Factors associated with condom use by sexually active male adolescents at risk for sexually transmitted disease

Abstract

Objective: The purpose of this study was to identify the predictors of condom use in a population of male adolescents at risk for sexually transmitted diseases (STDs).

Design: Cross-sectional cohort study.

Setting: Clinical sites (school-based, adolescent and STD clinics) providing reproductive health care to male adolescents in a midwestern city.

Participants: One hundred sixteen male adolescents 15 to 19 years of age were enrolled consecutively.

Outcome measures: Subjects completed a multi-instrument questionnaire examining sexual behaviors, attitudes, and beliefs about STDs and condoms, cognitive maturity, and health risk behaviors; urethral specimens were cultured for Chlamydia trachomatis and Neisseria gonorrhoeae.

Results: The median age was 17; 31% were white and 69% were African-American. Thirty-seven percent had urethral infections: 21% were infected with C trachomatis, 11% with N gonorrhoeae, and 5% with both organisms. More than 60% reported some experience with condoms and 23% reported condom use at last coitus. Consistent with the Health Belief Model, condom use for STD prevention was less likely among those reporting other health risk behaviors (odds ratio [OR] = 0.53; 95% confidence interval [CI] = 0.36 to 0.78; P < .001) and more STD risk behaviors (OR = 0.65; CI = 0.45 to 0.96; P = .03). Adolescents who were more highly motivated (OR = 1.58; CI = 1.09 to 2.30; P = .02) and who were more positive about condoms (OR = 1.83; CI = 1.25 to 2.68; P < .001) were more likely to report condom use for contraception. Adolescents using condoms for acquired immunodeficiency syndrome (AIDS) protection engaged in fewer behavioral (OR = .62; CI = 0.42 to 0.92; P = .02) and STD risks (OR = .67; CI = 0.45 to 0.99; P = .04). Three specific reasons for condom use were highly predictive of condom use at last intercourse: STD prevention (OR = 8.9; CI = 3.13 to 25.4; P < .001), birth control (OR = 2.1; CI = 1.05 to 4.25; P = .03), and AIDS prevention (OR = 2.4; CI = 1.05 to 5.42; P = .03).

Conclusion: Condom use among adolescent males is influenced by perceived benefit, namely prevention of pregnancy & avoidance of STDs including AIDS. Nonuse is associated with other risk-taking behavior.