AIDS and Behavior

, Volume 12, Issue 3, pp 412–418 | Cite as

A Theory-Based Approach to Understanding Condom Errors and Problems Reported by Men Attending an STI Clinic

  • Richard A. CrosbyEmail author
  • Laura F. Salazar
  • William L. Yarber
  • Stephanie A. Sanders
  • Cynthia A. Graham
  • Sara Head
  • Janet N. Arno
Original Paper


We employed the information–motivation–behavioral skills (IMB) model to guide an investigation of correlates for correct condom use among 278 adult (18–35 years old) male clients attending a sexually transmitted infection (STI) clinic. An anonymous questionnaire aided by a CD-recording of the questions was administered. Linear Structural Relations Program was used to conduct path analyses of the hypothesized IMB model. Parameter estimates showed that while information did not directly affect behavioral skills, it did have a direct (negative) effect on condom use errors. Motivation had a significant direct (positive) effect on behavioral skills and a significant indirect (positive) effect on condom use errors through behavioral skills. Behavioral skills had a direct (negative) effect on condom use errors. Among men attending a public STI clinic, these findings suggest brief, clinic-based, safer sex programs for men who have sex with women should incorporate activities to convey correct condom use information, instill motivation to use condoms correctly, and directly enhance men’s behavioral skills for correct use of condoms.


Condoms Men Sexually transmitted diseases Prevention Sexual behavior 



We gratefully acknowledge the support of the Rural Center for AIDS/STD Prevention, a joint project of Indiana University, University of Colorado, and the University of Kentucky. Support was also received from the Office of the Associate Dean for Research of the School of Health, Physical Education and Recreation, at Indiana University. We gratefully acknowledge the assistance of the research staff. The corresponding author had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.


  1. Albert, A. E., Hatcher, R. A., & Graves, W. (1991). Condom use and breakage among women in a municipal hospital family planning clinic. Contraception, 43, 167–176.PubMedCrossRefGoogle Scholar
  2. Amico, K. R., Toro-Alfonso, J., & Fisher, J. D. (2005). An empirical test of the information, motivation and behavioral skills model of antiretroviral therapy adherence. AIDS Care, 17, 661–673.PubMedCrossRefGoogle Scholar
  3. Bollen, K. A. (1989). Structural equations with latent variables. San Francisco, CA: John Wiley & Sons.Google Scholar
  4. Centers for Disease Control, Prevention. (1998). Facts about condoms and their use in preventing HIV infection and other STDs. Atlanta: Department of Health and Human Resources.Google Scholar
  5. Centers for Disease Control, Prevention. (2002). Sexually transmitted diseases treatment guidelines 2002. Morbidity and Mortality Weekly Report, 51, 1–60.Google Scholar
  6. Civic, D., Scholes, D., Ichikawa, L., Grothaus, L., McBride, C. M., Yarnall, K. S., et al. (2002). Ineffective use of condoms among young women in managed care. AIDS Care, 14, 779–788.PubMedCrossRefGoogle Scholar
  7. Crosby, R. A., DiClemente, R. J., Holtgrave, D. R., & Wingood, G. M. (2002). Design, measurement, and analytic considerations for testing hypotheses relative to condom effectiveness against non viral STIs. Sexually Transmitted Infections, 78, 228–231.PubMedCrossRefGoogle Scholar
  8. Crosby, R. A., DiClemente, R. J., Wingood, G. M., Lang, D., & Harrington, K. F. (2003). The value of consistent condom use: A study of STD prevention among African American adolescent females. American Journal of Public Health, 93, 901–902.PubMedGoogle Scholar
  9. Crosby, R. A., Salazar, L. F., DiClemente, R. J., Yarber, W. L., Caliendo, A. M., & Staples-Horne, M. (2005). Accounting for failures may improve precision: Evidence supporting improved validity of self-reported condom use. Sexually Transmitted Diseases, 32, 513–515.PubMedCrossRefGoogle Scholar
  10. Crosby, R. A., Sanders, S. A., Yarber, W. L., & Graham, C. A. (2003). Condom use errors and problems: A neglected aspect of studies assessing condom effectiveness. American Journal of Preventive Medicine, 24, 367–370.PubMedCrossRefGoogle Scholar
  11. Crosby, R. A., Sanders, S., Yarber, W. L., Graham, C. A., & Dodge, B. (2002). Condom use errors and problems among college men. Sexually Transmitted Diseases, 29, 552–557.PubMedCrossRefGoogle Scholar
  12. Crosby, R. A., Yarber, W. L., Sanders, S. A., & Graham, C. A. (2005). Condom discomfort and associated problems with their use among university students. American Journal of College Health, 54, 143–148.CrossRefGoogle Scholar
  13. Fisher, J. D., & Fisher, W. A. (1992). Changing AIDS-risk behavior. Psychological Bulletin, 111, 455–474.PubMedCrossRefGoogle Scholar
  14. Fisher, J. D., Fisher, W. A., Williams, S. S., & Malloy, T. E. (1994). Empirical tests of an information-motivation-behavioral skills model of AIDS-preventive behavior with gay men and heterosexual university students. Health Psychology, 13, 238–250.PubMedCrossRefGoogle Scholar
  15. Graham, C. A., Crosby, R. A., Sanders, S. A., & Yarber, W. L. (2003). Motivation of self, partner, and couple to use male condoms: Associations with condom use errors and problems. Health Education Monograph, Special Issue, 20, 60–64.Google Scholar
  16. Graham, C. A., Crosby, R. A., Sanders, S. A., & Yarber, W. L. (2005). Assessment of condom use in men and women. Annual Review of Sex Research, 16, 1–33.Google Scholar
  17. Grimley, D. M., Annang, L., Houster, S., & Chen, H. (2005). Prevalence of condom use errors among STD clinic patients. American Journal of Health Behavior, 29, 324–330.PubMedGoogle Scholar
  18. Holmes K. K., Levine, R., & Weaver M. (2004). Effectiveness of condoms in preventing sexually transmitted infections. Bulletin of the World Health Organization, 82, 454–461.PubMedGoogle Scholar
  19. Jöreskog, K. G., & Sörbom, D. (2004). PRELIS (Version 2.70). Chicago, IL: Scientific Software International.Google Scholar
  20. Jöreskog, K., & Sörbom, D. (2005). LISREL 8.72: (Computer software). Lincolnwood: Scientific Software Inc.Google Scholar
  21. Jöreskog, K., Sörbom, D., du Toit, S., & du Toit, M. (2000). LISREL 8: New statistical features. Lincolnwood: Scientific Software International, Inc.Google Scholar
  22. Kamb, M. L., Fishbein, M., Douglas, J. M. Jr., Rhodes, F., Rogers, J., Bolan, G., et al. (1998). Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: A randomized controlled trial. Project RESPECT Study Group. JAMA, 280, 1161–1167.PubMedCrossRefGoogle Scholar
  23. Lindberg, L. D., Sonenstein, F. L., Ku, L., & Levine, G. (1997). Young men’s experience with condom breakage. Family Planning Perspectives, 29, 128–131.PubMedCrossRefGoogle Scholar
  24. Mertz, K. J., Finelli, L., Levine, W. C., Mognoni, R. C., Berman, S. M., Fishbein, M., et al. (2000). Gonorrhea in male adolescents and young adults in Newark, New Jersey: Implications of risk factors and patient preferences for prevention strategies. Sexually Transmitted Diseases, 27, 201–207.PubMedCrossRefGoogle Scholar
  25. Richters, J., Donovan, B., & Gerofi, J. (1993). How often do condoms break or slip off in use? International Journal of STD & AIDS, 4, 90–94.Google Scholar
  26. Sanders, S. A., Graham, C. A., Yarber, W. L., & Crosby, R. A. (2003). Condom use errors and problems among young women who apply condoms on males. Journal of American Medical Women’s Association, 58, 95–98.Google Scholar
  27. Shlay, J. C., McClung, M. W., Patnaik, J. L., & Douglas, J. M. (2004). Comparison of sexually transmitted disease prevalence by reported condom use: Errors among consistent condom users seen at an urban sexually transmitted disease clinic. Sexually Transmitted Diseases, 31, 526–532.PubMedCrossRefGoogle Scholar
  28. Spruyt, A., Steiner, M. J., Joanis, C., Glover, L. H., Piedrahita, C., Alvarado, G., et al. (1998). Identifying condom users at risk for breakage and slippage: Findings from three international sites. American Journal of Public Health, 88, 239–244.PubMedCrossRefGoogle Scholar
  29. Steiner, M., Piedrahita, C., Glover, L., & Joanis, C. (1993). Can condom users likely to experience condom failure be identified? Family Planning Perspectives, 25, 220–223.PubMedCrossRefGoogle Scholar
  30. Trussell, J., Warner, D. L., & Hatcher, R. (1992). Condom performance during vaginal intercourse: Comparison of Trojan-Enz® and Tactylon™ condoms. Contraception, 45, 11–19.PubMedCrossRefGoogle Scholar
  31. Valappil, T., Kelaghan, J., Macaluso, M., Artz, L., Austin, H., Fleenor, M. E., et al. (2005). Female condom and male condom failure among women at high risk of sexually transmitted diseases. Sexually Transmitted Diseases, 32, 35–43.PubMedCrossRefGoogle Scholar
  32. Warner, D. L., & Hatcher, R. A. (1999). Male condoms. In R. A. Hatcher, J. Trussell, F. Stewart, W. Cates Jr., G. K. Stewart, F. Guest, & D. Kowal (Eds.), Contraceptive Technology (17th ed.) (pp. 325–352). New York: Irvington Publishers Inc.Google Scholar
  33. Warner, L., Clay-Warner, J., Boles, J., & Williamson, J. (1998). Assessing condom use practices: Implications for evaluating method and user effectiveness. Sexually Transmitted Diseases, 6, 273–277.CrossRefGoogle Scholar
  34. Yarber, W. L., Graham, C. A., Sanders, S. A., & Crosby, R. A. (2004). Correlates of condom breakage and slippage among university undergraduates. International Journal of STD & AIDS, 15, 467–472.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Richard A. Crosby
    • 1
    • 2
    • 3
    Email author
  • Laura F. Salazar
    • 4
  • William L. Yarber
    • 2
    • 3
    • 5
    • 6
  • Stephanie A. Sanders
    • 2
    • 3
    • 6
  • Cynthia A. Graham
    • 2
    • 3
  • Sara Head
    • 1
  • Janet N. Arno
    • 2
    • 7
  1. 1.College of Public HealthUniversity of KentuckyLexingtonUSA
  2. 2.Rural Center for AIDS/STD PreventionIndiana UniversityBloomingtonUSA
  3. 3.The Kinsey Institute for Research in Sex, Gender, and ReproductionIndiana UniversityBloomingtonUSA
  4. 4.Department of Behavioral Sciences and Health Education, Rollins School of Public HealthEmory UniversityAtlantaUSA
  5. 5.Department of Applied Health ScienceIndiana UniversityBloomingtonUSA
  6. 6.Department of Gender StudiesIndiana UniversityBloomingtonUSA
  7. 7.Department of Infectious DiseasesIndiana University School of MedicineIndianapolisUSA

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