Early condom use: Good for future teen health
The next patient in your exam room is a young female adolescent. How can you help motivate her when it comes to condom use?
Results from a new study suggest that teens who use condoms the first time they have sexual intercourse are more likely to continue using condoms into young adulthood.1 These adolescents also are less likely than their peers to have contracted a sexually transmitted disease (STD), researchers note.2
The scientists looked at adolescents who participated in the National Longitudinal Study of Adolescent Health, a federally funded, nationally representative study that followed 4,018 sexually active adolescents between 1994 and 2002. All of the teens had had sexual intercourse by the second year of the study. Participants were tested for chlamydia and gonorrhea in 2001 or 2002.
The study found that those who used condoms at sexual debut were 36% more likely to report condom use for their most recent sexual encounter and half as likely to test positive for chlamydia or gonorrhea when compared with those who did not use condoms at sexual debut. The lifetime number of sexual partners did not differ between those who had used condoms during their first sexual experience and those who had not.1
A take-home message is that while the adolescents in the study who used condoms at sexual debut were similar in their number of sexual partners as those who did not, and had the same frequency of sex, they were less likely to test positive for an STD, says Taraneh Shafii, MD, MPH, lead author of the analysis and an assistant professor of pediatrics at the University of Washington in Seattle.
Shafii's research has centered on condom use at sexual debut.2 She uses the analogy of use of seatbelts in cars or helmets in bicycle use; if condoms are used at the first time of intercourse, they become part of the expected experience. "We find through the research that (teens) continue to use (condoms) throughout their sexual activity; and with this most recent paper, even six to eight years later, they're still using condoms and are less likely to test positive for gonorrhea and chlamydia," she notes.
Talk with teens
What is your approach when talking with a young teen about condoms? It is important to gain an adolescent's trust prior to discussing sensitive subjects. A teenager must feel comfortable that the discussion will be confidential, says Shafii.
"As clinicians, we can establish rapport by spending time getting to know the adolescent and letting them have time to feel us out — to see if we are a safe person in which to confide," she states. "Before we start asking our patients about sensitive topics — like sex — we first ask them less intrusive questions about other areas like their home life, how they are doing in school, what they like to do for fun. Once they are comfortable talking with us, we can then proceed to the more difficult questions of alcohol/drug use and sexuality."
Once a trusting rapport has been established, it is time to assess whether the teen is contemplating or is sexually active. To talk about condom use, consider the following dialogues offered by Melanie Gold, DO, FAAP, FACOP, associate professor of pediatrics at the University of Pittsburgh and director of family planning services at Children's Hospital of Pittsburgh. Gold is the co-author of Teen-to-Teen: Teens Talk about Sex, Self-Esteem and Everything In-Between (Bridging the Gap Communications; 2005).
• Tell me what your thoughts are about what you plan to do in the future in terms of protecting yourself against pregnancy and protecting yourself against STDs.
This open-ended question allows teens to share their thoughts about protection. All teens are familiar with condoms, and they have ideas and beliefs about them, Gold says.
• Have you ever used a condom before? What have your experiences been with using them?
This portion of the dialogue allows the teen to list all the good and not-so-good things they perceive about condoms. If a teen starts out listing the "bad" things about condoms, Gold follows up with a statement such as, "You've told me the not-so-good things about condoms. What are some good things about them?"
• On a scale of 0-10, how important is it to you right now in your current situation to use a condom every time you have sex?
Follow this question with:
• On the same scale, how confident are you that you could use condoms, or use them with your partner?
Depending on which number is lower, focus on that question, Gold says. If a teen says, "My confidence is like an 8. I'm sure I could do it if I wanted to, but it's not important to me because I've been with my boyfriend for two years and we trust each other," Gold takes the lower number, and says, "You told me importance was like a 3. How come it's a 3 instead of a zero? What makes it that high?" She keeps asking, "What else makes it a 3 instead of a zero?" until the teen says, "There's nothing else." Then, she comes back with, "What would it take to make it a little more important, say a 4 or 5 instead of a 3?"
If the teen cannot offer any reasons, Gold asks permission to say, "Some kids have told me it would be more important if they thought their partner was cheating on them, or if they got an STD, or if they learned something about their birth control that made them realize it doesn't work as well as they might like it to, or they have a pregnancy scare. For you, what would make it a little more important?"
Gold says this approach, an adaptation of "motivational interviewing," gets teens thinking about the reasons for using condoms, in terms of why they are important, or why they are confident they can use them, while providing the clinician with signals for possibly increasing the teen's use of protection.3,4
What if a teen rejects condom use? Gold suggests a series of sentences as follows: "You know best what is going to be the most helpful for you and your situation. I'm not here to tell you what to do. I'm here to provide you with some information, but ultimately it is your decision and your choice. I'm not going to go home with you and sit on your shoulder and whisper in your ear and tell you what to do."
Gold then reminds the teen that it is his/her choice, and that while she, as their clinician, might be worried or concerned, she hears/understands that to them the decision to not use condoms is completely risk-free. The "completely risk-free" statement may catch teens' attention, because they will recognize that nothing is risk-free, says Gold.
Help teens identify the things they don't like about condoms, and ask them first what ideas they have about ways to get around those things they don't like. If they cannot come up with any solutions, ask them if they would be interested in hearing some things that other teens have found that work for them, offers Gold. If they aren't satisfied with the fit or feel of condoms, offer the idea of lubricants and different condom styles, she notes. "As health care providers, we love to give the solutions, but a teen is more likely to follow the solution they come up by themselves," observes Gold. "They are very solution-oriented and very creative. Teens can come up with really great solutions to their own barriers."
References
- Shafii T, Stovel K, Holmes K. Association between condom use at sexual debut and subsequent sexual trajectories: A longitudinal study using biomarkers. Am J Public Health 2007; Apr 26 [Epub ahead of print].
- Shafii T, Stovel K, Davis R, et al. Is condom use habit-forming? Condom use at sexual debut and subsequent condom use. Sex Transm Dis 2004; 31:366-372.
- Rollnick S, Mason P, Butler C. Health Behavior Change: A Guide for Practitioners. London, UK: Churchill Livingstone; 1999.
- Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change. 2nd ed. New York City: Guilford Press; 2002.
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