The role of affect in condom use decision making
Ellis, Erin M.
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This dissertation outlines a program of research that examined the role of affective associations in the decision-making process surrounding condom use. The decision whether or not to use a condom is impacted by both cognitive and affective factors, but research and interventions aimed at increasing condom use rarely address these affective processes directly. A more explicit integration of affective associations into decision-making theory and interventions may help to increase rates of condom use. To this end, the overarching goal of this research was to advance our theoretical understanding of the role of affect in condom use decision making. In the first of three studies, we established preliminary support for the behavioral affective associations model as a useful framework for studying condom use and sexual behavior. Affective associations with condoms had a direct effect on condom use and also mediated the relation of cognitive beliefs to behavior. These findings were replicated in Study 2, but in this study, the behavioral affective associations model did not extend to an analysis of the interplay between perceived risk and worry as predictors of condom use. Building on these cross-sectional findings, the third study involved an experimental study designed to provide stronger evidence for a causal relation between affective associations and condom use behavior. Findings from Study 3 suggest that an experimental manipulation changed affective associations with condoms, and also influenced behavior for participants who used condoms regularly at baseline. Furthermore, the condition's effect on condom selection behavior was mediated by participants' affective associations. Together, these findings replicate prior support for the role of affect in condom use decision making, and underscore the need to better integrate these factors into decision making theory and public health interventions. They also point to a number of unanswered questions that remain as directions for future research.