Effects of Attachment on Condom Use Attitudes and
BehaviorJohn K. Sakaluk, M.A.Omri Gillath, Ph.D.
University of Kansas
Outline
1. Determinants of condom use
2. Attachment theory
3. Present results from 4 experiments
4. What do results mean for condom use promotion
Condom Use Promotion
Critiques of Pure Reasoned Action
“Oversimplified” WHO, 2012
“Mechanistic” Feeney & Raphael, 1992
“Ignoring important interpersonal and affectional nature of sexual relationships” Ciesla et al., 2004
Our Relational Focus: Attachment
Attachment theory—an account of emotional bonding in close relationships
What’s a baby/person in distress to do? Bowlby 1969/1982
Extensions to adult romantic/sexual relationshipsFraley & Davis, 1997; Mikulincer & Shaver, 2007
Internal Working Models of Self and Other
Anxious-Preoccupie
dSecure
Fearful Avoidant
Dismissive Avoidant
Positive Other
Negative Other
Positive SelfNegative Self
Internal Working Models of Self and Other
Anxious-Preoccupie
dSecure
Fearful Avoidant
Dismissive Avoidant
Positive Other
Negative Other
Positive SelfNegative Self
Internal Working Models of Self and Other
Anxious-Preoccupie
dSecure
Fearful Avoidant
Dismissive Avoidant
Positive Other
Negative Other
Positive SelfNegative Self
Attachment and Condom Use Research
Feeney et al (1999, 2000): Avoidants like condoms more/use condoms more Anxious like condoms less/use condoms less
Bogaert & Sadava (2002): Secures don’t like/use condoms Anxious like/use condoms
Kershaw et al. (2007): Avoidants and anxious both don’t like/use condoms
Goals and Predictions of Our Research
Examine the causal effects of attachment on condom use attitudes and behaviorsPriming attachment styles
Gillath et al., 2008; Sakaluk, 2013
General hypotheses: Secure/Anxious share positive working model of other (esp. when sex-related)Security/Anxiety should cause more negative
condom use attitudes/less behavior
Study 1 (n = 335)
Control Prime
Security Prime
Anxiety Prime
Avoidance Prime
Self-Reported (Explicit) Condom Use Attitudes
If I always (never) used condoms every time I had penile-vaginal intercourse, it would be…
Caring Selfish
Smart Stupid
Responsible Reckless
Safe Dangerous
Protective Risky
Respectful Insulting
Right Wrong
(αs = .93, .95); Higher scores = more positive evaluation
Sakaluk & Muehlenhard, 2012
Results
Control Security Anxiety Avoidance
-0.4
-0.3
-0.2
-0.1
0
0.1
0.2
0.3
0.4
0.5
0.6
Discusison
Priming attachment styles that involve positive working models of other lead to self-report preferences for condom use
No examination of mediating mechanism
Study 2
Health behavior theories suggest perceiving threat to health as necessary precursor to taking actionHochbaum, 1958; Rosenstock, 1960
Perceived sexual health threat as mediator of attachment effects on condom use attitudes
Study 2 (n = 145)
Control Prime
Security Prime
Anxiety Prime
Avoidance Prime
Perceived Sexual Health Threat (α = .65)
1-7 scale (1 = not at all; 7 = extremely)
1. How safe do you feel having sex with your partners?
2. How confident are you that partners would not give you a sexually transmitted infection?
3. How suspicious are you of your partners cheating?
Mediation by Sexual Health Threat
Sec/Anx vs. Avo
Perceived Sexual Health
Threat
Explicit Attitudes
Total Effect (c): β = -.87** Direct Effect (c’): β = -.67*
β = -.60** β = -.19*
95% CI (-.01, -.50)Bootstrapped N = 10,000
DiscussionPositive working models of other lower
perceptions of sexual health threat more negative attitudes towards condom use
Studies 1-2 limited to self-report (explicit) measuresVulnerable to socially desirable respondingExplicit attitudes require motivation/opportunity to
translate to behavior
Study 3
What about implicit attitudes?Automatic, and not always consciously accessible
What kind of behaviors are implicit attitudes good at predicting?Socially sensitive behaviors Greenwald et al., 2009
When motivation/opportunity for deliberate consideration are low Fazio, 1990
Study 3 (n = 89)
Control Prime
Security Prime
Anxiety Prime
Avoidance Prime
Positive Negative
Condom Use Condom Non-Use
SexyDisgusting
Mediation by Sexual Health Threat
Sec/Anx vs. Avo
Perceived Sexual Health
Threat
Implicit Preferences
Total Effect [c]: β = -.18*
95% CI (.-02, .04)
Study 3 DiscussionSame effect on implicit attitudes, but not
mediated by sexual health threat perceptionsPoor measurement of threat perceptions to blame?
(α = .40)
Studies 1-3 limited to study of self-report and finger movements—what about behavior?Unfortunate that security has negative effect given
other benefits of secure attachment styleMikulincer & Shaver, 2007
Study 4
Mikulincer & Shaver’s (2007) review of security priming effects1. Increased mental health/well-being
Mikulincer et al., 2006
2. Decreased intergroup aggression/hostilityMikulincer & Shaver, 2001
3. Increased levels of altruism/pro-social behaviorMikulincer et al., 2003
Benefits of Security
Mikulincer & Shaver’s (2007) review of security priming effects1. Increased mental health/well-being
(e.g., Mikulincer et al., 2006)
2. Decreased intergroup aggression/hostility(e.g., Mikulincer & Shaver, 2001)
3. Increased levels of altruism/pro-social behaviorMikulincer et al., 2003
Study 4 (n = 228)
Control Prime
Security Prime
Anxiety Prime
Avoidance Prime
Results
Control Security Anxiety Avoidance0
0.5
1
1.5
2
2.5
3
3.5
Self-FocusOther-Focus
Security (v. control) x Framing interaction: eβ = 0.59, p = .03
Summary and Limitations
Consistent effect of security across Studies 1-4Effect of anxiety did not carry over to behavior
Ad-hoc measurement of sexual health threat perceptions was a limiting factor for Studies 2-3
Although Studies 1-2 diverse in age, otherwise homogenous samples across Studies 1-4
Conclusions and Future Directions
Relational factors play important role in condom use evaluation/behaviorSecurity effect in particular warrants consideration
for sexual health promotion
Examining causal effects of attachment on broader indicators of sexual health
Security Prime
“I had a boyfriend for six years and we got along from the first moment we met…and I had no fear of abandonment. I don't think he did either….we grew
very close and for awhile it seemed we'd be together forever.”
“My husband and I have that kind of relationship. We are in love, trust each other, depend in each
other for everything and share our feelings.”
Anxiety Prime
“He felt like a sieve through which my affection poured through.”
“When in public I would try to hold their hand or put my arm through theirs, but they would kinda brush me off…even when we were alone in the
house, they pulled away when I would touch them...”
Avoidance Prime
“When I was ready to break up with a boyfriend, every physical gesture he made was painful and
unendurable. I did not want to be close or intimate, I just wanted to escape his physical presence.”
“I met a man in whom I had a casual interest…He quickly became enamored of me, much more so than I of him. He wanted me to meet his family, move in with him, pick out his clothes, name his
pets, etc. It gave me the creeps.”
Control Prime
“A new girl at work started about 1 week ago.She is very standoffish, a know it all and worst of
allshe is the boss’s friend”
“I know a guy from work. I do not talk to him except for a few small conversations in passing. He
seems nice. He talks to many people at work.”