Making condoms available in high schools does not increase adolescent sexual activity, but it protects those who are already sexually active from some sexually transmitted diseases, according to a survey of more than 4,000 adolescents attending Massachusetts high schools. "Condom availability was not associated with greater sexual activity among adolescents but was associated with greater condom use among those who were already sexually active, a highly positive result," says Susan M. Blake Ph.D., of the Department of Prevention and Community Health at George Washington University School of Public Health and Health Services in Washington, D.C. "When condoms are available in schools and are successfully used by sexually active adolescents, they may be an effective means of preventing potentially harmful outcomes such as HIV/STDs and pregnancy," she adds.
Approximately half of all adolescents in grades nine through 12 report that they have had sex, with nearly 60 percent using condoms during their most recent sexual encounter, according to research cited in the study.
Blake and colleagues analyzed sexual risk behavior data from the 1995 Massachusetts Youth Risk Behavior Survey with the goal of seeing how students attending schools with condom availability programs differed from those whose schools lacked such programs. Twenty-one percent of the 4,166 students who participated in the survey were enrolled in schools with condom availability programs.
The practice of making condoms available in schools is fairly controversial and many of the small fraction of schools nationwide that do so are in Massachusetts. There, the Department of Education's HIV/AIDS education policy includes recommendations that district school boards consider making condoms - along with instruction on how to use them and HIV/AIDS education - available in secondary schools.
The researchers found adolescents enrolled in schools with condom availability were less likely to report being sexually active or to report having recent sexual intercourse. Also, sexually active adolescents in these schools were more likely to report having used condoms during their most recent sexual encounter. The study results are published in the June 2003 issue of the American Journal of Public Health.
Blake and colleagues found no pregnancy rate differences between adolescents in schools with and without condom availability programs, possibly because sexually active students in schools without condoms available were more likely to use non-condom contraception. Twenty-five percent of sexually active students in schools without condoms available and 13 percent of students in schools where condoms were made available used other forms of contraception.
"We suspect that the benefits of increased condom use may have been offset by use of other contraceptives among students enrolled in the schools without condom availability programs," Blake says.
The researchers also found no differences in perceived access to condoms between those who could get condoms at school and those who couldn't. Students may have been intimidated by the process of accessing condoms through school personnel rather than via a drug store or vending machine. Perhaps "because accessing condoms was likely to result in embarrassment, students did not perceive that access to condoms was greater," Blake says.
But the finding remains that reported condom use was greater among sexually active teens in condom availability schools. Even if these teens were too embarrassed to get condoms at the school clinic, the program may have indirectly influenced them to use condoms:
"It may not have been making condoms available per se that was associated with greater rates of condom use," Blake says, "but rather the fact that the adoption of such programs reflected broader community mores, communicated positive social norms and environmental supports and facilitated communication of family values and norms promoting condom use."
The researchers note the cross-sectional "moment-in-time" nature of their study as a limitation. Because the study was not designed to examine changes in condom use from pre- to post-program, they say, its findings don't definitively prove the condom availability programs influenced teen sexual behaviors.
"Nonetheless, our results suggest that making condoms available, a clear indication of social and environmental support for condom use, may improve HIV prevention practices," Blake concludes.
"There is a continuing need for effective HIV, STD and pregnancy prevention programs that discourage early onset of sexual activity and encourage protection among adolescents who are already sexually active."
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