The influence of self-esteem and self-silencing on self-efficacy for negotiating safer sex behaviors in urban Bahamian women.

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Material Information

Title:
The influence of self-esteem and self-silencing on self-efficacy for negotiating safer sex behaviors in urban Bahamian women.
Physical Description:
241 p. ; 28 cm.
Language:
English
Creator:
Neely-Smith, Shane L.
Publisher:
Barry University
Place of Publication:
Miami, Florida
Publication Date:
Copyright Date:
2003

Subjects

Subjects / Keywords:
Safe sex in AIDS prevention   ( mets )
Women -- Diseases -- Prevention   ( mets )
Women -- Health and hygiene -- Bahamas   ( mets )
Spatial Coverage:
Bahamas

Notes

Summary:
The purpose of this study was to understand the characteristics that put urban Bahamian women at risk for HIV/AIDS so that gender appropriate and culturally sensitive prevention interventions could be developed and implemented.

Record Information

Source Institution:
The College of The Bahamas
Holding Location:
The College of The Bahamas Main Library
Rights Management:
All rights reserved by the source institution.
System ID:
AA00000028:00001


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Full Text
THE INFLUENCE OF SELF-ESTEEM AND SELF-SILENCING ON




SELF-EFFICACY FOR NEGOTIATING SAFER SEX BEHAVIORS IN




URBAN BAHAMIAN WOMEN














DISSERTATION




Presented in Partial Fulfillment of the




Requirements for the Degree of




Doctor of Philosophy in Nursing












Barry University









Shane L. Neely-Smith






2003


THE INFLUENCE OF SELF-ESTEEM AND SELF-SILENCING ON

SELF-EFFICACY FOR NEGOTIATING SAFER SEX BEHAVIORS IN

URBAN BAHAMIAN WOMEN



DISSERTATION

by

Shane L. Neely-Smith

2003

APPROVED BY:
Carol A. Patsdaughter, PhD, RN, ACRN
Chairperson, Dissertation Committee
Jessie Colin, PhD, RN
Member, Dissertation Committee
Sande Gracia Jones, PhD, ARNP, ACRN, CS, C, BC
Member, Dissertation Committee
Pegge Bell, PhD, ANP
Dean, School of Nursing


Copyright by Shane L. Neely-Smith 2003
All Rights Reserved


ACKNOWLEDGEMENTS




Without the blessings and guidance of the Almighty God, I would not have




had the intellectual curiosity, physical and emotional strength, and endurance to




travel down the path of knowledge to success. Additionally, the Almighty has




allowed me to meet many influential persons who have guided and supported me




down this path to success and to them I will always be grateful.




To my committee chair. Dr. Carol (Pat) Patsdaughter, who offered her




continued support, guidance, and kept me focused on the path of knowledge, I am




forever indebted. My committee members Dr. Jessie Colin and Dr. Sande Garcia




Jones and to my consultant and editor Dr. Rosanna DeMarco who kept the lines




of communication opened and offered their expert advise, I will always be




appreciative.




To the management, faculty, staff, and nursing students at The College of The




Bahamas: Mrs. Hilda Douglas, Ms, Ernestine Douglas, Mrs. Diane Pratt-Watson,




Ms. Zoreen Curry, Mrs. Theresa Moxey-Adderley, Mrs. Miriam Sands, Mrs.




Lindel Deveaux-Stuart, Mrs. Ingrid Mobley, Mrs. Yvonne McKenzie, Mrs.




Virginia Balance, Mrs. Vemita Cleare, Mrs. Dianne Holden, Mrs. Patricia Miller-




Brown, Mrs. Cora Dean, Mrs. Carmen Hepburn, Mrs. Geneive Scavella, Ms.




Rebecca Loomis, Dr. Beulah Gardiner-Farquharson, Ms. Patricia Ellis, Dr.




Thaddeus McDonald, Dr. Ronda Chipman-Johnson, Dr. Pandora Johnson, Mrs.




Willamae Johnson, and Dr. Suzanne Newbold, you will never know how your




words of encouragement helped me along the path of knowledge; to you I will




always be thankful.








i


To Ms. Christian Campbell who offered valuable information and advice and




Mrs. Ella Jane Neely, Mrs. Paulette Cash, Ms. Elizabeth Williams, and Mrs.




Nathalie Bonimy thank you for your words of encouragement which were very




instrumental in keeping me on the path of knowledge.




Special thanks goes out to Ms. Marva Jarvis, Ms. Bemadette Saunders, and




Dr. Herbert Orlander, who were always willing to shared their thoughts and




expert knowledge with me as I traveled along this path of knowledge.




To all of the persons who have assisted with this research including Senator




Trevor Whyll, Mr. D'Aguliar, Mrs. Gloria Gardiner, Mrs. Deborah Darville, Mrs.




Maggie Turner, Ms. Hart, Ms. Denise Samuels, Mr. William Fielding, and Mr.




Winston Rolle; Additionally, Broadcasting Corporation of The Bahamas (i.e.,




ZNS TV-13), Jones Communications International Ltd (i.e.. Love 97.5), and The




Tribune, I extend a heartfelt thank.




To urban Bahamian women without whom, this research would not have




been possible, many thanks to you for your willingness and patience in




participating in this research, thereby contributing to the body of knowledge




related to risks for HIV/AIDS in women in The Bahamas and around the world.
11


DEDICATION




This accomplishment is dedicated to my late parents Bernice and Harold




Wilmore who have supplied me with the prerequisites needed to persevere this




journey in pursuit of knowledge; may they continue to rest in peace.




To my mother-in-law, Dorrell Marsh, who continue to show me support and




confidence in my abilities; may God's blessings continue to follow you all the




days of your life.




To my precious gems, Romon Neely and Donisha Smith, who have allowed




me the time and space needed to travel the path of knowledge; may your future




continue to be bright and may God pour his special blessings upon you forever.




To my siblings, Sandra Thompson, Stephanie Mackey, Sylvia Wilmore,




Stephen Wilmore, Sherry Sturrup, Suzanne Wilson, Sonia Wilmore, Sharmaine




Morris, Shellina Wilmore, Sophia Sawyer, Stanley Wilmore, and Shelton




Wilmore, who have helped to shape the type of person that I am; may the




blessings of God overshadow you and may his goodness and mercy follow you




forever.




To my long time friends, Ms. Eleanor Whylly and Mrs. Nelcina Graham, who




continued to extend their friendship throughout my journey on the path of




knowledge; may the riches of God be yours forever.




And, most important, to my life partner and husband, Donovan Smith, who




continued to love me despite my grumpiness, who believed in me more than I




believed in myself, who stuck with me through thick and thin, and who




understood and helped me through my frustrations along the path of knowledge to








iii


success. May God continue to lead and guide us along life's way, and may our




love continue to grow stronger for each other. Thank you Donovan, thank God for




you, the wind beneath my wings.
IV


ABSTRACT




The Influence of Self-Esteem and Self-Silencing on Self-Efficacy




for Negotiating Safer Sex Behaviors in Urban Bahamian Women




Shane L. Neely-Smith




Barry University, 2003




Dissertation Chair: Dr. Carol (Pat) Patsdaughter




The rapidly increasing rate of HIV/AIDS among Bahamian women is




daunting for the future of Bahamian society. Despite many concerted efforts,




scientists are unable to find a cure for HIV disease and are faced with the multiple




challenges that treatment and management strategies bring for persons living with




AIDS. As a result, there is a major focus on HIV prevention. The purpose of this




study was to understand the characteristics that put urban Bahamian women at




risk for HIV/AIDS so that gender appropriate and culturally sensitive prevention




interventions could be developed and implemented.




A cross-sectional, correlational survey design was used to study the




relationships between select demographic variables (i.e., age, income, education),




self-esteem, self-silencing, and self-efficacy for negotiating safer sex behaviors in




urban Bahamian women. Data were collected from urban Bahamian women (N =




661) ages 18 to 78 years from a variety of community sites in Nassau, Bahamas.




Data were collected using an 80-item anonymous questionnaire which included:




(a) The 16-item Taylor' Self-Esteem Inventory (TSEI) (Taylor & Tomasic, 1996);




(b) The 31-item Silencing The Self Scale (STSS) (Jack & Dill, 1992); (c) The 12-


item Self-Efficacy Scale (SES) to measure self-efficacy for negotiating safer sex




behaviors (Dilorio et al., 1997); and (d) demographic and background questions.




Hypothesis testing was conducted using Pearson product-moment correlation




coefficients (r) and logistic regression analyses, which revealed mixed results.




Three of four hypotheses were supported, and the fourth hypothesis was partially




supported. Self-esteem and self-silencing were negatively correlated (r = -.56, p




< .01), self-esteem and self-efficacy for negotiating safer sex behaviors in urban




Bahamian women were positively correlated (r = .22, p < .01), and self-silencing




and self-efficacy for negotiating safer sex behaviors in urban Bahamian women




were negatively correlated (r = .I5,p< .01). Additionally, age (OR = 1.02, 95%




CI= 1.01-1.04), education (OR =1.10, 95% CI= 1.00-1.20), and self-esteem (OR




= 1.03, 95%) CI= 1.02-1.04) were significant independent and combined




predictors of self-efficacy for negotiating safer sex behaviors in urban Bahamian




women.




The results of this study suggest that in addition to being gender appropriate




and culturally sensitive, HIV prevention interventions developed and




implemented for Bahamian women should also be tailored with respect to age and




educational level and address self-esteem enhancement. Future research should




include replication of this study with rural Bahamian women, urban and rural




Bahamian men, and urban and rural Caribbean adolescents as well as evaluation




of theory-based self-esteem and skills building HIV prevention interventions.
VI


TABLE OF CONTENTS
Page

ACKNOWLEDGEMENTS.................................................... i

DEDICATION................................................................... iii

AB STRACT....................................................................... v

LIST OF TABLES............................................................... xi

LIST OF FIGURES.............................................................. xi

Chapters

1. INTRODUCTION......................................................... 1
Background of the Study............................................. 1
Statement of Purpose.................................................. 4
Research Questions.................................................... 5
Significance to Nursing................................................ 6
Theoretical Framework................................................ 8
Overview........................................................... 8
Theory of Self-Esteem........................................... 9
Theory of Silencing The Self.................................... 14
Theory of Self-Efficacy.......................................... 16
Relationship to Study............................................. 20
Assumptions....................................................... 23
Definition of Terms...................................................... 24
Research Hypotheses.................................................... 26
Scope and Delimitation of the Study.................................. 26
Limitations of the Study................................................ 27
Summary................................................................. 28

II. REVIEW AND CRITIQUE OF THE LITERATURE................. 30
Introduction.............................................................. 30
HIV/AIDS Epidemiology Related to Women....................... 31
Global............................................................... 31
Regional: Latin American and the Caribbean.................. 32
Local: The Bahamas............................................... 33
Women's Risk for HIV/AIDS......................................... 34
Biological Risks.................................................... 35
Behavioral Risks................................................... 35
Sociocultural Risks................................................ 40
Socioeconomic Risks.............................................. 43
Vll


Other Demographic Variables and Risks........................ 44
Self-Esteem............................................................... 45
Self-Esteem and Women............................................. 46
Self-Esteem and Bahamian Women............................... 53
Self-Esteem and Risk for HIV/AIDS.............................. 55
Self-Silencing............................................................. 58
Self-Silencing and Women.......................................... 59
Self-Silencing and Self-Esteem.................................... 64
Self-Silencing and Risk for HIV/AIDS........................... 67
Self-Efficacy.............................................................. 69
Self-Efficacy and Women........................................... 70
Self-Efficacy and Self-Esteem...................................... 74
Self-Efficacy and Negotiating Safer Sex Behaviors............. 79
Summary................................................................... 89

III. RESEARCH METHODOLOGY......................................... 91
Introduction............................................................... 91
Research Design.......................................................... 91
Setting...................................................................... 91
Sample...................................................................... 92
Power Analysis and Sample Size.................................. 92
Inclusion and Exclusion Criteria................................... 94
Recruitment Procedures............................................. 95
Instrumentation............................................................ 96
Measurement of Sample Demographic Data..................... 96
Measurement of the Independent Variables...................... 99
Selected Demographic Variables............................... 99
Self-Esteem....................................................... 100
Self-Silencing..................................................... 103
Measurement of the Dependent Variable ....................... 107
Self-Efficacy for Negotiating Safer Sex Behaviors........... 107
Data Collection Procedure............................................... 110
Collection of Data.................................................. 110
Protection of Human Subjects.................................... 112
Data Analysis.............................................................. 115
Exploratory and Descriptive Analyses........................... 115
Hypotheses Testing................................................. 116
Summary.................................................................... 120

IV. RESULTS..................................................................... 122
Introduction................................................................. 122
Description of the Sample................................................ 123
Response Rate and Post Hoc Power Analyses.................. 123
Demographic and Background Characteristics.................. 123
Exploratory Data Analysis for Measurements.......................... 125
Measurement Assessments................................................ 130
Vlll


Taylor's Self-Esteem Inventory (TSEI)........................... 130
Silencing The Self Scale (STSS)................................... 131
Self-Efficacy Scale (SES)........................................... 132
Descriptive Findings for Major Study Variables........................ 132
Taylor's Self-Esteem Inventory (TSEI)........................... 132
Silencing The Self Scale (STSS)................................... 134
Self-Efficacy Scale (SES)........................................... 136
Hypotheses Testing......................................................... 139
Hypothesis 1.......................................................... 139
Hypothesis 2.......................................................... 139
Hypothesis 3.......................................................... 140
Hypothesis 4.......................................................... 141
Summary..................................................................... 143

V. DISCUSSION and CONCLUSION........................................ 145
Introduction.................................................................. 145
Summary of the Study...................................................... 145
Discussion of Findings..................................................... 149
Demographic and Background Characteristics.................. 149
Relationship between major Study Variables.................... 155
Significant Predictors of Self-Efficacy............................ 157
Nonsignificant Predictors of Self-Efficacy...................... 163
Limitations of The Study................................................... 166
Implications for Nursing.................................................... 167
Education........................................................ 168
Practice............................................................. 168
Social Policy.......................................................... 171
Future Research...................................................... 174
Summary.......................................................................... 176

REFERENCES..................................................................... 178

Appendices

A. Letter to Owners Where Women Frequent........................... 209

B. Recruitment Flyer........................................................ 210

C. Participants' Survey..................................................... 211

D. Letter to Executive Director HIV/AIDS Department................ 212

E. Letter to Minister of Health............................................. 213

F. Author(s) Permission to Use Self-Esteem Inventory................. 214



ix


G. Author(s) Permission to Use Silencing The Self Scale............. 215




H. Author(s) Permission to Use Self-Efficacy Scale..................... 216




I. Institutional Review Board Approval................................... 217




J. Cover Letter to Participants.............................................. 218




K. List of Private Counsellors in Nassau, Bahamas..................... 219




L. List of HIV/AIDS Resources in Nassau, Bahamas................... 220




Vita................................................................................. 221
X


LIST OF TABLES
Page


1. Demographic and Background Characteristics of Sample.................... 126

2. Additional Demographic and Background Characteristics
of Sample............................................................................ 127

3. Additional Demographic and Background Characteristics
of Sample........................................................................... 128

4. Reliability Estimates: Internal Consistency (Cronbach's Alphas
and Spearman-Brown) Coefficients for Study Measures..................... 133

5. Descriptive Statistics for Major Study Variables.............................. 138

6. Bivariate Correlations Between Major Study Variables..................... 140

7. Forced Entry Logistic Regression for Variables Predicting
Self-Efficacy for Negotiating Safer Sex Behaviors (Model 1).............. 142

8. Forward Stepwise Logistic Regression for Variables Predicting
Self-Efficacy for Negotiating Safer Sex Behaviors (Model 2).............. 143
XI


LIST OF FIGURES
Page

1. Theoretical Model: Influence of Select Demographic Variables,
Self-Esteem, and Self-Silencing on Self-Efficacy for Negotiating
Safer Sex Behaviors in Urban Bahamian Women............................ 23
Xll


CHAPTER I
INTRODUCTION

Background of the Study

Bahamian women were at risk for acquiring HIV-infection from the time it

was first discovered in The Bahamas in 1985 since the virus has primarily been

spread through heterosexual transmission in Caribbean countries. In fact, the first

case of HIV/AIDS in The Bahamas was discovered during an autopsy of a female

cadaver (Gomez, 2002). As in most of the world, women in The Bahamas

represent the fastest growing segment of the population with HIV/AIDS.

Moreover, HIV/AIDS is the leading cause of death for Bahamian men and women

between the ages of 15 and 44 years (American Foundation for AIDS Research

[AMFAR], 2001; Campbell, 2001). As of December 31, 2002, The Bahamas had

a cumulative number of 9,329 reported cases of HIV/AIDS. Of these cases, 3,120

(34%)) have already died, and 4,162 (45%)) are women (Health Information and

Research Unit, 2003).

Among the hardest hit regions in the world, second only to Sub-Saharan

Africa (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2001), The

Bahamas has the highest annual incidence of HIV/AIDS in the English Speaking

Caribbean (Campbell, 2001). The Bahamas continues to report almost 400 new

cases of HIV per year in a population of just over 304, 000, of which 51%) are

women (Department of Statistics, 2001). The large number of new cases, coupled

with unreported cases, suggest a daunting future for Bahamian women and

Bahamian society at large. Although the Bahamian government responded very

early to the threat of HIV/AIDS with the establishment of a National HIV/AIDS


1


program to address the epidemic through surveillance, public education, blood




banking, and research, Bahamian women continue to have an increasing rate of




HIV infection (Campbell, 2001).




Unable to find a cure for HIV/AIDS, researchers have focused their attention




on prevention efforts by identifying risks factors (Cummings, Battle, Barker, &




Krasnovsky, 1999; Deren, Shedlin, & Beardsley, 1996; Kusseling, Shapiro,




Greenberg, & Wenger, 1996; Pulerwitz, Gortmaker, & DeJong, 2000) and




developing prevention interventions (Card, Benner, Shields, & Feinstein, 2001;




Dancy, 1996; John Hopkins AIDS Service, 2002; Morin & Charlebois, 2000).




Despite these numerous efforts, HIV rates in women all over the world continue




to escalate.




Global health organizations such as UNAIDS, World Health Organization




(WHO), and the Centers for Disease Control (CDC) have developed and




disseminated social policies and preventive strategies to decrease the HIV




acquisition rate and prevent transmission among women in countries around the




world. However, these strategies have been found to be unsuccessful in many




countries where they were adopted. Scientists soon shifted their efforts to address




gender and cultural issues such as those that influence women's personality and




behaviors and increase their risks for HIV/AIDS (Amaro & Raj, 2000).




As a part of the early response in The Bahamas to the HIV/AIDS pandemic,




national initiatives to enhance public knowledge concerning HIV/AIDS were




established. However, research initiatives have mainly focused on preventing




mother to child transmission (MTCT) through the availability of antiretroviral
2


drugs and discouragement of breastfeeding among HIV-infected mothers. While




this prevention initiative has shown success by decreasing the MCTC rate from




30%) to 10%) (Campbell, 2001), the rate of new HIV infection cases is rapidly




rising among Bahamian women.




There has been a paucity of research conducted in The Bahamas related to




HIV/AIDS. The few HIV/AIDS studies conducted in The Bahamas have mostly




been related to ongoing drug trials (e.g., ACTG 076 ) (Campbell, 2001) and




trends of HIV/AIDS, genital ulcer disease (GUD), and crack cocaine use




(Bauwens et al., 2002; Gomez, Bain, & Read, 1992; Gomez et al., 2002). One




study assessed the characteristics of HIV-infected pregnant women between 1990




and 1991 to determine associative risk factors for HIV/AIDS (Gomez, Bain,




Major, Gray, & Read, 1996). However, few studies have addressed the




characteristics of Bahamian women that may or may not put them at risk for




HIV/AIDS.




The Bahamas, like most other developing countries, depends on scientific




data pertaining to HIV/AIDS gathered from other countries such as Canada, the




United Kingdom, and the United States to establish national prevention initiatives.




Although Bahamians in general and Bahamian women in particular are usually




exposed to a cadre of HIV/AIDS educational programs through church meetings,




school meetings, professional clubs, and other social gatherings as well as in the




work environment and through media, new cases of HIV among Bahamian




women continue to be reported.
3


Prevention initiatives adopted from other countries are not reducing




acquisition and transmission of HIV/AIDS among Bahamians in general or




Bahamian women in particular. As a result, the healthcare and social system have




suffered the burden caused by escalating numbers of HIV-infected individuals,




lack of healthcare and socioeconomic resources, and limited numbers of available




healthcare professionals, particularly nurses. As stated by Gomez, Director of the




National AIDS program in The Bahamas, ".. .and unless we stem this disease,




there will be severe socioeconomic impacts" (AMFAR, 2001, p. 1).




In addition to childbearing, women have the roles of caregiving and




childrearing in The Bahamas. Moreover, the majority of Bahamian children are




raised solely by their mothers. Therefore, infection with HIV/AIDS negatively




impacts these women's roles resulting in decreased quality of life not only for




infected women but (also) for their children and spouses (Neely-Smith, 2002).




Statement of Purpose




The beliefs that prevention is paramount in the fight against HIV/AIDS and




that the most effective ways to prevent HIV are to identify risk behaviors are




shared globally by numerous researchers (Amaro & Raj, 2000; Jenkins, 2000;




Malow, Cassagnol, McMahon, Jenning, & Roatta, 2000; Quirk & DeCarlo, 1998).




However, holistic prevention approaches must be undertaken to include gender




and culturally specific strategies to enhance effective interventions (Amaro & Raj,




2000; Centers for Disease Control and Prevention [CDC], 1995).




In an effort to develop and implement gender and culturally specific




prevention interventions for Bahamian women, it is imperative to understand the
4


factors that may enhance or impede their self-efficacy for negotiating safer sex




behaviors. Numerous qualitative and quantitative studies from other countries




have already addressed women's risk factors for HIV/AIDS. Most have purported




that women's risk for HIV from heterosexual transmission is directly related to




culture, gender, and race/ethnicity factors (Beadnell, Baker, Marrison, & Knox,




2000; Brunswick et al., 1993; Dolcini, Catania, Choi, Thompson Fullilove, &




Coates, 1996; Erickson, 1997; Malow et al., 2000; Nyamathi, Flaskerud, & Leake,




1997; Ohva, Rienks, & McDermid, 1999; Roberts, 1999; Rose, 1995;




Ruangjiratain & Kenall, 1998; Salgdo de Snyder, Diaz Perez, & Maldonado,




1996; Schieman, 1998; Simoni, Walters, & Nero, 2000; Weir, Roddy, Zekeng,




Ryan & Wong, 1998; Williams, 1991; Wyatt et al., 2000). Although researchers




have been investigating concepts and behaviors such as self-esteem (Anderson,




2000; Fife & Wright, 2000; 0x1 ey, 2001), self-silencing (DeMarco, Johnson,




Fukunda, & Deffenbaugh, 2001; DeMarco, Miller, Patsdaughter, Chisholm, &




Grindel, 1998; Koutrelakos, Baranchik, & Damato, 1999), and self-efficacy




(Lindberg, 2000; McMahon, Malow, Jennings, & Gomez, 2001; Sharts-Hopko,




Regan-Kubinski, Lincolm, & Heverly, 1996), no study has specifically addressed




the influence of self-esteem and self-silencing on self-efficacy for negotiating




safer sex behaviors in women, and more specifically, in Bahamian women.




Research Questions




The following research questions were posed for this study:




1. Is there a relationship between self-esteem and self-silencing in urban




Bahamian women?
5


2. Is there a relationship between self-esteem and self-efficacy for negotiating




safer sex behaviors in urban Bahamian women?




3. Is there a relationship between self-silencing and self-efficacy for




negotiating safer sex behaviors in urban Bahamian women?




4. What are the relative contributions of select demographic variables (i.e.,




age, income, education), self-esteem, and self-silencing behaviors to self-efficacy




for negotiating safer sex behaviors in urban Bahamian women?




Answers to the above questions will assist nurses and other professionals in




The Bahamas and around the world to develop and implement effective gender




and culturally specific interventions to reduce the number of HIV/AIDS cases




among Bahamian women.




Significance to Nursing




In its position statement, the International Council of Nursing (ICN) (2000)




indicated that HIV/AIDS, sexually transmitted diseases (STDs), and women's




health are areas of critical concern for action. Moreover, national nurses'




associations have been urged to participate in sensitizing and educating the public




about HIV/AIDS. With over 7 million nurses in the world (Lutzen, 2000), the




profession has adopted the framework of "Health for All" by the World Health




Organization and, therefore, has been ready to accept the challenges HIV/AIDS




has bought upon the global health care system (Hilfinger Messias, 2001).




As a practice of caring (Bishop & Scudder, 1999), professional nursing




practice involves the maintenance of health, prevention of illness, restoration of




health, and the alleviation of suffering for clients of healthcare. The results of this
6


study will provide impetus for maintenance of health and prevention of illness




(i.e., HIV/AIDS and related illnesses as well as other sexually transmitted




diseases) for Bahamian women. Findings from this study will assist nurses and




other professionals develop and implement gender and culturally specific




interventions for public education and training such as workshops; continuing




education for nursing students, nurses, and other healthcare professionals; patient




teaching; and social policy development. Indirectly, the results of this study will




decrease the stress and strain which exist on the socioeconomic and healthcare




system from the overwhelming and increasing numbers of persons living with




HIV/AIDS in The Bahamas (AMFAR, 2001).




Since the mid 1980s, nursing has joined other healthcare professions in




seeking knowledge about HIV/AIDS through numerous research initiatives




(Goldrick, Baigis, Larsen, & Lemert, 2000). Despite these concerted efforts,




HIV/AIDS continues to challenge humankind in terms of its diversity in methods




of prevention, transmission, and management (UNAIDS/WHO/PAHO, 2000).




Although many strides have been made in the international fight against




HIV/AIDS, there are still many gaps in the global puzzle of HIV/AIDS. These




gaps are mainly due to decreased knowledge concerning personality traits and




social behaviors of specific gender and cultural groups and the influence of these




variables on HIV risk behaviors. The findings from this study can spawn many




other studies related to HIV/AIDS prevention initiative efforts not only in The




Bahamas but (also) in other countries around the world. Study findings will fill in




a major gap in global HIV/AIDS knowledge and add to the body of nursing
7


knowledge. Additionally, findings will bring The Bahamas and the rest of the




world one step closer to conquering the war against HIV/AIDS.




Theoretical Framework




Overview




Although Bahamian women share similarities with other women around the




world and Caribbean women in particular, they share only among themselves the




unique experience of being Bahamian women. However, even within the




Bahamian experience of being a woman, there are differences. Born and raised in




a patriarchal society with embedded racism, sexism, colorism, and classism,




history has placed upon Bahamian women traditional practices and cultural mores




which greatly influence their personality and behaviors related to their gender




roles. Historically, the role of Bahamian women was considered insignificant and




at best supportive by elite men. Moreover, beside having less social status by




virtue of gender, women were only allowed certain privileges based on their




social class level and skin shade or color (i.e., white, colored-light, or black).




Since the majority of Bahamian women were Black, they basically fell within the




lower-class strata of society (Saunders, 1994).




The 1960s bought on a new meaning to being Bahamian. The victory of a




new Black party provided equal opportunities for all Bahamians related to




educational and employment privileges. Many Bahamians, especially women,




took advantage of new equal opportunities and, as a result, the Bahamian nation




rapidly prospered and a heightened sense of pride developed among Bahamians




(Beardsley Roker, 2000). Although the rapid change in socioeconomic status and
8


equal opportunity provided a better outlook for Bahamian women, historical




baggage of traditional cultural practices of oppression remained dormant within




the psyche of these women, which greatly influenced their personality and




behaviors, particularly in the areas of intimacy and relationships (Tertullien,




1976).




In an effort to understand Bahamian women's personalities and behaviors




related to their risk for HIV/AIDS, it is important to gaze through the lens of




specific concepts as well as cognitive and behavioral theories related to self-




esteem, self-silencing, and self-efficacy. These concepts will form the framework




for this study and will be used as a guide to measurement of variables, analysis,




and interpretation of findings regarding Bahamian women's risk of acquiring and




transmitting HIV/AIDS.




Theory of Self-Esteem




Self-esteem is considered by many clinical scholars to be the evaluative




aspect of the self-concept defined as all aspects of the self, including roles and




identities (Adler, 1997; Burke & Reitzes, 1981; Cast & Burke, 2002;




Coopersmith, 1967; Wylie, 1961). It is believed that self-esteem is a personality




trait that is relatively stable over time and is made up of two dimensions: worth-




based self-esteem and efficacy-based self-esteem (Adler, 1997; Coopersmith,




1967; Gecas & Schwalbe, 1983). More importantly, self-esteem is




conceptualized on a continuum ranging from high to low implying that persons




with high self-esteem are happy, self-loving, and competent individuals who are




more able to deal with life stressors. Conversely, individuals with low self-esteem
9


are less competent, less self-satisfied, and less able to deal with life stressors,




resulting in such negative outcomes such as depression, anxiety, jealously, and




"bad" judgments (Burke & Stets, 1999; Cast & Burk, 2002; Coopersmith, 1967;




Gecas & Schwalbe, 1983; Rosenberg, 1965). In its simplest form, Rosenberg




(1965) defined self-esteem as "a favorable or unfavorable attitude toward the self




(p. 15).




The importance of self-esteem as a part of the self-concept is supported by




the fact that there has been extensive study of self-esteem by many disciplines




(Corning, 2002; Fife & Wright, 2000; Flaskerud & Uman, 1996; Geller,




Srikameswaran, Cockell, & Zaitoff, 2000; Heatherton & Polivy, 1991; Miyamoto




et al., 2001; Peden, Hall, Rayens, & Beebe, 2000; Riccierdelli & McCabe, 2001;




Roberts & Kendler, 1999; Stanley & Murphy, 1997). However, it is important to




view self-esteem within the context of how an individual develops and maintains




self-esteem, which is beneficial to self and society at large.




Expanding on identity theory, defined as "giving meaning to the self in a




social role or situation" (Burke & Stets, 1999, p. 348), Cast and Burke (2002)




developed a theory of self-esteem by integrating the three conceptual ways it has




been investigated: outcome, buffer, and motive. According to Cast and Burke




(2000), one gains self-esteem through the process of self-verification. Self-




verification occurs when there is a match between meaning in the social situation




and one's identity.




Since self-verification is essential to the production of self-esteem, it is




important to understand this process. Cast and Burke (2002) stated that:
10


There are four main conceptual parts to each identity control system: the




identity standard, the comparator, the output, and the input. Identity standards




provide an internal reference for the individual about the meanings and




expectations that are to be maintained. Inputs into the system are the




perceptions of self-relevant meanings in the social environment. The




comparator compares these perceptual inputs with meanings contained in the




standard. The output of the system is meaningful behavior that works to alter




the situation so that a match between self-relevant perceptions and the




situation and meanings contained in the standard is maintained. This is the




self-verification process, (p. 4)




These authors further elaborated:




That the normal operation of a role-identity (self-verification process) results




in behavior that produces a match between self-relevant meanings in the




situation and the meanings and expectations held in the identity standard. The




actions taken to do this constitute the role behaviors of the person occupying




the role, and these behaviors enact/create/sustain the social structure in which




the role is embedded. Perception of the behaviors that are relevant to the




identity the individual is seeking to verify thus become relevant to the




verification of that identity, (p. 5)




Stated another way, an individual's behavior is based on what she or he has




identified as the standard behavior in social situations. However, self-verification




is only possible when the behavior that the individual displayed matches what




another person or group expects the individual's behavior to be.
11


With a view of self-esteem as an outcome. Cast and Burke (2002) contended




that the process of verification affects all individuals or groups involved and




posited that any disturbances in the process will result in negative emotional




responses such as anger, depression, and anxiety. An individual's self-esteem is a




composite of worth-based self-esteem and efficacy-based self-esteem. Self-




verification reinforces an individual's feelings of being accepted and valued,




which enhances worth-based self-esteem. Therefore, the less accepted an




individual feels, the less worth-based self-esteem she or he may have. Efficacy-




based self-esteem, on the other hand, results when the individual realizes his or




her successful behaviors.




From the standpoint of self-esteem as a buffer, once an individual is able




to verify her or his identity with another individual or group, self-esteem is also




elevated. Similarly, when he or she is able to alter or control social situations,




self-esteem is enhanced. However, when there is a disruption in the self-




verification process, self-esteem developed from previous self-verifications will




sustain the individual or will act as a buffer during the times of distress but will




become depleted if the individual does not seek social situations to enhance self-




verification. Although they agreed that self-esteem is highly stable. Cast and




Burke (2002) likened self-esteem to a "reservoir of energy." It will sustain the




individual during disrupted self-verifications but will be depleted without




continued successful self-verifications. In other words, the more successful self-




verifications an individual has, the more self-esteem he or she will have and the




better equipped he or she will be to deal with life stressors.
12


As a motive. Cast and Burke (2002) contended that individuals search for




social situations that will enhance their self-esteem. In other words, individuals




will seek social situations that are likely to result in successful self-verification,




thus increasing self-esteem.




In essence, self-esteem is a positive and important attribute of self-concept




that enhances self-worth and competency and equips the individual to deal with




life stressors more effectively. Although considered a relatively stable trait,




frequent disruptions in the self-verification process can deplete the reservoir




resulting in low levels of self esteem and less self-competence, self-satisfaction,




and an inability to effectively deal with life stressors. However, an individual




develops self-esteem through frequent successful self-verification and by seeking




social interactions that are likely to result in successful self-verification between




individuals and groups.




For the purpose of this study, self-esteem will be measured using Taylor's




Self-Esteem Inventory (TSEI). This instrument was specifically developed for




Black populations, and initial psychometric evaluations were conducted on a




group of predominately (n = 444, 84%)) low-income. Black women (Taylor &




Tomasic, 1996). According to Taylor and Tomasic (1996), self-esteem is the




relative level of rewards and costs a person assigns to his or herself Moreover, a




person is presumed to have a high self-esteem when he or she assigns more




rewards than costs. Conversely, assigning more costs than rewards to the self will




result in low self-esteem. Social exchange theory, which provided the conceptual




framework for the TSEI and was developed by Thibuat and Kelly (1959), is a
13


form of relational theory that basically explains what motivates a person to act.




According to social exchange theory, people act by evaluating a given outcome.




In other words, weighing the benefits between costs and rewards of an outcome




will determine the behavior of an individual. Social exchange theory better




explains interpersonal conflicts and why people chose certain relationships or




behaviors over others than it does how an individual develops and maintains self-




esteem.




Although social exchange theory will not be included in the theoretical




framework for this study, the TSEI will be used to measure self-esteem for the




following reasons: (a) it was developed for Black populations and initially tested




on Black women; (b) it has highly favorable psychometric properties; (c)




according to Barrett (1978), the TSEI correlates high with some of the most




popular and well-utilized measures of self-esteem (i.e., Rosenberg and




Coopersmith inventories of self-esteem) (Adler, 1997), even higher than these




instruments correlated with each other; and (d) although the items are grouped in




costs and rewards dimensions, they fit better with Cast and Burke's (2002) theory




of self-esteem that explains how individual develops and maintains self-esteem.




Theory of Silencing The Self




Jack (1991) developed the theory of silencing the self to explain how




women's silencing behaviors contributed to their depressive states. While many




studies have linked Jack's theory with depression in women (Brody, Haaga, Kirk,




& Solomon, 1999; Carr, Gilroy, & Sherman, 1996; Hart & Thompson, 1996;




Thompson, 1995; Thompson, Whiffen, & Aube, 2001; Vaden Gratch, Bassett, &
14


Attra, 1995), this theory can also be used to explain how women's low levels of




self-esteem may increase self-silencing which may, in turn, put them at risk for




HIV/AIDS.




Expanding upon relational theory (Gilligan, 1982), Jack contended that a




relationship is so important to women that they will conform to any situation, in




this case silencing, to maintain it. Moreover, Jack purported that dependency and




passivity are not why women silence, as suggested by men, but rather that women




silence because of the value they place on relationship and the need to preserve it.




According to Jack (1991), women have many selves, but the self of intimacy is




the most important to women's self-esteem so that loss of this self can lead to




depression.




Historically, cultural mores and traditional practices enforced by social




context within the home have been responsible for socializing girls to view




themselves as inferior to men and weaker than men. Women also put others




before themselves, tend to be submissive to men, hide their true feelings if it




means hurting others or expressing anger, and always try to help and please




others. According to Jack (1991), these cultural practices are so imbedded in the




psyche of women that they become women's "over eye" (i.e., seeing themselves




by social and moral standards set forth by society). Jack contended that the "over




eye" has such strong influence on women that it cause them to neglect their own




values and standards to conform to those of men's. This is done through the




cognitive process of silencing to secure and maintain relationships. By listening to
15


the "over eye," women lose their authentic self which results in feelings of anger,




frustration, guilt, decreased self-worth, and depression.




Jack (1991) maintained that a woman may silence herself to maintain a




relationship that she depends upon to meet her financial needs. Another reason a




woman may silence is to protect the self from abuse and hurt within the




relationship. Fear of loss and rejection from partners are yet other reasons women




engage in silencing behaviors.




Jack (1991) further maintained that listening to the "over eye" results in two




opposing selvesthe divided selfwhich is the main cause of depression. To




take it a step further, since listening to the "over eye" results in loss of the




authentic self, there will be less favorable situations to enhance self-verification




for women. As stated in the theory of self-esteem, low self-esteem can lead to




frequent disruption in the self-verification process (i.e., silencing) which will




deplete the self-esteem "reservoir" and further lower self-esteem. As a result, the




individual may experience feelings of decreased self-worth and competency,




leading to increased silencing behavior. It is important to note that while self-




esteem can affect self-silencing, self-silencing can, in turn, affect self-esteem.




However, the bidirectional effect of self-silencing on self-esteem was not tested in




this study.




Theory of Self-Efficacy




Social Cognitive Theory (SCT), formally Social Learning Theory (SLT),




explains that human behavior is a triadic continuous reciprocal interaction of




personal (i.e., cognitive, affective, and biological), behavioral, and environmental
16


influences. However, the strength of each factor is dependent upon the




individual, the behavior in question, and the situated context in which the




behavior occurs. Moreover, the individual's personal characteristics such as age,




gender, ethnicity, thoughts, emotions, goals, beliefs, expectations, self-evaluation,




and sociocultural factors also influence his or her behavior. Toward this end,




people are seen as both products and producers of their environment (Bandura,




1986; 1989).




Bandura (1989) further asserted that the uniqueness of human beings that




allows them to engage in cognitive activities to achieve desired behaviors are due




to five basic capabilities: symbolizing, vicarious capability, forethought, self-




regulation, and self-reflection. Symbolizing consists of words and images that




give meaning to experiences and allows humans to store and retrieve information




to guide behaviors. Symbolizing capability also allows humans to think about




behaviors and outcomes without acting them out. Vicarious capability allows




humans to learn behaviors through observation. However, learning will only take




place if one is able to pay attention, retain information, and possess ability and




motivation to reproduce the behavior. The ability to self-motivate and guide




actions through anticipation is forethought capability. In other words, humans are




able to cognitively represent the future using present thoughts. The capability of




self-regulation is the internal control that determines which behaviors are




performed. However, social, motivational, and moral standards interact with self-




producing factors to determine chosen behaviors. Self-reflection allows humans to
17


think about and analyze their experience while modifying their thoughts to




achieve desired outcomes.




Self-efflcacy, according to Bandura (1986; 1989), is one of the most




important types of self-reflection. Moreover, it is a major determinant of self-




regulation. It is defined as the self-belief that one is capable and competent in




organizing and performing a desired behavior in a given situation. Bandura (1989)




asserted that people need more than just knowledge and skills to perform desired




behaviors. They need to have self-belief in their ability to exercise personal




control. It is their self-belief that affects what people actually chose to do, the




effort they put into doing it, their ability to persevere, their positive or negative




thought patterns, and the amount of distress they experience during demanding




situations.




Bandura (1986) made a clear distinction between self-efficacy and self-




esteem. He contended that self-esteem is the evaluation of self-worth, where self-




efficacy is concerned with judging personal capabilities; hence, self-efficacy is




task and domain specific. The specificity of self-efficacy is reflected by the




amount of research studies conducted to either determine the level of task and




domain specific self-efflcacy people have (Cerwonka, Isbell, & Hansen, 2000;




Faryna & Morales, 2000; Goh, Primavera, & Bertalini, 1996; Lindberg, 2000;




Wulfert & Choi, 1993) or to determine effective task and domain specific




interventions to enhance self-efflcacy (Clark & Dodge, 1995; Icard, Schilling, &




El-Bassel, 1995; McMahon et al., 2001).
18


According to Bandura (1989), low self-efficacy will cause an individual to




mismanage a situation which may result in negative consequences such as stress




and depression. To enhance an individual's self-efficacy, it is important to




understand how one gains and loses self-efficacy. The more a person succeeds at




performing the desired behavior, the higher or stronger her or his self-efficacy




will be. Conversely, the more a person fails at performing the desired behavior,




the lower or weaker his or her self-efficacy will be. However, if a person has




strong self-efficacy, occasional failures will not have much effect on judgment of




their capabilities. It is important to remember that efficacy is task and domain




specific so that a person may have a low or weak self-efficacy in one domain of




her or his life while also have a strong or high efficacy in another domain. An




individual can also gain or lose self-efficacy vicariously by observing others who




are comparable to themselves succeed or fail at performing behaviors. However,




observing failure by another person who was perceived as competent could result




in low self-efficacy for the observer. Verbal persuasion is another way an




individual can gain self-efficacy. The caveat is that unrealistic beliefs of personal




ability can lead to failure and loss of self-efficacy. Lastly, an individual's physical




state such as agitation, nervousness, and anxiety can cause dysfunction while




performing a behavior, resulting in failure and loss of self-efficacy. Bandura




(1989) maintained that successive achievements in the desired behavior, "requires




strong self-belief in one's efficacy to exercise personal control" (p. 26).
19


Relationship of Theoretical Framework to Study




Bahamian women's personalities are shaped by Bahamian cultural mores and




traditional practices sanctioned by society and enforced by strong religious faith




and parental up-bringing, particularly by their mothers. Historical customs of




racism, colorism, classism, and gender inequality have socialized Bahamian girls




to view themselves as being inferior to others; to neglect their needs and ensure




the needs of others are met; to nurture and care for the family and keep the house;




to suppress their true feelings in order not to hurt others; to please their spouses




and ensure their spouses' happiness; to be submissive to their spouses; and to bear




their spouses' children.




There were numerous times in the history of The Bahamas when men had to




leave their families in search for work. While some of them returned, others never




came back to their families (Saunders, 1994). Always desiring the best for their




children, Bahamian women struggled in a man's world to ensure a roof over their




children's head and food on the table (Tertullien, 1976). More recently, although




there are almost as many men as women in The Bahamas, the availability of men,




owing to incarceration and other social problems, leave most women to fend




alone for their children (Neely-Smith, 2002). Additionally, given the fact that




Bahamian men were socialized to prove their manhood by the number of sexual




partners coupled with Bahamian women's need for intimacy and relationship,




Bahamian women succumb to spousal sharing (McCartney, 1971). Moreover,




Bahamian women conform to female normative behaviors sanctioned by the




Bahamian patriarchal society to secure relationships.
20


Historical and present social context which helped to shape the demographics




of Bahamian women have had direct impact on their levels of self-esteem.




However, it is believed that instead of Bahamian women seeking social situations




that will lead to successful self-verification and, thus, increased self-esteem, they




comply with cultural and societal sanctioned female normative behaviors for fear




of losing intimate relationships. As a result, they silence themselves and




manipulate their internal cognitive structures in hopes of achieving verification




from their spouses. However, these women are never truly self-verified because




of the battle between the divided self They display compliant behaviors with their




spouses and gain their approval, but self-verification does not occur in women




because the process is faulty. Therefore, repeated faulty self-verification




processes lead to depletion of these women's already low self-esteem reservoir,




resulting in even lower levels of self-esteem.




It was hypothesized that self-esteem and silencing behaviors affect Bahamian




women's self-efficacy for negotiating safer sex behaviors. Bandura (1989)




asserted that decreased risk for HIV requires a sense of personal power and




control over sexual relationships. This means having the ability to manage




interpersonal relationships, which is believed to be difficult for Bahamian women.




Like many women around the world, Bahamian women probably are not able to




control sexual relationships for numerous reasons. First, they were socialized to




take a passive role during sexual activities. Additionally, Bahamian women deny




men's ability to be unfaithful, and they develop a false trust in an effort not to




"rock the boat." Sometimes these women are over-powered by men and forced to
21


engage in sexual activities but do not seek help for fear of embarrassment and loss




of relationship. Situational constraints such as depending upon men for finances




to meet the needs of self and children also hinder these women's abilities to




negotiate in sexual activities. However, it is mostly Bahamian women's fear of




rejection and loss of relationships that lead to their inability to control sexual




relationships.




It was believed that Bahamian women who have low self-esteem, high self-




silencing, and less self-belief that they have the power to control sexual situations




wouil, therefore, comply to sexual demands of their partners in an effort to please




them and secure intimate relationships. This compliant behavior is what put




Bahamian women at risk for HIV. Additionally, Bahamian women's inability to




succeed in controlling sexual situations leads to decreased self-efficacy for




negotiating safer sex behaviors. It is important to note, that because the




predominant mode of HIV transmission in The Bahamas is through heterosexual




transmission (96.2%)) (Gomez et al., 2002), Bahamian women's risk for HIV




basically lies in their efficacy in negotiating sexual activities.




Only when Bahamian women begin to seek out social and sexual situations




that will enhance their self-verification process (i.e., relationship change) will




they produce self-esteem to refill the reservoir. It was hypothesized that Bahamian




women's increased levels of self-esteem would lead to a decrease in their




silencing behaviors which would directly increase their self-efficacy for




negotiating safer sex behaviors. Toward this end, this study sought to understand
22


the influence that self-esteem and self-silencing have on self-efficacy for

negotiating safer sex behaviors in urban Bahamian women (Figure 1).
Select
Demographic
Variables (ie,
age, income,
education)
Figure L Theoretical Model: Influence of Select Demographic Variables,
Self-esteem, and Self-silencing on Self-efflcacy for Negotiating
Safer Sex Behaviors.

Assumptions

For the purpose of this study, it was assumed that:

1. Race and gender inequality are subtlety embedded in the minds of most

Bahamian women.

2. Older Bahamian women are more submissive in their intimate

relationships than are younger Bahamian women.

3. Well educated Bahamian women are more assertive in their intimate

relationships than are Bahamian women with less education.

4. Bahamian women with low income are very dependent on their spouses

for financial support.
23


5. Bahamian women care more about others than they do about themselves.




6. Bahamian women have a great need for intimacy and relationship.




7. Bahamian women tend to be very competitive with other women for




intimate relationships.




8. Bahamian women tend to be assertive in other aspects of their lives except




with intimate relationships.




9. Bahamian women generally love their spouses more than they love




themselves.




10. Bahamian women tend not to express their true feelings with their




spouses.




11. Bahamian women tend to deny that their partners are having affairs




despite evidence.




12. Bahamian women generally lack condom negotiation skills or do not like




using condoms.




13. Bahamian women would respond honestly to self report measures.




14. Selected study measures are gender as well as culturally appropriate and




sensitive.




Definition of Terms




Urban Bahamian Woman




Conceptual definition. An urban Bahamian woman is conceptually defined as




a woman who was born in The Bahamas and resides on the island of Nassau or




Freeport, Grand Bahama.




Operational definition. In this study, an Urban Bahamian woman was
24


measured by a nominal-level item on residence in either Nassau or Freeport,




Grand Bahama on the demographic instrument.




Self-Esteem




Conceptual definition. Self-esteem is conceptually defined as "the relative




level of rewards and costs individuals distribute to themselves. Persons high in




self-esteem are presumed to distribute more rewards than costs to themselves




than do persons low in self-esteem" (Taylor & Tomasic, 1996, p. 296).




Operational definition. In this study, self-esteem was measured by the




Taylor's Self- Esteem Inventory, a 16-item inventory with eight positive and eight




negative items. After reverse scoring of negative items, higher total inventory




scores indicated higher self-esteem (Taylor & Tomasic, 1996).




Silencing The Self




Conceptual definition. Self-silencing is conceptually defined as the ability of




a woman to withhold certain feelings, thoughts, and actions in an effort to create




and maintain safe, intimate relationships (Jack & Dill, 1992).




Operational definition. In this study, self-silencing was measured by the




Silencing The Self scale (STSS), a 31-item scale with four subscales (i.e..




Externalized Self-Perception, Care as Self-Sacriflce, Silencing the Self, and The




Divided Self) developed to measure types of women's silencing. The higher the




total STSS score, the greater the degree of silencing (Jack & Dill, 1992).




Self-Efficacy for Negotiating Safer Sex Behaviors




Conceptual definition. Self-efflcacy is conceptually defined as a self-belief




that one is capable and competent in organizing and performing desired behavior
25


in a given situation (Bandura, 1989). More specifically, it is the degree of




confidence that urban Bahamian women have in their perceived ability to




negotiate safer sex behaviors with intimate partners (i.e., sexual behaviors that




will prevent or decrease HIV/AIDS acquisition and transmission).




Operational definition. In this study, self-efficacy for negotiating safer sex




behaviors was measured by the Self-Efficacy Scale, a 12-item scale with three




subscales (i.e.. Refusal, Condom Use, and Discussion). The higher the total scale




score, the higher the self-efficacy for negotiating safer sex (Dilorio, Maibach,




O'Leary, Sanderson, & Celentano, 1997).




Research Hypotheses




The sociocultural context of Bahamian women's lives coupled with




theoretical foundations have contributed to the following hypotheses for this




study:




1. There will be a negative relationship between urban Bahamian women's




self-esteem and self-silencing behaviors.




2. There will be a positive relationship between urban Bahamian women's




self-esteem and self-efficacy for negotiating safer sex behaviors.




3. There will be a negative relationship between urban Bahamian women's




self-silencing and self-efficacy for negotiating safer sex behaviors.




4. Age, income, education, self-esteem, and self-silencing will make




significant independent and combined contributions to self-efficacy for




negotiating safer sex behaviors in urban Bahamian women.
26


Scope and Delimitations of the Study




The sample for this study was drawn from women who were born in The




Bahamas or have lived in The Bahamas for more than 10 years and resided on an




urbanized island of the Bahamas, where approximately 80%) of the population




reside (Department of Statistics, 2001). These women were 18 years or older




because the legal age in The Bahamas is 18 years and also because the sampling




procedure was one of convenience in which participants were recruited at various




public sites that Bahamian women visit frequently. Additionally, the sample was




drawn from a heterogeneous population with respect to their age, income,




education, employment, marital status, number of dependents, and HIV/AIDS




status.




Data were collected from urban Bahamian women on the variables of




demographic characteristics (i.e., age, income, education) self-esteem, self-




silencing, and self-efficacy for negotiating safer sex behaviors. Bivariate




statistical techniques were used to test relationships between and among




demographic and major study variables. Multivariate statistical techniques were




also used to identify the degree to which individual and combined variables




predict self-efficacy for negotiating safer sex behaviors in Bahamian women.




Limitations of the Study




Since convenience sampling was used to collect data for this study, there may




have been sampling bias, thus, limiting the ability to generalize findings.




Additionally, since data were collected over a three week period in numerous




public settings, there was a possibility that some women may have filled out the
27


survey more than once. Another limitation of the study was the possibility that




missing data or inaccuracies on self-report measures may have affected findings.




Summary




The rapidly increasing rate of HIV/AIDS among Bahamian women is




daunting for the future of Bahamian society. Despite many concerted efforts,




scientists have been unable to find a cure for HIV disease and are faced with the




multiple challenges that treatment and management strategies bring for persons




living with AIDS. As a result, there is a major focus on HIV prevention.




However, many prevention strategies have been ineffective with women and




particular cultural groups, and the rates of HIV/AIDS continue to rise around the




world.




To enhance effectiveness of prevention strategies, it is imperative to develop




interventions that are gender appropriate and culturally sensitive. In essence, by




understanding the personal characteristics of Bahamian women such as self-




esteem and self-silencing, which may or may not be related to their self-efficacy




for negotiating safer sex behaviors, gender and culturally specific preventive




measures can be developed and implemented in an effort to reduce acquisition




and transmission of the disease.




Chapter two will present a review of the literature to delineate the context




with what is know about this area of study. It will begin with a global overview




of HIV/AIDS and women in general and Bahamian women in particular from an




epidemiological standpoint. Additionally, quantitative and qualitative studies
28


related to women's risk factors for HIV/AIDS as they relate to the major variables




of this study will be summarized and critiqued.




Chapter three will present the research methodology for the study. The




design, sampling techniques, instruments that were used to measure the major




variables and their appropriateness to this study, ethical considerations, data




gathering procedure, and data analysis techniques will be described and justified.




Chapter four will present the results of the study. Description of the sample




including response rate and post hoc power analyses, exploratory data analysis




including measurement assessments and descriptive findings, and hypotheses




testing will be provided.




Chapter five will present a discussion of findings and conclusions of the




study. The results will be interpreted and discussed related to demographic and




background characteristics of the participants, the relationship between major




study variables, and significant and nonsignificant predictors of self-efficacy.




Additionally, limitations of the study and implications for nursing education,




practice, and future research will also be discussed.
29


CHAPTER II




REVIEW AND CRITIQUE OF THE LITERATURE




Introduction




This chapter will address HIV/AIDS epidemiology, risk for acquiring and




transmitting HIV/AIDS, and the major variables of the study as they relate to




women. First, the epidemiology of HIV/AIDS related to women globally, women




in Latin America and the Caribbean, and Women in The Bahamas will be




discussed. In addition, this chapter will evaluate factors that increase women's




risk for HIV/AIDS using qualitative and quantitative studies to support the




discussion. Lastly, the study major variables, self-esteem, self-silencing, and self-




efficacy for negotiating safer sex behaviors, will be discussed in relation to




women in general and specifically to their risk for HIV/AIDS. Qualitative and




quantitative studies in these areas will be summarized and critiqued. It is




important to note, however, that the small number of studies conducted with




Bahamian women related to the major study variables will limit discussion with




respect to this specific population.




A literature search was conducted in numerous disciplines to gather




information. Databases searched include Psychlnfo, Eric, Proquest, Ovid,




Medline, MedPub, CINAHL, HAPI, Dissertation Abstracts, and Psychological




Abstracts. Additionally, the Internet was explored using Google and Yahoo search




engines, authors of instruments used in this study were contacted for




bibliographies, and article reference lists were used to obtain appropriate research





30


studies that helped to provide a rich literature base to support this study. Research




studies and theoretical articles as well as books and book chapters written in




English were explored using various time frames from 1970 to 2003, depending




on whether the title, subject, or author's names were used to conduct the search.




Keywords and phrases used were (a) HIV risk and women, (b) HIV risk and




Black women, (c) Bahamas and HIV/AIDS, (d) self-esteem and women, (e) self-




esteem and Black women, (f) self-esteem and Bahamian women, (g) self-esteem




and risk for HIV/AIDS, (h) self-esteem and self-silencing, (i) self-esteem and




self-silencing and women, (j) self-esteem and self-silencing and Black women, (k)




self-silencing and risk for HIV/AIDS, (1) self-esteem and self-efficacy for




negotiating safer sex behaviors and women, (m) self-esteem and self-efficacy for




negotiating safer sex behaviors and Black women, (n) self-silencing and self-




efficacy for negotiating safer sex behaviors and women, (o) self-silencing and




self-efficacy for negotiating safer sex behaviors and Black women, (p) self-




efficacy for negotiating safer sex behaviors, and (q) self-efficacy and HIV/AIDS.




Additionally, names of authors and instruments that were used in this study were




also searched. These include Taylor's Self-Esteem Inventory (Taylor & Tomasic,




1996), Jack and Dill (1992) Silencing The Self Scale, and Dilorio et al.'s (1997)




Self-Efficacy Scale. Other keywords used to gather information for this study




were, "Bahamian women," "Black women," and "Caribbean women."




HIV/AIDS Epidemiology Related to Women




Global
31


Declared as the most devastating disease ever to affect humankind, an




estimated 42 million persons in the world were living with HIV/AIDS disease by




the end of 2002, including 5 million new cases in 2002. In Sub-Saharan Africa




alone, over 29 million Africans are living with HIV/AIDS. Moreover, the




prevalence rates among pregnant women have exceeded 30%) (UNAIDS/WHO,




2002). Most daunting is the fact that the majority of new cases of HIV are seen in




women, particularly young women. In Canada, for example, new cases of HIV




among women have increased from 8.5%) in 1995 to a soaring 20%) presently




(UNAIDS/WHO, 2002). In the US, Blacks make up 13% of the US population,




yet they comprise 38%) of the HIV/AIDS cases. For example, although women are




the fasting growing population with HIV/AIDS in the US, as in the rest of the




world. Black women are disproportionately affected. Black women make up an




estimated 64%) of new cases of HIV annually compared to their White and




Hispanic counterparts who make up only 18%) and 18%), respectively (CDC,




2002). As a result of the pervasive effect of HIV/AIDS, countries barely affected




by this disease only a decade ago are now reporting escalating numbers. For




instance, Indonesia, China, and some Eastern European countries (e.g., Estonia,




Russian Federation, and the Ukraine) which reported low rates of HIV/AIDS just




a decade ago are now seeing increases in HIV/AIDS cases within the general




population and specifically among groups with high risk behaviors such as female




sex workers and intravenous drug users (IDUs) (CDC, 2002; UNAIDS/WHO,




2002).




Regional: Latin America and the Caribbean
32


Although only 8% of the world's population lives in Latin American and the




Caribbean, there are approximately 1.8 million people in Latin America and




420,000 people in the Caribbean presently living with HIV/AIDS, and women




comprise the majority of new cases. Moreover, the Caribbean is the second most




HIV/AIDS affected region in the world, and AIDS is the leading cause of death in




some Caribbean countries (UNAIDS, 2002). To take a closer look at the effects of




HIV/AIDS on Caribbean women, given that heterosexual transmission is the




predominate mode for HIV infection in the Caribbean and that women are at




greater risk for acquiring HIV/AIDS than are men, it is no surprise that new cases




of HIV/AIDS are escalating among these women. For instance, Haiti, one of the




affected countries in the Caribbean, has 6% of the adult population living with




HIV/AIDS (AMFAR, 2001). Moreover, it was reported that 1 in every 10 Haitian




women living in Haiti may be infected with HIV/AIDS. Other Caribbean and




Central American countries such as the Dominican Republic, Barbados, Belize,




Guyana, and Honduras have reported HIV prevalence rate of at least 1% (IPS-




Inter Press Service, 2001; UNAIDS/WHO, 2002).




Local: The Bahamas




Second only to Haiti with a prevalence of almost 4%, The Bahamas have the




highest incidence of HIV/AIDS in the English speaking Caribbean (Campbell,




2001; UNAIDS/WHO, 2002). A small country with just over 304,000 people, of




whom 51%) are women (Department of Statistics, 2001), The Bahamas has




reported a cumulative number of 9,329 cases of HIV/AIDS as of December 31,




2002 (Health Information and Research Unit, 2003). In addition to women being
33


the fastest growing segment of the population with HIV/AIDS, they make up 45%)




of the total cases of HIV/AIDS in The Bahamas. Along with such a high rate of




HIV/AIDS per capita. The Bahamas continues to report almost 400 new cases of




HIV/AIDS per year. Moreover, HIV/AIDS is the leading cause of death for




Bahamian women and men between the ages of 15 to 44 years (Campbell, 2001).




What do these soaring HIV/AIDS numbers mean for women in the world in




general and women in The Bahamas in particular? The high rates of HIV/AIDS




among women mean that unless effective prevention interventions including




gender appropriate and culturally sensitive strategies are developed and




implemented to reduce the number of women becoming infected, HIV/AIDS rates




among women will continue to escalate, more infants will become infected with




HIV/AIDS through MTCT, and more women will die leaving an unbearable




socioeconomic burden on society due to increasing numbers of orphanages.




However, gender and culturally specific prevention interventions for women




cannot be developed without first identifying sociocultural, socioeconomic, and




intra- and interpersonal characteristics that put women at risk for HIV/AIDS.




Women's Risk for HIV/AIDS




In an effort to reduce the number of HIV/AIDS among women, it is




imperative to identify factors that put them at risk for this disease. Despite




women's knowledge about risk factors for HIV/AIDS, Black and other ethnic




minority women in particular still engage in high risk behaviors for HIV (Dolcini




et al., 1996; Malow et al., 2000; Moore, Harrison, & Doll, 1994; Salgado et al.,




1996; Ward & Samuel, 1999). Therefore, it is important to determine the factors
34


that make women vulnerable to HIV-infection and why some women are unable




to resist such high risk behaviors.




There are a myriad of behavioral factors that increase women's risk for




HIV/AIDS, some of which will be discussed briefly in this chapter. However, the




major focus of discussion will be on major variables of this study: select




demographic variables (i.e., age, income, education), self-esteem, self-silencing,




and self-efflcacy for negotiating safer sex behaviors.




Biological Risks




Women have a greater risk than men for HIV/AIDS by virtue of their




biological make-up. For example, women's increased vaginal surface area




coupled with the possibility of contracting sexually transmitted diseases (STDs),




which can cause disruption in the integrity of the vaginal mucosa and which are




sometimes asymptomatic, place women at greater risk than men for HIV/AIDS




(Cochran, 1989; Holmberg, 1997). Moreover, it was estimated that women are




eight times more likely to contract HIV/AIDS from a man than for a man to




contract HIV/AIDS from a woman (Brunswick et al., 1993; Quirk & DeCarlo,




1998).




Behavioral Risks




There are many behavioral factors that put women at risk for HIV/AIDS.




However, these behavioral factors are mediated by socioeconomic, sociocultural,




intrapersonal, and interpersonal (relational) factors. These factors help explain




why women engage in risky sexual behaviors with their male partners. One of the




reasons for women's risky sexual behaviors is that some women trust their
35


partners to be monogamous and, therefore, do not perceive themselves to be at




risk for HIV/AIDS, especially if they are married or in a long-term relationship.




For instance, a focus group study was conducted in Haiti to determine prevailing




norms and the capacity of Haitian women to negotiate sexual behavior change.




Haitian women in this study admitted to being afraid of contracting HIV/AIDS




but not through unprotected sex. These women were more afraid of becoming




sick and of the possibility of receiving HIV-infected blood in hospitals as a means




of contracting the disease. As a matter of fact, some of these women considered




themselves not only to be in trusting relationships but (also) as having an added




assurance that God will take care of them because of their claim to Christianity




(Ulin, Cayenutte, & Metellus, 2002). Similarly, Ward and Samuels (1999)




reported on a community-based study conducted in The Bahamas with 236




participants including males (n = 61, 26%)) and females (n = 175, 74%)) to




determine the socioeconomic factors that make women more vulnerable than men




to HIV/AIDS. Although the average age of first sexual encounter was 16.3 years




and the number of sexual partners in the past year ranged from 0 to 20, almost




three fourths (n = 190) of the sample thought that their risk for HIV/AIDS was




low. The remainder of the sample thought that their risk for HIV/AIDS was either




moderate or high. Consistent with these findings on perceived risk, only 47




women (29%)) in the sample stated that they always used condom during sexual




encounters.




Despite women's trust in their partners or spouses, some partners or spouses




are not honest about their sexual risk factors. For example, Stokes, MCKirnan,
36


Doll, and Burzette (1996) conducted a study with 350 bisexual men between the




ages of 18 to 30 years. These investigators found that up to 71%) of the




participants' female partners were unaware of their bisexual behaviors. Similarly,




Robins, Dew, Kingsley, and Becker (1997) conducted a study with 525




homosexual men, among whom 156 (29.7%)) were HIV positive, and found that




regardless of the participants' HIV status, they reported that they placed others at




risk for HIV/AIDS.




From the beginning of the HIV/AIDS epidemic, injecting drug users (IDUs)




were classified among the high risk groups (Cochran, 1989). Today, although




many women are not IDUs, because the major mode of transmission for




HIV/AIDS among women is by heterosexual transmission (UNAIDS/WHO,




2002), women who are sexual partners of IDUs are at risk for HIV/AIDS. For




example, in a study conducted in Southern Arizona with 123 female partners of




IDUs of whom 80%) belonged to ethnic minority groups, Erickson (1997) found




that these women predominately engaged in unprotected sexual behaviors with




their IDUs partners. These findings are disturbing since more recent empirical




studies continue to link intravenous injecting drug use as a predictor of HIV




seropositivity (Huba et al., 2000).




Noninjectable drugs such as alcohol, crack cocaine, and marijuana can




decrease women's decision-making capability during sexual encounters and,




therefore, can indirectly place them at risk for HIV/AIDS. In a study conducted




by Graves and Hines (1997), data were collected from two samples of racially




mixed adults. In the first sample, there were 2,247 participants including 804
37


Whites (35.8%), 737 Blacks (32.8%), and 706 Hispanics (31.4%). In the second




sample, there were 583 participants including 177 Whites (30.4%)), 189 Blacks




(32.4%)), and 217 Hispanics (37.2%)). The investigators examined the link




between alcohol consumption and risky activity with a new sexual partner in these




racially mixed samples. Among other findings, the investigators reported that




drinking was a predictor of not using condoms with casual partners among




women. In contrast, Scheldt and Windle (1996) conducted a study with 802




inpatient participants in five alcohol treatment centers to evaluate the relationships




between their personal situation variables and sexual risk behaviors. Although this




was a mixed group, of which 331 of the participants were women and 562 were




Black (70%)), findings from t-tests suggested that although men reported alcohol




use during the previous six months with nonprimary partners [^(148) = 3.68,/? <




.001] with greater frequency than did women [^(105) = 2.20, p< .05], both male




and female participants also used condoms more in those situations [^(148) =




6.23, P < .001 for men and t(\05) = 6.70, p< .05 for women].




Crack cocaine is another noninjecting drug that puts women at risk for




HIV/AIDS, mostly because women engage in frequent unprotected sexual




behaviors as a result of either decreased cognition or to exchange sex for drugs




(Richard, Bell, & Montoya, 2000). In a retrospective case-control study conducted




in The Bahamas representing 835 cases from 1985 to 1990, including 304 women




(40%)), Gomez et al. (2002) assessed the relationships among crack cocaine use,




genital ulcer disease (GUD), and HIV infections and concluded that case-control




analysis linked crack cocaine use, GUD, and HIV-infections. The odds ratio
38


between GUD and cocaine use increased from 1.2 (95%) CI, 0.7-2.0) to 1.6 (95%)




CI, 1.0-2.6) and 3.5 (95% CI, 1.9-6.4) in 1988 and 1990, respectively.




Additionally, the investigators reported that the highest odds ratio for cocaine use




to HIV infection was 8.1 in 1987 but has decreased thereafter. The investigators




concluded that the resurgence of increased transshipment of cocaine through the




Caribbean islands may be responsible for the present increases in new HIV/AIDS




cases in the region.




Abusive relationships are also a factor that put women at risk for HIV/AIDS




because women are either given decreased power or perceive themselves as




having decreased sexual negotiation powers. Pulerwitz et al. (2000) conducted




focus groups with 388 women at a community health clinic to develop an




instrument that measures sexual relationship powers and found that the more




physical violence these women reported, the less sexual relationship power they




had. Similarly, Beadnell et al. (2000) conducted a study that compared nonabused




(n = 70, 42%)), emotionally abused (n = 70, 42%)), and physical abused (n = 27,




16%)) women in primary relationships to determine their risk factors for HIV and




STDs and concluded that abused women were at greater risk for STDs, were more




likely to be raped, and were more likely to engage in sex for pay.




It is important to note, however, that stigma is also among the reasons for




women's risk for HIV/AIDS. According to Schieman (1998), some women might




not perceive themselves to be at risk for HIV because of the distance they place




between themselves and high risk groups such as homosexuals, prostitutes, and




IDUs. As a result, these women may engage in unprotected sex.
39


Among the cadre of factors that put women at risk for HIV/AIDS are




sociocultural and socioeconomic, intrapersonal, and interpersonal factors such as




self-esteem, self-silencing, and self-efficacy for negotiating safer sex behaviors.




The major study variables will be the focus for discussion in later sections of this




chapter.




Sociocultural Risks




Triandis and Suh (2002) stated that the elements of a culture are shared




values, standards, assumptions, norms, tools, and habits and that culture develops




conventional laws which determine what and to what extent information in the




environment is sampled. As one of the conventions, women's roles are sanctioned




by culture and society. Historically, women have held the role of childbearers,




childrearers, homemakers, and partner pleasers, although Loo and Thorpe (1998)




have reported a significant liberalization in attitudes toward women's roles in




society. The women's liberation movement of the 1960's and 1970's was the




impetus for some women taking control over their lives (i.e., reproductive




decision-making as well as education and employment opportunities). Despite




women's struggle for liberation, their attitudes, beliefs, and behaviors are still




bonded by cultural norms and traditional practices, which in turn affect their risk




for HIV/AIDS. Noteworthy is the fact that Black women come from a long




history of sexism, racism, colorism, and classism which have led to their




oppressive states and put them more at risk for HIV/AIDS than women of other




races (Trotman Reid, 2000). This statement is validated by the reported soaring




numbers of cases of HIV/AIDS among Black women in the world.
40


In support of how cultural norms and traditional practices can put women at




risk for contracting HIV/AIDS, Ruangjirantain and Kendall (1998) reported that




Thai culture affects women's ability to protect themselves from HIV infection.




These authors maintained that extramarital affairs with prostitutes are accepted




among men in Thai culture. Despite this practice. Thai culture has forbidden




women to refuse to have sex with their husbands, insist that their husbands use




condoms, or confront their husbands about their extramarital affairs. Moreover,




Thai women are not expected to question the social order in Thailand, but they are




expected to accept the patriarchal rules and traditional practices as morally right.




Similarly, Ranin and Wilson (2000) reported that African women are at risk for




HIV/AIDS because of cultural norms and traditional sexual practices in African




regions. Moreover, these authors contended that cultural norms and traditional




practices in African society sanctioned a limited status for African women




including a lack of control over their bodies.




The effects of cultural norms and traditional practices on women's risk for




HIV were documented by a study conducted in Indonesia by Basuki and




colleagues (2002). These investigators collected qualitative data from 204 sex




workers and their pimps through focus groups, in-depth interviews, and condom




dairies over four weeks to monitor condom use with their clients. Additionally,




quantitative data were collected via surveys from sex workers (n = 1,450) related




to their knowledge, attitudes, beliefs, and practices (KABP) about HIV/AIDS.




Among other findings, the investigators reported that female sex workers in




Indonesia engaged in unprotected sex more with Native and regular customers
41


and their boyfriends than they did with foreign clients. Moreover, of 5,603 sexual




contacts, the majority were with Native Indonesians (n = 4,292), resulting in




decreased condom use. When the women were asked how they decided which




clients should be made to use a condom, some stated that they use condoms with




foreign men because foreigners eat different kinds of food than Native




Indonesians, and as a result, they have a different type of sweat. Additionally,




these women stated that if a man is "clean," then they are more likely to have




unprotected with him. On the other hand, skinny men who are unable to walk




straight or a man with red spots on his penis are considered sick and would




warrant condom use. These findings explain why the numbers of HIV/AIDS cases




in Indonesia among female sex workers have escalated in recent years




(UNAIDS/WHO, 2002). In addition, many cultures that promote women to play




the submissive role and men the dominant role during sexual intimacy have aided




in women's lack of sexual negotiation powers and increase their risk for




HIV/AIDS (Deren et al., 19996; Malow et al., 2000; Salgado de Snyder, Acevedo,




Diaz-Perez, & Saldivar-Garduno, 2000; Tertullien, 1976).




Cummings and colleagues (1999) interviewed 142 African American women




to determine whether their risk for HIV/AIDS was influenced by their AIDS-




related worry status. Although study findings indicated that African American




women were worried about getting AIDS for various reasons such as engaging in




unprotected sex and lack of trust for partner or spouse, these women still engaged




in unprotected sex. As a matter of fact, some women held fatalistic beliefs about
42


their risk for HIV/AIDS such as "... if I'm gonna get it, I'm gonna get if or




"because what's meant to happen is gonna happen" (p. 339).














Socioeconomic Risks




Socioeconomic status of women cannot be overlooked in terms of their risk




for HIV/AIDS. Investigators have linked low socioeconomic status with increased




risk for HIV/AIDS (Trotman Reid, 2000). In some cultures, women carry the




brunt of the responsibilities to meet the needs of the family. For instance, in The




Bahamas where the majority of Bahamian children are solely raised by their




mothers without financial support from their fathers, women struggle to keep a




roof over their children's heads, food on the table, and clothes on their backs




(Neely-Smith, 2002). It is understandable why some women, particularly Black




women, ignore the threat of HIV/AIDS when these threats are viewed in the




context of complex socioeconomic burden they have to bear (Trotman Reid,




2000). More directly, lack of or inadequate income may be responsible for some




women's engagement in risky behaviors such as prostitution (UNAIDS/WHO,




2002).




Oliva and colleagues (1999) conducted focus groups with women (/V=63)




with high risk behaviors for HIV such as injection drug users, sex with injection




drug users, sex workers, and women with a history of sexual transmitted diseases




to identify barriers in accessing healthcare. Among their many stated barriers to




healthcare, cost related to lack of healthcare coverage took precedence over other
43


concerns. These women, some of who were at high risk for HIV due to lack of or




decreased income, also lacked healthcare access, which suggested lack of




preventive care for this vulnerable group of women. However, insufficient income




is not considered a risk factor for HIV in every situation. In a study to identify




HIV risk behaviors in Latinas, Peragallo (1996) found that women's income




status had no statistically significant relationship to risk for HIV/AIDS.




Other Demographic Variables and Risks




Age may also be a factor that puts a woman at risk for HIV/AIDS. For




instance, older women tend to be in stable committed relationships and, as a




result, may not see the need to engage in protected sex with their partners.




Additionally, some older women are peri-menopausal and may engage in




unprotected sex because they have completed their childbearing years and do not




consider themselves in need of protection from pregnancy any longer (Wyatt et




al., 2000). In a study to determine the relationship between alcohol and HIV risk




behaviors. Graves and Hines (1997) also found that older women were more




likely to engage in unprotected sex with a new partner than were their younger




counterparts.




Lastly, educational level is another variable that may be responsible for




women's risk for HIV/AIDS. In a study conducted with 125 women including




non-Latina Black (n = 59), White (n = 9), Asian (n = 4), and Latinas (n = 52) to




test their HIV/AIDS protective behaviors related to gender roles, relationship




power strategies, and precautionary sexual self-efficacy. Bowleg, Belgrave, and




Reisen (2000) found that the women's educational level significantly predicted
44


expressive gender roles which accounted for 14%) of the variance in their model.




Similarly, Graves and Hines (1997) found that education was a important




predictor of condom use in Hispanic women; the more educated the Hispanic




women, the more likely they engaged in safer sex behaviors.




Self-Esteem




Known as the evaluative component of the self-concept and sometimes used




synonymously with concepts such as self-worth, self-respect, self-acceptance, and




self-regard (Blascovish & Tomaka, 1991), self-esteem is viewed on a continuum




from low to high. Low self-esteem is viewed as a correlate of ill-health and the




inability to effectively cope with life stressors, whereas high self-esteem is viewed




as a correlate of good health and the ability to effectively deal with life stressors




(Cast & Burke, 2002; Cooopersmith, 1967).




The belief that self-esteem is important to the well-being of an individual is




seen in the extent to which it had been studied (Blascovish & Tomaka, 1991).




Among numerous self-esteem studies, scientists have investigated self-esteem




with other variables such as culture (Heine, Lehman, Markus, & Kitayama, 1999;




Tsai, Ying, & Lee, 2001), gender (Kling, Shibley Hyde, Showers, & Buswell,




1999), race (Poindexter-Cameron & Robinson, 1997), acculturation (Flaskerud &




Uman, 1996), stigma (Corning, 2002), abuse (Haj-Yahia, 2000), educational level




(Abu-Saad, 1999), age (Tsai et al., 2001), parenting (Barrett, 1977; Wilson,




1985), ill-health such as depression (Beeber, 1998; Peden et al., 2000), weight




(Cameron et al., 1996; Jambekar, Quinn, & Croker, 2001; Ricciardelli & McCabe,




2001; Schaumberg, Patsdaughter, Selder, & Napholz, 1995), religion (Anderson-
45


Scott, 1997; Francis & Gibbs, 1996), and risky behaviors (Hylton, 1999; Long-




Middleton, 2001; Mill, 1997; Nyamathi, 1991; Smith, Gerrard, & Gibbons, 1997).




Despite the extensive history of investigations, the pervasive nature of self-esteem




continues to warrant investigations (Kling et al., 1999).




Self-Esteem and Women




Although some studies have found no gender differences in levels of self-




esteem (Baker, Beer, & Beer, 1991; Mullis & Chapman, 2000), the majority of




studies have suggested that men have higher levels of self-esteem than do women.




Kling and colleagues (1999) conducted a meta-analysis on gender differences in




self-esteem which supported what most investigators have found; males tend to




have higher levels of self-esteem than do females, although the difference was




small as evidenced by consistent small effect sizes. These investigators conducted




two analyses to determine gender differences in self-esteem. The first analysis




was a composite of computerized search studies (N=2\6) with an overall effect




size of 0.21; the second analysis was with large data set from the National Center




for Education Statistics (NCES) with effect sizes ranging from 0.04 to 0.24.




On the other hand, Cremer, Vugt, and Sharp (1999) conducted a study with a




small group of British undergraduate female students (=31, 63%)) and male




students (=18, 37%)) to explore the relationship between gender and collective




self-esteem (CSE). Using a one-way analysis of variance, they found that on the




average CSE scores were significantly different by gender {F(\, 47) = l,p< .05].




Moreover, they found that women expressed a higher level of CSE than did men




(M= 5.79 vsM= 5.30), although variability in gender scores were not reported. It
46


is important to note, however, that due to the small sample size and limited




geographical area, findings of this study cannot be generalized to wider




populations.




Findings from such studies have prompted investigators to study reasons why




women tend to have lower levels of self-esteem than do men. Based on previous




studies that have found self-esteem levels to be higher in men than in women, one




may conclude that women may not be able to overcome life stressors as well as




men and as a result suffer many health consequences such as depression and other




mental illnesses, obesity, and cardiac conditions. Moreover, women may engage




in high risk behaviors as a result of their decreased sense of self-worth.




Cross and Madson (1997) explained that gender differences in self-construals




are the basis for documented differences in male and female self-esteem levels.




These scholars contended that men tend to operate from an independent self-




construal of autonomy, uniqueness, and individuality which are the assumptions




from which self-esteem is based. On the other hand, women tend to operate from




an interdependent self-construal of relationship with others. Moreover, Cross and




Madson (1997) purported that women actually gain self-esteem from their ability




to maintain relationships with others. It could be understood why investigators




have found men to have higher self-esteem than women when self-esteem, as a




concept of the Western world, is defined and measured on the basis of men's self-




construalautonomy, uniqueness, and individuality (Heine et al., 1999).




Although women around the world have a lot in common in terms of their




thinking, motivation, emotions, and social behaviors (Cross & Madson, 1997),
47


there are differences in terms of culture, race/ethnicity, and socioeconomic status




which may impact their level of self-esteem. The type of roles women and girls




are sanctioned to perform in a given culture may also impact their level of self-




esteem. For example, in some cultures, girls are socialized by parents and teachers




to engage in interdependent activities such as group play, nurturance, and caring




activities (Jack, 1991), which in turn foster low scores on most self-esteem scales.




Cultural values and trends also foster decreased levels of self-esteem for




women. In American culture, for example, the emphasis on being thin may shatter




a woman's self-esteem if she believes that she is overweight (Jambekar et al.,




2001). However, the effect of weight on self-esteem might be related more to




ethnicity than to gender. Cameron and colleagues (1996) conducted a study with




African American (n = 36, 22%)) and European American (n = 96, 78%)) pregnant




inner-city women to determine the relationships among weight, self-esteem, and




depressive symptomatology and found that African Americans reported higher




levels of self-esteem during their second and third trimesters than did their




European American counterparts [^(130) = 3.30,p < .01 and ^(130) = 2.S2,p =




.01, respectively]. These findings, however, should be viewed with caution since




ability to generalize to all African American and European American women is




limited due to the relatively small sample size. Furthermore, it may be that among




the many worries that inner-city African American women have to face such as




abuse, unemployment, and lack of housing, gaining weight is probably not a




major concern, especially since it is something they would expect to happen




during pregnancy.
48


Violence against women, which is tolerated in many cultures, is another




phenomenon researchers have investigated in relation to low self-esteem in




women. For instance, Haj-Yahia (2000) conducted a study in Palestine with 1,334




women using a random home selection procedure to determine the influence of




wife abuse and battering on self-esteem, depression, and anxiety. The investigator




found that despite the type of abuse (i.e., psychological, physical, sexual, and




economical), women showed low levels of self-esteem. Moreover, regression




analysis revealed that the more these women suffered abuse from their husbands,




the lower was their level of self-esteem: psychologically abused (P = -.342, p <




.0001); physically abused (P = -.03%,p< .0001); sexually abused (P = -.026,p<




.0001); and economically abused (P = -.02%,p< .0001). Conversely, Romans,




Martin, and Mullen (1996) conducted a study with a group of women (N= 411) to




determine if childhood sexual abuse (CSA) was a major determinant of low self-




esteem in adulthood. These researchers found no significant difference in




psychosocial predictors for low self-esteem between the two groups of women




studied, except when the CSA was intrusive. These investigators concluded,




however, that childhood temperament, poor mother-child relationship, low




qualification attainment, psychiatric morbidity, and CSA in its most intrusive




form, are predictors of low self-esteem in women.




Age is another factor that researchers have explored as an influence on self-




esteem in women. For example. Block and Robins (1993) suggested that girls




tend to lose self-esteem whereas boys tend to gain self-esteem during the




adolescent years. This difference may have something to do with cultural trends
49


and the value placed on body weight, which may be a struggle for many girls




during puberty.




Other socioeconomic factors that may not be specific to women yet may




impact their level of self-esteem are educational and income levels. According to




Wiggins, Schatz, and West (1994), well educated women have higher levels of




self-esteem than do less educated women. Similarly, Flaskerud and Uman (1996)




conducted a study to determine the effects of acculturation on self-esteem among




immigrant Latina women. They found that women from Central/South Americas




were more educated than their counterparts, which may have accounted for their




higher self-esteem scores. In the study conducted by Haj-Yahia (2000) with




Palestinian women, the investigator found that the women's educational level was




a significant contributor to the variance accounting for in self-esteem (P = .088, p




< .0001). However, educational level has been found to have a positive




relationship with self-esteem in various racial and ethnic groups. Thompson and




Keith (2001) conducted a study with a sample of Black Americans (N= 1,683),




including 1,043 (62%)) women, to determine the degree to which gender socially




constructs the importance of skin tone for evaluation of self-worth and self-




competence. Using two items from the Rosenberg (1965) Self-Esteem Scale to




measure self esteem and using a two-tailed test, the investigators found that




education correlated significantly with self-esteem for women (r = .01%, p < .05).




However, education was found to have no interaction effect with skin tone on




self-esteem. The investigators also reported that there were different interaction




effects between education and other sociodemographic variables and skin tone in
50


terms of effect on self-esteem. They found that skin tone did not have any effects




on self-esteem for women who were attractive or had high incomes, whereas skin




tone and education did.




Consistent with other researchers, Francis and Jones (1996) purported that




persons with higher social class tend to have higher self-esteem. Abu-Saad (1999)




substantiated this view in a study of Arab adolescents in Israel. This researcher




found that there was a significant relationship between self-esteem and




community type. Using the Rosenberg Self-Esteem Scale to measure self-esteem




in this sample, the investigator reported that adolescents who lived in the city




reported higher self-esteem scores (M= 82.03, SD = 10.9) than did adolescents




who lived in villages (M= 80.30, SD = 10.13) and than Bedouins (M= 75.96, SD




= 11.07), respectively. De-Meo (1998) further supported that the higher the




socioeconomic status, the greater the self-esteem level in a sample of Italian-




American women (N= 155) in New York City area. The study was conducted to




determine the relationships among ethnic identity, self-esteem, and career




attainment in these women. The investigator found that women with higher self-




esteem scores had higher career attainment when compared to women with low




self-esteem scores.




Lastly, researchers have postulated that race and ethnicity may have an




important influence on level of self-esteem. Mixed findings from a meta-analysis




conducted by Kling and colleagues (1999) noted that in some studies Whites have




been found to have higher self-esteem levels than Blacks, whereas in others the




reverse has be documented. However, some researchers have questioned whether
51


self-esteem instruments are measuring a different concept when Blacks have




reported higher self-esteem scores than their White counterparts (Cookson &




Persell, 1991; Hoelter, 1983). This alternative explanation is probably what led




Taylor and Tomasic (1996) to develop a self-esteem inventory specifically for




Black populations. Additionally, some researchers have hypothesized that positive




attitudes of Blacks concerning their race and ethnicity might explain, in part, the




discrepancy in self-report self-esteem scores between Blacks and Whites. For




example, Poindexter-Cameron and Robinson (1997) conducted a study to




determine the relationships among racial identity attitudes, womanist identity




attitudes, and self-esteem in African American college women from a




predominantly white university (n = 46, 54%)) and a historically black university




(n = 38, 46%)). Using the Rosenberg (1965) Self-Esteem Scale to measure self-




esteem in these two groups of students, findings revealed that African American




women at the predominately white university had higher self-esteem scores (M =




36.11, SD = 4.01) than did African American women in the historical black




university (M= 33.11, SD = 5.30). However, the researchers reported that Chi




square analysis showed a significant difference in the number of African




American women at the predominately white university as compared to African




American women at the historically black university who engaged in discussions




about Black womanhood within the past six months [% (1) = \3.A2,p < .0005],




which the researchers thought might have accounted for the difference in self-




esteem scores.
52


Self-Esteem and Bahamian Women




Despite the paucity of scientific data related to self-esteem and Bahamians in




general and Bahamian women in particular, much can be learned from the




historical and cultural roots of Bahamian women and how these roots may




influence their level of self-esteem. As discussed previously, Bahamian women




came from a long history of racism, sexism, colorism, and classism in a




patriarchal society (Saunders, 1994), which are likely to influence their self-




worth. Given the history of the socialization process for Black women and the fact




that positive reinforcements enhance and maintain self-esteem (Heine et al.,




1999), it can be assumed that Bahamian women who experience perpetuated




negative reinforcements related to their gender, skin tone, and class during their




up-bringing will probably have low levels of self-esteem.




Additionally, findings from a study conducted with Jamaican adolescents to




examine their racial identity, Africentric values, and self-esteem can be related to




Bahamian adolescents since The Bahamas and Jamaica share most of the same




historical roots of sexism, racism, colorism, and classism. Data were collected




from a sample of Jamaican girls ( = 81, 54%)) and boys (n = 73, 46%)) between




the ages of 8 to 13 years (M= 10.8 for boys and M= 11.1 for girls). Using the




Piers-Harris Children's Self-Concept Scale (PHCSCS) to measure self-esteem,




the investigators found that Jamaican female adolescents scored higher on the




self-esteem scale (M= 61.68, SD = 10.78) and (M= 58.01, SD = 3.37) than their




Jamaican male counterparts. Moreover, these investigators found that the pride of
53


being Black was strongly associated with Jamaican female adolescents' level of




self-esteem (r = .249, p< .01) (Akbar, Chambers, Jr., & Sanders Thompson,




2001).




Assuming that these findings can be generalized to Bahamian adolescents, it




would mean that Bahamian females have higher self-esteem levels than do




Bahamian males and that being Black is strongly associated with Bahamian




female adolescent's level of self-esteem. This assumption, along with the fact that




since the 1960's the people of The Bahamas were sensitized to be proud




Bahamians (Beardsley Roker, 2000), suggests the need for investigating self-




esteem among Bahamians in general and Bahamian women in particular.




Moreover, in an article on Bahamian culture and society featuring Bahamian




women, the author reported that there are two types of Bahamian women. The




first type of Bahamian women are considered fighters, independent, hard-




working, and supporting of self and family, which resemble characteristics of




high self esteem. However, the second type of Bahamian women, according to the




author, are the ones that are mostly married and will do anything to make their




marriages work. The author further maintained that despite the second type of




Bahamian women's level of education, they stay in poor relationships because




they feel dependent upon their spouses, insecure, have a low self-esteem, and are




afraid of being alone without a partner (Hanna-Ewers, 1999). It is important to




note, however, that this report was not empirically based. However, assuming that




these attributions about Bahamian women are true, it was interesting to explore




these women's level of self-esteem and the influence on their risks for HIV/AIDS.
54


Self-Esteem and Women's Risks for HIV/AIDS




Since self-esteem is considered a feeling of self-worth, self-respect, self-




regard, and self-acceptance (Blascovish & Tomaka, 1991), one would assume that




women with high self-esteem levels will have a low risk for HIV/AIDS because




their self-appreciation and self-respect discourage them from engaging in high




risk behaviors. While this may seem evident, there are some conflicting views




about self-esteem and risk for HIV/AIDS in the literature.




Mill (1997) conducted a qualitative study using focus groups with eight HIV




positive Aboriginal women to determine their HIV risk behaviors prior to them




contracting the disease. Among many other factors that contributed to these




women's risk for HIV/AIDS, all of the women reported having low self-esteem




before becoming infected. Many of the women stated that they really did not care




about themselves and felt that they did not deserve care. Some of the women




remembered engaging in high risk behaviors such as unprotected sex, drug use,




promiscuity, and prostitution, and they admitted that it was during the times when




they hated themselves that they engaged in these behaviors to cope with life




stressors. These women believed that if they had high levels of self-esteem, they




would have cared more about themselves and would not have put themselves at




risk for HIV/AIDS.




Similarly, a community-based study was conducted in The Bahamas to




determine socioeconomic factors that make women more vulnerable to




HIV/AIDS. It was reported that some of the participants during one of the focus
55


groups sessions attributed low self-esteem as a reason for Bahamian women's




HIV/AIDS risk. In fact, one of the participants shared with the group that she




grew up having low self-esteem and as a result used sex as an avenue to find self




fulfillment (Ward & Samuels, 1999).




Nyamathi (1991) conducted a study with homeless and drug-abusing




minority women (N= 581) of whom 81% were Black and 19% were Hispanic.




The purpose of the study was to determine the relationships among self-esteem,




sense of coherence, and support availability and emotional distress, somatic




complaints, and high risk behaviors including risk for HIV/AIDS. Using a revised




version of The Coopersmith (1967) Self-Esteem Inventory to measure self-




esteem, findings suggested that women who had high self-esteem and strong




sense of coherence reported significantly fewer high risk behaviors. However,




self-esteem along with coherence accounted for only 10%) of the variance in high




risk behaviors in these women. These findings suggest that many other




psychosocial variables may influence HIV/AIDS risk for this underserved,




disenfranchised group of women.




Contrary results regarding self-esteem and high risk behaviors were




documented by a study conducted by Hollar and Snizek (1996) to explore the




relationship between knowledge and self-esteem on the sexual practices of college




students. The sample consisted of 353 female (49.1%) and male (50.3%)). Using




the Rosenberg (1965) Self-Esteem Scale, the investigators found that both




genders with high levels of self-esteem reported engagement in high risk sexual




behaviors. More specifically, students who reported high levels of self-esteem and
56


high levels of knowledge were more likely to engage in risky behaviors (M =




4.21, p= .05, df= 2) than students with low levels of self-esteem. The




investigators concluded that high self-esteem might give students the feeling of




invulnerability or that engaging in high risk behaviors may improve students'




level of self esteem.




Similarly, Long-Middleton (2001) conducted a study on a multiracial sample




of female adolescents (N= 224) to determine the influence of mastery and self-




esteem on their risk reduction behaviors. This researcher found that mastery and




self-esteem, as measured by Rosenberg's (1965) Self-Esteem Scale, did not




predict risk reduction behaviors in this multiracial sample. The conclusion




reached by Hollar and Snizek (1996) in the previous study may also explain




findings of this study.




The majority of study findings that failed to link high self-esteem with low




risk behaviors were with adolescent groups (McNair, Carter, & Williams, 1998;




Smith et al., 1997), which may lead to the conclusion that adolescents'




developmental levels may be related to their risk taking behaviors (Ponton, 1998).




However, studies with adult participants have also produced similar results.




Hylton (1999) conducted personal interviews with black women (N= 30) in




Washington, D. C, 83%) of whom were seropositive to determine the




psychosocial factors related to their HIV prevention behaviors. The investigator




found that although most of the participants had high self-esteem, self-esteem had




no influence on these women's safer sex practices.
57


Despite conflicting findings regarding the relationship between self-esteem




and risk for HIV/AIDS, it is believed that the higher Bahamian women's levels of




self-esteem, the lower their risk for HIV/AIDS which should be evident by their




high levels of self-efflcacy for safer sex behaviors. However, although it is




believed that self-esteem can affect self-efflcacy for safer sex behaviors directly,




the influence of this variable may also be mediated by self-silencing behaviors in




Bahamian women.




Self-Silencing




According to Amaro and Raj (2000), silencing refers to the loss of voice or




the loss of self which is one of three common dynamics of oppression that may




interfere with a person's well-being. The impact of self-silencing on well-being




has prompted researchers to investigate self-silencing to determine linkage with




many other variables such as gender and cultural differences (Ali & Toner, 2001;




Duarte & Thompson, 1999; Koutrelakos et al., 1999; Remen, Chambless, &




Rodebaugh, 2002; Thompson, Geher, Stevens, Stem, & Lintz, 2001), personality




traits (Witte, Sherman, & Flynn, 2001), coping with illness (Ali et al., 2000;




DeMarco et al., 2001; Kayser, Sormanti, & Strainchamps, 1999), depression (Carr




et al., 1996; Hart & Thompson, 1996; Jack, 1991, Jack & Dill, 1992; Thompson,




1995), anger (Brody et al., 1999; Jack, 2001), abuse (Whiffen, Thompson, &




Aube, 2000), self-esteem (Cracco, 1999; Craver, 2000; Page, Stevens, & Galvin,




1996; Woods, 1999), and risk for HIV/AIDS (Bruner, 1997).
58


Self-Silencing and Women




Jack (1991) has contended that silencing the self is a gender-specific set of




cognitive schemas women use to ensure their performance of society sanctioned




normative female behaviors. Moreover, silencing is a way women cope to secure




relationships. Because women judge themselves by their ability to maintain




relationships (Gilligan, 1993), they silence themselves in an effort not to "rock the




boat." However, in the process of silencing and complying with cultural norms




and practices to maintain relationships, women experience a paradox between




ideal versus actual self and, thus, loss of the authentic self As a result, silencing




the self can be maladaptive and can lead to depression and decreased well-being




in women.




Although the theory of silencing the self was developed to explain why




women become depressed (Jack, 1991), the importance of self-silencing related to




interpersonal behaviors have encouraged investigators to study gender and




cultural differences in silencing behaviors. Scholars have maintained that cultural




norms and traditional practices have socialized girls to silence (Cross & Madson,




1997; Jack, 1991), which is manifested in girls' behaviors when they reach




adolescence (Brown & Gilligan, 1992). Although adolescent girls are very out-




spoken in relationships in some cultures and ethnic groups, the opposite is seen in




their relationships with male partners (Way, 1995). This behavior in girls is




consistent with that which is seen among Bahamian girls living in The Bahamas




(Tertullien, 1976).
59


Despite the belief that self-silencing is unique to women, investigators have




suggested that men also manifest silencing behaviors. Moreover, findings from




some studies have suggested that men silence more than do women (Haemmerlie,




Montgomery, Williams & Winborn, 2001; Thompson, 1995; Thompson et al.,




2001; Vaden Gratch et al., 1995). However, investigators have suggested that men




may silence for different reasons than do women. Duarte and Thompson (1999)




conducted a study to determine sex differences in self-silencing in a sample of




undergraduate students (N= 1,117), including 11% females. Using the Silencing




The Self Scale developed by Jack and Dill (1992), the researchers found that




men's global self-silencing scores were significantly higher than those of women




(F = 40.3,p< .001, df not specified). The researchers concluded that men may




perceive self-silencing differently than women in regard to themselves and their




relationships.




Remen and colleagues (2002) may have shed light on why men and women




differ in their perception of self-silencing in a study they conducted to determine




gender differences in the construct validity of Jack and Dill (1992) Silencing The




Self Scale (STSS). The investigators sampled 187 female and 169 male




undergraduate students and found gender differences in the scale structure using




exploratory and confirmatory factor analyses. While the factor analysis conducted




on the female subsample was consistent with Jack and Dill's (1992) defined four




subscales, the same was not found for men. The factor analysis conducted on the




subsample of men revealed another factor called Autonomy/Concealment, which




did not reflect any of Jack and Dill's (1992) original subscales. The investigators
60


concluded that men may silence as a way to maintain control and power in




relationships as opposed to women who silence to secure relationships. As a




result, the investigators cautioned against using Jack and Dill (1992) STSS with




men.




In addition to gender, scholars have maintained that women's silencing




behaviors are related to culture. Koutrelatos and colleagues (1999) conducted a




study using two of Jack and Dill's (1992) four subscales. Divided Self and Care




As Self-Sacrifice, to determine cultural and gender differences in a sample of




Greeks and Americans. The total sample size was 853, with 480 participants from




America (women comprised 65%) of this sample) and 373 from Greece (women




comprised 85%) of this sample). Findings showed that Greeks scored higher than




Americans on both subscales (p < .001 in each case, no test statistics reported),




although Greek men scored higher than Greek women on both subscales (p < .05,




no test statistic reported). The investigators concluded that the findings were




consistent with the practices and values of both American and Greek cultures (i.e.,




individualism versus collectivism). In other words, individualism is consistent




with independence and autonomy, and collectivism is consistent with




interdependence and connectedness. Self-silencing, according to Jack (1991), is




one's desire to stay connected and maintain relationships.




Conversely, Ali and Toner (2001) conducted a study with Caribbean-




Canadian women (n = 20) and Caribbean women living in the Caribbean (n = 20)




to examine their symptoms of depression, self-silencing, and domains of meaning




using both self-report and interviews. Although the sample was homogenous with
61


respect to sociodemographic status, Caribbean-Canadian women had higher self-




silencing scores (M= 88.3, SD = 29.5) than their Caribbean counterparts (M =




63.9, SD = 19.9) on Jack and Dill's (1992) STSS. Moreover, using Roy-Bargman




stepdown F analyses to control for meaningfulness, self-silencing, and depressive




symptoms in succession, Caribbean-Canadian women still had significantly




higher scores on the STSS than Caribbean women living in the Caribbean [F(l,




37) = 6.5,p = .023]. Additionally, although Caribbean-Canadian women showed




their domain of meaning as "self-nurturing" and Caribbean women living in the




Caribbean as "relational," Caribbean women living in the Caribbean still reported




less silencing behaviors. However, caution should be used when interpreting these




findings since the sample size was small.




Cultural differences may also be seen in the relationship between self-




silencing and depression among women from different ethnic groups. In a study




conducted with African American (n = 40) and Caucasian (n = 40) women to




determine the relationship between silencing the self and depression after




controlling for income and social desirability bias, Carr and colleagues (1996)




found that silencing the self was a significant predictor of depression in Caucasian




women (P = .61, p < .0001) but not in African American women (P = .17, ns).




Although African American women's scores on self-silencing (M= 82.05, SD =




18.80) were not significantly different than Caucasian women's STSS scores (M




= 80.25, SD = 20.75) and scores on Beck Depression Inventory (BDI) (M= 11.31,




SD = 7.31 versusM= 10.33, SD = 8.68), African American's self-silencing




behaviors appeared to have no relationship to depression. These findings have
62


perplexed investigators, especially since many previous studies have linked self-




silencing and depression (Hart & Thompson, 1996; Jack, 1991, Jack and Dill,




1992; Thompson, 1995). The investigators concluded that cultural values and




differing socialization practices in girls and women may have been responsible




for unanticipated findings.




In an attempt to identify areas for intervention, researchers have begun to




investigate how self-silencing behavior may impact coping behaviors of women




living with chronic diseases. Kayser et al. (1999) conducted a study to understand




how women living with cancer cope with this disease (N= 49) and used the Jack




and Dill's (1992) Silencing The Self Scale to measure relationship beliefs. Among




other findings, the investigators found that silencing the self was a significant




predictor of self-care agency as measured by the Exercise of Self-Care Agency




Scale (P = -.46, p < .01), an instrument that taps subconstructs such as attitude of




responsibility for self, motivation to care for self, the application of knowledge of




self-care, the valuing of health priorities, and self-esteem. This finding indicated




that women living with cancer who were more likely to report silencing behaviors




scored lower on self-care agency.




To further document the effects on silencing behaviors on coping with




chronic illness, DeMarco and colleagues (2001) conducted a study with African




American (n = 10), White (n = 4), and mixed Portuguese/Native American (n= I)




women living with HIV/AIDS to explore their silencing and affectivity behaviors.




The investigators used data triangulation obtained from responses to Jack and




Dill's (1992) STSS and semi-structured interviews. Findings indicated high
63


silencing behaviors among women living with HIV/AIDS (M= 102.40, SD =




15.72), especially in relation to women putting the needs of others (i.e., children




and dependents) before themselves. DeMarco and colleagues (1998) used data




from focus groups extracted from secondary analysis obtained from a group of




women living with HIV/AIDS (N= 14) and explored women's health care




experiences to determine what women needed to maintain their health. The




investigators found that although the women's experiences matched Jack and Dill




(1992) four subscales in the STSS, the women broke their silence and mobilized




themselves to action for survival. It was suggested that the women mustered up




the courage to act as a result of the life-threatening diagnosis of HIV/AIDS as




well as support from peers and health care professionals. The investigators




concluded that when faced with life-threatening situations, women may overcome




their silencing behaviors and "speak up" for their survival.




Given cultural norms and traditional practices in The Bahamas and how they




impact women's roles, it would be interesting to document Bahamian women's




self-silencing behaviors as measured by Jack and Dill (1992) STSS, a concept that




has never been explored in Bahamian women living in The Bahamas.




Self-Silencing and Self-Esteem




Since self-silencing can lead to depression and decreased well-being




(Jack, 1991) and since self-esteem is believed to be lower in women than men




(Cast & Burke, 2002; Kling et al., 1999), it is important to explore the connection




between self-silencing and self-esteem in women.
64


Despite the paucity of scientific evidence regarding the relationship between




self-silencing and self-esteem, scholars have posited a relationship between these




two variables, suggesting that high self-silencing behavior is associated with low




self-esteem (DeMarco et al., 2001; Jack, 1991). Woods (1999) conducted a study




with a convenience sample of abused (n = 53) and nonabused (n = 52) women to




examine their thoughts, feelings, and actions when developing and maintaining an




intimate relationship. One of the investigator's hypothesis was to test the




relationship between self-esteem as measured by Rosenberg Self-Esteem Scale




(RSE) (1965) and normative beliefs regarding maintenance of intimate




relationships as measured by Jack and Dill's (1992) STSS. Among other findings,




the investigator found that there was a strong inverse correlation between RSE




scores and STSS scores in the total sample of women (r = -.65, p < .0001).




Although findings suggested that women with low self-esteem have high




silencing behaviors or vice versa, a causal relationship could not been established.




In other words, these findings do not provide evidence to suggest that either one




of these variables leads to the other.




However, when Cracco (1999) conducted a study with female (n = 244) and




male (n = 199) undergraduate students to determine the relationships between




self-silencing across relationship domains and depression and self-esteem, the




investigator found that self-silencing predicted a significant proportion of the




variance in self-esteem and depression for women but only predicted self-esteem




for men.
65


Although the above study substantiated a relationship between self-silencing




and self-esteem, the directionality of the influence between the two variables




remains unknown. Freedman (1998) contended that when girls reach adolescence,




they experience a drop in self-esteem, which is manifested in three ways: (a)




academic decline, (b) diminishing dreams, and (c) self-silencing behaviors. Given




that self-silencing is one of the manifestations of low self-esteem seen in




adolescent girls, then self-esteem can be viewed as an antecedent to self-silencing,




a relationship that was tested in this present study.




To test this hypothesis. Page and colleagues (1996) conducted a study with a




sample of men (n = 90) and women (n = 91) to explore the relationships among




depression, self-esteem, and self-silencing behaviors. Using Jack and Dill's




(1992) STSS to measure self-silencing behaviors and the Multidimensional Self-




Esteem Inventory (MSEI) (O' Brian & Epstein, 1988) to measure global self-




esteem (GSE), the investigators found a significant moderate inverse correlation




between STSS and GSE (r = -.54, p < .01). Furthermore, the findings from




multiple regression analysis indicated that STSS and GSE accounted for 44%) of




the variance in depression which was measured by Beck Depression Inventory




(BDI), [F(3, 111) = 41.26,p< .001], and the interaction between STSS and GSE




significantly accounted for another 3%) of the variance in depression, [F(3, 111) =




%.10,p< .01]. These results indicated that the effect of self-silencing on




depression varies depending on the level of self-esteem. More specifically, self-




esteem appeared to moderate the effect of self-silencing on depression. At high




and moderate levels of self-esteem, self-silencing had no effect on depression;
66


only at low levels of self-esteem did self-silencing significantly contribute to




depression (B = .0%,p < .05).




The above studies have provided evidence that there is a relationship between




self-silencing and self-esteem and, more importantly, that there may be a




bidirectional relationship between self-silencing and self-esteem. However, in this




study, the hypothesis that was tested was derived from a linear model which




predicted that self-esteem would influence self-silencing behaviors which in turn,




would influence Bahamian women's self-efficacy for negotiating safer sex




behaviors.




Self-Silencing and Risk for HIV/AIDS




Given that the predominant mode for HIV/AIDS acquisition and transmission




in women is through unprotected sex with infected partners (UNAIDS/WHO,




2002) and that women silence themselves to maintain and secure intimate




relationships (Jack, 1991), it may be fair to assume that despite limited scientific




evidence, self-silencing behaviors can result in women's increased risk for




HIV/AIDS.




In some countries such as The Bahamas where cultural norms and traditional




practices have socialized women to be unassertive and passive during sexual




encounters, cases of HIV/AIDS have escalated among women (Gomez & Morin,




1996; UNAIDS, 2001). In other words, less assertive women may exhibit




increased silencing behaviors and, thus, increase their risk for HIV/AIDS due to




their inability or unwillingness to negotiate condom use. Although limited.
67


findings from studies have suggested that sexual communication generally results




in safer sexual behaviors.




Kelly and Kalichman (1995) have contended that communication between




intimate partners regarding safer sex issues can influence safer sex behaviors




through the use of condoms. Quina, Harlow, Morokoff, Burkholder, and Deiter




(2000) conducted a study with 816 predominately Caucasian women (n = 646,




79.2%)) to explore women's willingness to communicate with their intimate




partners. These researchers used two sexual communication scales adapted from




Deiter (1994), one scale assessing sexual communication for preference (SC-Pref)




and the other for information (SC-Info). Findings revealed that SC-Info was




significantly negatively correlated with frequency of unprotected sexual




intercourse (r = -.ll,p< .002, df not reported). This finding indicated that the




more information women gathered from their sexual partners, the less likely they




engaged in unprotected sex. However, this significant, but weak correlational




finding must be interpreted with caution. Additionally, since Caucasian women




comprised almost 80%) of the sample and the remainder consisted of various




ethnicities, caution must be exercised in generalizing this finding to other ethnic




groups.




Conversely, Bruner (1997) conducted a study with undergraduate women (N




= 219) to determine the relationship between self-silencing and safer sex




behaviors. Using Jack and Dill's (1992) STSS, the investigator found that




silencing the self was not significantly related to past condom use. However,




women with low silencing scores were significantly more likely to have intentions
68


to use condoms with their primary partners (r = .21, p< .007, df not reported).




Again, the weak correlation warrants caution in interpretation. Although




Thompson and colleagues (2001) did not measure silencing in their study with




male (n = 9\) and female (n = 179) undergraduate students to determine




psychological predictors of sexual behaviors related to AIDS transmission, they




used a Self-Perception of Safe Communication Scale and found through multiple




regression analysis that communication was not a significant predictor of risky




sexual behaviors (R = .03, ns).




Based on these limited findings related to a relationship between self-




silencing and women's risk for HIV/AIDS, the influence of self-silencing on self-




efficacy for negotiating safer sex behaviors in urban Bahamian women was tested




in this study.




Self-Efficacy




The belief that one has the ability to perform a behavior is strongly influenced




by what Bandura (1986; 1989; 1994) termed self-efflcacy. Moreover, Bandura




asserted that an individual gains self-efficacy through continual successes in




behaviors. Analogous to a feedback mechanism, the higher a person's self-




efficacy, the more likely he or she will repeat the behavior. Unlike other




psychosocial correlates such as self-esteem that are global in nature, self-efficacy




is conceptualized to be domain-specific. For instance, an individual can have a




high level of self-efficacy in one domain (i.e., performing physical exercise) and




yet a low level of self-efficacy in another domain (i.e., negotiating safer sex




behaviors).
69


Self-efficacy, as a model for behavioral change, has been studied within




many disciplines to determine predictive ability to bring about specific behavioral




change. Areas of self-efficacy studied by investigators to predict specific




behavioral change include clients' health management behaviors following




surgery (Gardner et al., 1999; Homko & Moran, 2000; Strychacz et al., 1997),




exercise performance (McAuley, Talbot, & Martinez, 1999; Vicki, 1998),




nutritional adherence (Schwarzer & Renner, 2000), contraceptive use (Levinson,




1995), hormonal therapy (Ali, 1999), and parenting ability of persons living with




HIV/AIDS (Dorsey, Klein, Forehand, & Family Health Project Research Group,




1999; Sharts-Hopko et al., 1996). Additionally, investigators have studied other




psychosocial factors such as self-esteem to determine the influence on




individuals' levels of self-efflcacy (Collins & Lightsey, Jr., 2001; Rosenthal,




Moore, & Flynn, 1991; Thompson & Keith, 2001) and self-efficacy in relation to




preventing and controlling high risk behaviors for HIV/AIDS such as sexual




behaviors (Marin, Tschann, Gomez, & Gregorich, 1998; Organista, Organista,




Bola, Garcia de Alba, & Moran, 2000; Trobst, Herbst, Masters, & Costa, 2002).




Self-Efficacy and Women




Since self-efficacy is domain-specific, as posited by Bandura (1986), it may




be fair to assume that self-efficacy is not generally gender related, although a




particular gender may be more efficacious in a given domain and in a given




context due to cultural norms and social practices. For example, because women




usually perform the role of nurturers, caregivers, and childrearers within most
70


cultures, they may have more parenting self-efficacy than men given that they




may have had more practice and successes in these areas.




Clark and Dodge (1999) conducted a study with women (N= 570) 60 years




of age and older to explore their self-efficacy as a predictor of cardiac disease




management at 4 months and again at 12 months. Self-efficacy was measured on




a scale of 1 (not at all confident) to 10 (very confident) with items related to




specific behaviors. The investigators found that self-efficacy predicted disease




management at 4 months and at again at 12 month in all domains: medication use




(parametric estimate at 4 months .221, SE .01, p = .002 and at 12 months .809,




SE, .05, p = .0001), following dietary recommendations (parametric estimate at 4




months .345, SE .04,p = .0001 and at 12 months .493, SE .05,p= .001),




exercising (parametric estimates at 4 months .388, SE .06,p= .0001 and at 12




months .415, SE .01, p = .0001), and stress reduction (parametric estimate at 4




months .161, SE .05,p = .001 and at 12 months All,SE .06,p= .OS). However,




the sample was made up of predominately Caucasian women (87%)), and the




remainder were of various ethnic backgrounds. Although at four months, race,




self-efficacy, and living alone accounted for 7%) of the variance in following




dietary recommendations and race combined with self-efficacy, living alone, and




education accounted for 29%) of the variance in stress reduction, the investigators




did not specifically report any self-efficacy differences by race. This information




may have shed some light on self-efficacy related to health management among




women of different racial groups.
71


Levinson (1995) conducted a study with 11 to 20-year-old adolescent girls




from California (n = 258) and Chicago (n = 263) to determine the relationships




among their contraceptive self-efficacy (CSE), reproduction and contraceptive




knowledge (RCK), and sexual behaviors. Using an 18-item CSE instrument with




four factors (i.e., assertive communication, physicality of sex, taking control, and




prevention of unprotected coitus) to measure CSE, the investigator unexpectedly




found that CSE did not influence the relationship between adolescent women's




RCK and their contraceptive behaviors, although CSE did explained 12%) of the




variance in RCK for the Chicago group and 28%) for the California group (p <




.05).




Despite some negative findings, investigators continue to suggest that self-




efficacy can predict behaviors. For instance, Dorsey et al. (1999) conducted a




longitudinal study with African American mother-child dyads (N= 205) of whom




32%) were mothers were living with HIV/AIDS. The investigators collected data




during two occasions separated by 12 to 14 months to explore the difference in




parenting self-efficacy and social support between the two groups. Using a




parenting self-efficacy scale to measure the mothers' perception of self in her role




as a parent, they found that parenting self-efficacy at baseline was a significant




predictor of parenting self-efficacy 12 to 14 months later (P = .14, p < .01). The




investigators reported that women living with HIV/AIDS had significantly lower




levels of parenting self-efficacy than did women uninfected with HIV disease.




Additionally, findings revealed that the relationship between parenting support at




baseline and parenting self-efficacy was significant for HIV-uninfected mothers
72


[P = .18; F(l, 134) = l.%5,p< .01] but not for the HIV-infected mothers [P = -.04;




F(1.61) = .37, ns]. The investigators concluded that mothers living with




HIV/AIDS may view offered support as a failure or perceived inability to deal




with their own problems and thus may feel less efficacious as parents.




Similarly, Sharts-Hopko and colleagues (1996) conducted a study with HIV-




infected mothers (/V= 41) to determine the relationships among perceived self-




efficacy, uncertainty, social support, psychological distress, and problem-focused




coping. The investigators used a visual analog scale with scores ranging from 1




(most negative) to 100 (most affirmative) to measure two dimensions of perceived




self-efficacy (PSE): perceived capability of meeting challenges associated with




their HIV infection (PSE-1) and confidence that they could succeed in meeting




those challenges (PSE-2). Although the authors could not conduct predictive




analysis due to small sample size, they found that PSE was negatively related to




psychological distress and duration of an HIV-infected child's illness (r = -.40, p




< .05 and r = -.43,p < .05, respectively), indicating that the higher the women's




perceived self-efficacy, the lower were their psychological distress and duration




of HIV-infected child's illness. In addition, PSE showed a positive relationship




with problem-based coping (r = .44, p< .05), indicating that the higher the




women PSE level, the more ways they were able to cope. However, causal




relationships could not be established so caution should be used when




generalizing these findings.




As scholars continue to investigate predictors of behaviors and interventions




for effective coping to decrease preventable diseases such as hypertension.
73


diabetes, and HIV/AIDS, self-efficacy will continue to be among the important




variables to predict and bring about behavioral change (Dennis & Goldberg, 1996;




Moore, Turner, Park, & Adler, 1996; Strychacz et al., 1997). Additionally, other




psychosocial variables such as self-esteem are also being investigated by




scientists to determine their influence on individuals' self-efficacy for domain-




specific behaviors.




Self-Efficacy and Self-Esteem




Self-efficacy and self-esteem are two psychological concepts that have been




widely studied, together and separately, in various disciplines and domains in an




effort to predict and/or bring about behavioral changes to improve individuals'




coping abilities with life stressors. However, scholars' views differ concerning the




association and causal relationship between these two concepts. Bandura (1986)




asserted that self-efficacy and self-esteem are differing concepts with no




important relationship since self-efficacy pertains to perceived capabilities, and




self-esteem pertains to perceived self-worth. Bandura (1986) further argued that




although both self-efficacy and self-esteem contribute to quality of life, a person




who feels inefficacious concerning a given task may do so without losing his or




her feeling of self-worth and vise versa. For example, a woman with a high level




of self-esteem may perceive herself to be inefficacious in mathematics with no




affect on her self-esteem level. Bandura's (1986) argument may be due to the fact




that this theorist viewed self-efficacy as domain and task specific and viewed self-




esteem to be a global feeling of self-worth.
74


In contrast, Gecas and Schwalbe (1983) maintained that there are two sources




of self-esteem: (a) efficacy-based self-esteem, which referred to "inner self-




esteem" that depends on individual competencies, and (b) esteem, which refer to




"outer self-esteem" that is based on the opinions of others. Similarly, Cast and




Burke (2002) stated that self-esteem is made up of two dimensions, efficacy-




based self-esteem and worth-based self-esteem. Moreover, Cast and Burke (2002)




agreed with Gecas and Schwalbe (1983) that efficacy-based self-esteem is the




central of the two and may indeed be responsible for maintaining the level of




worth-based self-esteem. Findings from a study conducted by these investigators




suggested that the efficacy-based part of the self-esteem appeared to be




responsible for buffering effects on unsuccessful self-verifications.




Differing views concerning self-esteem and self-efficacy have encouraged




scholars to seek answers to the following questions:




1. Is self-efficacy domain and task specific and does self-efficacy differ from




self-esteem as posited by Bandura (1986)? Or




2. Is self-efficacy one dimension of self-esteem as posited by Gecas and




Schwalbe (1983) and Cast and Burke (2002)?




Woodruff and Cashman (1993) suggested that there might be three levels of self-




efficacy: (a) task-specific self-efficacy, (b) domain-specific self-efficacy, and (c)




general self-efficacy. To shed more light on this view as it relates to self-esteem,




one might argue that self-esteem is indeed a combination of worth-based self-




esteem and efficacy-based self-esteem. Further, it is believed that the efficacy-




based aspect of self-esteem is tapped whenever scholars use general self-efficacy
75


instruments to measure self-efficacy. Consistent with Bandura's (1986) argument,




self-efficacy appears to be a combination of task-specific and domain-specific




self-efficacy, and self-efficacy as a concept is different from self-esteem.




However, it is believed that self-efficacy and self-esteem are related by virtue of




the efficacy-based aspect of self-esteem.




Although many studies have found a correlation between self-esteem and




self-efficacy (Bernard, Hutchinson, Lavin, & Pennington, 1996; Betz & Klein,




1996; Saracoglu, Minden, & Wilchesky, 1989; Stanley & Murphy, 1997;




Timmons, 1999), some findings have supported the notion that they are indeed




different constructs. Dickerson and Taylor (2000) conducted a study with female




university students (N= 123) to determine the impact of task-specific self-




efficacy (TSSE) and global self-esteem (GSE) on their choice of leadership task.




The investigators found that although TSSE and GSE were significantly




correlated (r = .61, p < .01), they were not equally strong in predicting leadership




task preference among the women (\3%o,p < .01 versus l%o,p< .05 of the




variance, respectively). Moreover, findings from this study led the investigators to




the conclusion that the relationship between TSSE and GSE would only be




slightly improved upon by using task- relevant abilities as a moderator (R = .03,




p<.05).




Conversely, Stanley and Murphy (1997) conducted a study with




undergraduate students (N= 165) to examine the relationships among general




self-efficacy, task-specific self-efficacy, and self-esteem. Using a battery of




scales, general self-efficacy and global self-esteem scales, the investigators found
76


that general self-efficacy and self-esteem overlapped in variance to predict task-




specific self-efficacy. For instance, the combined general self-efficacy scales




accounted for a significant proportion of variance accounted for (l%o,p < .00) in




task-specific self-efficacy before self-esteem was removed from the equation and




accounted for a nonsignificant proportion of variance (1%), ns) after the removal




of self-esteem from the equation. Moreover, the investigators found that the




correlation between general self-efficacy scales and self-esteem was so high (r =




-.14, p < .01) that they concluded that these variables were measuring the same




construct. However, the correlation was negative because high self-esteem scores




indicated low self-esteem levels and high self-efficacy score indicated high self-




efficacy levels. As a result, one might conclude that general self-efficacy and self-




esteem appeared to measure the same construct because general efficacy may




actually be measuring the efficacy-based aspect of self-esteem.




Social structures can act as both enhancers and barriers to self-esteem and




self-efficacy. Gecas and Schwalbe (1983) contended that life experiences may




increase and decrease self-esteem depending on the role one plays in a society.




For instance, in some societies where there are inequalities related to




race/ethnicity and gender, self-esteem and self-efficacy may have differential




predictive capabilities among these groups. Thompson and Keith (2001)




conducted a study with Black American men (n = 637) and women (n = 1,036) to




evaluate the influence of gender and skin tone on self-esteem and self-efflcacy.




The investigators found that although skin tone had a negative effect on self-




esteem and self-efficacy, these variables affected different self-domains in men
77


and women. More specifically, the investigators found that skin tone predicted




12% of the variance in self-efficacy for men and only 3% for women. On the




other hand, skin tone predicted 1%) of the variance in self-esteem for men and 9%)




for women. The investigators concluded that darker skinned men may feel




inefficacious because of less opportunity to demonstrate competence in a society




where inequality related to racism and colorism are displayed. This lack of




opportunity may cause darker skinned men to have decreased beliefs that they




have the capabilities to perform a task effectively. Similarly, darker skinned




women may have low levels of self-esteem because of their socialization process




in a society embedded with sexism, racism, colorism, and classism. This view was




supported by the fact that the investigators found that the more attractive and the




more income darker skin women had, the higher were their levels self-esteem.




Despite conflicting views as to whether self-efflcacy is a part of self-esteem




or whether self-efflcacy is an entirely different construct, given that self-esteem is




a feeling of self-worth and self-efficacy is a belief in self-capability, it is




reasonable to assume that a person's level of self-esteem would impact his or her




self-efficacy for a particular behavior. However, Rosenthal et al. (1991)




conducted a study with students from post-secondary institutions (N= 1,788)




between the ages of 17 to 20 years, of whom 73%) were females, to investigate




their sexual self-efficacy and sexual self-esteem on their sexual risk-taking




behaviors. Despite the fact that the investigators found that male students had




higher levels of self-esteem than did female students (F= \4.32,p < .001) and




female students had higher self-efficacy subscale scores than male students ("Say
78


No"F= I31.59,p< .001, t^not reported and "Assertive" F= 20.62,/? < .001, df




not reported), they found that self-efficacy and self-esteem accounted for less than




10%) of the variance in risk-taking behaviors for both genders, suggesting that




other mediating and/or moderating factors are also involved in decision to engage




in safer sex behaviors.




Self-Efficacy and Negotiating Safer Sex Behaviors




Early during the HIV/AIDS epidemic, scientists focused their attention on




changing behaviors such as sexual practices and injecting drug use to decrease




acquisition and transmission of the virus. In their quest for knowledge, however,




scientists quickly found that education alone was insufficient to bring about




behavioral change. As a result, they focused their attention on variables that may




predict high risk behaviors in an effort to target interventions to reduce such




behaviors. One such variable is self-efficacy (Bandura, 1986).




Sexual intimacy is a complex phenomenon which is one human basic need




that brings about a pleasurable experience. However, it is the primary mode by




which HIV/AIDS is acquired and transmitted (CDC, 2002; UNAIDS, 2002). For




instance, although HIV/AIDS can be acquired and transmitted by injecting drugs




with contaminated paraphernalia, having sexual intimacy with an HIV-infected




IDU could also result in its acquisition and transmission. Additionally, in the case




of a woman becoming infected via sexual intimacy, she could pass the HIV virus




to her baby, although the same could happen if she became HIV-infected via other




routes such as self-injection of drugs or receiving an HIV-infected blood




transfusion. Given the primary role of sexual intimacy in the acquisition and
79


transmission of HIV/AIDS and given that unprotected sexual intimacy between




two or more persons may result in HIV infection, it is imperative to focus on self-




efficacy for negotiating safer sex behaviors.




Bandura (1986, 1989, 1994) has contended that the higher an individual's




self-efficacy for a particular behavior, the more likely the individual will perform




the behavior; conversely, the lower the self-efficacy, the less likely the individual




will perform the behavior, which in essence suggest the predictive powers of self-




efficacy. Bandura further contended that the more successes an individual has in




performing a behavior, the higher his or her self-efficacy for that particular




behavior will be, which in essence suggests the diagnostic powers of self-efficacy.




Therefore, it may be fair to assume that an individual with a high level of self-




efficacy for negotiating safer behaviors has had many successes performing such




behaviors.




Investigators have found positive relationships between self-efficacy and




safer sex behaviors such as condom use, refusing sex, and sexual discussions




(Forsyth, 1999; Goh et al., 1996; Park, Sneed, Morisky, Alvear, & Hearst, 2002).




It has also been documented that self-efficacy training is successful in reducing




the risk for HIV/AIDS (Icard et al., 1995; Jemmott, Jemmott, Fong, & McCaffree,




1999; Jemmott, Jemmott, Spears, Hewitt, & Cruz-Collins, 1992). Additionally,




findings from numerous studies have suggested the predictive powers of self-




efficacy with respect to safer sex behaviors. Dilorio et al. (1997) conducted a




study with 641 participants ages 18 to 58 years, most of whom were African




Americans (n = 577, 90%)) and males (n = 379, 59.1%)) to evaluate the
80


psychometric properties of two instruments, one being the Condom Use Self-




Efficacy Scale. Among other findings, the investigators found that participants




who reported no condom use at last intercourse had significantly lower total self-




efficacy scores than those who reported use of a condom [t (584)= 3.%l,p< .001].




Similarly, participants who reported no condom use during the past month had




significantly lower self-efficacy scores than those who used condom at least one




during the last month [t (593)= 4. 91,/' < .001]. These findings suggested that the




less practice an individual has at performing safer sex behaviors, the less success




he or she is likely to encounter and the less efficacious he or she will feel.




Many early studies have investigated self-efficacy in gay men because they




were considered a high risk group. However, since women became a high risk




group due to biological (Holmberg, 1997) and behavioral (Beadnell et al., 2000;




Erickson, 1997; Stokes et al., 1996) factors coupled with the possibility for




MTCT, scientists were encouraged to investigate self-efficacy in relation to




negotiating safer sex behaviors in women. Lindberg (2000) conducted a study




with sexually active urban women (N= 100) aged 28 to 45 years to test a model




of the relationships among knowledge, self-efficacy, coping, and condom use.




Using the Condom Use Self-Efficacy Scale (CUSES) developed by Brafford and




Beck (1991) to measure self-efficacy for condom use, the investigator found that




condom use knowledge accounted for 28%) of the variance in self-efficacy (P =




.2%,p= .006), but more importantly, that self efficacy for condom use accounted




for 64%) of the variance in condom use (P = .64, p < .001). Additionally, self-




efficacy accounted for 28%) of the variance in problem-based coping (P = .28, p =
81


.006), and the total model accounted for 43%) of the variance in condom use




behavior (R^ = .43, p< .001).




Similarly, in a study with longitudinal follow-up conducted by Bryan, Aiken,




and West (1997) with female undergraduate students to develop, test, and




replicate a comprehensive model of the determinants of condom use among




young women, the investigators obtained self-report data from 198 women in the




first study and 238 women in the follow-up study. Using Brafford and Beck's




(1991) CUSES in study one and a combination of Brafford and Beck's (1991)




CUSES and Brien, Thombs, Mahoney, and Wallnau (1994) CUSES in the follow-




up study to measure condom use self-efficacy, the investigators found that in the




initial study, self-efficacy showed a significant positive association with




intentions to use condoms (r = .30, p < .001). In addition, these investigators




reported findings from the follow-up study that showed intention to use condoms




as a significant positive association with the percentage of time the participants




used condoms and their condom use at last intercourse (r = .69, p < .001 and r =




.66,p< .001, respectively). These findings indicate that as women's self-efficacy




increased, so did their safer sex behaviors, further suggesting their ability to




negotiate safer sex behaviors with their partners.




Investigators have also studied the ability of self-efficacy to discriminate




safer sex behaviors among groups with high risk behaviors. Brien et al. (1994)




conducted a study with 362 participants, the majority of whom were women




(56.6%)), to examine the dimensions of self-efficacy among three distinct groups




of condom users: (a) nonusers, (b) sporadic users, and (c) ritualistic users. Using
82


the revised Condom Use Self-Efficacy Scale initially developed by Brafford and




Beck (1991), the authors found that ritualistic condom users had higher scores on




all four of the subscales than the sporadic user and nonusers and that three of the




subscales scores were significantly different among these groups ("Partner's




disapproval, " Assertive," and "Intoxicants, F (2,272) = 3.51,p< .05;




F(2,212) = 5.16,p< .005; andF (2,272) = 6.51,p< .005, respectively), which




further supports the view that the more successes an individual has with safer sex




behaviors, the more self-efficacious he or she will be.




Similarly, Trobst and colleagues (2002) conducted a study with African




Americans (N=20\) to determine if personality characteristics influenced risk for




HIV/AIDS. Participants were categorized into groups based upon their HIV risk:




(a) low risk (n = 43, 21.4%), medium risk (n = 96, 47.8%), and high risk (n = 62,




30.8%)). The investigators reported that personality was, indeed, a predictor of




sexual risk. In addition, they reported that thrills and kicks were not predictors of




unsafe sex and that the high risk group had decreased opinion of their skills and




self-efficacy. However, the investigators did not report if and how self-efficacy




was measured in this study, which lends question to the validity of these findings.




In contrast to these findings, St. Lawrence and colleagues (1998) conducted a




community-based study with sexually active African American women (N= 423),




ages 17 to 65 years (M= 31.3, SD = 9.2), to examine the differences in their




condom use, which was categorized as (a) consistently, (b) inconsistently, and (c)




nonusers. Using a 2-item Self-Efficacy Scale based on Bandura's (1986) Social




Cognitive Theory, the investigators found that self-efficacy scores among the
83


three categories of condom users were not significantly different. However,




limited scale items and possibly lack of adequate scale validity may have been




responsible for such findings. Similarly, Youmans (2001) found that self-efficacy,




as measured by Rosenthal et al.'s (1991) Sexual Self-Efficacy Scale, along with




other variables did not predict condom use during sexual intercourse in a group of




college women (N= 157) ages 18 to 24 years.




To determine whether differences exist between genders and among ethnic




groups for self-efficacy to engage in safer sex behaviors, O'Leary, Goodhart,




Jemmott, and Boccher-Lattimore (1992) obtained self-report data from male (n =




372, 40.3%) and female (n = 549, 59.5%) college students, of whom 71.7% were




Whites, 9.6%) were Black/African Americans, 8.8%) were Asian/Pacific Islanders,




5.7%) were Hispanics/Latino, and 4.4%) were others. Using two self-efficacy




scales with items designed to assess self-efficacy for safer sex behaviors as




conceptualized in the Health Belief Model (HBM), the investigators found that




women reported significantly higher perceived self-efficacy for discussing




history/negotiating [ ^(385) = 2.05,p < .05] and for safer sex behaviors [^(389) =




2.02, p< .05], than did men. Additionally, the investigators found that there was a




significant effect for history/negotiating for safer sex behaviors F(4, 356) = 3.08,




p = < .05, which was accounted for by Asian/Pacific Island students having




significantly lower self-efficacy for discussing history/negotiating for safer sex




behaviors scores than did Blacks and Hispanics (t = 2.0, p < .05 and t = 2.l0,p<




.05, df not specified).
84


In further support of ethnic difference in self-efficacy to engage in safer sex




behaviors, Soet, Dilorio, and Dudley (1998) conducted a study with sexually




active female college students (N= 762), ages 18 to 25 years, of whom 46.5%)




were White and the remainder were African Americans. The purpose of the study




was to explore women's intra- and interpersonal factors affecting their condom




use and to determine possible ethnic differences between the two group of women




related to intra- and interpersonal factors. Using the 4-item Self-Efficacy Condom




Use subscale of the 12-item Self-Efficacy Scale revised by Dilorio and colleagues




in 1995 (C. Dilorio, personal communication, September 23, 2002), the




investigators found that higher self-efficacy in white women was significantly




associated with increased condom use [F (1, 352) = ll.54,p < .0001], but not in




African American women. Moreover, multiple regression analysis suggested that




high self-efficacy was a significant predictor of condom use among White women




accounting for 5%) of the variance, whereas self-efficacy did not predict condom




use in African American women.




Similarly, Gomez and Marin (1996) conducted a study with Latino (n = 513,




73.6%)) and non-Latino White (n = 184, 26.4%)) women to assess their




contraceptive use and condom use with steady male partners and explored ethnic




differences in sexual behaviors and psychosocial variables. Using a 4-item self-




efficacy scale for condom use to measure condom use self-efficacy, the




investigators found that non-Latino White women had significantly higher self-




efficacy scores than their Latino counterparts [t = 5.60, p< .007, df not reported].




However, these findings must be interpreted with caution because the self-
85


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P47_ST00267
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P182_ST00171 1398
P182_SP00154
P182_ST00172 1533
P182_SP00155
P182_ST00173
P182_SP00156 1755
P182_ST00174 1771 155 allowed
P182_SP00157 1926
P182_ST00175 1942 access
P182_SP00158 2066
P182_ST00176 2080 2271
P182_SP00159 2118
P182_ST00177 2134
P182_TL00019 2380 976
P182_ST00178 2392 101 more
P182_SP00160 702 2416
P182_ST00179 717 141 diverse
P182_SP00161 858
P182_ST00180 137 sample
P182_SP00162 2426
P182_ST00181 1028
P182_SP00163 8
P182_ST00182 1080
P182_SP00164 1193
P182_ST00183 1206 202
P182_SP00165 1408
P182_ST00184 1421 women.
P182_TL00020 665 2495
P182_ST00185 2497 6.
P182_SP00166 696 2531
P182_ST00186 713
P182_SP00167
P182_ST00187 821
P182_SP00168 1015
P182_ST00188 1029 2507
P182_SP00169 1105
P182_ST00189 1121 86 only
P182_SP00170 1207 2541
P182_ST00190 1222 conducted
P182_SP00171 1425
P182_ST00191 1439
P182_SP00172 1476 2530
P182_ST00192 1489 153 Nassau. 2000000
P182_SP00173 1642
P182_ST00193 1659
P182_SP00174 1753
P182_ST00194 1768
P182_SP00175 1962
P182_ST00195 1977
P182_SP00176
P182_ST00196 2027 Freeport, 000000006
P182_TL00021 2610 1581
P182_ST00197 122 Grand
P182_SP00177 724 2646
P182_ST00198 163 Bahama
P182_SP00178 901
P182_ST00199 914
P182_SP00179 1030 2656
P182_ST00200 1043
P182_SP00180 1136
P182_ST00201 1150 176
P182_SP00181 1326
P182_ST00202 2622
P182_SP00182 1361
P182_ST00203 1375
P182_SP00183
P182_ST00204 142
P182_SP00184 1633
P182_ST00205 1649
P182_SP00185 1787
P182_ST00206
P182_SP00186 1846
P182_ST00207 1854
P182_SP00187 1967
P182_ST00208 1981
P182_TL00022 2737
P182_ST00209
P182_TB00002 1388 3041 79
P182_TL00023 1394 3047 67 33
P182_ST00210


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MeasurementUnit pixel
sourceImageInformation
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OCRProcessing ID OCRPROCESSING_1
preProcessingStep
processingSoftware
softwareCreator Kirtas Technologies, Inc.
softwareName BookScan Editor
softwareVersion 3.6
ocrProcessingStep
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OCR Manager
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Layout
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TopMargin P145_TM00001 HPOS 0 VPOS 304
LeftMargin P145_LM00001 594 2782
RightMargin P145_RM00001 2249 301
BottomMargin P145_BM00001 3086 214
PrintSpace P145_PS00001 1655
TextBlock P145_TB00001 2588
TextLine P145_TL00001 604 310 1624 46
String P145_ST00001 311 347 45 CONTENT Spearman-Brown WC 1.00 CC 00000000000000
SP P145_SP00001 951 356 29
P145_ST00002 980 183 split-half 0000000000
P145_SP00002 1163 10
P145_ST00003 1173 245 coefficients) 0.94 0000700000000
P145_SP00003 1418 16
P145_ST00004 1434 58 36 for 000
P145_SP00004 1492 346 15
P145_ST00005 1507 184 subscales 000000000
P145_SP00005 1691
P145_ST00006 1707 69 and
P145_SP00006 1776 17
P145_ST00007 1793 115 scales 000000
P145_SP00007 1908 14
P145_ST00008 1922 322 96 24 were 0000
P145_SP00008 2018
P145_ST00009 2033 195 computed 00000000
P145_TL00002 601 425 1580
P145_ST00010
P145_SP00009 659 461 12
P145_ST00011 671 59 the
P145_SP00010 730
P145_ST00012 747 105 study 00000
P145_SP00011 852 471
P145_ST00013 868 137 sample
P145_SP00012 1005
P145_ST00014 1021
P145_SP00013 1090
P145_ST00015 1106 193 compared
P145_SP00014 1299
P145_ST00016 1313 88 with
P145_SP00015 1401
P145_ST00017 1416 estimates
P145_SP00016 1599
P145_ST00018 1614 94 from
P145_SP00017 1708
P145_ST00019 1724 169 previous
P145_SP00018 1893
P145_ST00020 1910 144 studies.
P145_SP00019 2054 19
P145_ST00021 2073 427 108 34 Items
P145_TL00003 600 540 1510
P145_ST00022 552
P145_SP00020 696 576
P145_ST00023 710 546 63 30 not
P145_SP00021 773
P145_ST00024 787 142 deleted 0000000
P145_SP00022 929
P145_ST00025 944
P145_SP00023 1038
P145_ST00026 1054 any
P145_SP00024 1123 586
P145_ST00027 1140
P145_SP00025 1324
P145_ST00028 1340 40 or 00
P145_SP00026 1380
P145_ST00029 1395
P145_SP00027
P145_ST00030 1527 99 since
P145_SP00028 1626
P145_ST00031 1641 129 "alpha 0.98 100000
P145_SP00029 1770 13
P145_ST00032 1783 35 if
P145_SP00030 1817 575 9
P145_ST00033 1826 106 items
P145_SP00031 1932
P145_ST00034 1948 162 deleted" 0.97 00000002
P145_TL00004 655 1596
P145_ST00035 126 values
P145_SP00032 726 691
P145_ST00036 741 181 indicated
P145_SP00033 922
P145_ST00037 936 75 that
P145_SP00034 1011
P145_ST00038 1025 159 deleting
P145_SP00035 1184 701
P145_ST00039 1198
P145_SP00036 1304
P145_ST00040 1318 124 would
P145_SP00037 1442
P145_ST00041 1456 661
P145_SP00038 1519
P145_ST00042 1533 92 have
P145_SP00039 1625
P145_ST00043 1639 190 improved
P145_SP00040 1829
P145_ST00044 1845 166 subscale
P145_SP00041 2011
P145_ST00045 2027
P145_SP00042 2096
P145_ST00046 2110 86 total
P145_TL00005 603 770 342
P145_ST00047 95 scale
P145_SP00043 698 806
P145_ST00048 713 232 reliabilities.
P145_TL00006 690 885 1463
P145_ST00049 165 Taylor's 0.93 00000050
P145_SP00044 855 931 18
P145_ST00050 873 239 Self-Esteem 00000000000
P145_SP00045 1112 921
P145_ST00051 1128 887 191 44 Inventory
P145_SP00046 1319
P145_ST00052 1335 135 (TSEI)
P145_SP00047 1470
P145_ST00053 1484 897 76 was
P145_SP00048 1560
P145_ST00054 1575 90 used
P145_SP00049 1665
P145_ST00055 1680 37 in
P145_SP00050 1717 920
P145_ST00056 1730 71 this
P145_SP00051 1801
P145_ST00057 1818 104
P145_SP00052
P145_ST00058 1935 891 38 to
P145_SP00053 1973
P145_ST00059 1988 measure
P145_TL00007 1000 1621
P145_ST00060 self-esteem. 000000000000
P145_SP00054 835 1036
P145_ST00061 854 This
P145_SP00055 940
P145_ST00062 955 213 instmment 0.91 000080000
P145_SP00056 1168
P145_ST00063 1182 consisted
P145_SP00057 1365
P145_ST00064 1381 of
P145_SP00058 1425 8
P145_ST00065 1433 1006 74 two
P145_SP00059
P145_ST00066 1523 185
P145_SP00060
P145_ST00067
P145_SP00061
P145_ST00068 1809 163 contains
P145_SP00062 1972
P145_ST00069 1012 20 a
P145_SP00063 2008
P145_ST00070 2020
P145_SP00064 2106
P145_ST00071 2124
P145_SP00065 2168
P145_ST00072 2182 1002 42 33
P145_TL00008 1115
P145_ST00073
P145_SP00066 707 1151
P145_ST00074 722 187 including
P145_SP00067 909 1161
P145_ST00075 925 1117
P145_SP00068 1150
P145_ST00076 959 155 Reward
P145_SP00069 1114
P145_ST00077 1129 85 (i.e., 0.90 000006
P145_SP00070 1214
P145_ST00078 1231 172 positive)
P145_SP00071 1403
P145_ST00079 1419
P145_SP00072 1488
P145_ST00080 1505
P145_SP00073 1524
P145_ST00081 1541 1116 109 Costs
P145_SP00074 1650
P145_ST00082 1666 84
P145_SP00075 1750
P145_ST00083 1768 negative)
P145_SP00076 1951
P145_ST00084 1966 items.
P145_SP00077 2081
P145_ST00085 2099 98 Each
P145_TL00009 1230 1564
P145_ST00086 item
P145_SP00078 687 1266
P145_ST00087 1242 77
P145_SP00079 778
P145_ST00088 792 rated
P145_SP00080 890
P145_ST00089 906 47 on
P145_SP00081 953
P145_ST00090 968
P145_SP00082 988
P145_ST00091 1003 1232 21
P145_SP00083 1024 1265
P145_ST00092 1040 141 (never) 0.60 7430308
P145_SP00084 1181 1276
P145_ST00093 1195 1236
P145_SP00085 1233
P145_ST00094 1250
P145_SP00086 1269
P145_ST00095 1286 (always) 0.51 73323458
P145_SP00087 1455
P145_ST00096 1472
P145_SP00088 1568
P145_ST00097 1582 174 resulting
P145_SP00089 1756
P145_ST00098
P145_SP00090 1807
P145_ST00099 1821 possible
P145_SP00091 1983
P145_ST00100 2000
P145_TL00010 1345 1598
P145_ST00101 1357 128 ranges
P145_SP00092 729 1391
P145_ST00102 744
P145_SP00093 788 11
P145_ST00103 799 1347
P145_SP00094 820
P145_ST00104 834 1351
P145_SP00095 872
P145_ST00105 888 64
P145_SP00096 934
P145_ST00106 950
P145_SP00097 1019
P145_ST00107 1035
P145_SP00098 1055
P145_ST00108 1067 87
P145_SP00099 1154
P145_ST00109 1172
P145_SP00100 1268
P145_ST00110 1283 range
P145_SP00101
P145_ST00111 1407
P145_SP00102 1451
P145_ST00112 1461
P145_SP00103 1482
P145_ST00113 1496
P145_SP00104 1534
P145_ST00114 1554 128.
P145_SP00105 1631
P145_ST00115 The
P145_SP00106 1725
P145_ST00116 1739 177 negative, 000000006
P145_SP00107 1916
P145_ST00117 1934 41
P145_SP00108 1975
P145_ST00118 1989 cost, 0.88 00006
P145_SP00109 2076 1389
P145_ST00119 2093
P145_TL00011 1460 1632
P145_ST00120
P145_SP00110
P145_ST00121 711 reverse
P145_SP00111 853
P145_ST00122 116 coded
P145_SP00112 984
P145_ST00123
P145_SP00113 1069
P145_ST00124 1085 summed
P145_SP00114 1251
P145_ST00125
P145_SP00115 1353
P145_ST00126 1366 60
P145_SP00116 1426
P145_ST00127 1441 136 reward
P145_SP00117 1577
P145_ST00128 1593
P145_SP00118 1633
P145_ST00129 1646 157 positive
P145_SP00119 1803 1506
P145_ST00130
P145_SP00120 1923
P145_ST00131 1938
P145_SP00121 1996
P145_ST00132 2010
P145_SP00122 2030
P145_ST00133 2043
P145_SP00123 2129
P145_ST00134 2147 self-
P145_TL00012 602
P145_ST00135 1581 esteem
P145_SP00124 737 1611
P145_ST00136 754 1587 111 score.
P145_SP00125 865
P145_ST00137 882 138 Higher
P145_SP00126 1020
P145_ST00138 223 self-esteem
P145_SP00127 1259
P145_ST00139 121 scores
P145_SP00128 1397
P145_ST00140 1412
P145_SP00129
P145_ST00141 1608 higher
P145_SP00130 1734
P145_ST00142 1747 114 levels
P145_SP00131 1861
P145_ST00143 1877
P145_SP00132 1921
P145_ST00144 1933 233
P145_SP00133 2166
P145_ST00145 2184 1576 An
P145_TL00013 1690 1481
P145_ST00146 index
P145_SP00134 1726
P145_ST00147
P145_SP00135
P145_ST00148 781 skewness
P145_SP00136 965
P145_ST00149 981 134 (-.315) 0002000
P145_SP00137 1736
P145_ST00150 1131
P145_SP00138 1200
P145_ST00151 1215 197 histogram
P145_SP00139
P145_ST00152
P145_SP00140 1514
P145_ST00153 1531 273 superimposed
P145_SP00141 1804
P145_ST00154 1819 normal
P145_SP00142 1956
P145_ST00155 1974 1702 curve
P145_TL00014 1805 1528
P145_ST00156
P145_SP00143 782 1841
P145_ST00157 796
P145_SP00144 871
P145_ST00158 1806 103 TSEI
P145_SP00145
P145_ST00159 1004
P145_SP00146 1125
P145_ST00160 1139
P145_SP00147 1234
P145_ST00161 146 slightly
P145_SP00148 1851
P145_ST00162 1411 206 negatively
P145_SP00149 1617
P145_ST00163 1634 skewed
P145_SP00150 1780
P145_ST00164
P145_SP00151 1881
P145_ST00165 1895
P145_SP00152
P145_ST00166 sample.
P145_TL00015 1920 1637
P145_ST00167 192 However, 00000006
P145_SP00153 1964
P145_ST00168 808 255 visualization 0000000000000
P145_SP00154 1063
P145_ST00169 1079
P145_SP00155
P145_ST00170
P145_SP00156 1190
P145_ST00171 1205
P145_SP00157 1402
P145_ST00172
P145_SP00158 1504
P145_ST00173 1521 274
P145_SP00159 1795
P145_ST00174
P145_SP00160 1947
P145_ST00175
P145_SP00161 2072
P145_ST00176 2089 148 showed
P145_TL00016 2035 1149
P145_ST00177
P145_SP00162 675 2071
P145_ST00178 688
P145_SP00163
P145_ST00179 763 228 distribution
P145_SP00164 991
P145_ST00180
P145_SP00165 1050
P145_ST00181 1058
P145_SP00166 1118
P145_ST00182 1133 2036
P145_SP00167 1237
P145_ST00183 1252 2047 120
P145_SP00168 1372
P145_ST00184 1387
P145_SP00169
P145_ST00185 1479 270 quasi-normal.
P145_TL00017 2150 1522
P145_ST00186
P145_SP00170 764 2186
P145_ST00187 Silencing
P145_SP00171 2196
P145_ST00188
P145_SP00172
P145_ST00189 1073 81 Self
P145_SP00173
P145_ST00190 1166 Scale
P145_SP00174
P145_ST00191 1284 (STSS)
P145_SP00175 1428
P145_ST00192 2162
P145_SP00176 1518
P145_ST00193 1532 91
P145_SP00177 1623
P145_ST00194 1638
P145_SP00178 1675 2185
P145_ST00195 1688
P145_SP00179 1759
P145_ST00196
P145_SP00180 1880
P145_ST00197 2156
P145_SP00181 1931
P145_ST00198 1945
P145_SP00182
P145_ST00199 2127
P145_TL00018 2265 1616
P145_ST00200 silencing.
P145_SP00183 2311
P145_ST00201 807
P145_SP00184 2301
P145_ST00202 899 2266 STSS
P145_SP00185 1007
P145_ST00203 consists
P145_SP00186 1179
P145_ST00204
P145_SP00187 1239
P145_ST00205 1249 2267 31 0.96
P145_SP00188 1291 2300
P145_ST00206 1311
P145_SP00189 1417
P145_ST00207
P145_SP00190 1502
P145_ST00208 1516 22 4
P145_SP00191 1538
P145_ST00209 1556
P145_SP00192 1740
P145_ST00210
P145_SP00193
P145_ST00211 1857 252 Extemalized 0.99 00001000000
P145_SP00194 2109
P145_ST00212 Self-
P145_TL00019 2380
P145_ST00213 222 Perception, 00000000006
P145_SP00195 822 2426
P145_ST00214 840 2381 Care
P145_SP00196 932 2416
P145_ST00215 947 2392 as
P145_SP00197 985
P145_ST00216 280 Self-Sacrifice, 000000000000006
P145_SP00198 2424
P145_ST00217 1303
P145_SP00199
P145_ST00218 1501
P145_SP00200
P145_ST00219 1578 Self,
P145_SP00201 1664
P145_ST00220 160 Divided
P145_SP00202 1840
P145_ST00221 101 43 Self).
P145_SP00203 1958 2423
P145_ST00222
P145_SP00204 2074
P145_ST00223
P145_TL00020 2495 1483
P145_ST00224 2507
P145_SP00205 676 2531
P145_ST00225
P145_SP00206 789
P145_ST00226 804
P145_SP00207 851
P145_ST00227 867
P145_SP00208
P145_ST00228 903 5-point
P145_SP00209 1044 2541
P145_ST00229 1057 122 Likert
P145_SP00210
P145_ST00230
P145_SP00211 1290
P145_ST00231 1305 151 ranging
P145_SP00212
P145_ST00232
P145_SP00213
P145_ST00233 1584 2497 1
P145_SP00214 1597 2530
P145_ST00234 1618 179 (strongly 0.70 750014034
P145_SP00215 1797
P145_ST00235 1810 disagree) 015301338
P145_SP00216 1997
P145_ST00236 2501
P145_SP00217 2049
P145_ST00237 2065 5
P145_TL00021 2610
P145_ST00238 178
P145_SP00218 780 2656
P145_ST00239 793 agree). 0.71 3013380
P145_SP00219
P145_ST00240 Total
P145_SP00220 1051 2646
P145_ST00241 1070 2611
P145_SP00221 1178
P145_ST00242 1197 2622
P145_SP00222 1317
P145_ST00243 1333 66 can
P145_SP00223 1399
P145_ST00244 1413
P145_SP00224
P145_ST00245 1537
P145_SP00225
P145_ST00246 1648 2612
P145_SP00226 2645
P145_ST00247 2616
P145_SP00227 1746
P145_ST00248 1766 78 155, 0.85 0006
P145_SP00228 1844 2654
P145_ST00249 1860
P145_SP00229
P145_ST00250 1963
P145_SP00230
P145_ST00251 2105
P145_TL00022 2725 1573
P145_ST00252 198 indicating
P145_SP00231 2771
P145_ST00253 813 2731 greater
P145_SP00232
P145_ST00254 966 silencing
P145_SP00233 1143
P145_ST00255 1156 203 behaviors.
P145_SP00234 1359 2761
P145_ST00256 1377 2727
P145_SP00235 1485
P145_ST00257 28 1, 06
P145_SP00236 2769
P145_ST00258 1552 8,
P145_SP00237 1583 23
P145_ST00259 1606 53 11, 0.80 006
P145_SP00238 1659
P145_ST00260 1681 15,
P145_SP00239
P145_ST00261 1752
P145_SP00240
P145_ST00262 1835
P145_SP00241 1878 2760
P145_ST00263 1897 2737
P145_SP00242 1993
P145_ST00264 2007 167 reversed
P145_TL00023 2840 1574
P145_ST00265 coded,
P145_SP00243 728 2884
P145_ST00266 746
P145_SP00244 815 2876
P145_ST00267 831 all
P145_SP00245 876
P145_ST00268 892
P145_SP00246 998
P145_ST00269 2852
P145_SP00247 1108
P145_ST00270
P145_SP00248
P145_ST00271 2846
P145_SP00249 1342
P145_ST00272 compute
P145_SP00250 1526 2886
P145_ST00273 1542
P145_SP00251 1562
P145_ST00274
P145_SP00252 1660
P145_ST00275 2841 107
P145_SP00253 1787
P145_ST00276 110
P145_SP00254
P145_ST00277
P145_SP00255 2875
P145_ST00278
P145_SP00256 2116
P145_ST00279 2132
P145_TB00002 1388 3041 79
P145_TL00024 1394 3047 67
P145_ST00280 130 0.92 020


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softwareName BookScan Editor
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TopMargin P218_TM00001 HPOS 0 VPOS 304
LeftMargin P218_LM00001 594 2782
RightMargin P218_RM00001 2243 307
BottomMargin P218_BM00001 3086 214
PrintSpace P218_PS00001 1649
TextBlock P218_TB00001 2588
TextLine P218_TL00001 690 310 1547 46
String P218_ST00001 316 145 38 CONTENT esteem, WC 0.91 CC 0000006
SP P218_SP00001 835 354 18
P218_ST00002 853 69 36 and 1.00 000
P218_SP00002 922 346 17
P218_ST00003 939 122 sexual 000000
P218_SP00003 1061 16
P218_ST00004 1077 224 risk-taking. 000000000000
P218_SP00004 1301 356 15
P218_ST00005 1316 160 Journal 0.94 0002001
P218_SP00005 1476 11
P218_ST00006 1487 47 of 00
P218_SP00006 1534 6
P218_ST00007 1540 228 Community 000000000
P218_SP00007 1768
P218_ST00008 1784 34 & 0.64 3
P218_SP00008 1818
P218_ST00009 1829 162 Applied 0001040
P218_SP00009 1991 7
P218_ST00010 1998 239 Psychology, 0.95 04000010000
P218_TL00002 691 427 171 42
P218_ST00011 31 1, 0.65 07
P218_SP00010 722 469
P218_ST00012 740 77-88. 0.92 000220
P218_TL00003 600 540 1533
P218_ST00013 281 Ruangjiratain, 0.96 00000000000006
P218_SP00011 881 586 20
P218_ST00014 901 541 45 43 S., 0.80 006
P218_SP00012 946 584
P218_ST00015 963 35
P218_SP00013 998 576
P218_ST00016 1013 168 44 Kendall, 0.93 00000006
P218_SP00014 1181
P218_ST00017 1198 542 27 J. 10
P218_SP00015 1225 19
P218_ST00018 1244 139 (1998). 0000000
P218_SP00016 1383
P218_ST00019 1400 293 Understanding 0000000000000
P218_SP00017 1693 13
P218_ST00020 1706 182 women's 0000050
P218_SP00018 1888
P218_ST00021 1903 74 risk 0000
P218_SP00019 1977 14
P218_ST00022
P218_SP00020 2035 9
P218_ST00023 2044 89 HIV
P218_TL00004 701 655 1461
P218_ST00024 176 infection
P218_SP00021 877
P218_ST00025 891 37 in
P218_SP00022 928
P218_ST00026 943 175 Thailand 00000000
P218_SP00023 1118
P218_ST00027 1132 154 through
P218_SP00024 1286
P218_ST00028 1302 134 critical
P218_SP00025 1436
P218_ST00029 1452 274 hermeneutics.
P218_SP00026 1726
P218_ST00030 1740 194 Advances 0.87 00000055
P218_SP00027 1934
P218_ST00031 1948 658 32
P218_SP00028 1985 12
P218_ST00032 1997 656 165 Nursing 0005000
P218_TL00005 688 770 435
P218_ST00033 161 Science, 0.62 50461067
P218_SP00029 849 814
P218_ST00034 866 116 21(2), 0.48 108767
P218_SP00030 982 816
P218_ST00035 999 772 124 42-51. 0.39 870775
P218_TL00006 604 885 1473
P218_ST00036 156 Salgado
P218_SP00031 760 931
P218_ST00037 775 de
P218_SP00032 819 921
P218_ST00038 837 146 Snyder,
P218_SP00033 983
P218_ST00039 1000 887 V.
P218_SP00034 1043
P218_ST00040 1059 59 N., 0.72 206
P218_SP00035 929
P218_ST00041 1135 185 Acevedo,
P218_SP00036 1320
P218_ST00042 1338 886 56 A.,
P218_SP00037 1394
P218_ST00043 1410 232 Diaz-Perez, 00000000006
P218_SP00038 1642
P218_ST00044 1658 53 M.
P218_SP00039 1711
P218_ST00045 1730
P218_SP00040 1774
P218_ST00046 1788 41 J., 0.75 106
P218_SP00041
P218_ST00047 1846
P218_SP00042 1881
P218_ST00048 1900 177 Saldivar-
P218_TL00007
P218_ST00049 181 Garduno,
P218_SP00043 871 1044
P218_ST00050 888 1001 A.
P218_SP00044 1036
P218_ST00051 950 140 (2000).
P218_SP00045 1090 1046
P218_ST00052 1107
P218_SP00046
P218_ST00053 1413 60 the
P218_SP00047
P218_ST00054 1490 sexuality
P218_SP00048 1666
P218_ST00055 1682
P218_SP00049 8
P218_ST00056 1734 283 Mexican-born
P218_SP00050 2017
P218_ST00057 2030 1012 147 24 women 00000
P218_TL00008 1115 1518
P218_ST00058
P218_SP00051 759 1151
P218_ST00059 92 their
P218_SP00052 864
P218_ST00060
P218_SP00053 951
P218_ST00061 964 58 for
P218_SP00054 1022
P218_ST00062 1035 102 0010
P218_SP00055 1137 2
P218_ST00063 1139 1116 123 AIDS.
P218_SP00056 1262
P218_ST00064 1277 Psychology 0400000000
P218_SP00057 1509 1161
P218_ST00065 1523
P218_SP00058 1570
P218_ST00066 1579 143 Women 0.88 00041
P218_SP00059 1722
P218_ST00067 1738 201 Quarterly, 0001041000
P218_SP00060 1939
P218_ST00068 1959 1117 24, 007
P218_SP00061 1159 22
P218_ST00069 2039 169 100-109.
P218_TL00009 1230 1611
P218_ST00070 0.97
P218_SP00062 1276
P218_ST00071
P218_SP00063 1266
P218_ST00072
P218_SP00064
P218_ST00073 1232
P218_SP00065
P218_ST00074 0.63 506
P218_SP00066 1274
P218_ST00075 1134 93 Diaz
P218_SP00067 1227
P218_ST00076 1241 120 Perez, 0.81 500006
P218_SP00068 1361
P218_ST00077 1377
P218_SP00069 1430
P218_ST00078 1449
P218_SP00070 1493
P218_ST00079 1502 40 j.,
P218_SP00071 1542
P218_ST00080 1559 1231
P218_SP00072 1594
P218_ST00081 1609 237 Maldonado, 0000000006
P218_SP00073
P218_ST00082 1862 52
P218_SP00074 1914
P218_ST00083 1933 (1996).
P218_SP00075 2072
P218_ST00084 2091 AIDS:
P218_TL00010 1345 1511
P218_ST00085 91 Risk
P218_SP00076 779 1381
P218_ST00086 792 193 behaviors
P218_SP00077 985
P218_ST00087 1357 132 among
P218_SP00078 1133 1391
P218_ST00088 1148 90 mral 8000
P218_SP00079 1238
P218_ST00089 1253 174 Mexican
P218_SP00080 1427
P218_ST00090 1441
P218_SP00081 1587
P218_ST00091 1602 153 married
P218_SP00082 1755
P218_ST00092 1351 30 to
P218_SP00083 1806
P218_ST00093 1821 migrant
P218_SP00084 1975
P218_ST00094 1988 159 workers
P218_SP00085 2147
P218_ST00095 2162
P218_TL00011 1460 1332
P218_ST00096
P218_SP00086 747 1496
P218_ST00097 761 135 United
P218_SP00087 896
P218_ST00098 914 States.
P218_SP00088 1037
P218_ST00099 1051 114 AIDS 0002
P218_SP00089 1165
P218_ST00100 1173 207 Education
P218_SP00090 1380 1495
P218_ST00101 1393 329 andPprevention, 000000505000007
P218_SP00091 1506
P218_ST00102 1739 8(2), 0.47 07376
P218_SP00092 1830
P218_ST00103 1852 1462 134-142.
P218_TL00012 1575
P218_ST00104 204 Saracoglu,
P218_SP00093 808 1621
P218_ST00105 825 1577 54 B.,
P218_SP00094 879 1619
P218_ST00106 895 Minden,
P218_SP00095 1060
P218_ST00107 1076 H.,
P218_SP00096
P218_ST00108 1576
P218_SP00097 1186
P218_ST00109 1201 223 Wilchesky,
P218_SP00098 1424
P218_ST00110 1440
P218_SP00099 1492
P218_ST00111 (1989).
P218_SP00100 1651
P218_ST00112 1670 The
P218_SP00101 1744
P218_ST00113 1760 217 adjustment 0000000000
P218_SP00102
P218_ST00114 1992
P218_SP00103 2036
P218_ST00115 2047 students
P218_TL00013 1690 1526
P218_ST00116 87 with
P218_SP00104
P218_ST00117 790 learning
P218_SP00105 952 1736
P218_ST00118 967 213 disabilities
P218_SP00106 1180
P218_ST00119 1195
P218_SP00107 1725
P218_ST00120 1246 198 university
P218_SP00108 1444
P218_ST00121
P218_SP00109 1529
P218_ST00122 1543 its
P218_SP00110 1588
P218_ST00123 1603 233 relationship
P218_SP00111 1836
P218_ST00124 1851 1696
P218_SP00112 1889
P218_ST00125 1905 self-esteem 00000000000
P218_SP00113 2129
P218_ST00126 2145
P218_TL00014 1805 1250
P218_ST00127 254 self-efflcacy. 0.90 00000007700000
P218_SP00114 945
P218_ST00128 960 2060013
P218_SP00115 1120 1841
P218_ST00129 0.89 01
P218_SP00116 1179 1
P218_ST00130 188 Learning 05100200
P218_SP00117 1368
P218_ST00131 1376 238 Disabilities, 0251123232550
P218_SP00118 1614 1847
P218_ST00132 1634 22(9), 0.60 007276
P218_SP00119 1750
P218_ST00133 1769 1807 172 590-592.
P218_TL00015 1920
P218_ST00134 Saunders, 000000006
P218_SP00120 1964
P218_ST00135 810 1921 G.
P218_SP00121 852 1956
P218_ST00136 (1994).
P218_SP00122 1010 1966
P218_ST00137 1026 Bahamian 0.83 21310210
P218_SP00123 1233 1955
P218_ST00138 1923 society 5002532
P218_SP00124 1385
P218_ST00139 1397 94 after 00050
P218_SP00125 1491
P218_ST00140 1505 280 emancipation. 5000000000000
P218_SP00126 1785
P218_ST00141 1802 192 Kingston,
P218_SP00127 1994
P218_ST00142 2011 Jamaica: 0.98 10000000
P218_TL00016 689
P218_ST00143 2037 61 Ian
P218_SP00128 750 2071
P218_ST00144 764 149 Randle.
P218_TL00017 2150
P218_ST00145 Schaumberg,
P218_SP00129 858 2196
P218_ST00146 875 2152 L.
P218_SP00130 913 2186
P218_ST00147 930 L.,
P218_SP00131 2194
P218_ST00148 267 Patsdaughter, 5000000000006
P218_SP00132 1265
P218_ST00149 1283 2151 C.
P218_SP00133 1323
P218_ST00150 1341
P218_SP00134
P218_ST00151 1417 133 Selder,
P218_SP00135 1550
P218_ST00152 1566 F.
P218_SP00136
P218_ST00153 E.,
P218_SP00137 1671
P218_ST00154 1688
P218_SP00138 1723
P218_ST00155 1737 180 Napholz, 50400006
P218_SP00139 1917
P218_ST00156
P218_SP00140 1971
P218_ST00157 1990 (1995).
P218_TL00018 2265 1435
P218_ST00158 186 Hypnosis
P218_SP00141 874 2311
P218_ST00159 890 2277 39 as
P218_SP00142 2301
P218_ST00160 a
P218_SP00143 965
P218_ST00161 979 clinical
P218_SP00144 1122
P218_ST00162 1138 240 intervention
P218_SP00145 1378
P218_ST00163 1392
P218_SP00146 1450
P218_ST00164 136 weight
P218_SP00147 1598
P218_ST00165 1612 reduction
P218_SP00148 1798
P218_ST00166 1814
P218_SP00149 1883
P218_ST00167
P218_TL00019 2380 1331
P218_ST00168 265 improvement
P218_SP00150 954 2426
P218_ST00169 968
P218_SP00151 1004 2415
P218_ST00170 1018 2392 young
P218_SP00152 1142
P218_ST00171 1157 98 adult
P218_SP00153 1255 2416
P218_ST00172 1267 155 women.
P218_SP00154 1422
P218_ST00173 005
P218_SP00155 1513
P218_ST00174 268 International 0005000000000
P218_SP00156 1794
P218_ST00175
P218_SP00157 1962
P218_ST00176 1973
P218_TL00020 686 2495 884
P218_ST00177 Psychiatric 05000000000
P218_SP00158 2541
P218_ST00178 926 2496
P218_SP00159 1091
P218_ST00179 1099 Research, 055500000
P218_SP00160 1293 2537
P218_ST00180 1315 7(3), 0.70 80006
P218_SP00161 1405
P218_ST00181 1423 2497 99-106.
P218_TL00021 2610 1508
P218_ST00182 Scheldt, 0.82 00008006
P218_SP00162 2654
P218_ST00183 2612 D.
P218_SP00163 2646
P218_ST00184 836 66 M.,
P218_SP00164 902
P218_ST00185 919 2611
P218_SP00165
P218_ST00186 969 Windle,
P218_SP00166 1125
P218_ST00187 1141
P218_SP00167 1194
P218_ST00188 1213
P218_SP00168 1352 2656
P218_ST00189 1370 Individual
P218_SP00169 1571
P218_ST00190 1589
P218_SP00170
P218_ST00191 1675 202 situational
P218_SP00171 1877
P218_ST00192 1894 158 markers
P218_SP00172 2052
P218_ST00193 2068
P218_TL00022 2725 1482
P218_ST00194 157 condom
P218_SP00173 847 2761
P218_ST00195 861 2737 use
P218_SP00174 927
P218_ST00196 942
P218_SP00175 1011
P218_ST00197 1028 62 sex
P218_SP00176
P218_ST00198 1104 88
P218_SP00177 1192
P218_ST00199 1206 231 nonprimary
P218_SP00178 1437 2771
P218_ST00200 2731 partners
P218_SP00179
P218_ST00201 1627
P218_SP00180
P218_ST00202 1775 alcoholic
P218_SP00181
P218_ST00203 1970 inpatients:
P218_TL00023 2840 1409
P218_ST00204 173 Findings
P218_SP00182 2886
P218_ST00205 95 from
P218_SP00183 970 2876
P218_ST00206
P218_SP00184
P218_ST00207 2841 178 ATRISK
P218_SP00185 1237
P218_ST00208 1254 113 study.
P218_SP00186 1367
P218_ST00209 137 Health 050000
P218_SP00187 1520 2875
P218_ST00210 1531 242 00000000007
P218_SP00188 1773
P218_ST00211 1792 15(3), 008877
P218_SP00189 1906
P218_ST00212 1928 2842 185-192. 02000000
P218_TB00002 3041 81
P218_TL00024 1389 3047 33
P218_ST00213 203


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SP P139_SP00001 721 346 14
P139_ST00002 735 230 44 Bahamians, 0.94 0000000006
P139_SP00002 965 354 18
P139_ST00003 983 69 and 000
P139_SP00003 1052 15
P139_ST00004 1067 174 "Others" 0.95 10000002
P139_SP00004 1241 17
P139_ST00005 1258 206 comprised 000000000
P139_SP00005 1464 356
P139_ST00006 1478 311 112 43 2.3%), 0.73 000806
P139_SP00006 1590 21
P139_ST00007 1611 84 .5%), 0.70 00806
P139_SP00007 1695
P139_ST00008 1713
P139_SP00008 1782
P139_ST00009 1796 64 35 2%) 0.69 080
P139_SP00009 1860 16
P139_ST00010 1876 of 00
P139_SP00010 1920 8
P139_ST00011 1928 61 the
P139_SP00011 1989
P139_ST00012 2005 148 sample, 0.91 0000006
P139_TL00002 601 425 1615
P139_ST00013 248 respectively. 0000000000000
P139_SP00012 849 471 19
P139_ST00014 868 427 53 34 To
P139_SP00013 921 461
P139_ST00015 936 431 169 40 compute 0000000
P139_SP00014 1105
P139_ST00016 1121 437 24 an
P139_SP00015 1165
P139_ST00017 1181 66 age
P139_SP00016 1247 13
P139_ST00018 1260 170 variable, 0.93 000000006
P139_SP00017 1430 469
P139_ST00019 1446 60
P139_SP00018 1506
P139_ST00020 1521 85 year 0000
P139_SP00019 1606
P139_ST00021 1620 in
P139_SP00020 460
P139_ST00022 1670 which
P139_SP00021 1791
P139_ST00023 1806 participants 000000000000
P139_SP00022 2036
P139_ST00024 2051 165 reported 00000000
P139_TL00003 540 1537
P139_ST00025 75 that
P139_SP00023 675 576
P139_ST00026 688 they
P139_SP00024 772 586
P139_ST00027 786 552 96 were
P139_SP00025 882
P139_ST00028 895 91 born
P139_SP00026 986
P139_ST00029 1000 was
P139_SP00027 1075
P139_ST00030 1092 202 subtracted 0000000000
P139_SP00028 1294
P139_ST00031 1308 95 from
P139_SP00029 1403
P139_ST00032 1418 542 107 2003. 0.99
P139_SP00030 1525
P139_ST00033 1542 256 Examination 00000000000
P139_SP00031 1798
P139_ST00034 1813
P139_SP00032 1857
P139_ST00035 1865
P139_SP00033 1925
P139_ST00036 1940 197 frequency
P139_TL00004 602 655 1593
P139_ST00037 228 distribution
P139_SP00034 830 691
P139_ST00038 845
P139_SP00035 914
P139_ST00039 929 histogram
P139_SP00036 1126 701
P139_ST00040 1140 88 with
P139_SP00037 1228
P139_ST00041 1245 273 superimposed
P139_SP00038 1518
P139_ST00042 1533 137 normal 000000
P139_SP00039
P139_ST00043 1688 667 curve
P139_SP00040 1795
P139_ST00044 1810 58 for
P139_SP00041 1868 12
P139_ST00045 1880
P139_SP00042
P139_ST00046 1955 67
P139_SP00043 2022
P139_ST00047 2035 160 variable
P139_TL00005 770
P139_ST00048 167 revealed
P139_SP00044 768 806
P139_ST00049 784 782 20 a
P139_SP00045 804
P139_ST00050 818 100 quasi
P139_SP00046 918 816 6
P139_ST00051 924 153 -normal
P139_SP00047 1077
P139_ST00052 1095 237 distribution.
P139_SP00048 1332
P139_ST00053 1351 The
P139_SP00049 1426
P139_ST00054 1441 152 average
P139_SP00050
P139_ST00055 1609
P139_SP00051 1675
P139_ST00056 1690
P139_SP00052 1734 9
P139_ST00057 1743 59
P139_SP00053 1802
P139_ST00058 1817 231
P139_SP00054 2048
P139_ST00059 2062 76
P139_TL00006 885 1589
P139_ST00060 887 105 34.31 0.97
P139_SP00055 707
P139_ST00061 726 897 103 years
P139_SP00056 829 931
P139_ST00062 (SD 0.74 700
P139_SP00057 920
P139_ST00063 934 898 26 10
P139_SP00058 960 908
P139_ST00064 976 111 9.97), 0.90 000006
P139_SP00059 1087
P139_ST00065
P139_SP00060 1174
P139_ST00066 1188
P139_SP00061 1248
P139_ST00067 1264 138 sample
P139_SP00062 1402
P139_ST00068 1416 134 ranged
P139_SP00063 1550
P139_ST00069 1565
P139_SP00064 1601
P139_ST00070 1617
P139_SP00065 1683
P139_ST00071 1698 94
P139_SP00066 1792
P139_ST00072 41 33
P139_SP00067 1854
P139_ST00073 1869 891 38 30 to
P139_SP00068 1907
P139_ST00074 1922 45 78
P139_SP00069 1967
P139_ST00075 1984 years.
P139_SP00070 2096
P139_ST00076 2116
P139_TL00007
P139_ST00077 majority
P139_SP00071 1046
P139_ST00078 (n 0.38 74
P139_SP00072 822
P139_ST00079 837 1013
P139_SP00073 863 1023
P139_ST00080 880 1002 81 42 575, 0.85 0006
P139_SP00074 961 1044
P139_ST00081 980 81%)) 0.82 00800
P139_SP00075 1083
P139_ST00082 1100
P139_SP00076 1144 1036
P139_ST00083 1152
P139_SP00077 1212
P139_ST00084 1226
P139_SP00078 1457
P139_ST00085 1473 205 completed
P139_SP00079 1678
P139_ST00086 1694 1006 at
P139_SP00080 1728
P139_ST00087 1741 least
P139_SP00081 1832
P139_ST00088 1850
P139_SP00082 1892 1035
P139_ST00089 1908 1012
P139_SP00083 2011
P139_ST00090 2027
P139_SP00084 2071
P139_ST00091 2081 school,
P139_TL00008 1115 1628
P139_ST00092
P139_SP00085 671 1151
P139_ST00093 687 only
P139_SP00086 1161
P139_ST00094 788 1116 3.3%) 0.79 00080
P139_SP00087 888
P139_ST00095 904 39
P139_SP00088 943
P139_ST00096 958 1128
P139_SP00089 984 1138
P139_ST00097 998 65 21)
P139_SP00090 1063
P139_ST00098 1079
P139_SP00091 1123
P139_ST00099 1131
P139_SP00092 1191
P139_ST00100 1206
P139_SP00093 1436
P139_ST00101 1452
P139_SP00094 1658
P139_ST00102 1672 73 less
P139_SP00095 1745
P139_ST00103 1759 than
P139_SP00096 1844
P139_ST00104 1863 1117
P139_SP00097 1905 1150
P139_ST00105 1127 104
P139_SP00098 2024
P139_ST00106 2040
P139_SP00099 2084
P139_ST00107 2094 136 school.
P139_TL00009 1230 1594
P139_ST00108 1231 98 Over
P139_SP00100 1266
P139_ST00109 713 half
P139_SP00101 794 11
P139_ST00110 805 ( 0.61 07
P139_SP00102 843 1276
P139_ST00111 858 1243
P139_SP00103 884 1253
P139_ST00112 899 1232 82 351, 0.83
P139_SP00104 981 1274
P139_ST00113 56%))
P139_SP00105 1104
P139_ST00114
P139_SP00106
P139_ST00115 1173
P139_SP00107 1233
P139_ST00116
P139_SP00108
P139_ST00117 1492 71 had
P139_SP00109 1563
P139_ST00118 1579 1242
P139_SP00110 1599
P139_ST00119 1613 164 monthly
P139_SP00111 1777
P139_ST00120 145 income
P139_SP00112 1936
P139_ST00121 1952
P139_SP00113 1996
P139_ST00122 2007 133 $1,500 006000
P139_SP00114 2140
P139_ST00123 2156 or
P139_TL00010 1345 1639
P139_ST00124 146 greater.
P139_SP00115 747 1391
P139_ST00125 764 1347 Four
P139_SP00116 1381
P139_ST00126 872 fifths 0.88 700000
P139_SP00117 975
P139_ST00127 991
P139_SP00118 1029
P139_ST00128 1358
P139_SP00119 1070 1368
P139_ST00129 1086 531,
P139_SP00120 1168 1389
P139_ST00130 1187 141 80.3%)) 0.86 0000800
P139_SP00121 1328
P139_ST00131 1344
P139_SP00122 1388
P139_ST00132 1396
P139_SP00123 1456
P139_ST00133 1470
P139_SP00124 1701
P139_ST00134 1715 1357
P139_SP00125 1811
P139_ST00135 1827 194 employed
P139_SP00126 2021
P139_ST00136 (see
P139_SP00127 2114
P139_ST00137 2129 Table
P139_TL00011 606 1460 1568 161
P139_ST00138 1). 0.56 607
P139_SP00128 650
P139_ST00139 690 1576 On
P139_SP00129 748
P139_ST00140 761 1575
P139_SP00130 821
P139_ST00141 1587 average, 00000006
P139_SP00131 1621
P139_ST00142 1014
P139_SP00132 1074
P139_ST00143 1089
P139_SP00133 1320
P139_ST00144 1336 166 attended
P139_SP00134 1502
P139_ST00145 1515 93 their
P139_SP00135 1608
P139_ST00146 place
P139_SP00136 1724
P139_ST00147 1739
P139_SP00137 1784
P139_ST00148 159 worship
P139_SP00138 1951
P139_ST00149 1966 five 0.81 7000
P139_SP00139 2042
P139_ST00150 2058
P139_SP00140 2133
P139_ST00151 2148 1588
P139_TL00012 603 1509
P139_ST00152 5.07)
P139_SP00141 703 1736
P139_ST00153 717 times
P139_SP00142 824 1726
P139_ST00154 839 1702 63 per
P139_SP00143 902
P139_ST00155 915 135 month,
P139_SP00144 1050
P139_ST00156 1066 but
P139_SP00145 1130
P139_ST00157 1145 132 church
P139_SP00146 1277
P139_ST00158 1293 210 attendance
P139_SP00147 1503
P139_ST00159
P139_SP00148 1652
P139_ST00160 1667
P139_SP00149 1761
P139_ST00161 1692
P139_SP00150 1725
P139_ST00162 1696
P139_SP00151 1851
P139_ST00163 1866 0.96
P139_SP00152 1912
P139_ST00164 1927
P139_SP00153 2034
P139_ST00165 2049
P139_TL00013 1805 1597
P139_ST00166 month.
P139_SP00154 736 1841
P139_ST00167 755
P139_SP00155
P139_ST00168 844
P139_SP00156 1011
P139_ST00169 1027
P139_SP00157 1071
P139_ST00170
P139_SP00158 1139
P139_ST00171 1154
P139_SP00159 1384
P139_ST00172 1398
P139_SP00160 1494
P139_ST00173 1510 either
P139_SP00161 1622
P139_ST00174 1635 married
P139_SP00162 1788
P139_ST00175 1804
P139_SP00163 1843
P139_ST00176 1818
P139_SP00164 1883 1828
P139_ST00177 1898 1807 83 232,
P139_SP00165 1981 1849
P139_ST00178 1999 142 35.1%))
P139_SP00166 2141
P139_ST00179 2158
P139_TL00014 1538
P139_ST00180 115 single
P139_SP00167 718
P139_ST00181 734
P139_SP00168
P139_ST00182 787 1933
P139_SP00169 813 1943
P139_ST00183 828 229,
P139_SP00170 911 1964
P139_ST00184 34.6%)), 0.80 00008006
P139_SP00171 1081
P139_ST00185 1098
P139_SP00172 1186 1956
P139_ST00186 1201 86
P139_SP00173 1287
P139_ST00187 1302 1932
P139_SP00174 1322
P139_ST00188 few
P139_SP00175 1410
P139_ST00189 1422 women
P139_SP00176
P139_ST00190 1582 who
P139_SP00177
P139_ST00191 1682
P139_SP00178 1846
P139_ST00192 1859
P139_SP00179 1934
P139_ST00193 1947
P139_SP00180 2032
P139_ST00194 2045
P139_TL00015 1566
P139_ST00195 185 separated 003000000
P139_SP00181
P139_ST00196 803 0.27
P139_SP00182 842
P139_ST00197 856
P139_SP00183
P139_ST00198 2037 27, 006
P139_SP00184 955 2079
P139_ST00199 972 129 4.1%),
P139_SP00185 1101
P139_ST00200 1119 172 divorced
P139_SP00186 1291
P139_ST00201 1306
P139_SP00187
P139_ST00202 1360
P139_SP00188 1386
P139_ST00203 1400
P139_SP00189 1458
P139_ST00204 1475
P139_SP00190 1604
P139_ST00205 2047
P139_SP00191 1662
P139_ST00206 1674 182 widowed
P139_SP00192 1856
P139_ST00207 1872
P139_SP00193 1910
P139_ST00208
P139_SP00194
P139_ST00209 1971 14,
P139_SP00195
P139_ST00210 2041 128 2.1%).
P139_TL00016 2150 1539
P139_ST00211 While
P139_SP00196 2186
P139_ST00212 737 2162
P139_SP00197 757
P139_ST00213
P139_SP00198 937 2196
P139_ST00214 953
P139_SP00199 992
P139_ST00215 2163
P139_SP00200 1032 2173
P139_ST00216 1047 2152 429,
P139_SP00201 2194
P139_ST00217 1148 64.9%)) 0.87
P139_SP00202 1290
P139_ST00218
P139_SP00203 1350
P139_ST00219
P139_SP00204
P139_ST00220 1433
P139_SP00205 1664
P139_ST00221 1679
P139_SP00206
P139_ST00222
P139_SP00207
P139_ST00223 1944
P139_SP00208 2029
P139_ST00224 2043
P139_TL00017 2265
P139_ST00225 280 heterosexuals, 00000000000006
P139_SP00209 881 2309
P139_ST00226 131 almost
P139_SP00210 1030 2301
P139_ST00227 2266 89 27%) 0.77 0080
P139_SP00211 1133
P139_ST00228 1149
P139_SP00212 2311
P139_ST00229 1202 2278
P139_SP00213 2288
P139_ST00230 111) 0.23 7778
P139_SP00214
P139_ST00231 1348
P139_SP00215 1392
P139_ST00232
P139_SP00216
P139_ST00233
P139_SP00217 1706
P139_ST00234 1722 did
P139_SP00218 1783
P139_ST00235 1797 2271 not
P139_SP00219
P139_ST00236 1874 156 respond
P139_SP00220 2030
P139_ST00237
P139_SP00221
P139_ST00238 2095 this
P139_TL00018 2380
P139_ST00239 item
P139_SP00222 2416
P139_ST00240 113
P139_SP00223
P139_ST00241 because
P139_SP00224
P139_ST00242
P139_SP00225 2426
P139_ST00243 1099
P139_SP00226 1160
P139_ST00244 2386
P139_SP00227 1237
P139_ST00245 1250 218 understand
P139_SP00228 1468
P139_ST00246 1481
P139_SP00229 1541
P139_ST00247 1555 243 terminology
P139_SP00230
P139_ST00248 2392
P139_SP00231
P139_ST00249
P139_SP00232 1929
P139_ST00250
P139_SP00233 2006
P139_ST00251 2019 97 want
P139_SP00234
P139_ST00252
P139_TL00019 2495 1642
P139_ST00253 158 disclose
P139_SP00235 760 2531
P139_ST00254 774
P139_SP00236 865
P139_ST00255 122 sexual
P139_SP00237 1003
P139_ST00256 1020 222 orientation.
P139_SP00238
P139_ST00257 1261
P139_SP00239
P139_ST00258
P139_SP00240 1517 2541
P139_ST00259
P139_SP00241 1577
P139_ST00260 1585
P139_SP00242 1645
P139_ST00261 1660
P139_SP00243 1891
P139_ST00262
P139_SP00244 1945
P139_ST00263 1960 2508
P139_SP00245 1986 2518
P139_ST00264 2001 2497 448,
P139_SP00246 2539
P139_ST00265 2102 67.8%))
P139_TL00020 2610
P139_ST00266
P139_SP00247 765 2656
P139_ST00267 780 having
P139_SP00248
P139_ST00268 928 fewer
P139_SP00249 1041 2646
P139_ST00269 1054
P139_SP00250
P139_ST00270 1153
P139_SP00251 1229
P139_ST00271 1244 171 children,
P139_SP00252 1415 2654
P139_ST00272 1431 110 while
P139_SP00253
P139_ST00273 1557 2622 87 over
P139_SP00254 1644
P139_ST00274
P139_SP00255
P139_ST00275 fifth
P139_SP00256 1776
P139_ST00276
P139_SP00257 1831
P139_ST00277 1845 2623
P139_SP00258 1871 2633
P139_ST00278 2612 143,
P139_SP00259 1969
P139_ST00279 143 21.6%))
P139_SP00260
P139_ST00280 2146
P139_TL00021 2725
P139_ST00281
P139_SP00261 660 2761
P139_ST00282
P139_SP00262 905 2771
P139_ST00283
P139_SP00263 1085
P139_ST00284
P139_SP00264
P139_ST00285 2737 48 no
P139_SP00265 1295
P139_ST00286 1311 children
P139_SP00266 1472
P139_ST00287 1487
P139_SP00267
P139_ST00288 1580
P139_SP00268 1691
P139_ST00289 2).
P139_TB00002 3041 79
P139_TL00022 1394 3047
P139_ST00290 124 010


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P147_ST00002 838 87 high 0000
P147_SP00002 925
P147_ST00003 939 192 reliability 00000000000
P147_SP00003 1131 16
P147_ST00004 1147 182 36 estimates 000000000
P147_SP00004 1329 346
P147_ST00005 1345 108 given 00000
P147_SP00005 1453
P147_ST00006 1467 60 the 000
P147_SP00006 1527 15
P147_ST00007 1542 186 relatively
P147_SP00007 1728
P147_ST00008 1744 103 small
P147_SP00008 1847
P147_ST00009 1863 153 number 000000
P147_SP00009 2016 13
P147_ST00010 2029 44 of 00
P147_SP00010 2073 10
P147_ST00011 2083 106 items
P147_SP00011 2189
P147_ST00012 2204 37 35 in
P147_TL00002 602 425 1621
P147_ST00013 88 each
P147_SP00012 690 461
P147_ST00014 706 77 (see
P147_SP00013 783 471
P147_ST00015 799 110 Table
P147_SP00014 909
P147_ST00016 924 48 4).
P147_SP00015 972 19
P147_ST00017 991 117 These
P147_SP00016 1108
P147_ST00018 1124
P147_SP00017 1306
P147_ST00019 1320 437 96 24 were
P147_SP00018 1416
P147_ST00020 1432 198 consistent
P147_SP00019 1630
P147_ST00021 1643 with
P147_SP00020 1731
P147_ST00022 1746 101 other
P147_SP00021
P147_ST00023 1861 183
P147_SP00022 2044
P147_ST00024 2059 164 reported 00000000
P147_TL00003 540 1569
P147_ST00025
P147_SP00023 638 575
P147_ST00026 651 61
P147_SP00024 712 576
P147_ST00027 726 187 literature.
P147_SP00025 913 17
P147_ST00028 930 144 Wilson
P147_SP00026 1074
P147_ST00029 1089 130 (1985)
P147_SP00027 1219 586
P147_ST00030 1234
P147_SP00028 1398
P147_ST00031 1414 552 20 a
P147_SP00029 1434
P147_ST00032 1448 227 Cronbach's 0.95 0000000050
P147_SP00030 1675
P147_ST00033 1691 alpha
P147_SP00031 1797
P147_ST00034 1812
P147_SP00032 1856 12
P147_ST00035 1868 542 68 42 .82, 0.85 0006
P147_SP00033 1936 584 18
P147_ST00036 1954 69 and
P147_SP00034 2023
P147_ST00037 2038 132 Taylor
P147_TL00004 655 1599
P147_ST00038
P147_SP00035 671 691
P147_ST00039 687 169 Tomasic 0000000
P147_SP00036 856
P147_ST00040 871 (1996)
P147_SP00037 1001 701
P147_ST00041 1016
P147_SP00038 1180
P147_ST00042 1196 667
P147_SP00039 1216
P147_ST00043 1232 656 348 45 Spearman-Brown 00000000000000
P147_SP00040 1580
P147_ST00044 1597 split-half
P147_SP00041 1779
P147_ST00045 1789 212 coefficient
P147_SP00042 2001
P147_ST00046 2015
P147_SP00043
P147_ST00047 2071 657 57 34 .84
P147_SP00044 2128
P147_ST00048 2144 for
P147_TL00005 600 770 288
P147_ST00049 010
P147_SP00045 660 806
P147_ST00050 674 86 total 0.98
P147_SP00046 760
P147_ST00051 777 771 111 TSEI.
P147_TL00006 885 627
P147_ST00052 188 Silencing 0.91 200500000
P147_SP00047 788 931
P147_ST00053 802 The 0.83 005
P147_SP00048 920
P147_ST00054 886 84 Self 0.80 2500
P147_SP00049 970 3
P147_ST00055 973 Scale 0.84 20005
P147_SP00050 1079 921
P147_ST00056 1097 (STSS) 0.86 020220
P147_TL00007 1000 1378
P147_ST00057 74
P147_SP00051 764 1036
P147_ST00058 782 107 STSS
P147_SP00052 889
P147_ST00059 904 1012 76 was
P147_SP00053 980
P147_ST00060 994 91 used
P147_SP00054 1085
P147_ST00061 1099 1006 30 to
P147_SP00055 1136
P147_ST00062 1151 measure
P147_SP00056 1315
P147_ST00063 1331 267 self-silencing
P147_SP00057 1598 1046
P147_ST00064 1612
P147_SP00058 1649 1035
P147_ST00065 1663 71 this
P147_SP00059 1734
P147_ST00066 1750 138 sample
P147_SP00060 1888
P147_ST00067 1904
P147_SP00061 1948 8
P147_ST00068 1956 112 urban
P147_TL00008 1115 1423
P147_ST00069 201 Bahamian
P147_SP00062 801
P147_ST00070 815 1127 155 women.
P147_SP00063
P147_ST00071 988 Although
P147_SP00064 1175 1161
P147_ST00072 1188
P147_SP00065 1248
P147_ST00073 1262
P147_SP00066 1348
P147_ST00074 1367 1116
P147_SP00067 1475
P147_ST00075 1492 demonstrated 000000000000
P147_SP00068 1759
P147_ST00076 1773
P147_SP00069 1860
P147_ST00077 1874 149 intemal 0.99 0000100
P147_TL00009 1230 1627
P147_ST00078 230 consistency
P147_SP00070 832 1276
P147_ST00079 846
P147_SP00071 1038
P147_ST00080 1054
P147_SP00072 1237 1266
P147_ST00081 1253 243 (Cronbach's 00000000050
P147_SP00073 1496
P147_ST00082 1512
P147_SP00074 1618
P147_ST00083 1632 1243 26
P147_SP00075
P147_ST00084 1676 .85;
P147_SP00076 1274 21
P147_ST00085 1765 1231
P147_SP00077 2113
P147_ST00086 2130 99 split-
P147_TL00010 1491
P147_ST00087 81 half
P147_SP00078 682 1381
P147_ST00088 692
P147_SP00079
P147_ST00089 917 1358
P147_SP00080 943 1368
P147_ST00090 961 73 .81)
P147_SP00081 1034 1391
P147_ST00091 1049
P147_SP00082 1137
P147_ST00092 1150
P147_SP00083 1221
P147_ST00093 1238 148 sample, 0000006
P147_SP00084 1386
P147_ST00094 1402
P147_SP00085 1462
P147_ST00095 1477 1346 Care
P147_SP00086 1568
P147_ST00096 1584 1357 38 as
P147_SP00087 1622
P147_ST00097 270 Self-Sacrifice
P147_SP00088 1910
P147_ST00098 1927 165 subscale
P147_TL00011 1460 1528
P147_ST00099 266
P147_SP00089 868
P147_ST00100 882 105 weak
P147_SP00090 987
P147_ST00101 193
P147_SP00091 1193 1506
P147_ST00102 1208
P147_SP00092
P147_ST00103 1407
P147_SP00093 1650
P147_ST00104 1666
P147_SP00094 1772
P147_ST00105 1786 1473
P147_SP00095 1483
P147_ST00106 1829 .40;
P147_SP00096 1898 1504
P147_ST00107 1918 1461 Spearman-
P147_TL00012 1575 1500
P147_ST00108 1577 135 Brown
P147_SP00097 735 1611
P147_ST00109 751
P147_SP00098 933 11
P147_ST00110 944 0.93 00007000000
P147_SP00099 1156
P147_ST00111 1169 1588
P147_SP00100 1195
P147_ST00112 1213 .34)
P147_SP00101 1286
P147_ST00113 1302 78
P147_SP00102 1380
P147_ST00114 1395
P147_SP00103
P147_ST00115 1520 49
P147_SP00104
P147_ST00116
P147_SP00105 1815
P147_ST00117 1831 124 alphas
P147_SP00106 1955
P147_ST00118 1970 58
P147_SP00107 2028
P147_ST00119 2040
P147_TL00013 603 1690
P147_ST00120
P147_SP00108 768 1726
P147_ST00121 784
P147_SP00109 875
P147_ST00122 891 1702
P147_SP00110 929
P147_ST00123 946
P147_SP00111
P147_ST00124
P147_SP00112 1396 1736
P147_ST00125 1410
P147_SP00113 1447 1725
P147_ST00126
P147_SP00114
P147_ST00127 1535 178 literature
P147_SP00115 1713
P147_ST00128 97
P147_SP00116 1823
P147_ST00129 1837 113 lower
P147_SP00117 1950
P147_ST00130 1962 85 than
P147_SP00118 2047
P147_ST00131 2063
P147_TL00014 1805 1573
P147_ST00132
P147_SP00119 765 1851
P147_ST00133 780
P147_SP00120 1841
P147_ST00134 850
P147_SP00121 910
P147_ST00135
P147_SP00122 1026
P147_ST00136 three
P147_SP00123
P147_ST00137 1154 184 subscales
P147_SP00124 1338
P147_ST00138 1354 150 (Duarte
P147_SP00125
P147_ST00139 1519 1806 &
P147_SP00126 1554
P147_ST00140 1571 221 Thompson, 000000006
P147_SP00127 1792 22
P147_ST00141 1814 1807 104 1999; 0.87 00006
P147_SP00128 1849
P147_ST00142 1935 Jack 0.96
P147_SP00129
P147_ST00143 2037
P147_SP00130 2072
P147_ST00144 2087 Dill, 0.88
P147_TL00015 606 1920 1545
P147_ST00145 1922 1992; 00016
P147_SP00131 710 1964
P147_ST00146 Koutrelakos
P147_SP00132 969
P147_ST00147 985 1926 et
P147_SP00133 1019
P147_ST00148 1033 56 al.,
P147_SP00134 23
P147_ST00149 1112
P147_SP00135
P147_ST00150 141 Remen
P147_SP00136 1373
P147_ST00151 1388
P147_SP00137 1422
P147_ST00152 1437 55
P147_SP00138
P147_ST00153 1509 109 2002; 0.82 10016
P147_SP00139
P147_ST00154 1637 211 Thompson 0.92 01004000
P147_SP00140 1848 1966
P147_ST00155 1862 1921
P147_SP00141 1897
P147_ST00156 1912 98 Hart,
P147_SP00142 2010
P147_ST00157 2032 119 1996).
P147_TL00016 2035 1562
P147_ST00158 However, 00000006
P147_SP00143 792 2079
P147_ST00159 811 120 scores
P147_SP00144
P147_ST00160 947 47 on
P147_SP00145
P147_ST00161 1008
P147_SP00146
P147_ST00162 1096
P147_SP00147 1261
P147_ST00163 1275 95 from
P147_SP00148 1370
P147_ST00164 1384 66 use
P147_SP00149 1450
P147_ST00165 1463
P147_SP00150 1551
P147_ST00166 1565
P147_SP00151 1677
P147_ST00167
P147_SP00152 1892
P147_ST00168 1906 146 women
P147_SP00153 2052
P147_ST00169 2066
P147_TL00017 2150
P147_ST00170 2162 even
P147_SP00154 693 2186
P147_ST00171 708
P147_SP00155 821
P147_ST00172 833
P147_SP00156 918
P147_ST00173 932 those
P147_SP00157
P147_ST00174 1050 209 previously
P147_SP00158 1259 2196
P147_ST00175
P147_SP00159 1438
P147_ST00176
P147_SP00160 1511
P147_ST00177 1525
P147_SP00161 1626
P147_ST00178 1641 166 samples.
P147_SP00162
P147_ST00179 1824 Reliability
P147_SP00163 2033
P147_ST00180 2049
P147_TL00018 2265 1633
P147_ST00181
P147_SP00164 2311
P147_ST00182
P147_SP00165 816 2300
P147_ST00183 830
P147_SP00166 890 2301
P147_ST00184 905
P147_SP00167 1083
P147_ST00185 1098 92 have
P147_SP00168 1190
P147_ST00186 1204 134 ranged
P147_SP00169
P147_ST00187 1353 94
P147_SP00170
P147_ST00188 1465 2267 .86
P147_SP00171 1522
P147_ST00189 1537 2271
P147_SP00172
P147_ST00190 1592 .94
P147_SP00173
P147_ST00191 1665
P147_SP00174 1722
P147_ST00192
P147_SP00175 1820
P147_ST00193 1840 2266
P147_SP00176 1947
P147_ST00194 1965
P147_SP00177 2034
P147_ST00195 2051 .60
P147_SP00178 2108
P147_ST00196 2122
P147_SP00179 2160
P147_ST00197 2178 .90
P147_TL00019 2380
P147_ST00198
P147_SP00180 659 2416
P147_ST00199 subscales.
P147_SP00181 867
P147_ST00200 888 2381
P147_SP00182 1236 2426
P147_ST00201
P147_SP00183 1435
P147_ST00202 1445 coefficients
P147_SP00184
P147_ST00203
P147_SP00185 1854
P147_ST00204 1869
P147_SP00186 2415
P147_ST00205 1919
P147_SP00187 1979
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P55_ST00237
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P55_ST00242 787
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P55_ST00244
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P55_ST00246 2841
P55_SP00224
P55_ST00247 1245 among
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P187_SP00038 1955
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P187_ST00059 1180 modeling
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P187_ST00088 1898
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P187_ST00090 offer
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P187_SP00085
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P187_ST00096 based
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P187_ST00097 1500 47 on
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P187_ST00100 1928
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P187_ST00101 2012 1351 57 act
P187_SP00092 2069
P187_ST00102 2083
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P187_ST00103 2136 role
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P187_SP00096
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P187_ST00108 1110 1466 counterparts
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P187_SP00099 1571
P187_ST00110 1586 1461 &
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P187_ST00111 1635 138 Norris, 0.88 2000006
P187_SP00101 1773 1504
P187_ST00112 1790 2002).
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P187_ST00113 Lastly,
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P187_ST00114 838 198 practicing
P187_SP00103
P187_ST00115 126 nurses
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P187_ST00116
P187_SP00105 1322
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P187_ST00118 1505 female
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P187_ST00119 patients
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P187_ST00123 2148 are
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P187_SP00122 1894
P187_ST00135 appropriate
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P187_ST00137 778 1811
P187_SP00124
P187_ST00138 831
P187_SP00125 1071
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P187_ST00140 1286
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P187_ST00143 1778
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P187_ST00145 1978
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P187_ST00146 2157
P187_TL00015 1920 1419
P187_ST00147 1926 149 prevent
P187_SP00133 750
P187_ST00148 762 103
P187_SP00134 865 1956
P187_ST00149 1921 123 AIDS.
P187_SP00135 989
P187_ST00150 1005 1922 Nurses 200000
P187_SP00136 1144
P187_ST00151
P187_SP00137 1290
P187_ST00152 1305 150 provide
P187_SP00138 1455
P187_ST00153 1471 1932
P187_SP00139 1491
P187_ST00154 296 nonjudgmental
P187_SP00140 1800
P187_ST00155 healthcare
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P187_ST00156 environment
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P187_ST00157 that
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P187_ST00159 1192
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P187_ST00163 1981 180 enhances
P187_TL00017 603 2150 904
P187_ST00164
P187_SP00148 826 2186
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P187_SP00149 899
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P187_ST00168 1207
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P187_TL00018 2265 265
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P187_ST00172 736 Policy
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P187_ST00173 2382
P187_SP00155 825 2416
P187_ST00174 842
P187_SP00156 971
P187_ST00175 985
P187_SP00157 1031
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P187_ST00180 of
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P187_SP00163 1742 2426
P187_ST00182 1756
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P187_ST00184 2501
P187_SP00165 638 2531
P187_ST00185 653 169 decrease
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P187_ST00188 1018
P187_SP00169 1062 8
P187_ST00189 1070
P187_SP00170
P187_ST00190 1174 2496 AIDS
P187_SP00171
P187_ST00191 1303
P187_SP00172 1340 2530
P187_ST00192 Bahamian
P187_SP00173 1555
P187_ST00193 1568 2507 156
P187_SP00174
P187_ST00194 1741 2497 From
P187_SP00175
P187_ST00195
P187_SP00176 1883
P187_ST00196 1899 societal
P187_TL00021 2610 1523
P187_ST00197 215 standpoint, 00000000006
P187_SP00177 818 2656
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P187_ST00199 977
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P187_ST00203 2616
P187_SP00183
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P187_ST00205 256 development
P187_SP00185 2067
P187_ST00206 2082
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P187_ST00207 national
P187_SP00186 2761
P187_ST00208 774
P187_SP00187 986 2771
P187_ST00209
P187_SP00188 1240
P187_ST00210 1257
P187_SP00189 1441
P187_ST00211
P187_SP00190
P187_ST00212 1544 2737
P187_SP00191
P187_ST00213 1617 135 gender
P187_SP00192 1752
P187_ST00214 1766
P187_SP00193 1990
P187_ST00215 2006
P187_TL00023 2840 1550
P187_ST00216 culturally
P187_SP00194 790 2886
P187_ST00217 172 sensitive
P187_SP00195 978 2876
P187_ST00218 993
P187_SP00196
P187_ST00219 1078
P187_SP00197 1252
P187_ST00220
P187_SP00198 1379
P187_ST00221 2852
P187_SP00199
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P187_SP00201
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P187_ST00225 1865 level.
P187_SP00203
P187_ST00226 1987 2841 A
P187_SP00204 2022 2875
P187_ST00227 2036 116 major
P187_TB00002 1388 3041 79
P187_TL00024 3047 67 33
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P97_ST00079 (1991)
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P81_ST00104 962 26
P81_SP00095 988 1368
P81_ST00105 1003 64 90)
P81_SP00096
P81_ST00106 1083
P81_SP00097 1152
P81_ST00107 1166 146 women
P81_SP00098
P81_ST00108 39
P81_SP00099 1366
P81_ST00109 1380
P81_SP00100 1406
P81_ST00110 1422 63 91)
P81_SP00101 1485
P81_ST00111 1499 1351
P81_SP00102
P81_ST00112 1553 147 explore
P81_SP00103 1700
P81_ST00113 1713
P81_SP00104 1773
P81_ST00114 1788 253 relationships
P81_SP00105 2041
P81_ST00115 2057 133 among
P81_TL00011 1460
P81_ST00116 221 depression,
P81_SP00106 823
P81_ST00117 842
P81_SP00107 1075 1504
P81_ST00118 1094
P81_SP00108 1163 1496
P81_ST00119 1179 00050000000000
P81_SP00109 1445
P81_ST00120 1458
P81_SP00110
P81_ST00121 1678 118 Using
P81_SP00111 1796
P81_ST00122 1810 Jack
P81_SP00112 1898
P81_ST00123 1913
P81_SP00113 1982
P81_ST00124 1995 Dill's 000050
P81_TL00012 1575 1612
P81_ST00125 (1992)
P81_SP00114 732 1621
P81_ST00126 750 STSS
P81_SP00115 857 1611
P81_ST00127 872
P81_SP00116 910
P81_ST00128 925 164 measure
P81_SP00117 1089
P81_ST00129 1106
P81_SP00118 1372
P81_ST00130 1385 193 behaviors
P81_SP00119 1578
P81_ST00131 1594
P81_SP00120 1663
P81_ST00132
P81_SP00121 1737
P81_ST00133 1750 353 Multidimensional 0000000000000000
P81_SP00122 2103
P81_ST00134 2122 92 Self-
P81_TL00013 1548
P81_ST00135 1692 145 Esteem
P81_SP00123 745 1726
P81_ST00136 761 191 Inventory
P81_SP00124 952 1736
P81_ST00137 968 150 (MSEI)
P81_SP00125 1118
P81_ST00138 1133 62 (O' 0.82 005
P81_SP00126 1195
P81_ST00139 1213 110 Brian
P81_SP00127 1323
P81_ST00140 1338 1691 &
P81_SP00128 1373
P81_ST00141 1388 159 Epstein,
P81_SP00129 1547 22
P81_ST00142 1569 109 1988)
P81_SP00130
P81_ST00143 1696
P81_SP00131 1730
P81_ST00144 1745 1702
P81_SP00132 1909
P81_ST00145 1924 120 global
P81_SP00133 2044
P81_ST00146 2063 self-
P81_TL00014 1805
P81_ST00147 1811 135 esteem
P81_SP00134 737 1841
P81_ST00148 753 (GSE),
P81_SP00135 888 1851
P81_ST00149 904
P81_SP00136 963
P81_ST00150 978 investigators
P81_SP00137 1231
P81_ST00151 1246 115 found
P81_SP00138 1361
P81_ST00152 1376 1817
P81_SP00139 1396
P81_ST00153 1412 208 significant 00000700000
P81_SP00140 1620
P81_ST00154 1634 183 moderate
P81_SP00141
P81_ST00155 1832 142 inverse
P81_SP00142 1974
P81_ST00156 correlation
P81_TL00015 1920 1493
P81_ST00157
P81_SP00143 765
P81_ST00158 783 1921
P81_SP00144 890
P81_ST00159 907
P81_SP00145 976
P81_ST00160 992 GSE
P81_SP00146 1084
P81_ST00161 1099 (r 0.61 70
P81_SP00147 1966
P81_ST00162 1147
P81_SP00148 1173
P81_ST00163 1188 1922 42 -.54, 0.63 00467
P81_SP00149 1274 1964
P81_ST00164 1284 1932 p
P81_SP00150 1314
P81_ST00165 1329 1925 25 <
P81_SP00151 1950
P81_ST00166 .01).
P81_SP00152 1456
P81_ST00167 1473 259 Furthermore,
P81_SP00153 1732
P81_ST00168 1748
P81_SP00154 1808
P81_ST00169 1822 162 findings 70000000
P81_SP00155 1984
P81_ST00170 1998 from
P81_TL00016 2035 1607
P81_ST00171 multiple
P81_SP00156 766 2081
P81_ST00172 781 regression
P81_SP00157 983
P81_ST00173 999 158 analysis
P81_SP00158 1157
P81_ST00174 1172 181 indicated
P81_SP00159 1353 2071
P81_ST00175
P81_SP00160 1441
P81_ST00176 2036
P81_SP00161
P81_ST00177 1583 68
P81_SP00162 1651
P81_ST00178 1667
P81_SP00163 1759
P81_ST00179 1774 accounted
P81_SP00164 1973
P81_ST00180 1988 57 for
P81_SP00165 2045
P81_ST00181 90 44%) 0.77 0080
P81_SP00166 2148
P81_ST00182 2164
P81_TL00017 2150
P81_ST00183
P81_SP00167 660
P81_ST00184 674 168 variance
P81_SP00168
P81_ST00185 856
P81_SP00169 2185
P81_ST00186 211 depression
P81_SP00170 1119 2196
P81_ST00187
P81_SP00171 1254
P81_ST00188 1267 2162
P81_SP00172 1343
P81_ST00189 190 measured
P81_SP00173
P81_ST00190 49 by
P81_SP00174 1610
P81_ST00191 1624 102 Beck
P81_SP00175
P81_ST00192 1739 224 Depression
P81_SP00176 1963
P81_ST00193 1978 2152
P81_TL00018 2265 1615
P81_ST00194 126 (BDI),
P81_SP00177 728 2311
P81_ST00195 748 94 [F(3, 0.40 61776
P81_SP00178
P81_ST00196 864 111) 0.23 7777
P81_SP00179
P81_ST00197 2278
P81_SP00180 989 2288
P81_ST00198 1004 2267 41.26, 0.44 575346
P81_SP00181 1125 2309
P81_ST00199 1135 2270 41 p< 0.92
P81_SP00182 1205
P81_ST00200 1223 2266 .001],
P81_SP00183 1332 2310
P81_ST00201 1350 0.97
P81_SP00184 1419 2301
P81_ST00202 1433 020
P81_SP00185
P81_ST00203 1507 interaction 0.99
P81_SP00186 1719
P81_ST00204 1733
P81_SP00187
P81_ST00205 1916
P81_SP00188 2023
P81_ST00206 2040 100
P81_SP00189 2109
P81_ST00207 2125
P81_TL00019 2380 1632
P81_ST00208 246 significantly 0.94 0000070000000
P81_SP00190 849 2426
P81_ST00209 200
P81_SP00191 1064 2416
P81_ST00210 1079 58
P81_SP00192 1137
P81_ST00211 148 another
P81_SP00193 1299
P81_ST00212 1313 2381 3%) 0.67 080
P81_SP00194
P81_ST00213 1392
P81_SP00195 1436
P81_ST00214 1444
P81_SP00196
P81_ST00215 1518
P81_SP00197 1686
P81_ST00216
P81_SP00198 2415
P81_ST00217 1752
P81_SP00199
P81_ST00218 1993 0.50 11777
P81_SP00200 2088
P81_ST00219 2110 7778
P81_SP00201 2194
P81_ST00220 2209 2393
P81_TL00020 2495 1435
P81_ST00221 2497 174 %.10,p< 0.54 7078700
P81_SP00202 777 2541
P81_ST00222 795 2496 83 .01].
P81_SP00203 878 2540
P81_ST00223 These
P81_SP00204 2531
P81_ST00224 1028 128 results
P81_SP00205 1156
P81_ST00225 1171
P81_SP00206 1352
P81_ST00226
P81_SP00207
P81_ST00227
P81_SP00208 1513
P81_ST00228 1528 112 effect
P81_SP00209 1640
P81_ST00229 1655
P81_SP00210 1699 11
P81_ST00230 1710
P81_SP00211 1976
P81_ST00231 1991 2507 47 on
P81_TL00021 2610
P81_ST00232
P81_SP00212 813 2656
P81_ST00233 826 varies
P81_SP00213 944 2646
P81_ST00234 960 205 depending
P81_SP00214 1165
P81_ST00235 1180 2622
P81_SP00215 1227
P81_ST00236
P81_SP00216 1301
P81_ST00237 1316 93 level
P81_SP00217 1409
P81_ST00238 1426
P81_SP00218
P81_ST00239 1481 self-esteem.
P81_SP00219 1715
P81_ST00240 2612 More
P81_SP00220 1839
P81_ST00241 specifically, 0.89 0000070000006
P81_SP00221 2092
P81_ST00242 2111
P81_TL00022 2725 1580
P81_ST00243 2731
P81_SP00222 2761
P81_ST00244 177 appeared
P81_SP00223 930 2771
P81_ST00245
P81_SP00224
P81_ST00246 996
P81_SP00225
P81_ST00247 1194
P81_SP00226
P81_ST00248 1269
P81_SP00227
P81_ST00249
P81_SP00228 1440
P81_ST00250 1451
P81_SP00229 1717
P81_ST00251 2737
P81_SP00230 1779
P81_ST00252 1794 220 depression.
P81_SP00231 2014
P81_ST00253 2032 2726 At
P81_SP00232
P81_ST00254 2095 87 high
P81_TL00023 2840 1559
P81_ST00255
P81_SP00233 2876
P81_ST00256 686
P81_SP00234 869
P81_ST00257 884 114 levels
P81_SP00235 998
P81_ST00258 1014
P81_SP00236 1058
P81_ST00259 1069
P81_SP00237 1303 2884
P81_ST00260 1322
P81_SP00238 1588 2886
P81_ST00261 had
P81_SP00239 1672
P81_ST00262 1687 2852 48 no
P81_SP00240 1735
P81_ST00263
P81_SP00241 1862
P81_ST00264 1876
P81_SP00242 1923
P81_ST00265 1938 depression;
P81_TB00002 3041
P81_TL00024 1402 3047 33
P81_ST00266


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P195_ST00042 773 1002 26 J. 10
P195_SP00037 799 1036
P195_ST00043
P195_SP00038 855
P195_ST00044 874 (1985).
P195_SP00039 1013
P195_ST00045 1030 216 Evaluation
P195_SP00040 1246
P195_ST00046 1262
P195_SP00041 1306
P195_ST00047 1316 1012 a
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P195_ST00048 1348 258 theory-based 000000000000
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P195_ST00049 1621 239 intervention
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P195_ST00057 1587
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P195_ST00059 1976 78 IB), 0.85 0006
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P195_ST00060 2072 1117 0416.
P195_TL00008 1230 400
P195_ST00061 193 (UMINo. 0.92 0000500
P195_SP00054 883 1276
P195_ST00062 903 187 8600615) 20000000
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P195_ST00066 951 40 J., 0.75
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P195_ST00067 1008 1346 &
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P195_ST00068 1058 103
P195_SP00060
P195_ST00069 1178 27
P195_SP00061 1205
P195_ST00070 1224 (1991).
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P195_ST00071 1384 242 Self-esteem,
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P195_ST00072 1644 226 alcoholism, 00000000006
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P195_ST00073 1889 182 sensation
P195_SP00065 2071
P195_ST00074 2088 158 seeking,
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P195_SP00066 797 1504
P195_ST00076
P195_SP00067 884 1496
P195_ST00077 899 differential
P195_SP00068
P195_ST00078 1134 aptitude
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P195_ST00079 1305 1466 70 test
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P195_ST00080 1390 1472 120 scores
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P195_ST00089 833 1607 4 0.66 3
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P195_ST00090 852 288 Psychological 3520303002013
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P195_ST00092 1333 69, 0.77
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P195_ST00093 1412 218 1147-1150.
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P195_ST00094 178 Bandura,
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P195_ST00095 795 1691 A.
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P195_ST00096 857 140 (1986).
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P195_ST00102 1685 1693 157 32 actions: 10320053
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P195_ST00108 1083 Cliffs,
P195_SP00096 1203 1849
P195_ST00109 1218 1807 66 NJ: 210
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P195_ST00110 1301 275 Prentice-Hall. 00000000000000
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P195_ST00111
P195_SP00098 1964
P195_ST00112 1921
P195_SP00099 1956
P195_ST00113 (1989).
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P195_ST00114 Perceived
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P195_ST00115 1226 246 self-efficacy 0000005330000
P195_SP00102
P195_ST00116 1486
P195_SP00103 1523 1955
P195_ST00117 1539 160 exercise
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P195_SP00105 1759
P195_ST00119 1769 control
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P195_ST00120 1924 1932 over
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P195_ST00121 2024 113 AIDS
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P195_ST00122 184 infection.
P195_SP00108 873
P195_ST00123 891 2037 33 In
P195_SP00109 930 2070
P195_ST00124 945 V.
P195_SP00110 988
P195_ST00125 1005
P195_SP00111
P195_ST00126 119 Mays,
P195_SP00112 1194 2081
P195_ST00127 1212 2036 G.
P195_SP00113 1254
P195_ST00128 56 W.
P195_SP00114 1327
P195_ST00129 Albee,
P195_SP00115 2079
P195_ST00130 1489
P195_SP00116 1524
P195_ST00131 1543 S.
P195_SP00117
P195_ST00132 1593 F.
P195_SP00118 1628
P195_ST00133 1649 197 Schneider
P195_SP00119 1846
P195_ST00134 (Eds.),
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P195_ST00135 2002 169 Primary 0.82 3010304
P195_TL00016 682 2150 1561
P195_ST00136 2153 prevention 0.81 1050503200
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P195_ST00137 915
P195_SP00122 962
P195_ST00138 AIDS: 40003
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P195_ST00139 1100 287
P195_SP00124 1387
P195_ST00140 1398 233 approaches 1110010355
P195_SP00125
P195_ST00141 1646 73 (pp.
P195_SP00126 1719 23
P195_ST00142 1742 185 128-141).
P195_SP00127 1927
P195_ST00143 1943 Newbury 2000000
P195_SP00128 2128
P195_ST00144 2142 101 Park,
P195_TL00017 2266 198
P195_ST00145 76 CA:
P195_SP00129 766 2301
P195_ST00146 788 Sage. 01000
P195_TL00018 2380 1549
P195_ST00147
P195_SP00130 2424
P195_ST00148 2381
P195_SP00131 2416
P195_ST00149 (1994).
P195_SP00132 2426
P195_ST00150 1018 118
P195_SP00133 1136
P195_ST00151 1153
P195_SP00134
P195_ST00152 1349 theory
P195_SP00135 1476
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P195_SP00136 1560
P195_ST00154 161
P195_SP00137 1737
P195_ST00155 1753
P195_SP00138 1797
P195_ST00156 136
P195_SP00139
P195_ST00157 1961 2392
P195_SP00140 2048
P195_ST00158 2060 2382 89 HIV
P195_TL00019 2495
P195_ST00159
P195_SP00141 2531
P195_ST00160 2497
P195_SP00142 2530
P195_ST00161 944
P195_SP00143 985
P195_ST00162 1003
P195_SP00144
P195_ST00163 1047 263 DiClemente.,
P195_SP00145 1310 2539
P195_ST00164
P195_SP00146 1354
P195_ST00165 1371 50 L..
P195_SP00147 1421
P195_ST00166 1438 Peterson,
P195_SP00148 1620
P195_ST00167 1637 2496
P195_SP00149
P195_ST00168 1688
P195_SP00150
P195_ST00169 1732 115 Mann
P195_SP00151 1847
P195_ST00170 1863
P195_SP00152 1991 2541
P195_ST00171 2005 223 Preventing 3050503200
P195_TL00020 2610 1446
P195_ST00172
P195_SP00153 2646
P195_ST00173 829 Theory 0.71 535002
P195_SP00154 2656
P195_ST00174 979
P195_SP00155 2645
P195_ST00175 methods 0.74 0533005
P195_SP00156 1232
P195_ST00176
P195_SP00157 1293
P195_ST00177 1299 behavioral 1531020013
P195_SP00158 1515
P195_ST00178 1527 2613 259 interventions 2035005032005
P195_SP00159 1786
P195_ST00179 1802
P195_SP00160
P195_ST00180 1893 25-59).
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P123_ST00080 1142 80 (not 0.79 8000
P123_SP00074 1222 11
P123_ST00081 1006 29 at
P123_SP00075 1273
P123_ST00082 1285 55 all
P123_SP00076 1340
P123_ST00083 1350 1012 84 23 sure 0.74 5005
P123_SP00077 1434
P123_ST00084 1447 1001 22 I
P123_SP00078 1469
P123_ST00085 86 can) 0.82 0007
P123_SP00079 1565
P123_ST00086 1579
P123_SP00080 1617
P123_ST00087 1636 42
P123_SP00081 1678
P123_ST00088 1695 230 (completely 80000050500
P123_SP00082 1925
P123_ST00089 1938
P123_SP00083 2022
P123_ST00090 2035
P123_SP00084 2057
P123_ST00091 2067 96 can). 0.86 00070
P123_TL00008 1115 1535
P123_ST00092 Total
P123_SP00085 1151
P123_ST00093 722 0000000000000
P123_SP00086 983
P123_ST00094
P123_SP00087 1104
P123_ST00095 1127 120 scores
P123_SP00088 1241
P123_ST00096 1257
P123_SP00089 1323
P123_ST00097 1338 range
P123_SP00090
P123_ST00098 1461
P123_SP00091 1556
P123_ST00099 1576 1117
P123_SP00092 1618 1150
P123_ST00100 1633
P123_SP00093 1671
P123_ST00101 1690
P123_SP00094 1757
P123_ST00102 1772
P123_SP00095 1860
P123_ST00103 1874 127 higher
P123_SP00096 2001
P123_ST00104 2016
P123_TL00009 754
P123_ST00105 198 indicating
P123_SP00097 799
P123_ST00106 813 87 high
P123_SP00098 900
P123_ST00107 114 levels
P123_SP00099 1028 1266
P123_ST00108 1044
P123_SP00100
P123_ST00109 1100 255 self-efficacy. 0.91 00000053300000
P123_TL00010 1345 1477
P123_ST00110 1346 156 Content
P123_SP00101 1381
P123_ST00111 859 151 validity
P123_SP00102 1010 1391
P123_ST00112 1024 58 for
P123_SP00103 1082
P123_ST00113 1094
P123_SP00104 1154
P123_ST00114 1169 initial
P123_SP00105 1282
P123_ST00115 1298 1347 43
P123_SP00106 1341 1380 9
P123_ST00116 -item
P123_SP00107
P123_ST00117
P123_SP00108 1564
P123_ST00118 1578 1357 76 was
P123_SP00109 1654
P123_ST00119 1670 219 established 00000000000
P123_SP00110 1889
P123_ST00120 1903 49 by
P123_SP00111 1952
P123_ST00121 1967
P123_SP00112 1987
P123_ST00122 104 panel
P123_SP00113 2105
P123_ST00123 2123
P123_TL00011 596 1460 1455
P123_ST00124 133 judges
P123_SP00114 729 1506
P123_ST00125 744 familiar
P123_SP00115 901 1496
P123_ST00126
P123_SP00116
P123_ST00127 1018 111 social
P123_SP00117 1129
P123_ST00128 1146 183 cognitive 000000000
P123_SP00118 1329
P123_ST00129 1343 136 theory, 0000006
P123_SP00119
P123_ST00130 1497 70
P123_SP00120 1567
P123_ST00131
P123_SP00121 1641
P123_ST00132 1655
P123_SP00122 1768
P123_ST00133 1785 266 psychometric 000000000000
P123_TL00012 1575 1604
P123_ST00134 197 properties
P123_SP00123 798 1621
P123_ST00135 812 1587 were
P123_SP00124 908 1611
P123_ST00136 924 188 estimated
P123_SP00125 1112
P123_ST00137
P123_SP00126 1221
P123_ST00138 1237
P123_SP00127
P123_ST00139 1271 group
P123_SP00128 1385
P123_ST00140 1401
P123_SP00129 1445
P123_ST00141 college
P123_SP00130 1596
P123_ST00142 1613 160 students
P123_SP00131
P123_ST00143 1789 53 (N 0.58
P123_SP00132 1842
P123_ST00144 1863 1588 26
P123_SP00133 1598
P123_ST00145 1909 132 1,380), 0600006
P123_SP00134 2041
P123_ST00146 2059 85 ages
P123_SP00135 2144
P123_ST00147 1577 41
P123_TL00013 600 1507
P123_ST00148 1696
P123_SP00136 638 1726
P123_ST00149 652 1692 25
P123_SP00137 697 1725
P123_ST00150 715 1702 years, 0.90 000006
P123_SP00138 828 1736
P123_ST00151
P123_SP00139 890
P123_ST00152 898 whom
P123_SP00140 1021
P123_ST00153 1037 1691 63%) 0.75 0080
P123_SP00141 1126
P123_ST00154 1140
P123_SP00142 1236
P123_ST00155 1250 134 female
P123_SP00143 1384
P123_ST00156 1400
P123_SP00144
P123_ST00157 1483 42.5%) 0.85 000080
P123_SP00145 1610
P123_ST00158 1624
P123_SP00146 1720
P123_ST00159 1734 116 black.
P123_SP00147 1850
P123_ST00160 1869
P123_SP00148 1944
P123_ST00161 1958 149 internal
P123_TL00014 1805 1607
P123_ST00162 consistency
P123_SP00149 832 1851
P123_ST00163
P123_SP00150 904 1841
P123_ST00164 916
P123_SP00151 976
P123_ST00165 990 total
P123_SP00152 1076
P123_ST00166
P123_SP00153 1190
P123_ST00167 1204
P123_SP00154 1291
P123_ST00168 71 this
P123_SP00155 1376
P123_ST00169 1393 sample
P123_SP00156 1530
P123_ST00170 1544 1817
P123_SP00157
P123_ST00171 0.49 5
P123_SP00158
P123_ST00172 1674 1818
P123_SP00159 1828
P123_ST00173 1717 1807 .91
P123_SP00160 1770
P123_ST00174 1790 158 (Dilorio
P123_SP00161 1948
P123_ST00175 1964 1811 et
P123_SP00162 1998
P123_ST00176 2013 56 al., 0006
P123_SP00163
P123_ST00177 2086 2000).
P123_TL00015 1920 1406
P123_ST00178
P123_SP00164 764 1956
P123_ST00179 779 142 revised
P123_SP00165
P123_ST00180
P123_SP00166
P123_ST00181 1107 0005005330000
P123_SP00167 1368 1966
P123_ST00182
P123_SP00168 1489
P123_ST00183 64 has
P123_SP00169
P123_ST00184 1583
P123_SP00170 1661
P123_ST00185 1675 145 yielded
P123_SP00171 1820
P123_ST00186 97 good
P123_SP00172 1932
P123_ST00187 1947
P123_TL00016 1536
P123_ST00188
P123_SP00173 2081
P123_ST00189 847 2047 122 across
P123_SP00174 969 2071
P123_ST00190
P123_SP00175 1086
P123_ST00191 1101 166 samples.
P123_SP00176 1267
P123_ST00192 1288 2036 Soet
P123_SP00177
P123_ST00193 1388
P123_SP00178
P123_ST00194 1436 al.
P123_SP00179
P123_ST00195 (1999)
P123_SP00180 1627
P123_ST00196 1643 202 conducted
P123_SP00181 1845
P123_ST00197 1861
P123_SP00182 1881
P123_ST00198 1897 study
P123_SP00183
P123_ST00199 2015
P123_SP00184 2102
P123_ST00200 2118
P123_TL00017 2150
P123_ST00201 2162
P123_SP00185 714 2196
P123_ST00202 731
P123_SP00186 775 2186
P123_ST00203 784
P123_SP00187 918
P123_ST00204
P123_SP00188 1074
P123_ST00205 1091 student
P123_SP00189
P123_ST00206 1247 0.72 800
P123_SP00190 1335
P123_ST00207 1351 615), 0.88 00006
P123_SP00191 1449
P123_ST00208
P123_SP00192 1511
P123_ST00209 1519 124
P123_SP00193
P123_ST00210 1658 2151 46.2%)
P123_SP00194
P123_ST00211 1799
P123_SP00195 1894
P123_ST00212 1908 110 white
P123_SP00196 2018
P123_ST00213 2034
P123_SP00197 2103
P123_ST00214 2120 53.8%)
P123_TL00018 2265 1541
P123_ST00215 2277
P123_SP00198 696 2301
P123_ST00216 709 118 black,
P123_SP00199 827 2309
P123_ST00217 843
P123_SP00200
P123_ST00218 946
P123_SP00201 966
P123_ST00219 980 mean
P123_SP00202
P123_ST00220 1102 age
P123_SP00203 1168 2311
P123_ST00221
P123_SP00204 1228
P123_ST00222 2267 20.97
P123_SP00205
P123_ST00223 1363 (SD 0.59 840
P123_SP00206
P123_ST00224 1452 2278
P123_SP00207 2288
P123_ST00225 1498 1.63) 0.99
P123_SP00208 1594
P123_ST00226 1609 2271
P123_SP00209 1647
P123_ST00227 1662 147 explore
P123_SP00210 1809
P123_ST00228 1823
P123_SP00211 1883
P123_ST00229 184 influence
P123_SP00212
P123_ST00230 2096
P123_TL00019 2380 1628
P123_ST00231 192 perceived
P123_SP00213 793 2426
P123_ST00232 809 215 dominance
P123_SP00214 2416
P123_ST00233 1040
P123_SP00215 1109
P123_ST00234 1125 172 ethnicity
P123_SP00216
P123_ST00235 1312 2392
P123_SP00217 1359
P123_ST00236 2381 182 women's 0.92 0000050
P123_SP00218 1555
P123_ST00237 1572 safer
P123_SP00219 1666
P123_ST00238 1681
P123_SP00220 1744
P123_ST00239 behavior.
P123_SP00221 1940
P123_ST00240 1957 119 Using
P123_SP00222 2076
P123_ST00241
P123_SP00223
P123_ST00242 2169 2382 12-
P123_TL00020 2495 1561
P123_ST00243 item
P123_SP00224 687 2531
P123_ST00244 705 262 0000005330000
P123_SP00225 967 2541
P123_ST00245 984
P123_SP00226 1087
P123_ST00246
P123_SP00227 1244
P123_ST00247 1258 48
P123_SP00228 1306
P123_ST00248 1320 143 Dilorio
P123_SP00229 1463
P123_ST00249 2501
P123_SP00230 1513
P123_ST00250 1527
P123_SP00231 1569
P123_ST00251 in
P123_SP00232 1625 2530
P123_ST00252 1644 2497 90 1995
P123_SP00233
P123_ST00253 1753 (C.
P123_SP00234
P123_ST00254 1826 153 Dilorio, 00000006
P123_SP00235 2539
P123_ST00255 1996 personal
P123_TL00021 2610 1600
P123_ST00256 318 communication, 0.96 00000000000006
P123_SP00236 920 2654
P123_ST00257 210 September
P123_SP00237 2656
P123_ST00258 1163 2612 23, 0.78 006
P123_SP00238
P123_ST00259 1238 2002)
P123_SP00239 1352
P123_ST00260 1366 2616
P123_SP00240 1404 2646
P123_ST00261 1419 2622 164 measure
P123_SP00241
P123_ST00262 1597
P123_SP00242 1657
P123_ST00263 1672 242 participants' 0000000000005
P123_SP00243 1914
P123_ST00264 1935 216 confidence
P123_SP00244
P123_ST00265 2166
P123_TL00022 2725
P123_ST00266 223 performing
P123_SP00245 824 2771
P123_ST00267
P123_SP00246 934 2761
P123_ST00268 950 2737
P123_SP00247
P123_ST00269 1027 185 practices, 0.94 0000000006
P123_SP00248 1212
P123_ST00270 227 Cronbach's 0000000050
P123_SP00249 1457
P123_ST00271 1473 alphas
P123_SP00250
P123_ST00272 57
P123_SP00251
P123_ST00273 1682
P123_SP00252 1742
P123_ST00274 1756 99 three
P123_SP00253
P123_ST00275 1871 subscales
P123_SP00254 2055
P123_ST00276 2070
P123_TL00023 2840 1515
P123_ST00277 reported
P123_SP00255 765 2886
P123_ST00278 2846
P123_SP00256 816 2876
P123_ST00279 830 be
P123_SP00257
P123_ST00280 894 2842 .74
P123_SP00258
P123_ST00281
P123_SP00259
P123_ST00282 173 Refused,
P123_SP00260 1209 2884
P123_ST00283 54 .93 0.98
P123_SP00261
P123_ST00284
P123_SP00262 1358
P123_ST00285 1372 Condom
P123_SP00263 1540
P123_ST00286 Use,
P123_SP00264 1642
P123_ST00287
P123_SP00265
P123_ST00288 1746 .87
P123_SP00266 1803
P123_ST00289
P123_SP00267 1876
P123_ST00290 1888 Discussion.
P123_TB00002 3041
P123_TL00024 1394 3047
P123_ST00291 108 002


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P98_ST00017 1236 75 that
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P98_ST00019 1527 157 condom
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P98_ST00020 1698 437 101 24 users
P98_SP00019 1799
P98_ST00021 1814 70 had
P98_SP00020 1884
P98_ST00022 1899 127 higher
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P98_ST00024 2178 47 on
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P98_ST00027 760 44 of
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P98_ST00028 812
P98_SP00026 872
P98_ST00029 889 184 subscales
P98_SP00027 1073
P98_ST00030 1087 85 than
P98_SP00028 1172
P98_ST00031 1186
P98_SP00029 1246
P98_ST00032 1263 164 sporadic
P98_SP00030 1427 586
P98_ST00033 1441 552 84 user
P98_SP00031 1525
P98_ST00034 1539
P98_SP00032 1608
P98_ST00035 1623 175 nonusers
P98_SP00033 1798
P98_ST00036
P98_SP00034 1883
P98_ST00037 1896
P98_SP00035 1971
P98_ST00038 1984 99 three
P98_SP00036 2083
P98_ST00039 2099
P98_SP00037 2143
P98_ST00040 2151
P98_TL00004 603 655 1535
P98_ST00041
P98_SP00038 787 691
P98_ST00042 667
P98_SP00039 925
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P98_ST00044 1051 246 significantly 0.94 0000070000000
P98_SP00041 1297 701
P98_ST00045 1312 171 different
P98_SP00042 1483
P98_ST00046 1497 134 among
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P98_ST00047 1644 these
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P98_ST00048 1760 groups
P98_SP00045 1894 28
P98_ST00049 1922 216 ("Partner's 01000000050
P98_TL00005 770 1455
P98_ST00050 240 disapproval, 0.88 000033000006
P98_SP00046 842 816
P98_ST00051 859 771 18 12 0.62 3
P98_SP00047 877 783
P98_ST00052 894 0.74 2
P98_SP00048 912
P98_ST00053 929 219 Assertive," 00000000063
P98_SP00049 1148 814
P98_ST00054 1165 0.98
P98_SP00050 1234 806
P98_ST00055 1249 253 "Intoxicants, 0.93 2000000000006
P98_SP00051 1502
P98_ST00056 1519
P98_SP00052 1537
P98_ST00057 1551 35 F
P98_SP00053 1586 805
P98_ST00058 1598 (2,272) 0060000
P98_SP00054 1740
P98_ST00059 1755 26 10
P98_SP00055 1781 793
P98_ST00060 1796 772 95 42 3.51, 0.42 80757
P98_SP00056
P98_ST00061 1901 775 41 p<
P98_SP00057
P98_ST00062 1989 68 .05; 0.83 0006
P98_TL00006 598 885 1571
P98_ST00063 177 F(2,212) 0.35 08777776
P98_SP00058 931
P98_ST00064 790 898
P98_SP00059 908
P98_ST00065 887 5.16,p< 0.57 7077700
P98_SP00060 1007
P98_ST00066 1024 94 .005; 0.87 00006
P98_SP00061 1118 19
P98_ST00067 1137 0.97
P98_SP00062 1206 921 11
P98_ST00068 1217 886 0.12
P98_SP00063 1252 920
P98_ST00069 1264 0.84 0161010
P98_SP00064 1406
P98_ST00070 1421
P98_SP00065 1447
P98_ST00071 1463 6.51, 0.40 70777
P98_SP00066 1557
P98_ST00072 1567 890 71
P98_SP00067 1638
P98_ST00073 1656 92 .005,
P98_SP00068 1748
P98_ST00074 1765 266 respectively), 0.92 00050000000006
P98_SP00069 2031
P98_ST00075 2047 122 which 02002
P98_TL00007 601
P98_ST00076 135 further
P98_SP00070 736 1036
P98_ST00077 751 1006 165 40 supports
P98_SP00071 916 1046
P98_ST00078 930
P98_SP00072 990
P98_ST00079 1004 view
P98_SP00073 1101
P98_ST00080 1114
P98_SP00074 1189
P98_ST00081 1201
P98_SP00075 1261
P98_ST00082 1276 1012 100 more
P98_SP00076 1376
P98_ST00083 1393 successes
P98_SP00077 1580
P98_ST00084 1596 an
P98_SP00078 1640
P98_ST00085 1655 199 individual 0000000000
P98_SP00079 1854
P98_ST00086 1870 64 has
P98_SP00080 1934
P98_ST00087 1948 88 with
P98_SP00081 2036
P98_ST00088 2053 safer
P98_SP00082 2147
P98_ST00089 62 sex
P98_TL00008 1115 1067
P98_ST00090 203 behaviors, 0000000006
P98_SP00083 803 1159
P98_ST00091 819
P98_SP00084 879 1151
P98_ST00092 1127
P98_SP00085 994
P98_ST00093 1011 self-efficacious 0000005330000000
P98_SP00086 1315
P98_ST00094 1330 he
P98_SP00087 1375
P98_ST00095 1390 or
P98_SP00088 1430
P98_ST00096 1445 63 she
P98_SP00089 1508
P98_ST00097 1522 74 will
P98_SP00090
P98_ST00098 1612 55 be.
P98_TL00009 692 1230 1431
P98_ST00099 190 Similarly,
P98_SP00091 882
P98_ST00100 900 129 Trobst
P98_SP00092 1029 1266
P98_ST00101 1043
P98_SP00093 1113
P98_ST00102 1128 207 colleagues
P98_SP00094 1335
P98_ST00103 1351 130 (2002)
P98_SP00095 1481
P98_ST00104 1498 conducted
P98_SP00096 1700
P98_ST00105 1716 1242 20 a
P98_SP00097 1736
P98_ST00106 1751 105 study
P98_SP00098 1856
P98_ST00107 1869
P98_SP00099 1957
P98_ST00108 1972 151 African
P98_TL00010 1345 1645
P98_ST00109 Americans
P98_SP00100 815 1381
P98_ST00110 831 191 (N 20\) 8007887
P98_SP00101 1022 1391
P98_ST00111 38 30 to
P98_SP00102 1074
P98_ST00112 1090 197 determine
P98_SP00103 1287
P98_ST00113 1301 if
P98_SP00104 1380 9
P98_ST00114 1344 220 personality
P98_SP00105 1564
P98_ST00115 282 characteristics 000000000000000
P98_SP00106 1862
P98_ST00116 209 influenced
P98_SP00107 2086
P98_ST00117 2101 risk
P98_SP00108 2175
P98_ST00118 2188 58 for
P98_TL00011 1460
P98_ST00119 103 HIV
P98_SP00109 703 1496 1
P98_ST00120 704 1461 123 AIDS.
P98_SP00110 827
P98_ST00121 844 234 Participants 000000000000
P98_SP00111 1078
P98_ST00122 1472 96
P98_SP00112
P98_ST00123 1204 228 categorized
P98_SP00113 1432
P98_ST00124 1446 76 into
P98_SP00114
P98_ST00125 133
P98_SP00115 1670
P98_ST00126 113 based
P98_SP00116 1797
P98_ST00127 1810 upon
P98_SP00117 1909
P98_ST00128 1923 their
P98_SP00118 2015
P98_ST00129 2027 1462 89
P98_SP00119 2116
P98_ST00130 2129 83 risk:
P98_TL00012 1575 1614
P98_ST00131 52 (a)
P98_SP00120 654 1621
P98_ST00132 669 low
P98_SP00121 743 1611
P98_ST00133 756
P98_SP00122 830
P98_ST00134 39 (n 0.58 80
P98_SP00123 883 1620
P98_ST00135 1588
P98_SP00124 924
P98_ST00136 939 1577 43, 016
P98_SP00125 997 1619
P98_ST00137 1014 154 21.4%),
P98_SP00126 1168
P98_ST00138 1185 161 medium
P98_SP00127 1346
P98_ST00139 1361
P98_SP00128 1435
P98_ST00140 1449 0.27
P98_SP00129 1488
P98_ST00141 1503
P98_SP00130 1529
P98_ST00142 1544 57 96, 0.80 006
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P98_ST00144 1790
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P98_ST00145 1874 87 high
P98_SP00134 1961
P98_ST00146 1975
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P98_ST00147 2064
P98_SP00136 2102
P98_ST00148 2117
P98_SP00137
P98_ST00149 2159 62, 0.79
P98_TL00013 1690 1562
P98_ST00150 152 30.8%)). 00008000
P98_SP00138 754
P98_ST00151 773 The
P98_SP00139 847 1726
P98_ST00152 862 investigators 0000000000000
P98_SP00140
P98_ST00153 1130 reported
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P98_SP00142 1383
P98_ST00155 1396
P98_SP00143 1615
P98_ST00156 1629 1702 32 was, 0.85
P98_SP00144 1734
P98_ST00157 1733 141 indeed,
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P98_ST00158 1893
P98_SP00146 1913
P98_ST00159 1926 180 predictor
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P98_ST00160 2120
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P98_SP00148 725 1841
P98_ST00162 741 risk.
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P98_ST00163 1807 33 In
P98_SP00150 880 1840
P98_ST00164 896 addition, 000000006
P98_SP00151 1849
P98_ST00165 1083 they
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P98_ST00166 1182
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P98_ST00167 1360
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P98_ST00171 1780 1817
P98_SP00158 1875
P98_ST00172 1890 1811 not
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P98_ST00173 1966 198 predictors
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P98_ST00174 2180
P98_TL00015 1920 1594
P98_ST00175 unsafe
P98_SP00161 729 1956
P98_ST00176 1932
P98_SP00162 808
P98_ST00177 824
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P98_ST00183 1386
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P98_ST00192
P98_SP00177 1143 2071
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P98_SP00183 1823
P98_ST00199 1837 how
P98_SP00184
P98_ST00200 1938 self-efficacy
P98_TL00017 2150
P98_ST00201 was
P98_SP00185 676 2186
P98_ST00202 measured
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P98_ST00203 895 37 in
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P98_ST00204 945 this
P98_SP00188 1016
P98_ST00205 1033 114 study, 000006
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P98_ST00206 1163
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P98_SP00191 1402
P98_ST00208 1418 167 question
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P98_ST00209 2156
P98_SP00193 1636
P98_ST00210 1650
P98_SP00194
P98_ST00211 1723 validity
P98_SP00195
P98_ST00212
P98_SP00196
P98_ST00213 1942
P98_SP00197 2044
P98_ST00214 2059 170 findings. 700000000
P98_TL00018 689 2265 1549
P98_ST00215 2267
P98_SP00198 728 2300
P98_ST00216 744 2271 155 contrast
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P98_ST00217
P98_SP00200 950
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P98_SP00201 1065
P98_ST00219 1079 findings,
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P98_ST00220 1271 2266 St.
P98_SP00203 1317
P98_ST00221 Lawrence
P98_SP00204 1530
P98_ST00222 1546
P98_SP00205
P98_ST00223
P98_SP00206 1838
P98_ST00224 (1998)
P98_SP00207
P98_ST00225 2000
P98_SP00208 2203
P98_ST00226 2218 2277
P98_TL00019 2380
P98_ST00227 224 community
P98_SP00209 826 2426 4
P98_ST00228 -based
P98_SP00210 957 2416
P98_ST00229 974
P98_SP00211
P98_ST00230
P98_SP00212 1179
P98_ST00231 1196 162 sexually
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P98_ST00232 1373 117 active
P98_SP00214 1490
P98_ST00233 1504
P98_SP00215
P98_ST00234 1669 American
P98_SP00216 1864
P98_ST00235 1878 2392 146 women
P98_SP00217 2024
P98_ST00236 2040 700
P98_SP00218 2128
P98_ST00237 2142 423),
P98_TL00020 2495 1521
P98_ST00238 2507 ages
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P98_ST00239 707 2497
P98_SP00220 749 2530
P98_ST00240 764 2501
P98_SP00221 802 2531
P98_ST00241 65
P98_SP00222 861
P98_ST00242 878 years
P98_SP00223
P98_ST00243 998 (M 730
P98_SP00224 1094
P98_ST00244 1110 31.3,
P98_SP00225 2539
P98_ST00245 1220 SD
P98_SP00226 1280
P98_ST00246 1295 2508
P98_SP00227 1321 2518
P98_ST00247 1336 9.2),
P98_SP00228 1422
P98_ST00248 1438
P98_SP00229 1476
P98_ST00249 166 examine
P98_SP00230 1658
P98_ST00250 1672
P98_SP00231 1732
P98_ST00251 1747 differences
P98_SP00232
P98_ST00252 1981
P98_SP00233 2017
P98_ST00253
P98_TL00021 2610 1628
P98_ST00254
P98_SP00234 759 2646
P98_ST00255 2622 use,
P98_SP00235 849 2654
P98_ST00256 865
P98_SP00236 986
P98_ST00257
P98_SP00237 1076
P98_ST00258 227
P98_SP00238 1319 2656
P98_ST00259 1334 as
P98_SP00239 1372
P98_ST00260
P98_SP00240 1440
P98_ST00261 245 consistently, 0000000000006
P98_SP00241
P98_ST00262 1720 (b)
P98_SP00242 1775
P98_ST00263 286 inconsistently, 0.96 000000000000006
P98_SP00243 2076
P98_ST00264 2094
P98_SP00244 2163
P98_ST00265 (c)
P98_TL00022 2725
P98_ST00266 2737 185 nonusers.
P98_SP00245 786 2761
P98_ST00267 Using
P98_SP00246 2771
P98_ST00268 937
P98_SP00247
P98_ST00269 970 128 2-item
P98_SP00248 1098
P98_ST00270 1117 261
P98_SP00249 1378
P98_ST00271 1395
P98_SP00250 1499
P98_ST00272 1512
P98_SP00251
P98_ST00273 1641
P98_SP00252 1688
P98_ST00274 1701 204 Bandura's 000000050
P98_SP00253 1905
P98_ST00275 1921 (1986)
P98_SP00254 2050
P98_ST00276 2069 Social
P98_TL00023 2840 1543
P98_ST00277 194 Cognitive
P98_SP00255 796 2886
P98_ST00278 Theory,
P98_SP00256 962
P98_ST00279 978
P98_SP00257 1038 2876
P98_ST00280 1053
P98_SP00258 1306
P98_ST00281
P98_SP00259 1436
P98_ST00282
P98_SP00260 1524
P98_ST00283 1540
P98_SP00261 1786
P98_ST00284 1803 2852 120
P98_SP00262
P98_ST00285 1939
P98_SP00263 2073
P98_ST00286 59
P98_TB00002 1397 3041 54
P98_TL00024 1403 3047
P98_ST00287 0.76 22


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P32_ST00042
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P32_ST00052 1964 71 this
P32_SP00048 2035
P32_ST00053 2051 80 end,
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P32_ST00054 131 people
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P32_ST00055 748 897 58 are
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P32_ST00056 822 85 seen
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P32_SP00052
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P32_ST00060 1262
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P32_ST00065 1980 193 (Bandura,
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P32_ST00066 1002 104 1986; 0.82 00206
P32_SP00060 710 1044 22
P32_ST00067 119 1989). 002000
P32_TL00008 1115 1466
P32_ST00068 Bandura
P32_SP00061 857 1151
P32_ST00069 871 130 (1989)
P32_SP00062 1001
P32_ST00070 1016 further
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P32_ST00071 1166 158 asserted
P32_SP00064 1324
P32_ST00072 1337 75 that
P32_SP00065 1412
P32_ST00073 1425
P32_SP00066 1485
P32_ST00074 1498 221 uniqueness 0000000000
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P32_ST00075 1735
P32_SP00068
P32_ST00076 1788 human
P32_SP00069 1922
P32_ST00077 1936 129 beings
P32_SP00070 2065
P32_ST00078 2078
P32_TL00009 1230 1627
P32_ST00079 127 allows
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P32_ST00080 743 98 them
P32_SP00072 841
P32_ST00081 856 1236 to
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P32_ST00083
P32_SP00075 1098 1265
P32_ST00084 1114 cognitive
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P32_ST00092
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P32_ST00095 859 234 capabilities:
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P32_SP00119
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P32_ST00134
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P32_ST00139 1395
P32_SP00126 1493
P32_ST00140 1509 out.
P32_SP00127 1579
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P32_ST00142 1806
P32_SP00129 2000
P32_ST00143 2016
P32_TL00015 1920 1622
P32_ST00144
P32_SP00130 754
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P32_ST00150 1565
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P32_ST00151 1774 162 learning
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P32_ST00162 attention,
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P32_SP00157 1349
P32_ST00174 The
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P32_ST00175 125
P32_SP00159 1583
P32_ST00176 1596
P32_SP00160 1635
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P32_SP00161 1911
P32_ST00178
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P32_ST00179 2011 108
P32_TL00018 2265 1626
P32_ST00180 actions
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P32_ST00181
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P32_SP00167 1449
P32_ST00185 1464 capability.
P32_SP00168 1667
P32_ST00186 1685 2267 In
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P32_ST00187 1740 other
P32_SP00170 12
P32_ST00188 1853 words,
P32_SP00171 1984 2309
P32_ST00189 2001
P32_SP00172 2154
P32_ST00190 2170 2277
P32_TL00019 2380 1604
P32_ST00191
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P32_ST00192 696 2386
P32_SP00174 734
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P32_ST00194 985 represent
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P32_ST00195 1180
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P32_ST00197 1385 using
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P32_ST00200
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P32_ST00204 905
P32_SP00185 2531
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P32_SP00186 1010
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P32_SP00187 1173
P32_ST00207 1190 137 control
P32_SP00188 1327
P32_ST00208 1342
P32_SP00189 1417
P32_ST00209 1432 216 determines
P32_SP00190 1648
P32_ST00210 1662
P32_SP00191 1783
P32_ST00211
P32_SP00192 1989
P32_ST00212 2005 2507
P32_TL00021 2610
P32_ST00213 performed.
P32_SP00193 2656
P32_ST00214 833 2612
P32_SP00194 2654
P32_ST00215 123 social,
P32_SP00195 1167
P32_ST00216 1184 261 motivational,
P32_SP00196 1445
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P196_ST00082 364 lymphogranuloma 000000000000000
P196_SP00074 1053 1276 25
P196_ST00083 1078 1242 verenum
P196_SP00075 1251 1266
P196_ST00084 1268 128 during
P196_SP00076 1396
P196_ST00085 1411 199 epidemics 000000000
P196_SP00077 1610
P196_ST00086 1626 of
P196_SP00078 1670
P196_ST00087 1680 106 crack
P196_SP00079 1786
P196_ST00088 1801 cocaine
P196_SP00080
P196_ST00089 1964 65 use
P196_SP00081 2029
P196_ST00090 2045
P196_SP00082 2114
P196_ST00091 2128 1232 88 HIV
P196_TL00010 1345 1469
P196_ST00092 infection
P196_SP00083 864 1381
P196_ST00093 879
P196_SP00084 915 1380
P196_ST00094 929
P196_SP00085 989
P196_ST00095 Bahamas.
P196_SP00086
P196_ST00096 1211 Sexually 25100000
P196_SP00087 1391
P196_ST00097 1397 242 Transmitted 00005000050
P196_SP00088 6
P196_ST00098 1645 189 Diseases, 0.63 005505557
P196_SP00089 1834 1389
P196_ST00099 1851 116 29(5),
P196_SP00090 1967
P196_ST00100 1984 1347 174 253-258.
P196_TL00011 1460 1589
P196_ST00101 Beadnell, 001000006
P196_SP00091 786 1504
P196_ST00102 802 1462 B.,
P196_SP00092 857
P196_ST00103 873 Baker,
P196_SP00093
P196_ST00104 1022 1461 31 S.
P196_SP00094
P196_ST00105 A.,
P196_SP00095 1128
P196_ST00106 1144 195 Morrison,
P196_SP00096 1339
P196_ST00107 1355 D.
P196_SP00097 1399
P196_ST00108
P196_SP00098 1482
P196_ST00109 1499
P196_SP00099 1534
P196_ST00110 1549 121 Knox,
P196_SP00100
P196_ST00111 1686
P196_SP00101 1730
P196_ST00112 1749 (2000). 0.98 0100000
P196_SP00102 1888
P196_ST00113 1905 HIVSTD
P196_SP00103 2100
P196_ST00114 73 risk 0000
P196_TL00012 1575
P196_ST00115 factors
P196_SP00104 822 1611
P196_ST00116 837
P196_SP00105 895
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P196_SP00106
P196_ST00118 1066 89 with
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P196_ST00121 1430 1581 168 partners.
P196_SP00110 1598 1621
P196_ST00122 1615 Sex 0.69 251
P196_SP00111
P196_ST00123 1695 122 Roles, 000557
P196_SP00112 1817 1619
P196_ST00124 155 42(78),
P196_SP00113 1989
P196_ST00125 2007 1577 661-689.
P196_TL00013 1607
P196_ST00126 198 Beardsley
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P196_ST00127 812 131 Roker,
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P196_ST00128 959 1692 P.
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P196_ST00129 1014 (Ed.).
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P196_ST00130 1141 138
P196_SP00118 1279
P196_ST00131 1301 The 0.83 005
P196_SP00119 1370 1725
P196_ST00132 1385 1693 118 32 vision 005000
P196_SP00120 1503
P196_ST00133 1517 47
P196_SP00121 4
P196_ST00134 1568 Sir 200
P196_SP00122
P196_ST00135 1637 Lynden 000050
P196_SP00123 1785
P196_ST00136 1796 187 Pindling:
P196_SP00124 1983
P196_ST00137 1998 1691 In
P196_SP00125
P196_ST00138 2054 his
P196_SP00126 2111
P196_ST00139 2125 1702 82 23 own 0.95 010
P196_TL00014 687 1805 1219
P196_ST00140 words. 000020
P196_SP00127
P196_ST00141 834 1807 154 Nassau, 2000006
P196_SP00128 988 1849
P196_ST00142 1004 193 Bahamas:
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P196_ST00143 1216 75
P196_SP00130 1291
P196_ST00144 1304 Estate
P196_SP00131 1425
P196_ST00145 1441
P196_SP00132
P196_ST00146 1497
P196_SP00133 1552
P196_ST00147
P196_SP00134 1715
P196_ST00148 1729 Pindling.
P196_TL00015 1920 1563
P196_ST00149 150 Beeber,
P196_SP00135 750
P196_ST00150 766 1922 38 L.
P196_SP00136 804 1956
P196_ST00151 825 1921
P196_SP00137
P196_ST00152 140 (1998).
P196_SP00138 1966
P196_ST00153 1037 Social
P196_SP00139
P196_ST00154 1174 support,
P196_SP00140
P196_ST00155 1349 234 self-esteem, 000000000006
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P196_ST00156 1601
P196_SP00142
P196_ST00157 1685 208 depressive
P196_SP00143 1893
P196_ST00158 1910 symptoms
P196_SP00144
P196_ST00159 2126
P196_TL00016 2035 1478
P196_ST00160 2047 124 young
P196_SP00145 2081
P196_ST00161 826 American
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P196_ST00162 1034 women.
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P196_ST00163 1205 IMAGE: 020000
P196_SP00148
P196_ST00164 1390 Journal
P196_SP00149
P196_ST00165 1561
P196_SP00150 1608 1
P196_ST00166 1609 2036 166 Nursing 0005000
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P196_ST00167 245 Scholarship, 200000050000
P196_SP00152 2030
P196_ST00168 2051 115 30(V), 0.26 658877
P196_TL00017 2152
P196_ST00169 91-92. 000010
P196_TL00018 2265 1627
P196_ST00170 Bernard,
P196_SP00153 2309
P196_ST00171 2267
P196_SP00154 824 2301
P196_ST00172 843 2266 C, 86
P196_SP00155 896
P196_ST00173 912 240 Hutchinson, 00000000006
P196_SP00156 1152
P196_ST00174 1172
P196_SP00157 1217
P196_ST00175 1234 Lavin,
P196_SP00158 1358
P196_ST00176
P196_SP00159 1432
P196_ST00177
P196_SP00160 1484
P196_ST00178 237 Pennington,
P196_SP00161 2311
P196_ST00179 1752 26 33 P
P196_SP00162 1778 2300
P196_ST00180 1795 (1996).
P196_SP00163 1934
P196_ST00181 1951 276 Ego-Strength, 0000000000006
P196_TL00019 2380 1508
P196_ST00182 hardiness, 0000000006
P196_SP00164 2424
P196_ST00183 904
P196_SP00165 1138
P196_ST00184 1157 255 self-efficacy, 00000000000006
P196_SP00166 1412 2426
P196_ST00185 197 optimism,
P196_SP00167
P196_ST00186
P196_SP00168 1714 2416
P196_ST00187 302 maladjustment: 00000000000000
P196_SP00169 2031
P196_ST00188 2048 Health-
P196_TL00020 2495 1406
P196_ST00189 related
P196_SP00170 2531
P196_ST00190 219 personality 00000000000
P196_SP00171 1056 2541
P196_ST00191 2501 constmcts 000008000
P196_SP00172 1272
P196_ST00192 1288
P196_SP00173 1357
P196_ST00193
P196_SP00174
P196_ST00194 1445 93 "Big
P196_SP00175 1538
P196_ST00195 1551 Five" 00002
P196_SP00176 1659
P196_ST00196 1675 model
P196_SP00177
P196_ST00197 1814
P196_SP00178 1858 9
P196_ST00198 1867 228 personality. 000000000000
P196_TL00021 2610 1051
P196_ST00199 287 Psychological 0500000000000
P196_SP00179 973 2656 7
P196_ST00200 980 232 Assessment 0555550500
P196_SP00180 1212 2645
P196_ST00201 1221 2611 213 Resources, 0550000550
P196_SP00181 2652
P196_ST00202 1455 91 3(2), 0.31 65777
P196_SP00182 1546
P196_ST00203 2612 115-131.
P196_TL00022 2725 1558
P196_ST00204 2727 Berry,
P196_SP00183 722 2771
P196_ST00205 738
P196_SP00184 794 2761
P196_ST00206 811
P196_SP00185 869 2769
P196_ST00207 2726
P196_SP00186 921
P196_ST00208 936 Feldman,
P196_SP00187 1120
P196_ST00209 1140
P196_SP00188
P196_ST00210 1191 137 (1985;. 0.87 0000080
P196_SP00189 1328
P196_ST00211 1343 172 Multiple 20000005
P196_SP00190 1515
P196_ST00212 1529 2728 210 regression 0500555000
P196_SP00191 1739
P196_ST00213 1754
P196_SP00192 2760
P196_ST00214 1798 178 practice. 000000050
P196_SP00193 1976
P196_ST00215 1993 London:
P196_TL00023 692 2841 100
P196_ST00216 Sage.
P196_TB00002 1388 3041
P196_TL00024 1394 3047
P196_ST00217 181 020


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P128_TL00004 601 655 1591
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P128_ST00035 874 134 factors
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P128_ST00041 1818 risk
P128_SP00038 1892
P128_ST00042 1906 57 for
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P128_ST00043 1975 103 HIV
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P128_TL00005 603 770 1531
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P128_ST00046 657
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P128_ST00048 896 151 specific 0.90 00000700
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P128_ST00049 1063
P128_SP00045 1132
P128_ST00050 1147 188 culturally
P128_SP00046 1335
P128_ST00051 1352 171 sensitive
P128_SP00047 1523
P128_ST00052 1538 212 prevention
P128_SP00048
P128_ST00053 1766 strategies
P128_SP00049 1950
P128_ST00054 1966 108 could
P128_SP00050 2074
P128_ST00055 2088 be
P128_TL00006 602 885 1444
P128_ST00056 developed
P128_SP00051 804 931
P128_ST00057 820
P128_SP00052 889 921
P128_ST00058 903 260 implemented 00000000000
P128_SP00053 1163
P128_ST00059 1176 891
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P128_ST00067 810 159 infected
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P128_ST00068 983 88 with
P128_SP00062 1071
P128_ST00069 1084
P128_SP00063 1144
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P128_ST00071 1284 261 Additionally, 0.95 0000000000006
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P128_ST00072 1561
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P128_ST00073 1636
P128_SP00067 1866
P128_ST00074 1880 1012
P128_SP00068 1976
P128_ST00075 1990
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P128_ST00076 2080
P128_TL00008 1115 1564
P128_ST00077
P128_SP00070 1151
P128_ST00078 706 1121 consent
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P128_ST00079 869
P128_SP00072 907
P128_ST00080 922 208 participate
P128_SP00073 1130 1161
P128_ST00081 1127
P128_SP00074 1220
P128_ST00082 1237 strictly
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P128_ST00083 1385 191 voluntary
P128_SP00076 1576
P128_ST00084 70
P128_SP00077 1661
P128_ST00085 1674
P128_SP00078 1749
P128_ST00086 1762 they
P128_SP00079 1846
P128_ST00087 1862
P128_SP00080 1970
P128_ST00088 1986 127 decide
P128_SP00081 2113
P128_ST00089 2127
P128_TL00009 1230 1606
P128_ST00090 1236 78 40 stop
P128_SP00082 681 1276
P128_ST00091 697 250 participating
P128_SP00083 947
P128_ST00092 963 at
P128_SP00084 997
P128_ST00093 1011 158 anytime
P128_SP00085 1169
P128_ST00094 1183 without
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P128_ST00095 1349 154 penalty.
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P128_ST00116
P128_SP00106
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P128_ST00118 assured
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P128_ST00124 1809 201 responses.
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P128_ST00125 2029
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P128_ST00127
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P128_ST00128
P128_SP00117 766
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P128_ST00135 1552 125 would
P128_SP00124
P128_ST00136 1691 have
P128_SP00125 1783
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P128_SP00127
P128_ST00139
P128_SP00128 2048
P128_ST00140 2064 81 data
P128_SP00129 2145
P128_ST00141 2160 68
P128_TL00013 1805 1586
P128_ST00142
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P128_ST00143 689 identification 0.94 00000070000000
P128_SP00131
P128_ST00144 169
P128_SP00132 1137
P128_ST00145 1153 (i.e., 000006
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P128_ST00146 1807 82 42 001, 0.85 0006
P128_SP00134 1338 1849
P128_ST00147 1356 002,
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P128_ST00148 1456 33 003 0.98
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P128_ST00149 1535 1837 4 .
P128_SP00137 1539
P128_ST00150 1551
P128_SP00138 1555
P128_ST00151 1567 27 .)
P128_SP00139 1594
P128_ST00152
P128_SP00140 1732
P128_ST00153 1746
P128_SP00141 1792
P128_ST00154 91 used
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P128_SP00143
P128_ST00156 1982
P128_SP00144 2063
P128_ST00157 1811 entry.
P128_TL00014
P128_ST00158
P128_SP00145
P128_ST00159 715 1932
P128_SP00146 811 1956
P128_ST00160 824
P128_SP00147 901
P128_ST00161 915
P128_SP00148 990
P128_ST00162 1002
P128_SP00149 1094
P128_ST00163 1108 234 information
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P128_ST00164 1355
P128_SP00151 1479
P128_ST00165 1493
P128_SP00152
P128_ST00166 1553 165 reported
P128_SP00153 1718
P128_ST00167
P128_SP00154 1769 1955
P128_ST00168 1784 group
P128_SP00155 1897
P128_ST00169 1913 94 form
P128_SP00156 2007
P128_ST00170 2023 86
P128_SP00157
P128_ST00171 2125
P128_TL00015 1459
P128_ST00172 189 reflecting
P128_SP00158 790 2081
P128_ST00173
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P128_ST00176 1231 172 general), 0.93 000000006
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P128_ST00177 further
P128_SP00163
P128_ST00178 1569 ensuring
P128_SP00164 1739
P128_ST00179 1753 147 privacy
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P128_ST00180 1916
P128_SP00166
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P128_ST00182
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P128_ST00184
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P128_ST00191 1640 2271
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P128_SP00177
P128_ST00193 1797
P128_SP00178
P128_ST00194 2062
P128_SP00179 2099 2300
P128_ST00195 2112 71 this
P128_TL00017 2380 1598
P128_ST00196
P128_SP00180 707 2426
P128_ST00197 721 2392
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P128_ST00201 1332
P128_SP00185
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P128_SP00186 1445
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P128_ST00204
P128_SP00188
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P128_SP00190
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P128_TL00018 2495 1467
P128_ST00208
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P128_ST00213 1544 or
P128_SP00196 1584
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P128_SP00197 1735
P128_ST00215 1748 back
P128_SP00198
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P128_TL00019 2610
P128_ST00217 memories.
P128_SP00199 2646
P128_ST00218
P128_SP00200 924 2656
P128_ST00219 937 2622
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P77_ST00101 less
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P77_ST00102
P77_SP00093 867 1391
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P77_ST00129 2006
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P77_ST00130
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P77_ST00131 795
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P77_ST00135 1413 from
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P77_SP00124 1693
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P77_TL00014 1805 1541
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P77_ST00146 1296 (n 0.38
P77_SP00133 1335
P77_ST00147 1349 1818
P77_SP00134 1375 1828
P77_ST00148 1390 64 40)
P77_SP00135
P77_ST00149
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P77_ST00152 1826
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P77_SP00140 1930
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P77_ST00201 195
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P77_ST00203
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P77_ST00204
P77_SP00187
P77_ST00205 2000 .17, 0.85 0006
P77_SP00188 2067
P77_ST00206 ns).
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P77_ST00207 187 Although
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P77_ST00208
P77_SP00190 953 2416
P77_ST00209 967
P77_SP00191
P77_ST00210 1176 2381 181 women's 0000050
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P77_ST00211 1374 2392 121
P77_SP00193 1495
P77_ST00212 1511
P77_SP00194
P77_ST00213 1574 267 self-silencing 00000000000000
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P77_ST00214 1856 720
P77_SP00196 1952
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P77_ST00216 2103
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P77_SP00202
P77_ST00222
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P77_SP00204 1459
P77_ST00224 1475
P77_SP00205
P77_ST00225 1691 2496 182
P77_SP00206 1873
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P77_TL00021 2610 1643
P77_ST00229 2623
P77_SP00209 627 2633
P77_ST00230 644 2612 80.25, 100006
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P77_ST00232
P77_SP00212
P77_ST00233 893 20.75)
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P77_ST00234
P77_SP00214
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P77_SP00215
P77_ST00236 1258
P77_SP00216
P77_ST00237 1319 102 Beck
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P77_ST00238 1434 224 Depression 0040000000
P77_SP00218 1658
P77_ST00239 1673 191 Inventory
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P77_ST00240 1880 (BDI)
P77_SP00220 1995
P77_ST00241 2012 45 0.60 650
P77_SP00221 2108 2655
P77_ST00242 2128
P77_SP00222 2141 2645
P77_ST00243 91 1.31, 00206
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P77_SP00223 660 2761
P77_ST00245 675 2738
P77_SP00224 2748
P77_ST00246 2727 80 7.31
P77_SP00225
P77_ST00247 2726 222 versusM 0.89 00000080
P77_SP00226
P77_ST00248 1055 116 10.33,
P77_SP00227 2769
P77_ST00249 1187
P77_SP00228 1247
P77_ST00250 1262
P77_SP00229 1288
P77_ST00251 1304 110 8.68),
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P77_ST00252 1431
P77_SP00231
P77_ST00253 1597 230 American's 0000000050
P77_SP00232
P77_ST00254 1844 266 00050000000000
P77_TL00023 2840
P77_ST00255 193 behaviors
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P77_ST00256 809 appeared
P77_SP00234 986 2886
P77_ST00257 999 2846
P77_SP00235 1037
P77_ST00258 1052 have
P77_SP00236 1144
P77_ST00259 1159 2852 48 no
P77_SP00237 1207
P77_ST00260 1221
P77_SP00238
P77_ST00261 1469
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P77_ST00262 1522 depression.
P77_SP00240 1742
P77_ST00263 1761 These
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P77_ST00264 1892
P77_SP00242 2053
P77_ST00265 93
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P179_ST00043 726
P179_SP00038 928
P179_ST00044 941 886 182 women's 0.92 0000050
P179_SP00039 1123
P179_ST00045 1138 93 level
P179_SP00040 1231
P179_ST00046 1249 84 (i.e., 000006
P179_SP00041 1333 931
P179_ST00047 1350 low
P179_SP00042 1424
P179_ST00048 1439 897 40 or
P179_SP00043 1479
P179_ST00049 1492 high)
P179_SP00044
P179_ST00050 1611
P179_SP00045 1655 11
P179_ST00051 1666 246 self-efficacy 0000005330000
P179_SP00046 1912
P179_ST00052 58 for
P179_SP00047 1985
P179_ST00053 1998 223 negotiating
P179_TL00007 1000
P179_ST00054 94 safer
P179_SP00048 697 1036
P179_ST00055 712 1012 sex
P179_SP00049 775
P179_ST00056 789 behaviors.
P179_SP00050
P179_ST00057 1009 186 Although
P179_SP00051 1195 1046
P179_ST00058 1209 99 there
P179_SP00052 1308
P179_ST00059 1322 31 is
P179_SP00053 1353
P179_ST00060 1369 120 global
P179_SP00054 1489
P179_ST00061 1507 1006 206 agreement
P179_SP00055 1713
P179_ST00062 1726
P179_SP00056 1801
P179_ST00063 1814 lack
P179_SP00057 1896
P179_ST00064 1911
P179_SP00058 1955
P179_ST00065 1965 175 adequate
P179_TL00008 1115 1440
P179_ST00066
P179_SP00059 746 1151
P179_ST00067 761
P179_SP00060 791
P179_ST00068 226 responsible
P179_SP00061 1032 1161
P179_ST00069 1047 57
P179_SP00062 1104
P179_ST00070 1119 1127 102 some
P179_SP00063 1221
P179_ST00071 1116
P179_SP00064 1416
P179_ST00072 1432 240 engagement
P179_SP00065 1672
P179_ST00073 1685
P179_SP00066 1722
P179_ST00074 1737 97 risky
P179_SP00067 1834
P179_ST00075 1848 193 behaviors
P179_TL00009 602 1230 1580
P179_ST00076 (UNAIDSWHO, 0.86 002000080006
P179_SP00068 947 1276
P179_ST00077 964 125 2001),
P179_SP00069 1089
P179_ST00078 1106
P179_SP00070 1266
P179_ST00079 1265 1242 76 was
P179_SP00071 1341
P179_ST00080 1356 1236
P179_SP00072 1419
P179_ST00081 115 found
P179_SP00073
P179_ST00082 1560
P179_SP00074 1598
P179_ST00083 be
P179_SP00075 1658
P179_ST00084 1674 20 a
P179_SP00076 1694
P179_ST00085 1709 0.93 00000700000
P179_SP00077 1917
P179_ST00086 180 predictor
P179_SP00078 2111
P179_ST00087 2124
P179_TL00010 1345 1447
P179_ST00088
P179_SP00079 1381
P179_ST00089
P179_SP00080
P179_ST00090 1346 183
P179_SP00081 1124
P179_ST00091 1139
P179_SP00082 1232
P179_ST00092
P179_SP00083 1293
P179_ST00093 1304 0.85 0005005330000
P179_SP00084 1550 1391
P179_ST00094 1565
P179_SP00085 1623
P179_ST00095 1636 222
P179_SP00086 1858
P179_ST00096 1874 95
P179_SP00087 1969
P179_ST00097 1357
P179_TL00011 1460
P179_ST00098
P179_SP00088 802 1496
P179_ST00099 819 Had
P179_SP00089 901
P179_ST00100
P179_SP00090 1061
P179_ST00101 1075 been
P179_SP00091 1168
P179_ST00102 190 measured
P179_SP00092 1372
P179_ST00103 1387 1472 on
P179_SP00093 1434
P179_ST00104 1450 an
P179_SP00094 1494
P179_ST00105 1508 150 interval
P179_SP00095
P179_ST00106
P179_SP00096 1767
P179_ST00107 1784
P179_SP00097 1821 1495
P179_ST00108
P179_SP00098 1905
P179_ST00109 1922 114 study,
P179_SP00099 2036 1506
P179_ST00110 2052
P179_TL00012 1575 1606
P179_ST00111 1587 34 proxy
P179_SP00100 716
P179_ST00112 730
P179_SP00101 788 12
P179_ST00113 800 172 financial
P179_SP00102 972
P179_ST00114 988 resources
P179_SP00103 1174
P179_ST00115 1189 may
P179_SP00104 1273
P179_ST00116 have
P179_SP00105 1380
P179_ST00117 1393
P179_SP00106 1487
P179_ST00118 1502
P179_SP00107 1522
P179_ST00119 1538 1581 161 stronger
P179_SP00108 1699
P179_ST00120 1712
P179_SP00109 1892
P179_ST00121 1906
P179_SP00110 1950
P179_ST00122 1961
P179_TL00013 1690 1540
P179_ST00123
P179_SP00111 659
P179_ST00124 672
P179_SP00112 895 1736
P179_ST00125 911
P179_SP00113 1005
P179_ST00126 1020 1702
P179_SP00114 1083
P179_ST00127 1097 192
P179_SP00115 1289
P179_ST00128
P179_SP00116 1725
P179_ST00129 1355
P179_SP00117 1468
P179_ST00130 1482
P179_SP00118 1684
P179_ST00131 1697
P179_SP00119 1852
P179_ST00132 1870 271 Alternatively, 00000000000006
P179_TL00014 1805 1563
P179_ST00133 since
P179_SP00120 702 1841
P179_ST00134
P179_SP00121 861
P179_ST00135 875 1817
P179_SP00122 951
P179_ST00136
P179_SP00123 1081
P179_ST00137 1094 1811
P179_SP00124
P179_ST00138 1145
P179_SP00125 1191
P179_ST00139 1207 associated
P179_SP00126 1409
P179_ST00140 1423 88 with
P179_SP00127 1511
P179_ST00141 1524 both
P179_SP00128
P179_ST00142 1628 66 age
P179_SP00129 1851
P179_ST00143
P179_SP00130 1778
P179_ST00144 1794 education, 0000000006
P179_SP00131 1995 1849
P179_ST00145 2012 154 perhaps
P179_TL00015 1920 1461
P179_ST00146 those
P179_SP00132 704 1956
P179_ST00147 720 101 other
P179_SP00133 821
P179_ST00148 833 variables
P179_SP00134
P179_ST00149 1027 151 masked
P179_SP00135 1178
P179_ST00150
P179_SP00136
P179_ST00151 influence
P179_SP00137
P179_ST00152 1465
P179_SP00138 1509
P179_ST00153 1519
P179_SP00139 1664
P179_ST00154 1679 1932
P179_SP00140
P179_ST00155 1743
P179_SP00141 1989 1966
P179_ST00156 2003
P179_TL00016 1498
P179_ST00157
P179_SP00142 824 2081
P179_ST00158 840
P179_SP00143 934 2071
P179_ST00159 950 2047 62
P179_SP00144
P179_ST00160 1026
P179_SP00145 1228
P179_ST00161 1245 2037 42 However, 00000006
P179_SP00146 1437 2079
P179_ST00162 1453 188 Peragallo
P179_SP00147
P179_ST00163 1657 130 (1996)
P179_SP00148 1787
P179_ST00164 1803 77 also
P179_SP00149 1880
P179_ST00165 1894
P179_SP00150 2009
P179_ST00166 2023
P179_TL00017 2150 1584
P179_ST00167 2151
P179_SP00151 2186
P179_ST00168 797
P179_SP00152 942
P179_ST00169 956
P179_SP00153 1050
P179_ST00170 1065 2162
P179_SP00154 1141
P179_ST00171 1156 2156
P179_SP00155 1219
P179_ST00172 1235 245 significantly 0000070000000
P179_SP00156 1480 2196
P179_ST00173 134 related
P179_SP00157 1629
P179_ST00174 1643
P179_SP00158 1681
P179_ST00175 92 their
P179_SP00159 1786
P179_ST00176 1799
P179_SP00160 1873
P179_ST00177 1887
P179_SP00161 1944
P179_ST00178
P179_SP00162 2059
P179_ST00179 2060 124 AIDS.
P179_TL00018 688 2265 1474
P179_ST00180 2267 Forty-two
P179_SP00163 2311
P179_ST00181 2271 percent
P179_SP00164
P179_ST00182 1062
P179_SP00165 2301
P179_ST00183 1114
P179_SP00166
P179_ST00184 230 participants 000000000000
P179_SP00167
P179_ST00185
P179_SP00168 1471 2300
P179_ST00186 1485 70
P179_SP00169 1555
P179_ST00187 1572
P179_SP00170 1676
P179_ST00188 164 reported
P179_SP00171
P179_ST00189 1871 2277
P179_SP00172 1915
P179_ST00190 1930
P179_SP00173 2075
P179_ST00191 2089 73 less
P179_TL00019 2380
P179_ST00192 85 than
P179_SP00174 685 2416
P179_ST00193 157 $18,000 0.91 0006000
P179_SP00175 859 2424
P179_ST00194 2392 per
P179_SP00176 938 2426
P179_ST00195 year.
P179_SP00177 1044
P179_ST00196 03000000
P179_SP00178 1248
P179_ST00197 1262
P179_SP00179 1361
P179_ST00198 1375
P179_SP00180 1406
P179_ST00199 1421 48 no
P179_SP00181 1469
P179_ST00200 219 established
P179_SP00182
P179_ST00201 1718 2386 poverty
P179_SP00183 1869
P179_ST00202 1883
P179_SP00184 1976
P179_ST00203 1993
P179_SP00185 2051
P179_ST00204 2065
P179_TL00020 2495 1548
P179_ST00205 Bahamas
P179_SP00186 2531
P179_ST00206 251 (Department
P179_SP00187 1048 2541
P179_ST00207 1063
P179_SP00188 1107
P179_ST00208 Statistics, 0.95 00000000006
P179_SP00189 1305 2539
P179_ST00209 2002),
P179_SP00190
P179_ST00210 1464
P179_SP00191 1609
P179_ST00211 levels
P179_SP00192
P179_ST00212
P179_SP00193 1789 2530
P179_ST00213 1804
P179_SP00194 1879
P179_ST00214
P179_SP00195 2074
P179_ST00215 2090 2507 are
P179_TL00021 2610 1588
P179_ST00216 reportedly
P179_SP00196 804 2656
P179_ST00217 126 higher
P179_SP00197 945
P179_ST00218 958
P179_SP00198 1043 2646
P179_ST00219 1056 105
P179_SP00199
P179_ST00220 1175
P179_SP00200
P179_ST00221
P179_SP00201 1412
P179_ST00222 1426 comparable
P179_SP00202 1656
P179_ST00223 1671 2622 133 groups
P179_SP00203
P179_ST00224 1819
P179_SP00204 2645
P179_ST00225
P179_SP00205 1973
P179_ST00226 1987 Caribbean
P179_TL00022 2725 1478
P179_ST00227 countries
P179_SP00206 2761
P179_ST00228 798 187 (Spadoni, 000000006
P179_SP00207 985 2771 22
P179_ST00229 1007 119 1977).
P179_SP00208 1126 19
P179_ST00230 107 Thus, 0.88 00006
P179_SP00209 1252 2769
P179_ST00231 1268
P179_SP00210
P179_ST00232 1483 2737 women
P179_SP00211
P179_ST00233 1644 83
P179_SP00212 1727
P179_ST00234 1742 2731
P179_SP00213
P179_ST00235 1818 feel
P179_SP00214 1889
P179_ST00236
P179_SP00215
P179_ST00237 1981 same
P179_TL00023 2840 962
P179_ST00238 171
P179_SP00216 772 2876
P179_ST00239 constraints
P179_SP00217 1002
P179_ST00240 1018 2852 39 as
P179_SP00218 1057
P179_ST00241 1071
P179_SP00219 1217
P179_ST00242
P179_SP00220 2875
P179_ST00243 1284
P179_SP00221 1385
P179_ST00244 1399 cultures.
P179_TB00002 1388 3041 79 45
P179_TL00024 1394 3047 67 33
P179_ST00245


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P10_ST00038 1042 1405 160 Purpose 0000000
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P10_ST00041 182 Research
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P10_ST00046 1037 1524 30 to
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P10_ST00047 1088 161 Nursing 0.97 2000000
P10_SP00036 1249
P10_ST00048 1256 1550 777
P10_SP00037 2033 94
P10_ST00049 2127 21
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P10_ST00052 1252 1607 0.21
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P10_ST00053 1577 19
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P10_ST00062
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P10_ST00063
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P10_ST00064 Silencing
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P10_ST00065 1277 75 The
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P10_ST00066 81 Self
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P10_ST00067 1452 1780 577
P10_SP00052 77
P10_ST00068 2106 1750 42 14
P10_TL00017 1805
P10_ST00069
P10_SP00053 1851
P10_ST00070
P10_SP00054 1841
P10_ST00071 262 Self-Efficacy 0005006330000
P10_SP00055 1339
P10_ST00072 1346 1837 686
P10_SP00056 74
P10_ST00073 1807
P10_TL00018 1863 1285
P10_ST00074 251 Relationship 000000000000
P10_SP00057 1114 1909
P10_ST00075 1128 1869
P10_SP00058 1899
P10_ST00076 1184
P10_SP00059 1295
P10_ST00077 1302 1895
P10_SP00060 2038 63
P10_ST00078 2101 1865 20
P10_TL00019 1920 1281
P10_ST00079 258 Assumptions
P10_SP00061 1122 1966
P10_ST00080 1130 1952 902
P10_SP00062 1956 69
P10_ST00081 1922 0.96
P10_TL00020 750 1978 1398
P10_ST00082 Definition
P10_SP00063 955 2014
P10_ST00083 970
P10_SP00064 1014
P10_ST00084 1980 125 Terms
P10_SP00065 1149
P10_ST00085 1156 2010 877
P10_SP00066
P10_ST00086
P10_TL00021 2035
P10_ST00087
P10_SP00067 932 2071
P10_ST00088 946 232 Hypotheses
P10_SP00068 1178 2081
P10_ST00089 1185 2067
P10_SP00069 2037 64
P10_ST00090 26
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P10_ST00092 887 and
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P10_ST00094 1237
P10_SP00073
P10_ST00095
P10_SP00074 1349
P10_ST00096 1367
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P10_ST00100 1020
P10_SP00078 1064
P10_ST00101 1072
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P10_ST00104 2152
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P10_ST00113 1359 THE
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P10_ST00118 1016 2412
P10_SP00093 72
P10_ST00119 2382 0.99
P10_TL00027 763 2438
P10_ST00120 102 HIV
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P10_SP00095
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P10_SP00099 1664
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P10_SP00100
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P10_ST00141
P10_SP00112 1067
P10_ST00142 1081 181 Bahamas
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P10_SP00114
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