General and sexual communication in established relationships: an exploration of possible links to condom use among young adults.
Article Type: Report
Subject: Condoms (Usage)
Young adults (Health aspects)
Young adults (Sexual behavior)
Interpersonal communication (Influence)
Authors: Boyle, Andrea M.
O'Sullivan, Lucia F.
Pub Date: 03/22/2010
Publication: Name: The Canadian Journal of Human Sexuality Publisher: SIECCAN, The Sex Information and Education Council of Canada Audience: Academic Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2010 SIECCAN, The Sex Information and Education Council of Canada ISSN: 1188-4517
Issue: Date: Spring-Summer, 2010 Source Volume: 19 Source Issue: 1-2
Product: Product Code: 3069770 Prophylactics & Diaphragms NAICS Code: 326299 All Other Rubber Product Manufacturing SIC Code: 3069 Fabricated rubber products, not elsewhere classified
Geographic: Geographic Scope: Canada Geographic Code: 1CANA Canada
Accession Number: 229542650
Full Text: Abstract: Rates of consistent condom use are typically low among young adults in established relationships. This exploratory investigation examines how young adults in relationships characterize their communication styles with their current partners. Communication difficulty within the relationship, including sexual communication, was further explored for associations with condom use. Thirty-two women and 22 men (18-24 years) tracked their condom use over a three-week period using daily diaries. Diary data subsequently were linked to reports of communication difficulties that emerged from analyses of the qualitative interview data addressing relationship communication. We found that those who reported some difficulty in communication practiced condom use more consistently than those who did not report such difficulties. No statistically significant differences were found for those who reported difficulty communicating about sex-related issues compared to those who reported feeling at ease discussing such issues. Results have implications for interventions promoting safer sex among young adults.

Acknowledgements: We gratefully acknowledge research support from NICHD Grant R01-HD41721 to Lucia F. O'Sullivan, Ph.D. The authors thank the students for their participation in the project, Giovanna Rodriguez for coordinating data collection and entry, Susie Hoffman, David Seal, and Abigail Harrison for help with designing the study, and Dr. Patricia Antoniello who helped implement the project.

Introduction

A recent national study of Canadian young adults who were unmarried and not living common law found a clear pattern of declining condom use at last intercourse with increasing age from 15-19 to 30-34 for both sexes (Rotermann & McKay, 2009). The authors offered several explanations for this trend but the one most pertinent to the current study was that increasing age brought with it a greater likelihood of being in a close relationship and that individuals in such relationships are less likely to practice safer sex (Misovitch, Fisher, & Fisher, 1997). Others have noted that consistent condom use is typically low among young adults (Moyo, Levandowski, MacPhail, Rees, & Pettifor, 2008; O'Sullivan, Udell, & Patel, 2006) and particularly so among those in committed relationships (Anderson, 2003; van Empelen & Kok, 2006; Woolf & Maisto, 2008). For example, one study showed that 62% of young adults reported using a condom outside of a relationship while only 19% reported using a condom within an established relationship (Anderson, Wilson, Doll, Jones, & Barker, 1999). Another study of 103 young heterosexual adults found that condom use was less likely with established partners (47%) than with casual sex partners (70%) (de Visser & Smith, 2001). The norm of serial monogamy among young adults compounds the problem of inconsistent condom use across partners and thus contributes to the spread of STIs (Bellis, Hughes, & Ashton, 2004; Corbin & Fromme, 2002).

In the early stage of a relationship, individuals are less likely to presume that the relationship is monogamous (Netting & Burnett, 2004) and they may therefore be more likely to practice safer sex. Once a relationship has been established, the request for condom use is more likely to be interpreted as a lack of trust or a sign of infidelity (Gebhardt, Kuyper, & Greunsven, 2003). The lesser likelihood of condom use in a steady relationship may thus be viewed as an aspect of pursuing or maintaining intimacy. In addition, in committed relationships condoms are often used as a secondary form of contraception rather than primarily as a means of disease prevention (O'Sullivan, Udell, Montrose, Antoniello, & Hoffman, in press).

The foregoing observations highlight the importance of understanding relationship dynamics and particularly communication styles in the relationships of young adult women and men in order determine how condom use is initiated and either maintained or discontinued over time. The current study thus sought to look beyond condom communication specifically and to explore the associations between condom use and the quality and extent of general and sexual communication.

Communication about condom use in relationships

Direct communication regarding condom use is associated closely with actual use of condoms in relationships (Allen, Emmers-Sommer, & Crowell, 2002). Interventions that target condom use, therefore, often focus on teaching communication skills for insisting upon condom use with a partner (for a review, see Noar, Carlyle, & Cole, 2006). However, findings are mixed regarding the success rate of communication skills training programs among young adults in committed relationships (Crosby et al., 2003). Although participants of these programs often demonstrate skill acquisition at the time of the study assessment, these skills are often not sustained as failure rates and low consistency in follow-up assessments are common (Tulloch, McCaul, Miltenberger, & Smyth, 2004). A premise of the current study is that examining communication styles more broadly--both with regard to general and sex-related topics--within an established relationship may reveal the larger context in which condom use is negotiated.

General communication styles in established relationships

Placing instances of condom use negotiation within a larger communication context provides meaning and clarity to what is taking place between partners (Baxter, 2007; Stamp, Vangelisti, & Knapp, 1994). Sexual communication, including discussions surrounding sexual histories and sexual preferences, predicts condom use among young persons in established relationships, even after controlling for communication about contraception use specifically (Widman, Welsh, McNulty, & Little, 2006). Consistent condom use takes communication, planning, and a shared goal between partners to ensure that condoms are available when sexual interactions take place. A communication style that fosters such planning, or the ability to discuss comfortably a range of topics with a partner, seems essential. In short, quantity of general communication in a relationship does not predict communication about sexual issues (Powell & Segrin, 2004). However, the quality of partners' general and sex-related communication, that is, the approaches or styles of communicating in a relationship, may be a useful metric for understanding discussions about condom use specifically, and thus are the focus here.

General communication within relationships has received a fair amount of research attention, but primarily for couples seeking therapy (Kelly, Fincham, & Beach, 2003; Sheras, & Koch-Sheras, 2006). The quality of communication within a couple has been linked to sexual and relationship satisfaction (Byers, 2005) and to intimacy within relationships (Emmers-Sommer, 2004). Open communication is associated with greater support in relationships, less conflict, more emotional expression, disclosure, and higher ratings of intimacy (Cuming & Rapee, 2009; Sparrevohn & Rapee, 2009). Other work has examined cultural issues, internal states, interpersonal competencies, communication apprehension, verbal and nonverbal behaviours, interactions, and interpersonal effect (for a review, see Stamp, 1999). However, little is known about general communication styles that develop between romantic partners from non-clinical samples.

The current study

The current study of young adult male and female urban college students used a mixed-methods design to monitor participants' sexual interactions over a three-week period and thereafter to interview them about their communication dynamics. The aim of the study was to address the following research questions:

RQ1: How do young adults in committed relationships characterize their communication regarding general issues and sex-related issues?

RQ2: How consistently do young adults in committed relationships use condoms during vaginal intercourse encounters with their primary partners? RQ3: Can styles of communicating among young adults be linked to consistency of condom use?

Methods

Participants

The sample comprised 22 male and 32 female young adults enrolled at an urban college in New York City. Participants were recruited by distributing fliers in classrooms (two computer science, two anthropology, and two social work courses to gather a range of students across disciplines). Those interested in participating in a study addressing "sex, relationships, and romance" were asked to call a study telephone number to be assessed for eligibility over the phone. To be eligible, participants had to be between the ages of 18 and 24 and currently in an established, sexually active heterosexual romantic relationship. Established relationships were considered to be those of at least three months' duration (assessed during phone contact), in line with research addressing young adults' views about when relationship status shifts from casual to established (O'Sullivan, Hoffman, Harrison, & Dolezal, 2006).

Participants' mean age was 20.2 years. Their race/ ethnicities were Black/African American (31.5%), White (42.6%), Hispanic/Latino (24.1%), and Asian (1.9%). The majority (90.7%) reported being in school full-time. More than half (57.4%) were born in the United States; the rest originated from a Caribbean country (14.8%), Europe (13.0%), or Other (14.8%). Most participants were never married and not cohabiting at the time of the study (81.5%). The remainder was married (9.3%) or cohabiting (9.3%). The average length of their primary relationship was 26.0 months (range 1 to 108). Two participants reported having children with their partner. More than half of the sample (57.4%) indicated that they had not had another serious relationship prior to the current one. None reported currently trying to get pregnant. All resided in high HIV prevalent neighborhoods of New York City.

Measures

Background questionnaire

Participants were asked to provide background information. This included age, race/ethnicity, country of origin, student status (full-time or part-time), current relationship status, length of primary relationship, and sexual history variables (number of sexual partners, number of sexual occasions in past 30 days, consistency of condom use, contraception, pregnancy attitudes and intentions).

Structured daily diaries

Respondents completed a highly structured, one-page form that comprised a series of questions about their sexual encounters. For each day, respondents indicated whether they engaged in some type of sexual activity (yes/no). For days on which sexual activity occurred, respondents reported the type of sexual activity in which they engaged (from a check list) and whether a condom was used during that encounter. Other questions (not used in this study) included who initiated the sexual activity, who controlled the pace of the encounter, whether the sexual encounter was expected or not, how much the sexual activity was wanted, how much the participant enjoyed the encounter (if at all), whether the interaction involved the use or experience of pressure or force, and whether the participant or his/her partner used alcohol or drugs soon before or during the sexual encounter. The daily diary was similar in structure to versions used in other recent diary studies (Hensel, Fortenberry, Harezlak, Anderson, & Orr, 2003; Hoffman, O'Sullivan, Dolezal, & Monroe-Wise, 2006).

Qualitative interview protocol

The interview protocol was designed to explore a number of aspects relating to young adults' intimate relationship histories. The interview referred to the daily diaries to explore participants' communication in their relationships, including communication about sexual topics specifically. Although data were collected on other partners, participants were asked to refer to their primary partners (established during screening) for both the daily diaries and the interview. All participants indicated that their relationships were ongoing during the study period. The first portion of the interview (analyzed here) assessed communication in the relationship. Interviewers used a number of guiding questions from a protocol developed by a team of experts in the field, including "How well do you and your partner communicate about sexual matters?" "How well do you talk about problems, pleasure, what you like and don't like?" "How well do you and your partner communicate about things in general, not just about sex?" and "How easy is it to talk to your partner about issues in your relationship?" Prompts included, "What is most hard to talk about?" and "What is most easy to talk about?" Interviewers used prompts as needed to ensure that participants expanded upon the patterns of general and sexual communication. The protocol was revised in an iterative fashion upon subsequent interviews to ensure full coverage of the topic, as recommended by Berg (1988).

Procedures

Participants who expressed interest in participating and who met the eligibility requirements were scheduled to meet with one of four interviewers who had training and experience in conducting sexuality-related interviews. After providing consent, participants completed the self-administered background questionnaire. Each participant then was taught how to complete the daily diary in individual half-hour sessions. All participants were compensated for completing the initial training and survey. They were then provided with three weeks' worth of forms and stamped envelopes and instructed to return their forms each day by mail to the study offices to ensure privacy, consistent and timely completion. Study personnel contacted participants if three consecutive days' of forms were missing to remind them to submit their forms and to address any questions or concerns that may have arisen since the training.

Following the three weeks of daily diary completion, participants were interviewed in a semi-structured interview that took approximately 90 minutes to complete. All interviews were conducted within 10 days of the end of data collection and were audiotaped, transcribed and proofed prior to analysis. Participants were compensated for completing the three weeks of diary data and then again for completing the interview. Thus, both quantitative data (questionnaire and diary) and qualitative data (interview) were collected as part of this study, making it possible to link reports of ease in communicating about sex-related issues and general relationship issues directly to condom use over a three-week period. The study protocol was reviewed and approved by our respective institutional review boards for protection of human subjects in research.

Data analysis

Eighty-one students participated in the initial training and began completing diary data. However, only those participants who returned at least 15 of the 21 forms and who completed a full follow-up interview were retained for analyses. Those who reported 15 or fewer days (n = 18) were not different from the sample retained in the analyses in terms of key background and sexual variables (age, number of sexual partners, consistency of condom use, length of primary relationship). Nine interviews did not have sufficient data pertaining to communication and thus could not be analyzed in the qualitative analyses. Thus, the final sample comprised 22 male and 32 female participants with a full diary and qualitative interview data set. The median number of completed diary days was 21.0 (mean = 20.4) across the three weeks of collection.

Interviews were transcribed verbatim into text with all identifying data removed to protect participant confidentiality. To ensure accuracy of the transcripts, the interviewer listened to the tape while reading the transcript for the first time, as suggested by Dicicco-Bloom and Crabtree (2006). Because qualitative content analysis is useful for providing knowledge and understanding of the study phenomena (Down-Wamboldt, 1992), it is an appropriate approach for learning about communication in relationships. Qualitative content analysis is defined as subjective interpretation of text data through a systematic classification process of coding and exploring patterns (Hsieh & Shannon, 2005). A consistent set of coding categories was used to label data segments containing similar content (Morgan, 1993). These categories were modified as analysis continued and new categories were added to capture all dimensions of the data (Morgan, 1993). Once coding was completed, coding categories for styles were then organized into a template, and illustrative quotes relevant to the categories were extracted from the interview transcripts. Reports of communication derived from the qualitative work were then compared to condom rates reported by the participants during the period of daily diary completion. Gender differences were analyzed using chi-square analyses for the primary communication styles that emerged. These analyses revealed no significant differences between male and female participants and, therefore, data were collapsed across gender in our presentation of analyses.

Results

Sample characteristics

The mean number of days with sexual activity was 5.94 (SD = 2.67, range 1-12) during the three-week period of diary collection. For vaginal intercourse occasions only, 16 participants (30%) indicated that they used condoms on every occasion of intercourse, whereas 9 participants (16%) indicated that they never used a condom during their sexual occasions. The remainder (n = 29; 54%) reported inconsistent condom use (unprotected occasions ranging from 25% to 90% of their intercourse occasions). Women reported a higher mean proportion of unprotected intercourse occasions than did men (Ms = 58.8 and 34.7, respectively), F(1, 52) = .87, p < .01. In a corresponding analysis of the pregnancy prevention efforts of participants who did not use condoms on every occasion of intercourse, the majority indicated that they relied on withdrawal to prevent pregnancy. Only 23% were using oral contraceptives for pregnancy prevention, although a few of these participants indicated that they were not doing so as consistently as required to provide full protection from pregnancy.

Communication styles identified in individual interviews

Four primary communication styles emerged after analyses of the interview data: (1) one-way communication about sexual topics and more general relationship issues (18 excerpts); (2) detailed, verbal (29 excerpts) versus indirect (15 excerpts) communication regarding sexual topics; (3) ease (19 excerpts) versus difficulty (16 excerpts) in discussing sexual topics; and (4) discrepancies in reports (22 excerpts) about ease (6 excerpts) versus difficulty (25 excerpts) in discussing general relationship issues.

One-way versus bi-directional communication about sexual topics and more general relationship issue.

A few participants reported that they were comfortable talking about a variety of sex-related issues with their partners, but that their partners were not as open, or vice versa (13%; 7/54). Thus, sex-related communication was characterized as a primarily one-way stream in their relationships. For example, one man described communication with his partner concerning sexual manners in the following way:

As a woman explained about her experiences with the same topic: "Unless I bring it up, it'll be non-existent." Unidirectional communication extended to general communication about issues in the relationship for three additional participants (5.6%; 3/54). Several participants indicated that only general communication about issues in the relationship was characterized by unidirectional communication (14.8%; 8/54). For example, when asked how well one individual and her partner communicated about things generally, rather than sexual matters specifically, one woman said:

In comparison to this one-way style, many participants did not characterize the communication in their relationships as being unidirectional (66.7%; 36/54) and a few individuals alluded to more bidirectional communication. This is illustrated in the following quote about sexual communication in one woman's relationship, "I'm not afraid to tell him if I want something or if I don't want something. And he's the same way. You know, i'm very open with him ... about sexual things."

Our analyses then linked one-way communication styles to the participants' three-weeks of daily diary monitoring, in particular to reports of their condom use during this period, to assess whether this communication style was related ultimately to condom use. Of note, we found that those who had one-way communication styles regarding sexual topics and/or general relationship issues were no more likely to use condoms consistently compared to those who did not speak of one-way communication in their relationships (38.9% and 25%, respectively), [x.sup.2](1, N = 54) = 1.1, p = .35.

Detailed, verbal versus indirect communication conversations regarding sexual topics

Relatively few participants mentioned that they relied solely on communicating about sex via body language or other indirect means of communicating about sexual matters, such as humour, (5.5%; 3/54), that they did not need to have a conversation because their partners "just knew what they liked" (7.4%; 4/54), or that they needed to balance direct communication with indirect communication tactics (14.8%; 8/54). By contrast, many participants reported that they could talk about sex in a very direct and detailed verbal fashion with their partners (53.7%; 29/54). When asked how well one communicated with a partner about sexual matters, one man stated, "We tell each other what we like, how we like it, and ... she tells me, you know, if it hurts or not. And she tells me if it feels good or whatever. We talk about those things." Likewise, one woman said:

Those who reported this direct style tended to indicate that this communication style expanded to more general relationship issues. When discussing how well they communicated about things in general in their relationships, one group discussed working out issues with their partner through direct communication about the concern. For instance, one woman stated, "Anything that has to be said, we'll say it. if you agree on it--good. If you don't, then we work it out. But it's always gonna be like that." Or as one man explained:

Interestingly, in our analyses linking participants' communication style to reported condom use 37.9% of those who always communicated with their partners about sex in a direct and detailed manner used condoms consistently compared to 20% consistency of condom use among those who combined direct and indirect tactics. However, this apparent difference was not statistically significant, [x.sup.2](1, N= 44) 01.47, p = .31

Ease versus difficulty in discussing sexual topics

Just over one third of participants claimed that sexual topics were easily and often discussed within the relationship (35.2%; 19/54). Fewer individuals mentioned that it was a difficult topic or that it could only be discussed under particular circumstances (29.6%; 16/54). For instance, some mentioned that they could only approach the topic if their partner was in a particular mood or if they felt they could present their concerns without hurting the others" feelings. Several participants stated that they avoided the topic altogether and others claimed that, "It just doesn't come up." However, many responded that it was frequently brought up: "We communicate very well. That's one thing we talk about a lot!" (female participant) or effortlessly brought up: "Sex is easy to talk about" (female participant) in the relationship. One man explained how it can become a comfortable topic of discussion:

In our comparison of consistency of condom use during the three-week period of diary collection, 26.3% of the participants who claimed easy and frequent discussion of sex with partners reported consistent condom use compared to 43.8% consistency of condom use among those who said it was difficult or only sometimes easy to discuss sex with their partners. However, this apparent difference was not statistically significant, [x.sup.2](1, N=40) = 1.17, p = .31.

Discrepancies in reports about ease versus difficulty in communication

Participants often claimed (40.7%; 22/54) that they could discuss anything with a partner, but later mentioned in their interview one or more topics that were difficult to bring up or that were avoided altogether. A descriptive report from one female participant illustrates well the contradictory statements that numerous participants made throughout the communication interview:

Q: How well do you and your partner communicate about things in general, not just about sex?

A: We communicate well. I think that we talk well ... we talk about everything. That's one thing I should say, that ... we have a real ... we communicate a lot. Maybe too much, because ... I mean ... I talk to him till I'm blue in the face, 'cause he's my best friend ... he says that I'm his best friend. So we talk about everything, like his mom, his uncle, his aunt. Everything ... that goes on, we talk about. And that's a good thing ... in some cases.

Q: How easy is it to talk to your partner about issues in your relationship?

A: It's not easy, because he thinks he's doin' everything right [laughs], you know? I don't tell him, like, when we're not fighting.

Q: Uh-huh?

A: So he doesn't know ... that ... "Oh, okay, I'm doin' something that hurts you," or whatever. But, yeah, we talk about that. Not too much, though. Not too much.

Q: So it sounds like--from what you said--that it's harder to talk about those things when you're not fighting?

A: Yeah, when we're not fighting. 'Cause when you're fighting, everything just comes out 'cause you don't care. But when we're not fighting ... it's so hard to just ruin the moment ... and bring up ... stuff ... that you wouldn't necessarily bring up if you were ... if you weren't angry.

Another distinct sub-theme was found among 11.1% (6/54) of participants who indicated that they and their partners could talk about absolutely anything and at no time in the interview contradicted themselves. This style was portrayed by one male participant as follows:

Q: It sounds like it's very easy to talk to your wife.

A: Yeah, very easy. This is ... the person, you know, I could talk to her--only with her.

Q: Is there anything that is hard to talk to her about?

A: No, nothing at all.

Q: Okay.

A: There are no things. I don't have any secrets you know, from her. Everything I think, I talk. Probably that's my problem sometimes ... what I think I talk.

By comparison, 46.3% (25/54) simply stated that some topics were difficult to discuss and never claimed that communication was easy. As an example, one man's response to a question on how easy it is, or is not, to talk to a partner about issues in the relationship was:

Examining associations among these styles and condom use, those reporting communication difficulties were more likely to be consistent in their condom use (48% of this group used condoms consistently) than were both those who showed discrepancies regarding the level of ease in communicating with a partner and those reporting that everything was easy to discuss, who were more inconsistent in their condom use (14.3% used condoms consistently), [x.sup.2](1, N = 53) = 7.12, p = .02. A follow-up analysis using ANOVA was conducted to determine whether the two groups varied in terms of relationship duration, but no differences emerged (Ms = 28.2 and 23.6 months, respectively), F(1, 52) = 0.49, p > .05.

Discussion

The current study represents a mixed-methods exploratory investigation of partner communication styles among individuals in committed romantic relationships. It is the first study to our knowledge to link individuals' descriptions of their communication styles from interview data to actual prospective diary data of condom use. Our findings add to our understanding of condom use in committed relationships and how condom negotiation may fit within the larger context of communication dynamics that develop in relationships. Condom use remains an important practice in committed relationships to prevent unwanted pregnancies, and given the current trend of serial monogamy among young adults (Corbin & Fromme, 2002), it remains imperative to understand how consistent condom use can be promoted so as to reduce the spread of STIs.

Consistent with the literature reflecting low rates of condom use among young adults (Moyo et al., 2008; O'Sullivan, Udell, & Patel, 206), and among young adults in committed relationships in particular (Anderson, 2003; van Empelen & Kok, 2006; Woolf & Maisto, 2008), the participants in the current study reported low rates of consistent condom use. Other research has connected this trend to a lack of trust or a sign of infidelity in relationships (Gebhardt, Kuyper, & Greunsven, 2003), suggesting that communication between partners may be central to increasing condom use rates among this population.

Four communication styles (or dimensions) emerged from our exploratory analysis of interview data among this sample. Although we cannot generalize from this sample to young adults in general, these results may constitute a foundation for future investigations in this area. In particular, our quantitative analysis indicates that one of these four styles was linked to consistent condom use. Specifically, consistent condom use was reported by participants who revealed in the individual interviews that they experienced some difficulties communicating with their partners. Conflict and its resolution is an inevitable component of romantic relationship communication (Egeci & Gencoz, 2006), and those who recognize this may be more realistic about the challenges associated with addressing it. Those who were aware of or could acknowledge the difficulty in communicating may have had a greater repertoire of skills to negotiate condom use with a partner, or perhaps histories of facing and overcoming communication challenges from sexual partners who wanted to forego condoms. Of note, those who indicated that communicating with their partner was easy were not more likely to be in longer term relationships, a context in which condom use often is discontinued (van Empelen & Kok, 2006; Woolf & Maisto, 2008), and thus were unlikely to have reported ease because they simply no longer used or discussed condoms whatsoever.

Other investigations into the link between communication and condom use highlight the importance of supporting an egalitarian model of communication around condom use and relationship issues (Crosby, Milhausen, Sanders, Graham, & Yarber, 2008). That only very few of the young adults interviewed in this study characterized their communication with partners in a bidirectional manner (although not asked about this directly in the interview) may have important implications. If future research supports a trend for low rates of bidirectional communication in relationships, interventions may be improved by demonstrating and encouraging bidirectional communication in young adults' romantic relationships.

A relatively large proportion of young adults interviewed (55%) expressed that sex-related issues with their partner was typically in a very direct and detailed fashion. Although intuitively a positive finding, other research suggests that effective pairing of verbal with nonverbal tactics during condom negotiations makes condom use more likely (Bird, Harvey, Beckman & Johnson, 2001). Nonverbal exchange includes physically putting a condom on oneself or a partner, buying or presenting condoms to a partner, or passively withdrawing from sex. These individuals may benefit from interventions that demonstrate the value of balancing both direct verbal exchanges with indirect, nonverbal exchanges. In general, educating young adults in committed relationships about how best to communicate more generally with a partner may be particularly useful in ensuring effective conversations about condom use (Parr, Boyle, & Tejada, 2008).

We did not find that communicating about sex-related issues comfortably was related to condom use. Many participants claimed that sexual topics in particular were easy to discuss in their relationships. Some participants even reflected that sex was the only topic that was effortless to discuss in the relationship. Very few reported that they could discuss sexual topics openly only under certain circumstances, that it was a difficult discussion topic, or that the topic of sex never arose. Although a seemingly positive finding, those who find sex to be a comfortable topic were not more likely to use condoms consistently than were those who said it is not an easy topic to discuss. Those individuals who reported complete ease when communicating about sexual issues might not have been accurate in or honest about how well they were communicating, or might not have been thorough with regard to ensuring all aspects were sufficiently addressed. Individuals typically lack insight into the effectiveness of their communication and overestimate the ability of the person listening to interpret their preferences (Van Boven, Gilovich, & Medvec, 2003), especially romantic partners (Vorauer & Cameron, 2002). We commonly overestimate how well partners understood the message and overestimate success of our communication goals (Keysar & Henly, 2002).

Study limitations and implications

Limitations of the study include obtaining reports based on only one partner's perspective. Future research should examine accounts from both partners to assess links between communication styles and condom use. Second, participants were asked to describe their general and sex-related communication, not condom-related communication specifically. Our focus in this study was general and sexual communication styles as the broader (and previously neglected) context of condom use. Participants' accounts of specific condom use negotiations may have provided additional information in understanding how condom use specifically fits into this broader context. However, given the high rates of non-use and inconsistent condom use, we were concerned about introducing demand characteristics to our interview data around such discussions and used the diary data for a more accurate account of actual condom use. Third, causal conclusions cannot be made by the current study. It is hoped that this study will spur interest in examining further communication patterns in established relationships and their links to condom use rates. There is surprisingly little research on styles of communication in this field. Finally, the sample size was sufficient to reach saturation according to established guidelines for purposive samples in qualitative research (Morse, 1995; Sandelowski, 1995). However, the sample size may have been insufficient to detect some of the potential associations within the quantitative diary data. Future research could involve surveying a larger sample of young adults about these communication styles and subsequently linking their communication to prospective condom use reports. In particular, analyzing differences between individuals in longer-term (possibly cohabiting) relationships and less well established relationships may yield insights into how communication evolves as relationships develop in intimacy and/or commitment.

The findings from this study suggest that understanding the broader communication context, that is, the ways in which partners communicate generally rather than just in terms of condom use, may be important ultimately for developing skills in negotiating condom use in committed relationships. Interventions could relay that not all topics are expected to be effortless, that difficulties or challenges in communication are common, and that improving or reinforcing the relationship context may be necessary for condom use to be maintained. Emphasizing that it will take considerable work to, discuss some issues, including issues relating to trust, and the implied messages behind condom requests, may be beneficial for partnered individuals. Educating young people about the range of perspectives, including misperceptions, in communication in relationships may be particularly useful in this regard for promoting more effective conversations about condom use (Parr, Boyle, & Tejada, 2008). Examining communication more broadly, particularly the extent to which an individual feels that a partner will be receptive to what may be a possibly tense discussion and confident that the partners will be able to handle effectively conflict that arises as a result, is recommended in future research addressing sexual health.

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Andrea M. Boyle (1) and Lucia F. O'Sullivan (1)

(1) Psychology Department, University of New Brunswick, Fredericton, NB

Correspondence concerning this article should be addressed to Andrea Boyle, Psychology Department, University of New Brunswick, Box 4400, Fredericton NB. E-mail: m6871@unb.ca
She never does. She is pretty closed. She
   doesn't really like talk about it too much.
   But she's more of a doer, you know? She ... I
   guess the topic is uncomfortable for her
   because she doesn't really talk about it too
   much. But you know, when it comes time
   for us to make love, it's not a problem.
   But as far as talking about it, she doesn't
   talk about it too much. You know, she's
   pretty closed and pretty shy about that.


Good. I mean, he's not really ... he's kind
   of the closed-in type sometimes. I have
   to be the one to, you know, say, "Listen,
   we need to talk. We need to just sit down
   and take a step back." He's not usually the
   one to, like ... he's not the aggressive type, I
   guess--like, be the one who's angry. He'll
   just hold it in, you know? And I have to be
   the one to [say], "Baby, what's wrong?" You
   know? "What happened?" So I guess that
   he's not really ... he doesn't communicate
   too well about things. I have to be the
   one to be aggressive and I have to be the
   one to like reach out to him sometimes.


It's like we openly agree to discuss--with each
   other--what we don't like, what we like, you
   know? When we want it, when we don't want
   it, if we want it like at the moment, if we want
   it after. Everything's very openly discussed.


In the initial [issues experienced in the
   relationship] that I've mentioned, that we've
   had, we've talked about thoroughly, like
   we've expanded on them completely, broken
   them down from many different aspects.


We're really open about everything ...
   that's something that's just developed
   within time and ... getting more comfortable
   with ourselves, and just being open
   and honest about things. And, yeah, I
   mean, as good as it could be, basically.


A: I would say it's pretty easy. It could be a
   lot easier, but ... it's okay. Because depending
   on the problem--if it's something I would
   say, dealing with sexual or ... very personal,
   it might be a little bit more technical to
   discuss than just discussing something of
   a regular social dealings--like, "Oh you
   know who I saw today, blah, blah, blah,"
   or, versus, "I'm not feeling you as much
   as I was before." That's a problem. That
   would come across harder to say than,
   "Yeah, you know, we did so-and-so and you
   know, I went to so-and-so," or "I saw this
   person--your friend--or whatever." That's
   much harder to communicate, I would say.
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