A Mixed-Methods Approach to Develop a Combined Model of U.S. College Student Alcohol-Associated Condomless Sex

Alan Z. Sheinfil, Madison Firkey, Veronica Bucci, Mikaela Gjoka, Sarah E. Woolf-King

Research output: Contribution to journalArticlepeer-review


Unhealthy alcohol use and sexually transmitted infections (STIs) are significant public health concerns for US college students. Because alcohol use and condomless sex often co-occur in this population, alcohol-associated condomless sex has been identified as a behavioral intervention target. Existing theoretical frameworks have not garnered sufficient empirical support to serve as the foundation for interventions. The primary goal of the current study was to use a mixed-methods approach to develop a model of college student alcohol-associated condomless sex that combines elements from well-established health behavior theories. In Aim 1, multilevel modeling was used to predict condomless vaginal sex in a sample of heterosexual college student drinkers (N = 53). Aim 2 consisted of in-depth interviews (n = 18) to gather perceptions about the role of alcohol in sexual activity and identify supplemental constructs omitted from theories in Aim 1. The multilevel model explained a significant proportion of variance in condomless vaginal sex at the between- and within-person level. Themes derived from the in-depth interviews identified complementary elements of condom use decision-making. Findings from both aims were synthesized to construct a combined model of alcohol-associated condomless sex. This model can be further refined and ultimately serve as the foundation of an alcohol-STI prevention-intervention.

Original languageEnglish (US)
Pages (from-to)1499-1518
Number of pages20
JournalArchives of Sexual Behavior
Issue number4
StatePublished - Apr 2024


  • Alcohol consumption
  • Condomless sex
  • Event-level
  • Mixed-methods
  • Sexually transmitted infections

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • General Psychology


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