Using the information-motivation behavioral model to predict sexual behavior among underserved minority youth.

The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic in the United States has stimulated considerable research on sexual behaviors as well as prevention efforts that focus specifically on adolescents and younger adults. Meta-analyses of these interventional studies show that the most effective interventions were those that have been constructed and implemented using a specific theoretical framework1–3 that contained attitudinal components, educational information, as well as behavioral skills training.1 Another particularly important point emerging from these meta-analytic reviews was that adolescents are a heterogeneous mosaic of subgroups consisting of different ethnicities/cultures, behavioral risk characteristics, and developmental levels. Furthermore, because of manifold differences between adolescent subgroups, developing interventions specifically for well-defined targeted subgroups of adolescents has been found to produce superior results in terms of reducing risky sexual behaviors.1,2 Therefore, the testing, retesting, and modification of the theoretical framework designed to explain and reduce the sexual risk-taking behaviors among adolescent subpopulations remain important tasks. Exploration of the unique application of these models to specific adolescent subgroups, particularly at-risk underserved minority populations, will ultimately lead to a more focused understanding of the unique risk factors facing these groups, as well as contribute to the development of more powerful tools and more effective interventions with these specific populations. Reviews of recent theoretical-based interventions for reducing risky sexual behaviors reveal that the information-motivation-behavior (IMB) model3,4 has been widely used and shown to be an effective theoretical foundation for modifying risky sexual behavior among multiple populations. Some examples include college students in general,3,5 female college students in particular,6,7 Latina college students,8 women in low-income housing,9 intravenous drug users,10 truck drivers,11 male and female sexually trasmitted infected patients,12 HIV-infected patients,13 and HIV-positive men who have sex with men.14 Additionally, the IMB model has also been found to explain a significant portion of the variance of sexual behavior among sexually active “mostly minority” older adolescents15 as well as condom use among juvenile offenders.13 However, little is known about the relationship between the IMB components and sexual behaviors among minority youth, especially underage youth. The present study employed the IMB theoretical framework and structural equation modeling (SEM) in order to examine relations among risky sexual behavior; information (knowledge about sexually trasmitted infections [STIs]/HIV and pregnancy); motivation (perceived pregnancy repercussions, attitudes against sexual activities); beliefs (perceived peer pressure about sexual behavior); and sexual behavior refusal skills among underserved African-American and Hispanic youth aged 11–17 years attending after-school clubs in Los Angeles, California. The significance of this study is 3-fold. First, it includes pre- and early adolescent individuals (ages 11–12 years) who have been largely excluded from research on sexual activities among youth. Many factors that affect sexual behavior, particularly sexual norms and attitudes, may be shaped and developed before youth reach their teen years.16 Additionally, despite the fact that a substantial proportion of minority boys and a slightly smaller proportion of girls report that their first sexual intercourse occurred before age 15, data on sexual behavior and its correlates are especially scarce among these preadolescent youth.17 Second, this research includes data on both African-American and Hispanic youth, recruited from 1 of the most underserved and impoverished areas in the nation.18,19 These youth are among those most at risk for the consequences of early adolescent sexuality, including sexually transmitted diseases, adolescent pregnancy, and secondary deleterious effects of early sexual activity including decreased academic attainment and other maladaptive outcomes. The results of this evaluation of the utility of the IMB model in explaining the determinants of sexual behavior among these minority youth may provide direction for future modifications of IMB-based interventions for this at-risk population. Theoretical Framework The IMB theoretical framework was developed by Fisher and colleagues3,4 and has been validated extensively in over a decade of correlational and experimental research concerning HIV-related behaviors.20 This model posits that sexual behavior is a function of the individual’s information about STIs, pregnancy-related knowledge, attitude and motivation toward sexual activity, and, subsequently, the behavioral skills essential to refuse sexual intercourse effectively, while minimizing the negative consequences that may come with this refusal. On the basis of this reasoning from the IMB model, information on how STIs are transmitted and the social, economic, and psychological consequences of teen pregnancy are prerequisites for informed discussions about sexual activities.3,21 However, information by itself has not been found to be sufficient in promoting decreased risky sexual behaviors. Assessing a person’s level of knowledge provides only a partial picture of how behavior is influenced.21–23 Highly informed individuals may have high or low motivation to remain sexually inactive while highly motivated individuals may or may not be highly informed. Therefore, conceptually, information and motivation both are thought to influence the use of behavioral skills to engage in or prevent sexual behavior in quite different ways.21 According to the IMB model, behavioral skills refer to the possession of the requisite skills to avoid sexual intercourse (eg, to be able to determine what situations to avoid, how to reject sexual intercourse effectively without losing a friend, etc).4 The model further assumes that factors such as perceived costs and benefits of risky sexual behaviors may also affect motivation to engage in a given activity. Clearly, in developing an effective intervention, it is vital to determine and fully identify the behaviors targeted for change. The IMB model views health-behavior modification as a process of providing relevant detailed information while understanding cultural practices and norms in order to carefully create an atmosphere conducive to the consideration of an alternative practice. Enhancing the motivation for the modification of behavior and providing culturally acceptable skills will ultimately lead to promoting alternative behaviors.3,4 In this study, we test a predictive theoretical model using constructs from the IMB model enhanced with key demographic variables of age, gender, and ethnicity. Developmentally, we expect that the older youth will have engaged in more sexual behaviors. We also expect that females will be more negative or concerned about the repercussions from pregnancy and feel more pressure to refrain from sexual activity. We position information and motivational components of the model as proximal predictors of sexual behavior refusal skills. In turn, we position the outcome of risky sexual behavior as initially predicted by lower refusal skills. However, we also assess whether any of the background demographics or intervening information or motivation constructs predict risky sexual behavior directly or rather if it is mediated through refusal skills.