Leveraging 2.5 years of weekly data from the Relationship Dynamics and Social Life Study, we investigate the relationship between young women’s sexual concurrency and their contraceptive behavior. Specifically, we (1) examine whether young women changed their contraceptive use when switching from one to multiple concurrent sexual partners in the same week; (2) explore the uniformity of contraceptive responses to concurrency across relationship context; and (3) compare the contraceptive behaviors of never-concurrent women with those of ever-concurrent women in weeks when they were not concurrent. Nearly one in five sexually active young women had sex with two or more people in the same week. When they were concurrent, these women’s odds of using any contraception increased threefold, and their odds of using condoms increased fourfold. This pattern of contraceptive adjustments was the same across relationship characteristics, such as duration and exclusivity. Yet when they were not concurrent, ever-concurrent women were less likely to use any contraception and used condoms less consistently than women who were never concurrent. We discuss these findings in the context of ongoing debates about the role of sexual concurrency in STI transmission dynamics.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Using a sexual network survey, Helleringer et al. (2009) found that concurrent partnerships are more likely to be HIV sero-discordant than serial partnerships in sub-Saharan Africa. From this, they concluded that concurrent partnerships are at greater risk of transmission.
Although we are primarily interested in the relationship between concurrency and condom use, we refer to contraceptive use more broadly because condom use may be determined jointly with use of other methods, depending on whether individuals are additionally concerned about unwanted pregnancy.
The response rate for the baseline survey was 84 %. Women who were temporarily residing outside the county in order to attend school or to acquire job training were also included.
Attrition rates differed by race and education at baseline. African American respondents and respondents who had never attended college completed an average of 11 and 12 fewer weekly surveys, respectively, than did white respondents and respondents who had at least some college education.
These relationships ranged from an online boyfriend to a one-night stand to a husband, and everything in between.
This was the case in one-third (32 %) of weeks in which women reported having sex with two or more people.
Respondents were first asked about sexual intercourse at the second journal. Our inclusion of one-week lagged variables in our final models, as described later, necessitates having completed three or more journals.
The survey asked about only heterosexual vaginal intercourse.
We also test two- and four-week lagged measures of concurrency. The results lead to substantively similar conclusions (available upon request).
Nontransitioning weeks include weeks when the respondent had either the same primary partner in the immediately preceding and following weeks, no partner in the immediately preceding and following weeks, or some combination thereof.
For relationships that were ongoing at baseline, this measure includes time together before RDSL participation.
For example, 37 % and 59 % of ever- and never-concurrent women (respectively) used some form of contraception every week that they had sex; 2 % and 3 % of ever- and never-concurrent women (respectively) never used any form of contraception in weeks when they had sex; 6 % of ever-concurrent women and 28 % of never-concurrent women used condoms every week that they had sex and used contraception; and 10 % of ever-concurrent women and 15 % of never-concurrent women never used condoms in weeks when they had sex and used contraception.
Because cheating may occur as part of relationship transitioning, we also test a three-way interaction term among concurrency, exclusivity, and transitioning. The coefficients on this interaction term are null, and the interaction is therefore not included in the final models (results not shown).
Transitioning partners indicates that a woman reported a distinct primary partner in the immediately preceding or immediately succeeding week (or both). The reference category is that she reported the same primary partner or no partner (or a combination) in those adjacent weeks.
Accordingly, we also do not include indicators of whether the respondent was in a relationship last week or had the same primary partner last week.
The one exception is that we do not control for number of prior weeks she has had sex with her current partner.
Adimora, A. A., Schoenbach, V. J., Taylor, E. M., Khan, M. R., & Schwartz, R. J. (2011). Concurrent partnerships, nonmonogamous partners, and substance use among women in the United States. American Journal of Public Health, 101, 128–136.
Andrinopoulos, K., Kerrigan, D., & Ellen, J. M. (2006). Understanding sex partner selection from the perspective of inner-city black adolescents. Perspectives on Sexual and Reproductive Health, 38, 132–138.
Barber, J. S. (2001). Ideational influences on the transition to parenthood: Attitudes toward childbearing and competing alternatives. Social Psychology Quarterly, 64, 101–127.
Barber, J. S., Gatny, H., & Kusunoki, Y. (2012). The results of an experiment: Effects of intensive longitudinal data collection on pregnancy and contraceptive use (PSC Research Report 12-781). Ann Arbor: Population Studies Center, University of Michigan.
Barber, J. S., Gatny, H. H., & Yarger, J. (2010, April). Relationship characteristics predicting unintended pregnancies reported in an online weekly survey: Preliminary results. Paper presented at the annual meeting of the Population Association of America, Dallas, TX.
Barber, J. S., Kusunoki, Y., & Gatny, H. H. (2016a). Relationship Dynamics and Social Life (RDSL) Study [Genesee County, Michigan], 2008–2012 [Public and highly restricted-use data]. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor]. https://doi.org/10.3886/ICPSR34626.v5
Barber, J., Kusunoki, Y., Gatny, H., & Schulz, P. (2016b). Participation in an intensive longitudinal study with weekly web surveys over 2.5 years. Journal of Medical Internet Research, 18(6), e105. https://doi.org/10.2196/jmir.5422
Barber, J. S., Kusunoki, Y., Gatny, H. H., & Yarger, J. (2013). Young women’s relationships, contraception and unintended pregnancy in the United States. In A. Buchanan & A. Rotkirch (Eds.), Fertility rates and population decline: No time for children? (pp. 121–140). London, UK: Palgrave Macmillan.
Bearak, J. M. (2014). Casual contraception in casual sex: Life-cycle change in undergraduates’ sexual behavior in hookups. Social Forces, 93, 483–513.
Blower, S. M., & Boe, C. (1993). Sex acts, sex partners, and sex budgets: implications for risk factor analysis and estimation of HIV transmission probabilities. Journal of Acquired Immune Deficiency Syndromes, 6, 1347–1352.
Boily, M.-C., Alary, M., & Baggaley, R. F. (2012). Neglected issues and hypotheses regarding the impact of sexual concurrency on HIV and sexually transmitted infections. AIDS and Behavior, 16, 304–311.
Brady, S. S., Tschann, J. M., Ellen, J. M., & Flores, E. (2009). Infidelity, trust, and condom use among Latino youth in dating relationships. Sexually Transmitted Diseases, 36, 227–331.
Clark, A. (2018). The role of residential mobility in reproducing socioeconomic stratification during the transition to adulthood. Demographic Research, 38, 169–196. https://doi.org/10.4054/DemRes.2018.38.7
Crosby, R. A., DiClemente, R. J., Wingood, G. M., Salazar, L. F., Head, S., Rose, E., & McDermott-Sales, J. (2008). Sexual agency versus relational factors: A study of condom use antecedents among high-risk young African American women. Sexual Health, 5, 41–47.
Eaton, J. W., Hallett, T. B., & Garnett, G. P. (2011). Concurrent sexual partnerships and primary HIV infection: A critical interaction. AIDS and Behavior, 15, 687–692.
England, P., Caudillo, M. L., Littlejohn, K., Bass, B. C., & Reed, J. (2016). Why do young, unmarried women who do not want to get pregnant contracept inconsistently? Mixed-method evidence for the role of efficacy. Socius: Sociological Research for a Dynamic World, 2, 1–15. https://doi.org/10.1177/2378023116629464
Finer, L. B., & Zolna, M. R. (2014). Shifts in intended and unintended pregnancies in the United States, 2001–2008. American Journal of Public Health, 104(Suppl. 1), S43–S48.
Fleming, D. T., & Wasserheit, J. N. (1999). From epidemiological synergy to public health policy and practice: The contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sexually Transmitted Infections, 75, 3–17.
Ford, K., Sohn, W., & Lepkowski, J. (2002). American adolescents: Sexual mixing patterns, bridge partners, and concurrency. Sexually Transmitted Diseases, 29, 13–19.
Freeman, E. E., Weiss, H. A., Glynn, J. R., Cross, P. L., Whitworth, J. A., & Hayes, R. J. (2006). Herpes simplex virus 2 infection increases HIV acquisition in men and women: Systematic review and meta-analysis of longitudinal studies. AIDS, 20, 73–83.
Gaydosh, L., Reniers, G., & Helleringer, S. (2013). Partnership concurrency and coital frequency. AIDS and Behavior, 17, 2376–2386.
Gelman, A., & Hill, J. (2007). Data analysis using regression and multilevel/hierarchical models. Cambridge, UK: Cambridge University Press.
Glynn, J. R., Dube, A., Kayuni, N., Floyd, S., Molesworth, A., Parrott, F., . . . Crampin, A. C. 2012. Measuring concurrency: An empirical study of different methods in a large population-based survey and evaluation of the UNAIDS guidelines. AIDS, 26, 977–985.
Goldenberg, T., Finneran, C., Andes, K. L., & Stephenson, R. (2015). “Sometimes people let love conquer them”: How love, intimacy, and trust in relationships between men who have sex with men influence perceptions of sexual risk and sexual decision-making. Culture, Health & Sexuality, 17, 607–622.
Gorbach, P. M., Drumright, L. N., & Holmes, K. K. (2005). Discord, discordance, and concurrency: Comparing individual and partnership-level analyses of new partnerships of young adults at risk of sexually transmitted infections. Sexually Transmitted Diseases, 32, 7–12.
Gorbach, P. M., & Holmes, K. K. (2003). Transmission of STIs/HIV at the partnership level: Beyond individual-level analyses. Journal of Urban Health, 80, iii15–iii25.
Gorbach, P. M., Stoner, B. P., Aral, S. O., Whittington, L. H., & Holmes, K. K. (2002). “It takes a village”: Understanding concurrent sexual partnerships in Seattle, Washington. Sexually Transmitted Diseases, 29, 453–462.
Halpern-Meekin, S., Manning, W. D., Giordano, P. C., & Longmore, M. A. (2013). Relationship churning, physical violence, and verbal abuse in young adult relationships. Journal of Marriage and Family, 75, 2–12.
Helleringer, S., & Kohler, H.-P. (2007). Sexual network structure and the spread of HIV in Africa: Evidence from Likoma Island, Malawi. AIDS, 21, 2323–2332.
Helleringer, S., Kohler, H.-P., & Kalilani-Phiri, L. (2009). The association of HIV serodiscordance and partnership concurrency in Likoma Island (Malawi). AIDS, 23, 1285–1287.
Helleringer, S., Kohler, H.-P., Kalilani-Phiri, L., Mkandawire, J., & Armbruster, B. (2011). The reliability of sexual partnership histories: Implications for the measurement of partnership concurrency during surveys. AIDS, 25, 503–511.
Helleringer, S., Mkandawire, J., & Kohler, H.-P. (2014). A new approach to measuring partnership concurrency and its association with HIV risk in couples. AIDS and Behavior, 18, 2291–2301.
Hess, K. L., Gorbach, P. M., Manhart, L. E., Stoner, B. P., Martin, D. H., & Holmes, K. K. (2012). Risk behaviours by type of concurrency among young people in three STI clinics in the United States. Sexual Health, 9, 280–287.
Higgins, J. A., Tanner, A. E., & Janssen, E. (2009). Arousal loss related to safer sex and risk of pregnancy: Implications for women’s and men’s sexual health. Perspectives on Sexual and Reproductive Health, 41, 150–157.
Javanbakht, M., Gorbach, P. M., Amani, B., Walker, S., Cranston, R. D., Datta, S. D., & Kerndt, P. R. (2010). Concurrency, sex partner risk, and high-risk human papillomavirus infection among African American, Asian, and Hispanic women. Sexually Transmitted Diseases, 37, 68–74.
Kalichman, S. C., Ntseane, D., Nthomang, K., Segwabe, M., Phorano, O., & Simbayi, L. C. (2007). Recent multiple sexual partners and HIV transmission risks among people living with HIV/AIDS in Botswana. Sexually Transmitted Infections, 83, 371–375.
Kelley, S. S., Borawski, E. A., Flocke, S. A., & Keen, K. J. (2003). The role of sequential and concurrent sexual relationships in the risk of sexually transmitted diseases among adolescents. Journal of Adolescent Health, 32, 296–305.
Koumans, E. H., Farley, T. A., Gibson, J. J., Langley, C., Ross, M. W., McFarlane, M., . . . St. Louis, M. E. (2001). Characteristics of persons with syphilis in areas of persisting syphilis in the United States: Sustained transmission associated with concurrent partnerships. Sexually Transmitted Diseases, 28, 497–503.
Kretzschmar, M., & Caraël, M. (2012). Is concurrency driving HIV transmission in sub-Saharan African sexual networks? The significance of sexual partnership typology. AIDS and Behavior, 16, 1746–1752.
Kretzschmar, M., & Morris, M. (1996). Measures of concurrency in networks and the spread of infectious disease. Mathematical Biosciences, 133, 165–195.
Kretzschmar, M., White, R. G., & Caraël, M. (2010). Concurrency is more complex than it seems. AIDS, 24, 313–315.
Kusunoki, Y. (Forthcoming). The dynamics of relationships and contraception during emerging adulthood. Journal of Marriage and Family.
Kusunoki, Y., Barber, J. S., Gatny, H. H., & Melendez, R. (2018). Physical intimate partner violence and contraceptive behaviors among young women. Journal of Women’s Health, 27, 1016–1025.
Kusunoki, Y., & Upchurch, D. M. (2011). Contraceptive method choice among youth in the United States: The importance of relationship context. Demography, 48, 1451–1472.
Lear, D. (1995). Sexual communication in the age of AIDS: The construction of risk and trust among young adults. Social Science & Medicine, 41, 1311–1323.
Lesthaeghe, R. J., & Neidert, L. (2006). The second demographic transition in the United States: Exception or textbook example? Population and Development Review, 32, 669–698.
Lichtenstein, B., Desmond, R. A., & Schwebke, J. R. (2008). Partnership concurrency status and condom use among women diagnosed with trichomonas vaginalis. Women’s Health Issues, 18, 369–374.
Macaluso, M., Demand, M. J., Artz, L. M., & Hook, E. W., III. (2000). Partner type and condom use. AIDS, 14, 537–546.
Manhart, L. E., Aral, S. O., Holmes, K. K., & Foxman, B. (2002). Sex partner concurrency: Measurement, prevalence, and correlates among urban 18–39-year-olds. Sexually Transmitted Diseases, 29, 133–143.
Manlove, J., Ryan, S., & Franzetta, K. (2007). Contraceptive use patterns across teens’ sexual relationships: The role of relationships, partners, and sexual histories. Demography, 44, 603–621.
Manning, W. D., Flanigan, C. M., Giordano, P. C., & Longmore, M. A. (2009). Relationship dynamics and consistency of condom use among adolescents. Perspectives on Sexual and Reproductive Health, 41, 181–190.
Manning, W. D., Giordano, P. C., & Longmore, M. A. (2006). Hooking up the relationship contexts of “nonrelationship” sex. Journal of Adolescent Research, 21, 459–483.
Manning, W. D., Giordano, P. C., Longmore, M. A., & Flanigan, C. M. (2012). Young adult dating relationships and the management of sexual risk. Population Research and Policy Review, 31, 165–185.
Manning, W. D., Longmore, M. A., Copp, J., & Giordano, P. C. (2014). The complexities of adolescent dating and sexual relationships: Fluidity, meaning(s), and implications for young adults’ well-being. New Directions for Child and Adolescent Development, 2014(144), 53–69.
McGrath, N. (2010). HIV: Consensus indicators are needed for concurrency. Lancet, 375, 621–622.
Mishra, V., & Bignami-Van Assche, S. (2009). Concurrent sexual partnerships and HIV infection: Evidence from national population-based surveys (DHS Working Paper No. 62). Calverton, MD: Macro International.
Morris, M. (2010). Barking up the wrong evidence tree. Comment on Lurie & Rosenthal, “Concurrent partnerships as a driver of the HIV epidemic in sub-Saharan Africa? The evidence is limited.” AIDS and Behavior, 14, 31–33.
Morris, M., Epstein, H., & Wawer, M. (2010). Timing is everything: International variations in historical sexual partnership concurrency and HIV prevalence. PLoS ONE, 5(11), e14092. https://doi.org/10.1371/journal.pone.0014092
Morris, M., & Kretzschmar, M. (1997). Concurrent partnerships and the spread of HIV. AIDS, 11, 641–648.
Nelson, S. J., Manhart, L. E., Gorbach, P. M., Martin, D. H., Stoner, B. P., Aral, S. O., & Holmes, K. K. (2007). Measuring sex partner concurrency: It’s what’s missing that counts. Sexually Transmitted Diseases, 34, 801–807.
Nunn, A., MacCarthy, S., Barnett, N., Rose, J., Chan, P., Yolken, A., . . . Riggins, R. (2014). Prevalence and predictors of concurrent sexual partnerships in a predominantly African American population in Jackson, Mississippi. AIDS and Behavior, 18, 2457–2468.
Paul, E. L., McManus, B., & Hayes, A. (2000). “Hookups”: Characteristics and correlates of college students’ spontaneous and anonymous sexual experiences. Journal of Sex Research, 37, 76–88.
Potterat, J. J., Zimmerman-Rogers, H., Muth, S. Q., Rothenberg, R. B., Green, D. L., Taylor, J. E., . . . White, H. A. (1999). Chlamydia transmission: Concurrency, reproduction number, and the epidemic trajectory. American Journal of Epidemiology, 150, 1331–1339.
Reniers, G., & Tfaily, R. (2012). Polygyny, partnership concurrency, and HIV transmission in sub-Saharan Africa. Demography, 49, 1075–1101.
Reniers, G., & Watkins, S. (2010). Polygyny and the spread of HIV in Sub Saharan Africa: A case of benign concurrency. AIDS, 24, 299–307.
Riehman, K. S., Wechsberg, W. M., Francis, S. A., Moore, M., & Morgan-Lopez, A. (2006). Discordance in monogamy beliefs, sexual concurrency, and condom use among young adult substance-involved couples: Implications for risk of sexually transmitted infections. Sexually Transmitted Diseases, 33, 677–682.
Rosenberg, M. D., Gurvey, J. E., Adler, N., Dunlop, M. B. V., & Ellen, J. M. (1999). Concurrent sex partners and risk for sexually transmitted diseases among adolescents. Sexually Transmitted Diseases, 26, 208–212.
Rosengard, C., Adler, N. E., Gurvey, J. E., & Ellen, J. M. (2005). Adolescent partner-type experience: Psychosocial and behavioral differences. Perspectives on Sexual and Reproductive Health, 37, 141–147.
Sangi-Haghpeykar, H., Poindexter, A. N., Young, A., Levesque, J. E., & Horth, F. (2003). Extra-relational sex among Hispanic women and their condom-related behaviours and attitudes. AIDS Care, 15, 505–512.
Sassler, S. (2010). Partnering across the life course: Sex, relationships, and mate selection. Journal of Marriage and Family, 72, 557–575.
Sawers, L., Isaac, A. G., & Stillwaggon, E. (2011). HIV and concurrent sexual partnerships: Modelling the role of coital dilution. Journal of the International AIDS Society, 14, 44. https://doi.org/10.1186/1758-2652-14-44
Sawers, L., & Stillwaggon, E. (2010). Concurrent sexual partnerships do not explain the HIV epidemics in Africa: A systematic review of the evidence. Journal of the International AIDS Society, 13, 34. https://doi.org/10.1186/1758-2652-13-34
Senn, T. E., Carey, M. P., Vanable, P. A., Coury-Doniger, P., & Urban, M. (2009). Sexual partner concurrency among STI clinic patients with a steady partner: Correlates and associations with condom use. Sexually Transmitted Infections, 85, 343–347.
Sterk, C. E., Klein, H., & Elifson, K. W. (2004). Predictors of condom-related attitudes among at-risk women. Journal of Women’s Health, 13, 676–688.
Tavory, I., & Swidler, A. (2009). Condom semiotics: Meaning and condom use in rural Malawi. American Sociological Review, 74, 171–189.
Udry, J. R., & Billy, J. O. G. (1987). Initiation of coitus in early adolescence. American Sociological Review, 52, 841–855.
Washington, C., Ding, L., Gorbach, P., Rosen, B., & Kahn, J. (2018). Individual and partner-level characteristics associated with vaccine-type and non-vaccine-type human papillomavirus infection in young women after vaccine introduction. Journal of Adolescent Health, 62(Suppl. 2), S2.
Weitzman, A., Barber, J. S., Kusunoki, Y., & England, P. (2017). Desire for and to avoid pregnancy during the transition to adulthood. Journal of Marriage and Family, 79, 1060–1075.
Wilkins, A. C., & Dalessandro, C. (2013). Monogamy lite: Cheating, college, and women. Gender & Society, 27, 728–751.
This research was made possible with three grants from the National Institute for Child Health and Development (R03HD087422-01, PI Weitzman; and R01HD050329 and R01HD050329-S1, PI Barber); with two population center grants from the National Institute for Child Health and Human Development to the Population Research Center at the University of Texas at Austin (P2CHD042849) and the Population Studies Center at the University of Michigan (R24HD041028); and with a training grant (T32AG000221) from the National Institute for Child Health and Human Development administered through the Population Studies Center at the University of Michigan, where Abigail Weitzman was a postdoctoral fellow. The authors thank Julia Behrman, Monica Caudillo, Yiwen Wang, Elizabeth Ela, and Heather Gatny for their insightful feedback and support of this manuscript along the way.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
About this article
Cite this article
Weitzman, A., Barber, J. & Kusunoki, Y. Sexual Concurrency and Contraceptive Use Among Young Adult Women. Demography 56, 549–572 (2019). https://doi.org/10.1007/s13524-019-00762-w
- Sexual concurrency
- Sexual health