Safe-sex among adolescents with serious mental illness: Pathways between parent-teen communication, self-efficacy, and condom use

Background: Adolescents with mental illness are at increased risk for HIV infection, STIs, and unintended pregnancy. While associations between effective condom negotiation, subsequent condom use, and prevention of negative health outcomes are well-established, predictors of safe-sex behavior among teens with mental illness remain nebulous. The purpose of the present study was to explore predictive pathways between parent-teen sexual communication, condom self-efficacy, condom negotiation, and condom use among adolescents with psychiatric illness. Methods: Participants included 798 adolescents (mean age = 14.9 years, 56.1% female, 57.2% sexually active) and their parents (89.5% female, 60% African American, and 31.5% married), recruited from mental health treatment centers for a multi-site randomized controlled trial aimed at preventing HIV infection among at-risk youth. For the purpose of the present study, baseline data regarding parent-adolescent communication (Miller Parent-Adolescent Sexual Communication Scale; Miller et. al., 1998), adolescent condom self-efficacy (Self-Efficacy for Condom Use; Prochaska, 1994), and adolescent-report regarding recent sexual activity (AIDS Risk Behavior Assessment; Donenberg et al., 2001) were examined. Results: Parent-adolescent sexual communication was found to predict a small but statistically significant proportion of the variance in adolescents' self-efficacy for using condoms. Self-efficacy, in turn, was a significant predictor of condom negotiation in adolescents' most recent relationship. Condom negotiation was found to predict nearly 80% of the variance in condom use. Conclusions: Study findings support links between communication, self-efficacy, and condom use, suggesting that adolescent self-efficacy for condom use and parent-teen communication about sexuality may be important areas for emphasis in future HIV prevention research.