title: Sorting through chickens and eggs: a longitudinal examination of the associations between attitudes, norms, and sexual risk behavior.
abstract: OBJECTIVE
  Health behavior theories posit that health-relevant attitudes, beliefs, and behavioral skills drive subsequent actions people take to protect themselves from health threats. Within the realm of HIV-related sexual risk behavior, much of the research in support of this notion is cross-sectional, rather than longitudinal, particularly in studies of gay and bisexual men. Other psychological theories (e.g., self-perception or cognitive dissonance theories) suggest that the opposite could be true--that health-relevant attitudes and beliefs might change as a function of previous risk or precautionary behavior. Appreciating the complex nature of these associations is essential for modifying theory and developing appropriate interventions.
  
  
  METHODS
  Using longitudinal data from gay and bisexual men (n = 1465), we used structural equation modeling to examine three possibilities--that perceived norms and attitudes about sexual risk would be (a) related to unprotected anal intercourse cross-sectionally, (b) related to unprotected anal intercourse at a subsequent time point, and/or (c) predicted from previous instances of unprotected anal intercourse.
  
  
  RESULTS
  Safe-sex norms and attitudes were related to unprotected anal intercourse cross-sectionally, but did not predict unprotected sex longitudinally. Rather, perceived norms and attitudes changed as a function of previous risk behavior.
  
  
  CONCLUSIONS
  These results raise the possibility that modified theoretical models might be necessary to adequately describe sexual risk behavior among gay and bisexual men.
authors.affiliation: Department of Psychology, University of Utah, 380 South 1530 East, Salt Lake City, UT 84122, USA. david.huebner@psych.utah.edu
authors.forename: David M
authors.initials: DM
authors.lastname: Huebner
authors.forename: Torsten B
authors.initials: TB
authors.lastname: Neilands
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Rebchook
authors.forename: Susan M
authors.initials: SM
authors.lastname: Kegeles
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D001727:Bisexuality; D019058:Community Networks; D015658:HIV Infections / Q000517:prevention & control; D018451:Homosexuality, Male; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012927:Social Control, Informal; D015206:Southwestern United States; D011795:Surveys and Questionnaires; D047568:Unsafe Sex; D055815:Young Adult