Decision-making style and gender moderation of the self-efficacy-condom use link among adolescents and young adults: informing targeted STI/HIV prevention programs.

OBJECTIVE: To test the moderating effects of decision-making style and gender on the relationship between condom use self-efficacy (CUSE) and condom use behavior among sexually active adolescents and young adults.
DESIGN: Cross-sectional study.
SETTING: Twenty-four continuation high schools in California. PARTICIPANTS: Data were collected between February 2008 to June 2009 from a sample of 1304 sexually active adolescents and young adults. The mean (SD) age of the participants was 16.8 (0.9) years, 41% were female, and the ethnicity frequencies were Hispanic, 65%; mixed, 13%; white, 11%; black, 6%; and other, 5%. MAIN EXPOSURES: The tools used were CUSE, decision-making-self-confidence, and decision-making-approach. MAIN OUTCOME MEASURE: Condom use during the most recent sexual intercourse (termed last sex).
RESULTS: Forty-five percent of sexually active participants used condoms at last sex. Decision-making-self-confidence and decision-making-approach significantly moderated the effect of CUSE on condom use. The positive relationship between CUSE and condom use was relatively stronger for males and females reporting high vs low decision-making-self-confidence. Among females, the relationship between CUSE and condom use at last sex was weaker for those reporting high vs low decision-making-approach. Both of these effects were observed at high levels of CUSE.
CONCLUSION: Programs for sexually transmitted infection/human immunodeficiency virus prevention including CUSE content may increase adolescent and young adult condom use by targeting interventions to decision-making style and gender.