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The effect of an Internet-based intervention designed
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adolescents
a
b
Lubia del Carmen Castillo-Arcos , Raquel Alicia Benavides-Torres , Fuensanta Lópezc
b
b
a
Rosales , Dora Julia Onofre-Rodríguez , Carolina Valdez-Montero & Lucely Maas-Góngora
a
School of Health Sciences, Universidad Autónoma del Carmen, Av. Concordia Núm. 4 Col.
Benito Juárez, Ciudad del Carmen, Campeche C.P. 24180, Mexico
b
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School of Nursing, Centro de Investigación y Desarrollo en Ciencias de la Salud,
Universidad Autónoma de Nuevo León, UANL, Universidad Autónoma de Nuevo León, UANL,
Av. Universidad S/N, Ciudad Universitaria, San Nicolás de los Garza, Nuevo León C.P. 66451,
Mexico
c
School of Psychology, Centro de Investigación y Desarrollo en Ciencias de la Salud,
Universidad Autónoma de Nuevo León, UANL, Universidad Autónoma de Nuevo León, UANL.,
Av. Universidad S/N, Ciudad Universitaria, San Nicolás de los Garza, Nuevo León C.P. 66451,
Mexico
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To cite this article: Lubia del Carmen Castillo-Arcos, Raquel Alicia Benavides-Torres, Fuensanta López-Rosales, Dora Julia
Onofre-Rodríguez, Carolina Valdez-Montero & Lucely Maas-Góngora (2015): The effect of an Internet-based intervention
designed to reduce HIV/AIDS sexual risk among Mexican adolescents, AIDS Care: Psychological and Socio-medical Aspects of
AIDS/HIV, DOI: 10.1080/09540121.2015.1073663
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AIDS CARE, 2015
http://dx.doi.org/10.1080/09540121.2015.1073663
The effect of an Internet-based intervention designed to reduce HIV/AIDS sexual
risk among Mexican adolescents
Lubia del Carmen Castillo-Arcosa , Raquel Alicia Benavides-Torresb , Fuensanta López-Rosalesc,
Dora Julia Onofre-Rodríguezb, Carolina Valdez-Monterob and Lucely Maas-Góngoraa
a
School of Health Sciences, Universidad Autónoma del Carmen, Av. Concordia Núm. 4 Col. Benito Juárez, Ciudad del Carmen, Campeche C.P.
24180, Mexico; bSchool of Nursing, Centro de Investigación y Desarrollo en Ciencias de la Salud, Universidad Autónoma de Nuevo León, UANL,
Universidad Autónoma de Nuevo León, UANL, Av. Universidad S/N, Ciudad Universitaria, San Nicolás de los Garza, Nuevo León C.P. 66451,
Mexico; cSchool of Psychology, Centro de Investigación y Desarrollo en Ciencias de la Salud, Universidad Autónoma de Nuevo León, UANL,
Universidad Autónoma de Nuevo León, UANL., Av. Universidad S/N, Ciudad Universitaria, San Nicolás de los Garza, Nuevo León C.P. 66451,
Mexico
Downloaded by [187.161.36.63] at 09:24 25 August 2015
ABSTRACT
Introduction: The purpose of the study was to evaluate the effect of an Internet-based intervention
to reduce sexual risk behaviors and increase resilience to sexual risk behaviors among Mexican
adolescents, a key HIV/AIDS risk group. Methodology: The study had a quasi-experimental design
with single-stage cluster sampling. Participants ages 14–17 were stratified by gender and
randomly assigned to either receive intervention “Connect” (which included face-to-face and
Internet-based sessions designed to reduce sexual risk behaviors and increase resilience to
sexual risk) or control (a general educational video on reducing health risks). A total of 9 survey
instruments were administered online through SurveyMonkey pre- and post-intervention to
assess changes in sexual risk and protective factors as well as two outcomes of interest: risky
sexual behaviors and resilience. Pearson correlation assessed instrument reliability while
multivariable linear regression models assessed two study hypotheses: (1) the effect of the
intervention on sexual behavior and resilience is mediated by adolescent age, gender, and
sexual experience and (2) risk and protective factors are mediators between the intervention and
sexual behavior. Results: The sample was composed of 193 adolescents between 14 and 17 years
old (n = 96 in the control group and n = 97 in the experimental group). Survey instruments were
reliable. Age was associated with pre-to-post test changes in sexual resilience (β = −6.10,
p = .019), which partially mediated the effect of the intervention on sexual resilience (β = 5.70,
p = .034). Social support was associated with pre-to-post test changes in risky sexual behavior
(β = −0.17, p = .039). Conclusion: Intervention “Connect” was independently associated with
improved self-reported resilience to risky sexual behaviors, though not with a reduction in those
behaviors in multivariate analyses. This is the first Internet-based intervention designed to
reduce HIV/AIDS sexual risk among Mexican adolescents.
Introduction
Adolescents are a key HIV/AIDS risk group. According
to the United Nations Children’s Fund (UNICEF,
2005), around 6000 people between 15 and 24 years
old are infected by HIV/AIDS every day around the
world. The United Nations Educational, Scientific and
Cultural Organization (2008) has estimated that the
number of teenagers infected with HIV around the
world will increase. Adolescence is a complicated stage
during which teenagers cope with physical, psychological, and social changes and are vulnerable to risky behavior (Uribe, Vergara, & Berona, 2009; Vinaccia et al.,
2007). Development of interventions to reduce sexual
risk behaviors among adolescents is an imperative
CONTACT Raquel Alicia Benavides-Torres
© 2015 Taylor & Francis
[email protected]
ARTICLE HISTORY
Received 17 December 2014
Revised 26 May 2015
Accepted 14 July 2015
KEYWORDS
Adolescence; prevention;
HIV; AIDS; social behavior
HIV/AIDS prevention strategy for this population but
are lacking (Castillo-Arcos, Benavides-Torres, & LópezRosales, 2012a; United Nations Programme on HIV/
AIDS, 2010).
The purpose of the study was to evaluate the effect of
an Internet-based intervention designed to reduce risky
sexual behavior and increase resilience to risky behaviors
among Mexican adolescents. We hypothesized that: (1)
the effect of the intervention on risky sexual behavior
and resilience is mediated by the adolescent’s age, gender, and previous sexual experiences; and (2) adolescentand community-level risk and protective factors are
mediators between the intervention and risky sexual
behavior.
2
L. C. CASTILLO-ARCOS ET AL.
Methodology
Design
The study had a quasi-experimental design with singlestage cluster sampling.
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Participants
Study participant and parent/guardian recruitment were
conducted through institution-wide announcements and
information sessions in an urban Mexican educational
institution with a catchment area that included a wide
range of socioeconomic levels. Inclusion criteria included
adolescents ages 14–17 years who were not married or in
a common-law cohabiting relationship. Study participants were stratified by gender and randomly assigned
to the control or experimental group. After the intervention, all participants were given a portable data storage
device and a gift certificate.
Parental/guardian consent and study participant
assent were obtained from all participants. The study
was conducted under the regulations of the Mexican
General Health Law on Health Research and authorized
by the ethics and research committee from the School of
Nursing of the Universidad Autónoma de Nuevo León.
values, positive coping strategies, and strategies to
increase levels of resilience [sessions 7 and 8]). The intervention was moderated by eight facilitators from the
health field, each of whom delivered the intervention
to 10–13 participants selected at random. An educational
video on reducing health risks was shown to the control
group (nutrition, mental health, prevention of drug use,
violence, and accident), and at the end the control group
was scheduled to receive the “Connect” intervention
program.
Survey instruments
Demographic data collected included age, gender, and
whether the participant had ever engaged in vaginal,
oral or anal sex. Nine survey instruments were used.
We consider two outcomes of interest captured in the
pre- and post-test surveys: (1) self-reporting any risky
sexual behaviors (defined as self-reporting unprotected
sex (vaginal or anal), multiple concurrent sexual partners, and alcohol or drug use during sex) and (2) resilience to risky sexual behavior (defined as the ability to
identify and practice strategies to avoid risky sexual
behavior). Surveys were administered via SurveyMonkey
immediately before the intervention (pre-test) and after
the final intervention session or control video (post-test).
Intervention
Analytic methods
The intervention is based on the conceptual framework
of Adolescent Sexual Resilience (Castillo & Benavides,
2012; López & Moreno, 2000) which focuses on how
protective factors modify the relationship between risk
factors and outcomes. The experimental group received
the “Connect: A Program on Responsible Sexuality”
intervention which consists of eight 1-hour sessions
(two face-to-face [sessions 1 and 8] and six online
[sessions 2 through 7]). Intervention “Connect” has
two components: educational and psychological. Sessions 1 and 2 comprise the educational component
which provides information on HIV/AIDS, biopsychosocial changes experienced during adolescence, and perceived vulnerability to HIV/AIDS. Sessions 3–8 comprise
the psychological component which includes activities
aimed at increasing levels of social competence and resilience. It is comprised of three elements: (a) Emotional
intelligence (identifying protective factors [family, social,
and/or individual], strengthening levels of self-esteem
and self-efficacy [sessions 3 and 4]); (b) Social skills
and effective communication (strengthening social
protective factors and reducing social risk factors, identifying strategies to negotiate safe sex [sessions 5 and 6]);
and (c) Resilience (identifying individual and family
Study participant demographics were described using
counts and percentages stratified by control or experimental group. Pre- and post-test survey items were
described using means and standard deviations (SDs)
stratified by the control or experimental group. The
internal reliability of the nine survey instruments was
analyzed using the Cronbach’s Alpha coefficient.
To assess the first hypothesis, two multivariable multiple linear regression models were built using backward
selection to assess mediation and associations between
intervention group, sexual experience, gender, age, and
the two outcomes of interest. To assess the second
hypothesis, one multivariable multiple linear regression
model was built using backward selection to assess
mediation and associations between intervention
group, sexual experience, gender, age, and the survey
items and the outcome of changes in pre-to-post test
scores for risky sexual behavior.
Results
One hundred ninety-three adolescents randomized to
control (n = 96) or experimental (n = 97) groups. All
adolescents completed the pre- and post-tests.
AIDS CARE
3
Table 1. Internal reliability of survey instruments.
Survey instruments
α
Pre-test
Post-test
Number of items
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Risk factors
Sexual uncertainty (Peter & Valkenburg, 2008)a
6
.71
.80
6
.71
.72
Perceived susceptibility of HIV infection (Lux & Petosa, 1994)a
60
.98
.98
Jalowiec coping (risk and protective) (Jalowiec, 2003)a
Protective factors
77
.94
.96
Family and social support for safe sexual behaviors (Castillo-Arcos et al., 2012b), adapted
from the HIV-Specific Social Support Scale (Darbes & Lewis, 2005)a
20
.79
.88
HIV/AIDS and STI knowledge (Jemmott, Jemmott, & Fong, 1992)b
10
.83
.89
Self-esteem (Rosenberg, 1965)b
27
.92
.92
Self-efficacy for HIV/AIDS prevention (López-Rosales & Moral-de la Rubia, 2001)b
Outcomes of interest
22
.87
.93
Sexual resilience (Castillo-Arcos et al., 2012b) adapted from
the Resilience Scale (Wagnild & Young, 1993)b
b
38
.97
.97
Sexual behavior (Jemmott et al., 1992; Villarruel, Jemmontt, Jemmontt, & Ronis, 2004)
Note: α: Cronbach’s alpha.
a
Translated from English to Spanish by the study investigators
b
Instruments previously translated into Spanish for use in previous studies (Gallegos, Villarruel, Gómez, Onofre, & Mississippi, 2007; Lopez-Rosales & Moral-de la
Rubia, 2001; Heilemann, Lee, & Salvador, 2003; Martínez-Maldonado, Pedrao, Alonso-Castillo, López-García, & Oliva-Rodríguez, 2008).
of the intervention on sexual resilience (β = 5.70, p
= .034). Age was similarly associated with pre-to-post
test changes in risky sexual behavior (β = 1.33, p = .045).
Table 4 indicates that, in a model initially containing
all survey instruments and participant demographics,
only decreased social support was significantly associated
with increased risky sexual behavior (β = −0.17, p = .039)
while HIV/AIDS susceptibility, self-efficacy, and age
were marginally associated (p < .1). Again, intervention
group was not associated with changes in risky sexual
behavior.
Participant age (experimental mean (SD) = 15.8 (0.5);
control mean (SD) = 15.7 (0.6)), gender (experimental
= 61.9% female; control = 64.6% female); and reporting
any previous sexual experience (experimental = 16.5%;
control = 13.5%) were balanced between the experimental and control groups (data not shown). The internal
reliability of the nine survey instruments was acceptable
(Table 1).
Table 2 shows that most pre-to-post changes in the
experimental group were in the expected direction with
the exception of Jalowiec coping which increased and
self-esteem which decreased. The control group also
showed changes in pre-to-post test scores which was
even greater than the pre-post test score changes
observed in the experimental group for sexual
uncertainty.
Table 3 indicates that age was associated with pre-topost test changes in sexual resilience (β = −6.10,
p = .019), which partially mediated the beneficial effect
Discussion
Intervention “Connect” was independently associated
with improved self-reported resilience to risky sexual
behaviors though not with a significant reduction in
those behaviors in multivariate analyses. Participant
age mediated the effect of the intervention on resilience,
Table 2. Pre- and post-intervention survey item scores stratified by control and experimental group.
Control (N = 96)
Pre-intervention
Mean
Risk factors
Sexual uncertainty
Perceived susceptibility of HIV infection
Jalowiec coping
Protective factors
Family support for safe sexual behaviors
Social support for safe sexual behaviors
HIV/AIDS and STI knowledge
Self-esteem
Self-efficacy for HIV/AIDS prevention
Jalowiec coping
Outcomes of interest
Sexual resilience
Risky sexual behavior
Note: SD: standard deviation.
Experimental (N = 97)
Postintervention
Pre-intervention
Postintervention
SD
Mean
SD
Difference
Mean
SD
Mean
SD
Difference
15.30
04.22
18.15
04.51
04.15
14.33
13.41
03.58
18.95
04.71
03.99
16.32
−1.89
−0.64
0.8
15.70
03.47
19.64
04.75
03.88
14.29
15.46
02.35
24.96
05.33
03.56
13.84
−0.24
−1.12
5.32
053.61
162.63
21.32
08.07
74.50
41.77
13.28
35.78
07.84
05.28
23.09
30.53
055.27
168.16
23.81
06.74
73.92
46.02
13.75
39.11
07.53
06.57
21.58
34.01
1.66
5.53
2.49
−1.33
−0.58
4.25
051.27
155.47
22.97
08.28
69.62
45.41
13.00
42.24
05.27
05.45
21.98
29.83
054.62
164.64
27.02
07.86
73.37
60.33
14.53
42.58
9.02
05.92
24.71
27.31
3.35
9.17
4.05
−0.42
3.75
14.92
64.35
04.72
13.45
10.91
64.31
05.18
16.08
11.54
−0.04
0.46
64.44
05.96
13.20
11.92
68.79
05.41
14.98
11.02
4.35
−0.55
4
L. C. CASTILLO-ARCOS ET AL.
Table 3. Results of multivariate multiple linear regression for the association between intervention group, sexual experience, gender,
age and the outcomes of interest.
Outcome variable
Parameter
B
Standard error
t
p-Value
Sexual resiliencea
Intercept
Any sexual experience (versus none)
Intervention group (versus Control)
Gender (M versus F)
Age (per year increase)
Intercept
Any sexual experience (versus none)
Intervention group (versus Control)
Gender (M versus F)
Age (per year increase)
86.55
7.31
5.70
−3.02
−6.10
−20.27
−1.38
−0.47
0.60
1.33
41.16
3.93
2.65
2.76
2.57
10.56
1.00
0.68
0.71
0.66
2.10
1.86
2.14
−1.09
−2.36
−1.91
−1.37
−0.69
0.84
2.02
.037
.065
.034
.276
.019
.057
.172
.489
.399
0.045
Risky sexual behaviorb
a
95%CI
5.13
−0.46
0.45
−8.49
−11.20
−41.17
−3.38
−1.82
−0.80
0.03
167.98
15.09
10.96
2.44
−1.00
0.62
0.61
0.87
2.00
2.64
Change in pre-to-post test scores.
Table 4. Results of multivariate multiple linear regression models of risk and protective factors associated with risky sexual behavior.
Outcome variable
Parameter
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Risky sexual behaviora
Intercept
Age (per year increase)
Risk factors
Perceived susceptibility of HIV/AIDS infection
Protective factors
Social support for safe sexual behaviors
Self-efficacy for HIV/AIDS prevention
a
Change in pre-to-post test scores.
indicating that participant age can importantly influence
the effectiveness of the intervention.
In testing the second hypothesis, we found that social
support (including from friends and healthcare providers) for safe sexual behaviors is associated with changes
in risky sexual behavior. These results support the findings by Patsdaughter, Kelley, Babington, and Diyer
(2005) and Henrich, Brookmeyer, Sharier, and Shahar
(2006), who found support for adolescents promotes
safer sexual behavior. Self-efficacy for HIV/AIDS prevention was marginally associated with changes in risk
behaviors. Atwood et al. (2012) similarly found that
self-efficacy was an important factor of protection for
HIV/AIDS. Perceived susceptibility was also marginally
associated with changes in risk behavior. Similarly,
Kalichman et al. (2002) found that perceived invulnerability to HIV was a risk factor for sexual risk behavior
among adolescents.
Changes in other survey instruments were not significantly associated with intervention group. This is likely
due to the unexpected effect of the control group on
changing pre-to-post test scores, thereby mitigating the
true effect of the intervention. In addition to the likely
mitigating effect of the control group, our study had
other limitations. We did not capture measures of participant socioeconomic status, and we have not assessed
the sustainability of the intervention over time. Future
studies will benefit from understanding the sustainability
B
Standard error
t
P-Value
−
0.16
9.35
0.59
1.90
.055
.059
95%CI
−0.04
2.30
0.16
0.08
1.94
.054
−0.00
0.32
−0.17
0.16
0.00
0.01
2.08
1.94
.039
.054
−0.03
0.00
−0.00
0.05
of such interventions without regular re-enforcement
and well as the effect of socioeconomic status on
enrollment.
Finally, this study demonstrated that an Internetbased intervention was feasible, acceptable. Women, a
key adolescent HIV/AIDS risk sub-group, were more
likely to participate in the intervention, which is consistent with other studies in which women are more willing
to participate and look for health information online
(Burke et al., 2007; Kontos, Bennett, & Viswanath,
2007). Due to the accessibility of the Internet at schools
and public libraries, Internet-based health interventions
are an increasingly viable strategy to reduce disparities
in intervention delivery and access.
Conclusion
Though intervention “Connect” was not associated with
a significant reduction in risky sexual behaviors in multivariate analyses, the crude reduction that was observed
may be clinically significant. Also, though we did not
observe significant changes in risk and protective factors
in the experimental versus control group, it is possible we
would have seen significant changes given a less healthoriented control arm. This study provided an opportunity to test the relationship between theoretical
constructs that support changes in sexual behavior.
Finally, we demonstrate the feasibility and acceptability
AIDS CARE
of implementing the first Internet-based intervention
designed to reduce HIV/AIDS sexual risk among Mexican adolescents.
Disclosure statement
No potential conflict of interest was reported by the authors.
Funding
Consejo Nacional de Ciencia y Tecnología [grant 45455] and
PAICYT, UANL [grant HU1129-11].
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ORCID
Lubia del Carmen Castillo-Arcos
http://orcid.org/
0000-0002-4368-4735
Raquel Alicia Benavides-Torres http://orcid.org/00000001-5113-4250
References
Atwood, K., Zimmerman, R., Cupp, P., Fongkaew, W., Miller,
B., Byrnes, H., … Chookhare, W. (2012). Correlates of precoital behaviors, intention and sexual initiation among thai
adolescents. The Journal of Early Adolescence, 32(3), 364–
386.
Burke, E., Finney, L., Squiers, L., Arora, N., Volckmann, L.,
Moser, R., & Hasse, B. (2007). Use of the Internet to communicate with health care providers in the United State:
Estimates from the 2003 and 2005 Health Information
national Trends Surveys (HINTS). Journal of Medical
Internet Research, 9(3), e20.
Castillo-Arcos, L., & Benavides-Torres, R. (2012). Modelo de
resiliencia sexual en el adolescente: Teoría de rango
medio. Aquichan, 12(2), 169–182.
Castillo-Arcos, L., Benavides-Torres, R., & López-Rosales,
F. (2012a). Intervención por Internet para reducir conductas sexuales de riesgo para VIH/SIDA: Una propuesta
innovadora. Desarrollo Científico de Enfermería, 20(8),
266–270.
Castillo-Arcos, L., Benavides-Torres, R., & López-Rosales, F.
(2012b). Vol. XIV de la Psicología Social en México.
Monterrey: Validación de la escala de resiliencia para sexo
seguro.
Darbes, L. A., & Lewis, M. A. (2005). HIV-specific social support predicts less sexual risk behavior in gay male couples.
Health Psychology, 24(6), 617–622.
Fondo de las Naciones Unidas para la Infancia (UNICEF).
(2005). VIH/SIDA infancia y adolescencia en América
Latina y el Caribe. Recuperado de http://www.unicef.org/
lac/infanciadolescencia.pdf
Gallegos, C. E., Villarruel, A. M., Gómez, M. V., Onofre, D. J.,
& Mississippi, Y. Z. (2007). Sexual communication and
knowledge among Mexican parents and their adolescent
children. Journal Association Nurses AIDS Care, 18(2),
28–34.
5
Heilemann, M., Lee, K. & Salvador, F. (2003). Psychometric
properties of the Spanish version of the resilience scale.
Journal of Nursing Measurement, 11(1), 61–72.
Henrich, C., Brookmeyer, K., Sharier, L., & Shahar, G. (2006).
Supportive relations and sexual risk behavior in adolescent
an ecological-transactional approach. Journal of Pediatric
Psychology, 31(3), 286–297.
Jalowiec, A. (2003). The Jalowiec coping scale. In O. L.
Strickland & C. DiIorio (Eds.), Measurement of nursing outcomes: Self care and coping (2nd ed.). (Vol. 3, pp. 71–87).
New York: Springer.
Jemmott, J. B. III., Jemmott, L. S., & Fong, G. T. (1992).
Reduction in HIV risk-associated sexual behaviors among
black male adolescents: Effects of an AIDS prevention intervention. American Journal of Public Health, 82, 372–377.
Kalichman, S., Stein, J., Malow, R., Averhart, C., Devieux, J.,
Jennings, T., Prado, G., & Feaster, D. (2002). Predicting protected sexual behavior using the information-motivation.
Behaviour skill model among adolescent substance abusers
in court-ordered treatment. Psychology, Health & Medicine,
7(3), 327–338.
Kontos, E., Bennett, G. & Viswanath, K. (2007). Barriers and
facilitators to home computer and internet use among
urban novice computer users of low socioeconomic position. Journal of Medical Internet Research, 9(4), e31.
Lux, K. M., & Petosa, R. (1994). Preventing HIV infection
among juvenile delinquents: Educational diagnosis using
the health belief model. International Quarterly of
Community Health Education, 15, 145–164.
López, R. F., & Moreno, L. Y. (2000) Programa psicoeducativo
de prevención del SIDA en adolescentes de Monterrey.
México: Universidad Autónoma de Nuevo León.
López-Rosales, F., & Moral-de la Rubia, J. (2001). Validación de
una escala de autoeficacia para la prevención del SIDA en
adolescentes. Salud Pública de México, 43(5), 421–432.
Martínez-Maldonado, R., Pedrao, L. J., Alonso-Castillo, M. M.,
López-García, K. S., & Oliva-Rodríguez, N. N. (2008).
Autoestima, autoeficacia percibida, consumo de tabaco y
alcohol en estudiantes de educación secundaria de área
urbana y rural de Monterrey, Nuevo León, México.
Revista Latino-Americana de Enfermería, 16(especial), 1–8.
Organización de las Naciones Unidas para la Educación, la
Ciencia y la Cultura (UNESCO) (2008). Informe sobre la
epidemia mundial del sida, 2008. Recuperado de http://
www.unaids.org/es/KnowledgeCentre/HIVData/GlobalReport/
2008/2008_Global_report.asp
Patsdaughter, C., Kelley, B., Babington, L., & Diyer, J. (2005). A
comparison of sexual risk behavior of Dominican adolescents in their homeland and in the United States. Journal
of Multicultural Nursing & Health, 11(1), 63–68.
Peter, J., & Valkenburg, P. (2008). Adolescents’ exposure to
sexually explicit internet material, sexual uncertainty, and
attitudes toward uncommitted sexual exploration.
Communication Research, 35 (5), 579–601.
Rosenberg, M. (1965). Society and the adolescent self-image.
Princeton, NJ: Princeton University Press.
United Nations Programme on HIV/AIDS. (2010). 2011–2015
strategy. Getting to zero. Recuperado de http://www.unaids.
org/en/media/unaids/contentassets/documents/unaidspubli
cation/2010/JC2034_UNAIDS_Strategy_en.pdf
Uribe, R. F., Vergara, V. T., & Berona, C. (2009). Suceptibilidad
y autoeficacia frente al VIH/SIDA en adolescents de Cali-
6
L. C. CASTILLO-ARCOS ET AL.
Downloaded by [187.161.36.63] at 09:24 25 August 2015
Colombia. Revista Latinoamericana de Ciencias Sociales,
niñez y juventud, 7(2), 1513–1533.
Villarruel, A. M., Jemmontt, J. B. III, Jemmontt, L. S., & Ronis,
D. L. (2004). Predictors of sexual intercourse intentions
and condom use among Spanish dominant youth: A test
of the theory of planned behavior. Nursing Research, 53
(3), 172–181.
Vinaccia, S., Quiceno, J., Gaviria, A., Soto, A., Gil, M., &
Ballester, R. (2007). Conductas sexuales de riesgo para
infección por VIH/SIDA en adolescentes colombianos.
Terapia Psicológica, 25(1), 39–50.
Wagnild, G. M., & Young, H. M. (1993). Development and
psychometric evaluation of the resilience scale. Journal of
Nursing Measurement, 1, 165–178.