WITHDRAWN: Negotiation Skills As the Gateway to Adolescent Condom Use: A Mediation Analysis of Condom Use Self-Efficacy Dimensions

Introduction: Condom use self-efficacy has been noted as a strong predictor of actual condom use. Self-efficacy can incorporate many dimensions of an individual’s perceived ability to successfully perform a behavior. We hypothesize that various dimensions of condom use self-efficacy will each have a unique effect on condom behavior but that self-efficacy related to negotiating contraceptive use with a partner will mediate the relationships between other self-efficacy dimensions and condom use. Because research suggests that condom use discussions operate differently for boys and girls, we include gender as a moderator.

Methods: As part of the HealthWise South Africa study, we collected longitudinal survey data on risk and health behavior for 6,357 eighth graders in the Western Cape. Structural equation modeling was used to examine a subsample of sexually active students (N=713; M_age=13.96). In addition to negotiation ability, the domains of self-efficacy we identified related to technical skill, intent or will to use condoms, and ability to obtain condoms. Actual condom use was based on having or using a condom at last sex and frequency of condom use.

Preliminary Results: Boys were more likely to have had and used a condom at last sex, but girls were more likely to have wanted to use one at their last sexual encounter. Boys reported higher perceived technical skill and ability to obtain condoms, while girls had higher perceived intention to use condoms and negotiation skill. The fit of the hypothesized mediation model was good (CFI=0.987, TLI=0.983, RMSEA=0.025). Self-efficacy to negotiate was positively associated with condom use and significantly mediated the effects of intent and ability to obtain condoms on condom use. Intent to use condoms had significant effects on condom use above and beyond the mediated effect. Technical skill had a marginally significant association with condom use and was not significantly related to self-efficacy to negotiate. Gender-stratified analysis revealed that the mediated effect of self-efficacy to negotiate was significant for girls but not for boys.

Discussion: The dimensions of self-efficacy have different relationships with condom use and negotiation ability seems to mediate the effects of some types of self-efficacy and condom behavior. Furthermore, negotiation ability seems to be a more important factor for ensuring condom use for girls than for boys. Understanding the nuances of how condom use self-efficacy relates to behavior could inform the creation of more tailored initiatives that more effectively and efficiently improve youth condom use. Future research will examine how a school-based sexual risk reduction program affects the relationships among the condom use self-efficacy dimensions and condom use.