Interventions for safer sex behaviors among college students.
Abstract: Safer sex behaviors (monogamy, sexual abstinence, correct and consistent condom usage) are important for prevention of sexually transmitted diseases and HIV/AIDS among college students. The purpose of this article was to review studies addressing interventions for safer sex behaviors among college students. A search of seven databases (CINAHL, MEDLINE, ERIC, Academic Search Premier, Scopus, Web of Science, and Social Sciences Citation Index) was conducted for the time period between 1990 and February 2010. A total 11 intervention studies related to safer sex behaviors were extracted. Information-motivation-behavioral skills model was commonly used for interventions promoting safer sex.
Subject: College students (Sexual behavior)
College students (Health aspects)
Disease transmission (Health aspects)
AIDS (Disease) (Health aspects)
Sex (Health aspects)
Safe sex (Health aspects)
Condoms (Health aspects)
HIV (Viruses) (Health aspects)
Authors: Kanekar, Amar
Sharma, Manoj
Pub Date: 06/22/2010
Publication: Name: American Journal of Health Studies Publisher: American Journal of Health Studies Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 American Journal of Health Studies ISSN: 1090-0500
Issue: Date: Summer, 2010 Source Volume: 25 Source Issue: 3
Topic: Canadian Subject Form: Sexual behaviour
Product: Product Code: E197500 Students, College; 3069770 Prophylactics & Diaphragms NAICS Code: 326299 All Other Rubber Product Manufacturing SIC Code: 3069 Fabricated rubber products, not elsewhere classified
Accession Number: 308741511
Full Text: INTRODUCTION

Safer sex is important for protection against STDs (sexually transmitted diseases) and HIV/AIDS (Human Immunodeficiency virus/acquired immunodeficiency syndrome). Consistent and correct condom usage along with a monogamous relationship are two important aspects for STD and HIV/ AIDS prevention. The HIV/AIDS epidemic has grown to alarming proportions. At the start of 2010, there were an estimated 59 million HIV/AIDS cases in 194 reporting countries and territories. Of the 35 million living with HIV infection worldwide, about 3% live in the United States (Stine, 2010). Young adults continue to be a vulnerable population affected by HIV/AIDS. In 2009, about 22,000 adolescents aged 13-24 became infected with the HIV virus (Stine, 2010).

Determinants for engaging in HIV/AIDS related risky sexual behavior in college students are multiple such as low-self esteem and emotional distress (Ethier et al., 2006), gender along with improper social norms and inadequate condom use skills (Dilorio, Dudley & Soet, 2007), and various personality and demographic factors(Mehrotra, Noar, Zimmerman & Palmgreen, 2009). Some of the risk behavior pattern among adolescents' whites and blacks could be differentiated based on factors such as binge drinking, substance use, injection drug use and tobacco use (Hallfors, Iritani, Miller, & Bauer, 2007).

Behavioral interventions in the form of HIV/ AIDS prevention messages significantly improved the likeliness of condom usage among some Indonesian participants but didn't succeed in actual behavioral change (Turk, Ewing, & Newton, 2006). Harm-reduction approaches in HIV/AIDS counseling among adolescents address the barriers they have for engaging in safer sex, focus on perceptions that might affect risky behaviors, focus on safe sex planning and end in referral making (Pinto, 2000). It is in this backdrop that the purpose of this review article is to present studies addressing interventions for safer sex behaviors among college students.

METHODS

In order to collect materials for this review a detailed search of CINAHL, MEDLINE, ERIC, Academic Search Premier, Scopus, Web of Science, Social Sciences Citation Index databases was carried out for the time period between 1990 and February 2010. A Boolean search strategy, where the key words entered for search were "HIV/AIDS prevention" and "interventions" and "college students" and "safer sex" and "interventions" and "college students" in differing orders was used to extract studies related to interventions for safer sex among college students.

The criteria for inclusion of studies were (1) publication in English language, (2) publication between 1990 and February 2010, (3) location of studies anywhere in the world, and (4) relating to interventions involving college students. Exclusion criteria were publications in languages other than English and studies published prior to 1990. A total of 11 studies met these criteria for interventions related to safer sex behaviors.

RESULTS

The studies that conducted interventions related to promotion of safer sex among college students are presented in Table I chronologically. The first interventional study (Turner, Korpita, Mohn, & Hill, 1993) was a randomized control trial which used a comprehensive health education intervention to alter risky behaviors towards safer sex behaviors which included increased condom usage and sexual abstinence. Te second study (Bryan, Aiken, & West, 1996) used a randomized experimental design to maintained greater sustainability of condom usage behaviors while the third interventional study (Ploem, & Byers, 1997) used information and communication skills training to enhance condom use sustainability. Information-motivation-behavioral skills model was used in the fourth study (Fisher, Fisher, Misovich, Kimble, & Malloy, 1998) for discussing AIDS preventative behaviors and in the fifth study (Singh, 2003) for enhancing self-efficacy towards condom usage. The sixth study (Chernoff, & Davison, 2005) used normative feedback with an unintended effect of decrease in number of sexual partners in women receiving the intervention. The seventh study (Kiene, & Barta, 2006) used computer-tailor based IMB (information-motivation-behavior skills) model to increase safer sex preparatory behaviors. The eight study (Sanderson, & Yopyk, 2007) used condom promotion videotape for enhancing self-efficacy towards condom usage and the ninth study (Labrie, Pederson, Thompson, & Earleywine, 2008) used decisional balance motivational enhancement intervention to increase condom use scores. The tenth study (Schmiege, Levin, Broaddus & Bryan, 2009) used group interventions to reduce HIV/STD risk. This randomized controlled study concluded that group--based psychosocial intervention with an added component of motivational enhancement therapy is better in reducing risky sexual behaviors. The last study (Kanekar, Sharma, Cottrell, Succop, & Bernard, 2010) addressed a vulnerable population of African-American college students. It concluded that there was no difference between a brief theory-based safer sex intervention and a comparison knowledge-based intervention in promoting safer sex behavior.

As shown in Table 2, effects sizes were calculated for all the 11 studies using G-Power analysis software 3.1.2(Erdfelder, Foul, & Buchner, 1996). Sample size, alpha values and power (0.80) were used to conduct the desired calculations.

DISCUSSION

The purpose of this article was to review studies addressing interventions for safer sex behaviors among college students and also to identify studies addressing interventions conducted among a target population of college students to promote safer sex behaviors (such as sexual abstinence, practicing monogamy and consistent and correct condom usage) between 1990 and February 2010.

Based on this review of intervention literature for safer sex among college students a total of 11 studies could be identified in last 20 years which used some kind of interventional strategy to change attitudes and behaviors of college students towards safer sex. The dearth of intervention literature in population of college students is surprising as we would expect a large number of interventions in these students. All the 11 studies used an experimental design in their interventional approach. A little less than 50 %(5 out of the 11) studies (Fisher, Fisher, Misovich, Kimble, & Malloy, 1998; Kiene, & Barta, 2006; Labrie, Pederson, Thompson, & Earleywine, 2008; Schmiege, Levin, Broaddus, & Bryan, 2009; Singh, 2003) identified, used the information-motivation-behavioral skills enhancement model and motivational component as a part of safer sex promotion tool. The remaining 6 studies used multicomponent (Bryan., Aiken, & West, 1996), normative feedback (Chernoff, & Davison, 2005), information about safer sex (Ploem, & Byers, 1997), condom promotion videotape (Sanderson, & Yopyk, 2007), and a comprehensive health education (Turner, Korpita, Mohn, & Hill, 1993), and theory-based components (Kanekar, Sharma, Cottrell, Succop, & Bernard, 2010).

It seems that the IMB (information-motivation-behavioral skills model has been the most popular model tried among college students to promote safer sex behaviors. This model has been well validated over 15 years of research with diverse populations and cross--cultural settings (Fisher, & Fisher, 2000). It has also shown promise in adults where it builds skills for risk reduction along with lower rates of unprotected intercourse and fewer sexually transmitted infections. Literature on using this model also supports a full model usage against a single component such as information only. (Cornman, Schmiege, Bryan, Benziger, & Fisher, 2007; Kalichman et al., 2005).

Also what was evident from this review was that despite use of theory based predictors for safer sex such as social cognitive variables (O'Leary, Goodhart, Jemmott, & Boccher-Lattimore, 1992 ; Raj, 1996) and health belief model constructs (Boone, & Lefkowitz, 2004), no theory-backed intervention for safer sex among college students could be extracted. Using a theoretical framework is essential when devising interventions as this provides a common language of views and ideas across researchers in safer sex and HIV prevention research. It is extremely important to examine interventions which emphasize key constructs of a theory (Glanz, Rimer, & Vishwanath, 2008). In promoting safer sex a meta-analyses of interventions conducted to increase condom use found that many key constructs of commonly used theories were changed by interventions. (Albarracin et al., 2005). These can be then further explored or rejected (Beaty, Wheeler, & Gaiter, 2004).

CONCLUSION

This review clearly establishes need for more interventions to promote safer sex behaviors among college students. Knowledge-behavior gap seems to be an important component to be addressed when researchers plan to devise a safer sex intervention. Theory-backed interventions should be seen more for promoting safer sex in the form of increasing condom usage, promoting sexual abstinence or sexual partner reductions (monogamous relationships).

RECOMMENDATIONS FOR FUTURE INTERVENTIONS

There is a large need of conducting interventions which change the attitudes and behaviors of college students towards safer sex. These interventions should promote protective factors at the same time work towards minimizing risky factors for safe sex behaviors. Future interventions should be based on behavioral change theories which must measure the constructs before and after the intervention to give credence to a theoretical approach as opposed to an atheoretical approach. Intervention researchers use multiple theoretical approaches and it is important that they develop psychometrically robust instruments to measure changes in the theoretical constructs.

In models and theories of health behavior change, a linear relationship is often implied when one assumes that change in constructs of knowledge, attitude, and behavior would lead to a corresponding changed behavior outcome. Complex systems and chaos theory complement the linear effect of behavior change in terms of alternative approaches of addressing any health behavior problem such as quitting tobacco, engaging in physical activity or risk-reduction and substance abuse behaviors (Resnicow, & Page, 2008). Future studies should address this paradigm in a quantitative or a qualitative way to promote healthy behavior change especially in the context of safer sex promotion to prevent sexually transmitted infections including HIV/AIDS among college students.

REFERENCES

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Ethier, K., Kershaw, T., Lewis, J., Milan, S., Niccolai, L., & Ickovics, J. (2006).Self-esteem, emotional distress and sexual behavior among adolescent females: Inter-relationships and temporal effects. Journal of Adolescent Health, 38(3), 268.

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Kalichman, S. C., Cain, D., Weinhardt, L., Benotsch, E., Presser, K., Zweben, A. et al. (2005). Experimental components analysis of brief theory-based HIV/AIDS risk-reduction counseling for sexually transmitted infection patients. Health Psychology, 24(2), 198-208.

Kanekar, A. S., Sharma, M., Cottrell, R., Succop, P., & Bernard, A. (2010). Theory-based safer sex intervention among African-American College Students. American Journal of Health Studies, 25(1), 52-59.

Kiene, S. M., & Barta, W. D. (2006).A Brief individualized computer delivered sexual risk reduction intervention increases HIV/AIDS preventive behavior. Journal of Adolescent Health, 39, 404-410.

Labrie, J. W., Pederson, E. R., Thompson, A. D., & Earleywine, M. (2008). A brief decisional balance intervention increases motivation and behavior regarding condom use in high-risk heterosexual college men. Archives of Sexual Behavior, 37, 330-339.

Mehrotra, P., Noar, S. M., Zimmerman, R. S., & Palmgreen, P. (2009) Demographic and personality factors as predictors of HIV/STD partner-specific risk perceptions: Implications for interventions. AIDS Education and Prevention, 21(1), 39.

O'Leary, A., Goodhart, F., Jemmott, L. S., & Boccher-Lattimore, D. (1992). Predictors of safer sex on the college campus: A social cognitive theory analysis. Journal of American College Health, 40(6), 254-263.

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Ploem, C., & Byers, E. S. (1997).The effects of two AIDS risk-reduction interventions on heterosexual college women's AIDS related knowledge, attitudes and condom usage. Journal of Psychology and Human Sexuality, 9(1), 1-24.

Raj, A. (1996). Identification of social cognitive variables as predictors of safer sex behavior and intent in heterosexual college students. Journal of Sex & Marital Therapy, 22(4), 247-258.

Resnicow, K., & Page, S. E. (2008). Embracing chaos and complexity: A quantum change for public health. American Journal of Public Health, 98(8), 1382-1388.

Sanderson, C. A., & Yopyk, D. J. A. (2007). Improving condom use intentions and behavior by changing perceived partner norms: An evaluation of condom promotion videos for college students. Health Psychology, 26(4), 481-487.

Schmiege, S. J., Levin, M., Broaddus, M. R., Bryan, A. D. (2009). Randomized Trial of Group Interventions to reduce HIV/STD Risk and Change Theoretical Mediators among Detained Adolescents. Journal of Consulting and Clinical Psychology, 77(1), 38-50.

Singh, S. (2003). Study of the effect of information, motivation and behavioral skills (IMB) intervention in changing the AIDS risk behavior in female university students. AIDS CARE, 15(1), 71-76.

Stine, G. J. (2010). Aids Update 2010: An annual overview of Acquired Immune Deficiency Syndrome. McGrawHill, New York.

Turk, T., Ewing, M., & Newton, F. J. (2006). Using ambient media to promote HIV/AIDS protective behavior change. International Journal of Advertising, 25(3), 333-359.

Turner, J. C., Korpita, E., Mohn, L. A., & Hill, W. B. (1993). Reduction in sexual risk behaviors among college students following a comprehensive health education intervention. Journal of American College Health, 41(5), 187-194.

Amar Kanekar, MBBS, MPH, CHES, CPH, PhD

Manoj Sharma, MBBS, PhD

Amar Kanekar, MBBS, MPH, CHES, CPH, PhD, is an Assistant Professor of the Department of Health Studies, East Stroudsburg University of Pennsylvania, 200 Prospect Street, East Stroudsburg, PA, 18301-2999. Phone: (570)-422-3748. Fax: (570)-422-3848. E-mail: akanekar@po-box.esu.edu. Manoj Sharma, MBBS, PhD, is a Professor of the Health Promotion & Education, University of Cincinnati, PO Box 210068, Cincinnati, OH 45221-0068. Phone: (513) 556-3878. Fax: (513) 556-3898. E-mail: manoj.sharma@uc.edu
Table I. Interventions for promoting safer sex behaviors in college
students

Study                   Purpose                 Intervention/Design

Turner study (Turner    The purpose of this     This was a non-
et al., 1993).          study was to assess     randomized controlled
                        sexual behaviors of     trial where
                        college students        participants either
                        following a             received a
                        comprehensive health    comprehensive health
                        education               education
                        intervention            intervention
                                                (didactic lectures,
                                                small group
                                                discussions,
                                                prevention strategies
                                                for safer sex) or no
                                                seminar intervention.

Bryan study (Bryan et   The purpose of this     Randomized
al., 1996)              study was to            experimental design.
                        hypothesise that        Participants either
                        condom promotion        received one 45-min
                        intervention will       multicomponent safer
                        produce changes in      sex intervention or
                        correlates of condom    one 45-min stress
                        use as per the          management
                        psychosocial model      intervention
                                                unrelated to STDs

Ploem study (Ploem, &   The purpose of this     Participants were
Byers, 1997)            study was to assess     randomly assigned to
                        the effect of two       information group,
                        AIDS risk reduction     combination group and
                        interventions on        pretest-posttest
                        college womens AIDS     control groups
                        related knowledge,
                        attitudes towards
                        condom and actual
                        condom use at one
                        month follow-up
                        period

Fisher study (Fisher    The purpose of this     Pre and post
et al., 1998)           study is to design,     experimental design
                        implement and           was used and the
                        evaluate an AIDS risk   intervention
                        reduction               consisted of three
                        intervention among      2-hr sessions using
                        college students        the information-
                                                motivation and
                                                behavioral skills
                                                model. (IMB model

Singh study (Singh,     The purpose of this     3 sessions
2003)                   study was to examine    (information,
                        the effect of an        motivation and
                        intervention based on   behavioral skills) of
                        information/            intervention program
                        motivation /            were given to
                        behavioral skills to    participants in the
                        facilitate AIDS risk    experimental group
                        reduction behavior      and the control group
                        among college/          without intervention
                        university students

Chernoff                The purpose of this     Participants were
study (Chernoff, and    study was to develop    assigned to the
Davison, 2005)          and evaluate a brief    intervention group
                        intervention using      (normative feedback
                        normative feedback in   and goal setting
                        order to increase       instrument) and
                        risk-reduction among    control group
                        college students        (information related
                                                to AIDS prevention

Kiene study (Kiene,     The purpose of this     The experimental
& Barta, 2006)          study was to develop    group had an HIV
                        and evaluate a          prevention
                        computer--delivered     intervention which
                        theory-based tailored   was based on the
                        HIV/AIDS risk           information,
                        reduction               motivation and
                        intervention            behavioral skills
                                                model while the
                                                control group a
                                                nutrition education
                                                tutorial

Sanderson study         The purpose of this     Participants were
(Sanderson, &           study was to examine    randomly assigned to
Yopyk, 2007)            the effectiveness of    receive one of two
                        two condom promotion    30-min condom
                        videotapes on           promotion videotape
                        self-efficacy,          or to a wait-list
                        intentions and          control condition.
                        behavior                This study had an
                                                immediate and 4 month
                                                follow-up

Labrie study (Labrie    The purpose of this     Within--subjects
et al., 2008)           study was to            design was used and
                        determine if            participants were
                        decisional balance      randomly assigned to
                        with motivational       safer-sex
                        interviewing promotes   intervention group or
                        safer sex practices     alcohol-target
                        during one meeting.     intervention group.
                                                Decisional balance
                                                motivational
                                                enhancement
                                                intervention

Schmiege study          The purpose of this     A randomized
(Schmiege, Leven,       study was to evaluate   controlled design was
Broaddus, & Bryan,      three                   used. A total of 484
2009)                   interventions           ethnically diverse
                        (group-based theory     adolescents were
                        driven psychosocial     randomized to three
                        intervention (GPI),     different groups.
                        GPI + Group based       Data was collected at
                        motivational            pretest, post-test
                        enhancement therapy,    and at 3-month
                        and a control )based    follow-up.
                        as a harm reduction
                        strategy in
                        preventing risky
                        sexual behaviors

Kanekar study           The purpose of this     A randomized
(Kanekar, Sharma,       study was to            controlled design was
Cottrell, Succop,       determine to what       used where one group
Bernard, 2010)          extent constructs of    (n=73) of college
                        Social Cognitive        students were offered
                        Theory (i.e.            a theory/based
                        situational             intervention and the
                        perceptions for safer   other group (n=68)
                        sex, expectations for   were given a
                        safer sex,              knowledge/based
                        self-efficacy for       intervention focusing
                        safer sex, self-        on HIV/AIDS and
                        efficacy in             sexually transmitted
                        overcoming barriers     diseases.
                        for safer sex and
                        self-control for
                        safer sex) were
                        changed after an
                        SCT-based intervention
                        compared to a
                        non-theory
                        (knowledge-based)
                        intervention.

Study                   Salient results         Conclusion

Turner study (Turner    Experimental group      A comprehensive
et al., 1993).          men reported a          health education
                        statistically           intervention among
                        significant increase    college students can
                        in sexual abstinence    successfully alter
                        (p<0.05). Number of     sexual risk behaviors
                        experimental group      towards safer sex
                        women who reported      behaviors such as
                        always using condoms    increased condom
                        increased compared to   usage and sexual
                        control group women     abstinence.
                        who showed a
                        decrease. The
                        difference at 3
                        months was
                        significant (p=0.05).

Bryan study (Bryan et   (Analysis of            The intervention
al., 1996)              covariance) showed      increased
                        significant effects     intervention to use
                        in predicted            condoms at posttest
                        directions for all      as well as 6 weeks
                        constructs except       and 6 months later. A
                        susceptibility and      one-time intervention
                        severity (p<0.001).     with no booster
                        At 6-weeks-more         sessions induced
                        participants in         behavioral change
                        experimental group      that was maintained
                        carried condoms         even 6 months after
                        (p<0.01), told          intervention
                        partners to use
                        condoms (p<0.05).

Ploem study (Ploem, &   MANCOVA (Multiple       An intervention
Byers, 1997)            analysis of             supplementin AIDS
                        covariance) were        information with
                        conducted followed by   condom eroticization,
                        univariate analysis     condom normalization
                        of covariance.          and communication
                        Combination group had   skills training
                        significantly more      showed a sustained
                        positive attitudes      effect at improving
                        towards condom use      attitudes and
                        than information        sustained use of
                        group. A significant    condoms
                        interaction between
                        intervention and
                        change in condom use
Fisher study (Fisher    was found (p<0.002).    Findings from the use
et al., 1998)           The IMB model           of this IMB model
                        significantly           were consistent with
                        affected scores on      model's emphasis on
                        both indicators of      identifying
                        the information         empirically
                        construct, the          identified deficits
                        motivation construct    in AIDS risk
                        and the behavioral      reduction
                        construct at            information,
                        individual and group    motivation and
                        level (p<0.0001).       behavioral skills in
                        Condom used increased   efforts to change
                        significantly along     behavior.
                        with discussion about
                        AIDS preventative
                        behaviors

Singh study (Singh,     Analysis of             The findings in the
2003)                   covariance was used     present research
                        for analysis which      shows that
                        showed the following    information,
                        results: Personal and   motivation and
                        social motivation to    behavioral skills
                        engage in AIDS risk     essentially
                        reduction behavior      contribute to AIDS
                        increased               risk reduction
                        considerably (p<0.05)   behavior
                        and there was a
                        reduced perceived
                        difficulty to engage
                        in AIDS risk
                        reduction (p<0.01)
                        and also engagement
                        in AIDS risk
                        reduction behavior
                        increased
                        significantly
                        (p<0.01).

Chernoff                MANCOVA (multiple       Men in the
study (Chernoff, and    analysis of             intervention group
Davison, 2005)          covariances) were       reported a
                        significant for         significant increase
                        condom usage for        in condom usage with
                        vaginal intercourse     vaginal intercourse
                        (p<0.001), number of    whereas unexpectedly
                        sexual partners         women showed a
                        (p<0.001), and          significant reduction
                        discussion of safer     in the number of
                        sex (p<0.001). .        partners. The second
                                                effect was not
                                                expected given the
                                                brevity of the
                                                intervention

Kiene study (Kiene,     Analysis of             This IMB
& Barta, 2006)          covariance was used     (Information-
                        which yielded the       motivation-
                        following important     behavioral skills
                        findings: Treatment     model based computer
                        group showed an         tailored intervention
                        increase in frequency   showed increased
                        of condom use           condom use knowledge
                        information compared    and preparatory
                        to the controls         sexual behaviors
                        (P<0.01). There was
                        also an increase seen
                        in the frequency
                        of condom usage

Sanderson study         Analysis of
(Sanderson, &           covariance was          Condom promotion
Yopyk, 2007)            conducted. Self-        videos may be a
                        efficacy for            useful way of
                        suggesting condom use   increasing self-
                        to a partner showed     efficacy for condom
                        significance            use and intention to
                        (p<0.03). Refusal to    use condom and
                        have sex without a      reported condom use
                        condom showed           behavior among
                        significant effect of   college students.
                        condition (p=0.03)
                        and also intention to
                        use condoms showed
                        significant effect of
                        condition (p=0.03).

Labrie study (Labrie    Participants            The decisional
et al., 2008)           significantly           balance intervention
                        increased their         helps in increasing
                        condom use scores       motivation to change
                        from baseline at        risky sexual behavior
                        post-intervention       among college
                        (p<0.001) and at        students.
                        30-day follow up
                        (p<0.001). Forty
                        percent who used
                        condoms less than
                        ninety percent of
                        times showed 100%
                        usage.

Schmiege study          A significant main      Group based theory
(Schmiege, Leven,       effect was seen on      driven psychosocial
Broaddus, & Bryan,      each of the             intervention (GPI)
2009)                   theoretical mediators   and GPI +
                        in the arm getting      motivational
                        the GPI +               enhancement therapy
                        motivational            are superior harm
                        enhancement therapy     reduction strategies
                        components in           for prevention of
                        reduction in risky      risky sexual
                        sexual behavior         behaviors among
                        (p<0.05 & P<0.001).     ethnically diverse
                        Intentions              populations.
                        significantly
                        predicted later risky
                        sexual behaviors.
                        Model fit the data
                        adequately and
                        explained 21% of the
                        variance.

Kanekar study           The main effect of      The dose of the
(Kanekar, Sharma,       time was significant    theory-based
Cottrell, Succop,       (p<0.04) for the        intervention was
Bernard, 2010)          construct of            found to be
                        self-efficacy in        insufficient to
                        overcoming barriers.    promote safer sex
                        Having been ever        behaviors in a sample
                        diagnosed with a        of African-American
                        sexually transmitted    college students.
                        disease (p<0.02) and    Future interventions
                        year in school          need to increase the
                        (p<0.01) were           dose.
                        significant
                        demographic
                        covariates for
                        construct of
                        self-efficacy in
                        overcoming barriers
                        and having been ever
                        diagnosed with
                        sexually transmitted
                        disease (p<0.03) and
                        ever having taken a
                        sexuality class
                        (p<0.01) were
                        significant
                        covariates for
                        self-control for
                        safer sex.

Table 2. Effect size calculation of all the reported
studies between 1990-February 2010 using G-Power
3.1.2

Name of the study      Sample size   Calculated
                                     Effect Size

1) Turner study          N = 571      d = 0.06
(Turner et
al, 1993)

2) Bryan study           N = 198      d = 0.28
(Bryan et
al., 1996)

3) Ploem study           N = 112      d = 0.41
(Ploem, &
Byers, 1997)

4) Fisher study          N = 744      d = 0.06
 (Fisher et
al., 1998)

5) Singh study           N = 200      d = 0.22
(Singh,
2003)

6) Chernoff study        N = 155      d = 0.36
(Chernoff, and
Davison, 2005)

7) Kiene study           N = 157      d = 0.31
(Kiene, &
Barta, 2006)

8) Sanderson study       N = 220      d = 0.36
(Sanderson,
& Yopyk, 2007)

9) Labrie study          N = 315      d = 0.11
(Labrie et
al., 2008)

10) Schmiege study       N = 484      d = 0.33
(Schmiege, Leven,
Broaddus, & Bryan,
2009)

11) Kanekar              N = 141         --
study (Kanekar,
Sharma, Cottrell,
Succop, Bernard,
2010)

Name of the study         Type of      Significance
                         behavior

1) Turner study        Abstinence      p < 0.05
(Turner et             behavior
al, 1993)

2) Bryan study         Telling         p < 0.05
(Bryan et              partners
al., 1996)              to use
                       condoms
3) Ploem study         Condom use      p < 0.05
(Ploem, &              behavior
Byers, 1997)

4) Fisher study        Condom use      p < 0.01
(Fisher et             behavior
al., 1998)

5) Singh study         Behavioral      p < 0.05
  (Singh,              intention
  2003)                to engage
                       in AIDS
                       risk
                       reduction

6) Chernoff study      Condom use      p < 0.01
(Chernoff, and         at vaginal
Davison, 2005)         intercourse

7) Kiene study         Condom use      p < 0.05
(Kiene, &
Barta, 2006)

8) Sanderson study     Condom use      p < 0.01
(Sanderson,            self-efficacy
& Yopyk, 2007)

9) Labrie study        Condom use      p < 0.01
(Labrie et             intent
al., 2008)

10) Schmiege study     Risky           p < 0.05
(Schmiege, Leven,      sexual
Broaddus, & Bryan,     behavior
2009)

11) Kanekar            Safer sex       No
study (Kanekar,        behavior        significance
Sharma, Cottrell,
Succop, Bernard,
2010)
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