The validity of self-reported condom use among adolescents

Abstract

Background: Research and public health interventions designed to reduce the risk of sexually transmitted diseases (STDs) often are based on self-reported condom use. Yet, validation of self-reported condom use, in particular with adolescents, has rarely been described in the literature.

Methods: Baseline data were obtained from 540 adolescents, 13-21 years of age, enrolled in a 1-year longitudinal study of health beliefs, sexual behaviors, and STD acquisition. Of the 445 participants reporting to be sexually active, 404 (90.8%) agreed to a complete physical examination, including a genital examination, with STD screening after completing the self-administered written questionnaire. Participants' written self-report of condom use was compared to histories obtained by clinicians and laboratory diagnosis of acute STDs to assess validity of written self-report.

Results: Complete data were available for 321 females and 77 males of whom 52 females and 5 males had laboratory evidence of 63 infections. Although three individuals who had STDs reported to be consistent users of condoms, a significant association (P < 0.05) was found between those who reported more frequent condom use with the last two partners and the absence of STDs.

Conclusion: In this group of adolescents, self-report of condom use with the last two partners was associated with the absence of an acute STD. This finding suggests that self-reported condom use is a valid indicator of risk for STDs, with implication for those working with adolescents clinically and in research contexts.

PIP: Although most research on sexually transmitted disease (STD) risk behavior surveillance and prevention is based on self-reports of condom use, there have been few attempts to assess the extent to which self-reports accurately reflect true behavior. To validate this methodology, baseline data were obtained from 540 US male and female adolescents 13-21 years of age enrolled in a 1-year longitudinal study of sexual behaviors and STDs. Of the 445 participants who reported they were sexually active, 398 underwent genital examination and STD screening. 52 females and 5 males had laboratory evidence of acute STDs. 15.2% of females and 32.3% of males reported consistent condom use with their most recent sexual partner. Although 3 young people with STDs had reported they were consistent condom users, a significant (p 0.05) inverse association was found between consistency of reported condom use with the last 2 sexual partners and the occurrence of an acute STD. This finding suggests that, even among adolescents, self-reported condom use is a valid indicator of STD risk.