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Employing audio-assisted technology with a sample of 207 low-income urban minority adolescents receiving outpatient psychiatric care, Donenberg, Emerson, Bryant, and King (2006)
examined the effects of substance use on the relation between risky sex and peer, parent, and dispositional characteristics among teens in psychiatric care. As expected, negative peer influence and parental permissiveness were related to greater risky sex, but mainly among adolescents who reported substance use in the past 3 months. Substance use may operate as a risk factor for HIV by potentiating the influence of negative peer influence and permissive parenting on adolescent risky sex. Contrary to research on school-based populations, adolescent attitudes toward health, achievement, and school were not related to any of the outcome variables. These data suggest that negative peer influence and parental permissiveness may be more important influences on sexual risk than adolescent disposition, particularly for teens who endorse recent substance use. (pp. 197-198)
Donenberg and colleagues suggest that these "[f]indings highlight important targets for HIV prevention. Mental health practitioners have unique access to troubled teens and their families and can influence risk reduction efforts through education about exposure risks, teaching parents effective monitoring skills, and providing substance use treatment. By broadening the scope of mental health services to incorporate successful strategies for HIV prevention ..., clinicians can address adolescent sexual health and risk behaviour thereby changing the course of the epidemic" (p. 199).
Dutch investigators (van Empelen & Kok, 2006) examined condom use with casual and steady partners among 140 sexually active 14-16 year old Dutch secondary school students.
It was hypothesised that among adolescents[,] sex and subsequent … condom use with casual sex partners … [are] less likely to be considered in advance, more context-dependent and less habitual; whereas the opposite is true for steady relationships. Therefore, preparatory behaviours (buying and carrying condoms and communicating about condom use) were expected to mediate the intention-behaviour relation in the context of steady relationships, but not in the context of casual sex. Results confirmed that condom use with steady sex partners was explained by preparatory behaviours, habits, and to some extent, behavioural willingness, and that preparatory behaviours mediated the intention-behaviour relationship. Condom use with casual sex partners was predicted by risk willingness and intentions, without any mediation by preparatory behaviours. (p. 165)
Drawing on these findings, van Empelen and Kok submit that
[i]t is essential to increase awareness among young people of the likelihood that unexpected situations may occur, and to train and support them in taking preparatory actions. It is clear that when young people do not anticipate the possibility of a sexual encounter, their reactions may depend entirely on the opportunities existing in a given situation. As such, it is likely that young people who are willing to take the risk of unprotected sexual intercourse will do so. Anticipated regret may be a valuable means of highlighting the potential adverse effects of having engaged in a risky sexual situation, while simultaneously providing information on the outcome of a desired response – having condoms readily available and using them. (p. 178)
The investigators further suggest that
specific implementation plans ... could be used as a means of reinforcing the initiation and frequency of engaging in preparatory behaviours among young people. Implementation intentions (that is, specifying when, where and how the behaviour is performed) may increase the frequency of preparatory behaviours, because the contextual cues will elicit performance of the intended behaviour. … [T]his method requires that people possess a positive intention to perform a … behaviour. Thus, interventions should ensure that young people are motivated not only to use condoms, but also to buy condoms, carry them and communicate about condom use. (p. 178)
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Summer 2006 Newsletter / Volume 7, Issue 4 
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