Attitudes, Knowledge, and Behavior regarding Condom Use in Urban Black Adolescent Males

Article excerpt

INTRODUCTION

In 1988, 79% of males (Sonenstein, Pleck, & Ku, 1991) and 53.2% of females (Forrest & Singh, 1990) in the U.S. aged 15 to 19 had experienced sexual intercourse. Sexual activity may have serious negative health impact on adolescents. Unwanted teen pregnancy continues in epidemic efforts at prevention; in 1988, women 19 years of age and younger gave birth to 488,940 infants (National Center for Health Statistics: Advance Report of Final Natality Statistics, 1984; 1990.) Further, sexually active adolescents have remarkably high rates of sexually transmitted diseases; the Division of STD/HIV Prevention (1991) reported that two-thirds of all cases of sexually transmitted diseases occur in individuals 24 years of age and under.

Traditionally, attempts to identify the causes of unwanted adolescent pregnancies have targeted young women. Studies of males have generally focused on men over 19 years of age (Ryser & Spillane, 1974; Thompson & Spanier, 1978) or unwed teen fathers (Hendricks, 1982; Hendricks & Montgomery, 1983; Rivera, Sweeney, & Henderson, 1985). Ample evidence suggests that young men as well as young women are deeply affected by teen pregnancy. Young fathers report that early parenting has a significant impact on their lives (Vaz, Smolen, & Miller, 1983; Card & Wise, 1979). Further, research on sexually active adolescent women indicates that their partners contribute to decisions regarding sexual activity and contraception (Zabin & Clark, 1981).

Teenagers frequently use male methods of contraception for their early sexual experiences (Zelnick & Shah, 1983; Clark, Zabin, & Hardy, 1984). Zelnick and Kantner (1980) demonstrated that one-third of women who contracepted at first intercourse used condoms. Condoms are the only reversible and effective form of contraception that requires male participation. More importantly, condoms help prevent the spread of sexually transmitted diseases including AIDS (Conant et al., 1986). Data from the 1988 Survey of Adolescent Males demonstrate that, among 17- to 19-year-old males, the rates of sexual activity as well as rates of condom use have increased from 1979 to 1988 (Sonenstein, Pleck, & Ku, 1989).

In a survey of teen males aged 16 to 19 years, 34% of respondents reported that they always use condoms (Hingson et al., 1990). Teens often do not plan to use condoms in the future despite expressing the belief that condoms are valuable as a contraceptive method which prevents STDs (Kegeles, Adler, & Irwin, 1988).

Little is still known about the characteristics of male adolescents who use and do not use condoms. In the current epidemic of teen pregnancy and sexually transmitted diseases, identifying the population at increased risk with the goal of increasing condom use could have important implications for prevention. Thus, the aim of this study was to identify variables associated with condom use among a population of black adolescent males attending an inner-city adolescent medicine clinic.

The dimensions of the Health Belief Model were used as a framework for examining condora use in relationship to different variables (Rosenstock, 1966; Fishbein & Jacard, 1973; Katasky, 1977; Becker & Maiman, 1975). This model provides a basis for understanding decision-making processes for preventive health behaviors, i.e., condom use. It is founded on social-psychological theory and postulates that specific factors can help predict an individual's behaviors. These include one's perceived susceptibility to disease, benefits weighed against barriers to action, and either internal or external cues to actions. Additionally, demographic, social, and structural influences interact with these factors in determining actions. A crucial tenet of this model is the theory that an individual's health beliefs and thus preventative behaviors are mutable.

The following variables were postulated to be individually associated with increased likelihood of condom use: sociodemographic characteristics, superior knowledge about condom use, a past history of impregnating a partner or acquiring a sexually transmitted disease, number of sex partners in the past six months, reported fear of either pregnancy or of sexually transmitted diseases, communication about sex or contraception with sexual partners, parents or friends. …