECOGNITION (respect admiration) TRUE FRIENDSHIP (close companionship) WISDOM (a mature understanding of life) © u c r a E O Q. E w. O c c ( 0 e o a 6 I £ o C0 c < 0 o Q. E © 15 a ) ■a o 2 o a. 0 5 c o c < 0 E O a. E 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 PLEASE TURN THE PAGE AND CONTINUE. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 79 5 Below is another list of 18 values. Please rate each of them, the same as before. AMBITIOUS (hard-working, aspiring) BROADMINDED (open-minded) CAPABLE (competent, effective) CHEERFUL (lighthearted, joyful) CLEAN (neat, tidy) COURAGEOUS (standing up for your beliefs) FORGIVING (willing to pardon others) HELPFUL (working for the welfare of others) HONEST (sincere, truthful) IMAGINATIVE (daring, creative) 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 PLEASE TURN THE PAGE AND CONTINUE. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 80 INDEPENDENT (self-reliant, self-sufficient) INTELLECTUAL (intelligent, reflective) LOGICAL (consistent, rational) LOVING (affectionate, tender) OBEDIENT (dutiful respectful) POLITE (courteous, well-mannered) RESPONSIBLE (dependable, reliable) SELF-CONTROLLED (restrained, self-disciplined) c c <o 15 ® < D - c -g o < J o g c ■ = £ 9- c « m ™ I -i i " 0 — Q_ O p J= IS E g 1 I 1 s I | i 1 I I 2 c o S c o > 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 PLEASE TURN THE PAGE AND CONTINUE. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 81 INSTRUCTIONS Listed below are 10 values in alphabetical order. Your task i s to rank them in order of importance to YOU, as guiding principles in YOUR l i f e . Study the l i s t carefully and pick out the one value which i s the most important for you. Write the number “ 1 ” in the space beside i t . Then pick out the value which is second most important for you, and write the number “2” beside i t . Keep doing this until you have ranked every value. The value which i s the least important to you will be ranked number “10” Work slowly and think carefully. If you change your mind, fed free to change your answers. The end result should truly show how you really fee l . AN EXCITING LIFE (a stimulating, active life) ____ A SENSE OF ACCOMPLISHMENT (lasting contribution) ____ FREEDOM (independence, free choice) ____ HAPPINESS (contentedness) ____ HEALTH (free of disease and illness) ____ MATURE LOVE (sexual and spiritual intimacy) ____ PLEASURE (an enjoyable, leisurely life) ____ SELF-RESPECT (self-esteem) ____ TRUE FRIENDSHIP (close companionship) ____ WISDOM (a mature understanding of life) ____ PLEASE TURN THE PAGE AND CONTINUE. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 82 s Listed below are 7 values in alphabetical order. Your task i s to rank them in order of importance to YOU, as guiding principles in YOUR l i f e . Study the l i s t carefully and pick out the one value which is the most important for you. Write the number “1” in the space beside i t . Then pick out the value which i s second most important for you, and write the number “2” beside i t . Keep doing this until you have ranked every value. The value which i s the least important to you will be ranked number “7”. Work slowly and think carefully. If you change your mind, feel free to change your answers. The end result should truly show how you really feel. BROADMINDED (open-minded) CAPABLE (competent, effective) INDEPENDENT (self-reliant, self-sufficient) LOVING (affectionate, tender) OBEDIENT (dutiful, respectful) RESPONSIBLE (dependable, reliable) SELF-CONTROLLED (restrained, self-disciplined) THIS IS THE END OF THE VALUE SURVEY. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. APPENDIX B No. SELF-ADMINISTERED QUESTIONNAIRE CONFIDENTIAL Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 84 INSTRUCTIONS There is a great deal of concern today about the AIDS epidemic and how to deal with it. Because of the grave nature of this problem, we are going to ask you some personal questions. All of your answers are strictly confidential and will be used only for statistical reports. Your name and your ID number will not be requested at anytime, and they should NOT be written or appear anywhere on this Questionnaire. We need your frank and honest responses. There are no right or wrong answers. Please read all instructions and all questions carefully. Thank you again for your cooperation in this project. PLEASE TURN THE PAGE AND BEGIN. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 85 Please answer the following questions by circling the number corresponding to the best answer 1 What i s your gender'5 Male I Female 2 2 Are you a United States citizen? Yes 1 No 2 If your answer to Question 2 i s “No”, please specify your country of origin._______ 3 What i s your age1 _______ 4 Which of the following would best describe your racial background? American Indian or Alaskan Native 1 .Asian or Pacific Islander 2 Black, not of Hispanic origin 3 Hispanic 4 White, not of Hispanic origin 5 Other 6 If your answer to Question 4 i s “Other”, please specify how you would describe your racial background:________________________ BE SURE YOU HAVE ANSWERED ALL QUESTIONS ON THIS PAGE BEFORE YOU CONTINUE ON TO THE NEXT PAGE. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 86 IMPORTANT PLEASE READ CAREFULLY In this Questionnaire, you will see the words “sex”, “sexual activity”, “safer sex”, and “unsafe sex”. People mean different things by these words, but in answering these questions, we need everyone to use the same definitions. When you see the words “sex” or “sexual activity”, they refer to any mutually voluntary activity with another person that involves genital contact and sexual excitement or arousal, that is, feeling really turned on, even if intercourse or orgasm did not occur. Certain activities such as close dancing or kissing without genital contact should NOT be included. When you see the words “safer sex”, we mean any sexual behavior that significantly prevents or reduces the risk of contracting AIDS. This may include: • abstinence from all sexual activity, • the use of condoms, • any sexual activity having a low likelihood that blood, semen, or vaginal fluid will be transmitted between sexual partners (e.g., kissing, hugging, petting, intercourse with condoms). When you see the words “unsafe sex”, we mean any sexual behavior that significantly increases the risk of contracting AIDS. This may include: • vaginal or anal intercourse without the use of a condom, • any sexual activity having a high likelihood that blood, semen, or vaginal fluid will be transmitted between sexual partners. CONTINUE ON TO THE NEXT PAGE Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 87 Please read each of the following statements careniilv After each statement, please circle the number that best describes your reaction to the statement L'se the following numerical scaie 9 = Totally agree 8= Strongly agree 7 = Mainly agree 6 - Somewhat agree § * Undecided 4 - Somewhat disagree 3 = Mainly disagree 2 - Strongly disagree I = Totally disagree 5 Condoms are too much of a hassle to use. 6 I t ' s OK to get intoxicated or high before having sex. 7 Most of my close ihends would be comfortable talking about condoms with a new sexual partner. 8 Sleeping around with many different people holds no appeal for me a a > ® £ « S o « a « “ a > * a > ® a > < 0 , > * < 0 > > 5 » • a ' § « c § C 1 3 o i « o c C O S O T 3 9 8 7 6 5 9 8 7 6 5 9 8 7 6 5 4 3 1 1 © 03 03 CO © © © © (0 •o © 03© w 03 c tf) a t CO (0 5 <n"Ct n 1 0) **5>>■o a_>» E .2c*3 o cn to 5 5: o 4 3 - i 4 3 2 I 9 Most of my close friends think you shouldn't use alcohol 9 8 7 6 5 4 3 1 1 or drugs when having sex with a new sexual partner. 19 Most of my close friends think i t ’ s OK to practice unsafe sex 9 8 7 6 5 4 3 3 1 once in awhile. 11 1 would be embarrassed or afraid to discuss safer sex 9 8 7 6 5 4 3 3 1 with a new sexual partner. 13 Most of my close friends seldom use condoms when they 9 8 7 6 5 4 3 3 1 nave sex with a new partner. BE SURE YOU HAVE ANSWERED ALL QUESTIONS ON THIS PAGE BEFORE YOU CONTINUE ON TO THE NEXT PAGE. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 88 © S 9 ) a w a> a £ a> < 9 ( 8 >» G3 C O _ > * S? £ 5 w 23 e C O 2 9 3 7 9 S 7 9 8 7 9 3 7 9 3 7 9 3 7 © © © X. © ? 3 W © t r * n ts * ^ — o ® ® 3 « ■ c " * S 5 - I ® I f 5 " c o * _ n 3 c n 2 c/3 0 a ; © 0 ? B £ » B C O t f ) >. CJ c 5 c 13 Most of ray close fiends think you should only have sex with someone you're in love with. 14 Condoms should always be used whenever you have 93765-1331 intercourse, even with someone you know well. 15 I read every editorial in the newspaper every day 9 8 7 6 5 4 3 3 1 16. Most of my close thends practice unsafe sex now and then 9 8 7 6 5 4 3 3 1 17 Most of my close riends only have sex with people 9 8 7 6 5 4 3 3 1 they're in love with 18 You should always use a condom if you have sex 9 8 7 6 5 4 3 2 1 with a new person- 19 Right now, [ would like to be in a monogamous relationship. 9 8 7 6 5 4 3 2 1 20 Most of ray close riends think you should abstain from sex 9 8 7 6 5 4 3 2 1 until you're married or in a committed relationship 21 Most of my close riends think monogamous relations 9 8 7 6 5 4 3 3 ; are no fun. 22. Even i f 1 thought ray close friends practiced safer sex. 9 8 7 6 5 4 3 2 1 that would have NO influence on my decision to practice safer sex. 23 Having to worry about safer sex takes a lot of the enjoyment 9 8 7 6 5 4 3 21 out of sex. 24 Monogamous relations are no fun 9 8 7 6 5 4 3 2 1 25 Most of my close riends think condoms take very l i t t l e 9 8 7 6 5 4 3 2 1 away from the enjoyment of sex. BE SURE YOU HAVE ANSWERED ALL QUESTIONS ON THIS PAGE BEFORE YOU CONTINUE ON TO THE NEXT PAGE. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 89 93 5 03 03 V S j 93 "C CJ jo 03 SQ (6 <9 03 'Z 03 .C « *0 >» »> E -S c 93 93 33 i - 03 Z 93 n « a f l ; - a> - a i 2 s _ ( B > • « s " 5 > »• = . 2 6 £ S * ■= = c * ® 5 5 = •§ e " o - = - o = « c = o«so Swrs co5wt= 26 Most of my close friends believe you should practice 9 3 7 6 5 4 3 2 1 safer sex at a l l times, even with someone you know well 27 Most of my close friends are in monogamous relationships 9 S 7 6 5 4 3 2 I 23 Most of my dose friends engage in sexual activity 9 3 7 6 5 4 3 2 I on a regular basis. 29 You shouldn’ t have sex with someone unless 9 3 7 6 5 4 3 2 I you're in love with them 30 I t ' s OK to practice unsafe sex once in awhile 9 3 7 6 5 4 3 ; i 31 Most ofmy close friends think you should always use 9 3 7 6 5 4 3 2 I a condom if you have sex with a new person. 32 Most of my close friends think you don’ t need to use 9 8 7 6 5 4 3 2 1 a condom when having sex with someone you know well 33 I t ' s OK to have sex for fim even if you're not in love with 9 S 7 6 5 4 3 2 the other person. 34 I t ' s not worth practiring safer sex a l l the time because 9 S ~ 6 5 4 3 2 the likelihood of dying from AIDS i s so remote 35 Most of my close friends think sexual promiscuity poses 9 3 7 6 5 4 3 2 minimal health risks 36 Most of my close friends have abstained from 9 3 7 6 5 4 3 2 sexual activity altogether 37 Most of my close friends use condoms whenever they have 9 3 7 6 5 4 3 2 intercourse with a new partner BE SURE YOU HAVE ANSWERED ALL QUESTIONS ON THIS PAGE BEFORE YOU CONTINUE ON TO THE NEXT PAGE. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 90 s The following questions will ask you about vour sexual activity during the l a s ; I 2 months Remember, when you see the words “sex'* or "sexual activity", they refer to any mutually voluntary activity with another person that involves genital contact and sexual excitement or arousal, that i s . feeling really turned on. even if intercourse or orgasm did not occur. In answering these questions (and unless you are told otherwisei. please include a l l persons or times in the la s t 12 months when you had direct physical contact with the genitals (the sex organs > of someone else and sexual excitement or arousal occurred. Certain activities such as dose dancing or kissing without genital contact should NOT be included. Please answer the following questions by circling the number corresponding to the best answer 38 Over the past 12 months, have you been in a monogamous relationship with one and only one person7 (By monogamous relanonship. we mean that during the past 12 months, you have been married to. engaged to. dating, going out with, romantically involved with, or engaging in sexual activity with, one and oniv one person. and to the best of your knowledge, that person has been solely involved with you.) Yes No 2 39. In general, are you sexually attracted to Males exclusively 1 Both males 2 and females Females exclusively 3 40 Do you think of yourself as Heterosexual 1 Homosexual Bisexual 3 Something else 4 Don’ t know 5 BE SURE YOU HAVE ANSWERED ALL QUESTIONS ON THIS PAGE BEFORE YOU CONTINUE ON TO THE NEXT PAGE. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 91 4 1 Over the past 12 months, did you abstain from a i l sexual activity1 (By abstain, we mean that vou did NOT engage in any sexual acnvtty as defined : r . : . u s Questionnaire > Yes I No ; I t your answer to Quesnon a I i s “No**, piease turn to the next page now and continue on If your answer to Question 41 i s “Yes**, piease answer the following question: 42 Which statement best describes your reason for abstaining from sex over the past 12 months'’ I. I don't want to have sex yet. 2 I want to have sex. but I haven't found the tight partner ye t . 3 Some other reason. Please specify the reason._____________________________________ If you answered Quesnon 42. please now turn to Page 13 and continue on. CONTEXVE ON TO THE NEXT PAGE. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 92 j o 43 Over the l a s t 12 months, when you engaged in sexual activity with another person, did you have vaginal intercourse' 1 iBy vaginal intercourse, we mean when a male's penis i s inside a t'emaie's vagina I Yes I No 2 If your answer to Question -3 i s “So", please skip to Question 45 Otherwise, piease answer the following question. 44 Over the l a s t 12 months, when you had vaginal intercourse, approximately how- often did you use condoms'1 100% of the time 1 75% of the time 2 50% of the time 3 25% of the time 4 or le ss 0% of the time 5 45 Over the la s t 12 months, when you engaged in sexual activity with another person, did you have anal intercourse' 1 fBv anal intercourse, we mean when a male’ s penis i s inside his partner's anus or rectum. 1 Yes 1 No 2 If your answer to Question 45 i s “No”, please continue on to the next page now Otherwise. piease answer the following question: 46 Over the last 12 months, when you had anal intercourse, approximately how often did you use condoms'* 100% of the time 1 75% of the time 2 50% of the time 3 25% of the time 4 or less 0% of the time 5 CONTINUE ON TO THE NEXT PAGE. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 93 ;i Please answer Questions 4". 48 and 49 ONLY IF you had either vaginal or anal intercourse over the past 12 months If you did not have vamnal or anal intercourse over the past 12 months, please sidp to Question 50 47 U' you had vaginal or anal intercourse over the past 12 months, approximately how o t t e r , did you talk with your partner about using condoms before or during intercourse'1 100% of the time 1 75% of the time 2 50% of the time 3 25% of the time 4 or le s s 0 ° / . of the time 5 48 If you had vaginal or anal intercourse over the past 12 months, did you or your partner ev er practice "withdrawal" instead of using a condom- 1 (By "withdrawal", we mean when a male removes his penis from his partner prior to orgasm or ejaculation.) Yes 1 No 2 49 If you had vaginal or anal intercourse over the past 12 months, did you or your partner use a condom the la s t time you had intercourse1 Yes 1 No 2 50 Over the past 12 months, when you engaged in sexual activity with another person, did you engage in oral sex1 (By oral sex. we mean stimulating the genitals with the mouth, that i s licking or kissing your partner's genitals or when your partner does th i s to you) Yes i No 2 51 Over the past 12 months, how many different people have you had sexual activity with, even i f only one time1 Please put the appropriate number in this blank space.________ BE SURE YOU HAVE ANSWERED ALL QUESTIONS ON THIS PAGE BEFORE YOU CONTINUE ON TO THE NEXT PAGE. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 94 57 Over the past II months, approximately how many nines have you had sexual intercourse i vaginal or anal)'1 Please put the appropnate number m t h i s blank space________ 55 Over the past II months, have your sex partners been Please circle only one answer. Exclusively male Both male and female I Exclusively female 5 54 Over the past 11 months, approximately how often did you or your partner engage in sexual activity under the influence of alcohol0 100*4 of the time I 75% of the tune 2 50% of the time 3 15% of the time 4 or less 0% of the time 5 55 Over the past 12 months, approximately how often did you or your partner engage in sexual activity under the influence of marijuana or drugs0 100% of the time I 75% of the time I 50% of the time 3 15% of the time 4 or less 0*4 of the time 5 56 In terms of risk for contracting AIDS, do you think your sexual activity over the past 12 months has been Very risky 1 Somewhat nsky 2 Not at a l l risky 3 BE SURE VOL* HAVE ANSWERED ALL QUESTIONS ON THIS PAGE BEFORE YOU CONTINUE ON TO THE NEXT PAGE. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 95 Please read each of the following statements caretully . A f t e r each statement, please circle the number that best describes your reaction to the statement Use the following numencai scale 9= Totally agree 8 = Strongly agree 7 = Mainly agree 6 = Somewhat agree 5 = Undecided 4 = Somewhat disagree 3 = Mainly disagree 2 = Strongly disagree 1 = Totally disagree « ® < D r ? i ® < o ™ ® £ « . 8 . 5 a S ® S ® S- ® m ■oa s o i a ® 5> ® e tow-otn <o •£ "a t; >. > » ® > * S ’ 3 £ > - a > » . = c -= ® a ) ®- =c = « o ^ C TI ® '5 0 « •3 2= « o C 0 ® S o i — to 2 wd n S n p 57. Most of my close friends think i t ' s OK to get intoxicated 9 3 7 6 5 4 5 2 1 or high before having sex. 58 I have never been in a store. 9 8 7 6 5 4 5 2 1 59 Most of my close mends think worrying about safer sex 9 8 7 6 5 4 5 2 1 takes a lot of the enjoyment out of sex. 60 Most of my close friends often have sex under the 98765-452 i influence of alcohol or drugs. 61. One must practice safer sex at a l l times, even with someone 9 8 7 6 5 4 5 2 1 you know well. 62. Most of my close friends think you shouldn't have to 9 8 7 6 5 4 5 2 1 use condoms every time you have sex. 63 I shouldn’ t have to abstain from sex just to avoid AIDS 9 8 7 6 5 4 5 2 I 64 I t ' s too risky to sleep around with a l o t of people 9 8 7 6 5 4 5 2 BE SURE YOU HAVE ANSWERED ALL QUESTIONS ON THIS PAGE BEFORE YOU CONTINUE ON TO THE NEXT PAGE. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 96 © © © V o £ w o > ( 0 5 > CO > * m > * ? > s . c c . 0 r — 5 5 ' t o 5 © 03 I S ' Q * C Q T3 | e 2 i l l C "O s 0 — 44 1 — C / 3 2 65 Most of my close friends think condoms are too 9 3 * 6 5 4 3 1 ; much of a hassle to use 66 Being sexually promiscuous poses minimal health r i s k s . 9 3 * 6 5 4 3 1 ; 67 Most of my close mends talk about safer sex practices 9 8 * 6 5 4 3 1 ; with their sexual partners 68 You should abstain from sex until you're married 9 8 7 6 5 4 3 1 ' . or in a committed relationship. 69 You shouldn’ t have to use a condom every time you have 9 8 * 6 5 4 3 1 ; intercourse 70 Most of my close friends think they shouldn’ t be expected 9 8 * 6 5 4 3 1 ' . to abstain from sex just to avoid AIDS "1 Most of my close friends have sex with a lot of different people. 9 8 7 6 5 4 3 1 1 "1 Most of my close friends would like to be in a monogamous 9 3 * 6 5 4 3 !'. relationship right now *3 I would be perfectly comfortable talking about condoms 9 8 * 6 5 4 3 1 ; with a new sexual partner “4 Condoms take very l i t t l e away from the enjoyment of sex 9 8 7 6 5 4 3 1 1 75 Most of my close friends want to have as many sexual 9 8 * 6 5 4 3 1 1 partners as possible *6 If I thought my close friends used condoms regularly. 9 8 7 6 5 4 3 1 ! t t would influence me to use condoms regularly *7 I’ d like to have as many sexual partners as possible 9 8 7 6 5 4 3 1 1 BE SURE YOU HAVE ANSWERED ALL QUESTIONS ON THIS PAGE BEFORE YOU CONTINUE ON TO THE NEXT PAGE. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Mitmly ilisiiiuitiu Strongly disagree Totally disagree 57 1 5 s a O = > » „ £ a o £ « £ 5 » « o> e I »1^, 2 ? ! I oi<o o S S S .g ^ o > « > * ■ < 3 ^ .2“ ® »■ # '« «»>»»• I | § M I | a 1 o i « o c a « a a t - t f l 2 OT 2 ) 3 ) 5 0 1 P 78 I grow a i l my own food 9 8 7 6 5 4 3 2 I 79 Most of my close friends would be embarrassed or afraid 9 8 7 6 5 4 3 2 1 to discuss safer sex with a new sexual partner 80 Most of my close friends have no interest in sleeping around 9 8 7 6 5 4 3 2 1 with many different people. 81 Most of my close friends have had sexual intercourse 9 8 7 6 5 4 3 2 1 only once or twice. 82 I t ' s unwise to use alcohol or drugs before sex 9 8 7 6 5 4 3 2 1 83. I t ’ s important to practice safer sex with someone you don’ t 9 8 7 6 5 4 3 2 1 know well. 84. Most of my dose friends think i t ’ s too risky to 9 8 7 6 5 4 3 2 1 sleep around with a lot of people. 85 Most of my close friends practice safer sex 9 8 7 6 5 4 3 2 1 a l l of the time 86 Most of my close friends think i t ’ s not worth practicing 9 8 7 6 5 4 3 ; l safer sex a l l the time because the likelihood of dying from AIDS i s so remote. 87. Most of my close friends think i t ’ s OK to have sex for fun, 9 8 7 6 5 4 3 2 1 even i f you’ re not in love with the other person. BE SURE YOU HAVE ANSWERED ALL QUESTIONS ON THIS PAGE BEFORE YOU CONTINUE ON TO THE NEXT PAGE. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 98 38 Over ine past i 2 months, have you had one primary partner, that i s . one ''significant other." in your InY* Yes i No 2 39 If No. you are finished with this Questionnaire. I : Yes. did you have vaginal or anal intercourse with t h i s primary partner over the last 12 months1 Yes 1 No 2 90 Over the past 12 months, did you also have at least one, and perhaps more, ' ‘ secondary partners”, that i s . other people with whom you engaged in sexual activity besides your significant other1 Yes 1 No 2 91 If No. you are finished with this Questionnaire. If Yes. did you have vaginal or anal intercourse with any one or more of these secondary part n e r s ' * Yes I No 2 92 If No. you are finished with this Questionnaire. If Yes. when you had vaginal or anal intercourse over the l a s t 12 months with your PRIMARY PARTNER, what percentage of the time were condoms used ? (Examples: 0%, 30%. 80%, 100%, etc) Percentage:______ % 93 When you had vaginal or anal intercourse over the l a s t 12 months with your SECONDARY PARTNER OR PARTNERS, what percentage of the time were condoms used1 (Examples: 0%, 30%. 80%, 100%. etc ) Percentage:______% Put a check i n the space at the end of this line ONLY IF you do NOT want your answers to this Questionnaire to be used as part of this study ________ THIS IS THE END OF THE QUESTIONNAIRE. THANK YOU FOR YOUR COOPERATION. PLEASE PLACE THE QUESTIONNAIRE IN THE PRIVACY ENVELOPE AND RETURN IT TO THE PROCTOR Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Linked assets

University of Southern California Dissertations and Theses

Conceptually similar

PDF

An evaluation of a brief HIV /AIDS prevention intervention using normative feedback to promote risk reduction among sexually active college students

PDF

Genetic cross-relationships between criminal behavior and severe alcohol-related problems

PDF

Social-cognitive and behavioral attributes of subtypes of aggressors and victims in children's peer groups

PDF

Applying the theory of reasoned action to condom use: The effect of immediate consequences on intention-behavior consistency

PDF

Need for cognition and psychological adjustment in patients and partners of prostate cancer

PDF

What makes mentoring effective? Behavior analytic strategies as key components of successful mentor-mentee relationships: A pilot study

PDF

Alcohol expectancies and consumption: Age and sex differences

PDF

The relationship between work stress and family interaction in dual-earner couples

PDF

Self-reported stressors and cardiovascular reactivity among African American and white caregivers and noncaregivers

PDF

The therapy relationship: Developing a sound metaphysical description of personal relations

PDF

Adolescents' social attitudes: Genes and culture?

PDF

The relation between interpersonal sensitivity and depression

PDF

The relationship of body composition to self-concept, self-esteem and depression before and after a regular exercise program

PDF

Expectancies for alternative behaviors predict drinking problems: A test of a cognitive reformulation of the matching law

PDF

Affection and conflict in family relationships

PDF

Perceptions of dementia among Asian Indian Americans

PDF

Depressed children and the social and behavioral attributes of their best friend

PDF

Articulated thoughts about intentions to commit anti-gay hate crimes

PDF

Psychophysiological reactivity and the development of alcohol problems

PDF

History of depression, antidepressant treatment, and other psychiatric illness as risk factors for Alzheimer's disease in a twin sample

Asset Metadata

Creator Chernoff, Robert Alan (author)

Core Title Values and their relationships to HIV-related behavior, attitudes, and social norms

Degree Master of Arts

Degree Program Clinical Psychology

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag health sciences, public health,OAI-PMH Harvest,psychology, behavioral,psychology, social

Language English

Contributor Digitized by ProQuest (provenance)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c16-10323

Unique identifier UC11341466

Identifier 1383586.pdf (filename),usctheses-c16-10323 (legacy record id)

Legacy Identifier 1383586.pdf

Dmrecord 10323

Document Type Thesis

Rights Chernoff, Robert Alan

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA