Condom Use and Consistency Among Male Adolescents in the United States

doi:10.1016/j.jadohealth.2008.03.008

Journal of Adolescent Health

Volume 43, Issue 4, October 2008, Pages 325-333

https://doi.org/10.1016/j.jadohealth.2008.03.008 Get rights and content

Abstract

Purpose

To incorporate a behavioral model of health services utilization to examine whether male adolescents' family, individual, sex education, and partner factors are associated with several measures of condom use and consistency in heterosexual relationships.

Methods

We examine a sample of sexually experienced male adolescents 15–19 years of age in the 2002 National Survey of Family Growth (NSFG) to identify factors associated with condom use at first sex and last sex, condom consistency with their most recent sexual partner, and condom consistency in the past 4 weeks.

Results

Male adolescents who were Hispanic and those who did not receive formal sex education had lower odds of condom use and/or consistency, whereas African-American male adolescents and those with more positive attitudes about condoms had greater odds. Males who were older at most recent sex, who had an older sexual partner or a casual first sexual partner, who had a partner who used a method of contraception, who were in longer relationships, or who engaged in more frequent sex had reduced odds of contraceptive use.

Conclusions

Findings highlight multiple domains of influence on condom use behaviors among male adolescents. Programs that provide targeted services, address condom use attitudes, and help teens to negotiate condom use decision making with sexual partners may help to reduce high rates of sexually transmitted infections among male adolescents in the United States.

Section snippets

Predisposing factors: Family and individual sociodemographic factors and attitudes

Based on the health behavior model's emphasis on predisposing factors, we hypothesized that individual and family sociodemographic characteristics (including black race/ethnicity, higher family socioeconomic status, growing up with two biological parents, and more positive attitudes about condoms) would be associated with higher condom use and consistency.

Researchers have consistently found greater condom use among African-American males, in part because of their greater likelihood of

Enabling resources: Sex education and access to services

Following the health behavior model of condom use, we expected that enabling resources, including access to sex education, and discussions with parents about reproductive health topics would be associated with increased condom use and consistency among male teens. Because of higher clinic attendance among higher-risk teens, however, we anticipated that use of reproductive health services might be associated with reduced condom use and consistency. The majority of adolescent males report

Data

This study used data from the 2002 National Survey of Family Growth (NSFG) collected by the National Center for Health Statistics. It included a nationally representative sample of 7643 females and 4928 males 15–44 years of age. Individuals of Hispanic and black ethnicities and adolescents were oversampled. Males had a response rate of 78% overall, and teen males had a response rate of 81% [34]. The survey team obtained parental and individual consent for all teens less than 18 years of age [34]

Sample characteristics

More than two thirds (71%) of sexually experienced and sexually active males reported condom use at first sex and at most recent sexual intercourse, respectively (Table 1). Half of sexually active males reported consistent condom use with their most recent partner and over two-thirds reported consistent condom use in the last 4 weeks. Three fifths of sexually experienced males were non-Hispanic white or other race/ethnicity, 61% lived with two biological/adoptive parents and nearly two thirds

Discussion

This study extends previous research by incorporating a health services behavior model to assess how multiple dimensions of male adolescents' lives are associated with condom use and consistency in heterosexual relationships. Of particular interest are the effects of sex education, relationship and partner characteristics, and attitudes about condoms. All of these factors may potentially be addressed in program initiatives to improve male adolescents' roles in decision making about reproductive

Acknowledgments

This research was supported by grant FPR006015-01 from the Office of Population Affairs of the United States Department of Health and Human Services. The conclusions and opinions expressed here are those of the authors and do not necessarily reflect those of the funding agency. The authors thank Emily Holcombe for her assistance with the literature review.

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Sexual health education has been proven effective in improving adolescent sexual reproductive health outcomes. System-involved youth, including those in child welfare or juvenile justice systems, experience disproportionately poor outcomes as compared to youth in the general population, especially concerning STIs and early or unplanned pregnancies. Using logistic regression, this cross-sectional study examined the odds of condom use in a sample (n = 318; 61.3% males; 79.9% African American) of system-involved youth with multiple high-risk sexual behaviors. Specifically, it examined the impact of sexual health education, attitudes and beliefs about condoms, and the moderating effect of gender. The logistic regression models showed that youth were more likely to use a condom when exposed to comprehensive sexual health education (p < .05). Beliefs about condom effectiveness increased the odds of condom use in the second model (p < .01). Gender was not found to have a moderating effect. This study examined whether receiving comprehensive sexual health education and adolescent attitudes and beliefs towards condoms were associated with non-condom use using logistic regression in a sample of system-involved youth. Results suggest that comprehensive sexual health education could improve condom use in this vulnerable population.
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Greater condom use during oral sex among black youth may be attributed to similar factors associated with their higher likelihood of using condoms during intercourse [22,29,35]. For example, black males' greater tendency to use condoms during intercourse may, in part, be due to more positive attitudes toward condoms [29]. These attitudes may extend to condom use for all types of sex, including oral sex.
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More than half of AYAs had engaged in oral sex with an opposite-sex partner. Most youth reported having at least one oral sex partner in the last 12 months, with 16% of females and 24% of males reporting two or more partners. Condom use at the last oral sex was quite low (8% for females and 9% for males). Black males (adjusted odds ratio [AOR] = 3.46), black females (AOR = 2.65), and females of other race/ethnicities (AOR = 2.40) were more likely to use a condom at the last oral sex. Females aged 20–24 years (AOR = .31), females whose mothers had a college education or more (AOR = .43), and males and females who reported no intercourse experience were less likely to use a condom at the last oral sex (AORs = .46 and .20, respectively).
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Adolescents' condom attitudes are associated with condom use intention, and those who viewed condoms favorably were more likely to report future condom use intentions (Alvarez, Villarruel, Zhou, & Gallegos, 2010; Hogben et al., 2006; Lee, Lewis, & Kirk, 2011; Potard, Courtois, & Rusch, 2008; Small, Weinman, Buzi, & Smith, 2009). Positive attitudes and condom use intention are associated with greater likelihood of consistent use (Boone & Lefkowitz, 2004; Hogben et al., 2006; Manlove, Ikramullah, & Terry-Humen, 2008; Small et al., 2009). Attitudes toward condoms are also related to peer groups.
The purpose of this study was to identify predictors of sexual behavior and condom use in African American adolescents, as well as to evaluate the effectiveness of comprehensive sexuality and abstinence-only education to reduce adolescent sexual behavior and increase condom use. Participants included 450 adolescents aged 12–14 years in the southern United States. Regression analyses showed favorable attitudes toward sexual behavior and social norms significantly predicted recent sexual behavior, and favorable attitudes toward condoms significantly predicted condom usage. Self-efficacy was not found to be predictive of adolescents' sexual behavior or condom use. There were no significant differences in recent sexual behavior based on type of sexuality education. Adolescents who received abstinence-only education had reduced favorable attitudes toward condom use, and were more likely to have unprotected sex than the comparison group. Findings suggest that adolescents who receive abstinence-only education are at greater risk of engaging in unprotected sex.
Associations Between Sex Education and Contraceptive Use Among Heterosexually Active, Adolescent Males in the United States
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This study examined associations between reports of receiving education on topics commonly included in sex education (e.g., abstinence only, comprehensive) prior to age 18 years and contraceptive use at the last sex among heterosexually active, 15- to 20-year-old males in the United States.
Cross-sectional data from 539 males participating in the 2011–2013 National Survey of Family Growth were analyzed. Bivariate and multinomial logistic regression analyses adjusting for confounding estimated associations between receipt of seven sex education topics (e.g., information on HIV/AIDS, how to say no to sex) and contraceptive use at the last sex (i.e., dual barrier and female-controlled effective methods, female-controlled effective method only, barrier method only, and no method).
Nearly, all participants (99%) reported receiving sex education on at least one topic. Education on sexually transmitted diseases (94.7%) and HIV/AIDS (92.0%) were the most commonly reported topics received; education on where to get birth control was the least common (41.6%). Instruction about birth control methods (adjusted odds ratio [AOR] = 3.01; 95% confidence interval [CI] = 1.32–6.87) and how to say no to sex (AOR = 3.39; CI = 1.33–8.64) were positively associated with dual contraception compared to no use. For each additional sex education topic respondents were exposed to, their odds of using dual methods compared to no method was 47% greater (AOR = 1.47; CI = 1.16–1.86).
Exposure to a larger number of sex education topics is associated with young men's report of dual contraception use at the last sex. Comprehensive sex education, focusing on a range of topics, may be most effective at promoting safer sex among adolescent males.
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To describe the extent to which African-American male adolescents perceive responsibility for contraception and condom use and to understand the perceived importance of dual method use for respondents in casual versus committed relationships.
Data were collected using surveys informed by formative focus group sessions. Participants included African-American male high-school students aged 14–19 years from the Chicago's South Side. Respondents were surveyed regarding contraceptive behavioral intentions and perceived importance of dual method use. Responses were compared by relationship type. Logistic regression modeling was used to determine the association between contraception responsibility and perceiving dual method protection as important for each sexual relationship type.
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Original articleCondom Use and Consistency Among Male Adolescents in the United States

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Predisposing factors: Family and individual sociodemographic factors and attitudes

Enabling resources: Sex education and access to services

Data

Sample characteristics

Discussion

Acknowledgments

J Health Soc Behav

J Adoles Health

J Adolesc Health

It's a guy thing: Boys, young men, and teen pregnancy prevention

Societal and individual determinants of medical care utilization in the United States

Milbank Q

Adolescent males' orientation toward paternity and contraception

Fam Plann Perspect

The dynamics of young men's condom use during and across relationships

Fam Plann Perspect

Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, 2002Vital Health Statistics 23 (24)

Acculturation and the sexual and reproductive health of Latino youth in the United States: A literature review

Perspect Sex Reprod Health

Increased condom use among teenage males, 1988–1995: The role of attitudes

Family Plann Perspect

Gender, ethnic and acculturation differences in sexual behaviors: Hispanic and non-Hispanic white adults

Hispanic J Behav Sci

Sexual risk and protective factors: Factors affecting teen sexual behavior, pregnancy, childbearing, and sexually transmitted disease

Attitudes, knowledge, and behavior regarding condom use in urban black adolescent males

Adolescence

The changing impact of religion on the sexual and contraceptive behavior of adolescent women in the United States

J Marriage Fam

The role of mother–daughter sexual risk communication in reducing sexual risk behaviors among urban adolescent females: A prospective study

J Adolesc Health

The effects of contraceptive education on method use at first intercourse

Fam Plann Perspect

Reductions in HIV risk-associated sexual behaviors among black male adolescents: Effects of an AIDS prevention intervention

Am J Public Health

Adolescent males' condom use: Relationships between perceived cost–benefits and consistency

J Marriage Fam

The association of sexual behaviors with socioeconomic status, family structure and race/ethnicity among US adolescents

Am J Public Health

Original article
Condom Use and Consistency Among Male Adolescents in the United States