This article was downloaded by: [187.161.36.63] On: 25 August 2015, At: 09:24 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: 5 Howick Place, London, SW1P 1WG AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20 The effect of an Internet-based intervention designed to reduce HIV/AIDS sexual risk among Mexican 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 Click for updates 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 Published online: 24 Aug 2015. 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 To link to this article: http://dx.doi.org/10.1080/09540121.2015.1073663 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. 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Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions 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. Downloaded by [187.161.36.63] at 09:24 25 August 2015 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 Downloaded by [187.161.36.63] at 09:24 25 August 2015 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 Downloaded by [187.161.36.63] at 09:24 25 August 2015 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]. Downloaded by [187.161.36.63] at 09:24 25 August 2015 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.