Objective: To review factors associated with adolescent condom use for the prevention of sexually transmitted diseases (STDs).
Data sources: Thirty-six references on adolescent development, STDs, STD risk factors, and factors influencing condom use among heterosexual adolescents.
Study selection: Twenty-two research articles addressing issues influencing condom use by heterosexual adolescents.
Data synthesis: This review identifies unique risk factors related to adolescents and their risk for STDs, barriers to and facilitators of condom use, and suggestions for health care providers to increase condom use among adolescents.
Conclusions: Although research on condom use among adolescents has inherent difficulties, current findings, along with reported high rates of STDs in this population, indicate infrequent and inconsistent condom use. Many factors contribute to the motivation for condom use and should be assessed individually. Using the Health Belief Model as a theoretical framework, health care providers can guide the adolescent to make realistic risk assessments and identify positive ways of incorporating condoms into their sexual lives. Further research then must be conducted to test the effectiveness of this approach.
PIP: A nurse practitioner at Women's and Children's Health Services in Philadelphia, Pennsylvania, has reviewed 26 documents on adolescent development, sexually transmitted disease (STDs), STD risk factors, and factors influencing condom use among heterosexual adolescents to develop recommendations for STD prevention programs. She uses the constructs of the Health Belief Model (HBM) to incorporate the findings of the literature review into the recommendations. Adolescents tend to use condoms infrequently and inconsistently. They also have a high rate of STDs. The perception that one can enjoy sex with condoms, condom use allows sex at the spur of the moment, condoms are clean and easy to use, condoms are popular with peers, and condoms require the male to be responsible has a positive association with intention to use condoms among adolescents. Among males, the perception of positive attitudes from their girlfriends toward condoms and an increased confidence in their ability to use condoms correctly is positively associated with condom use. Factors associated with nonuse include perceived barriers to condom use (inconvenience, reduced sexual pleasure, or embarrassing to use), increased use of nonbarrier contraceptives since they remove pregnancy prevention as a motivation for condom use, many lifetime partners, intercourse with strangers, multiple sex partners, and alcohol or illicit drug use. HBM focuses on the individual's perceptions, so health providers and educators should assess the individual's needs and how the adolescent's current behavior is meeting these needs. After identifying perceptions about condom use, the provider can intervene. Interventions include targeting misconceptions and perceptions of personal vulnerability and helping the adolescent do a more realistic risk assessment. Providers should focus on the social and physical benefits of condom use rather than just on the health benefits. They should also emphasize modes of STD transmission and effective means of protection, including a demonstration of condom use on a model.