Unsafe Sex: Do Feelings Matter?

Researchers from the Bradley Hasbro Children’s Research Center and the Warren Alpert Medical School of Brown University studied 222 adolescents between the ages of 13 and 18 with psychiatric disorders and found that feelings do matter when it comes to making decisions about safe sex. Specifically, the findings suggest that lack of self-efficacy (the belief that one could effectively engage in a particular behavior) when confronted with the stress of using condoms is a powerful barrier to their use.

“We found that adolescents need help feeling more comfortable and less distressed about discussing and using condoms,” says lead author Celia Lescano, PhD, with the Bradley Hasbro Children’s Research Center and the Warren Alpert Medical School of Brown University.

Self-efficacy is akin to self-confidence and can be defined as a person’s beliefs about his or her own capabilities to produce effects or change in his or her life. In the context of this study, the authors found that teens with higher self-efficacy about condom use (i.e. they felt that they could effectively use condoms) were more likely to use them consistently even when feeling upset, bad about themselves, depressed or angry.

This study has wider implications for all teens engaging in sexual behavior because difficulty with distress during condom use is not confined to those who are clinically depressed, the authors say.

“As it turns out, managing the stresses associated with condom use is important. Adolescents can learn to decrease their anxiety about discussing and using condoms in order to use them safely and effectively,” explains Lescano.

Prior studies show that adolescents suffering from psychological distress may become overwhelmed in sexual situations because of relationship concerns (the fear of rejection), previous traumatic sexual experiences, or low self-esteem (little motivation to keep oneself healthy).

“Going forward, helping teens decrease distress and increase their effective skills is a critical component to HIV prevention strategies,” says Lescano.

While most HIV prevention interventions focus on acquiring practical behavioral skills like how to use a condom, the authors conclude that more needs to be done to protect oneself from HIV and other sexually transmitted diseases.

The role of emotions in the engagement of health promoting behaviors, specifically condom use in this case should not be overlooked, the authors conclude.

“Using active strategies to deal with how well one manages the distress that arises in the face of a difficult situation such as asking one’s partner to use a condom should be a priority for HIV intervention programs,” Lescano says; “those who work with adolescents should be aware of the need to focus on the emotional aspects of engaging in health-promoting behaviors.”

The findings appear in the Journal of Prevention and Intervention in the Community, Vol. 33. No.1/2 2007.