Predictors of Condom Acquisition After an STD Clinic Visit.

Data from a survey of 691 men and women who made patient visits to an inner-city sexually transmitted disease (STD) clinic and were given coupons to redeem for condoms at a neighborhood pharmacy show that only 22% of the sample did so. Gender, ethnicity marital status and education were not significant predictors of whether study participants redeemed their coupons. Factors that significantly predicted coupon redemption included the extent of acculturation and age, with those who were older and less acculturated more likely to do so. Other significant factors were having a primary sexual partner and having had more than one sexual partner in the last month; having ever had an STD was negatively associated with coupon redemption. A perception of being at high STD risk and a favorable attitude about condoms also significantly predicted condom acquisition. All these variables, except for attitude toward condoms and a history of an STD, remained significant when entered into a logistic regression controlling for the influence of all independently significant predictors.

(Family Planning Perspectives, 27:29-33, 1995)

A better understanding of the predictors of condom acquisition among individuals at high risk of acquiring and transmitting sexually transmitted diseases (STDs) is needed to plan interventions in the sexual and reproductive health care settings they use. Inner-city public STD clinics treat large numbers of individuals with multiple risk factors for STDs, including frequent unprotected sex, multiple sexual partners, history of an STD and residence in communities with exceptionally high rates of infection with the human immunodeficiency virus (HIV) and other STDs, as well as high rates of unintended pregnancies. (1) Such clinics serve primarily low-income residents, many of whom are recent immigrants to the United States. Specially targeted and culturally appropriate prevention programs are needed to educate different groups within this clinic population and promote consistent condom use, for protection from both disease and pregnancy.

A number of studies have examined patterns and predictors of condom use. (2) Differences by race and education exist in knowledge of and attitudes toward HIV and other STDs, and in self-reported condom use. (3) The extent of acculturation also has been shown to be related to one's perceived HIV risk and high-risk behavior. For example, less acculturated Hispanic men have more positive attitudes toward condoms and carry them more frequently than do more acculturated Hispanic men; (4) however, Hispanics in general may be less likely than non-Hispanic whites or blacks to use condoms. (5) For immigrants from English-speaking countries, to whom the standard language measure of acculturation does not apply, their length of residence in the United States may also influence condom acceptability.

Individuals who are at the greatest risk for HIV and STD infection--such as STD clinic clients--are unlikely to report consistent condom use. (6) Furthermore, the use of contraceptive methods other than the condom has been negatively associated with condom use. (7)

Several studies have documented the relationship between psychosocial factors and self-reported condom use. While these factors may all play some role in predicting condom use, the findings across studies have been inconsistent. (8) Although some studies have shown that gender and cultural background influence psychosocial predictors of condom use, (9) few have been based on samples that were sufficiently large and diverse to fully explore the relationship. Further, most of these studies have been limited by reliance on self-reports of condom use, instead of on behavioral measures.

In this article we use an innovative proxy measure--a strategy of dispensing coupons for condoms that was first employed by Solomon and DeJong (10) -- to identify factors that predict condom acquisition following patient visits to a large STD clinic in New York City. Women and recent immigrants to the United States constitute significant proportions of this clinic populaiton. Thus, the gender and cultural diversity of the patient population make it an ideal sample with which to examine the characteristics of individuals who are sufficiently motivated to redeem the coupon at a local pharmacy. Specifically, we were interested in learning whether there were differences in condom acquisition that would suggest targeting interventions to special population groups. We were also interested in learning the risk profiles of clients who redeemed their coupons--that is, whether motivated clients were at a relatively high or low risk for acquiring an STD.