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ORIGINAL PAPER
Relationship Factors’ Impact on Condom Use Among
College Students
Sara K. Fehr
1
•Rebecca A. Vidourek
2,3
•Keith A. King
2
•
Laura A. Nabors
2
Published online: 17 February 2018
Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Research indicates that a number of college students are at risk for HIV,
sexually transmitted diseases, and unplanned pregnancy as a result of their sexual
behaviors. Specific behaviors placing college students at risk include having sex
with multiple partners, poor communication about safer sex practices with their
sexual partners and not using condoms consistently and correctly when engaging in
sexual activity. The purpose of this paper is to identify potential differences in safer
sex practices and factors that influence condom use among college students. A four-
page, 18-item survey was developed to determine participants’ condom use and the
impact of relationship status and other demographic factors on condom use.
Analyses revealed that the number of lifetime vaginal sexual partners and partici-
pants’ sex influenced condom use. There were no significant differences in rela-
tionship status, duration, trust, honesty and condom use. These findings should be
considered with designing interventions to increase condom use among college
students.
Keywords Relationship Monogamous Condom College University
&Rebecca A. Vidourek
Rebecca.vidourek@uc.edu
1
Department of Health & Kinesiology, Texas A&M, College Station, TX 77843, USA
2
Heath Promotion and Education, University of Cincinnati, Cincinnati, OH 45221, USA
3
Health Promotion and Education, University of Cincinnati, Cincinnati, OH 44221, USA
123
Sexuality & Culture (2018) 22:724–739
https://doi.org/10.1007/s12119-018-9503-9
Introduction
Despite ongoing efforts by public health professionals, a significant number of
college students self-report engaging in risky sexual behaviors, including: having
sex with multiple partners, not discussing safer sex practices with sexual partners
and not using condoms consistently when engaging in sexual activity (Baldwin and
Baldwin 2000; Flannery et al. 2003; Gullette and Lyons 2006; Lewis et al. 1997).
The American College Health Association’s National College Health Assessment
(ACHA-NCHA) (2013b) discovered that nearly half (49.6%) of college students
engaged in vaginal sex in the past 30 days. Of those college students who reported
having vaginal intercourse, only 50.3% reported consistently using a condom or
other barrier method in the past 30 days. Equally as concerning, only 29.2% of
those engaging in anal sex and 5.7% of those engaging in oral sex reported
consistently using a condom or barrier method in the past 30 days. Additionally,
45.7% reported using male condoms and another form of contraceptive method
simultaneously (American College Health Association [ACHA] 2013b).
Failure to adopt safer sex practices, such as consistent condom use, increases the
risk for HIV, sexually transmitted diseases (STDs) and unplanned pregnancy among
college students (Centers for Disease Control and Prevention [CDC] 2012). Young
adults ages 20–24 years account for nearly 75% of all HIV diagnoses (CDC 2011).
Despite this, research indicates that a large number of adolescent and young adults
underestimate their HIV risk and therefore do not utilize male latex condoms as a
form of protection when engaging in sexual intercourse (CDC 2011). According to
ACHA-NCHA (2013b), a number of respondents reported being diagnosed or
treated by a professional in the past 12 months for a sexually transmitted infection.
Approximately 1.2% were diagnosed or treated for Chlamydia, 0.8% for genital
herpes, 1.4% for genital warts/HPV, 0.4% for Gonorrhea, 0.3% for HIV infection,
and 0.3% for Pelvic Inflammatory Disease (PID). While these numbers represent a
relatively small proportion of respondents, it is important to note that 123,078
college students participated in the ACHA-NCHA study (ACHA 2013b) and
therefore these percentages represents thousands of college students. Additionally,
these percentages may not be representative of the true numbers of STDs in the
population because these infections are often asymptomatic and go unnoticed and
undiagnosed (CDC 2014). Moreover, the ACHA-NCHA (2013b) reported that
16.1% of sexually active college students indicated they or their partner had used
emergency contraception in the past 12 moths and approximately 2% of female
respondents reported an unplanned pregnancy in the past 12 months.
When used correctly and consistently, male latex condoms are very effective in
preventing the transmission of STDs, HIV and unintended pregnancy (CDC 2014).
Although it can be difficult to accurately estimate the effectiveness of male latex
condoms independent of theoretical settings, numerous studies have determined that
condoms are a highly effective barrier to genital secretions, bacteria and viruses and
provide individuals with protection against STDs and unplanned pregnancy (CDC
2014).
Relationship Factors’ Impact on Condom Use Among College…725
123
Condom Use Among Non-monogamous and Monogamous Partners
Research has found that the adopting of safer sex practices and condom use differs
by relationship type. Lewis et al. (2012) analyzed the sexual practices of those who
hooked up with a sexual partner. Hooking up is categorized as a casual dating/non-
monogamous relationship and is defined as physical intimacy (kissing, touching,
oral sex, vaginal sex, or anal sex) with a person the participant was not dating and
with whom there was no expectation of a committed romantic relationship. Lewis
et al. found that participants were more likely to use condoms if they were engaging
in sexual activity with a casual acquaintance or an ex-boyfriend or ex-girlfriend.
Similarly, Fielder and Carey (2010) examined the sexual characteristics and
behaviors (including partner type, relationship duration and condom use) of college
students engaging in hook ups and those in committed romantic relationships.
Approximately 27% of participants who reported sexual hook ups engaged in oral
sex, 27% engaged in vaginal sex, and none engaged in anal sex. Among those study
participants who reported a sexual hook up, 0% reported using a condom during oral
sex and 69% reported using a condom during vaginal sex. Additionally, of the
approximately 20% of study participants in committed romantic relationships, 1%
used a condom when engaging in oral sex, 75% used a condom when engaging in
vaginal sex, and 44% used a condom when engaging in anal sex (Fielder and Carey
2010). Fielder and Carey also examined the sexual behaviors of participants who
reported engaging in both a sexual hook up and sexual activity with a committed
partner. In both cases of hook ups and romantic interactions, 0% of participants
reported using condoms when engaging in oral sex. Among participants who
reported having vaginal sex during a hook up, 67% reported using a condom while
74% reported using a condom during vaginal sex with a committed partner (Fielder
and Carey 2010).
Studies comparing safer sex practices and condom use among casual dating/non-
monogamous partners versus those in committed/monogamous relationships were
also identified in the literature. Milhausen et al. (2013) examined the prevalence and
predictors of condom use among college students. Their study revealed that female
students engaging in vaginal sex with a committed partner were less likely to use
condoms than female students who were engaging in vaginal sex while hooking up.
Many cited using another form of birth control as a reason for condom nonuse
(Milhausen et al. 2013). These finding were supported by the research of Winfield
and Whaley (2005) who found that unmarried cohabitating partners and married
cohabitating partners were less likely to use condoms than single participants.
Additionally, married participants were twice as likely to not use condoms than
participants living with partners (Winfield and Whaley 2005).
Condom Use and Duration, Trust and Honesty
Previous studies found that increased relationship duration could negatively
influence condom use among college students. Research by Sanders et al. (2006)
revealed that women who used condoms (both those who apply condoms and those
who do not apply condoms) were less likely to be in a sexually exclusive
726 S. K. Fehr et al.
123
relationship with their partner and to report a higher number of sexual partners.
Couples might discontinue condom use in favor of other forms of birth control as
the relationship progresses and becomes more committed and as they believe their
risk of contracting an STD is lower and therefore barrier methods are no longer need
to prevent the transmission of diseases (Sanders et al. 2006). Similarly, Harvey et al.
(2006) found the duration of participants’ relationships was negatively associated
with condom attitudes and partner norms. As relationship duration increased,
partner’s attitudes towards condoms and partner norms became more negative
(Harvey et al. 2006). Literature revealed that increased trust could negatively
influence condom use among college students. Patel et al. (2006) found that among
their participants whose condom use was consistent throughout the dating phase but
inconsistent in the stable phase, the building of trust was cited as a contributing
factor. As trust developed between partners, participants perceived their risk of
STDs to be lower and in turn, terminated condom use (Patel et al. 2006). Very little
has been written regarding the impact of partners’ honesty on condom use. While
increased duration, trust and the perception of honesty among partners might
contribute to condom non-use in favor of other birth control methods; the possibility
of contracting HIV or other STDs is still present. The concept of ‘‘safety’’ in
monogamy is not supported in the literature and places college students at great risk
(Vail-Smith et al. 2010).
Study Purpose
The purpose of this study is to identify potential differences in safer sex practices
and factors that influence condom use in vaginal intercourse, defined as insertion of
the penis into the vagina, among sexually active college students. In doing so, health
education professionals can glean a better understanding of the factors which impact
condom use in the context of college students’ sexual relationships and ultimately
create effective health promotion programming to increase condom use in this
population. More specifically, the following research questions will be examined:
1. Does condom use differ based on relationship status (casual dating/non-
monogamous versus committed/monogamous sexual relationships) among
college students?
2. Does condom use differ based on the duration of the relationship among college
students?
3. Does condom use differ based on perceived trust between partners?
4. Does condom use differ based on perceived honesty between partners?
5. Does condom use among students who are sexually active and have at least one
lifetime vaginal intercourse partner differ based on sex, race, grade or sexual
orientation?
6. Does condom use among students who are sexually active and have at least one
lifetime vaginal intercourse partner differ based on number of vaginal and anal
sexual partners?
Relationship Factors’ Impact on Condom Use Among College…727
123
Methods
Participants
Participants in this study were 18–32 year old students enrolled at a large, urban
public university in the United States. Students were recruited from undergraduate
classes at the university. All student participation was voluntary. If students did not
wish to participate, the principal investigator instructed students to sit quietly while
the survey questionnaire was being administered. The Institutional Review Board
granted approval for the current study.
Instrument
A four-page, 18-item survey was developed to determine participants’ condom use
and the impact of relationship status on condom use. Definitions for vaginal sex,
anal sex and oral sex were provided at the top of the first page of the survey. Sexual
intercourse was defined as the insertion of the penis into the vagina. Oral sex was
defined as any oral to genital contact. Anal sex was defined as the insertion of the
penis into the anus. The survey was divided into four sections: (1) relationship
information, (2) knowledge, (3) barriers and benefits, and (4) demographics.
Section one assessed relationship factors and condom use when engaging in
vaginal, anal and oral sex. The first question verified that the participant was
currently involved in a sexually intimate relationship. If they answered ‘‘yes’’, they
were instructed to continue to the subsequent question. If they answered ‘‘no’’, they
were directed to section two, which assessed their overall sexual health knowledge.
Question two asked participants to describe their current relationship by selecting a
‘‘relationship type’’ from a list of four options. The options included (1) Casual,
having sexual contact with one person, (2) Casual, having sexual contact with
multiple people, (3) Dating, mainly one person but not sexually exclusive, and (4)
Monogamous, having sexual contact with only one person. Question three asked
participants how long they had been involved in their current relationship and they
were given the option of less than 1 month, 1–6 months, 6 months–1 year,
1–3 years, and more than 3 years. The fourth question asked students if they had
ever used condom in their current relationship and participants could either indicate
‘‘yes’’ or ‘‘no’’. The fifth question was divided into three subsections that asked
about condom use when engaging in (1) vaginal, (2) anal and (3) oral sex. Each of
the three subsections asked about how often participants used condom in the past
7 days, past 30 days and past year by having them select either never, rarely, often,
always or not applicable. Question six asked participants to indicate if they or their
partner used any other form of birth control other than condoms. If ‘‘yes’’ students
were asked to indicate the method from a list of 11 options. Finally, using a Likert-
type scale of 1–5 (1 =strongly disagree; 5 =strongly agree), participants rated six
statements pertaining to relationships dynamics such as trust, honesty and
communication.
728 S. K. Fehr et al.
123
Section two assessed participants’ sexual health knowledge. Participants were
asked to indicate whether nine statements were either true or false based on their
understanding of sexual health. Section three addressed participants’ perceived
barriers and benefits to condom use in their current relationship. Participants were
given 11 potential barrier options as well as an ‘‘other’’ category where participants
were asked to describe any barriers not included on the provided list. Participants
were also given a list of 7 potential benefit options as well as an ‘‘other’’ category
where participants were asked to describe any benefits not included. Participants
were to check all barriers and benefits that applied. Each checked box was coded as
1, while each unchecked box was coded as 0, resulting in an overall potential range
of 0–12 for barriers and a range of 0–8 for benefits. Section four asked participants’
demographic information. This section contained eight items: age, grade, sex, race/
ethnicity, sexuality education, number of sexual partners and sexual orientation.
Students were asked to check the box next to their response (e.g. male or female, yes
or no).
Procedures
The first author’s dissertation committee and the Institutional Review Board (IRB)
at the University of Cincinnati approved the research proposal, survey instrument,
informational letters, and all consent forms. Content validity was established by
distributing the survey to a panel of four experts. Each expert was asked to review
the electronic copy of the survey and provide the researchers with any suggested
changes. Suggested revisions were reviewed by the research team and those
considered appropriate were utilized in the final survey instrument. To determine
test–retest reliability for nonparametric items, Kendall’s tau-b correlation coeffi-
cients were computed resulting in coefficients great than .70. Cronbach Alphas were
also calculated to assess reliability for each of the parametric data, resulting in
coefficients greater than .70 indicating the survey instrument was reliable. Internal
consistency reliability analyses were also calculated resulting in a coefficient greater
than .80 indicating the survey was reliable.
In the span of one academic semester, a combined total of 483 students
completed the survey. The primary investigator began data collection in each class
by first explaining the purpose of the study and informing students that their
responses would be completely anonymous. Students were also told that their
participation was voluntary and that by completing the questionnaire, students were
giving their consent to participate in the study. Students were then given a cover
letter that restated the purpose of the study, that answers would be kept completely
anonymous, that participation was voluntary, and that by completing the survey they
were granting permission for their responses to be used in the study. The time
required to complete the survey was between 10 and 15 min.
The researcher maintained participants’ anonymity by instructing them not to put
their name, student identification number or any other personal identifiers on the
survey. The researcher then instructed students to place their surveys face down in a
box located at the front of the room. Once all surveys had been placed in the box, it
was sealed. After data collection in each class, the principal investigator opened the
Relationship Factors’ Impact on Condom Use Among College…729
123
box containing the surveys to gain an accurate count of the number of completed
surveys. A sample of 483 surveys was used in this study. Surveys were kept secure
in the principal investigator’s locked office file cabinet.
Data Analysis
Data was analyzed using the Statistical Package for the Social Sciences (SPSS)
(Version 22.0). Descriptive statistics (frequencies, means, standard deviations,
ranges) were used to describe the demographic information. Odds ratios were
conducted to determine whether participants’ relationship status could predict
condom use. A series of one-way analysis of variances (ANOVAs) were calculated
to determine whether condom use differed based on relationship duration, trust, and
honesty. Logistic regression was also conducted to determine if condom use differed
based on sex, race grade level, sexual orientation, and number of lifetime vaginal
and anal sexual partners. Prior to analysis, an alpha of .05 was established to
determine significance.
Results
Demographic Characteristics
A total of 483 undergraduate students participated in this study. Of college students
surveyed, the majority (64.2%) reported being currently involved in a sexually
intimate relationship (Table 1). Participants were equally female and male. The
majority of respondents (62.5%) classified themselves as underclassman. Regarding
race, the majority of participants were white.
Condom Use Among Non-monogamous and Monogamous Partners
Results indicated that 17.3% of participants were in involved self-defined non-
monogamous relationships and 82.7% in monogamous relationships (Table 2).
Among participants engaged in a non-monogamous relationship, 36.5% reported
using condoms never or rarely and 63.5% reported using condoms often or always
(Table 3). Among participants engaged in a monogamous relationship 41.0%
reported using condoms never or rarely and 59.0% reported using condoms often or
always with their partner. Statistical analyses reveled that monogamy in the
relationship did not significantly influence condom use.
Condom Use and Duration, Trust and Honesty
Results indicated slightly more than half of participants (54.2%) had been in
relationships for 6 months or more (Table 2). Of participants involved in
relationships for 6 months or less, 37.7% reported using condoms never or rarely
and 62.3% reported using condoms often or always (Table 3). Of participants
involved in relationships for more than 6 months, 40.6% reported using condoms
730 S. K. Fehr et al.
123
Table 1 Demographic characteristics of students
Item n%
Currently involved in a sexually intimate relationship
Yes 310 64.2
No 173 35.8
Sex
Female 238 49.5
Male 243 50.5
Grade
Freshman 192 40.0
Sophomore 108 22.5
Junior 98 20.4
Senior 82 17.1
Race/ethnicity
American Indian or Alaska Native 4 .8
Asian 34 7.1
Black or African American 27 5.6
Hispanic or Latino 8 1.7
Native Hawaiian or Other Pacific Islander 1 .2
White 385 80.2
Multiracial 21 4.4
Received sexuality education
Yes 458 95.8
No 20 4.2
Lifetime sexual partners
Vaginal
0 83 17.7
1 123 26.2
2–4 139 29.6
5–7 62 13.2
8–10 37 7.9
11 or more 26 5.5
Anal
0 336 72.9
1 91 19.7
2–4 26 5.6
5–7 4 .9
8–10 1 .2
11 or more 3 .7
Sexual orientation
Exclusively heterosexual 369 79.2
Heterosexual 46 9.9
Mostly heterosexual 7 1.5
Relationship Factors’ Impact on Condom Use Among College…731
123
never or rarely and 59.4% reported using condoms often or always. Statistical
analyses reveled that relationship duration did not significantly influence condom
use. In the present study, the majority of participants believed that their partner will
not have vaginal, oral or anal sex with anyone outside the relationship and believed
their partners felt the same with an average score of (4.28) on a scale of 1 to 5
indicating a high degree of perceived trust (Table 4). Statistical analyses determined
that trust did not significantly influence condom use. In the present study, the
majority of participants believed their partner was honest with them about
everything in the relationship and that their partner believe that they were also
honest with an average score of (4.36) on a scale of 1 to 5 indicating a high degree
Table 1 continued
Item n%
Equally heterosexual and homosexual 16 3.4
Mostly homosexual 4 .9
Homosexual 8 1.7
Exclusively homosexual 16 3.4
Percents based on valid percents. Missing values excluded
N=483
Table 2 Relationship characteristics of students
Item n%
Description of current relationship
Casual, having sexual contact with one person 72 21.9
Casual, having sexual contact with multiple people 32 9.7
Dating, mainly one person but not sexually exclusive 25 7.6
Monogamous, having sexual contact with only one person 200 60.8
Length of current relationship
Less than 1 month 46 14.2
1–6 month 102 31.6
6 months–1 year 41 12.7
1–3 years 102 31.6
More than 3 years 32 9.9
Condom use in current relationship
Yes 267 81.7
No 60 18.3
Condom use: vaginal sex
Never/rarely 109 39.4
Often/always 168 60.6
Percents based on valid percents. Missing values excluded
N=483
732 S. K. Fehr et al.
123
of perceived honesty between partners (Table 4). Statistical analyses reveled that
honesty did not significantly influence condom use.
Condom Use by Sex, Race, Grade and Sexual Orientation
When examining condom use by sex, 31.7% of males reported using condoms never
or rarely and 68.3% reported using condoms often or always (Table 5). Among
females, 44.1% reported using condoms never or rarely and 51.9% reposted using
condoms often or always. Results indicated a significant difference in condom use
based on sex. Males were twice as likely as females to use condoms when engaging
in sexual activity. When analyzing condom use by race, 41.3% of white students
reported using condoms never or rarely and 58.7% often or always. Among
minority students, 34.1% reported using condoms never or rarely and 65.9%
reported using condoms often or always. Analyses determined race did not
significantly influence condom use. When examining condom use by grade, 35.3%
of underclassmen reported using condoms never or rarely and 64.7% used condoms
often or always. Upperclassmen were less likely to use condoms consistently; 46.8%
Table 3 Odds ratios for condom use relationship type and length
Item Never/rarely
n(%)
Often/always
n(%)
v
2
OR (95% CI)
Monogamous
No 38 (36.5) 66 (63.5) .552 .827 (.501, 1.365)
Yes 71 (41.0) 102 (59.0)
Length of relationship
0–6 months 40 (37.7) 66 (62.3) .223 .886 (.537, 1.463)
More than 6 months 67 (40.6) 98 (59.4)
Percents based on valid percents. Missing values excluded
N=483
**p\.05
Table 4 Condom use based on trust, honesty, and comfort
Item M (SD) F p
Trust
I trust that my partner will not have vaginal, oral or anal sex with anyone
outside our relationship
4.26 (1.163) .153 .961
My partner trusts that I will not have vaginal, oral or anal sex with anyone
outside our relationship
4.31 (1.107) .582 .676
Honesty
I am honest with my partner about everything in our relationship 4.39 (.864) 1.315 .265
My partner is honest with me about everything in our relationship 4.32 (.862) 1.899 .111
N=483; Missing values excluded from analyses
Means based on a 5-point scale (1 =strongly disagree, 5 =strongly agree)
Relationship Factors’ Impact on Condom Use Among College…733
123
reported using condoms never or rarely while 53.2% reported using condom often
or always. Statistical analyses found that grade did not significantly influence
condom use. When examining condom use by sexual orientation, 45.9% of
heterosexual participants reported using condoms never or rarely and 44.4% of
homosexual participants reported using condoms never or rarely. Statistical
analyses revealed that sexual orientation did not significantly influence condom use.
Condom Use by Number of Vaginal and Anal Sexual Partners
In the present study, past year condom use was examined by number of lifetime
vaginal and anal sexual partners. When analyzing condom use by number of
lifetime sexual partners, 25.5% of those with 1 vaginal sexual partner reported
condom use, 28.8% with 2–4 sexual partners recently used condoms and 25.9% with
5 or more partners reported recently using condoms (Table 6). Statistical analyses
revealed the students with one vaginal sexual partner were 4 times more likely than
students who had 5 or more sexual partners to have used condoms in the past year.
Those who had 2–4 vaginal sexual partners were 3 times more likely than those who
had 5 or more vaginal sexual partners to have used condoms in the past year. When
examining recent condom use by number of lifetime anal sexual partners, 18.8% of
those with 1 anal sexual partner reported recent condom use, 5.4% with 2–4 sexual
partners recently used condoms and 1.7% with 5 or more partners reported recently
using condoms (Table 6). Statistical analyses revealed that the number of lifetime
anal sexual partners did not significantly influence condom use.
Table 5 Odds ratios for condom use by sex, race, grade and sexual orientation
Demographic variable Never/rarely
n(%)
Often/always
n(%)
OR (95% CI)
Sex
Male 40 (31.7) 86 (68.3) 1.994 (1.202, 3.309)**
Female 64 (44.1) 69 (51.9)
Race
White 90 (41.3) 128 (58.7) 1.356 (.674, 2.729)
Minority 14 (34.1) 27 (65.9)
Grade
Freshman/sophomore 55 (35.3) 97 (64.7) .621 (.376, 1.028)
Junior/senior 51 (46.8) 58 (53.2)
Sexual orientation
Heterosexual 17 (45.9) 20 (54.1) 1.063 (.245, 4.599)
Homosexual 4 (44.4) 5 (55.6)
Percents based on valid percents. Missing values excluded
N=483
**p\.05
734 S. K. Fehr et al.
123
Discussion
Condom Use Among Non-monogamous and Monogamous Partners
In the present study approximately 4 in 5 participants were engaged in partner
perceived monogamous relationships. Those in both non-monogamous and
monogamous relationships reported using condom often or always more frequently
than never or rarely. Analyses found that monogamy in the context of a sexual
relationship did not significantly influence condom use. These findings contradict
previous research, which found that those in non-monogamous relationships were
more likely to use condoms than those in monogamous relationships (Fielder and
Carey 2010; Lewis et al. 2012; Milhausen et al. 2013; Winfield and Whaley 2005).
These conflicting findings might be attributed in part to response bias where
participants give what they believe to be socially desirable responses and report
higher rates of condom use.
While the influence of monogamy on condom use was not statistically significant
in this study, the impact of relationship status on condom use cannot be overlooked.
The literature has found that as relationships transition from non-monogamous to
monogamous, couples often change their safer sex practices and forgo condom use
in favor of other methods such as hormonal birth control (Milhausen et al. 2013;
Sanders et al. 2006). These alternate safer sex practices are utilized to prevent
pregnancy rather than the transmission of STDs. While those in monogamous
relationships might believe their risks of STDs and HIV to be lower, the concept of
‘‘safety’’ in monogamy is not supported in the literature and places college students
at great risk. Vail-Smith et al. (2010) investigated sexual infidelity among college
participants in self-reported monogamous relationships. This study revealed that
approximately 27% of male and 20% of female participants engaged in oral,
vaginal, or anal sex outside of their partner perceived monogamous relationship.
Table 6 Condom use by number of lifetime vaginal and anal sexual partners
Item Condom use (%) Exp (B) (95% CI)
Number of vaginal partners
1 123 (25.5) 4.285 (2.225, 8.251)***
2–4 139 (28.8) 3.041 (1.644, 5.627)***
5 or more
a
125 (25.9)
Number of anal partners
1
b
91 (18.8)
2–4 26 (5.4) 2.344 (.623, 8.813)
5 or more 8 (1.7) 0.00 (0.00, 0.00)
a
Indicates referent; Omnibus Chi Square =22.81, df =2. p\.001; model accounting for 8.4–11.4% of
the variance. Current condom use; the model correctly classified X% of cases
b
Indicates referent; Omnibus Chi Square =3.619, df =2. p\.001; model accounting for 7.0–10.1% of
the variance. Current condom use; the model correctly classified X% of cases
***p\.001
Relationship Factors’ Impact on Condom Use Among College…735
123
Among participants who reported having sex outside of their monogamous
relationship, only one-third disclosed their infidelity to their partner. More alarming
still is when asked how regularly they used condoms in the past 30 days,
approximately 40% reported ‘‘always’’ using condoms; 18% reported ‘‘most of the
time’’; 7% reported ‘‘sometimes’’; 10% reported ‘‘rarely’’; and 24% reported
‘‘never’’ using a condom during that time. With between 20–27% of participants
reporting a sexual infidelity and nearly 40% of respondents indicating inconsistent
condom use, it is clear that monogamy cannot be used as a reliable source of STD
prevention (Vail-Smith et al. 2010). As college students in ‘‘monogamous’’
relationships may be severely underestimating their risk, safer sex educational
programs should stress on the importance of consistent condom use regardless of
relationship type.
Condom Use and Duration, Trust and Honesty
In the current study, slightly more than half of participants had been in relationships
for 6 months or more and the majority of participants reported consistent condom
use. Contradictory to the present findings, previous research has found that
individuals often discontinue condom use as the relationship progresses (Harvey
et al. 2006; Sanders et al. 2006). Harvey et al., found a negative association between
condom use perception and relationship duration where participants viewed
condoms less favorably as the length of their relationship increased. It is possible
that participants in the current study gave what they believed to be socially desirable
answers and inflated rates of condom use. While these finding were not statistically
significant, it is important to note that consistent condom use was only reported by
approximately 60% of respondents. Therefore nearly half of participants are at risk
for contracting HIV, STDs or having an unplanned pregnancy.
In the present study, participants reported high levels of trust between their
partners and themselves. On a scale of 1–5, 1 representing very low levels of trust
and 5 representing very high levels of trust, the average was 4.28 indicating a high
degree of trust. Previous research would indicate that condom use would be
negatively impacted by high degree of trust (Patel et al. 2006) but this was not found
in the current study. Earlier research has found that as trust developed and grew
between sexual partners, consistent condom use would shift to inconsistent condom
use. Although trust did not significantly influence condom use in this sample, it
should be noted high levels of perceived trust do not necessarily equate to lower risk
and therefore consistent condom use should be stressed in safer sex interventions.
In the current study, participants reported high levels of perceived honesty
between their partners and themselves. On a scale of 1–5, 1 representing very low
levels of trust and 5 representing very high levels of trust, the average was 4.36
indicating a high degree of trust. Analyses reveled that honesty between partners did
not significantly influence condom use. Very little research has been published on
the association between honesty and condom use and it appears that perceived
honesty does not necessarily equate to lower levels of condom use among college
students. Whereas duration, trust, and honesty were not found to significantly
influence condom use in the presents study, prevention efforts should strive to make
736 S. K. Fehr et al.
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individuals aware of their relative risk and susceptibility to contracting STDs and
HIV and stress the importance of regular STD testing regardless of relationship
duration and perceptions of trust.
Condom Use by Sex, Race, Grade and Sexual Orientation
Results indicated that sex significantly impacted condom use. Approximately 70%
of males and 50% of females reported using condoms often or always when
engaging in sexual activity. These percentages are much higher than the national
average of approximately 27% for both sexes reported by the American College
Health Association (2013a). Analyses revealed that males were twice as likely to
use condoms when engaging in sexual activity than females. These findings may be
attributed to the fact that male partners are often responsible for providing condoms,
as female partners may fear embarrassment or ridicule if they were to purchase or
provide condoms in the relationship (Brackett 2004; Dahl et al. 1998). When
analyzing condom use by race, minority students reported slightly higher rates of
consistent condom use than white students. In the present study, race was not found
to significantly influence condom use but analyses revealed that approximately 41%
of white participants and 34% of minority students used condoms never or rarely,
placing their sexual health at risk (CDC 2011,2012,2015). The present analyses
found that participants’ grade did not significantly influence condom use. While not
statistically significant, upperclassmen reported less consistent condom use than
younger students. Their age and experiences might have a negative influence on
their perceptions of condoms and lead to less consistent use. Finally, sexual
orientation did not have a significant impact on condom use and both heterosexual
and homosexual participants reported nearly identical rates of condom use.
Regardless of sex, race, grade or sexual orientation, participants reported less than
consistent condom use when engaging in sexual activity so prevention efforts
should focus on all groups when delivering health education messages. Additional
safer sex interventions created for the college age population should stress the
numerous health benefits of latex condoms in an effort to increase their use among
this population.
Condom Use by Number of Vaginal and Anal Sexual Partners
This study examined the influence of total number of vaginal and anal sexual
partners on recent condom use. Analyses revealed participants who had one vaginal
sexual partner were 4 times more likely than students who had 5 or more sexual
partners to have used condoms in the past year and those who had 2–4 vaginal
sexual partners were 3 times more likely than those who had 5 or more vaginal
sexual partners to have used condoms in the past year. Perhaps most troubling is that
fact that those who had 5 or more vaginal sexual partners in their lifetime were the
least likely to report recent condom use. The negative association between an
increased number of lifetime vaginal partners and condom use places individuals
and their partners at great risk for STDs, HIV (CDC 2011,2015) and unplanned
pregnancy (CDC 2012).
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Analyses also found that 18.8% of those with 1 anal sexual partner in their
lifetime reported recent condom use, 5.4% with 2–4 sexual partners used condoms
recently and only 1.7% of participants with 5 or more lifetime anal sexual partners
reported recently using condoms. While the influence of lifetime anal sexual
partners on recent condom use was not statistically significant, it is alarming that the
overwhelming majority of participants do not use condoms when engaging in anal
sex. While individuals may refrain from condom use because pregnancy is not a
concern, research by the Centers for Disease Control and Prevention has found that
having anal sex without a condom and having multiple sexual partners increases an
individual’s risk of HIV and STDs (CDC 2012,2015). Educational efforts may
stress the risks associated with unprotected vaginal and anal sex.
Limitations
The limitations of this study should also be noted. First, participants were
undergraduate students at a large urban university in the Midwest and therefore
results may not be generalizable to other populations. Second, the study was limited
by participants’ honesty and self-reporting accuracy of the their condom use.
Finally, given the sensitive nature of the study, participants might have been
reluctant to answer questions about their sexual history.
Conclusions
Our findings should be considered by those designing interventions to increase
condom use among college students. Specifically those with more lifetime vaginal
sexual partners are less likely to report recent condom use, and males are more
likely to report consistent condom use than females.
Compliance with Ethical Standards
Conflict of interest The authors declare that they have no conflict of interest.
Human and Animal Rights All procedures performed in studies involving human participants were in
accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki
declaration and its later amendment or comparable ethical standards.
Informed Consent Informed consent was obtained from all individual participants included in the study.
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