Condom Embarrassment Scale

Abstract

The Condom Embarrassment Scale (CES) is an 18-item psychometric tool designed to quantify the level of embarrassment experienced by college-aged individuals regarding condom use. Developed by Vail-Smith, Durham, and Howard (1992), the scale measures the psychological discomfort, self-consciousness, and feeling of being ill at ease associated with condoms across three key behavioral domains: acquisition/possession, negotiation of use with a partner, and actual use during a sexual encounter. Utilizing a 5-point Likert scale, the CES provides a total score ranging from 18 (low embarrassment) to 90 (high embarrassment). Initial validation studies revealed strong internal consistency (Cronbach’s alpha = 0.92) and supported a three-factor structure explaining nearly 60% of the variance.

Keywords

Condom Embarrassment Scale, CES, Condom use, Sexual health, Contraceptive use, College students, Psychometrics, Embarrassment, Sex anxiety, Sexual negotiation

Authors

Karen Vail-Smith, Thomas W. Durham, H. Ann Howard

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Purpose

The primary purpose of the Condom Embarrassment Scale (CES) is to provide a standardized, reliable measure of the psychological barrier of embarrassment related to condom use. Research has consistently identified embarrassment as a significant construct inhibiting effective contraceptive use and safer sex practices among young adults.

The scale was developed specifically for research and educational applications to assess and quantify this discomfort. By segmenting embarrassment into distinct behavioral dimensions—acquisition, negotiation, and utilization—the CES allows researchers and health educators to pinpoint specific areas where intervention programs might be most effective in promoting safer sexual behavior.

Construct

The core construct measured by the CES is Condom Embarrassment, which is explicitly defined as the psychological discomfort, self-consciousness, and feeling of being ill at ease associated with the lifecycle of condom use. The authors hypothesized that this discomfort manifests across three critical stages of sexual interaction:

• Acquisition and Possession: Feelings of shame or awkwardness related to buying, obtaining, carrying, or possessing condoms.
• Negotiation: Discomfort associated with discussing condom use, asking a partner to use one, or providing a condom during foreplay.
• Actual Use: Embarrassment experienced during the physical application or removal of the condom, or when being watched by a partner during these actions.

Validity

Evidence for the validity of the CES was established through correlations with related psychological measures and behavioral outcomes, supporting its ability to measure the intended construct.

• Criterion Validity (Convergent): The total CES score demonstrated a significant positive correlation with the Sex Anxiety Inventory (Janda & O’Grady, 1980), yielding a Pearson product-moment correlation coefficient of r = 0.39. This result aligns with theoretical expectations, suggesting that higher levels of general sexual anxiety are associated with increased condom-related embarrassment.
• Predictive Validity: The CES score was significantly correlated in the predicted direction with scores on an STD/condom knowledge test (Solomon & DeJong, 1989), with an overall correlation of r = -0.34 (p < 0.01). This indicates that greater knowledge about sexually transmitted diseases (STDs) and condoms generally predicts lower embarrassment scores.
• Construct Validity (Behavioral): Further support for construct validity was derived from behavioral comparisons. Respondents who reported having purchased a condom scored significantly lower on the CES than those who had not. Similarly, sexually active individuals reported lower embarrassment scores compared to those who were not sexually active, suggesting that real-world engagement with condom use reduces the psychological discomfort measured by the scale.

Reliability

The reliability of the Condom Embarrassment Scale was assessed using measures of internal consistency and temporal stability.

• Internal Consistency: The scale demonstrated excellent internal consistency, with a high Cronbach’s alpha coefficient of 0.92 for the summed scores of the 18 items. This high value suggests that the items within the scale are highly interrelated and measure a single, coherent psychological construct (embarrassment).
• Test-Retest Stability: Temporal stability was assessed using a subset of 226 college students who completed the CES on two separate occasions. The resulting Pearson product-moment correlation coefficient was 0.78 (p < 0.001), indicating good stability of the scale scores over time.

Factor Analysis

A principal factor analysis employing varimax rotation was conducted on the responses of the initial sample (N=256). This analysis identified three major, distinct components of condom embarrassment, which collectively accounted for 59.4% of the total variance.

1. Factor 1: Acquisition/Possession Embarrassment

   • This factor accounted for the largest portion of the shared variance (45.0% of the common variance explained by the three factors).
   • It is characterized by embarrassment associated with acquiring, purchasing, obtaining, or possessing condoms.
   • Items loading heavily on this factor include: 1, 2, 3, 4, 5, 6, 7, and 12.

2. Factor 2: Actual Use Embarrassment

   • This factor accounted for 30.1% of the common variance.
   • It is associated with the psychological discomfort related to the physical process of actually using condoms during sexual activity.
   • Items loading heavily on this factor include: 14, 15, 16, 17, and 18.

3. Factor 3: Negotiation Embarrassment

   • This factor accounted for 24.9% of the explainable variance.
   • It is linked to embarrassment associated with negotiating the use of condoms, discussing them with a partner, or insisting on their use.
   • Items loading heavily on this factor include: 8, 9, 10, 11, and 13.

Instrument

Test Type: Self-report psychological scale

Format: 18 items utilizing a 5-point Likert scale response mode.

Language Available: English (Original research)

Population Group: College students and young adults

Age Group: Typically 18-24 years old (College population)

Population Details: Original study sample consisted of 256 college students (men and women). Women (M = 46.54, SD = 14.65) scored significantly higher on the scale than men (M = 41.81, SD = 14.74).

Test Methodology: Respondents circle a letter (A-E) corresponding to their level of agreement (Strongly Disagree to Strongly Agree). The scale requires approximately 10 minutes to complete.

Keywords

Psychological assessment, Safer sex, Contraceptive behavior, Factor structure, Psychometric evaluation, Test-retest reliability, Internal consistency, STDs, Sexual health education

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Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: [email protected] (Karen Vail-Smith)

Correspondence Address: Karen Vail-Smith, Department of Health Education and Promotion, East Carolina University, Greenville, NC 27858

Permissions & Fee and Test Year

The use of the Condom Embarrassment Scale (CES) for educational or research purposes is encouraged by the authors, who request notification regarding results derived from its application. The scale was originally published in 1992.

Reference’s

Baffi, C. R., Schroeder, K. K., Redican, K. J., & McCluskey, L. (1989). Factors influencing selected heterosexual male college students’ condom use. Journal of American College Health, 38, 137–141.

Beckman, L. J., Harvey, S. M., & Tiersky, L. A. (1996). Attitudes about condoms and condom use among college students. Journal of American College Health, 44, 243–249.

Bell, J. (2009). Why embarrassment inhibits the acquisition and use of condoms: A qualitative approach to understanding risky sexual behaviour. Journal of Adolescence, 32, 379–391.

Dahl, D. W., Gorn, G. J., & Weinberg C. B. (1998). The impact of embarrassment on condom purchase behaviour. Canadian Journal of Public Health, 89, 368–370.

Herold, E. S. (1981). Contraceptive embarrassment and contraceptive behavior among young single women. Journal of Youth and Adolescence, 10, 233–242.

Hingson, R. W., Strunin, L., Berlin, M., & Heeren, T. (1990). Beliefs about AIDS, use of alcohol and drugs, and unprotected sex among Massachusetts adolescents. American Journal of Public Health, 80, 295–299.

Hughes, C. B., & Torre, C. (1987). Predicting effective contraceptive behavior in college females. Nurse Practitioner, 12, 44–54.

Janda, L. H., & O’Grady, K. E. (1980). Development of a sex anxiety inventory. Journal of Consulting and Clinical Psychology, 48, 169–175.

Kallen, J. D., & Stephensen, J. (1980). The purchase of contraceptives by college students. Family Relations, 29, 358–364.

Moore, S. G., Dahl, D. W., Gorn, G. J., & Weinberg, C. B. (2006). Coping with condom embarrassment. Psychology, Health and Medicine, 11, 70–79.

Moore, S. G., Dahl, D. W., Gorn, G. J., Weinberg, C. B., Park, J., & Jiang, Y. (2008). Condom embarrassment: Coping and consequences for condom use in three countries. AIDS Care, 20, 553–559.

Solomon, M. Z., & DeJong, W. (1989). Preventing AIDS and other STDs through condom promotion: A patient education intervention. American Journal of Public Health, 79, 453–458.

Vail-Smith, K., Durham, T. W., & Howard, H. A. (1992). A scale to measure embarrassment associated with condom use. Journal of Health Education, 29, 209–214.

Valdiserri, R. O., Arena, V. C., Proctor, D., & Bonati, F. A. (1989). The relationship between women’s attitudes about condoms and their use: Implications for condom promotion programs. American Journal of Public Health, 79, 499–501.

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Items of the Condom Embarrassment Scale

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Instructions: The following items assess how embarrassed you do feel (or would feel) about condom use. Using the following scale, please respond to each of the items listed below.

A = Strongly Disagree B = Disagree

C = Neither Agree nor Disagree D = Agree

E = Strongly Agree

1. I am embarrassed or would be embarrassed about buying a condom from a drug store near campus.

2. I am embarrassed or would be embarrassed about buying a condom from a drug store close to where my parents live.

3. I am embarrassed or would be embarrassed about buying a condom from a place where I could be certain no one I know would see me.

4. I am embarrassed or would be embarrassed about obtaining condoms from Student Health Services (School Infirmary).

5. I am embarrassed or would be embarrassed about obtaining condoms from a local health department.

6. I am embarrassed or would be embarrassed about asking a pharmacist or drug store clerk where condoms are located in the store.

7. I am embarrassed or would be embarrassed about asking a doctor or other health care professional questions about condom use.

8. I am embarrassed or would be embarrassed about stopping during foreplay and asking my partner to use a condom.

9. I would be embarrassed if a new partner insisted that we use a condom.

10. I am embarrassed or would be embarrassed to tell my partner during foreplay that I am not willing to have sexual intercourse unless we use a condom.

11. I am embarrassed or would be embarrassed about being prepared and providing a condom during lovemaking if my partner didn’t have one.

12. I am embarrassed or would be embarrassed about carrying a condom around in my wallet/purse.

13. I am embarrassed or would be embarrassed about talking to my partner about my thoughts and feelings about condom use.

14. I am embarrassed or would be embarrassed if my partner watched me dispose of a condom after we had used it.

15. I am embarrassed or would be embarrassed about watching my partner put on a condom OR if my partner watched me put on a condom.

16. I am embarrassed or would be embarrassed about helping my partner put on a condom OR if my partner helped me put on a condom.

17. I am embarrassed or would be embarrassed about watching my partner remove a condom OR if my partner watched me remove a condom.

18. I am embarrassed or would be embarrassed about helping my partner remove a condom OR if my partner helped me remove a condom.