Psychology and Health
April, 2006, 21(2): 165–181
Condom use in steady and casual sexual relationships:
Planning, preparation and willingness to take risks
among adolescents
PEPIJN VAN EMPELEN1,2 & GERJO KOK2,3
1Department of Clinical and Health Psychology, Leiden University, Leiden,
The Netherlands, 2Center for Research on HIV/AIDS Prevention and Education
(Reshape), The Netherlands, and 3Department of Psychology, University of Maastricht,
Maastricht, The Netherlands
(Received 9 August 2004; in final form 20 June 2005)
Abstract
Condom use within steady and casual sexual relationships was examined among 14–16
year old Dutch adolescents from secondary school (N¼ 140). It was hypothesised that
among adolescents sex and subsequently condom use with casual sex partners is less
likely to be considered in advance, more context-dependent and less habitual; whereas
the opposite is true for steady relationships. Therefore, preparatory behaviours (buying
and carrying condoms and communicating about condom use) were expected to mediate
the intention–behaviour relation in the context of steady relationships, but not in the
context of casual sex. Results confirmed that condom use with steady sex partners
was explained by preparatory behaviours, habits, and to some extent, behavioural
willingness, and that preparatory behaviours mediated the intention–behaviour
relationship. Condom use with casual sex partners was predicted by risk willingness
and intentions, without any mediation by preparatory behaviours. The results indicate
that it is essential to increase awareness among adolescents that unexpected sexual
situations may occur and to train them to take preparatory actions.
Keywords: Preparatory behaviours, behavioural willingness, habits, condom use,
young people, planned behaviour
Correspondence: Pepijn van Empelen, Department of Clinical and Health Psychology, Leiden
University, P.O. Box 9555, 2300 RB Leiden, The Netherlands. Tel: 071 5273749. Fax: 071
527 4678. E-mail: P.vanEmpelen@fsw.LeidenUniv.nl
ISSN 0887-0446 print/ISSN 1476-8321 online
2006 Taylor & Francis
DOI: 10.1080/14768320500229898

Introduction
Sexually transmitted diseases (STDs) are an immediate threat for sexually active
young people (Centers for Disease Control and Prevention, 1998, 2003;
Panchaud, Singh, Feivelsen, & Darroch, 2000; Van de Laar, Haks, & Coenen,
2001). In the Netherlands this is evidenced by an increased incidence of STDs
and teenage pregnancies, as well as the onset of these problems at an earlier
age (Vogels, Buitendijk, Bruil, Dijkstra, & Paulussen, 2002). Condom use is an
effective method for preventing both STDs and teenage pregnancies among
young people. However, among Dutch adolescents one out of four reported
having had unprotected sex (no condom and no contraceptive pill) at first
intercourse, and one out of six (16%) reported having unprotected sexual
intercourse at last intercourse (VanWesenbeeck et al., 2003). Moreover, condoms
are used less consistently when young people consider themselves to be in a steady
relationship (Misovich, Fisher J. D., & Fisher W. A., 1997; Sheeran, Orbell,
& Abraham, 1999).
Psychosocial models, such as the Theory of Planned Behaviour (Ajzen, 1991),
have been shown to predict condom use fairly accurately (Albarracin, Johnson,
Fishbein, & Muellerleile, 2001); and HIV prevention programmes based on cog-
nitive behavioural theories have proved effective (Fisher J. D. & Fisher W. A.,
1992; Fisher W. A. & Fisher J. D., 1999; Kirby, 2002; Schaalma et al., 2002).
Although effective, most interventions rely only on the identification of determi-
nants of condom use in order to arrive at a better understanding of how young
people could be motivated to use condoms. Such approaches fail to take into
account the complexity of the behaviour. Notwithstanding some measure of suc-
cess, it has been shown that a gap exists between intended and actual condom use
behaviour, specifically in the context of young people and casual sexual contexts
(Albarracin et al., 2001).
Preparatory behaviours and planning
Recent theoretical models have tried to address the issue of the intention–
behaviour gap. For instance, the Aids Risk Reduction Model (ARRM) suggests
that there are three stages in adopting condom use (Catania, Kegeles, & Coates,
1990). The first stage entails the labelling of factors that are intended to raise
awareness of risk; the second stage is motivation; and the third stage is enactment,
which is post-intentional (see also Schwarzer, 1992; Bagozzi, 1992). Most of the
studies that have been conducted in an effort to gain an understanding of the
determinants of condom use have focused on the first two stages. Likewise,
interventions have focused primarily on these first two stages. The ARRM
suggests that motivation alone is not sufficient to implement one’s intention.
From a health education perspective, Bartholomew and coworkers
(Bartholomew, Parcel, Kok, & Gottlieb, 2001; Bartholomew, Parcel, & Kok,
1998) suggest a similar approach. They emphasise that people have to perform
a sequence of actions, which they call ‘performance objectives’, in order to
achieve a health behaviour change. Moreover, they make clear that performance
166 P. van Empelen & G. Kok