The Relationships between Health Risk Behaviors and Condom Use Among College Students

Purpose: The purpose of this study is to examine the relationships between health risk behaviors and condom use among college students. In 2022, individuals aged 13–24 accounted for 21% of new HIV infections (CDC, 2024), and this high incidence among younger populations highlights the importance of early intervention. This study specifically focuses on the effects of health risk behaviors such as smoking, alcohol use, drug use, and experiences with hookups or one-night stands on condom use among college students. Previous research on condom use has rarely examined multiple health and sexual risk behaviors simultaneously. Therefore, this study clarifies these relationships by considering various risk behaviors and basic demographic factors.

Methods: Using a convenience sampling method, data were collected from college students at a mid-sized university in Ohio, USA, through a survey questionnaire administered during class visits. Inclusion criteria were: college students aged 18–24 years, English speakers, and individuals with no self-reported cognitive impairment or diagnosis of major depression. Descriptive and logistic regression analyses were conducted using SPSS version 29.

Results: Out of 437 survey respondents, 323 participants who reported having sexual experience were included in the final analyses. The majority of participants were female (74.3%), with an average age of 20. Regarding condom use, 33.1% of participants reported always using condoms, while the majority reported never (19.8%) or sometimes (47.1%) using them. In terms of health risk behaviors, nearly all respondents (96.6%) reported not being smokers. However, a majority (51.4%) indicated they had consumed alcohol right before or during sexual activity. Additionally, 8.7% reported using illicit drugs before or during sex. Hookup or non-relationship sex was reported by 41.8% of participants, and 28.8% reported having had a one-night stand. The average number of lifetime sexual partners was 3.4. Logistic regression analysis revealed that only illicit drug use before or during sex was significantly associated with decreased condom use (OR = 0.78, p < .05). Other health and sexual risk behaviors were not significantly related to condom use. Age and gender were marginally associated with condom use, indicating that older and female students were less likely to use condoms (OR = 0.844, p = .068; OR = 1.745, p = .065), consistent with previous studies (Kanekar & Sharma, 2009; Menon et al., 2016; Thorpe et al., 2021).

Implications: Although this study is limited by its cross-sectional design, the absence of psychological and social factors such as peer norms and social influence, and potential recall and social desirability biases, it contributes to the understanding of the relationships between health risk behaviors and condom use among college students. Given the association between drug use and condom use, the findings underscore the need for targeted early interventions, policy reforms, and advocacy efforts aimed at reducing health risk behaviors in this population. Colleges, universities, and communities should implement evidence-based, comprehensive sexual health education programs that emphasize the risks associated with drug use in sexual contexts. Such programs have the potential to mitigate risk and improve sexual health outcomes among college students.