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Understanding the association between condom use at first and most recent sexual intercourse: An assessment of normative, calculative, and habitual explanations

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Abstract

The aim of this study was to provide a better understanding of the likely mechanisms underlying regular condom use. In 2009, 1145 sexually active individuals aged 18–65 years were surveyed online, after being recruited via an e-mail message circulated at a large Croatian university and posted on various social networking websites. Participants’ mean age was 28.1 years (SD = 8.01). Women constituted a slight majority of the sample (51.6%). The research questions – whether the frequently observed association between condom use at first and most recent sexual intercourse could be best predicted by (a) norm-oriented behavior; (b) calculative decision-making; or (c) habit formation – were tested using multiple logistic regression. Only the calculative and habitual motivational determinants of condom use were significant predictors. Unlike calculative use, which decreased the odds of condoms being used at both occasions, habitual use, as expected, increased the odds of condom use. In addition, the habitual modality of condom use significantly predicted consistent condom use with both casual and steady sexual partners. Age, being in a relationship, and the number of lifetime sexual partners were negatively associated with habitual condom use. The finding that habit plays a substantial role in consistent condom use suggests the need for further exploration of personality and relational factors associated with the initiation of habitual condom use.

Introduction

Consistent condom use is of central importance for sexual and reproductive health (Sheeran et al., 1999, UNAIDS, 2009). Exposure to sexual health risks has been well documented and a global rise in STIs and HIV prevalence seems to be particularly evident among individuals under the age of 25 (Inciardi & Williams, 2005). Although there is evidence of increased use of male condoms among young people (Santelli et al., 2007, Santelli et al., 2006), many sexually active individuals do not use condoms on a consistent basis (Hatherall et al., 2005, Manderson et al., 2005, Measor, 2006). Similar findings were recently reported in Croatia (Štulhofer et al., 2006, Štulhofer et al., 2007).

Condom use at first sexual intercourse is a good predictor of condom use at most recent intercourse (Hiršl-Hećej & Štulhofer, 2001, Shafii et al., 2004, Shafii et al., 2007). Several authors have suggested a possible role for habit formation in this association, but alternative causal mechanisms have seldom been considered (Ku et al., 1992, Shafii et al., 2004, Yzer et al., 2001). Moreover, although “habit formation” seems to be the favored hypothesis, it has not been empirically tested (Hiršl-Hećej & Štulhofer, 2001, Shafii et al., 2007, Sheeran et al., 1999). To the best of our knowledge, the mechanisms responsible for the association between condom use at first intercourse and current condom use have not been systematically investigated.

There are at least three possible explanations for the observed association between condom use at first and most recent intercourse. The first, the “normative hypothesis,” suggests that regular condom users can be distinguished from their peers by their strong adherence to social norms that reflect expectations that sex would (and should) not take place without the use of a condom (Breakwell et al., 1994, Sheeran et al., 1999). A second possibility (the “calculative hypothesis”) is that condom use is governed by (quasi) rational decision-making. A complex, highly subjective, and contextual calculation of costs and benefits of using a condom is said to determine whether or not condoms are used (Fisher, Williams, Fisher, & Malloy, 1999). Finally, the “habit formation hypothesis” argues that regular condom use does not depend on positive norms, risk calculations, or communication skills, but is a habit that develops early on (for various reasons, e.g., a strong fear of unwanted pregnancy) and is sustained by the force of non-deliberation.

This study explored whether the association between the use of the male condom at first and most recent sexual intercourse could be best predicted by three modalities or motivational determinants: (a) norm-oriented behavior; (b) calculative decision-making; or (c) habit formation. We expected the habitual modality to increase and the normative and calculative modalities to decrease the odds of regular condom use. Using a sample of 1145 sexually active individuals aged 18–65 years surveyed online in 2009, we tested these hypotheses with the aim of increasing understanding of the likely mechanisms underlying consistent condom use.

Section snippets

Recruitment procedure

Participants were solicited via an e-mail message distributed among students at the University of Zagreb and posted on Facebook and several electronic forums and mailing lists. In addition, the study was advertised on a popular dating website (>80,000 registered users) by placing a web banner with a brief study description. The e-mail message provided information about the study aims (to investigate the patterns of condom use) and invited individuals who were 18 years and over to follow a link

Results

To validate the use of the three motivational composites in the various subgroups, exploratory PCA using varimax rotation was carried out separately by gender, age (younger vs. older (≥31 years)), and use of condom at most recent sexual intercourse (yes/no) for all 15 items (analyses not presented here). The original three-component structure, characterized by four items loading on the normative, five on the calculative, and six on the habitual dimensions, remained consistent across the groups

Discussion

We tested three possible explanations for the frequently reported association between condom use at first and most recent sexual intercourse: norm-oriented behavior, calculative decision-making, and habit formation. Our findings suggest that a routine, non-deliberate behavior regulated by habit is the best predictor of regular condom use.

A conceptualization of consistent condom use as a matter of habit entails two important questions: how does this habit form and why do certain individuals

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    This study was a part of the research project Behavioral HIV Surveillance funded by the Croatian Ministry of Science, Education, and Sports. The authors would like to thank Željko Raukar for his assistance with data collection and Ivan Landripet for his comments on an earlier version of this paper.

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