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Association between Relationship Characteristics, Sexual Health Attitudes, and Dual Contraceptive Use among Young Adult College Students Aged 18-24

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Title: Association between Relationship Characteristics, Sexual Health Attitudes, and Dual Contraceptive Use among Young Adult College Students Aged 18-24
Language: English
Authors: Casola, Allison R., Matson, Pamela A., Jones, Resa M.
Source: Journal of American College Health. 2022 70(1):314-324.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 11
Publication Date: 2022
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: College Students, Interpersonal Relationship, Sexuality, Health Behavior, Student Attitudes, Contraception, Pregnancy, Intimacy, Trust (Psychology), Depression (Psychology), Self Esteem, Sexual Abuse, Student Characteristics, Sexually Transmitted Diseases
Assessment and Survey Identifiers: Rosenberg Self Esteem Scale, Center for Epidemiologic Studies Depression Scale
DOI: 10.1080/07448481.2020.1751172
ISSN: 0744-8481
Abstract: Objective: Determine the relationship characteristics, sexual health attitudes, and demographic factors associated with dual contraceptive use among college students. Participants: September-October 2018 via campus email, we recruited College of Public Health students attending a large, urban, public university (N= 424). Methods: Respondents completed a cross-sectional, Web-based sexual health questionnaire. Descriptive statistics were calculated. Multiple logistic regression models were run to determine the association between relationship characteristics, pregnancy and condom attitudes, demographics, and dual use the last time having sex. Results: In independent models, one-unit increase in trust (aOR = 0.982; 95% CI: 0.966-0.998) and commitment score (aOR = 0.987, 95% CI: 0.976-0.999) was inversely associated with dual use while sex with a casual date/acquaintance (aOR = 3.149; 95% CI: 1.550-6.397) was positively associated. In a fully adjusted model for all correlates, only trust score was significant (aOR = 0.982; 95% CI: 0.966, 0.998). Conclusions: Emotion-based constructs may be more influential on dual use behaviors than discrete relationship factors.
Abstractor: As Provided
Entry Date: 2022
Accession Number: EJ1328562
Database: ERIC
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  Value: <anid>AN0155283005;acl01jan.22;2022Feb18.02:10;v2.2.500</anid> <title id="AN0155283005-1">Association between relationship characteristics, sexual health attitudes, and dual contraceptive use among young adult college students aged 18–24 </title> <p>Objective Determine the relationship characteristics, sexual health attitudes, and demographic factors associated with dual contraceptive use among college students. Participants: September–October 2018 via campus email, we recruited College of Public Health students attending a large, urban, public university (N = 424). Methods: Respondents completed a cross-sectional, Web-based sexual health questionnaire. Descriptive statistics were calculated. Multiple logistic regression models were run to determine the association between relationship characteristics, pregnancy and condom attitudes, demographics, and dual use the last time having sex. Results: In independent models, one-unit increase in trust (aOR = 0.982; 95% CI: 0.966–0.998) and commitment score (aOR = 0.987, 95% CI: 0.976–0.999) was inversely associated with dual use while sex with a casual date/acquaintance (aOR = 3.149; 95% CI: 1.550–6.397) was positively associated. In a fully adjusted model for all correlates, only trust score was significant (aOR = 0.982; 95% CI: 0.966, 0.998). Conclusions: Emotion-based constructs may be more influential on dual use behaviors than discrete relationship factors.</p> <p>Keywords: dual contraceptive use; partner label; partner trust; sexual behavior</p> <p>Young adults (YA) aged 18–24 are disproportionally affected by adverse sexual and reproductive health outcomes, such as unintended pregnancy and sexually transmitted infections (STI).[<reflink idref="bib1" id="ref1">1</reflink>],[<reflink idref="bib2" id="ref2">2</reflink>] YAs account for the highest pregnancy rates (∼76 per 1,000) and incident STI cases (10 million) among all age groups in the United States.[<reflink idref="bib3" id="ref3">3</reflink>],[<reflink idref="bib4" id="ref4">4</reflink>] Unintended pregnancy can lead to long-term financial hardships and physical and psychological distress for young parents and their child, as young parents are more likely to live below the poverty line and rely on public assistance, receive delayed prenatal care, and have babies born preterm.[<reflink idref="bib5" id="ref5">5</reflink>] Additionally, while some STIs are curable if caught early, if left untreated they can have lasting complications among both males and females.[<reflink idref="bib6" id="ref6">6</reflink>]</p> <p>Fortunately, both YA pregnancy and STI incidence are preventable. Highly effective contraceptive methods, like long-acting reversible contraceptives (LARC), are most effective in preventing pregnancy but offer no protection against STIs. Conversely, condoms are the only method to protect against STIs but are less effective against pregnancy than LARCs.[<reflink idref="bib7" id="ref7">7</reflink>] Thus, dual protection, concurrent use of a highly effective method and a condom, is noted as the best way to prevent both UP and STIs.[<reflink idref="bib8" id="ref8">8</reflink>],[<reflink idref="bib9" id="ref9">9</reflink>] However, YA dual method use remains low.[<reflink idref="bib10" id="ref10">10</reflink>]</p> <p>College students account for about 43% of all YAs ages 18–24.[<reflink idref="bib11" id="ref11">11</reflink>] This subgroup tends to be a vulnerable, high-risk population – with increased rates of sexual activity and low prevalence of contraceptive and condom use.[<reflink idref="bib12" id="ref12">12</reflink>],[<reflink idref="bib13" id="ref13">13</reflink>] Further, YA college students are in the midst of life course transitions as they move into emergent adulthood, a developmental period characterized by personal identity exploration and development of behavioral patterns that can influence emotional and physical health functioning later in life.[<reflink idref="bib14" id="ref14">14</reflink>],[<reflink idref="bib15" id="ref15">15</reflink>] During this time, students may develop an increased sense of personal autonomy, greater confidence in their decision-making abilities, and explore new and/or unique social and sexual interactions and relationships.[<reflink idref="bib14" id="ref16">14</reflink>]</p> <p>From an interpersonal standpoint, current research has found greater trust,[<reflink idref="bib16" id="ref17">16</reflink>] exclusivity,[<reflink idref="bib9" id="ref18">9</reflink>] relationship commitment[<reflink idref="bib17" id="ref19">17</reflink>] and intimacy,[<reflink idref="bib18" id="ref20">18</reflink>],[<reflink idref="bib19" id="ref21">19</reflink>] and being in steady, long-term partnerships[<reflink idref="bib13" id="ref22">13</reflink>],[[<reflink idref="bib20" id="ref23">20</reflink>], [<reflink idref="bib22" id="ref24">22</reflink>]] associated with decreased contraceptive use and/or use of less effective contraceptive methods and increased risk of an STI. However, the landscape of YA relationships and sexual experiences is changing. YAs may have multiple, concurrent partners[<reflink idref="bib17" id="ref25">17</reflink>] or partner commitment without a traditional "boyfriend" or "girlfriend" label.[<reflink idref="bib22" id="ref26">22</reflink>],[<reflink idref="bib24" id="ref27">24</reflink>],[<reflink idref="bib25" id="ref28">25</reflink>] Given the pervasiveness of sexual activity among college students and the on-going changes in relationships, additional research is needed to further examine the variety of relationship characteristics, outside of fixed labels, associated with dual use behavior in order to better elucidate the spectrum of partnership factors related to YA method use and STI risk.[<reflink idref="bib9" id="ref29">9</reflink>],[<reflink idref="bib14" id="ref30">14</reflink>],[<reflink idref="bib15" id="ref31">15</reflink>],[<reflink idref="bib17" id="ref32">17</reflink>],[<reflink idref="bib26" id="ref33">26</reflink>],[<reflink idref="bib27" id="ref34">27</reflink>]</p> <p>The purpose of this study was to determine the relationship characteristics, pregnancy and condom attitudes, and demographic factors associated with dual contraceptive use among a sample of YA, ages 18-24, attending a large, urban public university. The Theory of Triadic Influence (TTI) was used as the theoretical framework for this study.[<reflink idref="bib28" id="ref35">28</reflink>] TTI is a comprehensive theory that allows for multiple determinants of health behaviors to be examined.[<reflink idref="bib28" id="ref36">28</reflink>] It postulates that health behavior is influenced by intrapersonal factors, interpersonal factors, and cultural-environmental factors.[<reflink idref="bib28" id="ref37">28</reflink>] In this study, we examined the interpersonal social factors that contribute to socio-normative beliefs about dual use, hence selection of partner trust and commitment, partner type, and perceived partner exclusivity measures. This theoretical framework, coupled with findings from prior research[<reflink idref="bib18" id="ref38">18</reflink>],[<reflink idref="bib19" id="ref39">19</reflink>],[<reflink idref="bib22" id="ref40">22</reflink>],[<reflink idref="bib24" id="ref41">24</reflink>],[<reflink idref="bib25" id="ref42">25</reflink>], provided support for our hypotheses: perceived non-exclusive partnerships, and having a non-romantic partner are associated with dual method use, while increased partner trust and increased partner commitment are inversely associated with dual method use the last time having sex.</p> <hd id="AN0155283005-2">Methods</hd> <p></p> <hd id="AN0155283005-3">Setting</hd> <p>The setting for this cross-sectional study was a large, urban university in the Northeastern United States. The university enrolls approximately 40,000 students per year and houses colleges of business, liberal arts, science and technology, and public health.</p> <hd id="AN0155283005-4">Study population and eligibility</hd> <p>All students aged 18–24 in the College of Public Health were eligible to complete a sexual and reproductive health questionnaire. Respondents were excluded from the analytic sample if they reported never having sexual intercourse during their lifetime or were not at risk for pregnancy the last time having sex, in that they only had anal sex, were trying to get pregnant, identify as male but did not have a female partner, identify as female but did not have a male partner, or had incomplete data at the item-level for the variables included in the analysis.</p> <hd id="AN0155283005-5">Questionnaire development</hd> <p>TTI guided questionnaire development.[<reflink idref="bib28" id="ref43">28</reflink>] Thus, questionnaire items included: demographics, sexual history, partner relationship factors, partner sexual violence, substance use, depressive symptoms and self-esteem, sexual health knowledge, sexual health attitudes, and self-efficacy to use a condom.</p> <hd id="AN0155283005-6">Sampling</hd> <p>The questionnaire was distributed via campus email in September and October 2018. The email included an invitation letter with informed consent language describing the study and the questionnaire link. An invitation letter with informed consent language was utilized, versus a traditional informed consent form, to retain participant anonymity (Temple University Institutional Review Board (IRB), #25316). The questionnaire took approximately 15–17 minutes to complete, and upon submission, students had the option of being directed to an external link to enter their email address for a chance to win one of 50 $10 gift cards to a local food establishment on campus.</p> <hd id="AN0155283005-7">Study measures and coding</hd> <p></p> <hd id="AN0155283005-8">Relationship characteristics</hd> <p>Four main independent variables were used to examine relationship characteristics. <emph>Commitment</emph> to last sexual partner was measured using the previously validated 7-item Investment Model Commitment Subscale (α = 0.97).[<reflink idref="bib29" id="ref44">29</reflink>] Item responses (e.g. "I want our relationship to last for a very long time"<emph>)</emph> were measured on a 9-point Likert scale: 0 (do not agree at all) to 8 (agree completely).[<reflink idref="bib29" id="ref45">29</reflink>] Partner commitment scores were calculated by taking the sum of all seven items, where higher scores denoted greater commitment with last sexual partner (range: 0–56).[<reflink idref="bib29" id="ref46">29</reflink>]<emph>Partner trust</emph> was measured using the previously validated 8-item Dyadic Trust Scale (<emph>α</emph> = 0.93).[<reflink idref="bib30" id="ref47">30</reflink>] Item responses, adapted to refer to the respondent's last sexual partner, were measured on a 7-point Likert scale from 1 (strongly disagree) to 7 (strongly agree).[<reflink idref="bib30" id="ref48">30</reflink>] Two additional measures: closeness ("<emph>I felt close to the partner I last had sex with")</emph> and love ("<emph>I loved the partner I last had sex with")</emph> were included in this scale. Total partner trust score was calculated by taking the sum of all 10 items where higher scores denoted greater feelings of trust toward the respondent's last sexual partner (range: 10-70).[<reflink idref="bib30" id="ref49">30</reflink>] Psychometrics of these two scales in our sample exhibited moderate to high internal consistency (partner trust: α = 0.93; partner commitment: α = 0.97).</p> <p> <emph>Partner label</emph> was measured by the question: "How would you best describe your last sexual partner?"[<reflink idref="bib25" id="ref50">25</reflink>],[<reflink idref="bib31" id="ref51">31</reflink>] Response choices included: romantic partner, casual date, stranger, acquaintance, friend, former romantic partner (an ex), and other. These responses were treated categorically with casual date and acquaintance being combined into a single category.[<reflink idref="bib12" id="ref52">12</reflink>] Responses of "other" were placed into the group best described by the specified label. Perceived <emph>partner exclusivity</emph> was measured by the question: "To the best of your knowledge, did this person have other sex partners while you were having a sexual relationship?".[<reflink idref="bib19" id="ref53">19</reflink>] Responses were measured categorically: yes [not exclusive], no [exclusive], and don't know.</p> <hd id="AN0155283005-9">Additional measures</hd> <p>Depressive symptoms, self-esteem, pregnancy attitudes, and condom attitudes were examined as covariates. <emph>Depressive symptoms</emph> were measured using the previously validated 10-item CES-D short form (α = 0.89).[<reflink idref="bib32" id="ref54">32</reflink>] All 10 items (e.g. "During the past week...I felt hopeful about the future.") were measured on a 4-point Likert scale: 0 (rarely or none of the time [less than 1 day] to 3 (all of the time [5-7 days]). Total scores are the sum of all items. Higher scores denote greater depressive symptoms (range: 0-30).[<reflink idref="bib32" id="ref55">32</reflink>]<emph>Self-esteem</emph> was measured using the previously validated 10-item Rosenberg Self-Esteem Scale (α = 0.86).[<reflink idref="bib33" id="ref56">33</reflink>] Items (e.g. "I feel I do not have much to be proud of.") were measured on a 4-point Likert scale: 4 (strongly agree) to 1 (strongly disagree). The total score was calculated by summing each item. Higher scores denoted higher self-esteem (range: 10–40).[<reflink idref="bib33" id="ref57">33</reflink>]<emph>Pregnancy attitudes</emph> were measured using the previously validated 5-item Attitudes Toward Potential Pregnancy Scale (α = 0.86). Item responses (e.g. "On a scale from 1 to 5 where 1 is not at all important and 5 is very important, right now how important is it to you to avoid becoming pregnant or getting the partner you last had sex with pregnant?") were measured on a 5-point analog scale anchored by a low response choice as 1 and a high response choice as 5.[<reflink idref="bib34" id="ref58">34</reflink>] Total attitude score was the sum of all items, where higher scores represented more positive pregnancy attitudes (range: 5-25).[<reflink idref="bib34" id="ref59">34</reflink>]<emph>Condom attitudes</emph> were measured using the previously validated 14-item Multi-Factor Attitudes Toward Condom Scale instrument (α = 0.82).[<reflink idref="bib35" id="ref60">35</reflink>] Items were measured on a 7-point semantic differential scale.[<reflink idref="bib35" id="ref61">35</reflink>] All items (e.g. "How comfortable do you think condoms are?") were reverse coded and summed so higher scores correspond to more positive attitudes (range: 14–98).[<reflink idref="bib35" id="ref62">35</reflink>] Psychometrics of these scales in our sample exhibited moderate to high internal consistency (depressive symptoms: α = 0.84; self-esteem: α = 0.91; pregnancy attitude: α = 0.76; condom attitude: α = 0.79).</p> <p>Other variables included were sex ("What is your sex?"; male, female), race ("Which of the following best describes you?"; white, Black, Asian, two or more races), Hispanic ethnicity ("Are you Hispanic or Latino?"; yes, no), age ("What is your age?"; years, range: 18-24), education ("What year are you?"; freshman/first year, sophomore, junior, senior, graduate student), age of sexual debut ("How old were you the first time you had sexual intercourse?"; years, range: 12-23), number of lifetime sexual partners ("During your lifetime, with how many partners have you had sexual intercourse?"; 1 person, 2–3 people, 4–9 people, 10 or more people), history of STI testing ("Have you ever been tested for a STI?"; no or not sure, yes), history of STI diagnosis ("Have you ever been diagnosed with a STI?"; no or not sure, yes), history of sexual violence ("Has an intimate partner ever forced you to have sex, even when you did not want to?"; yes, no), pregnancy history ("Have you ever been pregnant or gotten someone pregnant?"; yes, no), alcohol use [in the past 30 days] ("Within the last 30 days, on how many days did you use alcohol:"; never, have used but not in past 30 days, 1–2 days, 3–5 days, 6–9 days, 10-30 days), and marijuana use [in the past 30 days] ("Within the last 30 days, on how many days did you use marijuana:"; never, have used but not in past 30 days, 1–2 days, 3–9 days, 10–30 days).</p> <hd id="AN0155283005-10">Dual contraceptive use</hd> <p>The dependent variable was <emph>dual contraceptive use</emph>, measured by the question: "The last time you had sexual intercourse, what method did you or your partner use to prevent pregnancy? (Select all that apply)" with response options: "no method, birth control pills, condom, intrauterine device [IUD], implant, birth control shot, birth control patch, vaginal ring, withdrawal, not sure, or other". Method options were coded as: dual method users (condom and one of the following methods: IUD, implant, birth control pills, shot, patch, or vaginal ring) and non-users (use of a single method, withdrawal method, or no method). This dichotomous coding scheme is similar to a prior study by Goldstein et al.[<reflink idref="bib23" id="ref63">23</reflink>] Several other studies have also defined dual use as condom use and an effective method, such any hormonal method or long-acting method.[[<reflink idref="bib36" id="ref64">36</reflink>], [<reflink idref="bib38" id="ref65">38</reflink>]]</p> <hd id="AN0155283005-11">Statistical analysis</hd> <p>SAS 9.4 PROC FREQ, MEANS, and LOGISTIC were used to complete the study analyses (version 9.4, SAS Institute Inc, Cary, NC, 2017). Descriptive statistics were calculated. Internal consistency was assessed for all scales. Bivariate logistic regression models were fit for each independent variable and dual method use, as well as each covariate. Significant variables (p ≤ 0.25) at the bivariate level were retained and entered into the multivariable models. This preliminary cut point was selected because using more traditional cut-points (e.g. p < 0.05) may fail to identify important variables.[<reflink idref="bib39" id="ref66">39</reflink>] All non-correlated eligible variables were entered in the multiple logistic regression model and fit using backward elimination. Overall, five multivariable regression models were fit to determine the association between dual method use: one for each relationship characteristic independently (partner label, partner exclusivity, partner trust, and partner commitment) and one for all four relationship characteristics together. Backward elimination was used to reduce the number of variables in our models and generate the most parsimonious models possible.[<reflink idref="bib40" id="ref67">40</reflink>] Backward elimination also allowed for models to be built sequentially and provided opportunity to examine of a collection of models and maximize goodness of fit (e.g. full models and final models).[<reflink idref="bib40" id="ref68">40</reflink>]</p> <hd id="AN0155283005-12">Results</hd> <p></p> <hd id="AN0155283005-13">Sample characteristics</hd> <p>A total of 1,301 students attempted the questionnaire, but only N = 732 students submitted the questionnaire (56%). The final analytic sample included eligible participants with complete data for the variables included in the analysis (N = 424).</p> <p>Sample characteristics are displayed in Tables 1 and 2. The sample was predominately female (89%) and white (76%), with a mean age of sexual debut of 17 years old (SE = 0.078). Forty-two percent reported having >3 sexual partners during their lifetime, and 20% of the sample reported a history of sexual violence. Sixty-five percent of the sample reported their last sexual partner was a romantic partner, 9% denoted being non-exclusive with their partner, and 15% did not know their partner exclusivity status. About 24% of the sample reported dual method use the last time having sex, and both mean partner trust scores (M = 52.51, SE = 1.598) and partner commitment scores (M = 32.56, SE = 2.107) were significantly lower among dual users than non-users (Trust: M = 56.21, SE = 0.789; Commitment: M = 38.52, SE = 1.089).</p> <p>Table 1. Sample demographic and sexual health characteristics (N = 424).</p> <p> <ephtml> <table><thead><tr><td /><td>N (%)</td></tr></thead><tbody valign="top"><tr><td>Sex</td><td char="(" /></tr><tr><td> Female</td><td char="(">377 (88.9)</td></tr><tr><td> Male</td><td char="(">47 (11.1)</td></tr><tr><td>Race</td><td char="(" /></tr><tr><td> White</td><td char="(">322 (75.9)</td></tr><tr><td> Asian</td><td char="(">48 (11.3)</td></tr><tr><td> Black</td><td char="(">38 (9.0)</td></tr><tr><td> Two or more races</td><td char="(">16 (3.8)</td></tr><tr><td>Ethnicity</td><td char="(" /></tr><tr><td> Non-Hispanic</td><td char="(">395 (93.2)</td></tr><tr><td> Hispanic</td><td char="(">29 (6.8)</td></tr><tr><td>Education year</td><td char="(" /></tr><tr><td> Freshman/First year</td><td char="(">108 (25.5)</td></tr><tr><td> Sophomore</td><td char="(">52 (12.3)</td></tr><tr><td> Junior</td><td char="(">104 (24.5)</td></tr><tr><td> Senior</td><td char="(">96 (22.6)</td></tr><tr><td> Graduate student</td><td char="(">64 (15.1)</td></tr><tr><td>Alcohol use (past 30 days)</td><td char="(" /></tr><tr><td> Never used</td><td char="(">34 (8.0)</td></tr><tr><td> 0 days<xref ref-type="table-fn" rid="tfn2">a</xref></td><td char="(">32 (7.6)</td></tr><tr><td> 1–2 days</td><td char="(">76 (17.9)</td></tr><tr><td> 3–5 days</td><td char="(">118 (27.8)</td></tr><tr><td> 6–9 days</td><td char="(">105 (24.8)</td></tr><tr><td> 10–30 days</td><td char="(">59 (13.9)</td></tr><tr><td>Marijuana use (past 30 days)</td><td char="(" /></tr><tr><td>Never used</td><td char="(">162 (38.2)</td></tr><tr><td> 0 days<xref ref-type="table-fn" rid="tfn3">b</xref></td><td char="(">90 (21.2)</td></tr><tr><td> 1–2 days</td><td char="(">63 (14.9)</td></tr><tr><td> 3–9 days</td><td char="(">55 (13.0)</td></tr><tr><td> 10–30 days</td><td char="(">54 (13.0)</td></tr><tr><td>History of sexual violence<xref ref-type="table-fn" rid="tfn4">c</xref></td><td char="(" /></tr><tr><td> No</td><td char="(">339 (80.0)</td></tr><tr><td> Yes</td><td char="(">85 (20.0)</td></tr><tr><td>Lifetime number of sexual partners</td><td char="(" /></tr><tr><td> 1 person</td><td char="(">130 (30.7)</td></tr><tr><td> 2–3 people</td><td char="(">118 (27.8)</td></tr><tr><td> 4–9 people</td><td char="(">120 (28.3)</td></tr><tr><td> 10 or more people</td><td char="(">56 (13.2)</td></tr><tr><td /><td char="("><bold>Mean (SE)</bold></td></tr><tr><td>Age (years)<xref ref-type="table-fn" rid="tfn5">d</xref></td><td char="(">20.30 (0.088)</td></tr><tr><td>Age of sexual debut (years)<xref ref-type="table-fn" rid="tfn6">e</xref></td><td char="(">16.96 (0.078)</td></tr><tr><td>Pregnancy Attitude Score<xref ref-type="table-fn" rid="tfn7">f</xref></td><td char="(">8.70 (0.206)</td></tr><tr><td>Condom Attitude Score<xref ref-type="table-fn" rid="tfn8">g</xref></td><td char="(">70.18 (0.581)</td></tr></tbody></table> </ephtml> </p> <p>1 SE = Standard Error.</p> <ulist> <item>2 Have used alcohol, but not during the past 30 days.</item> <item>3 Have used marijuana, but not during the past 30 days.</item> <item>4 Question worded: "Has an intimate partner ever forced you to have sex, even when you did not want to?".</item> <item>5 Participant age, in years (range: 18–24).</item> <item>6 Age first had sex, in years (range: 12–23).</item> <item>7 Attitudes Toward Potential Pregnancy score (α = 0.76, range: 5-25). Higher scores denote more positive attitudes toward pregnancy.</item> <item>8 Multi-Factor Attitude toward Condom Scale score (α = 0.79, range: 37–95), adapted to refer to respondent's last sexual partner. Higher scores denote more positive attitudes toward condoms.</item> </ulist> <p>Table 2. Relationship characteristics overall and by dual method use status.</p> <p> <ephtml> <table><thead><tr><td /><td /><td><bold>Dual Method Use</bold><xref ref-type="table-fn" rid="tfn10">a</xref></td><td /></tr><tr><td /><td><bold>Overall</bold> (<italic>N</italic> = 424)</td><td><bold>Yes</bold><xref ref-type="table-fn" rid="tfn11">b</xref> (<italic>N</italic> = 101)</td><td><bold>No</bold><xref ref-type="table-fn" rid="tfn12">c</xref> (<italic>N</italic> = 323)</td><td>p-value</td></tr></thead><tbody valign="top"><tr><td /><td><bold>N (%)</bold></td><td char="(" /></tr><tr><td>Partner label<xref ref-type="table-fn" rid="tfn13">d</xref></td><td char="(" /><td char="(" /><td char="(" /><td char="(">0.021*</td></tr><tr><td> Romantic partner</td><td char="(">277 (65.3)</td><td char="(">57 (56.4)</td><td char="(">220 (68.1)</td><td char="(" /></tr><tr><td> Friend</td><td char="(">51 (12.0)</td><td char="(">15 (14.9)</td><td char="(">36 (11.1)</td><td char="(" /></tr><tr><td> Casual date or acquaintance</td><td char="(">45 (10.6)</td><td char="(">19 (18.8)</td><td char="(">26 (8.0)</td><td char="(" /></tr><tr><td> Former romantic partner<xref ref-type="table-fn" rid="tfn14">e</xref></td><td char="(">43 (10.1)</td><td char="(">8 (7.9)</td><td char="(">35 (10.8)</td><td char="(" /></tr><tr><td> Stranger</td><td char="(">8 (1.9)</td><td char="(">2 (2.0)</td><td char="(">6 (1.9)</td><td char="(" /></tr><tr><td>Partner exclusivity<xref ref-type="table-fn" rid="tfn15">f</xref></td><td char="(" /><td char="(" /><td char="(" /><td char="(">0.170</td></tr><tr><td> Exclusive<xref ref-type="table-fn" rid="tfn16">g</xref></td><td char="(">320 (75.5)</td><td char="(">70 (69.3)</td><td char="(">250 (77.4)</td><td char="(" /></tr><tr><td> Not exclusive<xref ref-type="table-fn" rid="tfn17">h</xref></td><td char="(">40 (9.4)</td><td char="(">21 (20.8)</td><td char="(">30 (9.3)</td><td char="(" /></tr><tr><td>Don't know<xref ref-type="table-fn" rid="tfn18">i</xref></td><td char="(">64 (15.1)</td><td char="(">10 (9.9)</td><td char="(">43 (13.3)</td><td char="(" /></tr><tr><td /><td><bold>Mean (SE)</bold></td><td char="(" /></tr><tr><td>Partner Trust Score<xref ref-type="table-fn" rid="tfn19">j</xref></td><td char="(">55.33 (0.715)</td><td char="(">52.51 (1.598)</td><td char="(">56.21 (0.789)</td><td char="(">0.039*</td></tr><tr><td>Partner Commitment Score<xref ref-type="table-fn" rid="tfn20">k</xref></td><td char="(">37.10 (0.976)</td><td char="(">32.56 (2.107)</td><td char="(">38.52 (1.089)</td><td char="(">0.013*</td></tr></tbody></table> </ephtml> </p> <ulist> <item>9 SE = Standard Error, * = p ≤ 0.05.</item> <item>10 Question worded: "The last time you had sexual intercourse, what method did you or your partner use to prevent pregnancy? (Select all that apply)".</item> <item>11 Use of a condom and a hormonal method: birth control pill, intrauterine device (IUD), implant, birth control shot, birth control patch, or birth control ring, the last time having sex.</item> <item>12 Use of a singleton hormonal method: birth control pill, intrauterine device (IUD), implant, birth control shot, birth control patch, or birth control ring, use of a condom, use of the withdrawal method, or no method the last time having sex.</item> <item>13 Question worded: "How would you best describe your last sexual partner?".</item> <item>14 An "ex" partner.</item> <item>15 Question worded: "To the best of your knowledge, did this person have other sex partners while you were having a sexual relationship?".</item> <item>16 Respondent's last sexual partner did not have any other concurrent sexual partners.</item> <item>17 Respondent's last sexual partner did have other concurrent sexual partners.</item> <item>18 Respondent is unsure if last sexual partner had other concurrent sexual partners.</item> <item>19 Dyadic Trust Scale with two additional items added, adapted to refer to the respondent's last sexual partner (α = 0.93, range: 10-70). Higher scores denote greater level of partner trust.</item> <item>20 Investment Model Commitment Subscale adapted to refer to respondent's last sexual partner (α = 0.97, range: 0-56). Higher scores denote greater level of relationship commitment.</item> </ulist> <hd id="AN0155283005-14">Multivariable models</hd> <p>Table 3 shows the separate multivariable models for each relationship characteristic. Six items were found significantly associated with dual method use (p ≤ 0.25) at the bivariate level and were entered into the multivariable models with each relationship characteristic measure: sex, race, lifetime number of sexual partners, education, pregnancy attitudes score, and condom attitudes score.</p> <p>Table 3. Independent association between relationship characteristics, sexual health covariates, and demographics (<emph>N</emph> = 424).</p> <p> <ephtml> <table><thead><tr><td>Partner trust model variables</td><td>Dual Method Use<xref ref-type="table-fn" rid="tfn22">a</xref> aOR (95% CI)</td></tr><tr><td>Fully Adjusted Model</td><td>Final Model</td></tr></thead><tbody valign="top"><tr><td>Partner trust score<xref ref-type="table-fn" rid="tfn23">b</xref></td><td><bold>0.980 (0.963, 0.997)*</bold></td><td><bold>0.982 (0.966, 0.998)*</bold></td></tr><tr><td>Pregnancy attitude score<xref ref-type="table-fn" rid="tfn24">c</xref></td><td><bold>0.925 (0.866, 0.987)*</bold></td><td><bold>0.926 (0.868, 0.987)*</bold></td></tr><tr><td>Condom attitude score<xref ref-type="table-fn" rid="tfn25">d</xref></td><td><bold>1.052 (1.029, 1.076)*</bold></td><td><bold>1.050 (1.028, 1.074)*</bold></td></tr><tr><td>Lifetime number of sexual partners</td><td /><td /></tr><tr><td> 1 person</td><td>1.000 (ref)</td><td>–</td></tr><tr><td> 2–3 people</td><td>1.000 (0.525, 1.905)</td><td>–</td></tr><tr><td> 4–9 people</td><td>0.611 (0.306, 1.220)</td><td>–</td></tr><tr><td> 10 or more people</td><td>1.328 (0.597, 2.953)</td><td>–</td></tr><tr><td>Education year</td><td /><td /></tr><tr><td> Freshman/first year</td><td>1.000 (ref)</td><td>1.00 (ref)</td></tr><tr><td> Sophomore</td><td>1.650 (0.715, 3.810)</td><td>1.764 (0.780, 3.988)</td></tr><tr><td> Junior</td><td>1.009 (0.483, 2.105)</td><td>0.974 (0.486, 1.950)</td></tr><tr><td> Senior</td><td>1.257 (0.590, 2.679)</td><td>1.153 (0.567, 2.344)</td></tr><tr><td> Graduate student</td><td><bold>2.992 (1.332, 6.720)*</bold></td><td><bold>2.965 (1.394, 6.307)*</bold></td></tr><tr><td>Sex</td><td /><td /></tr><tr><td> Female</td><td>1.000 (ref)</td><td>1.000 (ref)</td></tr><tr><td> Male</td><td><bold>0.292 (0.106, 0.806)*</bold></td><td><bold>0.279 (0.104, 0.750)*</bold></td></tr><tr><td>Race</td><td /><td /></tr><tr><td> White</td><td>1.000 (ref)</td><td>–</td></tr><tr><td> Asian</td><td><bold>0.305 (0.102, 0.917)*</bold></td><td>–</td></tr><tr><td> Black</td><td>0.544 (0.195, 1.520)</td><td>–</td></tr><tr><td> Two or more races</td><td>1.706 (0.521, 5.588)</td><td>–</td></tr><tr><td /><td>Dual Method Use<xref ref-type="table-fn" rid="tfn22">a</xref> aOR (95% CI)</td></tr><tr><td><italic>Partner commitment model variables</italic></td><td>Fully Adjusted Model</td><td>Final Model</td></tr><tr><td>Partner commitment score<sup>e</sup></td><td><bold>0.987 (0.974, 0.999)*</bold></td><td><bold>0.987 (0.976, 0.999)*</bold></td></tr><tr><td>Pregnancy attitude score<xref ref-type="table-fn" rid="tfn24">c</xref></td><td><bold>0.928 (0.868, 0.992)*</bold></td><td><bold>0.929 (0.871, 0.992)*</bold></td></tr><tr><td>Condom attitude score<xref ref-type="table-fn" rid="tfn25">d</xref></td><td><bold>1.050 (1.026, 1.073)*</bold></td><td><bold>1.048 (1.026, 1.071)*</bold></td></tr><tr><td>Lifetime number of sexual partners</td><td /><td /></tr><tr><td> 1 person</td><td>1.000 (ref)</td><td>–</td></tr><tr><td> 2–3 people</td><td>0.930 (0.485, 1.783)</td><td>–</td></tr><tr><td> 4–9 people</td><td>0.598 (0.297, 1.205)</td><td>–</td></tr><tr><td> 10 or more people</td><td>1.321 (0.593, 2.946)</td><td>–</td></tr><tr><td>Education year</td><td /><td /></tr><tr><td> Freshman/first year</td><td>1.000 (ref)</td><td>1.000 (ref)</td></tr><tr><td> Sophomore</td><td>1.538 (0.670, 3.530)</td><td>1.630 (0.724, 3.669)</td></tr><tr><td> Junior</td><td>0.936 (0.451, 1.941)</td><td>0.914 (0.459, 1.823)</td></tr><tr><td> Senior</td><td>1.167 (0.552, 2.467)</td><td>1.071 (0.529, 2.170)</td></tr><tr><td> Graduate student</td><td><bold>2.893 (1.294, 6.471)*</bold></td><td><bold>2.879 (1.361, 6.092)*</bold></td></tr><tr><td>Sex</td><td /><td /></tr><tr><td> Female</td><td>1.000 (ref)</td><td>1.000 (ref)</td></tr><tr><td> Male</td><td><bold>0.289 (0.104, 0.799)</bold></td><td><bold>0.279 (0.104, 0.751)*</bold></td></tr><tr><td>Race</td><td /><td /></tr><tr><td> White</td><td>1.000 (ref)</td><td>–</td></tr><tr><td> Asian</td><td><bold>0.306 (0.102, 0.919)*</bold></td><td>–</td></tr><tr><td> Black</td><td>0.575 (0.206, 1.599)</td><td>–</td></tr><tr><td> Two or more races</td><td>1.617 (0.494, 5.292)</td><td>–</td></tr><tr><td /><td>Dual Method Use<xref ref-type="table-fn" rid="tfn22">a</xref> aOR (95% CI)</td></tr><tr><td><italic>Partner label model variables</italic></td><td>Fully Adjusted Model</td><td>Final Model</td></tr><tr><td>Partner label<xref ref-type="table-fn" rid="tfn27">f</xref></td><td /><td /></tr><tr><td> Romantic partner</td><td>1.000 (ref)</td><td>1.000 (ref)</td></tr><tr><td> Friend</td><td>1.477 (0.688, 3.172)</td><td>1.500 (0.751, 2.995)</td></tr><tr><td> Casual date or acquaintance</td><td><bold>3.315 (1.536, 7.152)*</bold></td><td><bold>3.149 (1.550, 6.397)*</bold></td></tr><tr><td> Former romantic partner<xref ref-type="table-fn" rid="tfn28">g</xref></td><td>1.034 (0.425, 2.513)</td><td>0.950 (0.404, 2.234)</td></tr><tr><td> Stranger</td><td>1.430 (0.246, 8.299)</td><td>1.227 (0.225, 6.704)</td></tr><tr><td>Pregnancy attitude score<xref ref-type="table-fn" rid="tfn24">c</xref></td><td><bold>0.921 (0.861, 0.985)*</bold></td><td>–</td></tr><tr><td>Condom attitude score<xref ref-type="table-fn" rid="tfn25">d</xref></td><td><bold>1.051 (1.027, 1.075)*</bold></td><td><bold>1.046 (1.024, 1.069)*</bold></td></tr><tr><td>Lifetime number of sexual partners</td><td /><td /></tr><tr><td> 1 person</td><td>1.000 (ref)</td><td>–</td></tr><tr><td> 2–3 people</td><td>0.934 (0.484, 1.802)</td><td>–</td></tr><tr><td> 4–9 people</td><td>0.541 (0.261, 1.118)</td><td>–</td></tr><tr><td> 10 or more people</td><td>1.234 (0.542, 2.807)</td><td>–</td></tr><tr><td>Education year</td><td /><td /></tr><tr><td> Freshman/first year</td><td>1.000 (ref)</td><td>–</td></tr><tr><td> Sophomore</td><td>1.447 (0.628, 3.337)</td><td>–</td></tr><tr><td> Junior</td><td>0.896 (0.429, 1.873)</td><td>–</td></tr><tr><td> Senior</td><td>1.112 (0.522, 2.367)</td><td>–</td></tr><tr><td> Graduate student</td><td><bold>2.607 (1.165, 5.835)*</bold></td><td>–</td></tr><tr><td>Sex</td><td /><td /></tr><tr><td> Female</td><td>1.000 (ref)</td><td>1.000 (ref)</td></tr><tr><td> Male</td><td><bold>0.282 (0.101, 0.789)*</bold></td><td><bold>0.331 (0.122, 0.898)*</bold></td></tr><tr><td>Race</td><td /><td /></tr><tr><td> White</td><td>1.000 (ref)</td><td>1.000 (ref)</td></tr><tr><td> Asian</td><td><bold>0.297 (0.098, 0.896)*</bold></td><td><bold>0.263 (0.090, 0.775)*</bold></td></tr><tr><td> Black</td><td>0.543 (0.195, 1.511)</td><td>0.493 (0.181, 1.343)</td></tr><tr><td> Two or more races</td><td>1.618 (0.496, 5.276)</td><td>1.598 (0.512, 4.991)</td></tr><tr><td /><td>Dual Method Use<xref ref-type="table-fn" rid="tfn22">a</xref> aOR (95% CI)</td></tr><tr><td><italic>Partner exclusivity model variables</italic></td><td>Fully Adjusted Model</td><td>Final Model</td></tr><tr><td>Partner Exclusivity<xref ref-type="table-fn" rid="tfn29">h</xref></td><td /><td /></tr><tr><td> Exclusive<xref ref-type="table-fn" rid="tfn30">i</xref></td><td>1.000 (ref)</td><td>1.000 (ref)</td></tr><tr><td> Not Exclusive<xref ref-type="table-fn" rid="tfn31">j</xref></td><td>1.156 (0.502, 2.659)</td><td>1.174 (0.528, 2.612)</td></tr><tr><td>Don't know<xref ref-type="table-fn" rid="tfn32">k</xref></td><td>1.467 (0.752, 2.862)</td><td>1.476 (0.787, 2.769)</td></tr><tr><td>Pregnancy attitude score<xref ref-type="table-fn" rid="tfn24">c</xref></td><td><bold>0.917 (0.859, 0.979)*</bold></td><td><bold>0.919 (0.862, 0.980)*</bold></td></tr><tr><td>Condom attitude score<xref ref-type="table-fn" rid="tfn25">d</xref></td><td><bold>1.049 (1.026, 1.073)*</bold></td><td><bold>1.048 (1.025, 1.071)*</bold></td></tr><tr><td>Lifetime number of sexual partners</td><td /><td /></tr><tr><td> 1 person</td><td>1.000 (ref)</td><td>–</td></tr><tr><td> 2–3 people</td><td>1.009 (0.530, 1.919)</td><td>–</td></tr><tr><td> 4–9 people</td><td>0.655 (0.325, 1.322)</td><td>–</td></tr><tr><td> 10 or more people</td><td>1.442 (0.647, 3.214)</td><td>–</td></tr><tr><td>Education year</td><td /><td /></tr><tr><td> Freshman/first year</td><td>1.000 (ref)</td><td>1.000 (ref)</td></tr><tr><td> Sophomore</td><td>1.498 (0.656, 3.421)</td><td>1.598 (0.712, 3.586)</td></tr><tr><td> Junior</td><td>0.890 (0.428, 1.849)</td><td>0.879 (0.440, 1.759)</td></tr><tr><td> Senior</td><td>1.131 (0.536, 2.389)</td><td>1.064 (0.526, 2.154)</td></tr><tr><td> Graduate student</td><td><bold>2.559 (1.159, 5.653)*</bold></td><td><bold>2.640 (1.259, 5.537)*</bold></td></tr><tr><td>Sex</td><td /><td /></tr><tr><td> Female</td><td>1.000 (ref)</td><td>1.000 (ref)</td></tr><tr><td> Male</td><td><bold>0.296 (0.107, 0.818)*</bold></td><td><bold>0.285 (0.106, 0.767)*</bold></td></tr><tr><td>Race</td><td /><td /></tr><tr><td> White</td><td>1.000 (ref)</td><td><bold>-</bold></td></tr><tr><td> Asian</td><td><bold>0.310 (0.103, 0.932)*</bold></td><td>–</td></tr><tr><td> Black</td><td>0.553 (0.199, 1.539)</td><td>–</td></tr><tr><td>Two or more races</td><td>1.560 (0.478, 5.098)</td><td>–</td></tr></tbody></table> </ephtml> </p> <ulist> <item>21 <emph>Note:</emph> variables not included in the final models after backwards elimination denoted with "-". 95% Confidence intervals that do not contain a value of 1 are indicated in bold and with *. aOR = Adjusted Odds Ratio, CI = Confidence Intervals.</item> <item>22 Use of a condom and a hormonal method: birth control pill, intrauterine device (IUD), implant, birth control shot, birth control patch, or birth control ring, the last time having sex. Reference category: no dual method use.</item> <item>23 Dyadic Trust Scale with two additional items added, adapted to refer to the respondent's last sexual partner (α = 0.93, range: 10-70). Higher scores denote greater level of partner trust.</item> <item>24 Attitudes Toward Potential Pregnancy score (α = 0.76, range: 5-25). Higher scores denote more positive attitudes toward pregnancy.</item> <item>25 Multi-Factor Attitude toward Condom Scale score (α = 0.79, range: 37-95), adapted to refer to respondent's last sexual partner. Higher scores denote more positive attitudes toward condoms.</item> <item>26 Investment Model Commitment Subscale adapted to refer to respondent's last sexual partner (α = 0.97, range: 0-56). Higher scores denote greater level of relationship commitment.</item> <item>27 Question worded: "<emph>How would you best describe your last sexual partner?"</emph>.</item> <item>28 An "ex" partner.</item> <item>29 Question worded: "To the best of your knowledge, did this person have other sex partners while you were having a sexual relationship?".</item> <item>30 Respondent's last sexual partner did not have any other concurrent sexual partners.</item> <item>31 Respondent's last sexual partner did have other concurrent sexual partners.</item> <item>32 Respondent is unsure if last sexual partner had other concurrent sexual partners.</item> </ulist> <hd id="AN0155283005-15">Partner trust</hd> <p>One-unit increase in partner trust score was associated with decreased odds of dual method use (aOR = 0.982; 95% CI: 0.966, 0.998), controlling for pregnancy attitudes score, condom attitudes score, education, and sex.</p> <hd id="AN0155283005-16">Partner commitment</hd> <p>One-unit increase in partner commitment score was inversely associated with odds of dual method use the last time having sex (aOR = 0.987; 95% CI: 0.976, 0.999), controlling for pregnancy attitudes score, condom attitudes score, education, and sex.</p> <hd id="AN0155283005-17">Partner label</hd> <p>Students whose last sexual partner was a casual date or acquaintance had 3.149 times increased odds (95% CI: 1.550, 6.397) of dual method use compared to students who last had sex with a romantic partner, controlling for condom attitudes score, sex, and race.</p> <hd id="AN0155283005-18">Perceived partner exclusivity</hd> <p>Perceived exclusivity status was not associated with dual method use, controlling for pregnancy attitudes score, condom attitudes score, education, and sex.</p> <hd id="AN0155283005-19">All relationship characteristics</hd> <p>Table 4 shows the fully adjusted multivariable model with all variables retained from the bivariate modeling and backward elimination. One-unit increase in partner trust score was associated with decreased odds of dual method use the last time having sex (aOR = 0.982; 95% CI: 0.966, 0.998).</p> <p>Table 4. Multivariable association between relationship characteristics, health correlates, and dual contraceptive method use (N = 424).</p> <p> <ephtml> <table><thead><tr><td /><td>Dual Method Use<xref ref-type="table-fn" rid="tfn34">a</xref> aOR (95% CI)</td></tr><tr><td><italic>Variables</italic></td><td>Fully Adjusted Model</td><td>Final Model</td></tr></thead><tbody valign="top"><tr><td>Partner trust score<xref ref-type="table-fn" rid="tfn35">b</xref></td><td><bold>0.981 (0.956, 1.007)*</bold></td><td><bold>0.982 (0.966, 0.998)*</bold></td></tr><tr><td>Partner commitment score<xref ref-type="table-fn" rid="tfn36">c</xref></td><td>1.000 (0.978, 1.022)</td><td><bold>-</bold></td></tr><tr><td>Partner label<xref ref-type="table-fn" rid="tfn37">d</xref></td><td /><td /></tr><tr><td> Romantic partner</td><td>1.000 (ref)</td><td><bold>-</bold></td></tr><tr><td> Friend</td><td /><td><bold>-</bold></td></tr><tr><td> Casual date or acquaintance</td><td>2.660 (0.942, 7.507)</td><td><bold>-</bold></td></tr><tr><td> Former romantic partner<xref ref-type="table-fn" rid="tfn38">e</xref></td><td>0.827 (0.297, 2.302)</td><td><bold>-</bold></td></tr><tr><td> Stranger</td><td>1.138 (0.159, 8.160)</td><td><bold>-</bold></td></tr><tr><td>Partner exclusivity<xref ref-type="table-fn" rid="tfn39">f</xref></td><td /><td /></tr><tr><td> Exclusive<xref ref-type="table-fn" rid="tfn40">g</xref></td><td>1.000 (ref)</td><td><bold>-</bold></td></tr><tr><td> Not exclusive<xref ref-type="table-fn" rid="tfn41">h</xref></td><td>0.660 (0.235, 1.853)</td><td><bold>-</bold></td></tr><tr><td> Don't know<xref ref-type="table-fn" rid="tfn42">i</xref></td><td>0.733 (0.312, 1.725)</td><td><bold>-</bold></td></tr><tr><td>Pregnancy attitude score<xref ref-type="table-fn" rid="tfn43">j</xref></td><td><bold>0.925 (0.864, 0.991)*</bold></td><td><bold>0.926 (0.868, 0.987)*</bold></td></tr><tr><td>Condom attitude score<xref ref-type="table-fn" rid="tfn44">k</xref></td><td><bold>1.052 (1.028, 1.077)*</bold></td><td><bold>1.050 (1.028, 1.074)*</bold></td></tr><tr><td>Lifetime number of sexual partners</td><td /><td /></tr><tr><td> 1 person</td><td>1.000 (ref)</td><td><bold>-</bold></td></tr><tr><td> 2–3 people</td><td>0.955 (0.488, 1.869)</td><td><bold>-</bold></td></tr><tr><td> 4–9 people</td><td>0.545 (0.261, 1.007)</td><td><bold>-</bold></td></tr><tr><td> 10 or more people</td><td>1.229 (0.537, 2.815)</td><td><bold>-</bold></td></tr><tr><td>Education year</td><td /><td /></tr><tr><td> Freshman/first year</td><td>1.000 (ref)</td><td>1.000 (ref)</td></tr><tr><td> Sophomore</td><td>1.574 (0.672, 3.683)</td><td>1.764 (0.780, 3.988)</td></tr><tr><td> Junior</td><td>0.965 (0.456, 2.042)</td><td>0.974 (0.486, 1.950)</td></tr><tr><td> Senior</td><td>1.217 (0.565, 2.620)</td><td>1.153 (0.567, 2.344)</td></tr><tr><td> Graduate student</td><td><bold>2.814 (1.240, 6.388)*</bold></td><td><bold>2.965 (1.394, 6.307)*</bold></td></tr><tr><td>Sex</td><td /><td /></tr><tr><td> Female</td><td>1.000 (ref)</td><td>1.000 (ref)</td></tr><tr><td> Male</td><td><bold>0.282 (0.101, 0.786)*</bold></td><td><bold>0.279 (0.104, 0.750)*</bold></td></tr><tr><td>Race</td><td /><td /></tr><tr><td> White</td><td>1.000 (ref)</td><td><bold>-</bold></td></tr><tr><td> Asian</td><td><bold>0.288 (0.094, 0.880)*</bold></td><td><bold>-</bold></td></tr><tr><td> Black</td><td>0.524 (0.187, 1.474)</td><td><bold>-</bold></td></tr><tr><td> Two or more races</td><td>1.703 (0.511, 5.674)</td><td><bold>-</bold></td></tr></tbody></table> </ephtml> </p> <ulist> <item>33 <emph>Note:</emph> variables not included in the final models after backwards elimination denoted with "-". 95% Confidence intervals that do not contain a value of 1 are indicated in bold and with *. aOR = Odds Ratio, CI = Confidence Intervals.</item> <item>34 Use of a condom and a hormonal method: birth control pill, intrauterine device (IUD), implant, birth control shot, birth control patch, or birth control ring, the last time having sex. Reference category: no dual method use.</item> <item>35 Dyadic Trust Scale with two additional items added, adapted to refer to the respondent's last sexual partner (α = 0.93, range: 10-70). Higher scores denote greater level of partner trust.</item> <item>36 Investment Model Commitment Subscale adapted to refer to respondent's last sexual partner (α = 0.97, range: 0-56). Higher scores denote greater level of relationship commitment.</item> <item>37 Question worded: "<emph>How would you best describe your last sexual partner?"</emph>.</item> <item>38 An "ex" partner.</item> <item>39 Question worded: "To the best of your knowledge, did this person have other sex partners while you were having a sexual relationship?".</item> <item>40 Respondent's last sexual partner did not have any other concurrent sexual partners.</item> <item>41 Respondent's last sexual partner did have other concurrent sexual partners.</item> <item>42 Respondent is unsure if last sexual partner had other concurrent sexual partners.</item> <item>43 Attitudes Toward Potential Pregnancy score (α = 0.76, range: 5–25). Higher scores denote more positive attitudes toward pregnancy.</item> <item>44 Multi-Factor Attitude toward Condom Scale score (α = 0.79, range: 37–95), adapted to refer to respondent's last sexual partner. Higher scores denote more positive attitudes toward condoms.</item> </ulist> <p>One-unit increase in pregnancy attitudes score was also inversely associated with dual method use (aOR = 0.926; 95% CI: 0.868, 0.987), while a one-unit increase in condom attitudes score was associated with increased odds of dual method use (aOR = 1.050; 95% CI: 1.028, 1.074). Graduate students had 2.965 times increased odds of dual method use compared to freshman/first year students (95% CI: 1.394, 6.307). Additionally, male students had 0.279 times decreased odds of dual method use, compared to female students (95% CI: 0.104, 0.750).</p> <hd id="AN0155283005-20">Comment</hd> <p>This purpose of this work was to assess the association between relationship characteristics, sexual health attitudes, and dual contraceptive method use among YA college students aged 18–24. Sex with a casual date/acquaintance was positively associated with dual use compared to a romantic partner, and partner commitment scores were inversely associated with dual use in independent regression models. However, only partner trust was significantly associated with dual use in both the independent model and the fully adjusted model for all relationship characteristics.</p> <p>In the multivariable regression model simultaneously adjusting for all four relationship-related variables (i.e., partner commitment, partner label, and perceived partner exclusivity), only partner trust was significantly inversely associated with dual method use with each 1-unit increase in trust score (aOR = 0.982; 95% CI: 0.966, 0.998). This finding highlights the influence of partner trust on dual use behavior. Early in a relationship, intimacy tends to be low but can progressively develop.[<reflink idref="bib41" id="ref69">41</reflink>],[<reflink idref="bib42" id="ref70">42</reflink>] For YA college students navigating new social and sexual landscapes, sexual communication can be challenging.[<reflink idref="bib43" id="ref71">43</reflink>] It is plausible that once trust is established, YAs may be apprehensive to continue conversations about condom use, given that condoms can symbolize infidelity.[<reflink idref="bib19" id="ref72">19</reflink>] Overall, partner trust emotions may be more influential than discrete partner labels and titles and partner commitment emotions, and needs to be accounted for when discussing method use options with YA. Practitioners should ask about sexual partners and individual feelings toward that partner and tailor method use counseling conversations accordingly.</p> <p>While we expected partner trust to remain in our final model, it was surprising that it was the only characteristic associated with dual method use. Qualitative research has noted that conceptualization of partner trust may be influenced by past sexual experiences, sexual autonomy, emotional security and/or feelings of physical safety,[<reflink idref="bib44" id="ref73">44</reflink>],[<reflink idref="bib45" id="ref74">45</reflink>] and highlights that these elements may be even more influential on conceptualization and establishment of relationship trust if a YA has experienced sexual violence.[<reflink idref="bib44" id="ref75">44</reflink>] This is a particularly interesting connection, as 20% of students in our sample reported a history of sexual violence. But because of the cross-sectional design of our study, we are unable to determine if past experiences of sexual violence influenced recent perceptions of trust and method use behaviors. However, further mixed-methods research could provide rich insight on the intersection of partner trust, history of sexual violence, and contraceptive use behaviors; and inform future longitudinal research questions to examine the association of past violence exposure on current and future partner trust and method use among YA college students. Given the variable nature of partner trust, this could be acutely important for understanding how perceived partner emotions are contextualized and the full emotional continuum that drives method use decisions and utilization.</p> <p>Consistent with our hypothesis, students who reported having sex with a casual date/acquaintance had increased odds of dual method use compared to a romantic partner[<reflink idref="bib41" id="ref76">41</reflink>],[<reflink idref="bib46" id="ref77">46</reflink>],[<reflink idref="bib47" id="ref78">47</reflink>] in an independent model. However, it had a non-significant effect when adjusted for all other relationship characteristics. Regardless, this finding has critical campus public health implications as it suggests that individual STI risk perceptions are largely influenced by one's partner.[<reflink idref="bib19" id="ref79">19</reflink>] For example, YAs having sex with a casual or unfamiliar partner may feel an increased sense of STI risk, versus that of a more familiar, romantic partner.[<reflink idref="bib48" id="ref80">48</reflink>] There has been a documented tradeoff between condom and effective contraception use as familiarity with a partner increases.[<reflink idref="bib48" id="ref81">48</reflink>] Thus, as familiarity with a partner grows, a heightened sense of sexual safety could develop, diminishing perceived need for condom use. Shifting STI risk perceptions among sexual partners are alarming given increased trends in YA STI incidence.[<reflink idref="bib49" id="ref82">49</reflink>] Little concern for STIs and condom use could further contribute to these incidence rates and the spread of preventable sexual infections. Prevention efforts targeting YA in romantic relationships could be beneficial in improving dual method use.</p> <p>Increased partner commitment scores were also independently associated with decreased odds of dual method use but was non-significant when adjusting for all other relationship constructs. However, it still provides insight on an additional emotional construct that could influence method use behavior. Prior research has documented associations between increased commitment and decreased condom use.[<reflink idref="bib24" id="ref83">24</reflink>],[<reflink idref="bib50" id="ref84">50</reflink>],[<reflink idref="bib51" id="ref85">51</reflink>] Unlike partner label, partner trust and commitment are feelings that drive intimacy and foster a sense of emotional connection.[<reflink idref="bib46" id="ref86">46</reflink>] For YA, heavy emotional relationship investment may supersede intrapersonal perceptions of sexual risk and method use motives.[<reflink idref="bib50" id="ref87">50</reflink>],[<reflink idref="bib52" id="ref88">52</reflink>] Our finding supports these past studies and highlights that a greater sense of partner commitment could also decrease perceived sexual risk and condom use motivations. Public health initiatives should also account for how feelings of partner commitment may decrease the perceived need for contraception and focus on promoting STI risk awareness to improve condom and dual method behavior.</p> <hd id="AN0155283005-21">Strengths and limitations</hd> <p>This study has several strengths. Previously validated instruments with good psychometrics for partner trust and commitment were utilized, as well as an expanded measure of partner label and a measure of perceived partner exclusivity. Additionally, our sample included sexually active college students ag1ed 18–24, a population disproportionally burdened by pregnancy and STIs. Further, our sample also included YA males, a subgroup largely excluded from contraception and family planning research.[<reflink idref="bib36" id="ref89">36</reflink>],[<reflink idref="bib53" id="ref90">53</reflink>]</p> <p>Our study does have several limitations that should be kept in mind. First, almost half of the eligible sample that attempted the questionnaire did not complete and submit the questionnaire thus introducing possible non-response bias. The respondent characteristics of our sample (89% female, 76% white) are different than the total target population (76% females, 55% white). This level of non-response led to a lower response rate and could be underestimating our observed associations. It is possible that if all individuals that did not respond were dual method users, we would anticipate observing associations closer toward the null; but if all individuals that did not respond were method non-users we would anticipate observing greater magnitudes of association away from the null. Demographic characteristics of our analytic sample differed from the demographic characteristics of our overall source population. The source population was largely more diverse than our analytic sample (i.e., female: 76% source, 89% analytic; white: 55% source, 76% analytic; Black or African-American: 17% source, 9% analytic; Asian: 12% source, 11% analytic).[<reflink idref="bib54" id="ref91">54</reflink>] The sex of respondents excluded from the analytic sample due to missing data (n = 83) was not statistically different than those in the analytic sample (female: 83% of excluded vs. 89% of included, p-value = 0.124). Self-reported Black/African-American race also did not differ (12% of excluded vs. 9% of included, p-value = 0.394), nor did respondents of multiple races (5% of excluded vs. 4% of included, p = 0.677). However, Asian (22% of excluded vs. 11% of included, p-value = 0.006) and White (61% of excluded vs. 76% of included, p = 0.005) respondents excluded did significantly differ from the analytic sample. Prior research has denoted that less Asian students, compared to other racial groups, used contraception the last time having sex[<reflink idref="bib55" id="ref92">55</reflink>] while White respondents were more likely to use an effective method of contraception than Black subgroups.[<reflink idref="bib9" id="ref93">9</reflink>] Applying this in post-hoc analyses, our results for the association between trust and dual use could be attenuated. Second, we examined perception of partner exclusivity and did not ask about each respondent's own exclusivity. Because this partner exclusivity variable is subjective and could be based on an individual's assumption of what is true for the person they last had sex with, there could be differences in reporting. It is possible that there is an overreporting of perceived exclusivity and underreporting of unknown exclusivity status. Similarly, it is possible that romantic partnerships are being overreported. Therefore, our observed associations between perceived exclusivity, partner label, and method use may be biased toward the null. Third, a few limitations exist given the study was conducted with students enrolled in public health courses. For example, it is possible that these students may be more informed on pregnancy and STI risks and more likely to use dual methods than other YA college student populations. Therefore, our observed associations are likely biased toward the null and serve as a conservative estimate. Additionally, all data collected were self-reported, which could introduce potential social desirability and prevarication bias.[<reflink idref="bib56" id="ref94">56</reflink>] However, both trust and commitment measures utilized were previously validated with good psychometrics. Measures of partner label and perceived exclusivity were also based on items from previously administered questionnaires.[<reflink idref="bib19" id="ref95">19</reflink>],[<reflink idref="bib25" id="ref96">25</reflink>],[<reflink idref="bib31" id="ref97">31</reflink>] Thus findings may not be generalizable to all college students and/or non-student YA populations. Fourth, the correlation between trust and commitment was r = 0.72. There is usually concern for items at r = 0.70, but our observed correlation coefficient did not exceed 0.80.[<reflink idref="bib57" id="ref98">57</reflink>] Because trust and commitment are conceptually different constructs, and acceptable variance inflation factor (VIF) (trust = 2.19; commitment = 2.68) and tolerance (trust = 0.46; commitment = 0.37) values were noted, neither item was removed. Fifth, we added two additional items to the previously validated partner trust scale; however, these items did not adversely change internal consistency, as the Cronbach's alpha value remained unchanged (α = 0.93) if either the closeness variable or the love-related variable were excluded. Sixth, we utilized stepwise selection and a p-critical value of p ≤ 0.25 for bivariate analyses. This liberal cut point was selected because we sought to identify and include potential variables associated with contraceptive use behavior in our model. More traditional cut points (e.g. p < 0.05) may fail to identify important study variables.[<reflink idref="bib39" id="ref99">39</reflink>] Application of the 0.25 cut point value is aligned with Hosmer and Lemeshow's recommendations.[<reflink idref="bib39" id="ref100">39</reflink>] While this more liberal cut point could have allowed variables with questionable importance to be included and retained in the final models[<reflink idref="bib39" id="ref101">39</reflink>], possibly diluting our observed associations, we also examined the scientific plausibility of each eligible variable to ensure that all variables retained for model building were conceptually meaningful. Additionally, we included our four main independent variables in our models regardless of their bivariate p-value and also fit multivariable models for each relationship variable independently in order to best describe the associations between each measure individually as well as all four in the same model together. Lastly, our sample only included respondents who had a partner that was of the opposite sex. However, this only represents 6.7% of the sample.</p> <hd id="AN0155283005-22">Conclusions</hd> <p>This study extends current knowledge on the association between varied relationship characteristics and dual contraceptive method use among YA college students. Findings highlight that highly variable emotion-based relationship constructs such as partner trust may be more influential on dual use behavior than discrete factors, such as partner label and perceived exclusivity, and the emotion-based partner commitment construct. Campus public health efforts need to account for the influence partner trust can have on behavioral motives and risk perceptions and develop promotional messaging and media campaigns that highlight the importance of condom use and dual use regardless of how much a partner is trusted. Because promoting safe and healthy sexual and emotional relationships has traditionally been a top priority across college campuses, campus-based health clinics and wellness centers need to also consider addressing intimacy-related emotions and safe sex practices concurrently. Doing so could also improve dual method use and protect against adverse sexual and reproductive health outcomes during a formative time of YA development.</p> <hd id="AN0155283005-23">Acknowledgements</hd> <p>Thank you to Dr. Levent Dumenci for feedback on this paper. This work was partially supported by the Temple University College of Public Health [Visionary Research Fund, Fall 2017] and the Temple University Graduate School [Dissertation Completion Grant, Spring 2019].</p> <hd id="AN0155283005-24">Conflict of interest disclosure</hd> <p>The authors have no conflicts of interest to report. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Association between Relationship Characteristics, Sexual Health Attitudes, and Dual Contraceptive Use among Young Adult College Students Aged 18-24
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Casola%2C+Allison+R%2E%22">Casola, Allison R.</searchLink><br /><searchLink fieldCode="AR" term="%22Matson%2C+Pamela+A%2E%22">Matson, Pamela A.</searchLink><br /><searchLink fieldCode="AR" term="%22Jones%2C+Resa+M%2E%22">Jones, Resa M.</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2022 70(1):314-324.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 11
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2022
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Relationship%22">Interpersonal Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Sexuality%22">Sexuality</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Behavior%22">Health Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Attitudes%22">Student Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Contraception%22">Contraception</searchLink><br /><searchLink fieldCode="DE" term="%22Pregnancy%22">Pregnancy</searchLink><br /><searchLink fieldCode="DE" term="%22Intimacy%22">Intimacy</searchLink><br /><searchLink fieldCode="DE" term="%22Trust+%28Psychology%29%22">Trust (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Depression+%28Psychology%29%22">Depression (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Esteem%22">Self Esteem</searchLink><br /><searchLink fieldCode="DE" term="%22Sexual+Abuse%22">Sexual Abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Characteristics%22">Student Characteristics</searchLink><br /><searchLink fieldCode="DE" term="%22Sexually+Transmitted+Diseases%22">Sexually Transmitted Diseases</searchLink>
– Name: SubjectThesaurus
  Label: Assessment and Survey Identifiers
  Group: Su
  Data: <searchLink fieldCode="SU" term="%22Rosenberg+Self+Esteem+Scale%22">Rosenberg Self Esteem Scale</searchLink><br /><searchLink fieldCode="SU" term="%22Center+for+Epidemiologic+Studies+Depression+Scale%22">Center for Epidemiologic Studies Depression Scale</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/07448481.2020.1751172
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0744-8481
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: Determine the relationship characteristics, sexual health attitudes, and demographic factors associated with dual contraceptive use among college students. Participants: September-October 2018 via campus email, we recruited College of Public Health students attending a large, urban, public university (N= 424). Methods: Respondents completed a cross-sectional, Web-based sexual health questionnaire. Descriptive statistics were calculated. Multiple logistic regression models were run to determine the association between relationship characteristics, pregnancy and condom attitudes, demographics, and dual use the last time having sex. Results: In independent models, one-unit increase in trust (aOR = 0.982; 95% CI: 0.966-0.998) and commitment score (aOR = 0.987, 95% CI: 0.976-0.999) was inversely associated with dual use while sex with a casual date/acquaintance (aOR = 3.149; 95% CI: 1.550-6.397) was positively associated. In a fully adjusted model for all correlates, only trust score was significant (aOR = 0.982; 95% CI: 0.966, 0.998). Conclusions: Emotion-based constructs may be more influential on dual use behaviors than discrete relationship factors.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2022
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1328562
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1328562
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    Identifiers:
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        Value: 10.1080/07448481.2020.1751172
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 314
    Subjects:
      – SubjectFull: College Students
        Type: general
      – SubjectFull: Interpersonal Relationship
        Type: general
      – SubjectFull: Sexuality
        Type: general
      – SubjectFull: Health Behavior
        Type: general
      – SubjectFull: Student Attitudes
        Type: general
      – SubjectFull: Contraception
        Type: general
      – SubjectFull: Pregnancy
        Type: general
      – SubjectFull: Intimacy
        Type: general
      – SubjectFull: Trust (Psychology)
        Type: general
      – SubjectFull: Depression (Psychology)
        Type: general
      – SubjectFull: Self Esteem
        Type: general
      – SubjectFull: Sexual Abuse
        Type: general
      – SubjectFull: Student Characteristics
        Type: general
      – SubjectFull: Sexually Transmitted Diseases
        Type: general
      – SubjectFull: Rosenberg Self Esteem Scale
        Type: general
      – SubjectFull: Center for Epidemiologic Studies Depression Scale
        Type: general
    Titles:
      – TitleFull: Association between Relationship Characteristics, Sexual Health Attitudes, and Dual Contraceptive Use among Young Adult College Students Aged 18-24
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