{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T01:18:11Z","timestamp":1787793491169,"version":"build-2784847793"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background and objectives<\/jats:title><jats:p>Although the global human immunodeficiency virus (HIV) infection rate has decreased in recent years, the proportion and number of HIV-infected individuals aged 18\u201324\u202fyears has increased. The main mode of HIV transmission is sexual, a large proportion of the infected population are college students, and numerous health education activities have been implemented to prevent HIV infection, where mastery of relevant knowledge greatly improves. Nevertheless, the effectiveness of necessary protective measures is not ideal during actual behavior, indicating insufficient conversion of prevention knowledge to behavioral. To understand the factors and interactions that influence preventive behavior, we conducted a cross-sectional exploratory study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>Participants (<jats:italic>n<\/jats:italic>\u202f=\u202f1,111) were students from Heilongjiang Province. A survey questionnaire was distributed through online social platforms. The questionnaire collected data on sociodemographic variables, perception of infection risk (PIR), perceived benefits of preventive behavior (PBPB), perceived disorders of preventive behavior (PDPB), attitudes of preventive behavior (APB), and behavior of wearing condoms (BWC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>BWC did not differ significantly according to gender, academic qualification pursued, or subject major (<jats:italic>p<\/jats:italic>\u202f\u2265\u202f0.05), but did differ significantly based on sexual orientation, receiving HIV infection prevention education, and commercial and casual sexual behaviors. No significant correlation was detected between PIR and APB (<jats:italic>p<\/jats:italic>\u202f\u2265\u202f0.05), while PBPB and APB were significantly positively and PDPB and APB significantly negatively correlated (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05). Further, there was no significant correlation between PBPB and BWC (<jats:italic>p<\/jats:italic>\u202f\u2265\u202f0.05), while PIR and APB were positively correlated with BWC (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05), and there was a negative correlation between PDPB and BWC (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05). APB did not mediate between PDPB and BWC, but APB partially mediated between PDPB and BWC, accounting for approximately 9.96% of the total effect value, and played a fully mediating role (100%) between PBPB and BWC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our analysis indicates that PBPB acts on BWC through APB, PIR directly affects BWC, and PDPB can directly affect BWC, while also influencing BWC through APB. Future efforts to increase PBPB, PIR, and APB, reduce PDPB, and promote the use of condoms in sexual behavior among college students are warranted.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1544564","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T05:29:24Z","timestamp":1747978164000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["A cross-sectional survey about behavior of wearing condoms among college students who engage in sexual activity: the mediating role of attitudes of preventive behavior"],"prefix":"10.3389","volume":"13","author":[{"given":"Li","family":"Qi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronghuang","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Qu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaomei","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1016\/S0140-6736(18)31311-4","volume":"392","author":"Ghosn","year":"2018","journal-title":"HIV Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e0003422","DOI":"10.1128\/jvi.00034-22","article-title":"Reappraising the value of HIV-1 vaccine correlates of protection analyses","volume":"96","author":"Klasse","year":"2022","journal-title":"J Virol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"4305","DOI":"10.3390\/molecules27134305","article-title":"Microbial natural products with antiviral activities, including anti-SARS-CoV-2: a review","volume":"27","author":"Frediansyah","year":"2022","journal-title":"Molecules"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2654","DOI":"10.1097\/CM9.0000000000003383","article-title":"Society of infectious diseases; Chinese Medical Association. Chinese guidelines for diagnosis and treatment of human immunodeficiency virus infection\/acquired immunodeficiency syndrome (2024 edition)","volume":"137","year":"2024","journal-title":"Chin Med J"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1505","DOI":"10.11847\/zgggws2011-27-12-01","article-title":"China\u2019s HIV\/AIDS prevention and treatment is facing new situations and challenges","volume":"27","author":"Wu","year":"2011","journal-title":"Chin J Public Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1007\/s11904-019-00471-4","article-title":"History of the HIV epidemic in China","volume":"16","author":"Wu","year":"2019","journal-title":"Curr HIV\/AIDS Rep"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1604","DOI":"10.16835\/j.cnki.1000-9817.2015.11.004","article-title":"The situation and strategies for AIDS prevention and control in schools in our country","volume":"36","author":"Wu","year":"2015","journal-title":"Chin J Sch Health"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"131","DOI":"10.16728\/j.cnki.kxdz.2018.05.119","article-title":"Survey on condom awareness and use among post-95 higher vocational college students--taking a higher vocational college in Yiwu as an example","volume":"5","author":"Huang","year":"2018","journal-title":"Popular Sci"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1126\/science.aay0799","article-title":"HIV upsurge in China\u2019s students","volume":"364","author":"Li","year":"2019","journal-title":"Science"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"13596535211067589","DOI":"10.1177\/13596535211067589","article-title":"Advancing HIV prevention using tenofovir-based pre-exposure prophylaxis","volume":"27","author":"Abdool Karim","year":"2022","journal-title":"Antivir Ther"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1111\/hiv.12797","article-title":"Post-exposure prophylaxis for HIV infection in sexual assault victims","volume":"21","author":"Inciarte","year":"2020","journal-title":"HIV Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e492","DOI":"10.1016\/S2352-3018(23)00139-X","article-title":"Implementation of HIV prevention strategies globally","volume":"10","author":"Patel","year":"2023","journal-title":"Lancet HIV"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1016\/S0377-1237(17)30221-6","article-title":"Surgeon and HIV infection: post exposure prophylaxis: need of the hour","volume":"56","author":"Mohan Harjai","year":"2000","journal-title":"Med J Armed Forces India"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1097\/CM9.0000000000000647","article-title":"Human immunodeficiency virus prevention strategies in China","volume":"133","author":"Wu","year":"2020","journal-title":"Chin Med J"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"260","DOI":"10.3389\/fimmu.2018.00260","article-title":"Mechanisms for cell-to-cell transmission of HIV-1","volume":"9","author":"Bracq","year":"2018","journal-title":"Front Immunol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"968","DOI":"10.13419\/j.cnki.aids.2019.09.26","article-title":"The correct use of condoms by college students who engage in sexual activity and its influencing factors","volume":"25","author":"Liu","year":"2019","journal-title":"Chin J AIDS STD"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e1002729","DOI":"10.1371\/journal.pmed.1002729","article-title":"Progress in the HIV epidemic: identifying goals and measuring success","volume":"16","author":"Jones","year":"2019","journal-title":"PLoS Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2247","DOI":"10.1186\/s12889-022-14688-3","article-title":"School-based peer education interventions to improve health: a global systematic review of effectiveness","volume":"22","author":"Dodd","year":"2022","journal-title":"BMC Public Health"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e20190452","DOI":"10.1590\/0034-7167-2019-0452","article-title":"Factors associated with the knowledge and attitude of adolescents regarding male condom use","volume":"74","author":"Rodrigues","year":"2021","journal-title":"Rev Bras Enferm"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1111\/aphw.12262","article-title":"The health belief model predicts vaccination intentions against COVID-19: a survey experiment approach","volume":"13","author":"Zampetakis","year":"2021","journal-title":"Appl Psychol Health Well Being"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1177\/109019818801500203","article-title":"Social learning theory and the health belief model","volume":"15","author":"Rosenstock","year":"1988","journal-title":"Health Educ Q"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"733","DOI":"10.16168\/j.cnki.issn.1002-9982.2020.08.012","article-title":"Influence of different types of AIDS knowledge on AIDS-related health beliefs of junior college students","volume":"36","author":"Yu","year":"2020","journal-title":"Chin J Health Educat"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/0091-7435(86)90025-3","article-title":"Health promotion and the knowledge-attitude-behavior continuum","volume":"15","author":"Bettinghaus","year":"1986","journal-title":"Prev Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1065437","DOI":"10.3389\/frph.2023.1065437","article-title":"The sexual behavior of young people living with a disability: findings from the KAP study in northern Uganda","volume":"5","author":"Bukuluki","year":"2023","journal-title":"Front Reprod Health"},{"key":"ref25","first-page":"53","volume-title":"Health education","author":"Fu","year":"2017"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.3390\/ijerph16081359","article-title":"Environmental effects of the livestock industry: the relationship between knowledge, attitudes, and behavior among students in Israel","volume":"16","author":"Dopelt","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1007\/978-1-0716-1871-4_12","article-title":"Ex vivo HIV infection model of Cervico-vaginal and rectal tissue","volume":"2407","author":"Ouattara","year":"2022","journal-title":"Methods Mol Biol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1574","DOI":"10.1080\/09540121.2019.1612004","article-title":"Correlates of HIV-infection among men who have sex with men: results from a community-based, cross-sectional study in Tianjin","volume":"31","author":"Yu","year":"2019","journal-title":"China AIDS Care"},{"key":"ref29","first-page":"384","volume-title":"Medical statistics","author":"Yan","year":"2020"},{"key":"ref30","first-page":"52","volume-title":"Structural equation modelling: Operations and applications of AMOS","author":"Wu","year":"2010"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1089\/apc.2020.0148","article-title":"Assessing human immunodeficiency virus (HIV) prevention through knowledge and condom use among female sex workers at the border of Haiti and Dominican Republic","volume":"34","author":"Budhwani","year":"2020","journal-title":"AIDS Patient Care STDs"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e0210150","DOI":"10.1371\/journal.pone.0210150","article-title":"Poor quality male latex condoms found in Dominican Republic: quality assurance evaluation and public health impact","volume":"14","author":"Tremelling","year":"2019","journal-title":"PLoS One"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"S74","DOI":"10.1016\/j.ijnss.2020.07.010","article-title":"HIV\/AIDS related perception and behavior: a comparative study among college students of different majors in China","volume":"7","author":"Sun","year":"2020","journal-title":"Int J Nurs Sci"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"2325","DOI":"10.1007\/s10461-021-03194-z","article-title":"Dangerfield DT 2nd, white J. HIV prevention among cisgender men who have sex with transgender women","volume":"25","author":"Poteat","year":"2021","journal-title":"AIDS Behav"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1007\/s10461-011-9976-0","article-title":"Relationship factors associated with HIV risk among a sample of gay male couples","volume":"16","author":"Mitchell","year":"2012","journal-title":"AIDS Behav"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1379","DOI":"10.1007\/s10508-019-01564-2","article-title":"Exploring determinants of condom use among university students in Sudan","volume":"49","author":"Elshiekh","year":"2020","journal-title":"Arch Sex Behav"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"2745","DOI":"10.1590\/1413-81232017228.25892015","article-title":"Is there a relationship between students\u2019 knowledge of HIV\/AIDS ways of transmission and their responses regarding their proximity to people living with HIV\/AIDS?","volume":"22","author":"Santos","year":"2017","journal-title":"Ciencia & Saude Coletiva"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"882125","DOI":"10.3389\/fmed.2022.882125","article-title":"Understanding individual barriers to HIV testing among undergraduate university students: results from a cross-sectional study in Italy","volume":"9","author":"Licata","year":"2022","journal-title":"Front Med (Lausanne)."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1080\/07448481.2020.1757679","article-title":"Lost in translation: college students' knowledge of HIV and PrEP in relation to their sexual health behaviors","volume":"70","author":"Stutts","year":"2022","journal-title":"J Am Coll Heal"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"903596","DOI":"10.3389\/fmed.2022.903596","article-title":"How to safeguard university students against HIV transmission? Results of a cross-sectional study in southern Italy","volume":"9","author":"Licata","year":"2022","journal-title":"Front Med (Lausanne)"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"306","DOI":"10.34172\/hpp.2020.49","article-title":"Facilitators and barriers to condom use among Filipinos: a systematic review of literature","volume":"10","author":"De Torres","year":"2020","journal-title":"Health Promot Perspect"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1007\/s00038-016-0859-z","article-title":"Alcohol abuse and other factors associated with risky sexual behaviors among adolescent students from the poorest areas in Costa Rica","volume":"62","author":"Rios-Zertuche","year":"2017","journal-title":"Int J Public Health"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"e25242","DOI":"10.1002\/jia2.25242","article-title":"PrEP uptake preferences among men who have sex with men in China: results from a National Internet Survey","volume":"22","author":"Han","year":"2019","journal-title":"J Int AIDS Soc"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1177\/1557988318756132","article-title":"Perceptions of determinants of condom use behaviors among male clients of female sex workers in Indonesia: a qualitative inquiry","volume":"12","author":"Fauk","year":"2018","journal-title":"Am J Mens Health"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1080\/10410236.2017.1384435","article-title":"Anti-stigma HIV-related social advertising: no evidence for side effects on condom use","volume":"34","author":"Arendt","year":"2019","journal-title":"Health Commun"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/s13690-021-00777-z","article-title":"\"I always prefer to withdraw than use a condom\": contextualising condomless sex among east Asian and sub-Saharan African international students in Sydney","volume":"80","author":"Okeke","year":"2022","journal-title":"Arch Public Health"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"10022","DOI":"10.3390\/ijerph181910022","article-title":"Awareness, knowledge and risky behaviors of sexually transmitted diseases among young people in Greece","volume":"18","author":"Voyiatzaki","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"e0259359","DOI":"10.1371\/journal.pone.0259359","article-title":"Correction: knowledge, attitudes and practices towards people living with HIV\/AIDS in Lebanon","volume":"16","author":"Youssef","year":"2021","journal-title":"PLoS One"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"480","DOI":"10.3390\/healthcare9040480","article-title":"COVID-19-related fear, risk perception, and safety behavior in individuals with diabetes","volume":"9","author":"Musche","year":"2021","journal-title":"Healthcare (Basel)"},{"key":"ref50","first-page":"660","article-title":"Investigation on status quo of condom cognition and sexual behavior among 1897 college students in a university","volume":"36","author":"Yao","year":"2022","journal-title":"Chin J School Doctor"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"2305554","DOI":"10.1080\/25787489.2024.2305554","article-title":"HIV\/AIDS knowledge and attitudes towards HIV and condom use among internally displaced Libyan males. Is there a need to implement sex education?","volume":"25","author":"Elamouri","year":"2024","journal-title":"HIV Res Clin Pract"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"588","DOI":"10.3969\/j.issn.1006-3110.2020.05.021","article-title":"Investigation on AIDS knowledge, sexual attitudes and behaviors among freshmen of colleges and universities in Changsha","volume":"27","author":"Cheng","year":"2020","journal-title":"Pract Prev Med"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1544564\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T05:29:30Z","timestamp":1747978170000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1544564\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,23]]},"references-count":52,"alternative-id":["10.3389\/fpubh.2025.1544564"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1544564","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,23]]},"article-number":"1544564"}}