Eggers Sander M, Mathews Catherine, Aarø Leif E, McClinton-Appollis Tracy, Bos Arjan E R, de Vries Hein
School for Public Health and Primary Care (CAPHRI), Department of Health Promotion, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
Health System Research Unit, South African Medical Research Council, Cape Town, South Africa.
AIDS Behav. 2017 May;21(5):1417-1428. doi: 10.1007/s10461-016-1438-2.
Two of the most effective health behaviours with regard to HIV prevention are condom use and sexual abstinence. While determinants of condom use among sub-Saharan African adolescents have been studied extensively, factors related to abstinence have received far less attention. This study identified socio-cognitive determinants of primary and secondary abstinence intentions and of early sexual activity. This study also assessed whether these factors had a direct or indirect association with intentions to abstain from sex. A longitudinal design was used in which 1670 students (age 12-16) of non-private South African high schools filled in a questionnaire, with a follow-up after 6 months, concerning sexual abstinence, attitudes, social norms, self-efficacy, risk perception and knowledge. Logistic and linear regression analysis with latent factors was used to assess determinants of intentions and abstinence, and structural equation modelling was used to assess indirect effects. Results showed that among sexually inactive students, social norms predicted the intention to abstain from sex in the next 6 months. Among sexually active students, reporting less disadvantages of abstinence predicted the intention to abstain. Sexual activity at follow-up was predicted by attitudes and intention among sexually inactive girls, and by knowledge among sexually inactive boys. No predictors were found for sexually active adolescents. Structural equation modelling further showed that risk perception was indirectly related to intentions to abstain from sexual intercourse. We conclude that addressing socio-cognitive factors in order to motivate adolescents to delay sex is more likely to be successful before they experience sexual debut. In addition, this study shows that the effect of increasing risk perceptions, a strategy often applied by parents and HIV prevention programmes, is to a large extent mediated by more proximal cognitive factors such as attitude. Research is needed to identify factors that influence the execution of intentions to abstain from sex.
在预防艾滋病病毒方面，两种最有效的健康行为是使用避孕套和性禁欲。虽然撒哈拉以南非洲青少年使用避孕套的决定因素已得到广泛研究，但与禁欲相关的因素却很少受到关注。本研究确定了初次和二次禁欲意图以及早期性活动的社会认知决定因素。本研究还评估了这些因素与禁欲意图是直接还是间接相关。采用纵向设计，1670名南非非私立高中学生（年龄在12 - 16岁）填写了一份问卷，并在6个月后进行随访，内容涉及性禁欲、态度、社会规范、自我效能感、风险认知和知识。使用带有潜在因素的逻辑回归和线性回归分析来评估意图和禁欲的决定因素，并使用结构方程模型来评估间接影响。结果表明，在性活动不活跃的学生中，社会规范预测了未来6个月内禁欲的意图。在性活动活跃的学生中，报告较少禁欲弊端的学生预测有禁欲意图。随访时的性活动在性活动不活跃的女孩中由态度和意图预测，在性活动不活跃的男孩中由知识预测。对于性活动活跃的青少年未发现预测因素。结构方程模型进一步表明，风险认知与禁欲意图间接相关。我们得出结论，在青少年经历首次性行为之前，解决社会认知因素以促使他们推迟性行为更有可能成功。此外，本研究表明，增加风险认知这一家长和艾滋病预防项目常用的策略，其效果在很大程度上由态度等更直接的认知因素介导。需要开展研究以确定影响禁欲意图执行的因素。
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