Abstract
BACKGROUND: Little is known about how young people communicate about initiating intercourse. PURPOSE: This study was designed to gauge the prevalence of implied versus verbal consent at first intercourse in a U.S. college population, assess effects of consent type on contraceptive use, and explore the influences of gender, race and other factors. METHODS: We conducted and analyzed a cross-sectional survey of non-Hispanic white and black students from four universities, exploring associations between verbal and nonverbal consent, contraceptive use and covariates. RESULTS: Among those with consensual first intercourse experiences (N=1883), half (49%) provided nonverbal consent. Black men were the most likely to provide nonverbal consent (61%), followed by white men (55%), black women (51%), and white women (43%). Respondents who used condoms at first intercourse were more likely to provide verbal consent, suggesting that condoms may prompt sexual discussions (or vice versa). In contrast, even when controlling for covariates, those who provided nonverbal consent were less likely to have used contraception (significantly so for women). DISCUSSION: These findings confirm the hypothesis that young people who do not discuss whether to engage in vaginal intercourse for the first time are less likely to use contraception. These results add an important layer to our current conceptual model of sexual development, in particular, how young people adopt, or fail to adopt, behaviors that will keep them healthy once they decide to become sexually active. TRANSLATION TO HEALTH EDUCATION PRACTICE: Enhanced sexual communication skills are greatly needed. Public health practitioners should investigate type of consent in future research and programming, with sensitivity to gender and racial influences.