Georgia State School of Public Health Ph.D. student Jamal Jones discussed his research into condom use among young, black men during the APHA 2016 annual meeting in Denver. This is his presentation.

1. Why Do Young, Black Men Use
Condoms?
An Application of the Information Motivation and
Behavioral Skills Model to Predict Consistent
Condom Use among Young, Black Men
JAMAL JONES, MPH, ASHWINI TIWARI, PHD, LAURA F. SALAZAR,
PHD,
RICHARD A. CROSBY, PHD
PRESENTATION FOR THE 144TH APHA ANNUAL MEETING

2. Presenter Disclosures
The following personal financial relationships with
commercial interests relevant to this presentation
existed during the past 12 months:
Jamal Jones
No relationships to disclose

3. Introduction: Why study condom use
among young, black men?
 Sexually transmitted infections (STIs) including HIV affect Black
youth disproportionately, particularly among young, black
men1,2
 Represent a major health disparity for this population
 STD/HIV health disparities among young, black men are
exacerbated in the Deep South3,4

4. An example: HIV/AIDS
YBM HIV Diagnoses2
 Rates of new infections
11 times higher than
young, white males and
4 times higher than
young, Hispanic males
Among youth living with
HIV, 44% do not know they
are infected2
The Deep South3
 Accounts for 44% of all
people living with HIV in
US
 Accounted for 52% of
new AIDS diagnosis in
2014
Estimates of New Infections Among Youth
Aged 13-24 Years, by Race/Ethnicity and Sex,
United States 2014
Source: CDC. Diagnosis of HIV infection in the United States and dependent areas, 2014. HIV Surveillance Report

5. Condom Use: What We Know
 Male latex condom is the single best method for reducing the risk of
STD/HIV acquisition among sexually active individuals
 Empirical evidence suggests an inconsistency in condom use among
YBM
 Failure to use condoms correctly among YBM
 Very important to understand the theoretical factors associated with
condom use among YBM to increase consistency

6. The Information
Motivation Behavioral
Skills Model (IMB)
 Proposes three constructs: information,
motivation and behavioral skills,
influence health behaviors
 Information and motivation have direct
associations with behavioral skills
 Behavioral skills has a direct
association with the behavioral outcome
 Behavioral skills may mediate the
relationship between information and
the behavioral outcome as well as the
relationship between motivation and the
behavioral outcome

7. The IMB model has been used for HIV
prevention and observational studies but
with mixed results
• Several studies report significant direct effects of motivation on
behavioral skills and significant direct effects of behavioral skills
on condom use outcomes5-7
 But no direct effects of information on behavioral skills5-7
• One study reported a negative direct effect of information on the
condom use outcome7
• Other research found that information and behavioral skills had a
positive, direct effect on condom use behavior8
• None of these studies included a sample of YBM, exclusively

8. Purpose
 To test the direct and indirect associations
of IMB model constructs on consistency of
condom use among a sample of young,
black men, via path modeling

9. Methods
 Data were collected as part of a HIV prevention trial
 Only baseline data used for the present study
 Recruitment occurred at STD clinics
 Primary site (in New Orleans, LA)
 Two secondary sites (in Baton Rouge, LA and Charlotte, NC)
 From 2010 through 2012
 Participants provided informed consent; for those under age 18,
parental consent was provided as well as participants’ assent
 Inclusion criteria were: 1) biologically male, 2) self-identification
as Black/African American, 3) age 15-23 years, 4) engaging in
penetrative sex at least once in the past two months, and 5) not
knowingly HIV-positive

10. Measures
 Condom use information: assessed using a condom application
knowledge index, modified from Stanton and colleagues’ condom
use skills checklist9
 Motivation to use condoms: conceptualized as attitudes toward
condom use based upon the attitudes toward condom use
scale10, and assessed using 9 items
 Behavioral skills associated with condom use assessed using:
 A modified version of the Bradford and Beck condom self-
efficacy scale11
 Condom errors checklist (condom use application skills)
based upon the measures from a previous study assessing the
Information-Motivation-Behavioral Skills Model on condom use
behavior (conducted by two of the authors)7

11. Outcome: Consistency of Condom
Use
 Participants responded to questions related to:
 The number of times they engaged in penetrative, vaginal sex
or anal sex within the two months prior to answering the
questionnaire
 The number of times they engaged in penetrative vaginal sex
or anal sex with a condom within the same two-month time
frame
 For participants who reported both vaginal and anal sex
 Added the reported number of times they used a condom for
both types of sexual activity

12. Outcome: Consistency of Condom
Use
 Calculated the proportion of:
 Reported frequency of penile-vaginal sex and frequency of penile-
anal sex with a condom for all sexual occurrences
 Reported frequency of penile-vaginal sex and frequency of penile-
anal sex without a condom for all sexual occurrences
 Treated consistency of condom use as an observed, continuous
variable
 Consistency of condom use ranged from 0-100%.

13. Data Analysis
 Utilized full-information maximum likelihood estimation for
parameter estimates
 Path analyses for modeling IMB constructs
 Used bootstrapped standard error estimates
 1,000 bootstrapped samples
 For hypothesis testing of direct and indirect associations
 Estimated model fit statistics
 Fit a nested model constraining paths to “0” for regression
coefficients near zero (<0.001)
 set α at 0.05

14. Path Modeling
 Regressed the two behavioral skills variables (condom use
application skills score and perceived self-efficacy score) on the
information and motivation variables
 Allowed the information and motivation variables to covary
 Regressed consistency of condom use on the two behavioral
skills variables
 Regressed consistency of condom use on the information and
motivation variables
 Standardized regression coefficients reported

15. Results: Descriptive Statistics
 Most participants were single (98%)
 42% reported living at home with at least
one parent
 Most participants obtained either a high
school degree (43%) or completed some
college or better (21%)
 23% reported anal sex within the
previous 2 months
 Approximately 40% reported using a
condom during each sexual occurrence
 Of those reporting vaginal sex, only 39%
used a condom every time they engaged
in sexual intercourse
 Of those reporting anal sex,
approximately 80% used condoms every
time they engaged in anal sex
Table 1. Descriptive statistics for demographics, sex
occurrences, condom use, and model constructs

16. Results: IMB Model
 Table 2. Correlation Matrix
*Significant at p<0.05

17. IMB Model Fit
• The IMB Model fit to the data for the full
model : χ2 (17.94df=1) =, p <0.00001;
RMSEA=.157, 90% CI (0.099, 0.224);
CFI=0.935; SRMR=.04; R2=0.22
• The IMB Model fit to the data for the
nested model (path between
information and consistency of condom
use constrained to 0): χ2 (17.94df=2,
p=0.0001); RMSEA=0.107, 90% CI (0.065,
0.155); CFI=0.939; SRMR=0.04; R2=0.22
**Significant at p<0.05
***Estimate is 0 due to rounding

18. IMB Model: Indirect Associations
**Significant at p<0.05

19. Limitations
 Use of self-reported data limits the validity of the data used in
analyses
 Motivation construct did not include a measure of intentions to
use condoms, which has been done in previous studies
 Data are correlational
 Longitudinal data are necessary to define behavioral skills as
a mediator on the relationship between information and
consistency in condom use

20. Conclusions and Recommendations for
Future Research
 Condom application skills and motivation had the largest associations
with consistency of condom use among young, black men
 Studies assessing condom use as a behavioral outcome among young,
black men may want to:
 Assess condom application skills as a predictor and/or mediator
 Assess or control for motivation to use condoms
 Future studies should examine whether changes in condom application
skills and/or condom use motivation lead to changes in consistency in
condom use over time
 Use exploratory factor analyses or confirmatory factor analyses to
develop a comprehensive measure for condom use information