A cognitive analysis of college students' explanations for engaging in unprotected sexual intercourse

Delay Discounting and Sexual Decision-Making: Understanding Condom Use Behavior Among U.S. College Students

Condoms provide protection against sexually transmitted diseases; however, condomless sex remains common among college students and intentions to use condoms do not consistently translate into condom use. This study tested which indicator of condom use intentions from a delay discounting paradigm of condom-protected sex best accounted for variance in condom use behavior. The sample consisted of 187 sexually active college students (51.9% female) who completed measures of condom use during vaginal and anal sex over the past three months and a decision-making paradigm regarding condom intentions with hypothetical sexual partners. In separate models, condom behavior was regressed on one of three indicators of condom intentions: initial intentions to use a condom, delay discounting of condom-protected sex, and overall area under the curve across all trials. Results showed that delay discounting of condom-protected sex best accounted for variance in absolute frequency of condomless sex, whereas initial intentions to use a condom best accounted for variance in relative proportion of condomless sex. Future research directions and implications for interventions are discussed.

Evaluation of College Students' IPE Environment Based on User Rating Sparsity and Big Data Technology

Big data improves opportunities for enhancing and improving university students' IPE. In order to improve the accessibility of IPE for university students, this study integrates big-data techniques into the IPE (Ideological and Political Education) model of university students and builds the IPE platform. This study presents the idea of user rating sparsity and employs a two-step training strategy to address the issues of user cold start and sparse data in light of the drawbacks of conventional methods. This algorithm produces a very small data structure, which saves a lot of storage space. This study also uses hybrid recommendation technology, which effectively enables platform users to select customized update resources based on their interest information. According to test results, this method's suggestion accuracy can reach 95.69%, and it has a high user rating. This demonstrates that the method is reliable and accomplishes the desired result. This paper fully utilizes mega data to improve the accessibility of IPE for university students.

Neighborhood Disorder and Risk-Taking Among Justice-Involved Youth-The Mediating Role of Life Expectancy

Neighborhood disorder has been linked to perceptions of shorter life expectancies, and shorter life expectancies have been associated with greater risk-taking. Yet, no studies have combined these two pathways. Using data from the longitudinal Crossroads study, the present study assessed whether life expectancy mediates the association between neighborhood disorder and risk-taking-substance use, crime, and risky sex-among 1,093 justice-involved adolescents. Results indicate that neighborhood disorder was linked to lower estimated life expectancy which in turn related to higher rates of cigarette use, binge drinking, illicit drug use, offending, and casual sex. However, life expectancy did not explain the association between neighborhood disorder and marijuana use or inconsistent condom use.

Motivational Interviewing Skills as Predictors of Change in Emerging Adult Risk Behavior

Emerging adulthood is a unique developmental stage during which significant transitions in living environment, social networks, personal responsibilities, and identity development occur. Stress associated with these transitions relates to increases in health-risk behaviors, such as substance use and high-risk sexual behavior. This research examined health-risk behavior outcomes associated with the Young Adult Family Check-Up (YA-FCU). The YA-FCU comprises three sessions: an initial interview, an ecological assessment, and a feedback session that integrates motivational interviewing (MI) techniques. This study measured treatment fidelity of the YA-FCU and the extent to which therapists adhered to principles of MI during feedback sessions. Therapists included both licensed psychologists and trainees. The study also examined the relationship between therapists' MI fidelity and client change talk (CT), in order to determine if MI fidelity and client CT predicted postintervention health-risk behaviors among emerging adults who participated in the YA-FCU. Measures of health-risk behaviors were collected pre- and post- intervention. Results indicated overall adequate treatment fidelity. MI fidelity was positively related to client CT. Several indicators of MI fidelity predicted decreases in emerging adults' health-risk behaviors. For example, therapist ratio of reflections to questions predicted a decline in emerging adults' alcohol use frequency and marijuana use quantity. These results have important implications for YA-FCU training and implementation and indicate that MI consistent skills might be a mechanism of change in the YA-FCU intervention.

Condom use during COVID-19: Findings from an Australian sample of heterosexual young adults

Condoms are a valuable tool in combating the continued spread of sexually transmitted infections (STIs). Despite the fact that condoms are effective and easily accessible, young adults report inconsistent condom use and young adults represent a disproportionately large amount of new STI cases annually. The Behavioural Immune System theory suggests that health behaviours, such as condom use, are impacted by cognitive activation of perceived threat of disease. The advent of the COVID-19 pandemic may then have unforeseen impacts on condom use and the spread of STIs. The present study investigated changes in condom use during the pandemic, and any associations these changes may have had with perceived vulnerability to COVID-19. An Australian sample of 269 students completed a survey asking them to recall their condom use prior to COVID-19, and then their current condom use. Final analyses included a sample of 149 sexually active heterosexual participants. Results revealed a general decline in condom use. Single and coupled participants both reported less frequent condom use, but this decrease was more pronounced among single people. Gender did not moderate these effects. Surprisingly, diminished condom use was not significantly related to perceived threat of COVID-19. Findings of the present study have concerning implications for sexual health and sexual messaging during pandemics.

Determinants of Long-acting Reversible Contraception (LARC) Initial and Continued Use among Adolescents in the United States

Long-acting reversible contraception (LARC) has gained attention as a promising strategy for preventing unintended adolescent pregnancies in the United States. However, LARC use among adolescents at risk for pregnancy remains low compared to women in their 20s. The purpose of the current study was to synthesize the empirical literature published between 2010 and 2018 identifying the facilitators of and barriers to adolescents' (< age 20) LARC use in the United States. Thirty quantitative and qualitative studies were included in the current systematic review. The facilitators of and barriers to adolescent LARC use fell within five themes: LARC method characteristics, individual characteristics, social networks, healthcare systems, and historical time and geographical region. Barriers to adolescent LARC use largely echoed those identified in previous research noting the barriers to LARC use among young adult women (e.g., provider concerns with placing IUDs for nulliparous women, common adverse side effects associated with some LARC methods). However, qualitative studies identified adolescents' mothers as central figures in helping adolescents successfully obtain the LARC methods they desired. Conversely, adolescents' partners seemed to only play a minor role in adolescents' contraceptive decisions. Findings within the reviewed studies also suggested some subpopulations of adolescents may be experiencing pressure to initiate LARC use or have less ability to have their LARC device removed if they wish to discontinue use. Adolescent health practitioners and clinicians should consider the unique social-environmental influences of adolescents' contraceptive access and behaviors to best meet adolescents' contraceptive needs and desires.

Latkin C, C. M. Ho R, S. H. Ho C. Patterns of Risky Sexual Behaviors and Associated Factors among Youths and Adolescents in Vietnam

Youths and adolescents are vulnerable to HIV/STIs from unprotected sex. Promotion of young population's awareness about risky sexual behaviors is essential to develop contextualized interventions. A cross-sectional study was conducted in five Vietnamese provinces to document current attitudes and practices regarding sexual behaviors among youths. The information on sociodemographic characteristics, substance use, and sexual behaviors was collected via self-reported questionnaires. The factors associated with risky sexual behaviors were identified by the multivariate logistic regression. Among the 1200 participants, 73.5% reported having sex in their lifetime, and 48.1% used condoms at their latest sexual intercourse. Participants in urban areas were more likely not to intend to use condoms and had a higher unintended pregnancy rate than in rural areas. Older age was positively associated with not wanting to use and not using condoms. Substance-using participants were more likely to not use condoms. The participants taking alcohol or other stimulants before sex had a higher likelihood of unintended pregnancy. Respondents' attitudes and practices regarding sexual behaviors were associated with gender and employment. This study indicated that young population's awareness in Vietnam is high, however, risky sexual behaviors also remain common. Sex-related educational programs about the consequences of substance use, multiple sex partners, and unprotected sex should be developed.

Being on the Safe Side: A Qualitative Study of Condom Use Motivations According to Contraceptive Type among Adolescents in Atlanta, Georgia

STUDY OBJECTIVE

Quantitative data suggest that adolescent users of long-acting reversible contraception (LARC), compared with short-acting methods (pill, patch, ring, depot medroxyprogesterone acetate [DMPA]), might be less likely to use condoms. We qualitatively describe and explain adolescent contraceptive users' motivations for condom use, including variation according to contraceptive type.

DESIGN

Individual, in-depth qualitative interviews, analyzed thematically.

SETTING

Participants were recruited from public family planning clinics and an adolescent medicine clinic, as well as university and other community settings in Atlanta, Georgia.

PARTICIPANTS

Sexually active contraceptive users aged 17-19 years old (n = 30), including LARC (n = 10), DMPA (n = 10), and oral contraceptive (n = 10) users.

RESULTS

Of the 30 participants, most (n = 25; 83%) used condoms with their more effective contraceptive method, although 11 of 25 used them inconsistently (44%). Oral contraceptive users were particularly motivated to use condoms for pregnancy prevention, because of concerns about contraceptive method efficacy and a desire to be on "the safe side." In contrast, LARC users were primarily motivated by sexually transmitted infection (STI) prevention. DMPA users' motivations were more mixed. Across contraceptive type, factors influencing condom use motivations included sexual health education, personal awareness and/or experience, and perceived consequences and risk.

CONCLUSION

Because all participants were using an effective contraceptive method, it is notable that pregnancy prevention was a prominent motivator for using condoms, although LARC users reported STI prevention to be a more important motivation. Parental and school-based sexual health education that clearly addresses STI prevention in addition to pregnancy prevention has the potential to influence condom use motivations and behavior.

Exploring the Determinants of Risky Sexual Behavior Among Ethnically Diverse University Students: the Student Behavioral Health Survey-Web

Universities create policies and develop programs to prevent HIV and other sexually transmitted infections. Unfortunately, most historically Black colleges and Hispanic-serving institutions have limited information about student practices and program effectiveness. This study examined the prevalence and determinants of risky sex among students attending a Hispanic-serving university. A cross-sectional online survey was conducted to obtain sensitive data from a random sample of students. Nearly two-thirds (65.2%) of 632 respondents reported engaging in risky sex. Sexual risk was significantly associated with older age (AOR = 2.16, 95% CI 1.09-4.30), lower self-control (AOR = 0.58, 95% CI 0.34-0.97), and higher alcohol (AOR = 2.10, 95% CI 1.20-3.67) and drug use (AOR = 2.59, 95% CI 1.48-4.50). Most respondents were unaware of university policies and programs. Programs to improve sexual health must influence risk-taking students. Perceptions of self-control and use of alcohol and drugs affected sexual decision-making. These factors should be ascertained and addressed by behavioral interventions aimed at minimizing risky behaviors and limiting the transmission of sexually transmitted infections.

Contraceptive behavior of Portuguese higher education students

ABSTRACT Objective: To characterize the contraceptive practices of higher education students and to identify factors that contribute to the use of different contraceptive methods. Method: A cross-sectional, descriptive correlational study was carried out with a sample of 1946 students, with a mean age of 21 years (20.74±2.32), who attended courses at a University in the North of Portugal. Results: Of the factors studied, the female gender, younger ages, previous behavior of condom use, knowledge about contraception, attitude and self-efficacy for condom use were associated with safer contraceptive choices. Conclusion: Investing in sexual education for young people is an important public health strategy that can empower youth to make more appropriate choices and improve adherence to contraceptive methods, reducing the risk of unintended pregnancies and sexually transmitted diseases.

To Keep this Disease from Killing You: Cultural Competence, Consonance, and Health among HIV-positive Women in Kenya

The HIV/AIDS crisis continues in sub-Saharan Africa, where nearly 70% of infections are found. Despite recent efforts to supply antiretroviral therapy to those infected, most are not receiving medication and are forced to rely on self-management to remain healthy. In Kenya, many of those infected are women living in extreme poverty. This article presents the findings of research among poor women in Nairobi that examined the relationship between knowledge of a cultural model of self-managing HIV/AIDS, cultural consonance, and health. This biocultural study expands on earlier findings showing that knowledge of the model (competence) is a significant predictor of health by examining here how behavior consistent with that knowledge (consonance) affects health outcomes, as measured by CD4 counts, perceived stress, depressive symptoms, and recent illnesses.

Using Qualitative Methods to Understand Perceptions of Risk and Condom Use in African American College Women: Implications for Sexual Health Promotion

BACKGROUND

Young African American women are disproportionately affected with sexually transmitted infections (STIs) and unintentional pregnancies. Despite adequate knowledge, assertiveness, and negotiation skills, consistent condom use remains low.

AIMS

We sought to assess the role of pregnancy and STI risk perception in condom decision making among African American women.

METHOD

We conducted a phenomenological qualitative study. Utilizing a purposive sampling strategy, 100 African American women (18-24 years) were recruited from a historically Black college and university for an open discussion of condom use. Thirteen focus groups were conducted via a semistructured interview guide and analyzed with an inductive thematic approach.

RESULTS

Uniformly women perceived pregnancy as a greater threat than STIs which appears to be maintained by (a) their sense of fertility, (b) self-care concept, and (c) experiences with condom failure. Thus, women were skeptical about using condoms as a form of contraception. Women perceived casual sex as having the greatest HIV/STI risk and emphasized the importance of assertiveness and self-respect to negotiate condom use. However, condom use in monogamous relationships is less likely due to (a) testing/knowing partner's status, (b) relationship trust, and (c) the use of hormonal contraception for pregnancy prevention. Perceived threat of infidelity increases condom use.

CONCLUSION

The implications of these findings suggest sexual health promotion programs may focus on improving women's estimate of the effectiveness of condoms to prevent pregnancy and addressing women's reliance on testing for STI prevention.

Chlamydia testing and diagnosis following initiation of long-acting reversible contraception: A retrospective cohort study

BACKGROUND

Long-acting reversible contraception (LARC) effectively protects against pregnancy but provides no protection against sexually transmitted infections (STIs).

AIM

To compare rates of chlamydia testing and diagnosis for women initiating long-acting versus oral contraception.

MATERIALS AND METHODS

Retrospective cohort study involving data collection for 6160 women initiating post-abortion contraception at a large New Zealand regional public hospital abortion clinic (2009-2012), with chlamydia testing data obtained from the local laboratory during two-year follow up. Negative binomial regression modelling examined the effect of contraceptive method on two outcome measures: chlamydia testing and chlamydia diagnosis (adjusting for potential covariates of age, ethnicity, past chlamydia infection, pregnancy history) in year one and two of follow up.

RESULTS

Two thousand seven hundred and twenty nine women (44%) received a LARC and 1764 (28.6%) were prescribed oral contraception. Adjusted testing rates differed by contraceptive method only in year one (P < 0.01): with higher rates among copper intrauterine device users (relative risk (RR) 1.2, 95% CI 1.06-1.35), and lower rates for implant users (RR 0.84, 95% CI 0.72-0.99) compared with oral contraceptive users (reference group). No significant differences were observed in chlamydia diagnosis rates by contraceptive method (P > 0.05). Younger age, past chlamydia infection, Maori and Pacific ethnicity were associated with higher rates of chlamydia diagnosis (P < 0.01).

CONCLUSIONS

Known STI-related risk factors (age, ethnicity, past infection) but not contraceptive method were independently related to rates of subsequent chlamydia diagnosis. This suggests that increased LARC uptake would not occur at the expense of chlamydia control. Regular screening and risk reduction advice (including condom use) are important chlamydia control measures for at-risk groups.

Factors influencing college women's contraceptive behavior: An application of the integrative model of behavioral prediction

OBJECTIVE

This study investigated variables within the Integrative Model of Behavioral Prediction (IMBP) as well as differences across socioeconomic status (SES) levels within the context of inconsistent contraceptive use among college women.

PARTICIPANTS

A nonprobability sample of 515 female college students completed an Internet-based survey between November 2014 and February 2015.

METHODS

Respondents were asked about their contraception use, knowledge and information sources, demographic information, and IMBP factors, including attitudes, norms, and perceived behavioral control (PBC).

RESULTS

While overall attitudes, norms, PBC, and intentions for contraceptive use were high, only 46.8% of women used contraception consistently. Data also revealed only moderate levels of knowledge about contraception. While there were no differences across SES levels for attitudes, PBC, norms or knowledge, SES levels did differ in sources used to acquire contraceptive information.

CONCLUSIONS

This study highlights the need to consider where college women acquire contraceptive information which is associated with SES.

Motivating factors for dual-method contraceptive use among adolescents and young women: a qualitative investigation

OBJECTIVE

This qualitative study explores how adolescents and young women perceive the need for and describe the use of dual method contraception.

STUDY DESIGN

We interviewed 20 sexually active women aged 16-24 who attended an adolescent-focused Title X family-planning clinic and were using a non-barrier contraceptive method. We used a semi-structured interview guide that included domains related to sexual activity, knowledge of and use of contraceptives and condoms, and relationship factors. We coded transcripts using grounded theory techniques and used an iterative process to develop overarching themes.

RESULTS

Dual method contraceptive users primarily discussed pregnancy prevention as their motivating factor. Many expressed anxieties over an unplanned pregnancy and reported condom use as "back-up" contraception. Risk perception for pregnancy or STI acquisition did not necessarily change as relationship trust increased, but rather, their anxiety regarding the negativity of such outcomes decreased. Dual-method contraception use decreased when participants reported that condoms were not readily available, or when they self-described immaturity. Less frequently, participants reported dual method use for sexually transmitted infection (STI) prevention, and many substituted STI testing for condom use. Contraceptive type (short-acting vs. long-acting) did not influence reported attitudes towards dual method use.

CONCLUSION

Health educators and clinicians encourage condom use in young women due to the significant morbidity associated with STI acquisition. Most participants in our study view condoms as a way to improve pregnancy prevention. Acknowledging and addressing this divergence in motivation will allow caregivers to improve strategies for communicating the importance of dual method use.

IMPLICATIONS

Young women primarily describe pregnancy prevention as the reason for dual method use, STI protection is less salient. Consideration of this viewpoint by health educators and clinicians will allow us to communicate more effectively to prevent STI morbidity.

Exploring Infertility from the Cultural Context of Latino College Students: Results from a Preliminary Focus Group

Despite a racial/ethnic disparity, little research has examined minority group perceptions of infertility. After developing a 15-question English-language focus group guide, 13 Latino college students (ages 19-22) at a Midwestern university were recruited to participate in a focus group to discuss their perceptions of infertility in the context of their family and culture. The focus group was audio recorded, professionally transcribed, and analyzed according to the constructed Grounded Theory approach. Three major themes were identified: 1) infertility is not considered when looking towards the future; 2) infertility is not discussed due to shame; and 3) infertility does not require a medical resolution. College students have the opportunity to make lifestyle modifications that can optimize fertility, but intention to change behavior is contingent on accurate fertility knowledge, which is often influenced by cultural norms. Our results suggest that these Latino students do not consider infertility a risk in their future lives nor is infertility something they consider should be explicitly discussed. Importantly, they do not perceive the need for medical interventions when addressing infertility, which carries implications for treatment seeking. When creating educational interventions for infertility, it is important to take into account the cultural lens through which infertility is understood.

Identifying Psychosocial Variables That Predict Safer Sex Intentions in Adolescents and Young Adults

Young people are especially vulnerable to sexually transmitted infections (STIs). The triad of deliberate and effective safer sex behavior encompasses condom use, combined with additional information about a partner's sexual health, and the kind of sex acts usually performed. To identify psychosocial predictors of young people's intentions to have safer sex, as related to this triad, we conducted an online study with 211 sexually active participants aged between 18 and 24 years. Predictors [i.e., perceived behavioral control (PBC), subjective norms, and intention] taken from Fishbein and Ajzen's Reasoned Action Approach (RAA), were combined with more distal variables (e.g., behavioral inhibition, sensation seeking, parental monitoring, and knowledge about STIs). Beyond the highly predictive power of RAA variables, additional variance was explained by the number of instances of unprotected sexual intercourse (SI) during the last 12 months and reasons for using barrier protection during first SI. In particular, past condom non-use behavior moderated PBC related to intended condom use. Further, various distal variables showed significant univariate associations with intentions related to the three behaviors of interest. It may, therefore, be helpful to include measures of past behavior as well as certain additional distal variables in future safer sex programs designed to promote health-sustaining sexual behavior.

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OBJECTIVES

Risky sexual behaviour associated with sexually transmitted infections (STI) and sexual harassment are important topics in university environments and public health. This article compares these behaviours between student cohorts in 2005 and 2012 from a Western Canadian university. The sexual habits of young adults with multiple partners are also examined.

METHODS

Researchers conducted a comparative study of sexual behaviour among approximately 400 students per cohort. Estimates of prevalence and adjusted odds for age group and sex were used to analyze associations between the two cohorts and their sexual behaviours.

RESULTS

Trends in sexual behaviour of young adults are maintained with respect to the proportion of those who are sexually active and their number of partners. A reduction in sexual harassment is observed, especially towards women. The condom remains the most frequently used method of contraception, but its use is erratic, particularly among respondents with multiple sexual partners. Drinking and the use of drugs predisposes to unplanned sexual relations and to non-use of means to prevent STIs and pregnancy, particularly among respondents with multiple sexual partners.

CONCLUSIONS

The postsecondary student population should be informed of the risks associated with multiple sexual partners and alcohol and drug consumption leading to unplanned sexual acts. A sexual harassment policy contributes to reduction of incidents of harassment within a postsecondary institution.

Choosing the danger we think we know: Men and women's faulty perceptions of sexually transmitted infection risk with familiar and unfamiliar new partners

It is essential that we gain a clearer understanding of why young adults in Canada may fail to appropriately protect themselves from STI/HIV transmission. Partner familiarity plays an important role in judgements of partner safety. Previous research has indicated that young people believe that unprotected sex with a new/casual partner poses a greater risk than with a regular partner (Crawford, Turtle, & Kippax, 1990). However, a clear distinction must be made between familiar and unfamiliar new partners, as individuals have been shown to rely upon irrelevant factors, such as attractiveness and familiarity, to judge the relative safety of new sexual partners (e.g., Canin, Dolcini, & Adler, 1999; Kelly & Kalichman, 1995; Williams et al.; 1992). The current study aimed to examine the impact of partner familiarity on perceptions of partner appeal and STI transmission risk. Eighty-two undergraduate students (53 women) were presented with eight different vignettes and judged the hypothetical partners presented in each scenario. Vignette partners who were described as being familiar were judged to be more appealing sexually and romantically, more trustworthy, and lower risk for STI transmission. These findings support the idea that familiarity can be established relatively quickly and that familiarity indeed impacts perceptions of new sexual partners, such that individuals may engage in increased risk-taking with more familiar new partners, despite knowing next to nothing about their sexual history. Further, the current findings suggest that partner familiarity is an important dimension to consider when examining sexual risk-taking with casual or new sexual partners.

Dual method use among a sample of first-year college women

CONTEXT

Dual method use-using one protective method to reduce the risk of STDs and another to prevent pregnancy-is effective but understudied. No prior studies have employed an event-level approach to examining characteristics associated with dual method use among college women.

METHODS

In 12 consecutive monthly surveys conducted in 2009-2010, data on 1,843 vaginal intercourse events were collected from 296 first-year college women. Women reported on their use of condoms and hormonal contraceptives during all events. Multilevel regression analysis was used to assess associations between event-, month- and person-level characteristics and hormonal use and dual method use.

RESULTS

Women used hormonal contraceptives during 53% of events and condoms during 63%. Dual method use was reported 28% of the time, and only 14% of participants were consistent users of dual methods. The likelihood of dual method use was elevated when sex partners were friends as opposed to romantic partners or ex-boyfriends (odds ratios, 2.5-2.8), and among women who had received an STD diagnosis prior to college (coefficient, 2.9); it also increased with level of religiosity (0.8). Dual use was less likely when less reliable methods were used (odds ratio, 0.2) and when women reported more months of hormonal use (0.8), were older than 18 (coefficient, -4.7) and had had a greater number of partners before college (-0.3).

CONCLUSIONS

A better understanding of the characteristics associated with dual method use may help in the design of potential intervention efforts.

A qualitative examination of men's condom use attitudes and resistance: "it's just part of the game"

The purpose of this study was to investigate the variability in young heterosexual men's perceptions of the advantages and disadvantages of condom use in their casual sexual relationships. Because men who perceive greater disadvantages of condom use may be more likely to resist using them, we also explored the tactics that men employ to avoid using condoms. Semi-structured focus groups were conducted with single men who have sex with women (n = 60), aged 21-35 years, all of whom reported using condoms inconsistently. Transcripts were analyzed using a framework analysis approach. As expected, participants reported advantages and disadvantages to condom use that pertained to the likelihood and quality of sex, physical sensations during intercourse, and the risk of sexually transmitted infections and unwanted pregnancies. Within each of these topics, however, participants' appraisals of the relative pros and cons of condom use varied considerably. Additionally, participants reported that men use a wide range of condom use resistance tactics, including seduction, deception, and condom sabotage, and that the use of these tactics was viewed as normative behavior for men their age. These findings suggest that the effectiveness of sexual health prevention efforts could be enhanced by increasing young men's motivations to use condoms and by targeting social norms regarding condom use resistance. Additionally, the issue of men's condom use resistance clearly merits increased empirical investigation and intervention attention.

Condom use motivations and selected behaviours with new versus established sex partners

Objective To compare condom use motives and behaviours in the context of penile–vaginal intercourse (PVI) with new versus established sexual partners, using daily event-level data among a clinic-recruited sample. Methods: Participants (ages 15–65 years old) were recruited from five sexually transmissible infection (STI) clinics in three United States cities. They were provided with personal digital assistants and instructed to respond to daily questionnaire items regarding PVI events from the past 24 h. Generalised estimations equations were used to make inferences on age-adjusted estimated odds ratios, comparing events occurring with established versus new partners. Results: For males, pregnancy prevention was a more common motivation for condom use in new relationships (P < 0.001). Males with new sex partners were more likely to report condom use (P < 0.005) and also reported fewer errors or problems in condom use with new sex partners (P < 0.001). For females, pregnancy prevention (P = 0.03), STI acquisition (P < 0.001) and STI transmission (P = 0.005) were more likely to be motives for condom use with new versus established partners. Also, females with new sex partners were more likely to report condom use (P < 0.001) as well as using multiple condoms during a single event (P = 0.03). Conclusion: Event-level findings suggest that condom use motivations and behaviours vary depending on whether PVI occurs between established versus new sex partners. Condom use is more likely for PVI with new partners, but other condom-associated behaviours and motivations differ between females and males.

Schoolgirls and soccer moms: a content analysis of free "teen" and "MILF" online pornography

Viewing free online pornographic videos has increasingly become a common behavior among young people, although little is known about the content of these videos. The current study analyzed the content of two popular female-age-based types of free, online pornography (teen and MILF) and examined nuances in the portrayal of gender and access to power in relation to the age of the female actor. A total of 100 videos were selected from 10 popular Web sites, and their content was coded using independent raters. Vaginal intercourse and fellatio were the most frequently depicted sexual acts. The use of sex toys, paraphilias, cuddling, and condom use were rare, as were depictions of coercion. Control of the pace and direction of sexual activity was typically shared by the male and female actors. Moreover, there were no gender differences in initiation of sexual activity, use of persuasion, portrayals of sexual experience, or in professional status. However, female actors in MILF videos were portrayed as more agentic and were more likely to initiate sexual activity, control the pace of sexual activity, and have a higher professional status. Implications regarding the role of pornography in generating or reinforcing sexual norms or scripts are discussed.

An examination of the principles of influence on condom use decision making during casual sex encounters

Cialdini's (1984) principles of influence were employed to inform the decision-making process with respect to using condoms during casual sex. In the current study, focus groups (n = 9) were conducted to understand the relationship between the six principles of influence (authority, consistency, liking, reciprocity, scarcity, and social proof) and condom use in casual sex relationships. Results revealed that authority, consistency, and social proof were endorsed often as influencing condom use. Gender differences in the endorsement of the principles were also observed. The results speak to how these principles of influence aide the condom decision-making process during these often spontaneous sexual encounters and are discussed with an emphasis on the theoretical and practical implications for using these principles in future health campaigns.

A qualitative study of Ottawa university students' awareness, knowledge and perceptions of infertility, infertility risk factors and assisted reproductive technologies (ART)

BACKGROUND

Awareness of infertility risk factors is an essential first step to safeguard future fertility. Whereas several studies have examined university students' awareness of female fertility and related risk factors, the topic of male infertility has not been well examined. The objective of this study was to assess young men and women's awareness, knowledge and perceptions of infertility, male and female infertility risk factors and assisted reproductive technologies (ART).

METHODS

Semi-structured interviews were conducted in 2008 with a multi-ethnic sample of sixteen male and twenty-three female Ottawa university students, followed by qualitative data analysis to identify major themes. Interview topics included awareness of male and female infertility risk factors, infertility diagnosis/treatments and personal options in the event of future infertility.

RESULTS

Participants were generally familiar with infertility as a biomedical health problem, could identify sex-specific risk factors but overestimated fertility of women in their thirties and ART success rates. Reproductive health knowledge gaps and confusion of the physiological life-stage of menopause with infertility were apparent. Most participants would pursue in vitro fertilization or international adoption in the event of personal infertility. Some participants wished to use a 'natural' approach and were concerned with potential side effects of ART-related medications.

CONCLUSIONS

The general awareness of infertility in young adults is promising and supports the potential uptake for health promotion of fertility preservation. This study underscores the continued need for comprehensive sexual and reproductive health education and promotion for adolescents and young adults.

Dual use of long-acting reversible contraceptives and condoms among adolescents

Unintended pregnancy and sexually transmitted infections (STI) continue to be significant public health problems, and adolescents are disproportionately affected by both. With national attention and funding directed toward adolescent pregnancy prevention, promotion of long-acting reversible contraceptive (LARC) use among adolescents is both timely and relevant. However, LARCs provide no protection against STIs, requiring dual-method use of both LARC and barrier methods, most commonly the male latex condom, to address these issues simultaneously. Rates of both LARC and dual-method contraception are low in the United States, but have increased in recent years. Dual-method contraception is highest among younger women and adolescents with multiple or new sex partners. Consistent condom use remains a major barrier to dual-method use, as it necessitates admission of STI risk by both partners, and use is dependent upon two decision-makers rather than a single contraceptive user. Promoting the initiation and maintenance of LARC and condom use across multiple partnered sexual encounters requires understanding of individual, dyadic, and social influences. Successful maintenance of contraceptive and STI prevention behaviors requires individualized, longitudinal reinforcement, and social supports, but can ultimately reduce the burden of unintended pregnancy and STI among adolescents.

Inner contradictions among men who bareback

Barebacking, or intentional unprotected anal intercourse when HIV transmission can occur, emerged as a descriptive term in the 1990s, and marked greater acceptance by gay and bisexual men of dispensing with condom use under certain circumstances. In an exploratory study of men who used Internet sites to meet partners and reported recent episodes of barebacking, respondents outlined numerous strategies they deployed to avoid HIV infection instead of universal condom use. However, in interviews many participants acknowledged uneasiness with the flaws in their chosen strategies, and the contradiction between their urgent desire to remain HIV-free and their sexual practices. For some, the dissonance between the conflicting cognitions could be resolved through self-justification, mental compartmentalization, or invincibility beliefs so that barebacking could continue. For this subpopulation, continued reiteration of cognitive-based prevention messages has the potential to reinforce rather than undermine their attachment to inadequate strategies for disease avoidance.

Relative efficacy of a pregnancy, sexually transmitted infection, or human immunodeficiency virus prevention-focused intervention on changing sexual risk behavior among young adults

OBJECTIVES

Despite findings suggesting that young adults are more concerned about experiencing an unplanned pregnancy or contracting a sexually transmitted infection (STI) than becoming human immunodeficiency virus (HIV) infected, no empirical work has investigated whether the specific focus of an intervention may be more or less efficacious at changing sexual behavior.

PARTICIPANTS

Participants were 198 college students randomized to 1 of 4 conditions: pregnancy intervention, STI intervention, HIV intervention, or a control condition during 2008-2009.

METHODS

The authors compared the efficacy of 3 theory-based, sexual risk-reduction interventions that were exactly the same except for an exclusive focus on preventing pregnancy, STI, or HIV. Condom use and risky sexual behavior were assessed at baseline and 4-week and 8-week follow-up.

RESULTS

Participants exposed to the pregnancy or STI interventions reported greater condom use and less risky sexual behavior than those exposed to the HIV intervention.

CONCLUSIONS

The focus of sexual risk-reduction interventions may lead to differential behavior change among young adults.

Everywhere you go, everyone is saying condom, condom. But are they being used consistently? Reflections of South African male students about male and female condom use

Young men in South Africa can play a critical role in preventing new human immunodeficiency virus (HIV) infections, yet are seldom targeted for HIV prevention. While reported condom use at last sex has increased considerably among young people, consistent condom use remains a challenge. In this study, 74 male higher education students gave their perspectives on male and female condoms in 10 focus group discussions. All believed that condoms should be used when wanting to prevent conception and protect against HIV, although many indicated that consistent condom use was seldom attained, if at all. Three possible situations for not using condoms were noted: (i) when sex happens in the heat of the moment and condoms are unavailable, (ii) when sexual partnerships have matured and (iii) when female partners implicitly accept unprotected sex. Men viewed it as their responsibility to have male condoms available, but attitudes about whose decision it was to initiate condom use were mixed. Almost all sexually active men had male condom experience; however, very few had used female condoms. Prevention initiatives should challenge traditional gendered norms that underpin poor condom uptake and continued use and build on the apparent shifts in these norms that are allowing women greater sexual agency.

The impact of mental health problems and religiosity on African-American girls' HIV-risk

We investigated the relationship between religiosity, mental health problems, and two sexual risk behaviors-condom use and number of partners. Participants were 80 sexually active African American girls in psychiatric care and their caregivers. Results indicated differential relationships, depending on parent versus youth report. Mother's religiosity was positively related to girls' condom use and not to girls' number of partners. Controlling for other predictors in the models, mother's religiosity explained as much as 15% of the variance in girls' condom use. Whereas parent and adolescent reports of girls' depression/anxiety and rule-breaking were positively associated with number of partners, reports of aggression were associated with having fewer partners. Neither parent nor youth reports of girls' mental health problems were associated with condom use. Controlling for other predictors in the models, girls' mental health problems accounted for as much as 31% of the variance in number of partners. Findings underscore the importance of adopting an ecological framework to understand both the risk and promotive factors for sexual risk taking among troubled girls. The roles of specific aspects of psychopathology and religiosity in relation to sexual risk behavior among African American girls in psychiatric care are discussed.