Using the Health Belief Model to identify predictors of consistent condom use and incident STIs among African American adolescent females

Background: Sexually transmitted infections (STIs) and HIV disproportionately affect African American females. Condom use and incident STIs are commonly used as markers for HIV risk. The Health Belief Model (HBM) is a widely recognized framework for predicting risk behaviors, yet few studies have empirically tested the relationship between HBM constructs and HIV risk.

Methods: Prior to randomization and intervention, baseline data were collected from 715 African American females (15 to 21 years) participating in an HIV intervention program in Atlanta. Data collection included 1) a survey of demographic, psychosocial, and behavioral measures and 2) self-collected, laboratory-confirmed vaginal swabs for trichomoniasis, chlamydia, and gonorrhea. Using the HBM, we examined the association between five constructs with consistent condom use and incident STIs: demographic factors, perceived susceptibility, perceived benefits, perceived barriers, and cues to action. Condom use self-efficacy and condom negotiation self-efficacy were tested as mediators.

Results: Preliminary analyses reveal that perceived barriers and perceived susceptibility negatively predict consistent condom use. This relationship is partially mediated through condom negotiation self-efficacy. There is no mediation effect of condom use self-efficacy. Demographic variables, perceived benefits, and cues to action were not significant in the model. Increasing age and perceived barriers positively predict incident STIs. Neither self-efficacy for condom use or condom negotiation mediated this relationship.

Conclusions: These findings suggest that the Health Belief Model can be an effective tool for identifying predictors of condom use and incident STIs among African American females. Key constructs may be useful in designing culturally relevant HIV prevention interventions.