Affective associations mediate cognitive influences on adolescent condom use

BACKGROUND: Despite the well-known efficacy of condoms as a means of avoiding unwanted pregnancy and STIs, fewer than half of college students consistently use condoms. Much of the work on condom use and health decision-making focuses on cognitive and social factors (e.g., attitudes, social norms). In other domains, affective associations, the feelings and emotions individuals associate with a behavioral choice, have been shown to both influence behavior and mediate the influence of cognitive beliefs on behavioral choices. The purpose of this study was to examine whether behavioral affective associations with condoms predicted college students' condom use, and whether affective associations mediated the influences of known cognitive beliefs. METHOD: Sexually active college students ages 18 to 28 (N=81) self-reported their level of sexual activity, use of condoms, risk perceptions, and their affective associations, cognitive beliefs, and perceived social norms about condom use. RESULTS: Controlling for age, gender, and relationship status, neither social norms nor risk perceptions were associated with condom use. However, more positive affective associations with and beliefs about condoms were associated with a greater odds of currently using them (affective associations: OR=1.99, p<0.01; cognitive beliefs: OR=1.74, p=0.05). Moreover, affective associations fully mediated the influence of cognitive beliefs on current condom use (Sobel's z=2.42, p=0.01). CONCLUSIONS: Affective associations may influence the condom use decisions of college students. Interventions that stress accurate risk perceptions and attribute risky behavior to deliberative and cognitive decision-making may benefit from explicitly addressing the influential role of affect in decision-making.