Condom Availability in High Schools Not Linked to Increased Sexual Activity
According to the Centers for Disease Control and Prevention (CDC), in 2001, 46% of high school students reported that they had had at least one sexual encounter. A whopping 82% of these students did not use birth control pills, and 42% did not use a condom the last time they had sexual intercourse. What’s more, data from The Alan Guttmacher Institute show that U.S. teens have higher rates of pregnancy, birth, abortion, and sexually transmitted diseases (STD) than adolescents in other developed countries.
Clearly, there is a need to discourage early onset of sexual activity and to promote the use of protection among American adolescents who are already sexually active. Previous studies have looked at the use and impact of condom availability programs in schools by measuring the number of condoms distributed, changes in attitudes, number of students carrying condoms, and self-reported condom use.
In a recent study published in the February 2003 issue of American Journal of Public Health, researchers compared rates of sexual intercourse among students attending high schools with and without condom availability programs. Their results indicated that sexual intercourse among students in schools where condoms were made available was no more common than rates among students in schools without such programs. Additionally, students who reported being sexually active in the schools with programs were more likely to have used a condom during their most recent sexual encounter.
About the Study
Researchers at The George Washington University School of Public Health and the Academy for Educational Development in Washington, D.C. conducted a cross-sectional study (where subjects are assessed at a single point in time) to determine whether the presence of condom availability programs in high schools is associated with the sexual behaviors of students.
4,166 students in grades nine through twelve were randomly selected to participate. Researchers surveyed the students to find out about their sexual practices. They also looked at HIV instruction, perceptions of condom access, and parental communications regarding ]]>HIV/AIDS]]> . Health coordinators from the various school districts supplied information about condom availability programs to the researchers.
Students in schools with condom availability programs received a greater range of HIV instruction: they were more likely to have received instruction on preventing HIV infection; to have heard a presentation from a person with HIV/AIDS; and to have been taught how to use a condom in school. And yet, they were no more likely—and in fact, were less likely—to report ever having had sexual intercourse or having been sexually active in the preceding three months compared to students in schools without condom availability programs. What’s more, sexually active adolescents in the schools with condom availability programs were twice as likely as those in other schools to report using condoms during their previous sexual encounter. Even after controlling for condom use instruction, these positive associations remained significant.
Although these results are intriguing—and fly in the face of the longstanding argument that school-based contraceptive programs encourage promiscuity—the study suffers from some limitations. First, it was cross-sectional—meaning the findings don’t prove that a cause and effect relationship exists between condom availability programs and sexual practices. In addition, communities that implemented such programs likely differ from schools that don’t, in ways that aren’t apparent in this study but that could have influenced the outcomes.
How Does This Affect You?
The results suggest that skills-based prevention programs can indeed delay onset of sexual activity and reduce high-risk behaviors among sexually active adolescents. However, the study could not say whether it was the programs themselves that were associated with responsible sexual practices or merely the supportive environment. (Just having the programs, for instance, might signal approval of condom use to students—by school administrators as well as parents).
In any case, local policies promoting public discussion on sensitive issues like adolescent sexual health remain important. Studies like this one can help move the discourse from strictly ideological rhetoric to thoughtful science-based deliberation. Future research should follow students’ sexual behavior over the four years of high school in order to more reliably determine if and how condom availability programs actually reduce the harmful outcomes associated with early sexual activity.
The Alan Guttmacher Institute
National Institute of Allergy and Infectious Diseases: An Introduction to Sexually Transmitted Diseases
U.S. Department of Education
Blake SM, et al. Condom availability programs in Massachusetts high schools: Relationships with condom use and sexual behavior. AJPH . 2003;93:1-8.
Adolescents and School Health. Summary Results, 2001: United States. CDC. Available at:
Accessed May 29, 2003.
Teenagers’ Sexual and Reproductive Health. The Alan Guttmacher Institute. Available at:
Accessed May 29, 2003.
Last reviewed May 30, 2003 by ]]>Richard Glickman-Simon, MD]]>
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