Why communication is crucial: meta-analysis of the relationship between safer sexual communication and condom use

The purpose of this study was to quantitatively synthesize the growing literature on the relationship between safer sexual communication (SSC) among sexual partners and condom use, and to systematically examine a number of conceptual and methodological moderators of this relationship. Data from 53 articles published in 27 journals met criteria for the study. Fifty-five independent effect sizes coded from samples totaling N=18,529 were meta-analyzed. Results indicate that the mean sample-size weighted effect size of the SSC-condom use relation was r=.22, and a number of conceptual variables were found to moderate this relationship. Specifically, communication about condom use (r=.25) and sexual history (r=.23) had significantly (p<.05) larger effect sizes than communication about safer sex (r=.18). In addition, SSC measures operationalized differently had significantly (p<.05) different effect sizes. From largest to smallest, these were behavioral format (r=.29), intentional format (r=.18), and self-efficacy format (r=.13). Measures that tried to assess persuasion attempts as compared with informational exchanges were not found to have significantly different effect sizes (p>.05). Further, methodological moderators tended to be unrelated to effect size. Implications for the future study of safer sexual communication as well as the importance of emphasizing communication skills in HIV preventive interventions are discussed.     

Agreement of Self-Reported and Genital Measures of Sexual Arousal in Men and Women: A Meta-Analysis

The assessment of sexual arousal in men and women informs theoretical studies of human sexuality and provides a method to assess and evaluate the treatment of sexual dysfunctions and paraphilias. Understanding measures of arousal is, therefore, paramount to further theoretical and practical advances in the study of human sexuality. In this meta-analysis, we review research to quantify the extent of agreement between self-reported and genital measures of sexual arousal, to determine if there is a gender difference in this agreement, and to identify theoretical and methodological moderators of subjective-genital agreement. We identified 132 peer- or academically-reviewed laboratory studies published between 1969 and 2007 reporting a correlation between self-reported and genital measures of sexual arousal, with total sample sizes of 2,505 women and 1,918 men. There was a statistically significant gender difference in the agreement between self-reported and genital measures, with men (r = .66) showing a greater degree of agreement than women (r = .26). Two methodological moderators of the gender difference in subjective-genital agreement were identified: stimulus variability and timing of the assessment of self-reported sexual arousal. The results have implications for assessment of sexual arousal, the nature of gender differences in sexual arousal, and models of sexual response.     

Measuring the Effectiveness of Mass-Mediated Health Campaigns Through Meta-Analysis

A meta-analytic review was undertaken to examine the effects of mass communication campaigns on changes in behavior, knowledge, and self-efficacy in the general public. A review of the academic literature was undertaken and identified 1,638 articles from 1966 through 2012. Using strict inclusion criteria, we included 63 studies for coding and analyses. Results from these efforts indicated that campaigns produced positive effects in behavior change (r = .05, k = 61) and knowledge (r = .10, k = 26) but failed to produce significant increases in self-efficacy (r = .02, k = 14). Several moderators (e.g., health topic, the theory underlying the campaign) were examined in relation to campaign principles that are prescribed to increase campaign effects. The major findings are reviewed, and the implications for future campaign design are discussed.     

Risky sexual behaviors among sexually active first-year students matriculating at a historically Black college: Is a positive self-image an instigator?

A sample of 498 sexually active first-year students matriculating at a historically Black college in North Carolina was used to determine correlates of risky sexual behaviors. In an Ordinary Least Squares regression, the self-esteem element “I take a positive attitude toward myself” (B = 1.12, p = .05), non-condom use because of partner issues (B = .53, p = .05) and being drunk or high (B = 1.20, p = .001), oral sex (B = 1.74, p = .001), anal sex (B = .61, p = .04), and bisexuality (B = .85, p = .03) all increased the number of these behaviors. Higher scores on the condom usage scale (B = –.38, p = .002) were found to decrease the number of risky sexual behaviors. Illicit drug use was an underpinning of the surprisingly positive relationship between positive self-image and risky sexual behaviors. It was concluded that school-based social workers, mental health care professionals, and community-based prevention providers can play a critical role in the training of peer facilitators, development, and supervision of peer-driven risk-reduction programs to address the complex interplay among self-esteem, sex, and substances.     

The Influence of Graphic Format on Breast Cancer Risk Communication

Graphic displays can enhance quantitative risk communication. However, empiric data regarding the effect of graphic format on risk perception is lacking. We evaluate the effect of graphic format elements on perceptions of risk magnitude and perceived truth of data. Preferences for format also were assessed. Participants (254 female primary care patients) viewed a series of hypothetical risk communications regarding the lifetime risk of breast cancer. Identical numeric risk information was presented using different graphic formats. Risk was perceived to be of lower magnitude when communicated with a bar graph as compared with a pictorial display (p < 0.0001), or with consecutively versus randomly highlighted symbols in a pictorial display (p = 0.0001). Data were perceived to be more true when presented with random versus consecutive highlights in a pictorial display (p < 0.01). A pictorial display was preferred to a bar graph format for the presentation of breast cancer risk estimates alone (p = 0.001). When considering breast cancer risk in comparison to heart disease, stroke, and osteoporosis, however, bar graphs were preferred pictorial displays (p < 0.001). In conclusion, elements of graphic format used to convey quantitative risk information effects key domains of risk perception. One must be cognizant of these effects when designing risk communication strategies.     

Validation of the Diabetes Numeracy Test With Adolescents With Type 1 Diabetes

There is currently a lack of valid instruments to measure adolescent diabetes numeracy. The Diabetes Numeracy Test (DNT) was adapted for type 1 diabetes and was administered to 2 samples of adolescents. Sample 1 was administered the 39-item version of the DNT (DNT-39) with measures of self-management, responsibility, reading, and glycemic control (A1C). Sample 2 was administered the 14-item version of the DNT (DNT-14) with measures of self-management, responsibility, problem solving, and A1C. Both versions of the DNT showed adequate internal reliability. In Sample 1, the DNT-39 and DNT-14 were related (r = .87, p = .001), and both DNT versions were related to parent education (for DNT-14, r = .31, p = .02; for DNT-39, r = .29, p = .03) and reading (for DNT-14, r = .36, p = .005; for DNT-39, r = .40, p = .001). In Sample 2, the DNT-14 was related to A1C (r = ?.29, p = .001), reading skills (r = .36, p = .005), diabetes problem solving (r = .27, p = .02), adolescent age (r = .19, p = .03), and parent education (r = .31, p = .02). In combined analyses, 75% of items were answered correctly on the DNT-14 (range = 7–100), and performance was associated with age (r = .19, p = .03), pump use (r = .33 p = .001), and A1C (r = ?.29, p = .001). The DNT-14 is a feasible, reliable, and valid numeracy assessment that indicated adolescents with type 1 diabetes have numeracy deficits that may affect their glycemic control.     

Mental representation of self in relationships indirectly affects young Black women’s engagement in risky sexual behaviors through psychosocial HIV/STI risk factors

Black females are disproportionately affected by human immunodeficiency virus (HIV)/sexually transmitted infections (STIs), though individual-level sexual risk factors do not appear to explain racial/ethnic HIV incidence rate disparities. The current study examined the roles of attachment representations, working models of self and others, with psychosocial risk factors related to population-level sexual network features in association with risky sexual behaviors. A total of 560 Black emerging adult females (M age = 20.58, SD = 1.89) enrolling in a behavioral HIV prevention intervention trial completed the baseline assessment used in the current analyses. A series of multiple mediator models examined indirect effects of working models of self and others on sexual risk engagement through the following psychosocial HIV/STI risk factors: (a) partner communication self-efficacy, (b) fear of condom negotiation, (c) peer norms for risky sexual behavior, (d) partner trust and (e) sex-related alcohol expectancies. Results indicated an indirect effect of working model of self on the following: condom use with boyfriend/main partner through peer norms for risky sex (ab = .08, 95% CI [.02, .17]), any alcohol use prior to sex through peer norms for risky sex (ab = ?.06, 95% CI [?.12, ?.02]) and alcohol use prior to sex through sex-related alcohol expectancies (ab = ?.13, 95% CI [?.21, ?.05]). Findings provided evidence of a direct association between working model of self and each psychosocial HIV/STI risk factor included in the mediation models. Working model of self may help identify Black females at elevated risk for HIV/STI through these psychosocial risk factors.     

Sexual Knowledge,Sexual Attitude,and Life Satisfaction Among Korean Older Adults: Implications for Educational Programs

The aim of this study was to: identify the sexual knowledge, sexual attitude, and life satisfaction in Korean older adults; and explore significant factors among demographic characteristics, sexual activity, sexual knowledge, and sexual attitude, that influence life satisfaction among Korean older adults. Participants were recruited in community centers and public parks (N = 571). Data were collected on sexual knowledge, sexual attitudes, and life satisfaction using three valid and reliable instruments. Data were analyzed using t test, ANOVA, Pearson’s correlation, and hierarchical multiple regression. Educational level, gender, and living arrangement significantly affected sexual knowledge and attitudes (p < .001) among older adults. There was a positive relationship between sexual knowledge and attitudes (r = .490, p < .001), life satisfaction and sexual knowledge (r = .144, p = .001), and life satisfaction and sexual attitudes (r = .121, p = .004). Age (β = .16, t = 3.45, p < .01), gender (β = .52, t = 2.07, p < .05), presence of spouse (β = ?.12, t = ?2.42, p < .05), and sexual knowledge (β = .10, t = 2.17, p < .05) were factors with a significant influence on life satisfaction for older adults. When designing and implementing sexual counseling and education programs for older adults, individual background, sexual knowledge, and sexual attitudes must be assessed and considered. Also, those without spouses who live alone may need more attention because they tend to have low knowledge levels and negative attitudes toward sexual activity.     

Disparities in Health Information Access: Results of a County-Wide Survey and Implications for Health Communication

Health knowledge and behavior can be shaped by the extent to which individuals have access to reliable and understandable health information. Based on data from a population-based telephone survey of 1,503 respondents of ages 18 years and older living in Douglas County, Nebraska, in 2013, this study assesses disparities in health information access and their related covariates. The two most frequently reported sources of health information are the Internet and health professionals, followed by print media, peers, and broadcast media. Relative to non-Hispanic Whites, Blacks are more likely to report health professionals as their primary source of health information (odds ratio [OR] = 2.61, p < .001) and less likely to report peers (OR = 0.39, p < .05). A comparison between Whites and Hispanics suggests that Hispanics are less likely to get their health information through the Internet (OR = 0.51, p < .05) and more likely to get it from broadcast media (OR = 4.27, p < .01). Relative to their counterparts, participants with no health insurance had significantly higher odds of reporting no source of health information (OR = 3.46, p < .05). Having no source of health information was also associated with an annual income below $25,000 (OR = 2.78, p < .05 compared to middle income range) and being born outside of the United States (OR = 5.00, p < .05). Access to health information is lowest among society’s most vulnerable population groups. Knowledge of the specific outlets through which people are likely to obtain health information can help health program planners utilize the communication channels that are most relevant to the people they intend to reach.     

Gender differences in variables associated with sleep quality in chronic tension type headache

We aimed to evaluate gender differences in the relationships between headache features, sleep quality, anxiety, depressive symptoms, and burden of headache in 193 patients (73 percent women) with chronic tension type headache (CTTH). Sleep quality was assessed with the Pittsburgh Sleep Quality Index. Headache features were collected with a four-week diary. The Hospital Anxiety and Depression Scale was used to assess anxiety/depressive symptoms. Headache Disability Inventory was used to evaluate the burden of headache. In men with CTTH, sleep quality was positive correlated with headache frequency (r = 0.310; p = .018), emotional (r = 0.518; p < .001) and physical (r = 0.468; p < .001) burden of headache, and depressive symptoms (r = 0.564; p < .001). In women, positive correlations were observed between sleep quality and headache intensity (r = 0.282; p < .001), headache frequency (r = 0.195; p = .021), emotional burden (r = 0.249; p = .004), and depressive symptoms (r = 0.382; p < .001). The results of stepwise regression analyses revealed that depressive symptoms and emotional burden of headache explained 37.2 percent of the variance in sleep quality in men (p < .001), whereas depressive symptoms and headache intensity explained 17.4 percent of the variance in sleep quality in women (p < .001) with CTTH. Gender differences associated with poor sleep should be considered for proper management of individuals with CTTH.     

Communication Among Melanoma Family Members

Interventions to improve communication among family members may facilitate information flow about familial risk and preventive health behaviors. This is a secondary analysis of the effects of an interactive website intervention aimed at increasing communication frequency and agreement about health risk among melanoma families. Participants were family units, consisting of one family member with melanoma identified from a previous research study (the Case) and an additional first degree relative and a parent of a child 0–17. Family triads were randomized to receive access to the website intervention or to serve as control families. Family communication frequency and agreement about melanoma prevention behaviors and beliefs were measured at baseline and again at 1 year post randomization. Intervention participants of all three types significantly increased the frequency of communication to their first degree relatives (Parents, siblings, children; range = 14–18 percentage points; all p < .05). At baseline, approximately two-thirds of all three family members talked with at least some member of the family about cancer risk. Agreement between Cases and First Degree Relatives and between Cases and Parents increased from pre to post intervention in the intervention participants compared to the control participants (p < .05). These findings provide support for interventions to improve family communication about cancer risk.     

Development and Validation of the Chinese Health Literacy Scale for Chronic Care

This study aims to develop and test the psychometric properties of the Chinese Health Literacy Scale for Chronic Care (CHLCC). This is a methodological study with a sample of 262 patients 65 years of age and older who had chronic illnesses. Pearson's correlation, independent sample t tests, and analyses of variance were used. The CHLCC showed a significant positive correlation with Chinese literacy levels (r = 0.80; p < .001) but was negatively correlated with age (r =?0.31; p <.001). Respondents who were male (t =4.34; p <.001) and who had reached Grade 12 or higher in school (F = 51.80; p <.001) had higher CHLCC scores than did their counterparts. Individuals with high levels of health literacy had fewer hospitalizations than did their counterparts (β =?0.31; incidence rate ratio = 0.73; p <.05). The CHLCC also displayed good internal reliability (Cronbach'sα =0.91) and good test–retest reliability (intraclass correlation coefficient = 0.77; p <.01). The CHLCC is a valid and reliable measure for assessing health literacy among Chinese patients with chronic illness. The scale could be used by practitioners before implementing health promotion and education.     

Incorporating Communication into the Theory of Planned Behavior to Predict Condom Use Among African American Women

The present research extends the theory of planned behavior (TPB) to investigate how communication-related variables influence condom use intention and behavior among African American women. According to the TPB, attitudes, subjective norms, and self-efficacy are associated with behavioral intent, which predicts behavior. For women, it was argued that condom negotiation self-efficacy was more important than condom use self-efficacy in predicting consistent condom use. Moreover, an important environmental factor that affects condom use for African American women is fear or worry when negotiating condom use because the sex partners might leave, threaten, or abuse them. Fears associated with negotiating condom use were predicted to be negatively associated with attitudes, subjective norms, and self-efficacy. African American women (N = 560; M age = 20.58) completed assessments of TPB variables at baseline and condom use 3 months later. Condom negotiation self-efficacy was a significant indicator of behavioral intent, while condom use self-efficacy was not. Fear of condom negotiation was negatively associated with all TPB components, which was in turn significantly associated with behavioral intent and condom use. Implications for the TPB, safer sex literature, and sexually transmitted infection prevention intervention design are discussed.     

Knowing How and Knowing Why: testing the effect of instruction designed for cognitive integration on procedural skills transfer

Transfer is a desired outcome of simulation-based training, yet evidence for how instructional design features promote transfer is lacking. In clinical reasoning, transfer is improved when trainees experience instruction integrating basic science explanations with clinical signs and symptoms. To test whether integrated instruction has similar effects in procedural skills (i.e., psychomotor skills) training, we studied the impact of instruction that integrates conceptual (why) and procedural (how) knowledge on the retention and transfer of simulation-based lumbar puncture (LP) skill. Medical students (N = 30) were randomized into two groups that accessed different instructional videos during a 60-min self-regulated training session. An unintegrated video provided procedural How instruction via step-by-step demonstrations of LP, and an integrated video provided the same How instruction with integrated conceptual Why explanations (e.g., anatomy) for key steps. Two blinded raters scored post-test, retention, and transfer performances using a global rating scale. Participants also completed written procedural and conceptual knowledge tests. We used simple mediation regression analyses to assess the total and indirect effects (mediated by conceptual knowledge) of integrated instruction on retention and transfer. Integrated instruction was associated with improved conceptual (p < .001) but not procedural knowledge test scores (p = .11). We found no total effect of group (p > .05). We did find a positive indirect group effect on skill retention (B _ab  = .93, p < .05) and transfer (B _ab  = .59, p < .05), mediated through participants improved conceptual knowledge. Integrated instruction may improve trainees’ skill retention and transfer through gains in conceptual knowledge. Such integrated instruction may be an instructional design feature for simulation-based training aimed at improving transfer outcomes.     

Validating MMI scores: are we measuring multiple attributes?

The multiple mini-interview (MMI) used in health professional schools’ admission processes is reported to assess multiple non-cognitive constructs such as ethical reasoning, oral communication, or problem evaluation. Though validation studies have been performed with total MMI scores, there is a paucity of information regarding how well MMI scores differentiate the constructs being measured, the relationship between MMI scores (construct or total) and personality characteristics, and how well MMI scores (construct or total) predict future performance in practice. Results from these studies could assist with MMI station development, rater training, score interpretation, and resource allocation. The purpose of this study was to investigate the validity of MMI construct scores (oral communication and problem evaluation), and their relationship to personality measures (emotionality and extraversion) and specific scores from standardized clinical communications interviews (building the relationship and explaining and planning). Confirmatory factor analysis results support a two factor MMI model, however the correlation between these factors was .87. Oral communication MMI scores significantly correlated with extraversion (r _c  = .25, p < .05), but MMI scores were not related to emotionality. Scores for building a relationship were significantly related to MMI oral communication scores, (r _c  = .46, p < .001) and problem evaluation scores (r _c  = .43, p < .001); scores for explaining and planning were significantly related to MMI problem evaluation scores (r _c  = .36, p < .01). The results provide validity evidence for assessing multiple non-cognitive attributes during the MMI process and reinforce the importance of developing MMI stations and scoring rubrics for attributes identified as important for future success in school and practice.     

Examining the Principles of Influence on Safer Sex Communication During Casual and Committed Sexual Encounters

Teens and young people are at risk for contracting sexually transmitted infections. Understanding how relationship context may moderate the effectiveness of safer sex communication strategies among this demographic is important information for practitioners striving to promote safer sex behaviors. In this study, focus groups (N = 9) with college students were conducted and analyzed to examine the relation between 6 principles of influence (authority, consistency, liking, reciprocity, scarcity, and social proof) and safer sex communication during committed and casual sexual encounters. Results revealed that with the exceptions of social proof and consistency, the principles of influence were endorsed more frequently for casual than committed sexual encounters. For casual sexual encounters, the principles of authority, reciprocity, and scarcity arose as influential principles. For committed sexual encounters, the principles of consistency, liking, and reciprocity arose as influential principles. These results are discussed with an emphasis on the theoretical and practical implications.     

The influence of achievement before,during and after medical school on physician job satisfaction

In this longitudinal study, we investigated the relationship between physicians’ prior achievements (before, during and after medical school) and job satisfaction, and tested the two lines of reasoning that prior achievements influence job satisfaction positively or negatively, respectively. The participants were graduates who started their medical training in 1982 (n = 147), 1983 (n = 154), 1992 (n = 143) and 1993 (n = 153). We operationalised job satisfaction as satisfaction (on a 10-point scale) with 13 cognitive, affective and instrumental aspects of the participants’ jobs. The measures of achievement before, during and after medical school included pre-university grade point average, study progress and a residency position in the specialty of first choice, respectively. We included the effect of curriculum type (problem-based learning versus traditional), gender and years of experience as moderator variables. Higher achievers before and during medical school were more satisfied about their income (β = .152, p < .01 and β = .149, p < .05), but less satisfied with their opportunities for personal development (β = ?.159, p < .05). High achievers after medical school were more satisfied with professional accomplishments (β = .095, p < .05), with appreciation from support personnel (β = .154, p < .01) and from patients (β = .120, p < .05). Effect sizes were small. Prior achievements influenced job satisfaction. The direction of the influences depended on the job satisfaction aspect in question, which indicates that it is important to distinguish between aspects of job satisfaction. To optimize job satisfaction of high achievers, it is important for graduates to obtain their preferred specialty. Furthermore, it is vital to provide them with enough opportunities for further development.     

Energy Drink Consumption and Associated Health Behaviors Among University Students in an Urban Setting

The objective of this study is to describe energy drink consumption and health behaviors among college students attending a predominantly minority university. Undergraduate and graduate students attending a private, minority-serving university were invited to participate in an online survey between September 2009 and August 2010. Out of 2,500 students, 407 participated yielding a response of 16 %. Analysis assessed energy drink consumption as well as participation in sport activities and high-risk behaviors. Energy drink consumption is significantly related with drinking alcohol to inebriation and driving (r = .14, p < .05) and to riding with a drunk driver (r = .15, p < .05). Athletes were more likely to engage in drinking alcohol to inebriation and driving F (1, 186) = 6.12, p < .02. Energy drink consumption is a common practice among racial minority university students. Tailored health promotion strategies and interventions are needed to address misconceptions of energy drink and alcohol mixing.     

Youth health outcomes from the Connect-to-Protect coalitions to prevent adolescent HIV infections

We assessed the relationships among HIV-related social and behavioral outcomes resulting from an adolescent-focused HIV structural change initiative in eight urban sites operating Connect-to-Protect coalitions. Over a 4-year period, annual cross-sectional panels of adolescents (N = 2248) completed an audio-computer-assisted interview, providing data on satisfaction with their communities as adolescent-supportive environments, internalized HIV stigma, lifetime HIV-testing, lifetime sexual risk-taking and number of sexual partners in the prior year. We used structural equation modeling to estimate hypothesized links between time since coalition mobilization to our social and behavioral outcomes. Over the 4 years, adolescents perceived their communities to become more supportive (p < .05). Positive perceptions of community support were associated with lower lifetime HIV sexual risk (p < .05). The effect of time on risk behavior was mediated by perceptions of community support. Stigma was unchanged over time. Stigma had damaging effects on risk behavior, effects which were also mediated by perceptions of community support. Special efforts are needed to address the deleterious effect of HIV stigma on high-risk urban adolescents.