Currie, Candace

Kirby, Joanna Louise Michelle

van der Sluijs, Winfried

English

University of St. Andrews - Pure

Attitudes towards condom use among young people

St Andrews Research Repository

IntroductionThe promotion of condom use among young people hasreceived increasing attention, given its importance in reducinglevels of unintended pregnancies and sexually transmittedinfections (STIs). Despite this however, a proportion of youngpeople still fail to protect themselves during sexual intercourseand previous findings indicate condom use as more commonamong boys than girls (Currie et al., 2008). Adolescentcondom use has been shown to be influenced by severalfactors, including personal health values, (Rosengard et al.,2001), previous sexual risk behaviours (Brown et al., 1992),availability of sex and relationships education (Mueller et al.,2008) and communication with parents (Miller et al., 1998).Attitudes and feelings towards condoms and condom use mayalso influence subsequent use of condoms among youngpeople (Bell, 2009; Nguyen et al., 1994). Having a positiveattitude towards contraceptive responsibility, for example, hasbeen associated with a positive effect on intentions to usecondoms among adolescent males (Nguyen et al., 1994).Likewise, embarrassment surrounding purchasing and carryingcondoms has been shown to inhibit acquisition and use ofcondoms among young people (Bell, 2009).The impact of sex education on sexual health and condomuse is still largely unclear. A large proportion of studies haveshown positive impacts on sexual risk behaviour, includingimproved awareness of risk and knowledge of risk reductionstrategies and intention to practice safer sex (Kirby et al., 2005;Wellings et al., 2006). However, other studies have shown nochange, with an investigation of the theoretically based sexeducation programme (SHARE) showing no difference inconception or terminations compared with conventionalprovision (Henderson et al., 2007). This briefing papersupplement investigates attitudes towards condoms amongyoung people in Scotland. It identifies gender differencesbetween attitudes and subsequent use. Associations areexplored between key sex education topics in school andattitudes towards condoms among young people.Summary of main findings• Girls are more likely than boys to feel embarrassed aboutbuying condoms or uncomfortable carrying condoms.There are no gender differences in the proportion of boysand girls who find condoms too expensive to use regularly.• Boys who do not feel comfortable carrying condoms areless likely to use a condom than those who do feelcomfortable or who do not have an opinion on this topic.Among boys, there is no significant association betweencondom use and reporting condoms as too expensive touse regularly, or embarrassment of buying condoms. Nosignificant associations are evident between condomattitudes and condom use among girls.• Among those young people who have positive attitudestowards condoms (do not feel embarrassed buyingcondoms or do not feel uncomfortable buying condoms),boys are more likely than girls to have used a condom atlast intercourse.• Pupils who receive sex education are less likely to havenegative views about condoms than those who have notreceived sex education. With the exception of menstruationand HIV / AIDS, all topics have an association with attitudes(either feeling condoms are too expensive to buy regularlyand/or not feeling comfortable carrying condoms), althoughthe topics influencing these attitudes vary by gender.Having received sex education appears to have nosignificant influence on feeling embarrassed about buyingcondoms for either gender.Attitudes towards condom useYoung people were asked how much they agreed withstatements about buying and carrying condoms. Figure 1shows attitudes towards condoms for boys and girls. Aroundone fifth of boys and girls feel that condoms are too expensiveto buy regularly. However, significantly more girls than boyswould feel embarrassed buying condoms or carrying condomswith them. Almost two-fifths (38%) of boys report that theywould be embarrassed buying condoms compared withalmost half (49%) of girls. Similarly, only one-fifth (20%) of boysdo not feel comfortable carrying condoms compared with onethird (33%) of girls.Attitudes towards condoms and condom useFigure 2 shows the association between attitudes towardscondoms and condom use. Boys who do not feel comfortablecarrying condoms are less likely to use a condom than thosewho do feel comfortable or who do not have an opinion on thistopic. Over four fifths (85%) of those who feel comfortableTHE UNIVERSITY of EDINBURGHHBSC Supplement 18bHBSC is the Health Behaviour in School-Aged Children: WHO Collaborative Cross-National Study October 2010Attitudes towards condom use amongyoung peopleJoanna Kirby, Winfried van der Sluijs and Candace CurrieChild and Adolescent Health Research Unit, The University of EdinburghHBSC SUPPLEMENT No.18bcarrying condoms report having used a condom at lastintercourse, compared with less than three quarters (71%) ofthose who do not feel comfortable carrying condoms, or donot have an opinion on this topic. There is no significantassociation between condom use and feeling condoms aretoo expensive or being embarrassed buying condoms amongboys. No significant associations are evident between attitudestowards condoms and condom use among girls. Among thoseyoung people who do not feel embarrassed buying condomsor have no opinion on the topic, boys (85%) are more likely tohave used a condom at last intercourse than girls (75%).Similarly, among those who do not feel uncomfortable carryingcondoms or have no opinion, 85% of boys report having useda condom at last intercourse compared with 73% of girls.There are no gender differences between positive attitudesand condom use in relation to the price of condoms.Sex education and attitudes towardscondomsYoung people were asked about the sex education theyreceived at school. Over 80% of pupils report discussing eightout of the ten key sexual health topics at schools (personalrelationships, sexual feelings and emotions, menstruation,sexual development, sexual intercourse, getting pregnant /getting a girl pregnant, condoms, other contraceptives,HIV/AIDS and other sexually transmitted infections). Onlydiscussion of menstruation and getting pregnant was reportedto be significantly higher among girls.Positive associations are found between sex educationtopics and young people’s attitudes towards condoms (eitherfeeling condoms are too expensive to buy regularly and/or notfeeling comfortable carrying condoms). The only topics thathave no effect on these attitudes towards condom use foreither gender are menstruation and HIV/AIDS. No significantassociations are found between sex education and feelingFigure 1: Attitudes towards condoms among 15-year-oldsby genderFigure 2: Association between attitudes towardscondoms and condom use by genderFigure 3: Association between sex education topics andfeeling condoms are too expensive among 15-year-olds%ofyoungpeoplewhoagree0102030405060GirlsBoysDon’t feelcomfortablecarrying condoms†Embarrassedto buycondoms†Condoms tooexpensive touse regularly%usedcondomsatlastintercourse0102030405060708090100Disagree or no opinionAgreeGirlsBoys†GirlsBoysGirlsBoysCondoms tooexpensive tobuy regularlyEmbarrassedto buycondomsDon’t feelcomfortablecarrying condoms%reportingcondomstooexpensivetouseregularly0510152025303540No sex educationHad sex educationGirlsBoys†GirlsBoys†GirlsBoys†GirlsBoys†SexualdevelopmentGettingpregnantCondoms Othercontraceptives† Significant difference (p<0.05)† Significant difference (p<0.05)† Significant gender difference (p<0.05)embarrassed about buying condoms for either gender.Figures 3 and 4 show the association between sex educationand feeling condoms are too expensive and feelinguncomfortable carrying condoms respectively. Figure 3 showsthat boys who have sex education on sexual development,getting pregnant, condoms and other contraceptives are lesslikely to find condoms too expensive, compared with thosewho have not received sex education on these topics.Although a positive trend appears to be present, no significantassociations are found among girls. Figure 4 shows that boyswho have received sex education on personal relationships,sexual intercourse or condoms, are less likely to report feelingHBSC SUPPLEMENT No.18buncomfortable about carrying condoms than those who havenot. Among girls, those who have received sex educationabout sexual feelings and emotions, sexual development andSTIs are less likely to report feeling uncomfortable aboutcarrying condoms than those who have not.DiscussionThis briefing paper has shown how attitudes towards condomuse vary by gender, and how this is associated with condomuse. It also shows how the sex education topics covered inschool may influence young people’s attitudes towardscondoms. Findings showed more positive attitudes towardscondoms among boys than girls. Girls were more likely to feelembarrassed buying condoms than boys and moreuncomfortable carrying them than boys. Furthermore, whilehaving more positive feelings towards carrying condoms wasassociated with using condoms among boys; this was not thecase for girls. Although reasons for this gender disparity arenot further investigated within the HBSC survey, previousqualitative findings have shown that buying and carryingcondoms in advance could suggest that sexual intercourse isanticipated; a label which is often seen as undesirable amonggirls (Bell, 2009). As such, this may be an area which needs tobe addressed within SRE. Although no significant associationswere found between finding condoms too expensive to buy, orbeing embarrassed buying condoms and condom use, it isimportant to note that since the 2006 HBSC survey, theavailability of free condoms has improved in Scotland (e.g.c:card, a free condom service), as a result of the nationalsexual health strategy, Respect and Responsibility (ScottishExecutive, 2005). Issues surrounding condom price,purchasing and availability may therefore be changing andwarrant further investigation.Sex education in schools is common among both genders,with high proportions of pupils reporting having discussed themajority of key sexual health topics at school. An importantand encouraging finding is the effect of sex education onattitudes towards condoms among young people. Resultshighlight the importance of sexual health education in helpingto form positive attitudes towards condom use, particularlyamong boys. However, the types of topics which provedeffective differed between boys and girls. This suggests thatboys and girls may respond to different types of sex educationand that lessons may benefit from being gender specific. Sexeducation on HIV/AIDS was not shown to have anyassociations with attitudes towards condoms. This maysuggest that young people’s knowledge and/or understandingof HIV/AIDS is limited, or that an association is not being madebetween HIV/AIDS and condom use among young people. Arecent study has indicated that the relationship betweenHIV/AIDS knowledge and sexual behaviour is indeed complex.Findings indicated that better knowledge of HIV/AIDS couldlead to more consistent condom use; however, adolescentswho started sex earlier and used condoms inconsistentlytended to be more knowledgeable about HIV/AIDS (Berten andvan Rossem, 2009).The findings from this paper must of course, be consideredin relation to its strengths and limitations. Our findings suggestthat sex education has an effect on influencing young people’sattitudes towards condoms, and that these effects differbetween boys and girls. It is important to recognise therefore,that other factors may be of more relevance to girls and thatgender specific sex education may help to support changes ingirls’ sexual health. It must also be acknowledged thatattitudes towards condoms may be influenced by other factorsnot covered in this briefing paper, such as family structure,socio-economic status, family, peer and other socialinfluences. The subjective nature of pupils’ reporting of theirsex education and attitudes towards condoms must also beconsidered. A previous study also demonstrated that in aFigure 4: Association between sex education topics andfeeling uncomfortable carrying condoms among 15-year-olds%reportingfeelinguncomfortablecarryingcondomsPersonalrelationshipsSexual feelingsand emotionsSexualdevelopmentSexualintercourse0102030405060No sex educationHad sex educationGirlsBoysGirlsBoys†GirlsBoys†Girls†BoysGirls†BoysGirlsBoys†Condoms STIs† Significant difference (p<0.05)Contact for informationDr Winfried van der SluijsChild and Adolescent Health Research Unit (CAHRU)The Moray House School of EducationThe University of EdinburghSt Leonard’s Land, Holyrood RoadEdinburgh EH8 8AQT: 0131 651 6268E: winfried.van.der.sluijs@education.ed.ac.ukW: www.education.ed.ac.uk/cahruThe University of Edinburgh is a charitable body, registered in Scotland, with registration number SC005336.HBSC SUPPLEMENT No.18bgroup of young people who received HIV education 5-12weeks prior to a survey, only two-thirds remembered attendingthe sessions when later questioned (Brown et al., 1992).These results highlight the importance of further developingpositive attitudes towards condoms among young people.Certain types of sex education are associated with youngpeople’s attitudes towards condoms, however these differ bygender. The importance of gender specific sex education istherefore highlighted. Importance must be placed onimproving both adolescent boys’ and girls’ feelings towardsobtaining and carrying condoms and reducing their inhibitionsin the practicalities associated with this.Additional measures used in this briefingpaperSex education at schoolYoung people were asked about how often they had receivedschool classes on a variety of topics. Have you had anyclasses at school that have given information or discussed thefollowing topics? Personal relationships with boyfriends orgirlfriends / Sexual feelings and emotions / Menstruation(periods) / Sexual development (puberty) / Sexual intercourse /Getting pregnant or getting a girl pregnant / Condoms / Othercontraceptives / HIV or AIDS / Other sexually transmittedinfections (No / Yes, once / Yes, a few times / Yes, many times)Attitudes towards condom useYoung people were asked about their attitudes towardscondoms. Here are some statements about condoms. Pleasesay how much you agree or disagree with each one. Condomsare too expensive to use regularly / I would be embarrassed tobuy a condom / I don’t feel comfortable carrying condoms withme. (Agree a lot / Agree a bit / Neither agree nor disagree /Disagree a bit / Disagree a lot)References:Bell J. (2009) Why embarrassment inhibits the acquisition and use ofcondoms: A qualitative approach to understanding risky sexualbehaviour. Journal of Adolescence, 32, 379-391.Berten H. and Van Rossem R. (2009) Doing worse but knowing better:an exploration of the relationship between HIV/AIDS knowledge andsexual behavior among adolescents in Flemish secondary schools.Journal of Adolescence, 32, 1303-1319.Brown LK, Diclemente RJ, and Park T. (1992) Predictors of condom usein sexually active adolescents. Journal of Adolescent Health, 13, 651-657.Currie C et al (eds) (2008) Inequalities in young people’s health: HBSCinternational report from the 2005/2006 Survey. Health Policy forChildren and Adolescents No. 5, WHO Regional Office for Europe,Copenhagen, Denmark.Kirby D, Laris BA and Rolleri L. (2005) Impact of Sex and HIVEducation Programs on Sexual Behaviors of Youth in Developing andDeveloped Countries. Youth Research Working Paper No 2. FamilyHealth International.Henderson M, Wight D, Raab GM, Abraham C, Parkes A, Scott S. andHart G. (2007) Impact of a theoretically based sex educationprogramme (SHARE) delivered by teachers on NHS registeredconceptions and terminations: final results of cluster randomised trial.British Medical Journal, 334, 133.Miller KS, Levin ML, Whitaker DJ and Xu X. (1998) Patterns of condomuse among adolescents: the impact of mother-adolescentcommunication. American Journal of Public Health, 88, 1542-1544.Mueller TE, Gavin LE, and Kulkarni A. (2008) The association betweensex education and youth’s engagement in sexual intercourse, age atfirst intercourse, and birth control use at first sex. Journal of AdolescentHealth, 42, 89-96.Nguyen MN, Saucier J-F and Pica LA. (1994) Influence of attitudes onthe intention to use condoms in Quebec sexually active maleadolescents. Journal of Adolescent Health, 15, 269-274.Rosengard C, Adler NE, Gurvey JE, Dunlop MBV, Tschann JM, MillsteinSG and Ellen JM (2001) Protective role of health values in adolescents’future intentions to use condoms. Journal of Adolescent Health, 29,200-207.Scottish Executive (2005) Respect and Responsibility: Strategy andAction Plan for Improving Sexual Health. Edinburgh. Scottish Executive.Wellings K, Collumbien M, Slaymaker E, Singh S, Hodges Z, Patel Dand Bajos N. (2006) Sexual behaviour in context: a global perspective.The Lancet, 368, 1706-28.

Doing worse but knowing better: an exploration of the relationship between HIV/AIDS knowledge and sexual behavior among adolescents in Flemish secondary schools.

Impact of a theoretically based sex education programme (SHARE) delivered by teachers on NHS registered conceptions and terminations: final results of cluster randomised trial.

Inequalities in young people’s health:

Influence of attitudes on the intention to use condoms in Quebec sexually active male adolescents.

Patterns of condom use among adolescents: the impact of mother-adolescent communication.

Predictors of condom use in sexually active adolescents.

Protective role of health values in adolescents’ future intentions to use condoms.

Respect and Responsibility: Strategy and Action Plan for Improving Sexual Health.

Sexual behaviour in context: a global perspective.

The association between sex education and youth’s engagement in sexual intercourse, age at first intercourse, and birth control use at first sex.

Why embarrassment inhibits the acquisition and use of condoms: A qualitative approach to understanding risky sexual behaviour.

Attitudes towards condom use among young people

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University of St. Andrews - Pure

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University of St. Andrews - Pure