Journal of Adolescent Health
Volume 43, Issue 4 , Pages 325-333, October 2008

Condom Use and Consistency Among Male Adolescents in the United States

Child Trends, Washington, DC

Received 29 October 2007; accepted 20 March 2008. published online 25 June 2008.

Article Outline

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.

Keywords: Condom use, Condom consistency, Males, Adolescents

 

See Editorial p. 313

Increased research and program attention has focused on male involvement in reproductive health decision making, especially among teen populations [1]. Male partners can improve couple-level reproductive health outcomes by using condoms consistently with sexual partners to prevent sexually transmitted infections (STIs) and unwanted pregnancies. A better understanding about how multiple dimensions of heterosexual male adolescents' lives are associated with condom use and consistency will help inform STI and pregnancy prevention efforts.

To assess multi-dimensional influences on male condom use and consistency, we apply a behavioral model of health service utilization. Dimensions of this model include predisposing characteristics, enabling resources, and individual need for health services [2], [3]. Predisposing characteristics include family and individual sociodemographic characteristics and health beliefs and attitudes. Enabling resources are those that allow an individual to use a particular health service, such as access to sex education and reproductive health services. Males' perceived need for health services include their level of sexual activity and characteristics of risky partners. Following this health services behavior model, we expand previous research by using nationally representative data to assess the association between adolescent males' family, individual, sex education and partner factors and their condom use and consistency.

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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 discussing sex and contraception with their parents, peers, and partners [4], [5], [6], [7]. Condom use and consistency has been found to be lower among Hispanic teens, especially those who are immigrants [6], [7], [8], [9], [10].

Two family background predisposing factors, namely, low parental socioeconomic status and nonintact family structure, are associated with risky sexual behaviors for teens, in part because of greater opportunity costs associated with STIs and pregnancy among teens with more advantaged backgrounds [11]. Alternatively, when opportunities for social and economic advantage are limited, teens may be more likely to engage in risky sexual behaviors that lead to early pregnancy or STIs. Several studies have found that higher parental education and family income are associated with increased condom use and consistency among both males and females [9], [12], [13], [14], [15]; however research linking family background and condom use among males has shown mixed findings. Although one study of urban black males found that living with two biological parents is associated with higher condom use consistency [16], two nationally representative studies found no association between family structure and condom use or consistency among males and females [17], [18].

A health behavior model also highlights attitudes as predisposing factors that inform health beliefs, which, in turn, may influence the inclination toward health service use [2]. A meta-analysis found that positive attitudes toward condom use (such as perceived partner appreciation of condom use) are reliable predictors of condom use, and that more perceived barriers to condom use (such as a perceived reduction in physical pleasure) are negatively associated with condom use and consistency [19].

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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 receiving some form of sex education [7]. A recent study has identified several STI/pregnancy prevention programs that have had impacts on condom use; however there is considerable variability in the curricula, and many sex education programs do not show impacts on condom use [20]. Higher levels of parent–teen communication in general [21], [22], as well as specific communication about sex and birth control [23], [24], are associated with higher contraceptive and condom use among adolescents.

Adolescents' use of reproductive health services, from a doctor or family planning clinic, reflects both access to health services and perceived need of services. Males are much less likely than females to have access to reproductive health services and clinic attendance tends to be higher among men from communities with a higher risk of STIs [25]. Limited research has examined the association between clinic attendance and condom use, although one study of teen females found that attending a family planning clinic before first sex was associated with reduced condom use [26].

Need for services: Sexual history and partner characteristics 

Consistent with the health behavior model, we hypothesized that characteristics of sexual histories and partners that may indicate a greater perceived need for reproductive health services (including a younger age at first sex, having a casual sexual relationship and having more sexual partners) would be associated with increased condom use. In addition, we posited that having an older or younger sexual partner, being in a steady relationship with more frequent sexual activity, and having a partner who is using another contraceptive method would be associated with reduced condom use and consistency.

Males who are younger at first sex, as well as those with more sexual partners or casual sexual partners, may face an especially greater perceived need for condom use because of their increased exposure to STIs. Extensive research shows that teens use condoms more consistently with casual versus steady partners because of a greater perceived risk for STIs in these relationships [27], [28]. Conversely, condom use declines with age and in longer, more committed relationships with more frequent sexual activity [29], [30], [31], partly because female partners are more likely to use hormonal contraceptive methods in such relationships [30]. Also, having a much older or younger partner is associated with reduced odds of contraceptive and/or condom use [6], [29], [32], [33]; however few studies have specifically examined the role of partner age difference for male condom use.

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Methods 

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].

Our analytic sample includes 542 male adolescents aged 15–19 years who had ever engaged in sexual intercourse (designated as sexually experienced males). For analyses of condom use at last sex, we restricted the sample to 366 sexually active males who had had sexual intercourse in the 3 months before their interview. We further restricted the sample to 347 males who reported on condom consistency with their most recent sexual partner. Finally, analyses of condom consistency in the past 4 weeks were restricted to 285 male adolescents who reported having sex at least once during the 4 weeks before the interview.

Measures 

Dependent variables 

We examined four dependent variables, measuring condom use and consistency during heterosexual vaginal intercourse. The first dependent variable measured condom use at first sexual intercourse, based on responses to two questions: (1) “That first time that you had sexual intercourse, did you or she use any methods to prevent pregnancy or sexually transmitted disease?” and (2) “That first time, what methods did you and she use to prevent pregnancy or sexually transmitted disease?” The second dependent variable measured condom use at last sexual intercourse based on a similar set of questions about their most recent sexual experience. Because of our interest in condom use consistency with specific partners and in consistency over time but potentially across relationships, we included two measures of condom consistency. The third dependent variable measured condom consistency with most recent partner based on the following question: “During the past 12 months, what percent of the times that you and she had sex together did you use a condom?” The fourth dependent variable measured condom consistency in the last 4 weeks, using reports of frequency of sexual activity and condom use. Consistent condom use for these outcomes was defined as 100%.

Individual and family background variables 

We measured three individual and family characteristics, including race/ethnicity and whether the teen lived with two biological or adoptive parents at age 14 years. Because of missing or inaccurate information on income in the NSFG [34], we operationalized family socioeconomic status as highest parental education.

Sex education and access to services 

We included two measures of sex education. The first measured whether respondents received formal instruction about “how to say no to sex” and “methods of birth control.” We created four categories: (1) neither abstinence nor birth control education; (2) abstinence only; (3) birth control only; and (4) both abstinence and birth control. For analyses of condom use at first sex, we measured sex education received before first sex. For all other analyses, we assessed sex education received before age 18 years. We also measured the number of sexual health topics that a respondent discussed with his parent(s), including how to say no to sex, birth control methods/access, sexually transmitted diseases, and how to use a condom. For access to services, we measured whether the respondent had ever received reproductive health services (including advice about STDs, birth control, sterilization, or HIV/AIDS) from a physician or reproductive health clinic.

Sexual history and partner characteristics 

For models predicting condom use at first sex, we included measures of the respondent's age at first sex and characteristics of his first sexual partner. For models predicting condom use at last sex and condom consistency, we included the respondent's age at last sex and characteristics of his most recent sexual partner. Partner characteristics included age difference between the respondent and his partner (comparing those who were at least 1 year younger or older than their partner with those who were the same age), and relationship type (going steady, going out once in a while, and just friends/just met/other). We also measured whether the respondent's partner used a method of contraception, length of most recent sexual relationship, number of lifetime sexual partners, and frequency of sex in the last 4 weeks. With regard to use of a contraceptive method by the respondent's partner, we included birth control pills, injectable contraceptives, Depo-Provera, Lunelle, foam, jelly, cream, suppository, hormonal implant, and/or Norplant. We did not include methods such as rhythm, withdrawal, or use of the female condom.

Condom attitudes 

We created an index of positive condom attitudes based on the average response across three questions asking, “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?” The questions asking about less physical pleasure and feeling embarrassed were reverse coded so that a higher score represented a more positive attitude (range: 1 = no chance to 5 = an almost certain chance).

Statistical methods 

Bivariate chi-square analyses tested whether condom use outcomes differed by individual and family characteristics, sex education experience, relationship characteristics, and condom attitudes. Multivariate logistic regression analyses tested for associations between independent and dependent variables after controlling for other potentially confounding factors. All analyses were weighted, and we used Stata to control for the complex sampling design of the NSFG.

Models of condom use at first sex excluded variables that may have been measured after first sex: sexual health topics discussed with parents, receipt of reproductive health services, characteristics of recent sexual experiences and attitudes toward condoms. Furthermore we excluded frequency of sex in the last 4 weeks in models of condom consistency with last partner, because we focused on partner-specific relationship characteristics in these models.

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Results 

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 had parents who completed some college or more. About half of the males in both samples received sex education about both abstinence and birth control, whereas one in five sexually experienced males did not receive either type of sex education before their first sexual experience. One third of sexually active males had ever received reproductive health services at a clinic, doctor's office, or other location. Sexually experienced males had their first sexual experience, on average, at age 15 with a partner who was about 8 months older than them, whereas sexually active males were almost age 18 at most recent sex with a similar-aged partner. Males had a steady partner in 51% of first and 74% of most recent sexual relationships. In 18% of first and 53% of recent relationships, their partner used a contraceptive method. Overall, males reported positive attitudes toward condoms, with an average score of 3.9 on a 1–5 index.

Table 1. Distribution of dependent variables and individual, family, sex education, sexual history characteristics, and condom atttitudes, among sexually experienced and sexually active males aged 15–19 years
CharacteristicSexually experiencedaSexually activeb
Dependent variable
Condom use at first sex71.1%—
Condom use at last sex—70.7%
Condom consistency with most recent partner—50.2%
Condom consistency in last 4 weeks—67.9%
Individual characteristics
Race/ethnicity
Hispanic19.0%19.3%
Non-Hispanic white/other61.0%62.0%
Non-Hispanic black20.1%18.8%
Family background characteristics
Family structure at age 14
Two biological or adoptive parents60.9%63.9%
One biologcal and one adoptive parent/step-parent16.1%14.2%
Single biological parent13.8%13.5%
Other9.1%8.4%
Parental education
Less than high school8.0%7.3%
High school/GED26.9%28.3%
Some college33.4%33.1%
B.A. or higher31.8%31.3%
Sex education
Formal sex education instruction
Neither abstinence nor birth control21.3%13.3%
Abstinence only24.6%22.4%
Birth control only8.4%9.1%
Both abstinence and birth control45.7%55.2%
Number of sexual health topics discussed with parents (0–4)—1.8
Ever received any reproductive health services—34.3%
Characteristics of first/last sex
Age at first sex (10–19 years)/last sex (15–19 years)15.217.8
Mean age of first/last partner15.917.8
Age difference with partner
Younger than partner46.4%23.3%
Same age as partner37.0%29.1%
Older than partner16.5%47.7%
Relationship with partner
Going steady51.2%73.9%
Going out once in a while14.2%8.4%
Just friends/just met/other34.6%17.7%
Partner used contraceptive method18.2%52.5%
Length of sexual relationship (1 = ≤1 month; 4 = ≥1 year—2.7
Number of sexual partners (1 to ≥4)—2.8
Frequency of sex in the last 4 weeks (1 to ≥8)—3.4
Condom attitudes
Posititve condom attitudes (1–5)—3.9
N542366
Total100.0%100.0%

aSexually experienced is defined as ever having had heterosexual sexual intercourse.

bSexually active is defined as having had heterosexual intercourse in the past 3 months.

Bivariate analyses 

Race/ethnicity, sex education, characteristics of first and last sex, and condom attitudes were associated with condom use and consistency (Table 2). Factors associated with greater condom use and/or consistency include: African-American race/ethnicity, having more positive condom attitudes, and discussing a greater number of health topics with their parents (marginally significant). Factors associated with reduced condom use and/or consistency include: being older at first or last sex, having an older sexual partner or one who used a contraceptive method, being in a longer sexual relationship, and a greater frequency of sexual intercourse.

Table 2. Bivariate associations between individual, family, sex education, and sexual history characteristics and condom attitude factors and condom use outcomes, among males aged 15–19 years
CharacteristicUsed condom at first sexUsed condom at last sexUsed condom 100% of time for sex with last partnerUsed condom 100% of time for sex in last 4 weeks
Individual characteristics
Race/ethnicity⁎⁎⁎ ⁎⁎
Hispanic66.5%59.9%46.9%50.5%
Non-Hispanic white/other67.9%69.4%48.4%67.1%
Non-Hispanic black85.3%86.1%59.2%87.6%
Family background characteristics
Family structure at age 14 years
R lived with two biological or adoptive parents70.7%67.6%48.6%64.8%
R lived in any other family structure71.7%76.2%52.3%72.8%
Parental education
Completed high school or less73.1%71.8%50.4%68.9%
Completed some college or more70.2%69.9%49.9%67.3%
Sex education
Formal sex education/instruction
Neither abstinence nor birth control60.9%57.8%46.6%52.2%
Abstinence only75.2%77.6%48.8%69.5%
Birth control only74.0%75.5%61.4%73.4%
Both abstinence and birth control73.1%70.2%49.8%70.2%
Number of sexual health topics discussed with parents +
0—62.3%51.4%57.3%
1–2—71.0%49.6%67.4%
3–4—77.3%49.9%76.1%
Receipt of health services
Ever received reproductive health services—76.9%48.0%70.6%
Never received reproductive health services—67.5%51.4%66.3%
Characteristics of first/last sex
Age at first sex⁎⁎⁎
≤14 years72.4%———
15–16 years77.6%———
≥17 years58.8%———
Age at last sex ⁎⁎⁎+⁎⁎
15–16 years—94.0%64.6%93.8%
17–18 years—70.0%50.6%69.1%
≥19 years—60.7%42.9%56.7%
Age difference with partner +⁎⁎⁎
Younger than partner69.7%59.4%31.3%58.6%
Same age as partner72.8%80.1%65.9%81.6%
Older than partner71.2%70.5%50.4%64.7%
Relationship with partner
Going steady73.2%69.5%48.3%66.0%
Going out once in a while79.4%65.6%52.5%65.2%
Just friends/just met/other64.6%78.3%59.5%77.0%
Partner's contraceptive use ⁎⁎⁎⁎⁎⁎⁎⁎
Partner used a contraceptive method62.8%65.3%39.8%62.4%
Partner did not use a contraceptive method72.9%86.2%65.5%83.3%
Length of most recent sexual relationship ⁎⁎⁎⁎⁎⁎⁎⁎⁎
≤1 month—84.9%83.4%88.4%
2–5 months—82.8%54.3%77.1%
6–11 months—78.5%49.1%68.1%
≥1 year—57.7%35.0%59.2%
Frequency of sex in the last 4 weeks ⁎⁎⁎ ⁎⁎⁎
1 time—92.6%—92.8%
2–3 times—74.7%—74.1%
4–7 times—70.6%—65.3%
≥8 times—36.2%—34.9%
Condom attitudes
Positive attitudes towards condoms—⁎⁎⁎⁎⁎⁎⁎⁎
1–3—56.3%36.1%51.6%
4–5—82.3%60.1%81.1%
N542366347285

⁎⁎⁎p < .001

⁎⁎p < .01

⁎p < .05

+p < .10.

Multivariate analyses 

Table 3 shows multivariate results from logistic regression analyses predicting condom use outcomes. Model 1 includes individual and family factors and Model 2 adds characteristics of males' sexual relationships and condom attitudes. In Model 1 analyses of condom use at first sex, black adolescents had three times the odds of condom use as did whites. In contrast, males who received neither abstinence nor birth control education had 50% lower odds of condom use at first sex, compared with those who received one or both types of sex education (OR = .51). In Model 2, the race/ethnicity finding persisted and sex education became marginally significant. In addition males who had just met, or were just friends with, their partner at the time of first sex had 44% lower odds of condom use at first sex than males who were going steady with their first sexual partner. Males whose first sexual partner used a contraceptive method had marginally lower odds of using a condom the first time they had sex.

Table 3. Odds ratios from logistic regression models predicting condom use outcomes among male adolescents aged 15–19 years
CharacteristicUsed condom at first sexUsed condom at last sexUsed condom 100% of time for sex with last partnerUsed condom 100% of the time for sex in last 4 weeks
Model 1Model 2Model 1Model 2Model 1Model 2Model 1Model 2
Individual characteristics
Race/ethnicity
Hispanic1.001.00.66.731.001.38.49⁎.45+
Non-Hispanic white/other(1.00)(1.00)(1.00)(1.00)(1.00)(1.00)(1.00)(1.00)
Non-Hispanic black3.00⁎⁎3.10⁎⁎2.58+1.851.83+1.853.95⁎2.94+
Family background characteristics
Lived with two biological or adoptive parents at age 14 years1.021.04.78.621.001.04.84.72
Parental education (1–4).99.98.93.981.071.16.92.89
Sex education
No formal sex education instruction.51⁎.50+.48.64.931.37.36+.41+
Number of sexual health topics discussed with parents (0–4)——1.161.15.97.961.171.10
Ever received any reproductive health services——1.251.22.84.65.83.59
Characteristics of first/last sex
Age at first sex (10–19 years)/last sex (15–19 years)—.94—.76+—.82—.60⁎⁎
Age difference with partner
Younger than partner—.82—.44⁎—.18⁎⁎⁎—.43+
Same age as partner—(1.00)—(1.00)—(1.00)—(1.00)
Older than partner—.94—.73—.74—.48
Relationship with partner
Going steady—(1.00)—(1.00)—(1.00)—(1.00)
Going out once in a while—1.32—.68—1.53—1.25
Just friends/just met/other—.56⁎—.81—1.85—.92
Partner used contraceptive method—.57+—.72—.39⁎⁎—.95
Length of most recent sexual relationship———.64⁎⁎—.55⁎⁎⁎—.68⁎
Number of sexual partners———.92—1.00—.79
Frequency of sex in last 4 weeks (1 to ≥8 times)———.80⁎⁎⁎———.73⁎⁎⁎
Condom attitudes
Positive attitudes toward condoms———2.29⁎⁎—2.55⁎⁎⁎—3.50⁎⁎⁎
F(df)3.04(5)⁎2.21(11)⁎1.57(7)4.15(17)⁎⁎⁎.72(7)4.47(16)⁎⁎⁎2.14(7)⁎3.52(17)⁎⁎⁎
N542542366366347347285285

⁎⁎⁎p < .001;

⁎⁎p < .01;

⁎p < .05;

+p < .10.

In Model 1 analyses of condom use at last sex, black race/ethnicity was associated with marginally higher odds of condom use. However this association was attenuated in Model 2 when characteristics of the last sexual relationship and condom attitudes were included. In Model 2, older age at last sex (marginally significant), being younger than one's partner, being in a longer sexual relationship, and greater frequency of sexual intercourse were associated with reduced odds of condom use at last sex. In addition, males who reported more positive condom attitudes had greater odds of using a condom at most recent sex.

The next set of analyses examined condom consistency with most recent partner. In Model 1, black adolescents had marginally higher odds of consistent condom use with their most recent sexual partner, but this association was attenuated in Model 2. In Model 2, several relationship and partner characteristics were associated with lower odds of condom consistency with most recent partner, including being younger than one's partner, having a partner who used a contraceptive method, and being in a longer sexual relationship. In contrast, more positive attitudes about condoms were associated with greater odds of consistent condom use with the most recent sexual partner.

Finally, in Model 1 analyses of condom consistency in the 4 weeks before the interview, compared with whites, Hispanic adolescents had lower odds of consistency than their white counterparts, and black adolescents had greater odds. Not receiving formal sex education was associated with marginally lower odds of using condoms consistently. Findings from Model 1 persist in Model 2, although race/ethnicity became only marginally significant. Also, in Model 2, an older age at most recent sexual experience, having a longer sexual relationship and more frequent sexual activity were associated with lower odds of consistent condom use. Having an older sexual partner was associated with marginally lower odds of consistent condom use. More positive attitudes toward condoms were also associated with greater odds of using condoms consistently in the past 4 weeks.

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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 health outcomes and to increase condom use in sexual relationships. For example, our findings suggest that programs addressing multiple domains of influence, including choice of partner and attitudes about condoms, may be effective in helping to reduce the high rates of STIs among U.S. teens.

We found that the lack of enabling resources, measured as no formal sex education, was associated with only half the odds of using a condom at first sex and less than half the odds of using a condom consistently. In preliminary multivariate models, we found no differences in the effects of sex education on condom use by the type of sex education teens received (e.g., only abstinence messages versus more comprehensive sex education). These findings confirm results of another recent study showing that any kind of formal sex education is associated with sexual experience and contraceptive use among teens [35]. The lack of a difference between the types of sex education may be because program effects are sensitive to program content, activities, and intensity [20] that are not measured in the NSFG. These analyses suggest that formal sex education may improve condom consistency, and our finding that one in five sexually experienced teen males did not receive formal sex education before their first sexual experience highlights the need to target messages to teens before they have sexual intercourse. In contrast, unlike some previous studies [19], discussions between teens and parents about sexual health topics were not significantly associated with any condom use outcome, after controlling for formal sex education, indicating the greater effects of formal versus informal sex education in this study.

Bivariate analyses indicate only one-third of males in our sample reported receiving reproductive health services, which highlights the low use of services in this population [25]. However we did not find any multivariate association between receiving services and condom use. Future longitudinal research is needed to determine associations between services and subsequent condom use.

Our study highlights the role of sexual relationships and partners in condom use decision making, with risky partner characteristics representing a greater perceived need for reproductive health services. As hypothesized, older age at last sex, more frequent sexual experience, and longer sexual relationships were associated with reduced odds of condom use and consistency, supporting previous research [31]. Some studies suggest that reduced condom use among older teens or in longer relationships is due to the greater likelihood that a partner is using a more effective method to avoid pregnancy [6], [31]. We also found that a partner's contraceptive use was negatively associated with condom use and consistency, but relationship length and age at last sex remained important. Because many teens do not know their partners' sexual history, especially those whose partners engage in sexual risk taking [19], [28], these findings highlight the need to maintain consistency of condom use over time and across relationships.

In contrast to our hypothesis of greater condom use with casual sexual partners, we found a negative association between casual partners and the odds of condom use at first sex. This finding supports some other research showing reduced contraceptive use among teens with casual partners, possibly because of reduced communication in early casual relationships [26], [36], [37]. The negative association between having an older sexual partner and condom use and consistency supports studies showing that older partners are associated with greater sexual risk taking [6], [29], [32], [33]. These findings suggest that males are more likely to risk STIs with an older female, despite the fact that older females tend to have longer sexual histories than partners of similar age [7]. Younger teen males also may be less likely to discuss condom use with an older partner. Some of the most effective STI prevention programs incorporate role-playing exercises to reinforce communication between partners about sexual risks and to improve negotiation skills surrounding condom and contraceptive use [20], which may be particularly important for males, who are less likely than females to initiate these conversations [19], [37].

As hypothesized, we found more positive attitudes about condoms were associated with greater odds of condom use and consistency. This finding supports previous research finding that men who view condom use as having more “benefits” than “costs” are more likely to use condoms consistently and emphasizes the importance of programs that increase knowledge and awareness of the risks associated with not using condoms, improve motivations to use condoms for STI and pregnancy prevention, and help males to become more comfortable discussing condoms with new partners [17], [20].

As hypothesized, we also found an association between predisposing sociodemographic differences and the odds of condom use and consistency. Specifically, our research supports other studies [4], [5], [6], [7] by finding that African-American males have greater odds of condom use and consistency, although some of these associations were marginal and were attenuated after including positive condom attitudes, which were highest among African-Americans in our sample. Some researchers posit that greater condom use among African-American males reflects lower perceived trust that a partner will use a contraceptive method [38]. In addition, Hispanic individuals had only half the odds of using condoms consistently as whites, reinforcing findings indicating especially low condom use among Hispanics [7], [8], [10]. Our sample size was not large enough to compare immigrant and native-born Hispanics, but some research suggests that first generation Hispanics have especially low condom use [8], [10], indicating the need to target STI and pregnancy prevention programs to the varied population of Hispanics in the U.S. [39].

There are several limitations to this study. Male reports of condom use and consistency are higher in the NSFG than those based on some in-depth calendar histories [30] and may reflect over-reporting in national cross-sectional surveys. The NSFG sampling framework also excludes nonhousehold populations such as incarcerated and homeless teens, and thus limits the extent to which our findings can be generalized to all adolescents. Another limitation of cross-sectional data is that information on our predictors (including attitudes) and outcomes was collected at the same time. However, the NSFG partially ameliorates this problem by providing event history data, collecting retrospective information on first and most recent sexual experiences and the timing of sex education. Despite these weaknesses, our study extends previous research by finding many domains of influence on condom use among male teens.

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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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PII: S1054-139X(08)00186-9

doi:10.1016/j.jadohealth.2008.03.008

Refers to article:

  • Can We Afford to Be Complacent About Teens' Use of Condoms?

    Freya Lund Sonenstein
    Journal of Adolescent Health October 2008 (Vol. 43, Issue 4, Pages 313-314)

Journal of Adolescent Health
Volume 43, Issue 4 , Pages 325-333, October 2008

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