Predictors of reported condom use in central Harlem youth as conceptualized by the health belief model

Abstract

Purpose: To examine the relationship of reported condom use to specific sociodemographics, psychosocial variables, and perceptions of and motivations for condom use as conceptualized by the Health Belief Model.

Methods: This study performed a cross-sectional survey of 557 adolescents enrolled in a hospital-based pregnancy prevention program in an urban community hospital (Harlem Hospital). Multiple logistic regression analysis examined the combined relationship of the significant psychosocial variables to consistent condom use.

Results: Males were less likely than females to report teen-parent conflict and depression and more likely to report support for birth control, participation in community activities, and favorable attitudes toward delaying parenthood. Consistent with the Health Belief Model adjusting for age, the strongest predictors of consistent condom use were partner preference for condoms, perceived benefit of avoidance of pregnancy, male gender, and support for birth control (usually by a parent).

Conclusions: The data on this urban, predominantly African-American sample of adolescents suggest the importance of the influences on specific motivations to use protection--that is, the wish to avoid pregnancy, human immunodeficiency virus/acquired immunodeficiency syndrome, and sexually transmitted diseases, although the mechanisms are still unclear. In addition, gender and the modifying effects of parental and partner support of the use of protection strongly influence the reported use of condoms by adolescents. These factors (in addition to psychosocial factors such as depression) may be important in planning interventions to increase condom use by sexually active teens.

PIP: The relationship of condom use to the sociodemographic, psychosocial, and cognitive factors included in the Health Belief Model was investigated in a cross-sectional study of 557 primarily low-income, African-American youth 12-19 years of age (mean age, 15.9 years) enrolled in a pregnancy prevention program at Harlem Hospital, New York City, during 1991-93. 74% reported ever having sex, 51% in the preceding 3 months. At last intercourse, 47% used no protection, 43% reported condom use, and 10% used another method. Males were more than 4 times as likely to report condom use than females. Males had more assets, more positive attitudes toward delaying parenthood, less teen-parent conflict, less depression, and more social support for birth control than females. Consistent with the Health Belief Model, the strongest predictors of consistent condom use (after adjustment for age) were partner preference for condoms, perceived benefit of avoidance of pregnancy, male gender, and social (mostly parental) support for birth control. These factors should be considered in the planning of interventions to increase condom use among sexually active teenagers.