The Condom Use Self-Efficacy Scale in Substance Use Disorder Treatment-Seeking American Indian Adults

Abstract

Background

American Indians (AIs) experience substance use disorder and sexual risk related inequities with elevated rates of sexually transmitted infections, unintended pregnancy, and fetal alcohol spectrum disorders. Substance misuse is associated with risky sexual behaviors including condomless sex. Objectives: The current study aimed to test the validity of the Condom Use Self-Efficacy Scale (CUSES) and the relationship between self-efficacy and condom use behaviors in AI individuals with substance use disorders (SUDs). Exploratory analyses also examined changes in condom use self-efficacy across SUD treatment. Methods: As part of a larger randomized controlled trial, AI individuals (N = 79) seeking SUD treatment completed baseline measures of condom use self-efficacy and sexual risk behaviors. Results: Confirmatory factor analysis (CFA) indicated that a 3-factor, 10-item version of the CUSES was a reliable and valid measure in this population. Condom use self-efficacy was associated with condom use behavior and increased during SUD treatment. Conclusions: Overall, it appears that the CUSES is a valid measure in AI individuals, is related to condom use behavior, and increases with SUD treatment. There is a need for future research to integrate these findings into AI cultural values. Addressing sexual risk behaviors in SUD treatment may be an important target and future research is needed to understand predictors of condom use self-efficacy and determine potential intervention targets to reduce sexual risk behaviors and related health inequities.

Keywords:

• Self-efficacy
• condom use
• sexual risk
• substance use disorder treatment
• American Indian
• psychometric

Acknowledgements

The authors wish to thank our Southwest Tribal partners: Governor, Tribal Council; our Tribal research counselors and research assistant; director and staff at the reservation-based outpatient treatment center, and our participants for working to better their lives and contribute to science.

Author contributions

Investigation/Methodology/Project administration/Resources: KLV; Conceptualization: KNS, KLV, AHV; Formal analysis: KNS; Writing – original draft: KNS, KLV, AHV; Writing – review and editing: KNS, KLV, AHV

Clinical trial registration

Data used in the current study was part of a larger randomized clinical trial that was registered on Clinicaltrials.gov (NCT03203889).

Disclosure statement

Dr. Venner has a financial conflict of interest (FCOI) due to providing consultation and training, has fully disclosed these interests to Taylor and Francis, and has an FCOI management plan at the University of New Mexico.

Additional information

Funding

Research reported in this publication was supported by the National Institute on Drug Abuse under Award Number R01 DA021672. The content is solely the responsibility of the authors and does not necessarily reflect the official view of the National Institute on Drug Abuse.