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Does the Promotion and Distribution

of Condoms Increase Teen Sexual


Activity? Evidence from an HIV
Prevention Program for Latino Youth

Deborah E. Sellers, PhD, Sarah A. McGraw, PhD, and John B. McKinlay, PhD

Introduction and distribution of condoms.'7'18 In devel-


oping countries, these programs target
Proponents of contraception educa- both the general adult population and
tion and condom availability programs high-risk populations such as prosti-
argue that teenagers are sexually active tutes.19'20 In the United States, such
and must be provided with the means to programs are more likely to target high-
protect themselves against pregnancy and risk populations such as homosexual men,
sexually transmitted diseases. Figures for intravenous drug users, and prostitutes,
1988 indicated that about 50% of female although in some areas condoms are
adolescents and 60% of male adolescents distributed to a broader adult popula-
15 to 19 years of age had engaged in tion.2122 The controversy over condom
sexual intercourse,1-3 more than 1 in 10 distribution arises primarily when general
teenage girls was pregnant,2'4 and 1 in 6 adolescent populations are targeted."
sexually experienced teens had a sexually The first school-based condom avail-
transmitted disease.5'6 The long incuba- ability program in the United States was
tion period of the human immunodefi- implemented in a school district in Com-
ciency virus (HIV) and the number of merce City, Colo, in 1988.10 In 1991, the
cases of acquired immunodeficiency syn- New York City school board adopted a
drome (AIDS) among adults in their 20s condom availability program after a na-
have also raised concern about the rate of tionally publicized debate.1023 Since that
HIV infection among adolescents, even time, similar programs have been imple-
though relatively few cases of AIDS have mented or approved in at least 45 other
occurred among teens.7 Opponents of cities and towns throughout the United
condom availability programs maintain States.24 In some of these programs,
that the provision of condoms endorses access to condoms is provided in school-
and thus promotes sexual activity.5'>'2 based health clinics; in other programs,
This issue was raised in the confirmation specially trained faculty, staff, and/or
hearings for Dr Joycelyn Elders as sur- volunteers provide condoms at designated
geon general of the United States when times and places. Under both methods of
Sen Dan Coates (R, Ind) expressed distribution, however, students who want
concem that "just promoting condoms as condoms must make some effort to
a solution to the problem can promote acquire them. Condoms are not automati-
promiscuity."'3 An even stronger position cally given to every student. In addition,
was expressed by Phyllis Schlafly during most condom availability programs repre-
the debate over the distribution of con- sent one component of a more comprehen-
doms in the New York City public sive HIV prevention or sexuality educa-
schools: "condom distribution programs tion program.8
produce an increase in teen-age sexual To date, little research has focused
activity."'14 The goal of this study was to on the question of whether programs that
empirically evaluate the assertion that the
promotion and distribution of condoms The authors are with the New England
increases adolescent sexual activity. Research Institute, Watertown, Mass.
Since the consistent and correct use Requests for reprints should be sent to
John B. McKinlay, PhD, New England Re-
of condoms reduces the risk of HIV search Institute, 9 Galen St, Watertown, MA
infection,1"'15"16 HIV/AIDS prevention 02172.
programs often include the promotion This paper was accepted June 22, 1994.

December 1994, Vol. 84, No. 12


Condoms and Teen Sex

include the promotion and distribution of presentations at large community events; have a condom in his or her possession.27
condoms increase adolescent sexual activ- and door-to-door and street corner can- After adjustment for covariates, the odds
ity. One study of three school-based vassing. This canvassing included distribu- of possessing a condom at the time of the
health clinics that dispensed contracep- tion of a kit that provided condoms and follow-up interview were 2.3 (P < .01)
tives found that the percentage of stu- pamphlets on how to use them. Condoms and 2.0 (P = .07) times greater for boys
dents who had ever had sex, the mean age were also freely available at the interven- and girls, respectively, in the intervention
at first intercourse, and the frequency of tion office and at all intervention activi- city. The intervention also lowered the
sex in the previous 4 weeks were no higher ties. Project messages promoting the use risk of HIV infection in males and females
among students in schools with clinics of condoms were disseminated through- by 9% and 15%, respectively, after adjust-
than among students in matched compari- out the intervention neighborhood via ment for baseline risk and other covari-
son schools.25 Another study 'evaluated radio and television public service an- ates; however, these differences did not
the effect of a direct mailing about nouncements, posters in local businesses achieve statistical significance (Ps = .20
condoms, including coupons for free and public transit facilities, and a quar- and' .15, respectively).27 More details
condoms, to 16- and 17-year-old low- terly newsletter produced by the peer about the measurement of HIV risk and
income boys.26 This study found no differ- leaders. Use of a variety of channels for the effects of the intervention are avail-
ence between the experimental and con- the distribution and promotion of con- able elsewhere.27'29
trol groups in the percentage who had doms, as well as other project messages,
ever had sex or the mean number of acts ensured relatively easy access to condoms Analysis
of coitus; however, the method of interven- and rather pervasive saturation of the To assess whether this HIV preven-
tion, the short time period between the project message in the target neighbor- tion program that included the promotion
intervention and follow-up, and the focus hood. A more comprehensive description and distribution of condoms increased the
on lifetime sexual activity limit the utility of the intervention is available else- level of sexual activity in the target
of this study. where.27 population of Latino adolescents, the
A recent evaluation of an HIV Evaluation of the intervention con- intervention and comparison samples were
prevention program among Latino teenag- sisted of a longitudinal comparison of compared on three outcomes: the percent-
ers in two northeastern cities provides probability samples of Latino youth from age experiencing the onset of sexual
data with which to empirically examine the intervention city (Boston) and a activity between the baseline and fol-
the question of whether the promotion comparison city (Hartford, Conn). Hart- low-up interviews, the change in the
and distribution of condoms increases ford was selected as the comparison city percentage with multiple partners be-
sexual activity in a population-based because it provided a comparable inner- tween the baseline and follow-up inter-
sample of adolescents. Three specific city Latino population and because its views, and the change in the mean
questions were addressed: (1) Were ado- 160-km (100-mile) distance from Boston frequency of sex between the baseline and
lescents who had not initiated sexual minimized the possibility of intervention follow-up interviews. If the intervention
activity prior to the prevention program activities affecting the comparison site. increased adolescent sexual activity, then
more likely to initiate activity as a result of Areal probability samples, rather than the rate of onset of sexual activity, the
the intervention? (2) Were adolescents school- or participant-based samples, were change in the percentage with multiple
who were sexually active by the end of the used because the intervention targeted partners, and/or the change in the fre-
intervention more likely to have multiple the general adolescent population. To quency of sex between the baseline and
partners as a result of the intervention? draw a representative, probability sample follow-up interviews in the intervention
and (3) Were adolescents who were of Hispanic adolescents in each city, group would be greater than that in the
sexually active by the end of the interven- census blocks in which at least 20% of the comparison group.
tion having sex more frequently as a result population was of Spanish origin were Sexual activity was defined as vaginal
of the intervention? selected as target neighborhoods. In these or anal intercourse. Muliple partners was
target neighborhoods, standard block sam- defined as two or more sex partners in the
Methods pling and household enumeration proce- 6 months prior to the interview. Frequency
dures were used to identify eligible His- ofse was the respondents' estimate of the
Study Design panic adolescents. A detailed description number of times they had had sex in the
In 1990 in Boston, Mass, an 18- of the enumeration and sampling proce- previous 6 months.
month community-based AIDS preven- dures has been provided elsewhere.27 29 The onset of sexual activity analysis
tion program was initiated among Latino Trained, bilingual staff completed included only respondents who were not
youth,27 a group at high risk of HIV baseline interviews before and follow-up sexually active at the baseline interview.
infection.28 The multifaceted community interviews after the intervention activities, The multiple partner and frequency of sex
intervention, which was designed to in- which took place between June 1990 and analyses included only respondents who
crease HIV/AIDS awareness and to December 1991. Interviewers, who were were sexually active by the follow-up
reduce the risk of HIV infection by paired with respondents of the same sex, interview.
increasing the use of condoms among protected confidentiality in both inter- The comparison of unadjusted rates,
sexually active teens, included both the views by conducting them in private however, did not take into account any
promotion and distribution of condoms. places. Interviews covered sociodemo- baseline differences between the compari-
Intervention activities, which were con- graphic information, AIDS knowledge son and intervention samples. The quasi-
ducted by specially trained peer leaders, and attitudes, and sexual activity and experimental design of the evaluation
included workshops in schools, commu- condom use. required that baseline differences be-
nity organizations, and health centers; The HIV prevention program in- tween the intervention and comparison
group discussions in the homes of youth; creased the likelihood that a teen would groups on factors related to the outcome

American Journal of Public Health 1953


December 1994, Vol. 84, No. 12
Sellers et al.

ties in the comparison city, which took


place because of the general attention to
Boys Girls HIV education and prevention during the
80 80 Intervention period under study. The percentage of
70 _ # 70 I CComparison respondents who reported participating
Percent Sexually Active 60 _
Among Respondents ,/ 60 in AIDS programs and workshops was
Who were Not Sexually Active 50 - 50 -
similar in both cities, but a significantly
by the Baseline Interview 40 - , 40
30 - 30 larger proportion of the intervention
20 - 20 group reported receiving either a condom
10 _ 10 - kit or free condoms (62% vs 42% of
0 0 females and 90% vs 73% of males). In the
Baseline Follow-up Baseline Follow-up intervention city, 75% of respondents
responded positively to one or more of
80 80 three questions during the follow-up inter-
Percent with 70 70 view that inquired about exposure to items
Multiple (2+) Sex Partners 60 (posters, newsletter, condom kit) specifi-
in the Six Months Prior 60
to the Follow-up Interview 50 50 cally associated with the intervention pro-
Among Respondents 40 40 gram, indicating that exposure to the
Who were Sexually Active 30 30 intervention activities was rather extensive.
by the Follow-up Interview 20 20 In evaluations of the effects of the
10 10
0 0 intervention, analytic attention focused
Baseline Follow-up Baseline Follow-up on residence in the intervention city
rather than documented participation in
specific activities because the goal was to
40 40 reach the entire population of Latino
Mean Frequency of Sex 35 35 adolescents in the target neighborhoods
in the Six Months Prior tO 30 30 of the intervention city. The intervention
the Follow-up Interview 25 n
B .o 25
Among Respondents 20 20
included some formally organized presen-
Who were Sexually Active 15 15 tations and workshops that teens could
by the Follow-up Interview 10 10 attend, but much of the activity involved
5 5 more diffuse efforts-including public
0 0 service announcements on local radio
Bascline Follow-up Baseline Follow-up stations, posters in businesses and public
transit facilities, and outreach workers on
FIGURE 1-Unadjusted value of outcome measures for intervention and street corners and at community
comparison groups, by gender and time of interview. events-to expose the target population
to project messages. Thus, similar to
intention-to-treat analyses in clinical tri-
als, residence in the intervention city
of interest be statistically controlled.30 set of covariates that included artifacts of constituted exposure to the intervention,
Consequently, multivariate regression the study design, competing HIV preven- and the effect of the intervention on
methods were used to determine the tion activities, and factors related to sexual behavior was captured via an
effect of the intervention on each out- adolescent sexual activity, as well as an indicator for such residence.
come after any differences between the indicator for intervention city. The mul- For all three outcomes, the regres-
intervention and comparison samples on tiple partners and frequency of sex analy- sion analysis was completed in three steps.
factors related to that outcome had been ses also included the baseline level of the First, respondent's age and the study
controlled. Logistic regression was used outcome and thus constituted an analysis design covariates were forced into the
for the onset of sexual activity and of change between baseline and follow- model. Second, a backward stepwise
multiple partner analyses. Ordinary least up.32 The appendix provides a complete procedure including all other covariates
squares regression analysis was used for description of the covariates and their (except the intervention indicator) was
frequency of sex. In order to satisfy the operationalization. Factors related to ado- completed. The backward procedure, with
assumption of homoscedasticity in ordi- lescent sexual activity were culled from a conservative criterion for removal
nary least squares regression, a natural log previous research.33-50 Male respondents (P = .2), permitted control of influential
transformation was applied to frequency and female respondents were analyzed covariates, even if not strictly statistically
of sex in the previous 6 months.31 To separately since previous research indi- significant. Finally, the indicator for inter-
permit retention of respondents who cates that different factors influence the vention city was forced into the model to
reported no sex in the previous 6 months, sexual activity of young men and young assess-the effect of the intervention after
a constant (1) was added to each score women.33,34,4l other covariates had been controlled.
prior to this transformation. The measures of participation in Model fit was checked with the Hosmer-
The onset of sexual activity, multiple HIV prevention activities similar to those Lemeshow goodness-of-fit statistic for
partners at follow-up, and frequency of of the intervention were included to logistic regressions51 and residual analysis
sex at follow-up were each regressed on a control for the effect of prevention activi- for linear regressions.52

1954 American Journal of Public Health December 1994, Vol. 84, No. 12
Condoms and Teen Sex

The influence of sampling proce-


dures on the survey estimates was as- TABLE 1-Effect of the Intervention on the Level of Sexual Activity after
sessed by calculating sample weights and Adjustment for Covariates Related to Adolescent Sexual Activity,
design effects.53 The sample weights var- Competing HIV Prevention Activities, and Artifacts of the Study
ied little across respondents (2.79 to 3.67), Design
and the distributions of weighted and
unweighted outcome variables were essen- Outcome Males Females
tially the same. Design effects, which
incorporated the influence of clustering of Onset of sexual activity between baseline and
follow-up interviewsa (logistic regressionb)
respondents within households, were close Odds ratio 0.08* 1.24
to one (0.96 to 1.06). Consequently, 95% confidence interval 0.01, 0.57 0.44, 3.46
unweighted results involving standard Hosmer-Lemeshow goodness of fit (P level) 6.08 (.638) 4.95 (.763)
variance estimates are reported. No. 89 138
Multiple (2+) sexual partners in the 6 months
prior to the follow-up interviewc (logistic
Results regressionb)
Odds ratio 0.90 0.06**
Baseline interviews were completed 95% confidence interval 0.43,1.91 0.01, 0.43
with 586 Latino adolescents who were 14 Hosmer-Lemeshow goodness of fit (P level) 5.51 (.702) 4.60 (.800)
to 20 years of age and were primarily No. 211 192
Puerto Rican (94%). The baseline re- Frequency of sexd in the 6 months prior to the
sponse rate was 84.4%. Follow-up inter- follow-up interviewc (ordinary least
views were completed with 536 of these squares regressionb)
Regression coefficient .21 -.11
respondents, for a follow-up response rate 95% confidence interval -0.20, 0.62 -1.74, 4.26
of 91.5%. The attrition rates (7.2% and Adjusted R2 .276 .380
9.3% in the intervention and comparison No. 211 192
cities, respectively) were minimized by
contacting each respondent at 3-month Note. See Appendix for a description of the covariates and their operationalization.
aAmong respondents who were not sexually active at baseline.
intervals between baseline and follow-up bThe regression analysis was completed in three steps. First, respondent's age and two covariates
to obtain current address and telephone measuring artifacts of the study design were forced into the equation. Second, a backward
information. stepwise procedure with a conservative criterion for removal (P = .20) was applied to all other
covariates. Finally, the intervention indicator was forced into the equation. The resuits for this final
Of the 536 respondents who re- step are reported.
sponded to both the baseline and the CAmong respondents who were sexually active by the follow-up interview.
din order to satisfy the assumption of homoscedasticity in ordinary least squares regression, a
follow-up interviews, 256 (47.8%) re- natural log transformation was applied to frequency of sex in the previous 6 months.31 To permit
ported no sexual activity prior to the retention of respondents who reported no sex in the previous 6 months, a constant (1) was added
baseline interview. Of these, 227 (88.7%) to each score prior to this transformation.
*P < .05; **P < .01.
provided responses to all covariates in the
model for onset of sexual activity and thus
constituted the analytic sample for that
analysis. By the follow-up interview, 433
respondents (80.8%) reported sexual ac- follow-up was the same for females in Adjusted Intervention Effects
tivity. Of these, 403 (93.1%) provided both groups, even though the frequency
was slightly higher in the comparison
The unadjusted results presented in
valid responses to all covariates and thus Figure 1 do not control for baseline
constituted the analytic sample for the group. In addition, for females, the in-
crease in the percentage with multiple
differences between the intervention and
frequency of sex and multiple partner comparison samples. As mentioned ear-
analyses. partners in the 6 months prior to the
interview between the baseline and fol- lier, the lack of experimental control in
Unadjusted Intervention Effects low-up interviews was lower in the inter- the quasi-experimental evaluation design
vention group than in the comparison required that any differences between the
Figure 1 illustrates the unadjusted intervention and comparison groups on
intervention effects for both males and group. For male respondents, the onset of
sexual activity between the baseline and factors related to the outcome of interest
females by presenting the outcome mea- be statistically controlled.30 Table 1 and
sures for the intervention and comparison follow-up interviews and the increase in
the frequency of sex between baseline and Figure 2 present the results of the
groups. The top panel provides the rate of
follow-up were lower in the intervention multivariate regression analysis applied to
onset of sexual activity; the middle and
lower panels provide the change between than in the comparison group. However, each outcome to provide this statistical
the baseline and follow-up interview in the increase in the percentage with mul- control. Since the covariate results were
the proportion with multiple partners and tiple partners was greater in the interven- not central to the question of interest,
in the frequency of sex, respectively, in the tion group than in the comparison group. only the results obtained from forcing the
6 months prior to the interview. Thus, with the exception of the propor- intervention indicator into the model (the
For female respondents, the rate of tion of males with multiple partners, the last step in each regression analysis) are
onset of sexual activity was the same in the intervention did not accelerate the natu- reported.
intervention group as in the comparison rally occurring increase in the level of After control for the influence of
group. Similarly, the increase in the sexual activity among either males or other covariates, males in the intervention
frequency of sex between baseline and females. city were less likely to become sexually

December 1994, Vol. 84, No. 12 American Journal of Public Health 1955
Sellers et al.

than those in the comparison city. In fact,


*ODDS RATIO (Intervention:Comparison) male respondents in the intervention city
were less likely than those in the compari-
0.01 0.02 0.05 0.1 0.2 0.5 1 2 5 10 son city to experience the onset of sexual
activity. Among teens who were sexually
ONSET OF SEXUAL ACTIVITY* active by the end of the intervention, the
BOYS I * number of sexual partners and the fre-
quency of sex in the previous 6 months
GIRLS were no higher in the intervention city
than in the comparison city. Indeed,
MULTIPLE PARTNERS* female respondents in the intervention
BOYS city were less likely than those in the
comparison city to have had multiple sex
GIRLS I * l partners.
This lack of an increase in sexual
FREQUENCY OF SEX** activity as a result of promoting and
BOYS distributing condoms is consistent with
previous research. Generally, providing
GIRLS adolescents with information about repro-
duction and contraception has not in-
-2.0 -1.5 -1.0 -0.50.5 0.0 1.0 creased sexual activity.54 60 Instead, recent
programs that have combined reproduc-
**REGRESSION COEFFICIENT tive and contraceptive information with a
Note. The estimated effect of the intervention is shown after adjustment for differences between the message to delay early sexual involvement
intervention and comparison groups. Error limits indicate 95% confidence intervals. The onset of and the skills with which to achieve that
sexual activity analyses used logistic regression and were restricted to those not sexually active goal have documented a decrease in
before the baseline interview. The multiple partner analyses used logistic regression and were
restricted to those who were sexually active by the follow-up interview. The frequency of sex sexual involvement and activity.6063 An
analyses, which were also restricted to those sexually active by the follow-up interview, used evaluation of school-based health clinics
ordinary least squares linear regression. A natural log transformation was applied to frequency of that distributed contraceptives found no
sex after adding a constant (1) to each score.
increase in sexual activity.25
The lack of an increase in sexual
FIGURE 2-Effect of HIV prevention program, which includes the promotion activity as a result of providing adoles-
and distribution of condoms, on the sexual behavior of Latino cents with access to contraceptives is also
adolescents after adjustment for differences between the consistent with the experience in other
intervention and comparison groups.
developed nations. In countries such as
Sweden, the Netherlands, and England,
easy, confidential access to contraceptives
active than were males in the comparison among male respondents in the interven- for adolescents has been institutionalized.
city (odds ratio [OR] = 0.08, P = .011). tion group based on the unadjusted Yet levels of sexual activity among adoles-
For females, the intervention did not results was insignificant after adjustment cents in those countries are similar to
significantly increase or decrease the for differences between the intervention those in the United States, and, despite
chances of becoming sexually active and comparison groups. the similarity in the level of sexual activity,
(OR= 1.24, P = .692). Hosmer-Lem- The intervention did not significantly the teen pregnancy rate in those countries
eshow statistics of 6.08 (P = .638) and affect the frequency of sex for either male is generally considerably lower than that
4.95 (P = .763) for males and females, or female respondents. Residual analysis in the United States.64
respectively, indicate that the fit of both indicated no problems with the fit of This investigation was limited in
models was very good. either model. About 28% and 38% of the several ways. First, the power to detect
In terms of multiple partners, the variance was explained by the covariates differences between the comparison and
indicator for the intervention had an odds in the model for males and females, intervention cities was limited by the
ratio of 0.902 (P = .790) for males and an respectively. sample sizes available. For the onset of
odds ratio of 0.06 (P = .005) for females, sexual activity analysis for females and the
after the influence of the covariates had Discussion multiple partner analysis for males, the
been controlled. For both males and minimum detectable differences in the
females, the fit of the model was good, Evaluation of an HIV prevention unadjusted rates for the available sample
with Hosmer-Lemeshow statistics of 5.51 program that included the promotion and sizes (in a one-sided test with an alpha
(P = .702) and 4.60 (P = .800), respec- distribution of condoms provided no level of .10 and a power of .80) were about
tively. Thus, female respondents in the evidence to suggest that the availability of 18 and 15 percentage points, respec-
intervention city were significantly less condoms increased sexual activity or pro- tively.65 For both males and females, the
likely to have multiple partners at the moted promiscuity in the target popula- minimum detectable difference in the
follow-up interview than were their coun- tion of Latino adolescents. Adolescents in unadjusted frequency of sex in the previ-
terparts in the comparison city. In addi- the intervention city who were not sexu- ous 6 months was 13 contacts for a similar
tion, the apparently greater increase in ally active prior to the intervention were test. However, the multivariate analysis
the propensity to have multiple partners no more likely to become sexually active improved the power to detect differences

1956 American Journal of Public Health December 1994, Vol. 84, No. 12
Condoms and Teen Sex

by reducing within-group variances.32 In ior among high school students-United services and impact on sexual behavior.
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We would like to acknowledge the impor- use, and pregnancy experience of young
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1958 American Journal of Public Health December 1994, Vol. 84, No. 12
Condoms and Teen Sex

APPENDIX-Description of Covarlates
Factors related to adolescent sexual activity
Parental supervision: 1 = parents always "know where you are and what you are doing"; 0 = otherwise.
Parental attachment: Sum of responses (5 categories, never to always, coded so that high score indicates greater attachment) to 4
items: Do parents act fair and reasonable? Do parents act as if they don't care? Do parents blame or criticize you when you don't
deserve it? and Do you respect parents' opinion about important things in life?
Peer influence: 1 = respect friends' opinions more often than parents'; 0 = otherwise.
Importance of friends: 1 = responded very or fairly important to 2 items: importance of friends in life and importance of time spent with
friends: 0 = otherwise.
Normative environment: Product of number of best friends (0-5) who had sex in last 6 months with 5-category response (never = 1,
always = 5) to "How often would you like to be the kind of person your best friends are?"
Family intact: 1 = 2 parents (stepparents or natural parents) living in home at baseline; 0 = otherwise.
Socioeconomic status: Green's 2-factor index. 67
Age: respondent's age in years at baseline.
Changed residence: 1 = moved between baseline and follow-up interviews; 0 = otherwise.
Employment: 1 = employed at baseline; 0 = otherwise.
Dropout-follow-up: 1 = withdrew from school without high school degree by follow-up; 0 = otherwise.
Self-esteem: Rossenberg's 5-item scale.68
Church attendance per month: number of times attending church each month (12 = 12 or more).
Ever smoked: 1 = ever smoked even one puff of a cigarette; 0 = otherwise.
Ever consumed alcohol: 1 = 12 or more drinks of alcohol in lifetime; 0 = otherwise.
Drunk: 1 = 5 or more drinks in 1 day in past 12 months; 0 = otherwise.
Medium and high acculturation: Sample was divided into three levels of acculturation (0-7 = low, 8-9 = medium, and 10-15 = high)
based on the sum of the 5-category responses (1 = Spanish only, 5 = English only) to questions about language use with friends,
language use with family, and the language of the interview; indicators (1 = yes, 0 = no) for the medium and high levels of accultura-
tion were used as covariates.
Medium acculturation-socioeconomic status: Product of indicator for medium level of acculturation and socioeconomic status.
High acculturation-socioeconomic status: product of indicator for high level of acculturation and socioeconomic status.
Worry about AIDS: response (1 = not at all, 4 = a great deal) to "How much do you worry that you could get AIDS?"
AIDS knowledge: scale measuring AIDS knowledge constructed from 13 yes/no items about the mechanisms of transmission, means
of lowering risk of infection, and cure or prevention of the virus.
Living with partner-follow-up: 1 = living with partner at time of follow-up interview; 0 = otherwise.
Multiple partners-baseline: 1 = 2 or more sex partners in 6 months prior to baseline interview; 0 = otherwise.
Frequency of sex-baseline: frequency of sex in 6 months prior to baseline interview.

Intervention activities
AIDS program: 1 = hosted AIDS discussion group in home; 0 = otherwise.
AIDS workshop: 1 = attended AIDS workshop or forum outside of home; 0 = otherwise.
Condom kit: 1 = received condom kit, including condoms and information about how to use them; 0 = otherwise.
Free condom: 1 = received free condom in the last 6 months; 0 = otherwise.

Study design
Smoking study participant: 1 = participant in previous smoking study; 0 = otherwise.
Months to follow-up: number of months between the baseline and follow-up interviews.

December 1994, Vol. 84, No. 12 American Journal of Public Health 1959