Increasing condom use by changing people's feelings about them: An experimental study

Objective: Given the well-documented efficacy of condoms as a means of preventing pregnancy and sexually transmitted infection transmission, the low rates of condom use among young adults necessitates a deeper understanding of the factors that influence condom use decision making. The central purpose of the current study was to examine how experimentally manipulated affective associations with condoms influence subsequent behavior in a condom selection task, thereby providing support for a causal relation of affective associations to behavior in this health domain. Method: Following a baseline assessment of cognitively based beliefs and affective associations, participants' (N = 171) affective associations with condoms were experimentally manipulated with an evaluative conditioning (EC) procedure. Images of condoms were paired repeatedly with positive or neutral affective stimuli. The key outcome measure was a behavioral choice task in which participants selected condoms upon completion of the experiment. Results: Participants in the positive condition reported more positive affective associations post-EC compared with those in the neutral condition, β = 0.33, p = .025, 95% CI (0.041, 0.63). For participants who regularly used condoms at baseline, those in the positive condition also selected significantly more condoms, RR = 1.39, p = .015, 95% CI (1.07, 1.83). This condition effect on behavior was partially mediated by the change in affective associations. There was no effect of condition on condom selection among participants who rarely used condoms at baseline. Conclusion: The current study extends our theoretical understanding of the affect-behavior relation in the realm of condom use, and provides preliminary support for interventions that target affective associations with condoms.