Condom availability in high school does not increase teenage sexual activity but does increase condom use

Making condoms available in high schools does not increase teenage rates of sexual activity, but does result in higher rates of condom use among sexually active students, according to a study of nearly 13,000 public high school students in New York City and Chicago.1 Sexually active students in New York-where condoms are made available to public high school students-were significantly more likely to have used a condom during their most recent act of intercourse than were sexually active students in Chicago, who do not have the same access to condoms.

Data were collected in 1994 from 7,119 students from 12 randomly selected New York public high schools and 5,738 students from 10 Chicago public high schools. New York was chosen for the study because its Board of Education implemented one of the first school condom distribution programs in 1991. Chicago was chosen because it has a large, unified urban school system similar to New York's: Its public schools are ethnically diverse, have a high dropout rate and provide students with education about HIV and AIDS, but not condoms.

Participants were students in grades 912 attending required classes. They completed self-administered questionnaires designed to measure their knowledge, attitudes and behavior related to sexual activity, condom use and HIV prevention. The researchers categorized students who had been in a New York or Chicago public high school for less than one year as "new students." Because these students had not attended their schools for a significant period of time, they probably did not participate in their schools' HIV and AIDS education programs and were used as a proxy baseline measure. The study categorized students who had been enrolled in a New York or Chicago public high school for one year or more as "continuing students."

Nearly 72% of students in both the New York and the Chicago samples were 15-17 years old, 18% were younger and 10% were older. Girls represented 54% of participants in New York and 53% in Chicago. Some 47% of respondents were black, while about 28% were Hispanic, 7% were Asian, 17% were white and fewer than 1% were Native American.

In both cities, 47% of new students and 60% of continuing students were sexually active, and predictably, sexual activity increased with age. Sexually active students in both cities were similar with respect to levels of different kinds of intercourse (vaginal, oral and anal sex), age at first intercourse and age of first partner. One-quarter of sexually active new students and one-fifth of sexually active continuing students in each city said they had had three or more partners in the previous six months.

However, sexually active continuing New York students reported a significantly higher rate of condom use in their last sexual encounter than did their counterparts in Chicago (61% vs. 56%). New students in New York and Chicago were about equally likely to report using condoms during their last intercourse (58% and 60%, respectively).

The researchers used logistic regression techniques to explore the factors influencing the likelihood of condom use at last intercourse among continuing students, controlling for a range of potentially confounding variables, including age, gender, race or ethnicity, number of partners and frequency of intercourse. The results indicated that continuing students in New York were significantly more likely than their Chicago counterparts to have used a condom at last intercourse (odds ratio, 1.4).

For high-risk students-those who reported having had three or more sexual partners in the past six months-the differential by city was even more pronounced. High-risk participants in New York were almost twice as likely as those in Chicago to have used a condom at last intercourse (odds ratio, 1.9). Furthermore, while fewer than 20% of New York's sexually active students said they had received a condom from school, high-risk students said they had done so in significantly higher proportions than low-risk students. A logistic analysis examining factors affecting the odds of sexual activity revealed no difference between continuing students in New York and Chicago. Nor did additional analysis yield significant results for a variety of subgroups and dependent variables.

The researchers concede that having no measurement of condom use among New York high school students before the condom availability program had begun was a major methodological limitation of the study. Nevertheless, they conclude, their findings illustrate that high school condom distribution programs can decrease urban teenagers risk of contracting HIV and other sexually transmitted diseases. School-based condom availability does not increase rates of adolescent sexual activity, as many opponents of public high school condom distribution argue, but does have a modest although significant effect on condom use.

"Thus, the fear that making condoms available will increase sexual activity, a primary political obstacle to making condoms available to high school students, appears to be unfounded," the investigators note. School-based condom availability, they add, is a "low-cost, harmless addition" to high school HIV and AIDS prevention education that deserves policy consideration.-M. Raab

Reference

1. Guttmacher S et al., Condom availability in New York City public high schools: relationships to condom use and sexual behavior, American Journal of Public Health, 1997, 87(9):1427-1433.

Copyright The Alan Guttmacher Institute Jan/Feb 1998
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