1. Mediation Analysis of an Effective Sexual Risk Reduction Intervention for Women Ann O’Leary, PhD Centers for Disease Control and Prevention Loretta S Jemmott, RN, PhD, FAAN and John B Jemmott III, PhD University of Pennsylvania

2. Purpose of Mediation Analysis Identify theoretically-derived intervention components responsible for effectiveness Identify those not contributing to intervention effectiveness Enables subsequent development of more cost-effective interventions and can contribute to theory

3. The Sister-to-Sister Intervention* Skill-based and Informational interventions delivered to 564 AA women in Newark, NJ. Both individual and group formats used for both types; a health promotion control included. Results: Skill-based interventions superior to health promotion control and, generally, to information interventions. * L.S. Jemmott, J. B. Jemmott, & A. O’Leary (in press). A randomized, controlled trial of brief HIV/STD prevention interventions for African American women in primary care settings: Effects on sexual risk behavior and STD rate. AJPH.

4. Data-analytic strategy for mediation analysis 1. IV (Skill-based intervention vs. health promotion control) significantly related to DV (condom use at last sex) 2. Theoretical mediators significantly improved by intervention 3. Association between IV and DV rendered non-significant when mediator(s) included in regression model

5. Theoretical mediators addressed by skill-based intervention Mediators derived from Social Cognitive Theory and Theory of Planned Behavior: Hedonistic expectations regarding condom use Expected partner reactions to condom requests Sex partner approval of condom use Self-efficacy to control sexual arousal Self-efficacy to carry condoms Self-efficacy to achieve consistent condom use

6. Theoretical mediators changed by the intervention Expected partner reactions to condom requests Sex partner approval of condom use Self-efficacy to carry condoms Self-efficacy to achieve consistent condom use

7. Theoretical mediators accounting for intervention effectiveness (univariate) Expected partner reactions to condom requests Sex partner approval of condom use Self-efficacy to carry condoms Self-efficacy to achieve consistent condom use

8. Theoretical mediators accounting for intervention effectiveness (multivariate) Self-efficacy to achieve consistent condom use

9. Implications and Conclusions Because men “control” condom use (i.e., they are the ones who wear them), many people believe that characteristics of women’s male partners are of paramount importance in their ability to achieve condom use. In a multivariate analysis, self-efficacy to achieve consistent condom use overrode the effects of partner characteristics in accounting for the intervention’s success regarding condom use.

10. Implications and Conclusions (cont.) Self-efficacy causes people to attempt behaviors, exert more effort, and demonstrate persistence to achieve them. Thus, even women who perceive their partners to be resistant and disapproving regarding condom use may be able eventually to prevail.

11. Implications and Conclusions (cont.) Interventions for women should provide ample opportunity to practice skills related to condom use, such as negotiation, communication, problem-solving and condom application. Contact information: aoleary@cdc.gov