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Medical and health educational services are insufficient to control AIDS risk behavior. A new conceptual model that can guide more effective behavioral change strategies for whole communities is required to modify sexual practices and control the AIDS epidemic. We integrated learning theories with an ecological model to create a behavioral-ecological conceptual model of sexual risk behavior. We assumed a developmental process of learning and ongoing social influence. Contingencies of reinforcement and other motivational variables operate among sexual partners, their peers, and family networks in the context of culture. Our model hierarchically arrays learning processes within common social institutions (e.g., schools). Making appropriate changes in numerous social institutions concurrently may culminate in sufficient change in theoretical independent variables to establish safer sexual practices in whole communities. Application to adolescents' sexual development is used to illustrate this model. The behavioral-ecological model suggests that multiple interventions, with emphasis on change in social networks, is necessary to control the AIDS epidemic. If this model is correct, traditional education interventions will fail to ensure safer sexual practices among adolescents and adults.

Sigmoidoscopy involves the insertion of a small scope into the anal cavity to inspect for abnormalities in the colon. Although the procedure is not believed to be painful, it is often noxious for patients because it produces embarassment and discomfort. We examined the effectiveness of two brief interventions designed to enhance coping: self-instructional training and relaxation. In the self-instructional conditions patients were given brief training to focus their attention on either their own (internal) or the doctor's (external) ability to regulate the situation. A third (control) group received attention but did not experience self-instructional training. Half of each of these three groups also received relaxation training, while the other half did not. Planned comparisons demonstrated that subjects in the self-instructional strategies rated themselves as less anxious, had fewer body movements during the exam, and emitted fewer verbalization than those in an attention control group. Patients in the external condition estimated that the exam took less time but tended to have elevated heart rates during the procedure. Those experiencing relaxation training tended to overestimate the duration of the exam, but made fewer requests to stop the exam and rated themselves as less anxious than patients who did not receive relaxation training.

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