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Data Collection Procedures

During November 2001, data were collected anonymously in a predominantly African American, “gay” male bar in Birmingham, Alabama, USA. All bar patrons were asked to participate, regardless of gender, by a trained recruiter. In order to ensure informed consent, the recruiter assessed sobriety of potential participants using established criteria. Questionnaires were self-administered and completed in secluded areas of the bars to enhance participants’ valid reporting of sensitive behaviors. Participants were compensated $10 for completing the survey. Data collection ended at 11:30 p.m. each night. The data were entered into an electronic database using double-entry procedures to assess and validate accuracy.


The questionnaire included 64 items. Items meas­ured participants’ sociodemographics, including age, race/ethnicity (American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Native Hawaiian/Pacific Islander or Caucasian/white), educational attainment, estimated yearly income, and health insurance coverage. online pharmacy uk

Sexual risk was measured by items that assessed the frequency of condom use during oral and anal intercourse with a male partner within the past 3 months, the number of sexual partners during the past 30 days and lifetime, and anal-oral sexual contact (“rimming”). Items assessed whether participants had ever received a positive HTV-serological test result and whether participants had ever, or in the past 5 years, been told that they had HIV or other sexually transmitted diseases.

Items measured non-sexual risk behaviors as well, including participant history of injecting drugs or steroids, sharing injecting-drug equipment, and receiving blood or blood products.

Items assessed participant history of HAV awareness, vaccination, testing, and treatment. Because the goal of this study was to examine vaccine uptake and not second dose compliance, vaccination against HAV was measured based on self-report of vaccination, regardless of completion of the two-dose series.

Theory-based, psychosocial predictors, based on the health belief model and the social cognitive theory, specifically related to HAV vaccination were measured using 32 items comprising seven scales that have been identified through rigorous psychometric scale development in a study of African American and white MSM. Briefly, measurement development using the diverse sample of358 MSM followed a two-step process. First, standard procedures of principal component analysis (PCA) with Varimax rotation employed to determine a factor structure for each scale on a slit half sample (n=179). The scree test, eigenvalues, the interpretability of the factors, theoretical considerations, factor loadings, and Cronbach’s coefficient alpha were used to define all factor structures. The remaining split-half (“holdout”) sample (n=179) was used for instrument confirmation analyses using AMOS, a statistical package that is commonly used for structural equation modeling (SEM). Confirmatory factor analysis (CFA) via SEM recently has become one of the primary methods of choice for measurement development. CFA recognizes the role of theory for establishing a structural model that organizes scale and subscale development. CFA permits evaluating the adequacy of a proposed factor structure. The scales, number of items per scale, sample items, and alpha coefficients for the current study sample are presented in Table 1.

Table 1. Description of Scale Measures

Scale Measure and Sample Item                                     Number of Items     a
Perceived practical barriers to HAV vaccination 5 0.73
Sample: 7 don’t have time to get vaccinated against hepatitis A.”
Health care provider communication CO 0.68
Sample: “1 can talk freely with my doctor or health care provider
about my sexual behavior.”
Perceived benefits of HAV vaccination 5 0.86
Sample: “Getting vaccinated against hepatitis A infection
would be a good way to protect my health.”
Perceived severity of HAV infection 4
Sample: “How serious would it be for you to get infected with hepatitis A?”
Perceived susceptibility to HAV infection 5 0.74
Sample: “People like me don’t get hepatitis A.”
Perceived general medical self-efficacy to complete the 2-dose vaccine series CO 0.85
Sample: “How sure are you that you could get 2 shots of the
hepatitis A vaccination, if you have a fear of needles or shots?”
Perceived personal self-efficacy to complete the 2-dose vaccine series 7 0.93
Sample: “How sure are you that you could get the hepatitis A vaccination,
if you are embarrassed to talk about sex with a doctor or healthcare provider?”

A final item assessed whether participants had completed the questionnaire previously. The response categories for each item within the questionnaire used binary, categorical or Likert-scale responses to facilitate readability and administration.

Statistical Analyses

SPSS for Windows 10.1 (Chicago, IL) was used for data analysis. Kolmogorov-Smirnov one-sample test was preformed to test whether the data were normally distributed. All distributions were normal at P<.05.
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All theory-based scales, measuring the psychosocial predictors, were dichotomized using median split and entered into a multivariable logistic regression model to test the independent contribution of each of the predictors while adjusting for the other predictors in the model. Accordingly, adjusted odds ratios (OR) and 95% confidence intervals were calculated to assess the magnitude of association between theory­based predictors and self-reported vaccination.

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