Elsevier

The Journal of Pediatrics

Volume 128, Issue 2, February 1996, Pages 288-295
The Journal of Pediatrics

Behavioral intervention to increase condom use among high-risk female adolescents,☆☆,,★★,

Presented in part at the annual meeting of the Society for Pediatric Research, San Diego, Calif., May 11, 1995.
https://doi.org/10.1016/S0022-3476(96)70413-4Get rights and content

Abstract

OBJECTIVE: To determine whether condom use among high-risk female adolescents could be increased by a behavioral intervention, with the use of infection with Chlamydia trachomatis as a biomarker of condom practices. DESIGN: Prospective, randomized, controlled intervention. SETTING: Urban family planning and sexually transmitted disease clinics. PARTICIPANTS: Two hundred nine female adolescents, aged 15 through 19 years, who were treated for C. trachomatis genitourinary infection, were randomly assigned to standard (control) or experimental (behavioral intervention) groups. One hundred twelve subjects returned for follow-up 5 to 7 months after enrollment and comprise the study subjects. MEASUREMENTS: Subjects completed a multiinstrument questionnaire measuring sexual behavior, condom practices, attitudes and beliefs, cognitive complexity, sociodemographics, and motivation at enrollment and follow-up. Endourethral and endocervical sites were sampled for C. trachomatis. RESULTS: Among the 112 subjects who returned for repeated examination, those who had received the experimental intervention reported increased use of condoms by their sexual partners for protection against sexually transmitted diseases (odds ratio = 2.4; p = 0.02) and for vaginal intercourse (odds ratio = 3.1; p = 0.005) at the 6-month follow-up. Multivariable logistic regression analysis controlling for condom use at enrollment demonstrated that the experimental intervention (odds ratio = 2.8; p = 0.03) and the higher cognitive complexity (odds ratio = 4.6; p = 0.02) independently contributed to greater condom use at follow-up. Despite greater use of condoms among the group who had received the intervention, use remained inconsistent and rates of reinfection with C. trachomatis were not significantly different (26% vs 17%; p = 0.3). CONCLUSION: Although a brief behavioral intervention among high-risk female adolescents can increase condom use by their sexual partners, incident infection does not appear to be reduced, because condom use remained inconsistent. (J PEDIATR 1996;128:288-95 )

Section snippets

METHODS

Sexually active female adolescents seeking care for reproductive health concerns at two family planning clinics and a county STD clinic were screened for endourethral and endocervical infection with Chlamydia trachomatis by means of standard tissue culture techniques.20 C. trachomatis was chosen as the biomarker infection because it is the most common treatable STD among adolescents and its recurrence rate is high enough to allow rate of incident infection to be used in a study of behavioral

RESULTS

Two hundred nine adolescent women with C. trachomatis genitourinary tract infection were enrolled; 112 (54%) returned for a follow-up visit 5 to 7 months later. To examine whether there was identifiable bias associated with attrition, we compared the sociodemographic and behavioral characteristics at enrollment of subjects who had dropped out with those who returned. At enrollment the two groups did not differ significantly in socioeconomic status, race/ethnicity, number of sexual partners in

DISCUSSION

Our results indicate that a brief intervention may modify specific condom behaviors of high-risk adolescents; after control for previous condom practices, adolescents who received the intervention reported a threefold greater condom use for vaginal intercourse 6 months later. Condom use was also related to less participation in behavioral risk activities, better attitudes about STDs and condoms, and greater cognitive complexity; use was greater among black subjects. In general, condom use at

Acknowledgements

We thank Carrie Carter and Debra Golden, who served as research assistants, and the staff members of the clinics.

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  • Cited by (0)

    From the Section of Adolescent Medicine, the Department of Pediatrics, Division of Biostatistics, and the Department of Medicine, Indiana University School of Medicine, and the Marion County Health Department, Indianapolis, Indiana

    ☆☆

    Supported in part by grants from the Centers for Disease Control and Prevention (R30/CCR502727), the National Institute for Allergy and Infectious Disease (U01 AI 31494), and the Maternal and Child Health Bureau (MCJ-IN 189596).

    aNow at the University of Michigan, Ann Arbor.

    ★★

    Reprint requests: Donald P. Orr, MD, Director, Section of Adolescent Medicine, Room 1740 N, Indiana University Medical Center, 702 Barnhill Dr., Indianapolis, IN 46202.

    0022-3476/96/$5.00 + 0 9/27/69138

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