CSIRO PUBLISHING
Sexual Health, 2015, 12, 67–70 http://dx.doi.org/10.1071/SH14155
Short Report
Purchasing condoms near a college campus: environmental barriers Annie M. Wilson A and Melinda J. Ickes B,C A
Transylvania University, 300 North Broadway, Lexington, KY 40508, USA. Department of Kinesiology and Health Promotion, University of Kentucky, 111 Seaton Building, Lexington, KY 40506-0219, USA. C Corresponding author. Email: [email protected] B
Abstract. Background: Given the propensity for college students to engage in sexual activity and the subsequent lack of consistent condom use, there is a need to determine environmental factors that may be motivating or deterring factors for college students to access condoms. This study aimed to determine the number of businesses available to purchase condoms from near a large, south-eastern college campus and investigate environmental differences between types of businesses. Methods: Environmental factors (e.g. distance from campus, barriers to purchasing, selection availability and price) were collected among businesses within a 2-mile radius of the campus. Both c2 and ANOVA determined significant differences between types of businesses (P 0.05). Results: Forty-two businesses sold condoms, 66.7% of which were convenience-type stores. The average distance from the campus was 1.33 miles (s.d. = 0.58). The average unit price of male condoms was significantly higher in drug store/pharmacies (M = 1.68) compared with convenience-type stores (M = 1.22) and grocery stores (M = 0.97); P = 0.005. Assistance was needed to purchase condoms in 25% of businesses. Barriers to purchasing condoms were significantly higher in convenience stores/gas stations (P < 0.05). Conclusion: Environmental barriers related to purchasing condoms exist and must be considered when targeting sexual health promotion on college campuses. Additional keywords: contraceptives, sexual health, young adult. Received 12 August 2014, accepted 7 January 2015, published online 9 February 2015
Introduction Rates of sexual activity among college students put them at risk for sexually transmissible infections and unintended pregnancies.1–3 Although male condoms are the most frequently cited contraceptive used during the last instance of sexual intercourse among college students,3 they are not consistently used. Barriers associated with condom use, including the purchasing environment, need to be considered. It is well-documented that youth report embarrassment when purchasing condoms, creating a hindrance to consistent condom use.4–6 Few studies have investigated environmental factors within the purchase setting that might influence embarrassment.7–10 Findings highlight environmental barriers, including lack of accessibility without assistance10,11 and location of condoms in areas of high visibility.9 Although telling, these studies were conducted in metropolitan areas, not necessarily near college campuses. Failing to consider environmental factors influencing condom purchasing among college students inhibits current prevention efforts. The purpose of this study was to determine the number of businesses selling condoms near a college campus and investigate environmental differences between businesses, including availability, price and accessibility. Journal compilation CSIRO 2015
Methods A cross-sectional, observational study was conducted near a university with a total enrolment of 28 000 students. The study was exempt from Institutional Review Board human subjects’ approval. Overall, 181 businesses were within a 2-mile radius of the college campus, 23.2% (n = 42) of which sold condoms and were included in the study. Measures Availability was assessed with eight items related to condom brand, type and size. Price was documented for both single and multi-packs of three of the most popular condom brands: Trojan, Durex and Lifestyles. Accessibility included items related to visibility, product placement and if assistance was needed (i.e. locked up, behind counter).10,11 Visibility was measured using a five-point scale (1 = very low visibility, 5 = very high visibility). Location of product placement was assessed via a checklist of common locations that condoms were sold.9,12 Procedures The Yellow Pages website was searched with the university and surrounding city postal code to ensure all possible businesses www.publish.csiro.au/journals/sh
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A. M. Wilson and M. J. Ickes
were included.10 Businesses were eliminated if they were more than 2 miles from the location tag. If businesses appeared in more than one category, they were only counted once. Data were collected in February 2012. Businesses were grouped as follows: (i) convenience stores/gas stations; (ii) grocery stores; (iii) pharmacies/drug stores; (iv) bookstores/gift shops; and (v) bars/clubs. The last group (n = 22) was omitted because none of the businesses sold condoms. Data analysis Differences among business type were examined using c2 analysis for categorical variables. Analyses of variance (ANOVA) were conducted for continuous outcomes, including price and accessibility. To determine accessibility, a sub-scale (range 5–17) was created to include the following: locked up, behind counter, need to ask in order to locate, level of traffic and level of visibility, with higher scores indicating less accessibility. All statistical analyses were completed using PASW ver.18 (SPSS Inc., New York, NY, USA) and significance was set at a P 0.05 level. Results The most common type of businesses were convenience stores/ gas stations (66.7%). The average distance from the campus was 1.33 miles (s.d. = 0.58), but four businesses sold condoms on campus. Most businesses (61.9%) sold two or more brands of condoms, with Trojan the most commonly carried (73.8%). Only 26.2% of businesses offered multi-packs. The average unit price for single-packs was M = 1.28, (s.d. = 0.37) and M = 0.82, (s.d. = 0.23) for multi-packs (Fig. 1). There was a significant difference between the unit price of single-pack condoms (F(3,38) = 6.48, P = 0.001), with higher unit prices in a drug store/pharmacy (M = 1.68, s.d. = 0.50), compared with a convenience store/gas station (M = 1.22, s.d. = 0.25; P = 0.01) and grocery stores (M = 0.97, s.d. = 0.20; P = 0.004). In the majority of businesses (88.1%), condoms were located without help. There was not a significant difference (c2(1, n = 42) = 0.61, P = 0.44) in the need for assistance to locate the condoms. In over half (57.1%) of the businesses, condoms were located in high or very high traffic areas: Average unit price single
73.8% were in the aisle, 25.0% behind the counter and 11.9% in a vending machine (only gas stations). The most common product placement (83.3%) was within the medicinal section and 28.6% were sold next to feminine items. Assistance was needed to purchase condoms in 25% of businesses, but they were not locked up in 95.2% of businesses. Overall accessibility was significant across the types of businesses (F(3,38) = 31.23, P = 0.02), with higher scores in convenience stores/gas stations (M = 10.75, s.d. = 1.86) compared with drug stores/pharmacies, (M = 8.75, s.d. = 0.71; P = 0.04) and grocery stores (M = 9.0, s.d. = 1.83; P = 0.04). Discussion The purpose of this study was to determine the number of businesses near a college campus that sold condoms and to investigate environmental differences. Overall, 23% of the businesses within 2 miles of a university sold condoms. Considering that a lack of availability is a known barrier to purchasing condoms,10 based on potential opportunity alone, it appears individuals seeking to purchase condoms within close proximity to the campus would be able to do so. There were also four businesses on campus that sold condoms, giving students living on campus an opportunity to purchase condoms as needed. Determining differences in student perceptions of purchasing condoms on v. off campus is warranted. Student health professionals may find it helpful to promote nearby businesses in which condoms are available during sexual health programming. Two-thirds of the businesses selling condoms near the college campus were convenience stores/gas stations. Previous research indicates most adolescents purchase condoms in drug stores and few acquire them in convenience stores;11 however, similar data were not available for college students. Although not a focus of this study, it would be remiss not to mention the fact that there may be other ways college students obtain condoms. There is a lack of research considering where college students acquire condoms. Nevertheless, studies with adolescents reinforce the importance of the purchasing environment, with the majority obtaining, or planning to obtain,
Average unit price multi
Average total unit price
Price (US$)
2.00
1.00
0.00
Bars, nightlife
Bookstores, gift shops
Convenience Grocery stores, gas stores, stations, quick markets, stops supermarkets
Pharmacies, drug stores
Business type Fig. 1. Unit price comparison between types of businesses.
Purchasing condoms: environmental barriers
condoms in stores rather than from settings where they are available for free.13 The greater contextual environment surrounding college campuses should therefore be considered. Availability and variety of condoms within businesses varied. Trojan and Durex were sold in over 70% of the businesses. Interestingly, Trojan and Durex brands were more likely to be sold in single or three-packs compared with multipacks with 12 or more condoms. Only 26% of businesses sold multi-packs of condoms, with the more abundant conveniencetype stores less likely to sell multi-packs. If multi-packs are not available, college students may be less likely to purchase condoms in advance and potentially have limited access when needed. Cost and affordability are often cited as barriers to contraceptive use.13,14 Results of this study reaffirmed the price differential when comparing package counts and brands across businesses. The average unit price across all businesses for single-packs was $1.28 and $0.82 for multi-packs. Pricing in areas surrounding college campuses may be inflated as unit costs were higher than those reported in urban areas.11 Similar to previous research, drug stores/pharmacies had significantly higher prices,11 averaging $0.46 more compared with convenience-type stores and $0.71 more compared with grocery stores. The inconsistencies in price when comparing brands and single v. multi-packs were quite astonishing and may very well influence purchasing patterns among college students. Although price may seem like an obvious barrier to purchasing condoms, other environmental factors, including accessibility, may be more influential. Adolescents prefer to purchase condoms from places where they are visible and quickly purchased, even when given a cheaper option.11 Onequarter of the businesses sold condoms behind the counter and required assistance to purchase, a previously reported barrier to condom access.8,10,15 When assessing overall accessibility, convenience stores/gas stations exhibited significantly more environmental barriers to purchasing condoms. However, as previously mentioned, these businesses were the most widely represented near the college campus, which may create barriers to college students purchasing condoms when needed. Only 12% of the included businesses sold condoms from vending machines, all of which were located in gas stations. Previous research indicates young people would prefer to purchase condoms through vending machines, considering the privacy and perceived lack of judgment.12,15 It is surprising that more businesses surrounding a college campus did not take advantage of this opportunity, particularly bars and restaurants frequented by college students. Sexual health advocates should partner with area businesses to install vending machines in bathrooms to promote both condom availability and accessibility. The study presented several limitations that should be noted. Data collection occurred near one campus, so results cannot be generalised to other campuses. Results could also have been impacted by timing of data collection. The authors recognise condoms can be acquired outside of the purchasing environments included within this study. However, staff from the student health centre revealed that the university distributes ~20 500 condoms per year (J. Brown, pers. comm., 12 December, 2014) via on-campus programming and through
Sexual Health
69
Table 1. Summary of findings Type of business Convenience store/ gas station
Significant findings *
*
*
Grocery store
*
*
*
Pharmacy/drug store
*
*
*
Male condoms less likely to be sold in aisles Did not sell multi-packs of male condoms Less comprehensive accessibility Most sold multi-packs of male condoms Least expensive unit price of multi-packs Higher comprehensive accessibility Most expensive unit price of single- and multi-packs Most sold multi-packs Higher comprehensive accessibility
the student health centre, which equates to less than one condom per student per year. This further makes the case that students will likely have to purchase condoms to access and use them on a consistent basis. Future studies aiming to examine condom availability and accessibility from an ecological perspective should assess all relevant sources from which college students may acquire condoms. Conclusions Although condoms were available to purchase, clear differences between business type and overall accessibility existed (Table 1). Price varied widely, with higher unit prices in drug stores/pharmacies. Accessibility factors were also apparent, particularly in convenience stores/gas stations. These factors are known to hinder purchasing behaviour, particularly among college students already reporting high levels of embarrassment.7,8,15 Environmental barriers to condom purchasing represent an incongruity between what is needed and what is available. College health professionals should have a general understanding of the surrounding purchasing environment as they encourage college students to consistently use condoms. Conflicts of interest None declared. Acknowledgements We would like to thank the University of Kentucky University Health Service for their support, particularly the expertise of Joanne Brown. In addition, we would like to thank Brandy Reeves, with the College of Public Health, for her insight regarding sexual health and college students. We would also like to thank the faculty within the Department of Kinesiology and Health Promotion for their support throughout the study.
References 1 Centers for Disease Control and Prevention. Sexually transmitted diseases (STDs); 2011. Available online at: http://www.cdc.gov/std/ default.htm [verified 13 July 2013]. 2 Finer LB, Zolna MR. Unintended pregnancy in the United States: incidence and disparities. New York: Guttmacher Institute; 2006. 3 American College Health Association. American College Health Association-National College Health Assessment II: Reference Group Data Report Spring; 2013. Hanover, MD: American College Health Association; 2013.
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4 Conley T, Collins B. Differences between condom users and condom nonusers in their multidimensional condom attitudes. J Appl Soc Psychol 2005; 35: 603–20. doi:10.1111/j.1559-1816.2005. tb02137.x 5 Helweg-Larsen M, Collins BE. The UCLA multidimensional condom attitudes scale: documenting the complex determinants of condom use in college students. Health Psychol 1994; 13: 224–37. doi:10.1037/ 0278-6133.13.3.224 6 Moore S, Dahl D, Gorn G, Weinberg C. Coping with condom embarrassment. Psychol Health Med 2006; 11: 70–9. doi:10.1080/ 13548500500093696 7 Welch Cline RJ, McKenzie NJ. Sex differences in communication and the construction of HIV/AIDS. J Appl Commun Res 1994; 22: 322–37. doi:10.1080/00909889409365407 8 Brackett K. College students’ condom purchase strategies. Soc Sci J 2004; 41: 459–64. doi:10.1016/j.soscij.2004.04.006 9 Scott-Sheldon LA, Glasford DE, Marsh KL, Lust LA. Barriers to condom purchasing: effects of product positioning on reactions to condoms. Soc Sci Med 2006; 63: 2755–69. doi:10.1016/j.socscimed. 2006.07.007
10 Rizkalla C, Bauman LJ, Avner JR. Structural impediments to condom access in a high HIV/STI-risk area. J Environ Public Health 2010; 2010: 1–5. doi:10.1155/2010/630762 11 Klein J, Rossbach C, Nijher H, Geist M, Wilson K, Cohn S, Siegel D, Weitzman M. Where do adolescents get their condoms? J Adolesc Health 2001; 29: 186–93. doi:10.1016/S1054-139X(01)00257-9 12 Dahl DW, Gorn GJ, Weinberg CB. The impact of embarrassment on condom purchase behavior. Can J Public Health 1998; 89: 368–70. 13 Huber LR, Ersek JL. Contraceptive use among sexually active university students. J Womens Health 2009; 18: 1063–70. doi:10.10 89/jwh.2008.1131 14 Cohen D, Scribner R, Bedimo R, Farley TA. Cost as a barrier to condom use: the evidence for condom subsidies in the United States. Am J Public Health 1999; 89: 567–8. doi:10.2105/AJPH.89.4.567 15 Bell J. Why embarrassment inhibits the acquisition and use of condoms: a qualitative approach to understanding risky sexual behaviour. J Adolesc 2009; 32: 379–91. doi:10.1016/j.adolescence. 2008.01.002
www.publish.csiro.au/journals/sh
Sexual Health, 2015, 12, 67–70 http://dx.doi.org/10.1071/SH14155
Short Report
Purchasing condoms near a college campus: environmental barriers Annie M. Wilson A and Melinda J. Ickes B,C A
Transylvania University, 300 North Broadway, Lexington, KY 40508, USA. Department of Kinesiology and Health Promotion, University of Kentucky, 111 Seaton Building, Lexington, KY 40506-0219, USA. C Corresponding author. Email: [email protected] B
Abstract. Background: Given the propensity for college students to engage in sexual activity and the subsequent lack of consistent condom use, there is a need to determine environmental factors that may be motivating or deterring factors for college students to access condoms. This study aimed to determine the number of businesses available to purchase condoms from near a large, south-eastern college campus and investigate environmental differences between types of businesses. Methods: Environmental factors (e.g. distance from campus, barriers to purchasing, selection availability and price) were collected among businesses within a 2-mile radius of the campus. Both c2 and ANOVA determined significant differences between types of businesses (P 0.05). Results: Forty-two businesses sold condoms, 66.7% of which were convenience-type stores. The average distance from the campus was 1.33 miles (s.d. = 0.58). The average unit price of male condoms was significantly higher in drug store/pharmacies (M = 1.68) compared with convenience-type stores (M = 1.22) and grocery stores (M = 0.97); P = 0.005. Assistance was needed to purchase condoms in 25% of businesses. Barriers to purchasing condoms were significantly higher in convenience stores/gas stations (P < 0.05). Conclusion: Environmental barriers related to purchasing condoms exist and must be considered when targeting sexual health promotion on college campuses. Additional keywords: contraceptives, sexual health, young adult. Received 12 August 2014, accepted 7 January 2015, published online 9 February 2015
Introduction Rates of sexual activity among college students put them at risk for sexually transmissible infections and unintended pregnancies.1–3 Although male condoms are the most frequently cited contraceptive used during the last instance of sexual intercourse among college students,3 they are not consistently used. Barriers associated with condom use, including the purchasing environment, need to be considered. It is well-documented that youth report embarrassment when purchasing condoms, creating a hindrance to consistent condom use.4–6 Few studies have investigated environmental factors within the purchase setting that might influence embarrassment.7–10 Findings highlight environmental barriers, including lack of accessibility without assistance10,11 and location of condoms in areas of high visibility.9 Although telling, these studies were conducted in metropolitan areas, not necessarily near college campuses. Failing to consider environmental factors influencing condom purchasing among college students inhibits current prevention efforts. The purpose of this study was to determine the number of businesses selling condoms near a college campus and investigate environmental differences between businesses, including availability, price and accessibility. Journal compilation CSIRO 2015
Methods A cross-sectional, observational study was conducted near a university with a total enrolment of 28 000 students. The study was exempt from Institutional Review Board human subjects’ approval. Overall, 181 businesses were within a 2-mile radius of the college campus, 23.2% (n = 42) of which sold condoms and were included in the study. Measures Availability was assessed with eight items related to condom brand, type and size. Price was documented for both single and multi-packs of three of the most popular condom brands: Trojan, Durex and Lifestyles. Accessibility included items related to visibility, product placement and if assistance was needed (i.e. locked up, behind counter).10,11 Visibility was measured using a five-point scale (1 = very low visibility, 5 = very high visibility). Location of product placement was assessed via a checklist of common locations that condoms were sold.9,12 Procedures The Yellow Pages website was searched with the university and surrounding city postal code to ensure all possible businesses www.publish.csiro.au/journals/sh
68
Sexual Health
A. M. Wilson and M. J. Ickes
were included.10 Businesses were eliminated if they were more than 2 miles from the location tag. If businesses appeared in more than one category, they were only counted once. Data were collected in February 2012. Businesses were grouped as follows: (i) convenience stores/gas stations; (ii) grocery stores; (iii) pharmacies/drug stores; (iv) bookstores/gift shops; and (v) bars/clubs. The last group (n = 22) was omitted because none of the businesses sold condoms. Data analysis Differences among business type were examined using c2 analysis for categorical variables. Analyses of variance (ANOVA) were conducted for continuous outcomes, including price and accessibility. To determine accessibility, a sub-scale (range 5–17) was created to include the following: locked up, behind counter, need to ask in order to locate, level of traffic and level of visibility, with higher scores indicating less accessibility. All statistical analyses were completed using PASW ver.18 (SPSS Inc., New York, NY, USA) and significance was set at a P 0.05 level. Results The most common type of businesses were convenience stores/ gas stations (66.7%). The average distance from the campus was 1.33 miles (s.d. = 0.58), but four businesses sold condoms on campus. Most businesses (61.9%) sold two or more brands of condoms, with Trojan the most commonly carried (73.8%). Only 26.2% of businesses offered multi-packs. The average unit price for single-packs was M = 1.28, (s.d. = 0.37) and M = 0.82, (s.d. = 0.23) for multi-packs (Fig. 1). There was a significant difference between the unit price of single-pack condoms (F(3,38) = 6.48, P = 0.001), with higher unit prices in a drug store/pharmacy (M = 1.68, s.d. = 0.50), compared with a convenience store/gas station (M = 1.22, s.d. = 0.25; P = 0.01) and grocery stores (M = 0.97, s.d. = 0.20; P = 0.004). In the majority of businesses (88.1%), condoms were located without help. There was not a significant difference (c2(1, n = 42) = 0.61, P = 0.44) in the need for assistance to locate the condoms. In over half (57.1%) of the businesses, condoms were located in high or very high traffic areas: Average unit price single
73.8% were in the aisle, 25.0% behind the counter and 11.9% in a vending machine (only gas stations). The most common product placement (83.3%) was within the medicinal section and 28.6% were sold next to feminine items. Assistance was needed to purchase condoms in 25% of businesses, but they were not locked up in 95.2% of businesses. Overall accessibility was significant across the types of businesses (F(3,38) = 31.23, P = 0.02), with higher scores in convenience stores/gas stations (M = 10.75, s.d. = 1.86) compared with drug stores/pharmacies, (M = 8.75, s.d. = 0.71; P = 0.04) and grocery stores (M = 9.0, s.d. = 1.83; P = 0.04). Discussion The purpose of this study was to determine the number of businesses near a college campus that sold condoms and to investigate environmental differences. Overall, 23% of the businesses within 2 miles of a university sold condoms. Considering that a lack of availability is a known barrier to purchasing condoms,10 based on potential opportunity alone, it appears individuals seeking to purchase condoms within close proximity to the campus would be able to do so. There were also four businesses on campus that sold condoms, giving students living on campus an opportunity to purchase condoms as needed. Determining differences in student perceptions of purchasing condoms on v. off campus is warranted. Student health professionals may find it helpful to promote nearby businesses in which condoms are available during sexual health programming. Two-thirds of the businesses selling condoms near the college campus were convenience stores/gas stations. Previous research indicates most adolescents purchase condoms in drug stores and few acquire them in convenience stores;11 however, similar data were not available for college students. Although not a focus of this study, it would be remiss not to mention the fact that there may be other ways college students obtain condoms. There is a lack of research considering where college students acquire condoms. Nevertheless, studies with adolescents reinforce the importance of the purchasing environment, with the majority obtaining, or planning to obtain,
Average unit price multi
Average total unit price
Price (US$)
2.00
1.00
0.00
Bars, nightlife
Bookstores, gift shops
Convenience Grocery stores, gas stores, stations, quick markets, stops supermarkets
Pharmacies, drug stores
Business type Fig. 1. Unit price comparison between types of businesses.
Purchasing condoms: environmental barriers
condoms in stores rather than from settings where they are available for free.13 The greater contextual environment surrounding college campuses should therefore be considered. Availability and variety of condoms within businesses varied. Trojan and Durex were sold in over 70% of the businesses. Interestingly, Trojan and Durex brands were more likely to be sold in single or three-packs compared with multipacks with 12 or more condoms. Only 26% of businesses sold multi-packs of condoms, with the more abundant conveniencetype stores less likely to sell multi-packs. If multi-packs are not available, college students may be less likely to purchase condoms in advance and potentially have limited access when needed. Cost and affordability are often cited as barriers to contraceptive use.13,14 Results of this study reaffirmed the price differential when comparing package counts and brands across businesses. The average unit price across all businesses for single-packs was $1.28 and $0.82 for multi-packs. Pricing in areas surrounding college campuses may be inflated as unit costs were higher than those reported in urban areas.11 Similar to previous research, drug stores/pharmacies had significantly higher prices,11 averaging $0.46 more compared with convenience-type stores and $0.71 more compared with grocery stores. The inconsistencies in price when comparing brands and single v. multi-packs were quite astonishing and may very well influence purchasing patterns among college students. Although price may seem like an obvious barrier to purchasing condoms, other environmental factors, including accessibility, may be more influential. Adolescents prefer to purchase condoms from places where they are visible and quickly purchased, even when given a cheaper option.11 Onequarter of the businesses sold condoms behind the counter and required assistance to purchase, a previously reported barrier to condom access.8,10,15 When assessing overall accessibility, convenience stores/gas stations exhibited significantly more environmental barriers to purchasing condoms. However, as previously mentioned, these businesses were the most widely represented near the college campus, which may create barriers to college students purchasing condoms when needed. Only 12% of the included businesses sold condoms from vending machines, all of which were located in gas stations. Previous research indicates young people would prefer to purchase condoms through vending machines, considering the privacy and perceived lack of judgment.12,15 It is surprising that more businesses surrounding a college campus did not take advantage of this opportunity, particularly bars and restaurants frequented by college students. Sexual health advocates should partner with area businesses to install vending machines in bathrooms to promote both condom availability and accessibility. The study presented several limitations that should be noted. Data collection occurred near one campus, so results cannot be generalised to other campuses. Results could also have been impacted by timing of data collection. The authors recognise condoms can be acquired outside of the purchasing environments included within this study. However, staff from the student health centre revealed that the university distributes ~20 500 condoms per year (J. Brown, pers. comm., 12 December, 2014) via on-campus programming and through
Sexual Health
69
Table 1. Summary of findings Type of business Convenience store/ gas station
Significant findings *
*
*
Grocery store
*
*
*
Pharmacy/drug store
*
*
*
Male condoms less likely to be sold in aisles Did not sell multi-packs of male condoms Less comprehensive accessibility Most sold multi-packs of male condoms Least expensive unit price of multi-packs Higher comprehensive accessibility Most expensive unit price of single- and multi-packs Most sold multi-packs Higher comprehensive accessibility
the student health centre, which equates to less than one condom per student per year. This further makes the case that students will likely have to purchase condoms to access and use them on a consistent basis. Future studies aiming to examine condom availability and accessibility from an ecological perspective should assess all relevant sources from which college students may acquire condoms. Conclusions Although condoms were available to purchase, clear differences between business type and overall accessibility existed (Table 1). Price varied widely, with higher unit prices in drug stores/pharmacies. Accessibility factors were also apparent, particularly in convenience stores/gas stations. These factors are known to hinder purchasing behaviour, particularly among college students already reporting high levels of embarrassment.7,8,15 Environmental barriers to condom purchasing represent an incongruity between what is needed and what is available. College health professionals should have a general understanding of the surrounding purchasing environment as they encourage college students to consistently use condoms. Conflicts of interest None declared. Acknowledgements We would like to thank the University of Kentucky University Health Service for their support, particularly the expertise of Joanne Brown. In addition, we would like to thank Brandy Reeves, with the College of Public Health, for her insight regarding sexual health and college students. We would also like to thank the faculty within the Department of Kinesiology and Health Promotion for their support throughout the study.
References 1 Centers for Disease Control and Prevention. Sexually transmitted diseases (STDs); 2011. Available online at: http://www.cdc.gov/std/ default.htm [verified 13 July 2013]. 2 Finer LB, Zolna MR. Unintended pregnancy in the United States: incidence and disparities. New York: Guttmacher Institute; 2006. 3 American College Health Association. American College Health Association-National College Health Assessment II: Reference Group Data Report Spring; 2013. Hanover, MD: American College Health Association; 2013.
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4 Conley T, Collins B. Differences between condom users and condom nonusers in their multidimensional condom attitudes. J Appl Soc Psychol 2005; 35: 603–20. doi:10.1111/j.1559-1816.2005. tb02137.x 5 Helweg-Larsen M, Collins BE. The UCLA multidimensional condom attitudes scale: documenting the complex determinants of condom use in college students. Health Psychol 1994; 13: 224–37. doi:10.1037/ 0278-6133.13.3.224 6 Moore S, Dahl D, Gorn G, Weinberg C. Coping with condom embarrassment. Psychol Health Med 2006; 11: 70–9. doi:10.1080/ 13548500500093696 7 Welch Cline RJ, McKenzie NJ. Sex differences in communication and the construction of HIV/AIDS. J Appl Commun Res 1994; 22: 322–37. doi:10.1080/00909889409365407 8 Brackett K. College students’ condom purchase strategies. Soc Sci J 2004; 41: 459–64. doi:10.1016/j.soscij.2004.04.006 9 Scott-Sheldon LA, Glasford DE, Marsh KL, Lust LA. Barriers to condom purchasing: effects of product positioning on reactions to condoms. Soc Sci Med 2006; 63: 2755–69. doi:10.1016/j.socscimed. 2006.07.007
10 Rizkalla C, Bauman LJ, Avner JR. Structural impediments to condom access in a high HIV/STI-risk area. J Environ Public Health 2010; 2010: 1–5. doi:10.1155/2010/630762 11 Klein J, Rossbach C, Nijher H, Geist M, Wilson K, Cohn S, Siegel D, Weitzman M. Where do adolescents get their condoms? J Adolesc Health 2001; 29: 186–93. doi:10.1016/S1054-139X(01)00257-9 12 Dahl DW, Gorn GJ, Weinberg CB. The impact of embarrassment on condom purchase behavior. Can J Public Health 1998; 89: 368–70. 13 Huber LR, Ersek JL. Contraceptive use among sexually active university students. J Womens Health 2009; 18: 1063–70. doi:10.10 89/jwh.2008.1131 14 Cohen D, Scribner R, Bedimo R, Farley TA. Cost as a barrier to condom use: the evidence for condom subsidies in the United States. Am J Public Health 1999; 89: 567–8. doi:10.2105/AJPH.89.4.567 15 Bell J. Why embarrassment inhibits the acquisition and use of condoms: a qualitative approach to understanding risky sexual behaviour. J Adolesc 2009; 32: 379–91. doi:10.1016/j.adolescence. 2008.01.002
www.publish.csiro.au/journals/sh
