This document presents a study on college students' knowledge and attitudes toward nonconsensual condom removal, also known as "stealthing". The study used focus groups and surveys to collect qualitative and quantitative data. Key findings included that most students were unaware of stealthing, but viewed it negatively once informed. Students saw stealthing as a violation of consent and trust. The study implications call for further research on stealthing prevalence and legal implications, as well as education on comprehensive consent definitions on college campuses.

1. “You do it without their knowledge:”
Is nonconsensual condom removal
the new public health emergency?
Presented by: Marwa Mohamed, BS, MPH (c)

2. Committee
Members
 Dr. Monideepa B. Becerra, Committee Chair,
Health Science and Human Ecology
 Dr. Paulchris Okpala, Committee Member,
Health Science and Human Ecology
 Prof. Amber Olney, Committee Member,
Health Science and Human Ecology

3. Background
 Sexual consent is often defined as the voluntary agreement to
participate in a sexual act, though the differing definitions across and
within United States make legal consensus difficult (“RAINN | Rape,
Abuse and Incest National Network,” n.d.)
 Seeking consent for a sexual act is relevant to public health as it helps
ensure prevention of sexual violence, sexually transmitted infections
(STIs), unwanted pregnancy, and emotional and psychological distress
(Brodsky, 2017).
 In recent years, due to popularization through social media,
nonconsensual condom removal, termed stealthing, is becoming
common, especially among young adults (Brodsky, 2017)
 Yet, little to no empirical evidence exists on this sexual behavior.

4. PurposeofStudy
andResearch
Questions
The purpose of this study is to address college students’
knowledge and attitude toward stealthing.
Research Questions:
1a. What is the current attitude and knowledge towards stealthing
among college students?
1b. Are there gender differences in perception towards stealthing
among college students?
2a. What is the current understanding of sexual consent among
college students?
2b. Are there gender differences in understanding sexual consent
among college students?
3. Does social norm play a role in promoting stealthing?

5. Study
Design
Use of an exploratory sequential mixed methods design.
Qualitative portion explores new concepts followed by
quantitative methods.
The Institutional Review Board of the California State University,
San Bernardino has approved this study (FY2017-86).
Methods

6. DataCollection
Data collection occurred in two phases from general
education course/laboratories:
 The first phase: qualitative data
 n = 13
 3 focus groups
 2 female groups
 1 mixed group (male and female)
 Consent was obtained from participants
 The primary interviewer asked the central
questions (along with probe questions) to the
focus group participants
 All data was digitally recorded and transcribed
verbatim
 5 points extra credit given to students from their
instructors

7. DataCollection
 The second phase: quantitative data
 n = 153
 Consent was obtained from participants
 7 questions related to sexual consent was asked
 2 open ended questions
 5 Likert scale questions
 5 points extra credit given to students from their
instructors

8. Data
Analysis:
Qualitative
 The qualitative results of the study were analyzed
using grounded theory approach.
 This method is often used to uncover social processes,
including social relationships and behaviors of groups
 These transcripts were analyzed using the grounded
theory approach of three major types of coding: open
coding, axial coding, and selective coding.
 Open coding: common words/text
 Axial coding: categorized into common groups
 Selective coding: highlight the core theme

9. DataAnalysis:
Quantitative
 All quantitative analysis data were analyzed in SPSS
v. 24 (IBM, Corp.)
 Descriptive statistics were conducted to assess the
prevalence of variables of interest, including sexual
consent related knowledge, attitude, self-efficacy.
 Sex differences were further assessed using
bivariate analyses (chi-square), with alpha less
than .05 to denote significance.
 Missing value was excluded from analyses

10. Results:QualitativeAnalysis
Several emergent
themes were
identified around the
central construct of
health-decision
making
First theme was
limited knowledge of
stealthing and lack of
awareness of
stealthing.
Second theme was
consent with multiple
sub themes, followed
by the third theme of
sexual assault.
Finally, the last
emergent theme
was the perception
of social norms in
stealthing behavior

11. Limited
Knowledgeand
Awareness
 When asked whether participants heard or knew the meaning of stealthing,
participants in the focus groups universally stated that they were not aware or
knew the meaning of stealthing. However, several associated a negative
connotation to the word.
“…I have no idea, never heard of it. It sounds kind of negative in a way.”
“...I don’t really know how to describe it. It just sounds negative.”
 Once participants were explained the meaning of stealthing, knowledge
continued to be a theme, especially around the its impact on health-decision
making.
“...when you wear a condom it generally means you guys are protecting
each other from any diseases, once you take off the condom you are no
longer protected.”

12. Consent
(privacyand
trust)
 Participants felt that removal of condom without a partner’s
knowledge was going against the consent for sexual act.
 Of particular, participants consistently noted that it violated trust
between partners and the lack of communication to remove the
condom.
“...basically again they took off the condom without your consent
and then continued to do something that you did not agree to do,
the terms changed.”
“It’s a violation of their consent, they should have been told if they
wanted to take off the condom that way, they have the choice
weather they want to continue or not. It is a violation of their
trust, privacy, and it’s a health concern as well.”

13. SexualAssault
 Participants expressed that stealthing should be considered sexual
assault as once the condom is removed without their partner’s consent.
“The second the page is split and you both are on different pages
there is an issue, as soon as you step over that boundary and remove
the condom without your partner's knowledge that is considered
sexual assault.”
 Participants also expressed that if both parties agree to take off the
condom, then it would not be considered sexual assault.
 Many participants agreed that stealthing should be against the law
because of the lack of consent and harm it can cause for an individual
“I feel once either partners say no or stop, or I don’t want this
anymore the moment the condom is removed without their
knowledge that’s when it becomes sexual assault.”

14. SocialNorm
 Some participants expressed confusion because in porn, which is socially norm
for young adults, there is no way to affirm if consent was asked or not prior to
removal of the condom.
 Participants consistently stated since lack of condom is prevalent in porn, it can
encourage curiosity, especially if it is normalized in porn.
“The first time someone sees stealthing in a porn video they might think it’s
a normal thing to do and if they see it so often it can encourage them to
probably try it too.”
 Participants expressed that stealthing in the porn industry is the same
correlation of video games and kids being violent.
“…not to stray off with video games, but it can apply to stealthing in porn
as well. People see video games and say “Oh my kid is violent now”, you can
imply the same exact thing with porn, “oh you watch porn this way, and so
you’re going to have sex this way.”

15. Social
Norm/Lackof
Awareness
 Participants noted that if individuals who watch porn do not realize that
the act of stealthing is wrong, the behavior may continue and also if there
is lack of knowledge on risk factors, nothing will prevent the behavior
“If they don’t know it’s wrong then they are not going to see it as
wrong. They are going to see it as, this is something fetishized and
something that I might like so I am going to try it. But if there is
educational explanation that stealthing shouldn’t be fetishized and
the risk factors and consequences that are associated to stealthing,
they would less likely try it.”

16. Results:QuantitativeAnalysisonmeaningofstealthing
~86% participants did not
know the meaning of stealthing.
~5 % reported it means to
have sex without consent
~5% reported that it means
you are tricking, manipulating,
deceiving, or “creeping” on
someone to have sex with them
0.7% reported that it means when someone
is infected with HIV and doesn’t tell the other
person
2.1% reported to hide something in plain sight
or do something without anyone else knowing

17. Results:QuantitativeAnalysisonConsent
Confidence (strongly agree/agree) in asking for consent = 96%
Confidence (strongly agree/agree) in giving consent = 94.7%
92% reported strongly agree/agree to unwanted touching, kissing, or hugging should
be considered sexual assault
A higher prevalence was noted among females (96.3%) as compared to males (89.4%).
16.6% reported strongly disagree/disagree that removal of a condom without
approval of sexual partners should be considered sexual assault
A higher prevalence was noted among males (17.9%) compared to females
(14.5%).

18. Conclusion
 Most participants were unaware of the meaning but considered it negative
upon word association.
 Upon learning the meaning, participants viewed it to be a break of trust,
privacy, consent, and attributed social norm (such as porn) to making it
popular.
 Understanding of consent was also varied. While most reported confidence
in giving or asking for consent, what is considered consent was varied and
there were sex differences.
 A higher portion of females considered unwanted advances to be considered
sexual assault
 A higher portion of males did not believe nonconsensual condom removal
should be sexual assault

19. ImplicationsforResearch
Stealthing has limited research, it is recommended to continue
exploring the new sex trend to prevent sexual assault, reduce STIs,
and emotional and psychological distress.
Further research is needed to look at population groups of those
who have committed the act of stealthing, understanding why the act
of stealthing is committed, and when the act of stealthing is
committed. It is important to understand why stealthing occurs to
address and implement future policies.
In addition, further research among the LGBT community is
important because they are at a higher risk of HIV and limited to no
research among the LGBT community.

20. ImplicationsforPractice
Our results demonstrate that there is a need for health educators to
assess the prevalence of such a behavior among young adults and
policy makers to assess the legal implications of nonconsensual
condom removal.
This further affirms the need for a comprehensive and concrete
definition of consent, especially in college campuses.
Campus health centers need enhance attention to address the
prevalence of this behavior among their college student population
and provide resources.

21. StudentHealthCenteronCampus
• The Student Health Center is open Monday-Friday from 8-5pm.
• Counseling and Psychological Services is available Monday-Friday with
extended hours Monday through Thursday.