Teens often misinformed about proper condom use
Your adolescent patients may say they know about condoms, but do they understand how to use them correctly? A recently published study reports that misconceptions about proper condom use are common among teens, even among those who have experience with the method.1
It is important that providers become aware of the likely discrepancy between adolescents’ knowledge about condom use and the actual practices related to their use, says the study’s co-author, Richard Crosby, PhD, Sexually Transmitted Diseases (STD) Prevention Fellow in Behavioral Science and Health Education in Atlanta-based Emory University’s Rollins School of Public Health.
Evidence suggests that misconceptions may be common, says Crosby. Thus, correcting these misconceptions may be a good starting point for motivating and instructing at-risk adolescents to use condoms correctly and consistently, he notes.
In the study, researchers analyzed data from the National Longitudinal Study of Adolescent Health to determine prevalence of misconceptions among 16,677 adolescents ages 15-21. The sample was divided into three groups: sexually experienced teens who had ever used condoms, sexually experienced teens who had never used condoms, and teens with no sexual experience.
Each participant was asked to answer "true," "false," or "I don’t know" in response to the following misconceptions regarding condoms:
- When putting on a condom, it is important to have it fit tightly, leaving no space at the tip.
- Vaseline can be used with condoms, and they will work just as well.
- Natural skin (lambskin) condoms provide better protection against the AIDS virus than latex condoms.
Logistic regression was used to analyze the answers in relation to survey participants’ age, race, gender, religious affiliation, sexual experience, experience with condoms, and perceived knowledge of condom use.
Depending on the survey participants’ intercourse experience and experience using condoms, 33%-50% believed the first two misconceptions and about one-fifth believed the third one. Misconceptions were less likely among older adolescents, those ever having intercourse, those reporting four or more lifetime intercourse partners, those who had used condoms, females, and those not reporting a religious affiliation.
Teens’ perceptions regarding their knowledge of proper condom use did not necessarily correspond to actual knowledge, according to the study analysis’ findings. Teens with experience using condoms who believed they knew how to use them correctly were no more likely to score correct responses than those with sexual experience who had never used condoms or those without sexual experience.2
In a separate paper, Crosby et al analyzed responses from a group of sexually active African-American adolescent females.3 Study participants completed a structured interview and provided vaginal swab specimens for STD testing. Subsequent to the interview, teens demonstrated their condom application skills using a penile model. A nine-item scale assessed their perceived self-efficacy to apply condoms.
Approximately 28% of the participants tested positive for at least one STD, and nearly 26% self-reported a history of STDs. Controlled analyses reveal that the teens’ self-efficacy for correct condom use was not related to their demonstrated skill. Also, their demonstrated ability was not related to any of the sexual risk behaviors. Recent experience applying condoms to a partner’s penis and demonstrated ability were not related to laboratory-diagnosed STDs or their self-reported STD history.
"Adolescents may unknowingly be at risk for HIV and STD infection owing to incorrect condom application," the researchers concluded. "Further, high-demonstrated ability to apply condoms was not related to safer sex or STDs."
Sexually active adolescents need more complete information about correct condom use, Crosby asserts. However, reducing sexual risk behaviors may require more than enhancing condom application skills; other relational skills may need to be addressed.
School and community-based programs should provide at-risk adolescents with knowledge, motivation, and skills that will lead toward the eventual adoption of condom use, says Crosby. However, there may be local constraints for these programs in teaching teens about condoms, condom use, and pregnancy/STD/HIV prevention, he notes. It is important that such programs be offered across a variety of venues so adolescents will receive education about condoms and condom use at several junctures during their formative years, Crosby states. "The recent Surgeon General’s Report4 regarding healthy sexuality punctuates the need to provide youth with a substantial sex education program," says Crosby. "Our findings simply suggest that one aspect of these programs should include in-depth education about correct condom use: first, knowledge acquisition, then skill acquisition."
What can you do? Take the time to ask some simple questions of your teen patients, says Ralph DiClemente, PhD, professor of public health and pediatrics at Emory University. DiClemente has authored several papers on adolescent preventive behavior. (See "Ask questions to access teens' condom knowledge," for some helpful questions in discussing condom use with adolescents.)
"This should take about two to three minutes, but you can save a life," says DiClemente. "Two or three minutes with a patient now can save you lots of hours down the road."
References
1. Crosby RA, Yarber WL. Perceived versus actual knowledge about correct condom use among U.S. adolescents: Results from a national study. J Adolesc Health 2001; 28:415-420.
2. Rosenberg J. Young people in the United States are often misinformed about the proper use of condoms. Fam Plann Perspect 2001; 33:235.
3. Crosby R, DiClemente RJ, Wingood GM, et al. Correct condom application among African-American adolescent females: The relationship to perceived self-efficacy and the association to confirmed STDs. J Adolescent Health 2001; 29:194-199.
4. Office of the Surgeon General. The Surgeon General’s Call to Action to Promote Sexual Health and Responsible Sexual Behavior. Rockville, MD; 2001.
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