Community Mental Health Journal

, Volume 41, Issue 3, pp 277–290

HIV Risk Reduction for Substance Using Seriously Mentally Ill Adults: Test of the Information-Motivation-Behavior Skills (IMB) Model

  • Seth Kalichman
  • Robert Malow
  • Jessy Dévieux
  • Judith A. Stein
  • Fred Piedman


The information-motivation-behavioral skills (IMB) model (Fisher & Fisher, 1992) was used as the theoretical framework for predicting unprotected sexual behavior among substance abusing men and women diagnosed with serious mental illnesses (n = 320; 150 men and 170 women, primarily of minority ethnicity). In a structural equation model, gender, HIV transmission knowledge, and motivational variables of pro-condom norms and attitudes, and perceived susceptibility predicted behavioral skills markers: condom use skills and condom use self-efficacy. Along with the other variables in the model, condom skills and condom self-efficacy were hypothesized to predict condom use over a six-month period. Results showed that greater condom skills were predicted by female gender, positive condom attitudes, and transmission knowledge. Engaging in lower rates of unprotected sex was predicted by pro-condom norms, less perceived susceptibility, and greater condom self-efficacy. Positive attitudes toward condoms had a significant indirect effect on rates of unprotected sex, exerting its influence through condom use self-efficacy. Results suggest that changing personal attitudes about condoms and reinforcing pro-condom attitudes among significant others will encourage condom use among seriously mentally ill (SMI) adults who are at high risk for HIV and other sexually transmitted diseases (STDs).


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  1. Bandura, A. 1997Self-efficacy: The exercise of controlFreemanNew YorkGoogle Scholar
  2. Bentler, PM 2002EQS 6 structural equations program manualMultivariate Software, IncEncino, CAGoogle Scholar
  3. Bentler, P. M., Dudgeon, P. 1996Covariance structure analysis: Statistical practice, theory, and directionsAnnual Review of Psychology47563592PubMedGoogle Scholar
  4. Carey, M. P., Carey, K. B., Kalichman, S. C. 1997aRisk for human immunodeficiency virus (HIV) infection among persons with severe mental illnessClinical Psychology Review17271291Google Scholar
  5. Carey, M. P., Carey, K., Weinhardt, L., Gordon, C. 1997bBehavioral risk for HIV infection among adults with a severe and persistent mental illness: Patterns and psychological antecedentsCommunity Mental Health Journal33133142Google Scholar
  6. Carey, M. P., Weinhardt, L. S., Carey, K. B. 1995Prevalence of infection with HIV among the seriously mentally ill: Review of research and implications for practiceProfessional Psychology: Research and Practice26262268Google Scholar
  7. Catania, J. A., Kegeles, S. M., Coates, T. J. 1990Towards an understanding of risk behavior: An AIDS risk reduction model (ARRM)Health Education Quarterly175372PubMedGoogle Scholar
  8. CDC2001HIV incidence among young men who have sex with men – seven US cities 1994–2000MMWR50440444Google Scholar
  9. Cournos, F., McKinnon, K. 1997HIV seroprevalence among people with severe mental illness in the United States: A critical reviewClinical Psychology Review17259269PubMedGoogle Scholar
  10. Drake, R., McLaughlin, P., Pepper, B., Minkoff, K. 1991Dual diagnosis of major mental illness and substance disorder: An overviewNew Directions for Mental Health Services50312PubMedGoogle Scholar
  11. Fisher, J. D., Fisher, W. A. 1992Changing AIDS risk behaviorPsychological Bulletin111455474PubMedGoogle Scholar
  12. Fisher, J. D., Fisher, W. A., Malloy, T. E. 1994Empirical tests of an information-motivation-behavioral skills model of AIDS-preventive behavior with gay men and heterosexual university studentsHealth Psychology13238250PubMedGoogle Scholar
  13. Gibson, D. R., Lovelle-Drache, J., Young, M. T., & Chesney, M. (1992). HIV risk linked to psychopathology in IV drug users. International Conference on AIDS, Abstract POC 4691, 1992Google Scholar
  14. Gordon, C., Carey, M., Carey, K., Maisto, S., Weinhardt, L. 1999Understanding HIV related risk among persons with severe and persistent mental illness: Insights from qualitative inquiryJournal of Nervous and Mental Disease187208216PubMedGoogle Scholar
  15. Hu, L. T., Bentler, P. M. 1999Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternativesStructural Equation Modeling6155Google Scholar
  16. Jemmott, J. B., Jemmott, L. S., Fong, G. T. 1992Reductions in HIV risk-associated sexual behaviors among black male adolescents: Effects of an AIDS prevention interventionAmerican Journal of Public Health82372377PubMedGoogle Scholar
  17. Kalichman, S. C., Carey, M. P., Carey, K. B. 1996Human immunodeficiency virus (HIV) risk among the seriously mentally illClinical Psychology: Science and Practice3130143Google Scholar
  18. Kalichman, S. C., DiFonzo, K., Kyomugsha, F., Simpson, D., Presser, K., Bjordstrom, B. 2001When briefer can be better: Single session approaches to HIV risk reduction interventionsInteramerican Journal of Psychology354158Google Scholar
  19. Kalichman, S.C., Kelly, J.A., Johnson, J., Bulto, M. 1994Factors associated with risk for Human Immunodeficiency Virus (HIV) infection among chronic mentally ill adultsAmerican Journal of Psychiatry151221227PubMedGoogle Scholar
  20. Kalichman, S. C., Sikkema, K. J., Kelly, J. A., Bulto, M. 1995Use of a brief behavioral skills intervention to prevent HIV infection among chronic mentally ill adultsPsychiatric Services46275280PubMedGoogle Scholar
  21. Kelly, J. A. 1997HIV risk reduction interventions for persons with severe mental illnessClinical Psychology Review17293209PubMedGoogle Scholar
  22. MacCallum, R. 1986Specification searches in covariance structure modelingPsychological Bulletin100107120Google Scholar
  23. Mueser, K. T., Bennett, M., Kushner, M. G. 1995

    Epidemiology of substance abuse among persons with chronic mental disorders

    Lehman, A. F.Dixon, L. eds. Double Jeopardy: Chronic Mental Illness and Substance Abuse. Harwood Academic PublishersNew York
    Google Scholar
  24. Mueser, K. T., Yarnold, P. R., Levinson, D. F., Singh, H., Bellack, A. S., Kee, K., Marrison, R. L., Yadalam, K. G. 1990Prevalence of substance abuse in schizophrenia: Demographic and clinical correlatesSchizophrenia Bulletin163156PubMedGoogle Scholar
  25. Otto-Salaj, L., Kelly, J., Stevenson, L., Hoffman, R., Kalichman, S. 2001Outcomes of a randomized small-group HIV prevention intervention trial for people with serious mental illnessCommunity Mental Health Journal37123144PubMedGoogle Scholar
  26. Rosenberg, S. D., Goodman, L. A., Osher, F. C., Swartz, M., Essock, S. M., Butterfield, M. I., Constantine, N., Wolford, G. L., Salyers, M. 2001Prevalence of HIV, Hepatitis B and Hepatitis C in people with severe mental illnessAmerican Journal of Public Health913137PubMedGoogle Scholar
  27. Somlai, A., Kelly, J., McAuliffe, T., Gudmundson, J., Murphy, D., Sikkema, K., Hackl, K. 1998Role play assessments of sexual assertiveness skills: Relationships with HIV/AIDS sexual risk behavior practicesAIDS and Behavior2319328Google Scholar
  28. Sorensen, J. L., London, J., Morales, E. 1991

    Group counseling to prevent AIDS

    Sorensen,  J.Wermuth, D.Gibson, K.Choi, J.Guydish, S.Batki, S. eds. Preventing AIDS in drug users and their sexual partners.GuilfordNew York99115
    Google Scholar
  29. Stewart, D. L., Zuckerman, C. J., Ingle, J. M. 1994HIV seroprevalence in a chronically mentally ill populationJournal of the National Medical Association86519523PubMedGoogle Scholar
  30. St. Lawrence, J. S., Jefferson, K. W., Alleyne, E., Brasfield, T. L. 1995Comparison of education versus behavioral skills training interventions in lowering sexual HIV-risk behavior of substance-dependent adolescentsJournal of Consulting and Clinical Psychology63154157PubMedGoogle Scholar
  31. Susser, E., Valencia, E., Berkman, A., Sohler, N., Conover, S., Torres, J., Betne, P., Felix, A., Miller, S. 1998Human immunodeficiency virus sexual risk reduction in homeless men with mental illnessArchives of General Psychiatry55266272PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Seth Kalichman
    • 1
  • Robert Malow
    • 2
  • Jessy Dévieux
    • 2
  • Judith A. Stein
    • 3
  • Fred Piedman
    • 4
  1. 1.Psychology DepartmentUniversity of ConnecticutStorrs
  2. 2.Florida International UniversityMiamiUSA
  3. 3.University of CaliforniaLos AngelesUSA
  4. 4.University of MiamiMiamiUSA

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