Measuring Correlates of HIV Risk Avoidance in Sub-Saharan Preadolescents Comfort Enah, Ph.D. RN Wright State University College of Nursing and Health Ian.

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Presentation transcript:

Measuring Correlates of HIV Risk Avoidance in Sub-Saharan Preadolescents Comfort Enah, Ph.D. RN Wright State University College of Nursing and Health Ian Kudel, Ph.D. Cincinnati VAMC, University of Cincinnati November 5, 2007 APHA 135th Annual Meeting & Exposition Funding: University of Cincinnati College of Nursing Deans Challenge Award

Overview Acquired Immune Deficiency Syndrome (AIDS) is a major health threat to sub-Saharan African youth Developing appropriate instruments to accurately measure protective behaviors is a necessity

Background: Sub-Saharan Africa The region has 10% of the world’s population but more than 60% of the worlds infected people Despite numerous efforts, less than 20% of those in need have access to antiviral Primary prevention remains is essential Little is known about the use of risk avoidance behaviors among preadolescents

Background: Cameroon Cameroons is one of the countries in the region In Cameroon 1 in 4 adolescents estimated at risk Early initiation of sexual activity Girls at higher risk Focus on youth identified as a priority by national health officials

Importance Appropriate Measures Accurately describe the use of risk avoidance behaviors Assist in appropriately identifying populations at risk Assure adequate assessment of interventions and programs

Preliminary Evaluation School based, completed in 2004 60 Cameroonian females Evaluated sexual abstinence behavior skills (SABSS) and Intentions to postpone sexual activity (IPSAS) Adequate internal consistency (SABSS, 0.67) IPSAS, 0.92) and Exploratory factor analysis (SABSS 2 factors, IPSAS 1factor) Measures renamed SABSS-CAM and IPSAS-CAM

Purpose of this study Second step in assessing reliability and validity with a larger and more heterogonous population

Method School based self-administered survey to 462 students in 8 randomly selected schools across two Cameroonian provinces Scales based on the Theory of Planned Behavior (Ajzen, 1981) SABSS-CAM, IPSAS-CAM, Perceived negative consequence of early sex scale (PNCES) Sexual abstinence behavior scale (SABS)

Theory of Planned Behavior

Measures Sexual Abstinence Behavior Skills Scale (SABSS-CAM): Modified from vignettes in a 1994 WHO curriculum, 5 items Intentions to Postpone Sexual Activity scale (IPSAS-CAM): A modified version of the adolescent Sexual Intentions Scale (Urdry & Billy 1987), 3 items

Measures Sexual Abstinence Behavior Scale (SABS): Modified version of Norris, Magnus and Clark’s (2003) Abstinence Behavior Scale (5 items) Perceived Negative Consequence of Early Sex Scale (PNCESS): Single item scale adapted from Norris, Magnus & Clark, 2003 Marlow-Crowne Social Desirability Scale (8 item short form) Demograpahics

Method: Analysis Initial evaluation of the SABS and the PNCES among Cameroonian students. Univariate distributions and relationships examined Preliminary analyses Demographics Psychometric evaluation of all instruments Internal consistencies Convergence validity Path model

Demographics 462 students, more female (61%), more from South West Province (54%) 66% from households with incomes less than 100,000frs CFA ($200) per month 51% had said no to sex at least once in past 3 months 27.3% sexually active No significant differences between participants from different provinces or age groups

Demographics: Sexual Activity by Age

Results: Means Scores by Age

Psychometrics SABSS-CAM: 0.54 IPSAS-CAM: 0.71 SABS: 0.66

Psychometrics Convergence Validity Intentions and behaviors skills(0.44, alpha<.01) Perceived consequence and behavior(0.10, alpha<.05) Perceived negative consequence and intentions(0.26, alpha <.01) Intentions and abstinence behavior (0.08, alpha<.05) Behavior skills and abstinence behavior (not significant)

Psychometric analysis Redundancy of items within each scale We decided to test a path model Do risk avoidance intentions, perceived negative consequence of sex, and abstinence skills predicts risk avoidance behavior

Path model Good model fit: χ2=1.330, df=2, p=0.51 CFI=1.00 RMSEA = 0.00 CFI=comparative fit index RMSEA=root mean square error approximation Interesting model, has similar relationships to the TPB but proposes new ones that need further exploration Interestingly in Cameroon, young females mostly engage in sex with older males, SABSS-CAM 5 speaks to this. A model that directly addresses this could potentially be useful.

Implications Further evaluation needed Reduce Redundancy and Local dependence Use only with females

Conclusions AIDS is a major threat Primary prevention in youth necessary Further evaluation of SABSS-cam and IPSAS-cam essential before use in evaluating interventions.