Teen condom use drops — What can providers do?
Executive Summary
Results from the 2013 National Youth Risk Behavior Survey indicate that among high school students who are sexually active, condom use has declined from 63% in 2003 to 59% in 2013. This decline follows a period of increased condom use throughout the 1990s and early 2000s.
• When providing instruction on how to use condoms, have patients unroll a condom onto a model of a penis or a banana, with eyes open and then again in the dark.
• Offer to help patients select a condom that is most suitable to their needs. Many clinics provide condoms in different sizes and textures to help patients find what best works for them.
Results from the 2013 National Youth Risk Behavior Survey indicate that among high school students who are sexually active, condom use has declined from 63% in 2003 to 59% in 2013. This decline follows a period of increased condom use throughout the 1990s and early 2000s.1
The Centers for Disease Control and Prevention (CDC) conducts the national survey among a national sample of approximately 13,000 U.S. high school students. In addition, the current report includes results from 42 states and 21 large urban school districts that conducted their own surveys.
The 2013 analysis indicates fewer teens are engaging in many behaviors that place their health at risk, says Stephanie Zaza, MD, director of the CDC’s Division of Adolescent and School Health. These positive steps include reducing cigarette smoking and dropping rates of physical fights. However, the results also indicate that some behaviors that can protect their health, such as using condoms, also are decreasing, notes Zaza.
"While this is still significantly higher than condom use was [which was 46%] in 1991 when the survey first began, we must address these behaviors that increase the risk of HIV and other sexually transmitted diseases, before they become lifelong habits that put young people’s health and safety at risk," says Zaza.
Other public health officials and youth advocates also voiced concern about the drop in condom use among American adolescents. In a statement accompanying the release of survey data, William Smith, executive director of the National Coalition of STD Directors, said, "This data is deeply troubling, especially given that we already know young people bear a disproportionate burden of sexually transmitted diseases [STDs], including HIV. We must be clear: Condoms are the best way to protect against STDs, including HIV, for those who are sexually active, and if youth continue to report a decrease in condom use, efforts to improve sexual health outcomes among this group will not be possible."
Robert Hatcher, MD, MPH, professor emeritus of gynecology and obstetrics at Emory University School of Medicine in Atlanta, points out two reasons why couples are most likely to not use condoms when condom use would be beneficial: "First, when they think they are not at risk; this would be risk for either pregnancy, infection or both," Hatcher observes. "Second, they don’t have a condom when they need it."
These two issues should be dealt with in every program seeking to increase condom use, and they must be explained to every individual or couple for whom condom use would be important, states Hatcher.
Condom use was 59% in 2013
Between 1991 and 2003, condom use increased from 46.2% to 63%. It stands at 59% in 2013. According to the group Advocates for Youth, young people need greater exposure to positive portrayals of condom use to remove the stigma, discomfort, and embarrassment associated with condoms and condom negotiation. Such messages need to be voiced in schools, in communities, and in the media, said Debra Hauser, MPH, Advocates for Youth president in a statement accompanying the publication of survey results.
"There are a few exceptions, but when was the last time we saw characters discuss condoms on TV?" observed Hauser. "Young people need continuous reinforcement that condoms are one of the most effective ways to stay safe and healthy."
Zaza says the CDC is committed to working with partners across the nation to protect young people from HIV, STDs, and unintended pregnancy, but such efforts must be done together.
"Everyone has a role to play — public health officials, healthcare providers, schools, and parents — in ensuring the safety, health, and well-being of youth across the United States," states Zaza. "A number of resources for healthcare providers serving adolescent patients that include information on how to talk to teens about condom use are available from CDC’s Division of Reproductive Health." (To access the CDC resources, visit http://1.usa.gov/1mHi8bC.)
According to Contraceptive Technology, condom effectiveness depends heavily on the skill level and experience of the user.2 Encourage patients to practice using condoms. When providing instruction on how to use condoms, have patients unroll a condom onto a model of a penis or a banana, with eyes open and then again in the dark. Offer to help patients select a condom that is most suitable to their needs, which might include the female condom. Many clinics provide condoms in different sizes and textures to help patients find what works best for them.
Use "What You Need to Know About Condoms" from the Sexual Health: An Adolescent Provider Toolkit produced by the Adolescent Health Working Group to help illustrate how to use condoms.3 (Access the toolkit at http://bit.ly/1nUYWYf.)
Remind patients that a new condom must be used with every act of intercourse if any risk of pregnancy or sexually transmitted infection exists. Also condoms should be donned before any genital contact, with the condom unrolled all the way to the base of erect penis. Immediately after ejaculation, the rim of the condom should be held while the penis is withdrawn, with the used condom disposed of safely.2
- Kann L, Kinchen S, Shanklin SL, et al; Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Youth risk behavior surveillance — United States, 2013. MMWR Surveill Summ 2014; 63 Suppl 4:1-168.
- Warner L, Steiner MJ. Male condoms. In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology: 20th revised edition. New York: Ardent Media; 2011.
- Monasterio E, Combs N, Warner L, et al. Sexual Health: An Adolescent Provider Toolkit. San Francisco, CA: Adolescent Health Working Group. Accessed at http://bit.ly/1nUYWYf.
