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Description
Recent reviews of empirical studies of condom use suggest that much of the literature in this domain is theory driven (e.g., Albarracin, Johnson, Fishbein, & Muellerleile, 2001; Sheeran, Abraham, & Orbell, 1999). The health belief model (HBM; Janz & Becker, 1984), theory of reasoned action (TRA; Ajzen & Fishbein, 1980) and theory of planned behavior (TPB; Ajzen & Madden, 1986), social cognitive theory (SCT; Bandura, 1986), information-motivation-behavioral skills model (IMB; Fisher & Fisher, 1992), AIDS risk reduction model (ARRM; Catania, Kegeles, & Coates, 1990), and the transtheoretical model (TTM; Prochaska, DiClemente, & Norcross, 1992) all have been tested within this behavioral domain (see Fisher & Fisher, 2000, for a review). In a comprehensive meta-analysis of this literature, Sheeran and Colleagues (1999) found variables derived from the TRA (attitudes, intentions), social norms, self-efficacy (from SCT), and preparatory behaviors (such as carrying condoms and communicating about condom use) to be highly correlated with heterosexual condom use. Further, in a quantitative review of personality literature that examined the relationship between personality traits and sexual risk taking, Hoyle, Fejfar, and Miller (2000) found sensation-seeking and impulsivity to be two of the individual difference variables most consistently and highly correlated with sexual risk taking. Finally, research on sexual risk behavior increasingly finds support for variables that take into account the context of the sexual situation, including the type of relationship or sexual partner one is involved with (see Misovich, Fisher, & Fisher, 1997; Noar, Zimmerman, & Atwood, 2004) as well as whether alcohol or other substances are used in a sexual situation (Cooper, 2002; Leigh, 2002). In the current investigation, we propose and test a model of condom use that incorporates these and other elements. In so doing, we build upon the theoretical and empirical literature on condom use, including recent work aimed at integrating health behavior theories (i.e., Bandura, 1998; Fishbein, 2000; Fishbein et al., 2001; Noar & Zimmerman, 2005).
Integrating the literature. As is evident from the Sheeran and Colleagues (1999) and Hoyle and Colleagues (2000) reviews, studies of health behavior theory and studies of personality largely have been conducted in isolation from one another. That is, one rarely sees personality characteristics integrated into studies of health behavior theories. Pinkerton and Abramson (1995) note this lack of integration, stating that research is needed to "better describe the complex mechanisms that underlie sexual behavior and their relations to personality and cognition" (p. 721). In addition, health behavior theories often are criticized for not taking into account a variety of situational and contextual influences that may impact condom use (i.e., Amaro, 1995; Amaro & Raj, 2000). The current study aims to integrate what has been learned from studies in these diverse areas into a comprehensive model of adolescent condom use. We next review the literature in the health behavior theory and personality domains in more detail, as well as literature related to situational/contextual and demographic variables.
Application of health behavior theories to condom use. Numerous studies have applied varying health behavior theories to adolescent and young adult condom use. Studies applying the HBM and its components have had perhaps the weakest results (Gerrard, Gibbons, & Bushman, 1996; Janz, Champion, & Strecher, 2002; Zak-Place & Stern, 2004), while studies applying the TRA/TPB (Albarracin et al., 2001; Albarracin, Kumkale, & Johnson, 2004), SCT (Forsyth & Carey, 1998; O'Leary, 2001; O'Leary et al., 2005), the IMB (Fisher & Fisher, 1992, 2000, 2002), and the TTM (Burkholder & Evers, 2002; Grimley, Prochaska, & Prochaska, 1997; Horowitz, 2003) have found stronger support for these theories and their respective variables. Some of the work on safer sexual behavior has resulted in new variables being added to existing theories (i.e., Bryan, Fisher, & Fisher, 2002; Grimley et al., 1997; Noar, Morokoff, & Redding, 2002), while in other cases entirely new models have been proposed, such as the IMB and ARRM. Some level of empirical support has been found for all of these theories in the safer sexual behavior area (i.e., see Fisher & Fisher, 2000; Noar, 2007).
What can we conclude from this rather large, multi-theoretical literature on condom use? The meta-analysis of heterosexual condom use predictors conducted by Sheeran and Colleagues (1999) suggests that attitudes, social norms, self-efficacy, and intentions, all assessed specifically in relation to condom use, are among the strongest predictors of heterosexual condom use. In addition, these authors found strong support for preparatory behaviors such as buying, carrying, and communicating about condoms as condom use predictors, a finding supported by a subsequent longitudinal study (Bryan et al., 2002). Further, the findings of this meta-analysis (which included heterosexual populations of various ages) appear to concur with studies specifically of adolescents in which similar variables have been found to predict condom use (e.g., Baele, Dusseldorp, & Maes, 2001; DiIorio et al., 2001; Harper, Hosek, Contreras, & Doll, 2003; Kirby, 2001). Meta-analyses of the use of TRA/TPB applied to condom use (Albarracin et al., 2001, 2004) also have provided support for the core variables of those theories, including attitudes, norms, and perceived behavioral control (or the similar concept of self-efficacy),as have longitudinal studies of TRA/TPB (e.g., Carvahal, Estrada, & Estrada, 2006; Gredig, Nideroest, & Parpan-Blaser, 2006; Morrison, Baker, & Gillmore, 2001; Rhodes, Stein, Fishbein, Goldstein, & Rotherum-Borus, 2007; Yzer, Siero, & Buunk, 2001). These findings, taken together, suggest that a theory of adolescent condom use should include these core variables.
Personality variables: Sensation-seeking and impulsivity. Aspects of one's personality can influence decisions made with regard to sexual behavior, which in turn can contribute to sexual risk taking and a lack of condom use (Donohew et al., 2000; Kalichman & Rompa, 1995; Pinkerton & Abramson, 1995). Of the many dimensions of personality, two dimensions that have received considerable empirical support in relation to sexual risk taking are sensation seeking and impulsivity (Hoyle et al., 2000), and such dimensions are incorporated within Zuckerman, Kuhlman, Joireman, Teta, and Kraft's (1993) alternative five-factor model of personality. Such personality factors also are included, although with less emphasis, in other models of personality such as the three-and five-factor models (i.e., Zuckerman et al., 1993). High sensation-seekers are theorized to be individuals who have greater needs for novelty, exciting and unusual experiences, and thrill seeking as compared with their lower sensation-seeking counterparts (Zuckerman, 1979). Impulsive decisionmakers are theorized to be individuals who have a tendency to make decisions without a great deal of thought, are less likely to plan ahead (i.e., for a sexual situation), and are more likely to act on impulse as compared with their rational decision-making counterparts (Donohew et al., 2000).
A fairly large literature indicates that high sensation seekers and impulsive decisionmakers, including among heterosexual adolescents, are likely to engage in various types of sexual risk taking (see Hoyle et al., 2000, for a review). For instance, in studies examining sexual risk taking in adolescents, those who were high sensation seekers or impulsive decisionmakers were more likely to engage in sexual risk taking practices such as casual sex, having multiple sexual partners, or unprotected sex as compared with low sensation seekers and rational decisionmakers (Arnett, 1994; Devieux et al., 2002; Donohew et al., 2000). It should be noted that although such personality traits have been found to be related to various sexual risk-taking activities including unprotected sex (e.g., Kalichman & Rompa, 1995), there appears to be little or no direct relationship between these personality traits and frequency of condom use (Noar, Zimmerman, Palmgreen, Lustria, & Horosewski, 2006; Sheeran et al., 1999). This suggests that there may be factors that provide indirect pathways between personality characteristics and condom use.
Situational/contextual variables: Close (and casual) relationships and birth control. As many scholars have noted, the context in which sexual behavior takes place can have a major impact on safer sexual behavior (Amaro, 1995; Canin, Dolcini, & Adler, 1999; Katz, Fortenberry, Zimet, Blythe, & Orr, 2000; Logan, Cole, & Leukefeld, 2002). In fact, it could be argued that all sexual behaviors take place within partnerships, with some being close relationships (or partnerships) and some being quite casual. Reviews of the literature have demonstrated the strong influence that relationships and interpersonal dynamics have on safer sexual behavior, and a consistent finding is that those in close sexual relationships are less likely to use condoms than those in casual sexual relationships (see reviews in Misovich et al., 1997; Noar et al., 2004). It appears that a variety of processes may be at work here, as those in close relationships may prioritize trust, romance, and love over concerns about sexually transmitted diseases (STDs) and thus engage in sexual risk-taking (i.e., Comer & Nemeroff, 2000; Hammer, Fisher, Fitzgerald, & Fisher, 1996; Katz et al., 2000). In fact, it is likely that in some cases adolescents have "unprotected sex" (sex without a condom) but do not see it as risky behavior. While researchers may view this behavior as risky, those in monogamous relationships may see no risk and thus no reason to use condoms (Civic, 2000; Overby & Kegeles, 1994).
In addition, many couples appear to use condoms early in a relationship, until a certain point when they decide that condoms are no longer necessary (i.e., Civic, 1999; Corbin & Fromme, 2002; Fortenberry, Tu, Harezlak, Katz, & Orr, 2002; Ku, Sonenstein, & Pleck, 1994; Macaluso, Demand, Artz, & Hook, 2000). At that point, they may stop using condoms and start using hormonal contraceptives (Civic, 1999, 2000; Hammer et al., 1996; Ku et al., 1994). In fact, extinguishing the use of condoms (and in some cases, replacing it with hormonal contraception) appears to be a trust-building step signaling that a relationship is moving from casual to more intimate (Aalsma, Fortenberry, Sayegh, & Orr, 2006; Hammer et al., 1996).
Situational/contextual variables: Alcohol use. A number of studies have examined the relationship between various types of substances (in particular, alcohol) and risky sexual behavior in adolescents and young adults (see reviews in Cooper, 2002; Fortenberry, 1995; Leigh, 2002; Markos, 2005). These reviews of the literature all illustrate that the association between alcohol use and sexual behavior is complex, and may vary according to type of sexual behavior, population under study, and with regard to other... |
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