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.
PIP: In Indianapolis, Indiana, health workers randomly assigned 209 female adolescents, 15-19 years old, all of whom were sexually active and had Chlamydia trachomatis infection, to either the standard education group or to the behavioral intervention group to determine whether a behavioral intervention could increase condom use among this high-risk group. Researchers used infection with C. trachomatis as a biomarker of condom practices. The standard intervention was an individual discussion with the clinic nurse about sexually transmitted diseases (STDs) (e.g., importance of partner treatment and condom use) using the normal clinic procedure and printed material on chlamydia infection. The behavioral intervention included a discussion of chlamydia infection using the printed pamphlet as a guide, demonstration of how to use a condom correctly using a plastic banana, encouragement to practice putting a condom on the proxy phallus during the visit, and providing skills to negotiate condom use with sexual partners. 54% (112) of the adolescents returned for follow-up 5-7 months after enrollment. Adolescents in the intervention group were much more likely to use condoms for protection against STDs at follow-up than at baseline (odds ratio [OR] = 2.4; p = 0.02) and for vaginal intercourse (OR = 3.1; p = 0.005). They were not more likely to use condoms during last intercourse, however. When the researchers controlled for the frequency of use of condoms for vaginal intercourse at enrollment, adolescents in the intervention group were significantly more likely to use condoms during vaginal intercourse at follow-up than at baseline (p = 0.01). The multivariable logistic regression revealed that the experimental intervention and higher cognitive complexity among some adolescents had an independent positive influence on condom use at follow-up (OR = 2.8, p = 0.03 and OR = 4.6, p = 0.02, respectively). Despite higher condom use rates in the intervention group, the rate of reinfection with C. trachomatis was not significantly different than the control group (26% vs. 17%; p = 0.3). In conclusion, the intervention did not achieve consistent condom use.