COGNITIVE AND BEHAVIORAL PREDICTORS OF SEXUALLY-TRANSMITTED DISEASE RISK BEHAVIOR AMONG SEXUALLY ACTIVE ADOLESCENTS

Objective: To identify important cognitive and behavioral predictors o f sexually transmitted disease (STD) risk behavior among a sexually ac tive adolescent cohort. Design: One-year longitudinal. study of health beliefs, sexual behaviors, and STD acquisition among 549 adolescents, 14 to 21 years of age. Setting: School- and community-based health cl inics in a large metropolitan area. Participants: Data from 410 sexual ly active adolescents completing surveys at baseline and 1-year follow -up. Interventions: None. Main Outcome Measurer Sexually transmitted d isease risk behavior-a composite measure of condom use consistency wit h most recent sexual partner(s), number of vaginal sex partners, and f requency of intercourse with most recent sexual partner(s). Results: F or girls (n=335), a model including baseline STD risk behavior, condom use self-efficacy, oral contraceptive use, communication with sexual partners about STD prevention, and alcohol use in connection with sexu al activity explained 21.1% of the variance in STD risk behavior at 1- year follow-up. For boys (n=75), the strongest predictors of STD risk behavior at follow-up included baseline STD risk behavior, perceived s usceptibility to STD, condom use self-efficacy, negative outcome expec tations associated with condom use, and perceived barriers to STD prev ention. Conclusions: Efforts targeting reduction in STD risk behavior must begin before the onset of somewhat stable patterns of sexual risk behavior. Among adolescents who are sexually active, interventions sh ould include components that increase condom use self-efficacy, build skills to communicate with sexual partners about STD prevention, and a ddress behaviors associated with STD risk behavior including oral cont raceptive use.