Condom availability in New York City public high schools: relationships to condom use and sexual behavior

Barrier Protection Use by Adolescents During Sexual Activity

Rates of sexual activity, pregnancies, and births among adolescents have continued to decline during the past decade to historic lows. Despite these positive trends, many adolescents remain at risk for unintended pregnancy and sexually transmitted infections (STIs). This technical report discusses the new data and trends in adolescent sexual behavior and barrier protection use. Since 2017, STI rates have increased and use of barrier methods, specifically external condom use, has declined among adolescents and young adults. Interventions that increase availability of or accessibility to barrier methods are most efficacious when combined with additional individual, small-group, or community-level activities that include messages about safer sex. Continued research informs public health interventions for adolescents that increase the consistent and correct use of barrier methods and promote dual protection of barrier methods for STI prevention together with other effective methods of contraception.

Condom Availability Programs in Schools: A Review of the Literature

OBJECTIVE

This review synthesizes findings from the peer-reviewed evaluation literature on condom availability programs (CAPs) in secondary schools.

DATA SOURCE

Peer-reviewed evaluation literature indexed in MEDLINE, EMBASE, PsychINFO, ERIC, CINAHL, Sociological Abstracts, SCOPUS, and POPLINE.

STUDY INCLUSION AND EXCLUSION CRITERIA

Manuscripts had to be, written in English, and report evaluation data from a US school-based CAP.

DATA EXTRACTION

Articles were coded independently by 2 authors. Discrepancies were resolved through open discussion.

DATA SYNTHESIS

We grouped findings into outcome evaluation and process evaluation findings. Outcome evaluation findings included sexually transmitted infections (STIs), pregnancy rates, condom use, contraception use, sexual risk, and substance use. Process evaluation findings included awareness of CAPs, attitudes toward CAPs, attitudes toward condoms, and receipt of education and instruction.

RESULTS

Of the 138 citations reviewed, 12 articles published between 1995 and 2012 met the inclusion criteria, representing 8 programs. Evaluations indicate CAPs yield condom acquisition rates between 23% and 48%, have mixed results related to condom use, and are not associated with increases in sexual and other risk behaviors. One program found CAPs were associated with a decrease in a combined rate of chlamydia and gonorrhea. One program found no association between CAPs and unintended pregnancy. Students' attitudes toward CAPs were favorable and awareness was high.

CONCLUSIONS

Condom availability programs are accepted by students and can be an appropriate and relevant school-based intervention for teens. Condom availability programs can increase condom use, but more evaluations are needed on CAP impact on rates of HIV, STIs, and unintended pregnancy.

A Systematic Global Review of Condom Availability Programs in High Schools

PURPOSE

High levels of HIV, sexually transmitted infections (STIs), and pregnancy among adolescents has motivated some countries to consider the implementation of condom availability programs (CAPs) in high schools. In this present study, we analyzed the impact of CAP on students' sexual behaviors and health outcomes.

METHODS

We conducted a systematic literature review of peer-reviewed articles published between 1990 and 2017.

RESULTS

Twenty-nine articles from seven countries were included in this review. We found that CAP does not increase sexual activity nor lead to a greater number of sexual partners. It also does not lower the age of sexual initiation. A majority of the studies reported an increase in condom uptake and use at last sex among students with CAP. All the studies that examined STI found a decrease of STI symptoms and rates for students with CAP compared with the control group. The data on HIV rates was inconclusive. There was no difference in pregnancy rates associated with participation in CAP programs.

CONCLUSION

This global literature review showed that the fears surrounding CAP and promiscuity are unfounded. Once CAP is in place, students utilize it, and condom use increases, which translates to improved sexual health outcomes.

Should condoms be available in secondary schools? Discourse and policy dilemma for safeguarding adolescent reproductive and sexual health in Rwanda

Introduction

As a response to challenges associated with adolescent reproductive and sexual health, policy makers in Rwanda have instituted preventive measures against risky sexual behaviours among adolescents. There is an ongoing debate on whether condoms should be made available in secondary schools to minimise risks related to unprotected sex in the context of a growing number of unintended pregnancies among school girls. This paper aims to examine the proposal of condom provision in Rwandan secondary schools through the analysis of policy narratives and the claims-making process.

Methods

A narrative policy analysis was used to understand the claims and counter claims surrounding the debate on the provision of condoms in secondary schools. Documents that were consulted include: the national reproductive health policy, the girls' education policy, the national behaviour change and communication policy for the health sector, the Rwanda national policy on condoms, the adolescent sexual reproductive health and rights policy and the Rwanda family planning policy.

Results

Social and cultural norms in the Rwandan context consider adolescent sexual practices as immoral and thus reject the idea of providing condoms in secondary schools. However, some stakeholders promoting reproductive health suggest that ignoring that some adolescents are sexually active will prevent them from accessing appropriate reproductive and sexual health protective programmes. Consequently, adolescents will be exposed to risky sexual behaviours, a situation which may be counter productive to the overarching goal of safeguarding adolescent sexual health which might impact their long-term education goals.

Conclusion

Making condoms available in secondary schools evokes different meanings among the debaters, underscoring the complex nature of the condom provision debate in Rwanda. This paper calls for a revision of policies related to adolescent reproductive and sexual health in order to answer to the issues of risky sexual behaviours among secondary school students.

MyLARC: A Theory-Based Interactive Smartphone App to Support Adolescents' Use of Long-Acting Reversible Contraception

STUDY OBJECTIVE

Develop and test the feasibility of a Health Belief Model theory-based interactive smartphone application (app) aimed at providing information and support to adolescents with long-acting reversible contraception (LARC).

DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS

Using a mixed-method design, we conducted 30 in-person interviews with adolescent LARC users who were enrolled in school-based health centers in New York City. Interviews were conducted in 2 phases: during phase 1, 12 participants viewed a pilot version of the app (MyLARC); during phase 2, 18 additional participants interacted with an expanded version of the app. Phase 2 participants downloaded MyLARC onto their smartphone and app usage was tracked.

MAIN OUTCOME MEASURES

Participants' responses to the in-person interviews and data usage of MyLARC from phase 2 determined the feasibility and acceptability of using MyLARC to support young women's satisfaction and continuation of LARC methods.

RESULTS

Noneducational games were recommended as an approach to provide information to adolescents in an engaging way, as well as educational graphics and visually appealing content. Data tracking of MyLARC usage among phase 2 participants revealed a total of 67 unique logins to the app with 18 average page visits per unique login. The total amount of times MyLARC was opened was 1197. The most frequented features were 'Info about LARC' (95 unique visits) and 'Games' (80 unique plays).

CONCLUSION

A theory-based interactive smartphone app with LARC-specific information and support is an appropriate and appealing medium to provide information and support to adolescents using LARC. Games represented a novel opportunity to engage adolescents with health information.

Child Sexual Abuse and Negative Affect as Shared Risk Factors for Sexual Aggression and Sexual HIV Risk Behavior in Heterosexual Men

Previous research has suggested that sexually aggressive behavior and sexual HIV risk behavior are associated. Childhood sexual abuse (CSA) is a well-established risk factor for both types of problematic sexual behavior. Negative affect (i.e., anxiety, depression, and anger) is a less well-studied risk factor, but it has been theorized to relate to both sexual aggression and HIV risk behavior. Thus, this study sought to (1) confirm the relationship between sexual aggression and HIV risk behavior, (2) establish CSA and negative affect as shared risk factors for sexual aggression and HIV risk behavior, and (3) evaluate whether negative affect mediates the relationship between CSA and sexual aggression and between CSA and HIV sexual risk in a sample of heterosexual men. We recruited 18- to 30-year-old heterosexual men (N = 377) from urban sexually transmitted infection clinics. Men completed measures of sexual HIV risk history (number of partners and condom use), sexual aggression history, CSA history, and trait negative affect (anger, anxiety, and depression). Structural equation modeling was used to examine hypothesized direct and indirect relationships. In the final SEM model, sexual aggression history and sexual HIV risk behavior were correlated. CSA was associated with both types of problematic sexual behavior. Anxiety significantly mediated the relationship between CSA and sexual aggression and between CSA and sexual HIV risk behavior (χ ²[1300] = 2121.79, p < .001; CFI = 0.905; RMSEA [90% CI] = .044 [.041-.047]). Sexual aggression appears to be part of a constellation of sexual risk behaviors; thus, it may be possible to develop prevention programs that target both sexual HIV risk and sexual aggression. CSA is a shared risk factor for sexual aggression and HIV risk behavior through the pathway of anxiety. Thus, anxiety might be one promising target for intervention.

The Effects of School-Based Condom Availability Programs (CAPs) on Condom Acquisition, Use and Sexual Behavior: A Systematic Review

We conducted a systematic review to assess the impact of school-based condom availability programs (CAPs) on condom acquisition, use and sexual behavior. We searched PubMed to identify English-language studies evaluating school-based CAPs that reported process (i.e. number of condoms distributed or used) and sexual behavior measures. We identified nine studies that met our inclusion criteria, with the majority conducted in the United States of America. We judged most studies to have medium risk of bias. Most studies showed that school-based CAPs increased the odds of students obtaining condoms (odds ratios (ORs) for individual studies ranged between 1.81 and 20.28), and reporting condom use (OR 1.36-3.2). Three studies showed that school-based CAPs positively influenced sexual behavior, while no studies reported increase in sexual activity. Findings suggest that school-based CAPs may be an effective strategy for improving condom coverage and promoting positive sexual behaviors.

Welfare, Liberty, and Security for All? U.S. Sex Education Policy and the 1996 Title V Section 510 of the Social Security Act

When adolescents delay (meaning they wait until after middle school) engaging in sexual intercourse, they use condoms at higher rates and have fewer sexual partners than those who have sex earlier, thus resulting in a lower risk for unintended pregnancies and sexually transmitted infections. The 1996 Section 510 of Title V of the Social Security Act (often referred to as A-H) is a policy that promotes abstinence-only-until-marriage education (AOE) within public schools. Using Stone's (2012) policy analysis framework, this article explores how A-H limits welfare, liberty, and security among adolescents due to the poor empirical outcomes of AOE policy. We recommend incorporating theory-informed comprehensive sex education in addition to theory-informed abstinence education that utilizes Fishbein and Ajzen's (2010) reasoned action model within schools in order to begin to address adolescent welfare, liberty, and security.

The Hawke's Bay Condom Card Scheme: a qualitative study of the views of service providers on increased, discreet access for youth to free condoms

OBJECTIVES

The incidence of sexually transmitted infections and unplanned pregnancies in adolescence is of concern. The Hawke's Bay District Health Board, New Zealand, set up a pilot condom card scheme ('the Scheme') to allow 13- to 24-year-olds, deemed suitable for the Scheme, to access free condoms from pharmacies on presentation of a Condom Card. Our study explored the views of service providers of a pilot Condom Card Scheme.

METHODS

Qualitative interviews were conducted with 17 service providers (nurses, pharmacists, pharmacy staff) between February and April 2013.

KEY FINDINGS

Our findings showed that the Scheme was viewed positively by service providers, who indicated almost universal support for the Scheme to continue. However, participants noted a perceived lack of advertising, low number of sites for collection of condoms, lack of flexibility of the Scheme's criteria relating to who could access the scheme and issues with some pharmacy service providers, all of which led to a number of recommendations for improving the Scheme.

CONCLUSIONS

The views of service providers indicate broad support for the continuation of the Scheme. Canvassing young people's suggestions for improving the Scheme is also essential.

Providing earplugs to young adults at risk encourages protective behaviour in music venues

For some young people, nightclubs and other music venues are a major source of noise exposure, arising from a combination of very high noise levels; relatively long attendance duration; and frequent, sustained participation over several years. Responsibility for hearing protection is largely left to individuals, many of whom choose not to wear earplugs. In order to encourage earplug use in these settings, a new approach is needed. The aim of the study was to examine whether presentation of hearing health information would result in increased use of earplugs, or whether provision of earplugs alone would be sufficient to change behaviour. A total of 51 regular patrons of music venues were allocated to either a low-information (lo-info) or high-information (hi-info) group. Both groups completed a survey about their current noise exposure, earplug usage and perceived risk of hearing damage. Both groups were also provided with one-size-fits-all filtered music earplugs. The hi-info group was also provided with audio-visual and written information about the risks of excessive noise exposure. After 4 weeks, and again after an additional 12 weeks, participants were asked about their recent earplug usage, intention to use earplugs in the future, and perceived risk of hearing damage. The results showed that after 4 weeks, the hi-info group's perceived personal risk of hearing damage was significantly higher than that of the lo-info group. After 16 weeks, these differences were no longer evident; however, at both 4 and 16 weeks, both the lo- and hi-info groups were using the earplugs equally often; and both groups intended to use earplugs significantly more often in the future. This suggests that the information was unnecessary to motivate behavioural change. Rather, the simple act of providing access to earplugs appears to have effectively encouraged young at-risk adults to increase their earplug use.

Evaluating Programs That Address Ideological Issues

There are important practical and ethical considerations for organizations in conducting their own, or commissioning external, evaluations and for both practitioners and evaluators, when assessing programs built on strongly held ideological or philosophical approaches. Assessing whether programs “work” has strong political, financial, and/or moral implications, particularly when expending public dollars, and may challenge objectivity about a particular program or approach. Using a case study of the evaluation of a school-based abstinence-until-marriage program, this article discusses the challenges, lessons learned, and ethical responsibilities regarding decisions about evaluation, specifically associated with ideologically driven programs. Organizations should consider various stakeholders and views associated with their program to help identify potential pitfalls in evaluation. Once identified, the program or agency needs to carefully consider its answers to two key questions: Do they want the answer and are they willing to modify the program? Having decided to evaluate, the choice of evaluator is critical to assuring that ethical principles are maintained and potential skepticism or criticism of findings can be addressed appropriately. The relationship between program and evaluator, including agreements about ownership and eventual publication and/or promotion of data, should be addressed at the outset. Programs and organizations should consider, at the outset, their ethical responsibility when findings are not expected or desired. Ultimately, agencies, organizations, and programs have an ethical responsibility to use their data to provide health promotion programs, whether ideologically founded or not, that appropriately and effectively address the problems they seek to solve.

Factors Associated With Parent Support for Condom Education and Availability

Expanding condom-related knowledge and skills and reducing barriers to condom use have the potential to help reduce pregnancies and sexually transmitted infections among youth. These goals are sometimes addressed through condom education and availability (CEA) programs as part of sexuality education in school. Parents are a key constituency in efforts to implement such programs. A representative statewide sample of households with children ( N = 1,093) in California was employed to examine parent support for CEA and the potential influences of demographics (gender, age, and Hispanic ethnicity), sociodemographics (education, religious affiliation, religious service attendance, and political ideology), and condom-related beliefs (belief in condom effectiveness and belief that teens who use condoms during sex are being responsible) on parent support for CEA. The parents in our sample reported a high level of support for CEA ( M = 3.23 on a 4-point scale) and believing in a high level of condom effectiveness ( M = 3.36 on a 4-point scale). In addition, 84% of the parents agreed that teens who use condoms during sex are being responsible. Hierarchical regression analyses showed that parents who were younger, Hispanic, with a lower educational attainment, without a religious affiliation, less religiously observant, and politically liberal were more supportive of CEA. After controlling for these demographic and sociodemographic factors, condom effectiveness and responsibility beliefs each added independently to the predictability of parent support for CEA. These findings suggest that parent education related to condom effectiveness could help increase support for school-based CEA programs.

Sexual health resources at Minnesota colleges: associations with students' sexual health behaviors

CONTEXT

Sexual risk behaviors are common among college students, and research examining the environmental context of these behaviors is important for prevention. The presence of college sexual health resources is a potentially important part of that context.

METHODS

In a 2010-2011 survey, 6,318 undergraduates from 28 two- and four-year Minnesota college campuses provided data on their sexual health behaviors. In addition, a specially designed inventory was used to assess the sexual health resources available on each campus. Multilevel regression was used to test the associations of four types of resources with students' condom use, birth control use, STD or HIV testing, and unplanned pregnancy.

RESULTS

In models that controlled for students' personal and demographic characteristics, the higher the level of sexual health resources at a college, the lower the likelihood that students had had intercourse without birth control, intercourse without a condom and involvement in unplanned pregnancy. For example, students attending colleges with the maximum number of general clinic resources had a lower predicted probability of reporting nonuse of reliable birth control at last intercourse than students attending colleges with no resources (7% vs. 14%). After college characteristics were adjusted for, most measures of resources remained significant, although associations were reduced; two measures became significant in unexpected directions.

CONCLUSIONS

Colleges' provision of sexual health resources may be associated with students' sexual health behaviors. Research using quasi-experimental or experimental designs is needed to assess the mechanisms underlying these associations; such work could lead to interventions that might help reduce students' risky behaviors.

A randomized effectiveness trial of a sex education program for minority youth in Miami, Florida

Through this study the authors assessed the outcomes of a randomized effectiveness trial of Project U-Turn, a comprehensive sex education program for at-risk youth in Miami, Florida. Data collection occurred at pretest, three month, and six month follow-ups with a sample of teenagers randomly selected and assigned to treatment (n = 549) and control (n = 424) groups. Results from logistical and generalized multilevel modeling indicated the program did not contribute to teen responses at three or six month follow-ups. Other variables, however, had some influence on predicting teen responses to questions about their current and future sexual activity. Gender, use of alcohol, and participation in religious services predicted responses from teens at pretest and at three and six month follow-ups. Discussion of the findings, as well as implications for evidence-based social work with teens conclude the article.

Condom use among sexually active rural high school adolescents personal, environmental, and behavioral predictors

Adolescents who engage in unprotected intercourse are at risk of pregnancy and sexually transmitted infection (STI). Although adolescents in rural areas participate in levels of sexual risk taking similar to that of nonrural youth, few data are available identifying factors that influence condom use among rural adolescents. The purpose of this study is to determine the predictive value of selected personal, environmental, and behavioral factors for condom use among rural adolescents in grades 9-12. A cross-sectional survey was conducted among sexually active youth (N = 613), ages 14-19, in three rural school districts in the Northeast. Using logistic regression, identified predictors for condom use include personal standards (odds ratio [OR] = 2.45; confidence interval [CI]: [2.39, 6.47]), condom use goals (OR = 1.32; CI [1.21, 1.45]), condom use at first intercourse (OR = 3.93; CI [2.39, 6.47]) and male gender. School nurses are encouraged to incorporate identified predictors of condom use when considering interventions promoting safer sexual behaviors among rural youth.

Same-Sex Sexual Behaviors Among Male Migrants in a Context of Male “Marriage Squeeze”

The male marriage squeeze in China may increase the prevalence of male same-sex sexual behaviors among unmarried male migrants who lack stable female sexual partners. The same-sex sexual behaviors among unmarried male migrants appear to be at high risk of transmission of human immunodeficiency virus (HIV) and sexually transmitted infections (STIs), mainly because of a lack of knowledge of these diseases. Using data from the “Survey on Reproductive Health and Family Life of Migrant Male Bachelors in Urban Areas” conducted in Xi’an City, Shaanxi Province, in December 2009 and January 2010, this study compares same-sex sexual behaviors of unmarried with that of married male migrants (including married but separated men who are migrating without their spouse or partner and cohabitating men who are migrating with their spouse or partner). It is reported that the prevalence of same-sex sexual behaviors among unmarried males reaches 11%, more than twice the 5.1% reported by married but separated men and thrice the 3.8% reported by cohabitating men. It also appears that the same-sex sexual behaviors is significantly associated with men’s attitudes toward same-sex sexual behaviors (odds ratio = 1.59, p < .001), toward life-long bachelorhood (odds ratio = 1.35, p < .01), and with marital status (odds ratio = 0.37, p < .01). The frequency of condom use appears to be higher among unmarried men than among men who are married, whether or not they migrated with their wives, and is significantly associated with scores on knowledge about HIV/AIDS (estimated coefficient = .12, p < .001) and STIs (estimated coefficient = .22, p < .01). It is also associated with the likelihood of same-sex sexual behaviors (estimated coefficients = .83, p < .01) and marital status (estimated coefficients for married but separated = −.50, p < .05; estimated coefficients for cohabitating = −.77, p < .001).

Children, adolescents, and the media: health effects

The media can be a powerful teacher of children and adolescents and have a profound impact on their health. The media are not the leading cause of any major health problem in the United States, but they do contribute to a variety of pediatric and adolescent health problems. Given that children and teens spend >7 hours a day with media, one would think that adult society would recognize its impact on young people's attitudes and behaviors. Too little has been done to protect children and adolescents from harmful media effects and to maximize the powerfully prosocial aspects of modern media.

Condom availability program in an inner city public school: effect on the rates of gonorrhea and chlamydia infection

PURPOSE

Sexual activity and sexually transmitted infection (STI) rates are high in adolescents. In this study, we sought to determine whether the initiation of a school-based condom availability program was associated with a decrease in STI rates.

METHODS

We compared the rates of STIs in 15-19-yr-olds reported to the Massachusetts Department of Public Health for the 3 years before and after a condom availability program was introduced in Holyoke, MA, as compared with a similar city, Springfield, MA, which did not have such a program.

RESULTS

Holyoke males, aged 15-19 years, showed a 47% decrease in the rates of gonorrhea and chlamydia infection combined over the 3 years after the implementation of the condom availability program, whereas similar aged males in Springfield had a 23% increase in the rates of gonorrhea and chlamydia infection. The difference in regression slopes in this period was significant (p < .01). Females, aged 15-19 years, from either Holyoke or Springfield, showed moderate, variable changes in rates of STIs after 2005; there was no significant difference in the regression slopes of STIs between Holyoke and Springfield.

CONCLUSIONS

Initiating a condom availability program in a city's high school was associated with a decrease in STI rates for 15-19-yr-old males but not females.

Barrier contraception among adolescents and young adults in a tertiary institution in Southwestern Nigeria: a cross-sectional descriptive study

Nigeria, like most African nations, is basically conservative, but the young people are becoming more sexually liberated, and the incidence of STD/HIV, unwanted pregnancies and abortions among these young people is on the increase. The use of barrier contraception (BC), which is a cost-effective method of preventing STD/HIV, unwanted pregnancies and its attending complications, has therefore become an important issue in reproductive health. This descriptive cross-sectional study was carried out among first year students of Osun State University, Nigeria. Four hundred respondents were studied using pre-tested semi-structured questionnaires. The respondents were selected by balloting. Most respondents (93%) had heard about the male condom as a method of barrier contraception. Most respondents (79.1%) supported the use of barrier contraceptives, but many (62.5%) thought it would promote sexual promiscuity, 33.4% believed that the use of barrier contraception reflected a lack of trust from the partner, and 38.7% felt barrier contraception is not necessary with a stable partner. One hundred and sixty one (40.5%) had used a form of barrier contraception before, but only 130 (32.7%) are currently using BC. The male condom was the most commonly used method (88.2%), followed by female condom and diaphragm (5.6% respectively). The prevention of STI and unwanted pregnancies were the main reasons (59%) given by respondents for using BC, while religion was the main reason given by non-users. The attitudes of these students toward barrier contraception and their practice were poor. The role of sex education at homes and religious gatherings cannot be over-emphasized.

American Academy of Pediatrics. Policy statement--sexuality, contraception, and the media

From a health viewpoint, early sexual activity among US adolescents is a potential problem because of the risk of pregnancy and sexually transmitted infections. New evidence points to the media adolescents use frequently (television, music, movies, magazines, and the Internet) as important factors in the initiation of sexual intercourse. There is a major disconnect between what mainstream media portray-casual sex and sexuality with no consequences-and what children and teenagers need-straightforward information about human sexuality and the need for contraception when having sex. Television, film, music, and the Internet are all becoming increasingly sexually explicit, yet information on abstinence, sexual responsibility, and birth control remains rare. It is unwise to promote "abstinence-only" sex education when it has been shown to be ineffective and when the media have become such an important source of information about "nonabstinence." Recommendations are presented to help pediatricians address this important issue.

Letting students be innovative! Using mini-grants to fund student-designed HIV/AIDS education

This article describes a project designed to use student leaders to increase the awareness of HIV/AIDS among college students. Student organizations apply for a competitive mini-grant that is used to increase their members' knowledge level about HIV/AIDS and increase the likelihood of individuals' practicing behaviors that would reduce the risk of transmission or contraction. Four student organizations receive funds to design a unique HIV/ AIDS prevention intervention that match its members' needs for a total of 126 individuals receiving HIV/AIDS education. An evaluation indicates positive behavioral intentions related to sexual communication and safer sex practices. Moreover, the majority of participants report the education received as relevant and applicable. The methods, intervention applications, and benefits to using an award competition to deliver HIV prevention education to college students in a nontraditional and innovative approach are detailed within this article.

Condom provision and education in Minnesota public schools: a telephone survey of parents

BACKGROUND

Increasing correct and consistent condom use among sexually active adolescents continues to be a critical public health goal, with schools serving as key agents for achieving this goal through sexuality education and condom use provision. This research aims to describe the views of parents regarding school-based condom distribution and education programs, and examines how these views differ across demographic groups.

METHODS

Parents of school-age children in Minnesota were surveyed in telephone interviews (N = 1605; 63% participation) regarding their beliefs about condom availability and education. Chi-square tests of significance were used to detect differences in agreement with each statement for 10 demographic and personal characteristics.

RESULTS

A majority of respondents held supportive views about condom availability and education programs. Strongest support centered on statements in the survey about teenagers needing information about condoms (86%) and showing actual condoms during classroom lessons (77%). Approximately two thirds of the parents agreed that school-based instruction about condoms should be "allowed" at the high school level (65%), and one fifth (21%) believed that this type of education should be "required." Support for condom availability and education programs differed significantly according to certain personal characteristics, with less supportive views from self-identified Born Again Christians and politically conservative parents.

CONCLUSIONS

Public discourse regarding school-based sexuality education should include the viewpoints of parents of school-aged children as key stakeholders. Parents' perspectives provide unique and critical insights that school administrators and educators should consider as they develop educational and programmatic offerings regarding condoms.

HIV testing practices and attitudes on prevention efforts in six diverse Chicago communities

Data describing local level HIV testing practices and attitudes regarding HIV prevention are rarely available, yet would be useful for HIV policy and evaluation. A comprehensive health survey was conducted in six community areas of Chicago (n = 1,699) in 2002-2003. The HIV prevention module of this survey was used for this analysis. The proportion that ever tested for HIV ranged from 40 to 75% and 11 to 38% were tested in the past 12 months. Residents favored: needle exchange programs (59-77%), HIV information in high schools (95-100%) and elementary schools (85-94%), and condom distribution in high schools (74-93%). Attitudes were less favorable regarding pharmacies selling clean needles (37-58%) and condom distribution in elementary schools (22-66%). Adults in these areas are over three times more likely to have been tested recently than adults nationally. Residents strongly favor community based HIV prevention initiatives such as needle exchange programs, condom distribution in high schools, and HIV prevention taught in schools. These evidence-based observations may be valuable in planning HIV prevention programs and in shaping policy.

Eroticizing creates safer sex: a research synthesis

This meta-analytic review examined the effectiveness of sexual risk reduction interventions in 21 studies (N=5,015) that integrated a safer sex eroticization component. Compared to controls, intervention participants exhibited lower sexual risk on 6 dimensions: HIV-related knowledge, attitudes toward condoms, condom use, overall behavioral risk, communication with sexual partners, and sexual frequency. Additional analyses examined pre- to post-test outcomes and showed significant improvement in condom use in the intervention compared to the control groups. Overall, findings suggest that eroticizing safer sex leads to more risk-preventive attitudes, which in turn facilitates less risky sexual behavior.

Children, adolescents, and advertising

Advertising is a pervasive influence on children and adolescents. Young people view more than 40,000 ads per year on television alone and increasingly are being exposed to advertising on the Internet, in magazines, and in schools. This exposure may contribute significantly to childhood and adolescent obesity, poor nutrition, and cigarette and alcohol use. Media education has been shown to be effective in mitigating some of the negative effects of advertising on children and adolescents.

Feasibility and use of school-based condom availability programs in Tijuana, Mexico

Condom availability programs (CAPs) may increase access to condoms and contribute to increased condom use among youth. This study describes the characteristics, degree of satisfaction, and gender differences among users of a CAP implemented in two high schools in Tijuana (Baja California, Mexico). A kiosk distributing free male condoms was set up in two high schools in Tijuana. Kiosk users (N=570) were more likely to be male, young, and/or enrolled in a lower SES school. Most kiosk users were either sexually active or planning to have sex. Females were less likely to request condoms and to continue using the kiosk, but more likely to request information on other contraceptive methods. Results demonstrate the feasibility of implementing CAPs in Mexican schools and suggest that these programs can improve adolescents' condom access.

Prevention and control of sexually transmitted infections among adolescents: the importance of a socio-ecological perspective--a commentary

The sexually transmitted infection (STI) epidemic among adolescents in the USA is inextricably tied to individual, psychosocial and cultural phenomena. Reconceptualizing the epidemic within an expanded socio-ecological framework may provide an opportunity to better confront its challenges. In this article, we use a socio-ecological framework to identify determinants of adolescents' sexual risk and protective behaviours as well as antecedents of their STI acquisition. The goal is to provide a synthesis of several discrete categories of research. Subsequently, we propose an integrated strategy that addresses the STI epidemic among adolescents by promoting a socio-ecological perspective in both basic research and intervention design. This approach may expand the knowledge base and facilitate the development of a broader array of intervention strategies, such as community-level interventions, policy initiatives, institutionally based programmes, and macro-level societal changes. Although there are inherent challenges associated with such an approach, the end result may have reciprocal and reinforcing effects designed to enhance the adoption and maintenance of STI-preventive practices among adolescents, and further reduce the rate of STIs.

Parent-child communication: a model for Hispanics on HIV prevention

The prevalence of Acquired Immunodeficiency Syndrome has become a global epidemic that has affected many different racial and ethnic groups. One group that has lacked attention is the Hispanic population, due to its distinctive cultural characteristics. Many of the Human Immunodeficiency Virus (HIV) infections in Hispanics occur in adolescents. A protective factor for preventing HIV infections in adolescents is parent-child communication about sexual intercourse; however discussions about sexuality are uncommon in Hispanic families. When promoting parent-child communication among Hispanics regarding sex, it is essential to include cultural characteristics and the use of a model for empowering both parents and adolescents. The cultural characteristics examined in this article are allocentrism, familialism, personal space, time orientation, power distance, gender roles, and fatalism. A partnership model for empowering parents and adolescents, and 5 steps of the partnership process are discussed.

Risky Business: What Primary Care Practitioners Need to Know About the Influence of the Media on Adolescents

Media can be powerfully prosocial, educational, and entertaining. Negative effects do exist, however, and they have been well documented. Despite the power of the new multinational media conglomerates and the intransigence of the entertainment industry,practitioners can make a difference in the future.

Do sexual health services encourage teenagers to use condoms? A longitudinal study

OBJECTIVE

Sexual health services have the potential to encourage teenagers' condom use through both the free supply of condoms and counselling. This study investigated whether 15/16-year-olds who attended sexual health services used condoms more and had different beliefs about condoms compared to those who did not use these services.

METHODS

First, a cross-sectional multivariate model investigated the association between service visits and condom consistency (a ratio of the number of times a condom was used to the number of times a teenager had sexual intercourse in the past year) in teenagers at age 15/16 years (n = 1013). Second, a longitudinal multivariate model examined links between service use and changes in condom-related cognitions measured at age 13/14 and age 15/16 years (n = 3432).

RESULTS

Visiting a service for free condoms was linked with greater condom consistency, after controlling for attitudes towards condoms, condom purchase and other factors. Visiting a service for other purposes was associated with lower consistency. Obtaining free condoms from services predicted greater condom self-efficacy and personal responsibility, and lower negative feelings relating to sexual pleasure when condoms were used. However, visiting a service for other purposes predicted less positive attitudes towards dual protection.

CONCLUSIONS

Obtaining free condoms from services was associated with greater condom use and positive changes in attitudes towards condoms, although the role of service counselling remains unclear. Services could do more to stress the need for continued dual protection against sexually transmitted infections (STIs) when prescribing the pill.

Developmentally appropriate sexual risk reduction interventions for adolescents: rationale, review of interventions, and recommendations for research and practice

BACKGROUND

Despite awareness of the need to design developmentally appropriate sexual risk reduction interventions for adolescents, limited information exists to identify the aspects of intervention design or content that make an intervention developmentally appropriate.

PURPOSE

(a) To clarify the rationale for designing developmentally appropriate interventions, (b) to review randomized controlled trials (RCTs) of adolescent sexual risk reduction interventions, (c) to identify developmentally appropriate strategies, (d) to examine the relationship between developmental appropriateness and sexual risk outcomes, and (e) to provide recommendations for research.

METHODS

The authors examined studies (n = 24) published before 2003 that evaluated a risk reduction intervention, sampled adolescents, used an RCT study design, and evaluated sexual behavior outcomes.

RESULTS

Content analysis indicated that the interventions tested were often tailored to the cognitive level of adolescents, as indicated by the use of exercises on decision making, goal setting and planning, and concrete explanation of abstract concepts. Interventions also addressed the social influences of risky sex such as peer norms and provided communication skills training. Overall, the interventions tested in RCTs were more effective in delaying the onset of sexual activity than in promoting abstinence among sexually active youth. Interventions with booster sessions were effective in reducing sexual risk behavior. The use of process measures, linked with developmental constructs, was rare. However, improvements in sexual communication skills and perceived norms for safer sex were associated with reductions in sexual risk outcomes.

CONCLUSIONS

Developmental transitions during adolescence influence sexual behavior and should be considered when developing and evaluating risk reduction interventions for youth. Future research should assess process measures of key developmental constructs as well as risk behavior and biological outcomes.

Evaluation of two school-based HIV prevention interventions in the border city of Tijuana, Mexico

This research project examined the individual and combined effectiveness of an HIV prevention workshop and a free condom distribution program in four high schools in Tijuana, Mexico. Adolescents (N = 320) completed baseline measures on sexual practices and theoretical correlates and participated in a two-part study. In Study 1, students were randomly assigned to an HIV prevention workshop or a control condition, with a 3-month follow-up assessment. Results indicate three significant workshop benefits regarding HIV transmission by altering sexual initiation, access to condoms, and traditional beliefs regarding condoms. In Study 2, we set up a condom distribution program at two of the participating schools, and students completed a 6-month follow-up assessment. Results indicate that exposure to the workshop followed by access to the condom distribution program yielded two beneficial results for reducing HIV transmission: moderating sexual initiation and increasing condom acquisition. Access to the condom distribution program alone had no effects on behavioral and psychosocial correlates of HIV transmission. We discuss implications of these results.

School-based condom availability programs

The repercussions of sexual activity among teens continue to be a significant issue in the United States. Detrimental consequences to unprotected sexual activity among teens include unintended pregnancy and acquiring a sexually transmitted disease (STD) or human immunodeficiency virus (HIV). It is estimated that each year approximately 3 million teens acquire an STD and 860,000 become pregnant. A variety of programs have been implemented in school systems in an attempt to reduce the STDs, HIV, and pregnancy among teens. One program is the distribution of condoms in the school. There are many factors that the school nurse must consider in the development of a school-based condom disbursement program. This article addresses school-based condom availability programs as well as issues for the school nurse to consider when implementing such a program.

Condom availability programs in Massachusetts high schools: relationships with condom use and sexual behavior

OBJECTIVES

This study assessed relationships between condom availability programs accompanied by community discussion and involvement and adolescent sexual practices.

METHODS

Sexual practice and condom use differences were assessed in a representative sample of 4166 adolescents enrolled in high schools with and without condom availability programs.

RESULTS

Adolescents in schools where condoms were available were more likely to receive condom use instruction and less likely to report lifetime or recent sexual intercourse. Sexually active adolescents in those schools were twice as likely to use condoms, but less likely to use other contraceptive methods, during their most recent sexual encounter.

CONCLUSIONS

The strategy of making condoms available, an indication of socioenvironmental support for condom use, may improve HIV prevention practices.

The impact of government policies and neighborhood characteristics on teenage sexual activity and contraceptive use

OBJECTIVES

This study sought to examine the effects of government policies and neighborhood characteristics on adolescent female sexual behavior to better inform future public policy decisions.

METHODS

Using a bivariate probit model and National Survey of Family Growth data on women aged 15 through 19 years, we estimated the probabilities of their being sexually active and, if sexually active, of their using contraceptives.

RESULTS

Variables measuring the cost of obtaining an abortion are not good predictors of sexual activity or contraceptive use. However, the relationship between family planning availability and contraceptive use is statistically significant at conventional levels.

CONCLUSIONS

Policymakers seem to have little leverage with regard to influencing the decision to become sexually active, although increased access to family planning services may encourage responsible contraceptive behavior. Neighborhood context is an important determinant of adolescent female sexual behavior.

Condom use errors and problems among college men

BACKGROUND

An essential yet understudied aspect of condom use is whether they are used correctly.

GOAL

The goal of the study was to comprehensively evaluate condom use errors and problems reported by heterosexual college men (N = 158).

STUDY DESIGN

A cross-sectional survey, involving a 3-month recall period, was conducted.

RESULTS

Of the 158 participants, 60% did not discuss condom use with their partner before sex; 42% reported they wanted to use condoms but did not have any available; 43% put condoms on after starting sex; 15% removed condoms before ending sex; 40% did not leave space at the tip; 30% placed the condom upside down on the penis and had to flip it over; and 32% reported losing erections in association with condom use. Nearly one-third reported breakage or slippage during sex. Few participants reported errors related to lubrication, storage, and reusing condoms. Higher error scores were associated with breakage/slippage rather than with consistency of condom use.

CONCLUSION

Condom use errors were common, and error scores were associated with breakage and slippage. Increasing the focus on correcting potential user failures may be an important public health strategy.

Clinic-based service programs for increasing responsible sexual behavior

Three general classes of clinic-based programs to increase responsible sexual behavior are considered: (a) clinic-based educational/counseling programs, (b) school clinic-based condom distribution programs, and (c) clinic-based STD/HIV screening programs. Consistent condom use may double in response to clinic-based counseling. However, consistent use seldom exceeds 50% of coital exposures. Extensive and personalized counseling interventions reduce incident sexually transmitted infections by 5% to 10%. Increases in responsible sexual behavior following school-based condom distribution programs is reported in some but not in all studies. Screening programs for sexually transmitted infections are associated with decreases in rates of some infections. STD/HIV screening should be considered an important aspect of healthy sexuality and an adjunct to other counseling efforts.

The impact of schools and school programs upon adolescent sexual behavior

Because most youth are enrolled in school for many years before they initiate sex and when they initiate sex, schools have the potential for reducing adolescent sexual risk-taking. This paper reviews studies which examine the impact upon sexual risk-taking of school involvement, school characteristics, specific programs in school that do not address sexual behavior, and specific programs that do address sexual risk-taking. Multiple studies support several conclusions. First, involvement in and attachment to school and plans to attend higher education are all related to less sexual risk-taking and lower pregnancy rates. Second, students in schools with manifestations of poverty and disorganization are more likely to become pregnant. Third, some school programs specifically designed to increase attachment to school or reduce school dropout effectively delayed sex or reduced pregnancy rate, even when they did not address sexuality. Fourth, sex and HIV education programs do not increase sexual behavior, and some programs decrease sexual activity and increase condom or contraceptive use. Fifth, school-based clinics and school condom-availability programs do not increase sexual activity, and either may or may not increase condom or contraceptive use. Other studies reveal that there is very broad support for comprehensive sex- and HIV-education programs, and accordingly, most youth receive some amount of sex or HIV education. However, important topics are not covered in many schools.

A qualitative assessment of condom use decisions by female adolescents who use hormonal contraception

Young women who use hormonal contraception are at increased risk of HIV. This study, based on the Health Belief Model, was designed to understand how adolescent women who use hormonal contraceptives make decisions about condom use. Thirty-nine young, minority women participated in open-ended interviews. The interviews were transcribed and analyzed by both authors separately. The results suggest that barriers to condom use include use of a hormonal method of contraception, perceived trust in a partner, and a perception of the condom as "irritating." Facilitators for condom use included not being with a steady partner and fear of pregnancy and infection. The young women also suggested that being able to talk to their parents about condom use, having condoms widely available, and seeing HIV-prevention messages in many venues would increase their use of condoms. They noted that seeing young, HIV-positive women demographically similar to themselves would also prompt them to use condoms. Nurses should incorporate these factors into HIV-prevention interventions for adolescents.

Where do adolescents get their condoms?

PURPOSE

To determine where adolescents obtain their condoms; the availability and accessibility of condoms; condom availability in relationship to different sexually transmitted disease (STD) rates; and the availability of safer sex information in places where condoms are sold.

METHODS

We conducted a random digit-dialed telephone survey of 259 14-19-year-old adolescents in Monroe County, New York. Self-reported health services use, knowledge and use of confidential services, and where adolescents obtained or intended to obtain condoms were assessed. Research assistants visited all retail establishments in five areas of similar population size with gonorrhea rates from 887 to 12,427 per 100,000 adolescents to assess how available and accessible condoms were in each store. Perceived access and actual condom availability and accessibility were compared using Chi-square and Student's t-tests.

RESULTS

Trained interviewers dialed 11,800 numbers in 1993, identifying 4449 (40%) households among 11,065 numbers reached successfully. Of these, 393 (8.8%) had eligible adolescents and 259 (66%) completed interviews. Most adolescents reported obtaining, or planning to obtain, condoms in stores rather than from free health care settings. Adolescents who have used condoms more often reported having obtained them without cost than having purchased them. Condoms were available at 101 (83%) of 122 stores identified. All drug stores and 75% of supermarkets sold condoms and displayed them openly. Most small grocery stores also sold condoms (92%), but were less likely to openly display them. No stores displayed or provided safer sex information. Areas with higher STD rates had more stores (p <.01), and more stores that sold condoms (p <.01). There was no difference in condom cost by area.

CONCLUSIONS

Many adolescents obtain their condoms in retail stores. Condom accessibility varied by store type and area STD rate. Increasing condom visibility in private grocery stores may increase the accessibility of condoms to adolescents in areas with highest STD rates.

Condom use by adolescents

The use of condoms as part of the prevention of unintended pregnancies and sexually transmitted diseases (STDs) in adolescents is evaluated in this policy statement. Sexual activity and pregnancies decreased slightly among adolescents in the 1990s, reversing trends that were present in the 1970s and 1980s, while condom use among adolescents increased significantly. These trends likely reflect initial success of primary and secondary prevention messages aimed at adolescents. Rates of acquisition of STDs and human immunodeficiency virus (HIV) among adolescents remain unacceptably high, highlighting the need for continued prevention efforts and reflecting the fact that improved condom use can decrease, but never eliminate, the risk of acquisition of STDs and HIV as well as unintended pregnancies. While many condom education and availability programs have been shown to have modest effects on condom use, there is no evidence that these programs contribute to increased sexual activity among adolescents. These trends highlight the progress that has been made and the large amount that still needs to be accomplished.