Measures Of Condom Use Research Articles

Condom Use and Consistency Among Male Adolescents in the United States

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.

Sexual agency versus relational factors: a study of condom use antecedents among high-risk young African American women

The influence that female partners exert regarding condom use is not well known. In the present study, the relative roles of personal sexual agency and relational factors in determining whether young African American women engaged in unprotected vaginal sex (UVS) were studied. A cross sectional study of 713 young, African American women (aged 15-21 years) was conducted. Data were collected using an audio-computer assisted self-interview. Three measures of sexual agency were assessed and three relational factors were assessed. To help assure validity in the outcome measure, condom use was assessed in five different ways. Multivariate analyses were used to determine whether variables independently predicted UVS. Two of the six predictor variables achieved multivariate significance with all five measures of condom use: (1) fear of negotiating condom use with male partners, and (2) indicating that stopping to use condoms takes the fun out of sex. A relational factor (male-dominated power imbalances) achieved multivariate significance for four of the five measures of UVS. A sexual agency factor (whether young women greatly enjoyed sex) achieved multivariate significance for three of the five measures. The results suggest that young African American women at high-risk of sexually transmissible infections (STI)/HIV acquisition may experience male-dominated power imbalances and also fear the process of negotiating condom use with their male partners. Although these factors were independently associated with UVS, two factors pertaining to sexual agency of these young women were also important predictors of UVS. Intervention efforts designed to avert STI/HIV acquisition among young African American women should therefore include programs to address both sexual agency and relational factors.

Agreement of Daily Diary and Retrospective Measures of Condom Use

This study compares condom use reported two ways. 251 heterosexual participants (63% female) reported condom use on a prospective daily diary and on a retrospective questionnaire. Proportion of condom use with vaginal sex was calculated from the diary data and contrasted with retrospective categories. Responses were consistent for some participants, especially those who used condoms never or always, but responses from others showed considerable variability. Participants with few sexual encounters were more likely than those with more encounters to use "never" and "every time" endpoints. The results call into question the way participants interpret the meaning of retrospective categories.

Measuring the Condom Use Self-Efficacy of Deployed, Enlisted Male U.S. Naval Personnel

This article summarizes the development and psychometric analysis of a condom use self-efficacy measure for deployed, enlisted male U.S. Naval personnel. Sample ethnic subgroups included European American, Latino/Hispanic, African American, Asian American, Native American, Pacific Islander, and Biracial/Multiracial. Excellent reliability statistics were obtained for the full sample (alpha = .93, N = 2,722) and various ethnic subgroups (alpha = .93 to .95, n = 44 to 1,383). Correlations between self-efficacy scores and measures of condom use were similar in magnitude to effect sizes reported in research involving civilian populations (r = .18 to .34). Significant differences in self-efficacy scores for groups of condom users (e.g., consistent and nonconsistent users) for the full sample of men and ethnic subgroups provided further support for construct validity (p < .05). Study findings support the reliability and validity of the condom self-efficacy measure in this population and indicate its usefulness and the need for investigating its psychometric properties in other populations.

The impact of HIV-related interventions on HIV risk behavior in a community sample of African American crack cocaine users

While there are reports of the impact of specific interventions designed to reduce HIV drug and sexual risk behaviors, there are few reports of the impact of HIV interventions in a community-based sample. We report on baseline data from a sample of African American crack smokers who were about to participate in an intervention designed to reduce HIV-related risk behaviors. The majority were male (80%), single (70%) and homeless (52%). Data indicated that 29% of the sample had been in a previous HIV intervention in the past 12 months, the majority in a correctional setting or CBO program. There were few systematic demographic differences between the two groups. Those who had been in an intervention reported using male and female condoms significantly more frequently on all measures of condom use, had positive condom use outcome expectations for male condoms and higher affective and situational condom-related self-efficacy beliefs. These data suggest that, at a community level, the spectrum of HIV risk-reduction programs does produce a significant improvement in condom use and related cognitions, although there is a need to cover a greater proportion of the population. Previous exposure to interventions must be a critical covariate in assessing the impact of future interventions.

Accounting for Failures May Improve Precision:Evidence Supporting Improved Validity of Self-Reported Condom Use

To determine whether a measure of unprotected vaginal sex that is adjusted for condom failures would produce improved accuracy in predicting biologically confirmed STDs (chlamydia and gonorrhea) among female teens. Self-reported measures were collected using audio-computer-assisted self-interviewing. DNA amplification for the presence of Chlamydia trachomatis and Neisseria gonorrhoeae was conducted. The unadjusted measure of unprotected vaginal sex was not significantly associated with biologically confirmed prevalence of STDs (prevalence ratio [PR] = 1.51; 95% CI = 0.71-3.21; P = 0.28). Alternatively, the adjusted measure achieved significance (PR = 3.59; 95% CI = 1.13-11.38; P = 0.014). More than one quarter (25.6%) of teens using condoms inconsistently and/or incorrectly tested positive for an STD compared to 7.1% among those reporting the consistent and correct use of condoms. Findings demonstrate that studies of condom effectiveness should use an adjusted measure of condom use to achieve precision and rigor.

Thinking Aloud to Create Better Condom Use Questions

Measuring the effects of HIV/AIDS prevention efforts through self-reported condom use data is problematic since such data are frequently subject to bias. The purpose of this study was to pretest a sexual behavior instrument to identify ways to improve comprehension and decrease recall and social desirability bias. The method used was cognitive interviewing, in which fifteen sex workers were asked to “think aloud” as they problem solved simulated tasks. Results indicated that (1) a lexicon of culturally appropriate terms for sex and partner types should be provided to interviewers, (2) recall of sexual behavior may be aided by using grids to record information, and (3) social desirability may be decreased if trust is established with the participants. Using the “think aloud” method to pretest instruments may help improve the validity of self-reported sex acts, but only more objective measures of condomuse may help to quantify such improvements.

HIV prevention heuristics and condom use among African-Americans at risk for HIV

The goal of this study was to improve understanding of whether incorrect HIV/AIDS heuristics and characteristics-based risk theories are barriers to HIV prevention among young African-Americans at increased risk for HIV. We explored: (1) the beliefs of men and women regarding disease prevention strategies, and (2) the relationship of such beliefs to safer sexual behaviours. In Phase I, semi-structured individual interviews were conducted with both members of 22 heterosexual couples at increased risk for HIV/STIs. Subsequently, in Phase II, structured individual interviews were conducted with another 40 women and 40 men (not couples). Participants in Phase I reported use of condoms and monogamy as major strategies for disease prevention. The beliefs that were endorsed by the largest percentage of Phase II participants were related to the ‘known partners are safe partners’ and ‘trusted partners are safe partners’ heuristics. Moreover, stronger endorsement of the ‘known partners’ heuristic was negatively associated with measures of condom use and pregnancy prevention behaviour. Our findings highlight the need for interventions and programmes to encourage intimate partners to consistently use condoms until both members of the dyad are tested and agree to mutual monogamy.

Condom Influence Strategies in a Community Sample of Ethnically Diverse Men and Women1

Few studies have examined comprehensively the ways in which men and women at risk for HIV infection influence their partners to use condoms. This study examines the condom influence strategies (CISs) of an ethnically diverse community sample of 113 (55% male) heterosexually active men and women. Results indicate that individuals at risk for HIV endorse a variety of CISs (withholding sex, direct request, seduction, relationship conceptualizing, risk information, deception, and pregnancy prevention) when attempting to procure condom use with a sexual partner. These CISs were related significantly and meaningfully to a set of safer sexual variables including 3 measures of condom use. Significant gender differences in CISs were not found. Results suggest that safer sexual behavior theories should continue to focus on interpersonal aspects of condom use and underscore the importance of an interpersonal approach to safer sexual intervention.

Association between condom use and HIV infection: a randomised study of self reported condom use measures.

STUDY OBJECTIVE: To compare the association between different measures of condom use and prevalent HIV infection. DESIGN: Randomised cross sectional study to assess association between HIV infection and different measures...

Measuring condom use among sex workers in the Dominican Republic.

The purpose of this paper is to assess the internal consistency of self-reported condom use among sex workers in Puerto Plata and Santo Domingo, Dominican Republic. We examined the responses to questions about condom use among 4 cross-sectional samples of sex workers. We compared measures based on: (1) questions using always-to-never scales; (2) questions about use with the past 5 clients; and (3) questions about use in the past week obtained from a retrospective coital log. In each sample, more women reported 'always' using condoms with clients than with each of the past 5 clients. In 3 of the 4 samples, only about half of the women who reported 'always' using condoms used condoms with the most recent 5 clients and with all clients in the past week. Internal consistency was significantly higher when the comparison was limited to use with the most recent 5 clients and use in the past week. Self-reported measures of condom use can be difficult to interpret. Assessing the internal consistency of several measures of use provides insight into the strengths and weaknesses of each measure.

Association of sexually transmitted diseases and infection with the human immunodeficiency virus: biological cofactors and markers of behavioural interventions.

Sexually transmitted diseases (STDs) interact uniquely with HIV infection, regardless of the form of sexual transmission of HIV. Both STDs and HIV infection are behaviorally and biologically intertwined with one another. This concept is called epidemiologic synergy since they facilitate the sexual transmission of one another. Assuming that one accepts this concept, innovative and comprehensive STD control programs along with community and individual-based prevention programs should provide a more effective HIV control program by reducing the efficiency of HIV transmission in high-risk individuals. Public health workers can assess the effectiveness of these programs by monitoring incident STDs in high-risk groups. Other benefits of using incident STDs as markers for HIV prevention include: biological validation of self-reported behavioral change, possible association between self-reports of behavioral change and recall or social desirability bias, representation of a major target population for HIV programs by people at risk for STDs, and sensitive, specific, and noninvasive STD-assays. Disadvantages of using incident STDs as markers for HIV prevention are: incident STDs are unreliable for detecting deficiencies in one individual component (i.e., condom use), they can be used only in areas with a high STD prevalence and high transmission probability, STD diagnostic assays are not 100% sensitive and specific, and untreated/undetected STDs at enrollment may be mislabeled as incident STDs at follow-up. Questions remain about the validity of self-reported condom use and the use of STDs to evaluate individual intervention measures, e.g., condom use within a short period of time. Monitoring of HIV incidence would be ideal, but it may take too long. Valid measures of condom use and other risk behavior are needed to determine risk status and changes in risk status over time. Thus, further research is needed to develop more accurate measures.

In Response: Condom Use to Prevent Incident STDs

In Response: Condom Use to Prevent Incident STDs

Does grandma need condoms? Condom use among women in a family practice setting.

To examine the relationship between age and condom use among women who are typically seen in the primary care setting. Survey of a population using a self-administered questionnaire. Four community-based family practice clinics located in a low-income, racially mixed geographical area. All consenting patients (N = 995) during their visits for routine Papanicolaou tests. The mean age of patients was 35 years, with a range of 75 years (12 to 87 years). Respondents were predominantly black (63.2%), 39.2% were single, and over 65% had incomes no greater than $15,000/y. The outcome measure of condom use is reported. Data analysis of patients' sexual behavior revealed that older women might be at risk for sexually transmitted diseases (STDs). The hypothesis that condom use is related to age emerged during data collection. Condom use is related to being younger (< 31 years), having had an STD, having a sexual partner in whom an STD was diagnosed, having a lower income, or being single or black. In multivariate models, marital status (single), age (< 31 years), and having a partner with an STD remain significant. Among unmarried women, the effects of age, race, and a partner with STD remain, and being a nonsmoker is also significant. In the multivariate analysis for unmarried women, only age (< 31 years) is significantly related to condom use. An independent random sample of charts revealed that almost 45% of the patients aged 45 years or younger received condom counseling, whereas condoms were discussed with none of those older than 45 years. Because older patients (those beyond child-bearing years) are less likely to use condoms and evidently receive little education about condom use, older patients must be educated about the need for condoms.

Validation of measures of condom and other contraceptive use among women at high risk for HIV infection and unitended pregnancy.

This study assessed the applicability of the transtheoretical model of behavior change (J.O. Prochaska & C.C. DiClemente, 1983, 1984) to the measurement of contraceptive use among 296 women at high risk for HIV infection and transmission. Structural equation modeling suggested that a measure of general contraceptive use could be used to assess use of oral contraceptives and hormonal implants but that measurement of condom use required separate assessments for main and other partners. Self-efficacy (SE) and decisional balance scales were internally consistent for general contraceptive use, for condom use with main partners, and for condom use with other partners. Consistent with research on other health behaviors, SE scores rose significantly across stages, from precontemplation to maintenance, and a shift in decisional balance was observed for 2 of 3 behaviors. This measurement strategy may enhance the ability to evaluate prevention programs for women at risk.The authors assessed the applicability of the transtheoretical model of behavior change to the measurement of contraceptive use among 296 women at high risk for HIV infection and transmission. Data were collected in 1992 from the US Centers for Disease Control's multisite Prevention of HIV in Women and Infants Demonstration Project. In the transtheoretical model, which originated from smoking cessation and psychotherapy research, behavior change is a gradual, continuous, dynamic process in which people move through a sequence of five stages. Structural equation modeling suggested that a measure of general contraceptive use could be used to assess the use of oral contraceptives and hormonal implants, but that measurement of condom use requires separate assessments for main and other partners. Self-efficacy (SE) and decisional balance scales were internally consistent for general contraceptive use, for condom use with main partners, and for condom use with other partners. SE scores rose significantly across stages, from recontemplation to maintenance, and a shift in decisional balance was observed for two of three behaviors. This measurement strategy may enhance the ability to evaluate prevention programs for women at risk.

Validation of measures of condom and other contraceptive use among women at high risk for HIV infection and unintended pregnancy.

This study assessed the applicability of the transtheoretical model of behavior change (J.O. Prochaska & C.C. DiClemente, 1983, 1984) to the measurement of contraceptive use among 296 women at high risk for HIV infection and transmission. Structural equation modeling suggested that a measure of general contraceptive use could be used to assess use of oral contraceptives and hormonal implants but that measurement of condom use required separate assessments for main and other partners. Self-efficacy (SE) and decisional balance scales were internally consistent for general contraceptive use, for condom use with main partners, and for condom use with other partners. Consistent with research on other health behaviors, SE scores rose significantly across stages, from precontemplation to maintenance, and a shift in decisional balance was observed for 2 of 3 behaviors. This measurement strategy may enhance the ability to evaluate prevention programs for women at risk.

HIV Infection in Thailand: The Use of Condoms-Reply

In Reply. —Dr VanLandingham is critical of the measure of condom use given in our study of HIV infections in young men in northern Thailand. We used self-reported condom use with last CSW instead of usual condom use in order to improve the recall of the subjects. However, we asked participants several questions about their use of condoms, including frequency of usual condom use with CSWs and other sexual partners. Each of these condom-use variables was examined for its association with HIV-1 prevalence in univariate and multivariate analysis. In univariate analysis, we found either no significant association between reported condom use and HIV-1 prevalence or an increased prevalence associated with more frequent reported condom use with CSWs. For example, among men who reported usually using condoms with CSWs, the HIV prevalence was 18.5%, compared with 13.8% in those reporting some condom use but less than half the time and 9.4%

The impact of AIDS on an urban population of high-risk female minority adolescents: Implications for intervention

Purpose: This study's purpose was to describe acquired immunodeficiency syndrome (AIDS)-related concerns, risk behaviors, and psychosocial/situational determinants of condom use among an urban minority population of sexually active, adolescent girls. In addition we sought to define the accuracy of personal AIDS risk-assessment, the relative importance of AIDS in relation to other concerns, and the broader context of sexual experience and attitudes in this population. Methods: A cross-sectional interview study was conducted involving sexually active female adolescents attending a pediatric clinic in an inner-city university-affiliated community hospital. Sixty-nine subjects (ages 13–19 yr, 90% African-American) were enrolled. While the goals of this study were primarily descriptive, subject characteristics felt to impact on condom use were identified prior to data collection and were examined against several measures of usage including: use at the time of last sexual intercourse, overall frequency of condom use, and reported behavior change to include initiation of or increased condom usage. Results: Forty-one percent of participants reported knowing someone with AIDS. Global concern regarding this disease was high, although worry about povertyrelated issues was often greater. Despite concern and high measures of AIDS risk (median number of sex partners, 3; past sexually transmitted disease, 55%; past pregnancy 77%), most participants perceived themselves to be at low personal risk owing to current monogamy, lack of intravenous drug use, and implicit trust in their partner's safety. Discussion with their partner about actual risk and awareness of the importance of past behaviors was generally lacking. Although 98% were aware that condoms may prevent AIDS, 64% used condoms half of the time or less when they had sex and use appeared to be primarily for contraception. Several intrinsic cognitive/psychological and extrinsic social/situational factors were found to correlate with measures of condom use. Conclusions: Participants' sexual histories and behavior emphasize the need for concern regarding AIDS risk in this population. Patterns of sexual behavior and beliefs regarding committed relationships raise challenging questions regarding how to motivate sexually active members of this population to use condoms more frequently. Programs aimed at AIDS prevention among urban minority adolescents need to be cognizant of the larger personal and sociocultural context in which these teenagers are making health-behavior choices.

A comparison of three clinic-based AIDS education programs on female adolescents' knowledge, attitudes, and behavior

Health providers are becoming increasingly aware that adolescents are a population at risk for acquired immune deficiency syndrome (AIDS) and have identified education as essential for prevention. This study evaluates three clinic-based programs designed to determine the effects of education on knowledge and attitudes regarding AIDS and condom acquisition. Seventy-five sexually active females attending adolescent health clinics were randomly assigned to one of three groups: 1) controls (C) receiving no education; 2) education (E) alone consisting of a brief lecture on AIDS; and 3) enhanced education (EE) where the lecture was provided as well as a videotape describing the importance of condom use. All participants completed the AIDS Knowledge Questionnaire —Revised, the AIDS Attitude Survey, a self-report measure of condom use and received a coupon that could be exchanged for free condoms from the hospital pharmacy. A significant effect was found for knowledge, where both E and EE were superior to controls ( p < .001). No statistical differences were noted across groups regarding attitudes or condom acquisition. However, all adolescents in the EE group who reported prior condom use obtained condoms from the pharmacy as compared to the other groups ( p < .05). Our results suggest that educating adolescents in medical settings can improve their knowledge about AIDS. Didactic lectures in combination with videotape presentations on condom use appeared to be the best format for reinforcing an adolescent's existing behavior.