Prioritizing Education about Condom Use among Sexually Active Adolescent Females
Christ, Michael J., Raszka, William V., Jr., Dillon, Christopher A., Adolescence
The most effective means of preventing sexually transmitted diseases (STDs) and pregnancy in sexually active adolescents is consistent use of a traditional male latex condom (Brown et al., 1992; DiClemente, 1990; Joffe, 1993), and it is important to understand factors that influence condom use in this population. Several surveys have shown that only a minority of adolescent females are consistent condom users. Forrest and Singh (1990) and Mosher (1990) reported that only 22%-47% of adolescent females in their surveys used condoms during their first intercourse, and only 21%-33% were currently using them. Rickert et al. (1989) reported that only 10% of females had ever purchased a condom. Weisman et al. (1991) found that only 28% used condoms during their most recent intercourse, and only 17% used them more than 90% of the time.
Several studies have identified factors that influence condom use among female adolescents. Norris and Ford (1993) suggested that negative experience with condoms decreases the likelihood of using condoms again in the future. Several studies have shown an association between risk-taking behaviors and inconsistent condom use (Brown et al., 1992; DiClemente, 1992; Hingston et al., 1990; Jessor, 1992). Self-efficacy theory (Strecher et al., 1986) is also relevant to effective condom use. Bandura (1989) suggested that low self-efficacy among college students contributes to inconsistent condom use, and Jemmott and Jemmott (1992; Jemmott, Jemmott, & Hacker, 1992; Jemmott et al., 1992) and O'Leary et al. (1992) used social-cognitive theory and the theory of planned behavior to relate self-efficacy to intent to use condoms.
The body of knowledge regarding adolescent condom use is broad and varied. However, based on these studies, at least four main factors are thought to influence condom use in adolescent females: prior negative experiences with condoms, frequency of risk-taking activities, self-efficacy in obtaining condoms and using them correctly, and perception of condom efficacy in preventing STDs and pregnancy. Faced with limited time during clinic visits and the obvious need for intervention, it would be beneficial to know which factors are most significantly associated with planned condom use. In order to help prioritize topics for clinic-based education, the present study investigated this issue.
A questionnaire was administered to the first 200 sexually active females presenting to an adolescent clinic for routine gynecological care between January and June, 1994. The clinic provides primary care to military beneficiaries between the age of 13 and 21 living in west Texas. Subjects remained anonymous, and data were maintained using the patients' initials and the last four digits of the medical record number. They were assured that their responses would remain confidential, and no one refused to participate. Parental consent was not obtained; under the Mature Minor Doctrine, an adolescent 14 or older may give consent for medical care and is allowed confidentiality. Covered by this doctrine are the issues of pregnancy, contraception, and sexually transmitted disease, topics most adolescents are not willing to discuss with their parents. The study was approved by the institution's Human Use Committee and the Department of Clinical Investigation.
The survey contained 53 questions, modified from several other studies (Brown et al., 1992; Norris & Ford, 1993; Bandura, 1989; Azjen & Fishbein, 1980), relating to a variety of sexual activities. Questions concerned negative experiences with prior condom use, the frequency of risk-taking activities, confidence in the ability to obtain condoms and use them correctly, and perception of condom efficacy in preventing STDs and pregnancy. Responses to the question, "Do you plan to use a condom during your next sexual encounter?" were of central interest, because according to the theory of reasoned action (Azjen & Fishbein, 1980; Jemmott & Jemmott, 1991) and the theory of planned behavior (Jemmott & Jemmott, 1992; Jemmott, Jemmott, & Hacker, 1992; Jemmott et al. …