Title: New Study on Condom Use Among Males Highlights Need for Changing Attitudes and Improving Negotiation Skills

Source: Jennifer Manlove, Erum Ikramullah, and Elizabeth Terry-Humen, “Condom Use and Consistency Among Male Adolescents in the United States,” Journal of Adolescent Health (June 2008): 1-9. 

This study, by researchers from Child Trends, an independent, nonpartisan research center, examines what factors affect condom use and consistency among adolescent males in the United States. The researchers gathered their data from the 2002 National Survey of Family Growth (NSFG), which was conducted by the National Center for Health Statistics. Their sample included 542 males ages 15–19 who reported having engaged in sexual intercourse. 

The researchers looked at four different measures of condom use during vaginal heterosexual intercourse: condom use at first sexual intercourse, condom use at last sexual intercourse, condom consistency with most recent sexual partner, and condom consistency in the last four weeks. They also looked at demographic variables such as race/ethnicity, family structure, and family socioeconomic status. 

In addition, the researchers examined variables related to access to sexual health knowledge and services. They looked at whether respondents had received abstinence education or birth control education before their first sexual intercourse; how many sexual health topics they had discussed with their parents; and whether they had ever received reproductive health services. The researchers also created an index of positive attitudes towards condoms based on the average response to three questions: “What is the chance that…1) if you used a condom during sex, you would feel less physical pleasure? 2) it would be embarrassing for you and a new partner to discuss using a condom? and 3) if you used a condom, a new partner would appreciate it?” 

Finally, they examined a number of characteristics related to sexual history and partners: age at first and last sex, age difference between respondent and his partner, relationship type (steady or casual), whether the respondent’s partner used contraception (other than condoms), length of last sexual relationship, number of lifetime partners, and frequency of sex in the last four weeks.

• 71% of males in the sample used a condom at first sexual intercourse, 71% used a condom at last sexual intercourse, 50% used a condom consistently with their most recent partner, and 68% used a condom consistently in the four weeks before the interview. 

• One in five respondents had not received any type of sexual education prior to their first sexual experience. These males were 50% less likely to use a condom at first sex than those who had received either abstinence or birth control education. In contrast, talking to parents about sexual health or receiving reproductive health services did not seem to influence condom use or consistency.

• African-American males were more likely than their white counterparts to consistently use condoms, while Hispanic males were half as likely as non-Hispanic white teens to use condoms consistently. 

• Respondents who first initiated sexual intercourse with a casual partner were less likely to report using a condom at first sex than those who were in a steady relationship with their first sexual partner.

• Males who were older at first or last sexual experience, were younger than their partner, had a partner who used another contraceptive method, were in a longer sexual relationship, or had sexual intercourse more frequently were less likely to consistently use condoms. 

• Males who had more positive attitudes towards condoms were more likely to consistently use them.

This new study provides valuable information about the effects of many different factors on condom use among teen males, and points to multiple ways of improving the effectiveness of STD- and pregnancy-prevention programs by increasing condom use among adolescent males. 

To begin with, the study illustrates the importance of early sexuality education for teens. The researchers found that more than one fifth of the respondents had not received any type of sexual education prior to their first sexual experience and that these teens were 50% less likely to use a condom when they first engaged in intercourse. Teens must be given the information they need to make healthy decisions before they become sexually active. While this study did not find any significant difference between the effects of abstinence-only and birth control education on condom use, its measures of the differences between sexual education programs were limited. Respondents were simply asked if they had received formal instruction about “how to say no to sex” and “methods of birth control.” The researchers note that “the lack of a difference between the types of sex education may be because program effects are sensitive to program content, activities, and intensity that are not measured in the NSFG.”1 What is abundantly clear, however, is that teens must not go without formal sexuality education.

In addition to highlighting the importance of early sexuality education for teens, the results point to various other factors that should be addressed in order to promote condom use among males. Like previous research, this study found that males were less likely to consistently use a condom when they were in longer, more committed relationships. Previous studies have posited that this may be because teens consider these relationships less risky in terms of STDs and pregnancy. Furthermore, males were less likely to use a condom consistently with an older partner, despite the fact that, in general, older females have longer sexual histories. These findings illustrate the importance of properly educating young people about the actual risks they face with all partners 

Although the reduced rate of condom use in a steady long-term relationship was an expected finding, the fact that teens were less likely to use a condom at first sex with a casual partner is counterintuitive and worrisome. Due to the greater perceived risk in early casual relationships, the researchers had hypothesized that the opposite would hold true. One explanation is that in early casual relationships there is often less communication between partners—especially about sexual risks and contraception. Given these findings, sex education and STD- prevention programs would do well to focus on promoting open communication and helping teens negotiate condom use with all types of partners.

The low rates of condom use among Hispanic males, which have been confirmed by other studies, are also of particular concern and should spur greater efforts to create sexuality education programs that are relevant to the specific needs of Hispanic communities in the United States. 

The study also suggests that prevention efforts should try to develop positive attitudes towards condoms among males. The single most consistent predictor of condom use was whether the respondent had more positive attitudes towards condoms. In order to develop these attitudes, sexuality education programs should emphasize both the benefits of using condoms and the costs of not do so. Sadly, abstinence-only-until-marriage programs often go out of their way to undermine young people’s confidence in condoms. These programs regularly provide misinformation about the effectiveness and reliability of this important method of protection. If young people do not believe that condoms work, there is little motivation for them to use them. Comprehensive sexuality education is therefore needed to ensure that teens learn not only the dangers of unprotected sex but also what they can do to protect themselves.

This study adds greatly to our understanding of condom use among male adolescents and speaks to the need for comprehensive sexuality education that reaches teens before they become sexually active, helps them openly communicate about sexual health and contraception with their partners, is culturally competent, and promotes positive attitudes towards condoms among young men.