Changes in Adolescent Males' Use of And Attitudes Toward Condoms, 1988-1991.

Data from more than 1,000 sexually active young males interviewed in 1988 for the National Survey of Adolescent Males at ages 15-19 and reinterviewed in 1990-1991 at ages 17-22 show that as the respondents grew older, their condom use declined. Although respondents' attitudes about the effects of condoms on pregnancy risk, partner appreciation, sexual pleasure and embarrassment became more favorable toward condom use over time, their degree of worry about AIDS and their perceived likelihood of getting AIDS declined. When data on males aged 17.5-19 in each time period were contrasted, the level of condom use was found to be essentially constant. Several condom-related attitudes among this age-group had become more favorable, although their perceived risk of acquiring AIDS had diminished. Multivariate analyses revealed that decreased worry about AIDS and increased denial of the seriousness of AIDS were modestly associated with a decline in condom use. Change in condom use was also affected by change in perceive d reduction in sexual pleasure and by female partner's appreciation of condom use.

(Family Planning Perspectives, 25:106-110 & 117,1993)

Because of increasing public and professional concern about human immunodeficiency virus (HIV) infection, condom use and the factors influencing it have become a major area of research. Researchers have focused particularly on condom use by adolescents because the proportions of teenagers who are sexually active are high, but the proportions infected with HIV are still low. As the National Research Council has noted, "the greatest opportunities for 'getting ahead' of the AIDS epidemic lie in the...populations that currently have low prevalence of AIDS and HIV infection. These opportunities must not be lost or squandered, for once lost, they are gone forever." (1)

Promoting condom use by sexually active adolescents is a major part of the overall strategy for minimizing the spread of HIV. Data concerning how condom use and condom-related attitudes are--or are not--changing among adolescent males can be of considerable value in assessing the success of current efforts to reduce HIV transmission. In this article, we investigate condom use and condom-related attitudes reported in the National Survey of Adolescent Males (NSAM), a longitudinal data set consisting of a nationally representative sample of young men initially interviewed in 1988 and reinterviewed in 1990-1991. This article focuses on condom use in heterosexual sex; trend data on homosexual sex and injectable drug use--other major routes of HIV transmission--are provided elsewhere. (2)

Previous analyses of condom use in the 1988 survey included a comparison with data from the 1979 National Survey of Young Men. (3) In the comparable subsample in the two surveys (17-19-year-old men living in metropolitan areas), the rate of self-reported condom use at last intercourse among those who were sexually active rose from 21% in 1979 to 58% in 1988. Data on condom use reported in samples of females show similar increases. (4) Other analyses have suggested that condom use at first intercourse was markedly greater among men who became sexually active in 1987 or 1988 than among those who initiated intercourse in earlier periods; (5) this trend corresponded to increases in condom sales between 1986 and 1987. (6) Our data enable us to determine whether this trend has continued.

In previous analyses of the 1988 survey, we examined the relationship between condom use and four categories of condom-related attitudes that might motivate condom use: pregnancy prevention; AIDS avoidance; partner expectations; and other personal consequences such as embarrassment and reduction in sexual pleasure. For each category, we assessed young men's perceived personal costs and benefits of condom use and assessed their normative belief in male responsibility to prevent pregnancy. In distinguishing perceived cost-benefits from normative beliefs, we drew on the Theory of Reasoned Action, (7) although we did not assess normative beliefs in the format specified by this theoretical approach.

Five measures--with at least one in each of the four areas--were associated with consistency of condom use: the belief that males have some responsibility for preventing pregnancy; frequency of worry about AIDS; anticipation that a partner would appreciate the respondent's willingness to use condoms; the perception that condoms are embarrassing; and the belief that condoms reduce men's sexual pleasure to an important degree. (8) In addition, denial of the seriousness of AIDS was associated with condom use at last intercourse. Our new data permit us to examine to what extent these and other attitudes related to condoms have changed.