The Condom Embarrassment Scale (CES)<\/strong> is an 18-item psychometric assessment developed by Karen Vail-Smith, Thomas W. Durham, and H. Ann Howard in 1992 to quantify the multidimensional construct of embarrassment associated with condom acquisition, interpersonal negotiation, and physical application. Rooted in social-evaluative psychological theories and public health paradigms, the instrument addresses a pervasive non-rational affective barrier to safe sexual practices among emerging adults and sexually active populations. Factor analytic evaluation indicates that the CES is underpinned by three distinct, highly interpretable dimensions: (1) Condom Acquisition and Possession<\/em>, (2) Condom Application and Physical Disposal<\/em>, and (3) Condom Negotiation and Interpersonal Communication<\/em>. Each item is rated on a 5-point Likert scale<\/a> ranging from 1 (“Strongly Disagree”) to 5 (“Strongly Agree”), generating an overall composite score between 18 and 90, where higher scores signify elevated levels of situational and anticipatory embarrassment.<\/p>\n Psychometric evaluation demonstrates high internal consistency (Cronbach’s $\\alpha = .92$<\/span>) and robust temporal stability across test-retest administrations ($r = .78, p<\/span> < .001$). The construct validity of the CES is corroborated by statistically significant positive correlations with general sexual anxiety ($<\/span>r = .39$), as measured by the Sex Anxiety Inventory, and negative correlations with sexually transmitted infection (STI) and condom knowledge among women ($<\/span>r = -.35, p < .001$). Furthermore, known-groups comparisons validate the instrument's capacity to discriminate between individuals based on behavioral histories, including prior condom purchases and current sexual activity. As an empirical instrument, the CES provides health psychologists, behavioral epidemiologists, and clinical sexologists with a standardized metric to evaluate barrier contraception hesitance, formulate targeted educational interventions, and assess the emotional mechanisms underlying sexual health decision-making.<\/p>\n Condom Embarrassment Scale, sexual health, contraceptive self-efficacy, sexual anxiety, barrier contraception, health behavior, public health measurement, sexual communication, STI prevention, psychometrics, impression management, social evaluative anxiety<\/p>\n The Condom Embarrassment Scale was conceptualized, operationalized, and empirically validated by a multidisciplinary team of health educators, behavioral scientists, and clinical psychologists:<\/p>\n Correspondence regarding the original development and empirical administration of the scale was directed to Karen Vail-Smith at the Department of Health Education and Promotion, East Carolina University (Email: The primary purpose of the Condom Embarrassment Scale (CES) is to provide an empirical, standardized measure of the self-conscious affective states\u2014specifically embarrassment, social awkwardness, and self-directed communicative inhibition\u2014that impede the consistent acquisition, discussion, and utilization of male condoms. Emerging during the height of the HIV\/AIDS epidemic and amidst escalating rates of sexually transmitted infections (STIs) among university populations, the scale was created to address a critical omission in health education: the assumption that cognitive awareness of disease transmission translates directly into prophylactic behavior.<\/p>\n Empirical public health literature consistently reveals a substantial knowledge-behavior gap in reproductive healthcare. While college students and young adults frequently demonstrate adequate biomedical knowledge regarding the mechanics of HIV\/STI transmission and pregnancy prevention, actual rates of barrier contraceptive adherence remain suboptimal. The theoretical rationale advanced by Vail-Smith and colleagues (1992) posits that emotional and social-evaluative costs\u2014foremost among them, acute embarrassment\u2014frequently supersede rational decision-making at critical junctures of sexual behavior. Condom use is not a solitary or purely mechanical act; it is embedded within complex social scripts that require individuals to navigate commercial retail environments, intimate communication with sexual partners, and the tactile reality of sexual mechanics.<\/p>\n In research contexts, the CES serves as an explanatory variable to model sexual risk-taking. Investigators employ the scale to isolate which specific dimensions of the prophylactic process generate the greatest psychological friction, enabling precise modeling of health behavior trajectories. In applied clinical, educational, and public health settings, the instrument provides an actionable diagnostic profile. University health centers, family planning clinics, and adolescent health outreach programs utilize the CES to evaluate baseline discomfort before and after psychosexual interventions, communication workshops, or marketing campaigns designed to normalize contraceptive access. By delineating whether an individual’s hesitation stems from the retail purchase counter, interpersonal boundary-setting, or the bedroom, practitioners can tailor psychoeducational strategies to address the precise psychological bottleneck inhibiting preventative behavior.<\/p>\n The central psychological construct measured by the CES is condom embarrassment<\/strong>, conceptualized by Vail-Smith, Durham, and Howard (1992) as the subjective psychological discomfort, self-consciousness, situational anxiety, and feeling of being ill at ease across three operational phases of condom utilization: retail acquisition, interpersonal negotiation, and intimate application. Embarrassment, within contemporary affective science, is categorized as a self-conscious emotion elicited by real or imagined violations of social norms, public exposure of private behavioral intentions, or threats to one’s preferred social identity (Goffman, 1959<\/a>). When applied to sexual health, this affective state manifests along three core dimensions:<\/p>\n This subscale captures the anticipatory and real-time social evaluative dread associated with obtaining condoms in public or semi-public spaces. Purchasing or requesting condoms requires an implicit admission of sexual intention or activity. For many emerging adults, this exposure triggers fears of negative social evaluation, moral judgment, or social stigmatization by retail personnel, peers, healthcare providers, or authority figures. The construct reflects psychological vulnerability across distinct retail and institutional settings:<\/p>\n The interpersonal dimension addresses the communicative barriers that arise within an intimate dyad. Introducing a condom into an encounter challenges traditional, spontaneous sexual scripts and demands assertive verbal communication. Embarrassment in this domain is fueled by cognitive fears of interpersonal rejection, partner offense, or relational rupture. Specific facets include:<\/p>\n The tactile and visual dimension focuses on the physical mechanics of condom usage in the immediate presence of a sexual partner. Unlike cognitive intentions, physical execution requires manual dexterity and intimate visibility, rendering individuals vulnerable to performance anxiety and body-focused self-consciousness:<\/p>\n The conceptual structure of the Condom Embarrassment Scale is grounded in established sociocognitive and dramaturgical models of human behavior, integrating constructs from Social Cognitive Theory<\/a>, Dramaturgical Sociology<\/a>, Sexual Script Theory<\/a>, and the Health Belief Model<\/a>.<\/p>\n Erving Goffman\u2019s (1959) seminal work on impression management provides the theoretical foundation for understanding condom-related embarrassment. Goffman posited that social life is a staged performance in which actors strive to present an idealized self-image (“face”) while avoiding situational missteps that lead to a “spoiled identity.” Condom acquisition and deployment inherently threaten an actor’s face-work:<\/p>\n Developed by John Gagnon and William Simon (1973), Sexual Script Theory posits that sexual interactions are governed by learned cultural, interpersonal, and intrapsychic scripts. Traditional Western sexual scripts celebrate passion, spontaneity, and unspoken mutual escalation. Within this framework, introducing a condom introduces an explicit, planned, and hygienic interruption. The CES captures the emotional tension that ensues when individuals must violate the “spontaneity script” to introduce preventative hygiene, creating social friction and self-consciousness.<\/p>\n Albert Bandura\u2019s (1986) Social Cognitive Theory<\/a> emphasizes the role of self-efficacy\u2014the subjective belief in one’s capability to execute behaviors necessary to achieve specific outcomes. Self-efficacy in condom use is multifaceted, requiring not only technical knowledge but also social and communicative competence. Embarrassment serves as an affective inhibitor that directly degrades self-efficacy expectations. High perceived embarrassment generates avoidance behaviors, diminishing an individual\u2019s belief that they can successfully purchase, negotiate, or apply condoms in emotionally charged situations.<\/p>\n Within Rosenstock’s (1974) Health Belief Model, preventive health behaviors depend on perceived susceptibility, perceived severity, perceived benefits, and perceived barriers<\/em>. While biomedical education often elevates perceived susceptibility and severity regarding STIs, the CES quantifies non-financial, psychological barriers. The affective cost of experiencing social humiliation, awkwardness, or partner rejection frequently outweighs abstract, probabilistically distant health risks, resulting in inconsistent barrier contraceptive compliance.<\/p>\n Vail-Smith, Durham, and Howard (1992) established the psychometric validity of the Condom Embarrassment Scale through construct, convergent, divergent, and criterion-related methodologies utilizing a development sample of $N = 256$<\/span> undergraduate university students.<\/p>\n To evaluate convergent validity, the CES was administered alongside established psychometric instruments measuring related affective and psychosexual dimensions. The composite score of the CES demonstrated a statistically significant positive correlation with the Sex Anxiety Inventory (SAI)<\/strong> developed by Janda and O’Grady (1980):<\/p>\n $$r = .39, \\quad p < .001$$<\/span><\/p>\n This moderate correlation supports the theoretical expectation that general affective discomfort surrounding sexuality is associated with condom embarrassment, while also indicating that condom embarrassment is an independent construct not redundant with generalized sex anxiety.<\/p>\n The scale was evaluated against an objective STD\/condom knowledge test developed by Solomon and DeJong (1989). Theoretically, higher cognitive competence regarding prophylactic mechanics and disease etiology was hypothesized to attenuate affective discomfort. Across the full sample ($N = 256$<\/span>), a statistically significant overall negative correlation was obtained ($r = -.34, p<\/span> < .01$). However, distinct gender differences emerged upon disaggregation:<\/p>\n Construct validity was further established through known-groups comparisons analyzing reported sexual behaviors:<\/p>\n Subsequent psychometric investigations (e.g., Dahl et al., 1998; Moore et al., 2006, 2008; Bell, 2009) have replicated these findings across diverse demographic samples, validating the CES as a robust predictor of real-world retail purchasing avoidance and partner negotiation failures.<\/p>\n The Condom Embarrassment Scale possesses high internal consistency and temporal stability, making it suitable for both cross-sectional survey research and longitudinal interventional designs.<\/p>\n In the initial psychometric validation study conducted by Vail-Smith et al. (1992), the total 18-item scale yielded an overall internal consistency coefficient of:<\/p>\n $$\\alpha = .92$$<\/span><\/p>\n This high Cronbach’s alpha indicates minimal measurement error and high item covariance, demonstrating that the individual items reliably measure the overarching construct of condom-related social-evaluative discomfort. Subscale internal consistencies consistently exceed standard psychometric thresholds across the literature, typically ranging from $\\alpha = .84$<\/span> to $\\alpha = .91$<\/span> for Acquisition, $\\alpha = .82$<\/span> to $\\alpha = .88$<\/span> for Negotiation, and $\\alpha = .80$<\/span> to $\\alpha = .86$<\/span> for Application\/Disposal.<\/p>\n To assess the temporal stability of the instrument over time, Vail-Smith and colleagues administered the CES across two distinct testing sessions to a subsample of $n = 226$<\/span> college students. A Pearson product-moment correlation coefficient was calculated between baseline and retest composite scores:<\/p>\n $$r = .78, \\quad p < .001$$<\/span><\/p>\n This correlation confirms substantial test-retest reliability over time, indicating that condom embarrassment operates as a stable, trait-like affective disposition while maintaining sufficient sensitivity to detect shifts following targeted behavioral or educational interventions.<\/p>\n The structural dimensionality of the Condom Embarrassment Scale was established via Exploratory Factor Analysis (EFA)<\/a> on responses from the initial validation cohort of $N = 256$<\/span> university undergraduates.<\/p>\n A principal factor analysis (PFA) followed by orthogonal Varimax rotation<\/a> was executed on the 18 items. The analysis yielded a three-factor solution based on the Kaiser criterion (eigenvalues $> 1.0$<\/span>) and an examination of the scree plot. Collectively, the three extracted factors accounted for 59.4% of the total variance<\/strong> across the item pool.<\/p>\n2. Keywords<\/h2>\n
3. Authors<\/h2>\n
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vailsmithk@ecu.edu<\/code>).<\/p>\n4. Purpose<\/h2>\n
5. Psychological Construct<\/h2>\n
1. Condom Acquisition and Possession Embarrassment<\/h3>\n
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2. Condom Negotiation and Interpersonal Communication Embarrassment<\/h3>\n
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3. Condom Application, Erection Maintenance, and Physical Disposal Embarrassment<\/h3>\n
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6. Theoretical Framework<\/h2>\n
Dramaturgical Theory and Impression Management<\/h3>\n
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Sexual Script Theory<\/h3>\n
Social Cognitive Theory and Self-Efficacy<\/h3>\n
Health Belief Model (HBM)<\/h3>\n
7. Validity<\/h2>\n
Convergent Validity<\/h3>\n
Criterion and Divergent Validity: STI\/Condom Knowledge<\/h3>\n
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Known-Groups and Behavioral Validity<\/h3>\n
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8. Reliability<\/h2>\n
Internal Consistency<\/h3>\n
Test-Retest Stability<\/h3>\n
9. Factor Analysis<\/h2>\n
Extraction and Rotation Parameters<\/h3>\n
Factor Decomposition<\/h3>\n