title: When condom use is not condom use: an event-level analysis of condom use behaviors during vaginal intercourse.
abstract: BACKGROUND
  Little is known about event-level condom use errors during vaginal sex.
  
  
  OBJECTIVE
  The aim of this article is to examine factors associated with complete condom use compared to forms of incomplete condom use, including delayed condom application and early condom removal, over a 30-day period.
  
  
  METHODS
  Data were collected in 2008 from 1,875 men during a prospective daily diary study of sexual behavior and condom use. Incomplete condom use was assessed during vaginal intercourse considering situational, relational, intrapersonal, and behavioral predictors. Analyses were generalized estimating equation multinomial logistic regression.
  
  
  METHODS
  Condom use during vaginal sex: complete use, delayed application, early removal, and both delayed application/early removal.
  
  
  RESULTS
  Of 29,714 diary reports, 30% (8,876) included vaginal intercourse. Analyses were conducted (in 2009) on 83.2% of these intercourse events (6,325), during which condoms were used and for which participants provided complete data. Incomplete condom use included penetration before applying condoms during 12% of events (749), removing condoms before intercourse ended during 3.1% (198), and both types of incomplete use during 2% (129) of events. Erection quality (less than typical erect penile length and circumference, less rigidity, and difficulty maintaining erection) was associated with greater odds of incomplete use, as was a participant's history of other recent incomplete use. Perceptions of condom comfort and recent previous complete use were protective factors against incomplete use.
  
  
  CONCLUSIONS
  Men's incomplete condom use is associated with recent condom use patterns, as well as with their physiological characteristics and perceptions of condoms during sexual intercourse. Event-level analyses such as these help describe how incomplete condom use occurs among individuals incorporating condoms into their sexual activities.
authors.affiliation: Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA. djhensel@iupui.edu
authors.forename: Devon J
authors.initials: DJ
authors.lastname: Hensel
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Stupiansky
authors.forename: Debby
authors.initials: D
authors.lastname: Herbenick
authors.forename: Brian
authors.initials: B
authors.lastname: Dodge
authors.forename: Michael
authors.initials: M
authors.lastname: Reece
mesh_terms: D000328:Adult; D017280:Condoms; D004868:Equipment Failure; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D015999:Multivariate Analysis; D011446:Prospective Studies; D021841:Safe Sex; D012725:Sexual Behavior; D014481:United States