DEMOGRAPHIC

AND

HEALTH

SURVEYS

DHS WORKING PAPERS

2020 No. 170

Jean-Robert Rwenge Mburano

Franklin Bouba Djourdebbe

Emmanuel Ekambi Ekambi

September 2020

This document was produced for review by the United States Agency for

International Development.

Social and Individual Factors Associated with

Condom Use among Single Youths:

An Analysis of the 2018 Cameroon

Demographic and Health Survey

DHS Working Paper No. 170 

Social and Individual Factors Associated with Condom Use 

among Single Youths: 

An Analysis of the 2018 Cameroon Demographic and Health Survey 

Jean-Robert Rwenge Mburano1

Franklin Bouba Djourdebbe1

Emmanuel Ekambi Ekambi1

Institute for Training and Research in Demography (IFORD)— 

University of Yaounde 2, Cameroon 

ICF 

Rockville, Maryland, USA 

September 2020 

1

 Institute for Training and Research in Demography (IFORD)—University of Yaounde 2, Cameroon 

Corresponding author: Rwenge Mubrano Jean-Robert, rwenge_mburano@yahoo.fr, phone n° 237 

662052691 
Acknowledgments: We would like to thank Shireen Assaf and Christina Juan as mentors, and Flora 

Aninditya and Madeleine Wayack as co-mentors, of the 2020 DHS Fellows Program for providing technical 

support and insights on this analysis. We also would like to thank Shireen Assaf and Sara Riese for their 

useful comments. The DHS Fellows Program is funded by USAID and implemented by ICF. 

Editor: Diane Stoy 

Document Production: Chris Gramer 

This study was implemented with support from the United States Agency for International Development 

(USAID) through The DHS Program (#720-0AA-18C00083). The views expressed are those of the authors 

and do not necessarily reflect the views of USAID or the United States Government. 

The DHS Program assists countries worldwide in the collection and use of data to monitor and evaluate 

population, health, and nutrition programs. For additional information about The DHS Program contact: 

DHS Program, ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; phone: +1 301-572-0950; 

fax: +1 301-572-0999 or +1 301-407-6501; email: reports@dhsprogram.com; Internet: www.dhsprogram.com. 

Recommended citation: 

Rwenge Mburano, Jean-Robert, Franklin Bouba Djourdebbe, and Emmanuel Ekambi Ekambi. 2020. Social 

and Individual Factors Associated with Condom Use among Single Youths: An Analysis of the 2018 

Cameroon Demographic and Health Survey. DHS Working Paper No. 170. Rockville, Maryland, USA: 

ICF. 
iii 

CONTENTS 

TABLES ........................................................................................................................................................ v 

FIGURES .................................................................................................................................................... vii 

ABSTRACT ................................................................................................................................................. ix 

1 BACKGROUND AND OBJECTIVES OF THE STUDY .................................................................. 1 

2 LITERATURE REVIEW AND CONCEPTUAL FRAMEWORK ....................................................... 3 

2.1 Theoretical approaches ...................................................................................................... 3 

2.2 Conceptual framework ........................................................................................................ 3 

2.2.1 Family characteristics ............................................................................................ 4 

2.2.2 Extra-family characteristics .................................................................................... 5 

2.2.3 Media exposure...................................................................................................... 5 

2.2.4 Individual characteristics ........................................................................................ 6 

3 METHODOLOGY ............................................................................................................................. 7

3.1 Data ..................................................................................................................................... 7 

3.2 Variables ............................................................................................................................. 7 

3.3 Statistical analyses .............................................................................................................. 9 

4 RESULTS ...................................................................................................................................... 11 

4.1 Background characteristics of the respondents ................................................................ 11 

4.2 Bivariate associations of social and individual factors with condom use .......................... 13 

4.3 Results from multivariate analyses ................................................................................... 16 

4.3.1 “Determinants” of condom use ............................................................................. 16 

4.3.2 Characteristics of the groups at risk and those of the others .............................. 18 

4.3.3 Mechanisms of action of social factors ................................................................ 18 

5 DISCUSSION ................................................................................................................................. 23 

6 CONCLUSION AND RECOMMENDATIONS ............................................................................... 25 

REFERENCES ............................................................................................................................................ 27 

v 

TABLES 

Table 1 Variables used in the analyses .................................................................................. 8 

Table 2 Percent distribution of single females and males age 15-24 who had had 

sexual intercourse within the 12 months before the 2018 CDHS by selected 

characteristics .......................................................................................................... 11 

Table 3 Proportion of single youths age 15-24 who used condom at the last sexual 

intercourse during the 12 months before the 2018 CDHS by gender and their 

selected characteristics ............................................................................................ 14 

Table 4 Logistic regression on condom use at the last sexual intercourse among 

single females and males age 15-24, 2018 CDHS .................................................. 16 

Table 5 Logistic regression models on condom use in which each type of social factor 

is controlled by individual ones (single females age 15-24, 2018 CDHS) ............... 19 

Table 6 Logistic regression models on condom use in which each type of social factor 

is controlled by individual ones (single males, age 15-24, 2018 CDHS) ................. 21 

vii 

FIGURES 

Figure 1 Conceptual framework ............................................................................................... 4

ix 

ABSTRACT 

In Cameroon, two-fifths of the population is between age 15 and 24. Adolescents and youths are an 

important social group for the development of the country and the realization of its demographic dividend. 

Promotion of sexual and reproductive health will enable youth to transform their potential into 

development. 

This study aimed to identify the determinants of condom use at the last sexual intercourse among single 

youths, highlight gender differences in the factors associated with condom use, and identify the 

characteristics of youths who were less likely to use condoms. To achieve these objectives, we analyzed 

data from the 2018 Cameroon Demographic and Health Survey from 1,464 single females and 989 single 

males age 15-24. Multivariate logistic regression was used to test the study hypotheses. 

Overall, 51% of the female and 66% of male youths reported using condoms at their last sexual intercourse. 

For both sexes, the protective factor was not having children. Among the females, belonging to the 

Bamileke or Mbo ethnic groups and delaying first sexual intercourse were also protective, while working 

in modern or service sectors was the main risk factor. Among male youths, residing in households whose 

heads have a higher educational level was protective, and household poverty was the main risk factor. 

These findings support Cameroon’s multisectoral approach to HIV/AIDS prevention among youths, and 

emphasize the importance of involving parents, teachers, and youths. 

Key words: Condom use, determinants, gender differences, single youth, age 15-24, Cameroon, subSaharan Africa. 

1 

1 BACKGROUND AND OBJECTIVES OF THE STUDY 

The sexual and reproductive health of young people is currently a scientific and programmatic priority in 

Africa, within a permanently changing socioeconomic and cultural context (Hindin et al. 2012). The 

growing emphasis on the sexual and reproductive health of young people reflects their significant 

contribution to the continent’s demographic dynamics and their vulnerability to sexual and reproductive 

health risks (Hindin et al. 2012). 

In Cameroon, the onset of the HIV/AIDS epidemic in the mid-1980s was addressed by the National AIDS 

Control Committee (CNLS) through HIV prevention plans beginning in 1987 through 2000 (Salla Ntounga 

1993; Tsala Tsala 2004). The initial plans had limited results (Tsala Tsala 2004). Research, policies, and 

programs focused primarily on students and prostitutes, because these two groups had been formally 

identified as high-risk groups (Tsala Tsala 2004). During that time, adolescents and young people did not 

appear to be concerned about HIV/AIDS. By 1998, according to DHS data, the rates of having multiple 

sexual partners remained quite high among single male and female youth, and few reported using condoms 

at their last sexual intercourse (31.1% and 17.2%, respectively) (Fotso et al. 1999). 

The reorganization of the CNLS in 2001 and implementation of the 2000-2005 and 2006-2010 programs 

aimed to improve the lives of the entire population living with HIV/AIDS, including children, adolescents 

and young people, and orphans. The programs used a multisectoral approach (MINSANTE 2000, 2005) 

and led to appreciable results. Rates of condom use at last sexual intercourse increased among single male 

youth, from 31.1% in 1998 to 57.3% in 2004 and 72% in 2011; and among female youth, from 17.2% in 

1998 to 52.2% in 2004 and 59.5% in 2011 (Fotso et al. 1999; INS and ORC Macro 2004; INS and ICF 

International 2012). However, since 2011, condom use has decreased significantly among single male 

youth, from 72% in 2011 to 66.3% in 2018, and single female youth, from 59.5% to 50.9% (INS and ICF 

International 2012, 2020). Such declines in condom use may be contributing to an increase in HIV 

prevalence among male youth from 0.4% in 2011 to 0.7% in 2018 among those age 15-19, and from 0.6% 

in 2011 to 1.5% among those age 20-24 (INS and ICF International 2012, 2020). 

These data suggest that approaches to the sexual health of youth should be reexamined in Cameroon to 

identify the factors associated with current condom use in this group, and to use this information to plan 

appropriate interventions. This study responds to this need by focusing on the prevalence and factors 

associated with condom use among single males and females age 15-24 in Cameroon, using data from the 

2018 Cameroon Demographic Health Survey (CDHS). The study was designed to: 

• Identify social and individual factors associated with condom use among single youths living in 

Cameroon. 

• Identify characteristics of youths who were less likely to use condoms. 

• Highlight gender differences in factors associated with condom use among single youths. 

This report includes five sections: a brief literature review and conceptual framework; methodology; results; 

discussion of the findings; and, our conclusion and recommendations. 

3 

2 LITERATURE REVIEW AND CONCEPTUAL 

FRAMEWORK 

2.1 Theoretical approaches 

Three theoretical approaches to youth sexual behavior have been highlighted from the existing literature: 

individual, social, and political. According to the individual approach, adolescents are rational actors 

(Guiella 2012) who take initiative and make decisions favorable or unfavorable to the improvement of their 

knowledge, attitudes, and practices in sexual health. The social approach considers sexual behaviors to be 

the outcome of social norms and values that are internalized by youth from their family socialization (Tsala 

2010; Wamoyi et al. 2015), and the influence of schools (Lloyd 2010), media (Kwankye and Augustt 2007; 

Oladeji and Ayangunna 2017), religious groups (Cerqueira-Santos and Koller 2016), and peers 

(Bingenheimer et al. 2015; Fearon et al. 2015; Tsala 2010; Yode and LeGrand 2008). The political approach 

suggests that the adoption of safe sexual behaviors depends upon policies, programs, and laws implemented 

in the field of sexual and reproductive health (Peto et al. 2000; Wamoyi et al., 2015). 

Many previous studies were based on these approaches. Some that were oriented towards the social 

perspective used variables related to the family environment (Babalola et al. 2005; Pop and Rusu 2015; 

Steele et al. 2020) or the extra-family environment (i.e., schools, religious groups, workplace and peers 

groups) (Bingenheimer et al. 2015; Cerqueira-Santos and Koller 2016; Fearon et al. 2015; Lloyd 2010). 

Others that focused on the individual perspective used the psychosocial characteristics of youth (Babalola 

and Quénum-Renaud 2002; Krugu et al. 2016; Meekers and Klein 2002). As Goethals (quoted by Djamba, 

1997) noted, “...No one theoretical position can be used alone to generate sophisticated hypotheses for 

research in the area of sexual behavior,” especially in the case of the use of condoms for preventing 

HIV/AIDS. 

Thus, as social phenomena are complex and can only be understood by using a systemic approach, i.e., an 

approach that takes into account social and individual factors and their interrelationships in the same model, 

most previous studies are limited. In the African context, where the family plays an important role in the 

socialization of children, the question should be if HIV/AIDS prevention policies among youth that focus 

on media and peers are effective, and what, if any, factors should be given more attention. Thus the 

relevance of this research, which will provide answers to the following questions: 

1) What are the social and individual factors of condom use among single youths in Cameroon? Do 

social factors directly influence condom use or indirectly through individual factors? 

2) What are the priority target groups of single youth among which condom use is low? 

3) What are the gender differences in the factors that influence condom use among single youths? 

2.2 Conceptual framework 

Our conceptual framework (Figure 1) shows how we used a systemic approach to highlight the determinants 

of condom use among single youth. The framework is based on the health belief model (HBM) of 

Rosenstock (1966, 1974) and the social learning theory (SLT) of Rotter (1954) and Bandura (1977). These 
4 

theories focus on behavioral change. According to the HBM, an individual’s preventive practices with 

regard to a disease depend on the severity of the disease, the individual’s perceptions of their susceptibility 

to the disease, the potential benefits from preventative practices, and the barriers to adopting such practices 

(Chaisamrej et al. 2009; Glanz et al. 2002). The model considers the influences of the social environment 

and other motivating factors such as the media, knowledge of health problems, a person’s self-efficacy (i.e., 

one’s belief in one’s ability to succeed) in adopting preventive practices, and other individual characteristics 

(Glanz et al. 2002). The SLT explicitly suggests that interactions between individuals and their social 

environment affect preventive practices. We assessed the influence of social environment via the family 

characteristics (family composition, education of the household head (HH), sex of the HH, household size, 

household living standard, and ethnicity), extra-family characteristics (school attendance and youth’s 

education level, religion, youth’s economic activity, and association attendance), and media exposure. 

Figure 1 Conceptual framework 

2.2.1 Family characteristics 

Family characteristics are important factors in socialization and social control. Young people living with 

both parents are known to be less likely to engage in risky sexual behaviors than those living in singleparent families or stepfamilies (Guiella 2012; Pop and Rusu 2015; Steele et al. 2020). Previous studies have 

not assessed the association between living in an extended or large family and sexual risk behaviors. We 

hypothesized that there is a positive association between living in large family and condom use among 

young people because parents and other adults can be involved in the sexual education of children. Since 

several studies have shown that female heads of households invest more than their male counterparts in 

their children, in terms of time, money, emotional support, and education (Clevenot and Pilon 1996; Pilon 

1996), we anticipated that living in a female-headed household is positively associated with condom use. 

In addition, young people who live in a household headed by a highly educated individual would likely be 

better informed about the prevention of STIs/HIV/AIDS. Similarly, those living in a household with a high 

FAMILY CHARACTERISTICS

Family composition

Education of Household Head

Sex of Household Head

Household size

Ethnicity

Household living standard

EXTRA-FAMILY

CHARACTERISTICS

School attendance

Youth’s education level

Religion

Youth’s economic activity

Association attendance

MEDIA

Television

Radio

Newspaper/Magazine

INDIVIDUAL CHARACTERISTICS

In-depth knowledge of HIV/AIDS

Knowledge of source of condoms

Perception of gender inequalities

Opinion on children’s education on condom use

HIV test already done

Agree that women can request for condom use

Age at first sexual intercourse

Non-consensual sex

Relationship with the last partner

Parity

Multi-partnership

SEXUAL BEHAVIOR

Condom Use

Social factors

Outcome

Individual factors
5 

living standard may have the financial support necessary for accessing services and purchasing condoms. 

However, in a context where female condoms are not used and men make most decisions about sexual 

intercourse, the household living standard may be more associated with condom use among young men 

than young women. In Africa, the ethnic group is the place where cultural models are produced and 

reproduced. Sexual norms and values, the elements of these models, are transmitted to children within the 

family in their early childhood. According to Rwenge (2004), the Bamileke ethnic group may have higher 

rates of condom use than other ethnic groups because it has a high level of social control and strong social 

cohesion. The combination of these factors may increase the awareness of Bamileke youths about the 

negative consequences of HIV/AIDS on survival of the family group. 

2.2.2 Extra-family characteristics 

Socialization and social control of children continue outside the family in school, peer groups, and religious 

organizations, which can influence condom use. School attendance and a high level of education are 

positively associated with condom use because they improve young people’s knowledge of sexual health 

and the prevention of STIs/HIV/AIDS (Lloyd 2010). In the Cameroon context, where HIV/AIDS 

prevention through peer education has been implemented (MINSANTE 2010, 2014), we hypothesized the 

same positive association between condom use and peer group attendance (Bingenheimer et al. 2015; 

Fearon et al. 2015). This may be due to the tendency of youths to do what they believe their friends are 

doing, or what they believe their friends think they should do. These are respectively called “the descriptive 

and injunctive norms perspectives” (Collado, Staats and Sancho, 2017). 

In previous studies concerning Cameroon, such as those undertaken by Rwenge (2012) and Tsala (2010), 

the association between the economic activity of youth and the use of condoms has not been assessed, 

although it can also highlight the influence of peers. Frequent contact with peers and other persons allows 

those working in the modern or informal sectors of the economy to have a better knowledge of HIV/AIDS 

and its prevention methods, and have greater condom use than those working in more isolated areas such 

as farms. 

As another source of social control, religion can provide positive and normative behaviors among young 

people. However, in Ghana, Takyi (2003, quoted by Tsala, 2010) found a negative and significant 

association between religion and condom use: compare to those who declared no religion, Catholic, 

Protestant, other Christian, and Muslims were less likely to report condom use. In Cameroon, Tsala (2010) 

found a nonsignificant association between the two variables. Indeed, in this country, most religious 

denominations advocate sexual abstinence before marriage and disapprove of condom use (Rwenge 2012). 

As a result, these groups do not actively participate in the fight against HIV/AIDS that promotes condom 

use. 

2.2.3 Media exposure 

Television, radio, and magazines are the main channels through which young people receive HIV/AIDS 

prevention messages in Cameroon from the government and its partners. It has been hypothesized that the 

likelihood of using condoms should be higher among youths who are more exposed to these media 

messages than among others (Bessinger 2004; Muli and Lawoko 2014; Oladeji and Ayanganna 2017; 

Ntshiqa et al. 2018). Indeed, according to these researchers, the influence of the media depends largely on 

its contents. For example, in Cameroon, awareness campaigns implemented by the Ministry of Public 
6 

Health and NGOs such as the “Association Camerounaise de Marketing Social” (ACMS) and the Cameroon 

National Association for Family Welfare (CAMNAFAW) via television and other communication channels 

enable young adults to improve their knowledge, attitudes, and practices in sexual health (Rwenge 2012). 

2.2.4 Individual characteristics 

Individual factors include youths’ knowledge, attitudes, and behaviors related to sexuality and 

STIs/HIV/AIDS. Most previous researches have hypothesized that there is a positive association between 

knowledge of HIV/AIDS, awareness of its severity, and adoption of positive HIV prevention attitudes and 

practices. However, in adjusted multivariate analyses, knowledge of HIV/AIDS was not associated with 

any risky sexual behavior among men in Rwanda (Rugigana et al. 2014), contrary to the results found 

among female youths in Cameroon (Rwenge 2012). 

Knowledge of AIDS leads youths to the realization that those whose HIV test results are negative should 

take more precautions to preserve their status, and those with positive results should do the same to protect 

their partners (Barrere 2012). Other individual factors that facilitate the use of condoms include knowing 

where to obtain condoms, being in favor of sex education for children, being in favor of gender equality, 

and thinking that a woman has the ability to ask her partner to use condoms. In contrast, early entry into 

sexual activity, the occurrence of nonconsensual sex, and the occurrence of casual sex are risk factors 

(Rwenge 2012; Tsala 2010). 

We hypothesized in this study that family and extra-family characteristics as well as media exposure lead 

to positive results in condom use among youths only when they are accompanied by improvement in their 

individual characteristics, which act as mediators and which may explain how social factors are associated 

with condom use among youths. 
7 

3 METHODOLOGY 

3.1 Data 

The data for this study came from the 2018 DHS survey conducted in Cameroon by the National Institute 

of Statistics (INS), in collaboration of the Ministry of Public Health (MSP). Among its specific objectives, 

two explicitly dealt with knowledge and attitudes about STIs and AIDS, sexual behaviors, and HIV testing. 

The 2018 CDHS survey was nationally representative, household-based, and designed to provide 

population and health indicator estimates at the national, urban-rural, and regional levels. For more details 

about the sampling and technical assistance for the 2018 CDHS survey, see the final report (INS and ICF 

International 2020). 

The sample for this study included 1,464 single female youths and 989 single male youths age 15-24 who 

answered the question about condom use during the last sexual intercourse that occurred in the 12 months 

before the survey. Single female or male youths are those who declared during the survey that they were 

never married or were not currently living with a partner. 

3.2 Variables 

Table 1 shows the variables used in the analyses. Variables listed in the conceptual framework that were not 

available in the 2018 CDHS data included participation in associations (which provides information about 

peers’ influence), knowledge of the source of condoms, opinion on children’s education on condom use, 

and occurrence of nonconsensual sex. 
8 

Table 1 Variables used in the analyses 

Concepts Variables* Definition Specifications Family environment • Family composition 

• Household size • Sex of the household head (HH) • Education level of the HH • Household living standard • Ethnicity 

• Based on the combination of the 

kinship with the household head (HH) 

• Number of the household’s members • Self-explanatory • Highest educational attainment of the 

HH 

• Wealth index built using the 

socioeconomic characteristics of housing 

• Self-explanatory 

• 1) Nuclear; 2) Extended; 3) Head with children; 4) Head with children and 

others; 5) Others 

 (Nuclear: a couple and their dependent children; Extended: a couple with 

dependent children and others; Others: complex or neither parent present) 

• 1) 1-3; 2) 4-6; 3) 7-8; 4) 9+ • 1) Male; 2) Female • 1) No education; 2) Primary; 3) Secondary; 4) Higher • 1) Highest; 2) Fourth; 3) Middle; 4) Second; 5) Lowest • 1) North; 2) Beti-Boulou; 3) Bassa; 4) Bamileke; 5) Mbo; 6) North-West/SouthWest; 7) Others 

Extra-family environment 

• Youth’s education level • Religion • Youth’s economic activity 

• Youth’s highest educational 

attainment 

• Self-explanatory • Self-explanatory 

• 1) No education and primary; 2) First cycle of secondary; 3) Second cycle of 

secondary; 4) Higher 

• 1) Catholic; 2) Protestant; 3) Muslim; 4) No religion or animist • 1) Not working; 2) Modern and services; 3) Sales; 4) Agriculture; 5) Manual  (Modern sector: reported occupations were professional, technical and 

managerial) 

Media exposure • Degree of media exposure • Index built with three variables: 

frequency of watching TV, frequency of listening to radio, and frequency of reading newspaper/magazine 

• 1) Not exposed; 2) Low exposure; 3) Moderately exposed; 4) Highly exposed 

Individual characteristics 

• In-depth knowledge of AIDS • Perception of gender inequalities • HIV test already done • Agree that women can ask their 

partner to use condom 

• Age at first sex • Multi-partnership • Relationship with the last sexual 

partner 

• Parity 

• Built using the youths’ knowledge of 

the HIV/AIDS’ means of prevention (CP and DP) and transmission (JP, HLP and SPN)** 

• Built using youths’ opinions of the fact 

that a man beat his wife (GNA, GNB, GNC, GND and GNE)*** 

• Self-explanatory • Self-explanatory • Age at coital debut • Number of sexual partners during the 

last 12 months 

• Self-explanatory • Permits to know if the respondent 

has/has not at least one child 

• 1) Has in-depth knowledge of AIDS; 2) Does not have • 1) Not favorable; 2) Less favorable; 3) Very favorable • 0) No; 1) Yes • 0) No; 1) Yes • 1) Less than 15; 2) 15-19; 3) 20+ • 1) 1; 2) 2+ • 1) Boyfriend not living together; 2) Casual partner • 1) No; 2) Yes 

Sexual behavior • Condom use at last sexual 

intercourse 

• Obvious • 0) No; 1) Yes 

* Not related to any concept, the place of residence has been included among the variables of interest. It was constructed using the variable “v022 or mv022: sample strata”: Yaounde 

and Douala have been recoded to 1) large towns, all other urban strata (Adamaoua-urban, Centre-urban, East-urban, Far North-urban, Littoral-urban, North-urban, North-West-urban, West-urban, South-urban and South-West-urban) to 2) small towns and rural strata (Adamaoua-rural, Centre-rural, East-rural...South-rural) to 3) rural. 

** CP=always using condom during sex to reduce risk of getting HIV; DP=one sex partner only, who has no other partners, reduce risk of getting HIV; JP=can get HIV from mosquito 

bites; HLP=a healthy-looking person can have HIV; SPN=can get HIV by supernatural means. 

***GNA=beating justified if wife goes out without telling husband; GNB=beating justified if wife neglects the children; GNC=beating justified if wife argues with husband; GND=beating 

justified if wife refuses to have sex with husband; GNE=beating justified if wife burns food. 
9 

3.3 Statistical analyses 

In the analyses, condom use at the last sexual intercourse was the dependent variable and the others were 

independent variables. Descriptive statistics, frequencies, and percentages were computed to describe the 

social and individual characteristics of the respondents, as well as the variation of the percentages of the 

respondents who used condoms at the last sexual intercourse during the 12 months before the survey. 

Logistic regression analyses were used to identify determinants of condom use at last sex and the 

characteristics of youths who were less likely to use condoms. 

As we hypothesized in our conceptual framework that family and extra-family characteristics and media 

exposure are associated with condom use through their individual characteristics, seven logistic regression 

models were used among single male youths and the same models among female youths. This included the 

full model (see Table 4) and another other six models, which were produced by controlling each of the three 

types of social characteristics by individual ones. 

Models 1, 3, and 5 display the effects of social characteristics, in the presence of the place of the residence. 

Model 1 includes the family environment variables, Model 3 the extra-familial environment variables, and 

Model 5 media exposure (see Figure 1 and Table 1) with the addition of place of residence. 

Models 2, 4, and 6 display the effects of social characteristics, in the presence of the place of the residence 

and the individual characteristics. Model 2 includes the family environment variables, Model 4 the extrafamilial environment variables, and Model 6 media exposure (see Figure 1 and Table 1) with the addition 

of the individual characteristics and place of residence. 

The full model includes all independent variables. 

In all analyses, sampling weighting was used to account or adjust for disproportionate sampling and 

nonresponse. The multistage sampling design was also taken into account. 

The analyses were conducted with STATA 16 software. The probability thresholds were 0.001, 0.01 and 

0.05. 

11 

4 RESULTS 

4.1 Background characteristics of the respondents 

Table 2 presents the percentage distribution of the sample. Overall, 51% of female youths and 66% of male 

youths reported that they used condoms at their last sexual intercourse. Most female youths lived in 

extended family households (32%) or in single-parent households with children and others (20%). Most of 

the male youths lived in extended family households (25%) or in other types of households with neither 

parent present or with a complex structure (31%). More than two-fifths of youths lived in households with 

at least seven members (57% of the females and 46% of the males). The percentage of youths living in a 

female-headed households is higher among female youths (39%) than male youths (27%). The majority of 

female and male youths lived in households with heads who had attained secondary or tertiary education 

(58% and 63%, respectively). The majority of female and male youths were Bamileke (25% and 28%, 

respectively), Beti-Boulou (31% and 29%, respectively), or from the Northern ethnic groups (12% and 

18%, respectively). 

Table 2 Percent distribution of single females and males age 15-24 who had sexual intercourse 

within the 12 months before the 2018 CDHS by selected characteristics 

Single females 

(n=1,464) 

Single males 

(n=989) 

Background characteristics Number % Number % 

A) CONDOM USE AT THE LAST SEXUAL 

INTERCOURSE 

Yes 745 50.9 655 66.3 

No 719 49.1 334 33.7 

B) FAMILY CHARACTERISTICS Family composition 

Nuclear 267 18.2 171 17.3 

Extended 462 31.6 248 25.1 

Head with children 206 14.1 109 11.0 

Head with children and others 297 20.3 152 15.3 

Others 231 15.8 310 31.3 

Household size [1-3] 186 12.8 251 25.4 

[4-6] 440 30.1 287 29.0 

[7-8] 357 24.4 187 18.9 

[9+] 480 32.8 264 26.7 

 

Sex of the household’s head Male 892 60.9 722 73.0 

Female 572 39.1 267 27.0 

 

Education level of the household’s head No education 125 8.7 89 9.2 

Primary 472 33.0 270 28.0 

Secondary 647 45.3 481 49.9 

Higher 186 13.0 125 13.0 

Household Wealth Index Lowest 63 4.3 36 3.7 

Second 211 14.4 141 14.2 

Middle 303 20.7 235 23.8 

Fourth 411 28.0 254 25.7 

Highest 476 32.5 323 32.6 

 

Ethnicity North 179 12.2 179 18.2 

Beti-Boulou 460 31.4 289 29.3 

Bassa 89 6.1 43 4.4 

Bamileke 371 25.4 281 28.4 

Mbo 70 4.8 54 5.4 

North-West/South-West 141 9.6 62 6.2 

Others 155 10.6 81 8.1 

Continued... 
12 

Table 2 Percent distribution of single females and males age 15-24 who had had sexual intercourse 

within the 12 months before the 2018 CDHS by selected characteristics (continued)

Single females 

(n=1,464) 

Single males 

(n=989) 

Background characteristics Number % Number % 

C) EXTRA-FAMILY CHARACTERISTICS 

Religion 

Catholic 711 48.6 473 47.8 

Protestant 489 33.4 270 27.3 

Muslim 94 6.4 136 13.7 

Other Christians 124 8.4 52 5.2 

Others 46 3.1 58 5.8 

Youth’s education level 

No education and primary 212 14.5 137 13.9 

First cycle of secondary 518 35.4 362 36.7 

Second cycle of secondary 515 35.2 366 37.1 

Higher 219 15.0 123 12.4 

Youth’s occupation 

Not working 777 53.1 233 23.5 

Modern and service 172 12.0 95 9.6 

Sales 215 14.7 133 13.5 

Agriculture 198 13.5 224 22.7 

Manual 102 7.0 304 30.7 

D) MEDIA EXPOSURE Not exposed 260 17.8 146 14.8 

Low exposure 536 36.6 329 33.3 

Moderately 514 35.1 424 42.9 

Highly 153 10.5 90 9.1 

 

E) INDIVIDUAL CHARACTERISTICS

No. Sex. partners last 12 months 

1 1259 86.0 628 63.6 

2+ 205 14.0 360 36.4 

Age at first sex 

<15 204 14.0 136 13.7 

15-19 1130 77.5 774 78.3 

20+ 124 8.5 79 8.0 

In-depth knowledge of AIDS 

No 871 60.5 561 57.2 

Yes 569 39.5 420 42.8 

Perception of gender inequalities 

Not favorable 1076 75.3 651 68.0 

Less favorable 300 21.0 267 27.9 

Very favorable 53 3.7 39 4.1 

Have already done an HIV test 

No 366 25.0 425 43.0 

Yes 1098 75.0 563 57.0 

Agree that women can ask their partner 

to use condom 

No 283 19.6 125 12.9 

Yes 1158 80.4 845 87.1 

Relationship with the last partner

Boyfriend not living together 1418 96.9 841 85.0 

Casual partner 46 3.1 148 15.0 

Number of children 

0 1013 69.2 875 88.5 

1+ 451 30.8 113 11.5 

F) OTHER Area of residence 

Rural 458 31.3 318 32.2 

Small town 541 37.0 380 38.5 

Large town 465 31.7 290 29.4 

Total 1,464 100.0 989 100.0 

With extra-family characteristics, the majority of youths were Catholic (49% of female and 48% of male 

youths) or Protestant (33% of female and 27% of male youths). The level of education did not vary by 

gender, with the proportions approximately the same at no education or primary level (15% of female and 
13 

14% of male), at the first cycle of secondary level (35% and 37%), the second cycle of secondary level 

(35% and 37%), and the higher level (15% and 12%). About 53% of female youths were not working during 

the survey, 15% worked in the sales sector, 14% in agriculture, 12% in the modern sector or services, and 

7% were manual workers. Among male youths, these proportions are 24%, 14%, 23%, 10%, and 31%, 

respectively. 

The proportion of youths not exposed or with low exposure to the media is higher among female youth 

compared to male youth (54% and 48%, respectively). 

With the individual characteristics, 40% of females and 43% of male youths had an in-depth knowledge of 

HIV/AIDS. The proportion of female youths who had been tested for HIV/AIDS (75%) was higher than 

that for male youths (57%). The majority of individuals do not approve of gender inequalities (75% of 

females and 68% of males) and they agreed that women can request the use of condoms by their partners 

(80% and 87%, respectively). About 14% of male and female youths had their first sexual intercourse before 

age 15. This proportion is 78% at age 15-19 and 8% at age 20-24. About 14% of females and 36% of the 

male youths had multiple sexual partners in the 12 months before the survey; fewer female youths (3%) 

than male youths (15%) had sex with casual partners during this period; and 31% and 12%, respectively, 

reported at the time of the survey that they had already had at least one child born alive. 

4.2 Bivariate associations of social and individual factors with condom 

use 

Table 3 presents the association between each independent variable and condom use at last sex among 

single youths who lived in Cameroon in 2018. For both sexes, some social factors (except family 

composition, sex of household head, and youth’s religion) and having at least one child were significantly 

associated with condom use. For both sexes, the number of sexual partners, the perception of gender 

inequalities, the relationship with last partner, being supportive of women who can request condom use by 

their partners, and being tested for HIV were not significantly associated with condom use. Household size, 

the household head’s education level, the youth’s education level, and age at first sexual intercourse were 

associated with condom use among female youths only and having an in-depth knowledge of HIV among 

only the male youths. 

Among female youths, at the family level, the proportion of condom use is lower than the national average 

(51%) in households with nine members or more (44.8%). The head of household’s educational level is 

positively associated with condom use. For example, the proportion of condom use is higher than the 

national average in households headed by someone with higher education (59%) and lower in those whose 

heads had no education (40%). For both sexes, a similar association was observed between the household 

living standard and condom use. At the same level, among female youths, ethnicity was also associated 

with the dependent variable. The proportion of condom users is higher among the Bamileke (62%) and the 

Mbo (67%) ethnic groups than the others. Among male youths, the same is observed (75% and 66%), 

although for males, these two ethnic groups do not differ significantly from Bassa (68%) and “others” 

(70%). 
14 

Table 3 Proportion of single youths age 15-24 who used condom at the last sexual intercourse 

during the 12 months before the 2018 CDHS by gender and their selected 

characteristics 

Single females Chi-square Single males Chi-square 

Background characteristics % 95% CI P-value % 95% CI P-value 

A) FAMILY ENVIRONMENT 

Family composition 0.504 0.895 

Nuclear 52.4 [45.1,59.7] 66.6 [57.3,74.8] 

Extended 47.6 [41.8,53.6] 66.2 [59.9,72.0] 

Head with children 55.2 [47.3,62.9] 70.8 [59.7,79.9] 

Head with children and others 49.9 [44.0,55.8] 65.6 [55.3,74.7] 

Others 53.1 [46.6,59.6] 64.8 [59.2,70.0] 

Household size 0.032 0.061 

[1-3] 53.4 [45.8,60.9] 70.6 [63.4,76.8] 

[4-6] 53.9 [48.6,59.2] 66.3 [59.8,72.3] 

[7-8] 53.9 [48.0,59.8] 70.6 [63.2,77.0] 

9+ 44.8 [40.1,49.6] 59.0 [51.4,66.3] 

Sex of the household’s head 0.536 0.715 

Male 50.2 [46.3,54.1] 65.8 [61.8,69.6] 

Female 52.0 [47.6,56.3] 67.5 [59.1,74.9] 

Education level of the household’s head 0.050 0.057 

No education 40.1 [30.5,50.5] 54.5 [42.5,66.0] 

Primary 49.4 [44.5,54.4] 65.2 [58.0,71.8] 

Secondary 52.2 [47.5,56.9] 67.3 [62.8,71.4] 

Higher 58.6 [49.9,66.9] 75.0 [64.5,83.2] 

Household Wealth Index 0.002 <0.001 

Lowest 37.3 [22.0,55.7] 26.8 [14.3,44.6] 

Second 38.6 [32.5,45.0] 46.1 [35.5,57.1] 

Middle 49.0 [44.0,54.0] 70.1 [63.8,75.7] 

Fourth 55.2 [49.0,61.2] 70.9 [64.1,76.9] 

Highest 55.6 [50.7,60.4] 73.0 [66.7,78.6] 

Ethnicity <0.001 0.037 

North 42.9 [33.6,52.8] 62.2 [52.6,71.0] 

Beti-Boulou 49.4 [44.4,54.4] 61.0 [54.5,67.1] 

Bassa 45.8 [32.9,59.3] 68.1 [52.1,80.8] 

Bamileke 62.4 [56.3,68.0] 74.9 [68.9,80.1] 

Mbo 66.6 [55.5,76.2] 65.6 [52.4,76.7] 

North-West/South-West 43.2 [32.2,54.9] 58.1 [44.3,70.7] 

Others 39.7 [32.3,47.7] 69.6 [57.0,79.8] 

B) EXTRA-FAMILIAL ENVIRONMENT Religion 0.158 0.878 

Catholic 52.9 [48.2,57.5] 67.3 [62.3,72.0] 

Protestant 47.4 [42.2,52.7] 63.9 [55.5,71.5] 

Muslim 61.8 [48.5,73.5] 67.2 [57.1,76.0] 

Other Christians 48.2 [38.4,58.2] 62.3 [47.9,74.8] 

Others 41.6 [26.4,58.5] 69.9 [54.0,82.2] 

Youth’s education level 0.003 0.099 

No education and primary 40.3 [33.4,47.5] 57.6 [48.1,66.5] 

First cycle of secondary 48.2 [43.3,53.2] 65.1 [59.3,70.4] 

Second cycle of secondary 55.1 [50.3,59.8] 68.9 [63.4,73.8] 

Higher 57.4 [49.1,65.4] 71.6 [61.7,79.9] 

Youth’s occupation 0.022 <0.001 

Not working 53.9 [49.4,58.3] 69.5 [61.2,76.7] 

Modern and services 43.0 [36.6,49.6] 75.1 [64.5,83.4] 

Sales 56.1 [47.9,64.0] 71.3 [61.4,79.4] 

Agriculture 43.3 [35.6,51.5] 51.3 [44.5,58.1] 

Manual 44.8 [33.9,56.3] 69.8 [63.5,75.5] 

C) MEDIA EXPOSURE 0.003 <0.001 

Not exposed 38.0 [30.5,46.3] 49.1 [40.2,58.0] 

Low exposure 52.5 [47.5,57.5] 65.3 [59.2,70.9] 

Moderately 53.4 [48.4,58.4] 71.4 [65.4,76.8] 

Highly 58.3 [48.4,67.6] 73.5 [61.6,82.8] 

Continued... 

 
15 

Table 3 Proportion of single youths age 15-24 who used condom at the last sexual intercourse during 

the 12 months before the 2018 CDHS by gender and their selected characteristics (continued)

Single females Chi-square Single males Chi-square 

Background characteristics % 95% CI P-value % 95% CI P-value 

D) INDIVIDUAL No. Sex. partners last 12 months 0.474 0.873 

1 50.4 [47.2,53.5] 66.1 [61.5,70.3] 

2+ 53.9 [44.8,62.7] 66.7 [60.2,72.5] 

Age at first sex 0.002 0.842 

<15 39.0 [33.2,45.2] 68.6 [59.0,76.9] 

15-19 53.4 [49.7,57.0] 65.7 [61.3,69.8] 

20+ 48.2 [38.7,57.8] 67.6 [53.5,79.1] 

In-depth knowledge of AIDS 0.593 0.033 

No 52.1 [48.4,55.7] 63.7 [59.0,68.1] 

Yes 50.4 [45.6,55.3] 70.4 [65.4,75.0] 

Perception of gender inequalities 0.128 0.209 

Not favorable 50.9 [47.5,54.4] 68.0 [63.2,72.4] 

Less favorable 55.2 [48.4,61.7] 64.2 [58.1,69.9] 

Very favorable 38.8 [25.8,53.5] 52.7 [32.6,71.9] 

Have already done an HIV test 0.236 0.329 

No 53.9 [48.2,59.5] 64.3 [59.0,69.2] 

Yes 49.9 [46.3,53.4] 67.8 [62.7,72.4] 

Agree that women can request the use of 

condom No 44.7 [38.1,51.5] 61.7 [51.1,71.3] 

Yes 52.6 [49.1,56.0] 67.2 [63.1,71.0] 

Relationship with the last partner 0.852 0.739 

Boyfriend not living together 50.9 [48.0,53.9] 66.0 [62.1,69.7] 

Others 49.3 [32.5,66.2] 67.6 [58.4,75.6] 

Number of children <0.001 <0.001 

0 57.9 [54.3,61.4] 69.0 [65.1,72.6] 

1+ 35.1 [29.5,41.2] 45.1 [34.5,56.2] 

E) OTHER 

Area of residence 0.030 <0.001 

Rural 44.7 [40.2,49.3] 55.2 [48.5,61.8] 

Small town 54.4 [49.5,59.2] 69.3 [64.5,73.8] 

Large town 52.8 [46.4,59.2] 74.3 [67.0,80.5] 

Total 50.9 [47.9,53.9] 66.3 [62.6,69.8] 

At the extra-family level, the educational level of female youths is positively associated with condom use. 

The rate of condom use increases from 40.3% for those with no education or primary education level to 

57.4% for those with a higher education level. With occupation, the proportion of condom use is higher 

among the female youths who worked in the sales sector (56%) or were not working (54%) than among 

those who worked in other professions (between 43-45%). Among the male youths, only those who worked 

in the agricultural sector (51%) differ from others (between 70-75%) by their low rate of condom use. 

For both sexes, the percentage of condom use increases with the degree of media exposure. For example, it 

is higher than the national average among youths who are highly exposed to the media (58% among females 

and 74% among males) and lower among those not exposed to the media (38% and 49%, respectively). 

At the individual level, among female youths, the proportion of condom use is lower for those who began 

sexual activity at age 15 or younger (39%) than at the other ages (48% at age 20 or more and 53% at age 

15-19). Among male youths, in-depth knowledge of HIV/AIDS is positively associated with condom use 

(70% for those with in-depth knowledge versus 64% for those who do not have this knowledge). For both 

sexes, having at least one child is negatively associated with the condom use, with 35% and 45% for female 

and male youth respectively with at least one child versus 58% and 69% for female and male youth with 

no children. 
16 

Finally, the proportion of condom use is greater in large towns (53% among female and 74% among male 

youths) and small towns (54% and 69%) than in the rural areas (45% and 55%). 

4.3 Results from multivariate analyses 

In this section, we describe the factors associated with condom use (the “determinants”) (Table 4), the 

characteristics of the groups at risk (where the odds ratios of using condoms are lower than in the reference 

groups), those where the odds ratios are higher, and the mechanisms of action of social factors (Tables 5 

and 6). Among the independent variables, only one, the household size, was eliminated to avoid the 

multicollinearity problem. The different VIF (variance inflation factors) showed that household size is 

strongly correlated with family composition. 

4.3.1 “Determinants” of condom use 

The full models (Table 4) show that, for both sexes, the “determinant” of condom use at the last sexual 

intercourse is the number of children ever born. 

The gender differences in the determinants of condom use are important. The following are variables that 

acted as determinants among female youths only: ethnicity, youth’s occupation, and age at first intercourse. 

Among male youths, the variables that acted as determinants were the head of household’s education level 

and the household’s living standard. 

Table 4 Logistic regression on condom use at the last sexual intercourse among single females 

and males age 15-24, 2018 CDHS 

Single females Single males 

Background characteristics OR 95% CI OR 95% CI 

A) FAMILY ENVIRONMENT 

Family composition 

Nuclear (reference) 1.0 1.0 

Extended 0.8 0.5 - 1.2 1.0 0.5 - 1.8 

Head with children 1.2 0.7 - 2.1 1.5 0.7 - 3.4 

Head with children and others 1.2 0.7 - 2.0 0.9 0.4 - 2.1 

Others 0.8 0.5 - 1.3 0.7 0.4 - 1.3 

Sex of the household’s head 

Male (reference) 1.0 1.0 

Female 0.9 0.6 - 1.4 0.8 0.4 - 1.5 

Education level of the household’s head 

No education (reference) 1.0 1.0 

Primary 1.2 0.8 - 2.1 1.9 1.0 - 3.8 

Secondary 1.3 0.8 - 2.2 1.8 0.9 - 3.6 

Higher 1.7 0.9 - 3.3 2.8* 1.1 - 7.2 

Household Wealth Index 

Lowest 0.9 0.4 - 2.3 0.2* 0.1 - 0.9 

Second 0.7 0.4 - 1.1 0.5 0.2 - 1.1 

Middle 0.9 0.6 - 1.3 1.3 0.7 - 2.2 

Fourth 1.1 0.7 - 1.6 1.1 0.6 - 1.8 

Highest (reference) 1.0 1.0 

Ethnicity 

North (reference) 1.0 1.0 

Beti-Boulou 1.6 1.0 - 2.6 0.7 0.3 - 1.3 

Bassa 1.3 0.6 - 2.8 1.0 0.4 - 2.6 

Bamileke 2.1** 1.3 - 3.6 1.2 0.7 - 2.2 

Mbo 2.9** 1.4 - 5.7 0.9 0.4 - 2.1 

North-West/South-West 1.4 0.6 - 3.1 0.6 0.3 - 1.5 

Others 1.1 0.6 - 1.9 1.2 0.6 - 2.5 

Continued... 

 
17 

Table 4 Logistic regression on condom use at the last sexual intercourse among single females and 

males age 15-24, 2018 CDHS (continued)

Single females Single males 

Background characteristics OR 95% CI OR 95% CI 

B) EXTRA-FAMILIAL ENVIRONMENT Religion Catholic (reference) 1.0 1.0 

Protestant 0.8 0.6 - 1.1 1.0 0.6 - 1.5 

Muslim 1.4 0.8 - 2.7 1.2 0.6 - 2.1 

Other Christians 0.8 0.5 - 1.3 1.0 0.5 - 2.0 

Others 0.5 0.2 - 1.1 0.9 0.4 - 1.8 

 

Youth’s education level No education and primary (reference) 1.0 1.0 

First cycle of secondary 1.1 0.8 - 1.6 0.8 0.5 - 1.4 

Second cycle of secondary 1.1 0.7 - 1.8 0.8 0.5 - 1.5 

Higher 1.2 0.6 - 2.3 0.5 0.2 - 1.3 

Youth’s occupation Not working (reference) 1.0 1.0 

Modern and services 0.7* 0.4 - 1.0 1.7 0.8 - 3.5 

Sales 1.3 0.9 - 2.0 1.0 0.5 - 1.8 

Agriculture 1.0 0.7 - 1.5 0.7 0.4 - 1.3 

Manual 0.6 0.4 - 1.1 1.0 0.6 - 1.7 

 

C) MEDIA EXPOSURE 

Not exposed (reference) 1.0 1.0 

Low exposure 1.1 0.8 - 1.6 1.0 0.6 - 1.7 

Moderately 1.1 0.7 - 1.7 1.5 0.8 - 2.6 

Highly 1.6 0.9 - 2.9 1.4 0.6 - 3.2 

D) INDIVIDUAL No. Sex. partners last 12 months One (reference) 1.0 1.0 

Two and more 1.1 0.8 - 1.7 0.9 0.6 - 1.3 

 

Age at first sex <15 (reference) 1.0 1.0 

15-19 1.5* 1.0 - 2.2 0.8 0.5 - 1.5 

20+ 1.0 0.6 - 1.8 1.0 0.4 - 2.3 

 

In-depth knowledge of AIDS No (reference) 1.0 1.0 

Yes 0.8 0.6 - 1.1 1.2 0.9 - 1.5 

 

Perception of gender inequalities Not favorable (reference) 1.0 1.0 

Less favorable 1.2 0.9 - 1.7 1.1 0.7 - 1.5 

Very favorable 0.6 0.3 - 1.2 0.6 0.2 - 1.7 

 

Have already done an HIV test No (reference) 1.0 1.0 

Yes 0.8 0.6 - 1.1 0.9 0.6 - 1.4 

 

Agree that women can request the use of 

condom No (reference) 1.0 1.0 

Yes 1.3 0.9 - 1.8 1.2 0.7 - 2.2 

 

Relationship with the last partner Boy/Girlfriend not living together 

(reference) 1.0 1.0 

Others 0.7 0.4 - 1.4 1.2 0.7 - 1.9 

Number of children 0 (reference) 1.0 1.0 

1+ 0.5*** 0.3 - 0.7 0.4** 0.2 - 0.7 

 

E) OTHER 

Area of residence 

Rural (reference) 1.0 1.0 

Small town 1.0 0.7 - 1.4 0.9 0.6 - 1.6 

Large town 0.8 0.5 - 1.2 1.2 0.6 - 2.2 

N 1,505 947 

* p≤0.05; **p≤0.01; ***p≤0.001 
18 

4.3.2 Characteristics of the groups at risk 

The results of the study reveal that, among male youths, individuals living in households whose heads 

attained higher education (OR=2.8) are more likely to use condoms than those living in households with 

heads without education. Young men living in households in the lowest wealth index quintile (OR=0.2) are 

less likely to use condoms than those living in households in the highest wealth index quintile. The results 

also reveal that, among female youths, individuals from the Bamileke (OR=2.1) or Mbo (OR=2.9) ethnic 

groups are more likely to use condoms than those from the northern ethnic groups. Finally, for young 

women, being employed in the modern or service sectors (OR=0.7) is negatively associated with condom 

use, compared to nonworking individuals. 

The youths with at least one child are less likely to use condoms than those with no children (OR=0.5 

among females and 0.4 among males). Among the females, individuals who had their first sexual 

intercourse at age 15-19 were more likely to use condoms (OR=1.5) than those who began sexual activity 

at a younger age. There was no significant difference in condom use between female youths who had their 

first sex at age 20 or more and those who entered in sexual activity at age 15 or younger. 

4.3.3 Mechanisms of action of social factors 

Among female youths, the results from logistic regression in which each type of social factor was controlled 

by individual factors (Table 5) are: 

1. The effect of the household standard of living was nullified and that of ethnicity was attenuated 

when individual characteristics were included (see odds ratios for these variables in Models 1 and 

2 in Table 5). 

2. Further analyses showed that in-depth knowledge of HIV/AIDS attenuated the effect of ethnicity, 

and age of first intercourse and number of children born alive nullified that of the household 

standard of living (results not presented). This last individual factor nullified the effect of HIV test 

(results not presented). 

3. The effect of youth’s education level was nullified and that of the degree of media exposure was 

attenuated in the presence of individual characteristics (see odds ratios for youth’s education in 

Models 3 and 4 in Table 5 and odds ratios for media exposure in Models 5 and 6 in Table 5). Indepth knowledge of HIV/AIDS and perception of gender inequalities nullified the effect of youth’s 

education level, and this last individual factor and age at first intercourse attenuated that of the 

degree of media exposure (results not presented). 

Among male youths, the results from the logistic regression models in which each type of social factor was 

controlled by individual factors (Table 6), and further analyses showed that the effect of household standard 

of living was attenuated (see Models 1 and 2 in Table 6) by the age of first intercourse and the effect of the 

degree of media exposure was attenuated (Models 5 and 6 in Table 6) by in-depth knowledge of HIV/AIDS, 

the perception of gender inequalities, and the number of children born alive (results not presented). 
19 

Table 5 Logistic regression models on condom use in which each type of social factor is 

controlled by individual factors (single females age 15-24, 2018 CDHS) 

M1 M2 M3 M4 M5 M6 

Background characteristics OR 95% CI OR 95% CI OR 95% CI OR 95% CI OR 95% CI OR 95% CI 

A) FAMILY ENVIRONMENT 

Family composition 

Nuclear (reference) 1.0 1.0 

Extended 0.7 0.5 - 1.2 0.8 0.5 - 1.2 

Head with children 1.2 0.7 - 2.1 1.3 0.7 - 2.2 

Head with children and others 1.0 0.6 - 1.7 1.2 0.7 - 2.1 

Others 0.9 0.6 - 1.4 0.8 0.5 - 1.3 

Sex of the household’s head 

Male (reference) 1.0 1.0 

Female 0.9 0.6 - 1.2 0.9 0.6 - 1.3 

Education level of the household’s 

head 

No education (reference) 1.0 1.0 

Primary 1.2 0.8 - 2.0 1.3 0.8 - 2.1 

Secondary 1.3 0.8 - 2.1 1.3 0.8 - 2.2 

Higher 1.6 0.9 - 3.0 1.8 0.9 - 3.3 

Household Wealth Index 

Lowest 0.6 0.3 - 1.5 0.8 0.3 - 1.9 

Second 0.5*** 0.3 - 0.8 0.6 0.4 - 1.0 

Middle 0.7* 0.5 - 1.0 0.9 0.6 - 1.3 

Fourth 0.9 0.6 - 1.3 1.1 0.8 - 1.6 

Highest (reference) 1.0 1.0 

Ethnicity 

North (reference) 1.0 1.0 

Beti-Boulou 1.5 1.0 - 2.3 1.4 0.9 - 2.3 

Bassa 1.1 0.6 - 2.3 1.1 0.5 - 2.4 

Bamileke 2.3*** 1.5 - 3.8 2.0** 1.2 - 3.3 

Mbo 2.7** 1.4 - 5.1 2.6** 1.3 - 5.0 

North-West/South-West 1.0 0.5 - 2.2 1.2 0.5 - 2.5 

Others 1.0 0.6 - 1.6 1.0 0.6 - 1.7 

B) EXTRA-FAMILIAL ENVIRONMENT 

Religion Catholic (reference) 1.0 1.0 Protestant 0.8 0.6 - 1.1 0.9 0.6 - 1.2 Muslim 1.6 0.9 - 2.8 1.5 0.8 - 2.7 

Other Christians 0.9 0.6 - 1.3 0.8 0.5 - 1.3 

Others 0.7 0.3 - 1.5 0.6 0.3 - 1.3 

Youth’s education level No education and primary (reference) 1.0 1.0 First cycle of secondary 1.3 0.9 - 1.8 1.3 0.9 - 1.9 Second cycle of secondary 1.7* 1.1 - 2.5 1.5 1.0 - 2.3 

Higher 1.9* 1.1 - 3.2 1.8 1.0 - 3.3 

Youth’s occupation Not working (reference) 1.0 1.0 Modern and services 0.7* 0.5 - 1.0 0.7* 0.4 - 1.0 Sales 1.2 0.8 - 1.7 1.2 0.8 - 1.8 

Agriculture 0.9 0.6 - 1.3 0.9 0.6 - 1.3 

Manual 0.7 0.4 - 1.2 0.7 0.4 - 1.1 

C) MEDIA EXPOSURE 

Not exposed (reference) 1.0 1.0 

Low exposure 1.7** 1.2 - 2.5 1.4 1.0 - 2.0 

Moderately 1.8* 1.1 - 2.7 1.4 0.9 - 2.2 

Highly 2.1** 1.2 - 3.6 1.9* 1.1 - 3.5 

D) INDIVIDUAL No. Sex. partners last 12 months One (reference) 1.0 1.0 1.0 

Two and more 1.1 0.8 - 1.7 1.2 0.8 - 1.8 1.1 0.8 - 1.6 

Age at first sex <15 (reference) 1.0 1.0 1.0 

15-19 1.5* 1.0 - 2.1 1.5* 1.0 - 2.2 1.5* 1.0 - 2.1 

20+ 1.0 0.6 - 1.8 1.1 0.6 - 1.9 1.1 0.6 - 1.8 

In-depth knowledge of AIDS No (reference) 1.0 1.0 1.0 

Yes 0.9 0.7 - 1.1 0.8 0.6 - 1.1 0.9 0.7 - 1.1 

Continued... 
20 

Table 5 Logistic regression models on condom use in which each type of social factor is controlled by 

individual factors (single females age 15-24, 2018 CDHS) (continued)

M1 M2 M3 M4 M5 M6 

Background characteristics OR 95% CI OR 95% CI OR 95% CI OR 95% CI OR 95% CI OR 95% CI 

Perception of gender inequalities Not favorable (reference) 1.0 1.0 1.0 

Less favorable 1.2 0.9 - 1.6 1.2 0.8 - 1.6 1.2 0.8 - 1.6 

Very favorable 0.6 0.3 - 1.2 0.6 0.3 - 1.1 0.6 0.3 - 1.1 

Have already done an HIV test No (reference) 1.0 1.0 1.0 

Yes 0.8 0.6 - 1.1 0.9 0.6 - 1.2 0.9 0.7 - 1.2 

Agree that women can request the 

use of condom No (reference) 1.0 1.0 1.0 

Yes 1.3 0.9 - 1.8 1.3 0.9 - 1.8 1.3 1.0 - 1.8 

Relationship with the last partner Boy/Girlfriend not living together 

(reference) 1.0 1.0 1.0 

Others 0.7 0.3 - 1.3 0.9 0.5 - 1.6 0.9 0.4 - 1.7 

Number of children 0 (reference) 1.0 1.0 1.0 

1+ 0.5*** 0.3 - 0.7 0.5*** 0.3 - 0.6 0.4*** 0.3 - 0.6 

E) OTHER 

Area of residence 

Rural (reference) 1.0 1.0 1.0 1.0 1.0 1.0 

Small town 1.1 0.8 - 1.5 1.0 0.7 - 1.5 1.2 0.9 - 1.7 1.2 0.9 - 1.6 1.3 1.0 - 1.7 1.2 0.9 - 1.6 

Large town 0.8 0.5 - 1.1 0.8 0.5 - 1.2 1.1 0.8 - 1.7 1.1 0.8 - 1.5 1.1 0.8 - 1.6 1.1 0.7 - 1.5 

N 1,571 1,505 1,605 1,536 1,605 1,536 

* p≤0.05; **p≤0.01; ***p≤0.001 
21 

Table 6 Logistic regression models on condom use in which each type of social factor is 

controlled by individual factors (single males, age 15-24, 2018 CDHS) 

M1 M2 M3 M4 M5 M6 

Background characteristics OR 95% CI OR 95% CI OR 95% CI OR 95% CI OR 95% CI OR 95% CI 

A) FAMILY ENVIRONMENT 

Family composition 

Nuclear (reference) 1.0 1.0 

Extended 1.0 0.6 - 1.7 1.0 0.5 - 1.7 

Head with children 1.5 0.7 - 3.1 1.5 0.7 - 3.5 

Head with children and others 1.0 0.5 - 2.2 0.9 0.4 - 2.1 

Others 0.7 0.4 - 1.3 0.7 0.4 - 1.2 

Sex of the household’s head 

Male (reference) 1.0 1.0 

Female 0.8 0.5 - 1.5 0.8 0.4 - 1.5 

Education level of the household’s 

head 

No education (reference) 1.0 1.0 

Primary 1.6 0.9 - 3.1 1.8 1.0 - 3.5 

Secondary 1.6 0.8 - 3.1 1.7 0.9 - 3.4 

Higher 2.2 0.9 - 5.0 2.2 0.9 - 5.3 

Household Wealth Index 

Lowest 0.2*** 0.1 - 0.5 0.2** 0.1 - 0.6 

Second 0.4* 0.2 - 0.9 0.4* 0.2 - 0.9 

Middle 1.2 0.7 - 1.9 1.2 0.7 - 2.1 

Fourth 1.0 0.7 - 1.7 1.1 0.7 - 1.7 

Highest (reference) 1.0 1.0 

Ethnicity 

North (reference) 1.0 1.0 

Beti-Boulou 0.7 0.4 - 1.2 0.6 0.3 - 1.2 

Bassa 0.7 0.3 - 1.7 0.9 0.4 - 2.4 

Bamileke 1.2 0.7 - 1.9 1.1 0.6 - 2.0 

Mbo 0.7 0.4 - 1.5 0.8 0.4 - 1.9 

North-West/South-West 0.6 0.3 - 1.2 0.6 0.3 - 1.4 

Others 1.1 0.6 - 2.1 1.0 0.5 - 2.1 

B) EXTRA-FAMILIAL ENVIRONMENT 

Religion Catholic (reference) 1.0 1.0 Protestant 0.9 0.6 - 1.3 0.8 0.5 - 1.3 Muslim 1.0 0.6 - 1.7 1.1 0.6 - 1.9 Other Christians 0.9 0.5 - 1.7 0.9 0.5 - 1.7 Others 1.1 0.5 - 2.4 1.1 0.5 - 2.5 

Youth’s education level No education and primary 

(reference) 1.0 1.0 First cycle of secondary 1.2 0.7 - 1.9 1.1 0.7 - 1.7 Second cycle of secondary 1.3 0.8 - 2.1 1.2 0.7 - 2.0 Higher 1.2 0.6 - 2.3 0.9 0.5 - 1.7 

Youth’s occupation Not working (reference) 1.0 1.0 Modern and services 1.3 0.6 - 2.6 1.5 0.7 - 3.2 Sales 1.1 0.6 - 1.9 1.1 0.6 - 2.1 Agriculture 0.6 0.4 - 1.0 0.6 0.4 - 1.1 Manual 1.1 0.6 - 1.8 1.1 0.6 - 1.9 

C) MEDIA EXPOSURE 

Not exposed (reference) 1.0 1.0 

Low exposure 1.6* 1.0 - 2.6 1.4 0.9 - 2.3 

Moderately 2.0** 1.2 - 3.3 1.9* 1.1 - 3.2 

Highly 2.2* 1.1 - 4.4 2.1 0.9 - 4.5 

D) INDIVIDUAL No. Sex. partners last 12 months 

One (reference) 1.0 1.0 1.0 

Two and more 0.9 0.6 - 1.4 0.9 0.6 - 1.4 0.9 0.6 - 1.4 

Age at first sex <15 (reference) 1.0 1.0 1.0 

15-19 0.9 0.5 - 1.5 0.9 0.5 - 1.4 0.9 0.5 - 1.5 

20+ 0.9 0.4 - 2.2 0.9 0.4 - 2.0 0.8 0.4 - 1.9 

Continued... 

 
22 

Table 6 Logistic regression models on condom use in which each type of social factor is controlled by 

individual factors (single males, age 15-24, 2018 CDHS) (continued)

M1 M2 M3 M4 M5 M6 

Background characteristics OR 95% CI OR 95% CI OR 95% CI OR 95% CI OR 95% CI OR 95% CI 

In-depth knowledge of AIDS No (reference) 1.0 1.0 1.0 

Yes 1.1 0.8 - 1.5 1.2 0.9 - 1.6 1.2 0.9 - 1.5 

Perception of gender inequalities Not favorable (reference) 1.0 1.0 1.0 

Less favorable 1.0 0.7 - 1.5 0.9 0.6 - 1.2 0.9 0.6 - 1.3 

Very favorable 0.6 0.2 - 1.7 0.6 0.2 - 1.7 0.6 0.2 - 1.7 

Have already done an HIV test No (reference) 1.0 1.0 1.0 

Yes 0.9 0.7 - 1.4 1.0 0.7 - 1.4 0.9 0.6 - 1.3 

Agree that women can request the 

use of condom No (reference) 1.0 1.0 1.0 

Yes 1.2 0.6 - 2.1 1.3 0.8 - 2.3 1.1 0.7 - 1.7 

Relationship with the last partner

Boy/Girlfriend not living together 

(reference) 1.0 1.0 1.0 

Others 1.2 0.7 - 2.0 1.1 0.7 - 1.7 1.1 0.7 - 1.7 

Number of children 0 (reference) 1.0 1.0 1.0 

1+ 0.4** 0.2 - 0.7 0.3*** 0.2 - 0.6 0.4*** 0.2 - 0.6 

E) OTHER 

Area of residence 

Rural (reference) 1.0 1.0 1.0 1.0 1.0 1.0 

Small town 1.1 0.7 - 1.7 1.0 0.6 - 1.7 1.4* 1.0 - 2.1 1.3 0.9 - 2.1 1.6* 1.1 - 2.3 1.5 0.9 - 2.3 

Large town 1.3 0.8 - 2.2 1.3 0.7 - 2.3 1.7* 1.0 - 2.8 1.8* 1.0 - 3.1 1.9** 1.2 - 3.1 1.9* 1.1 - 3.3 

N 1,008 947 1,031 969 1,031 969 

* p≤0.05; **p≤0.01; ***p≤0.001 
23 

5 DISCUSSION 

One of the important results from the descriptive analyses is that the proportion of young adults who used 

condoms at their last sexual intercourse was 51% among the females and 66% among the males. In 2011, 

these proportions were respectively 60% and 72%. These findings highlight a relaxation of HIV/AIDS 

preventive practices among youths in Cameroon. This has been observed in other developing countries and 

explained in Cameroon by Billong et al. (2020) by the fact that expenditures related to the fight against 

HIV/AIDS are generally oriented towards antiretroviral treatment. In 2017, for example, the prevention of 

this pandemic for out-of-school youth accounted for only 1.9% of expenditures, and the communication for 

social and behavioral change in the general population accounted for 14.5% (Billong et al. 2020). Thus, 

HIV/AIDS programs for young adults received the lowest prevention funding, and this could have caused 

the problem of condom shortage. There was an annual growth of 24% in the number of condoms distributed 

in 2010-2014 in Cameroon, and then an annual decrease of 10%. As suggested by MINSANTE (2016), this 

problem could be explained by funding constraints. 

The results from multivariate analyses demonstrate the relevance of the systemic explanatory approach to 

condom use among youths in Cameroon because we highlighted the “determinants” of this behavior at the 

family, extra-family, and individual levels of independent variables. The degree of media exposure did not 

affect the use of condoms among single youths. 

The results of the study highlight the role of household human and financial capital in improving male 

youths’ sexual behaviors. The positive influence of the household head’s educational level occurred only at 

its highest level, and this result can be understood if we take into account the sexual education of children 

in the family setting. This requires parents to be well informed about youths’ sexual and reproductive health 

(Breunar et al. 2016; Pop and Rusu 2015). At a higher level of education, parents develop the capacity to 

communicate more easily with their sons about sexual and reproductive health matters. Another explanation 

is that educated parents invest more than others in the quality of their children, and may be more motivated 

to communicate with their children about subjects related to the prevention of pregnancies and STI / HIV / 

AIDS. This could be an important area for future research. 

The positive association observed among male youths between household living standard and condom use 

reflects the fact that parental financial support plays an important role in improving preventive practices. 

Those who lived in households with a wealth index quintile higher than the second quintile are less likely 

to be vulnerable to economic pressures that could expose them to high-risk behaviors, and are also more 

likely to have access to good health-care services that encourage healthy lifestyle practices. 

As the household head’s education level and the household living standard were associated with condom 

use in the multivariate logistic regression models only among male youths, and the same was observed 

among female youths in the case of ethnicity, youth’s occupation, and age at first intercourse, effective 

intervention for promoting condom use should be differently packaged for female and male youths. 

The fact that, among female youths, individuals from Bamileke and Mbo ethnic groups were more likely 

to use condoms than others suggests that interventions should be less reinforced in West and Littoral 

regions, where Bamileke and Mbo live, than in the North, East, and other regions. This result concurs with 

findings published in 2004 by Rwenge. No previous study has evaluated the effect of youths’ economic 
24 

activity on condom use. In the Cameroonian context, the result obtained does not confirm the hypothesis 

concerning the relation between youth’s economic activity and condom use. Contrary to expectations, 

young females who worked in the modern/service sector or were manual workers were less likely to use 

condoms than those who were not working. The age gap between partners may explain this relationship, 

and may be higher among female youths who worked in the modern/service sector or were manual workers 

than those who were not working. Indeed, as among the latter, most of the individuals are enrolled in school, 

and most of them recruit their partners among individuals of the same age group. This highlights the 

importance of the problem of unbalanced power relationship: most female youths who worked in 

modern/service sector or were manual workers had sexual intercourse with older men, and therefore their 

ability or capacity to influence the behavior of their partners is low. 

Furthermore, among female youths, the positive relationship between age at first sexual intercourse and 

condom use corroborates observations made in other contexts, notably in Mali (Boileau 2006) and in 

Burkina Faso (Yode and LeGrand 2012). This suggests that delaying the onset of sexual activity could be a 

safer way to protect sexual and reproductive health. In the case of the number of children ever born, its 

negative association with condom use observed among female and male youths is an expression of trust 

between partners, and intimacy that would be stronger within relationships solidified by the birth of at least 

one child than within other relationships. 

Other important results were highlighted with the logistic regression models in which each type of social 

factor was controlled by the individual factors. These models showed that the influence of some social 

factors was attenuated or nullified in the presence of individual factors, and that social factors have 

significant direct and indirect effects on youths’ condom use. For example, among female youths, in-depth 

knowledge of HIV/AIDS explains some of the influence of ethnicity, and delaying first sexual intercourse 

and not having children to raise fully explain that of household standard of living. In other words, among 

female youths, individuals living in households in the second wealth index quintile and those living in 

households in the middle wealth index quintile were less likely to use condoms than those living in 

households in the highest wealth index quintile because a good proportion of the former started sexual 

activity at a younger age (33% and 22% versus 6%) and had at least one child (41% and 40% versus 21%). 

Furthermore, among them, delaying first sexual intercourse and a negative perception of gender inequalities 

may explain the influence of media exposure. Among young males, this last individual factor, as well as indepth knowledge of HIV/AIDS and not having children to raise, played the same role in the case of media 

exposure. Thus, positive changes in youths’ family, extra-family, and media environments should lead to 

the improvement of their sexual behaviors if they play the same role in the case of their knowledge, 

attitudes, perceptions, and practices about STDs/HIV/AIDS. 

Our study results have one important limitation. The cross-sectional nature of DHS data does not allow for 

establishing temporal priority of independent variables and for evaluation of causal implications. Thus, the 

results are simple associations among variables. Because the study highlighted that social factors are 

associated with youths’ condom use via their individual characteristics, longitudinal or biographical studies 

of youths’ sexual behaviors are needed to show how changes over time in the youths’ social environment 

(familial environment, extra-familial environment, and media) affect behavioral changes through 

perceptions and attitudes, and are either directly or indirectly related to HIV/AIDS prevention. 
25 

6 CONCLUSION AND RECOMMENDATIONS 

The “determinants” of single youths’ condom use were found at the family, extra-family, and individual 

levels of independent variables. The degree of media exposure was not associated with condom use among 

either male or female youths. These findings support Cameroon’s multisectoral approach to HIV/AIDS 

prevention among youths, and emphasize the importance of involving parents, teachers, and youths. 

27 

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