Condom Use. The Examined Studies

¶ … condom use. The examined studies concern, respectively, the accuracy of parents' beliefs about condom use, condom use within marriage, and adolescent males' knowledge of and use of condoms. Each examination will take into account the details of each study, including how it was undertaken, results, and the authors' conclusions.

Eisenberg et al.'s (2004) article "Parents' Beliefs About Condoms and Oral Contraceptives: Are They Medically Accurate?" focuses on the accuracy of the education parents give to their children about condoms and oral contraceptives. Multiple national organizations strongly emphasize the need for parents to be their children's primary sex educators, but little is known about how accurately a parent may educate her child (Eisenberg et al., 2004). Moreover, while much research on the impact of parent-child communication about sex has been inconclusive, studies have shown that both teenagers and parents want and value communication about sexuality (Eisenberg et al., 2004). Eisenberg et al.'s (2004) research strives to address this dilemma -- a desire to communicate, but potential incompetence -- by surveying parents' beliefs about the effectiveness, safety and function of condoms and oral birth control.

Participants of the study were 1,049 parents of 13-17-year-olds living in Minnesota (500) and Wisconsin (569), 68% percent of which were female, in their forties and white (Eisenberg et al., 2004). This sample included Catholics and Protestants (Eisenberg et al., 2004). Most parents' highest education level was either high school or bachelor's degree, and the majority was politically conservative or "middle of the road" (Eisenberg et al., 2004, p 53). Almost half had an annual household income of $41,000 to $80,000 (Eisenberg et al., 2004, p 53).

The study was carried out from March through June 2002 via telephone survey, which on average took about 16 minutes to complete (Eisenberg et al., 2004). The investigators queried the participants on how effective they thought condoms were when used regularly and correctly, how well birth control pills worked when used consistently and correctly, and how many teenagers were able to use each method (Eisenberg et al., 2004). Participants could choose to respond with an item from a three-point scale, which generally consisted of something similar to "Very," "Somewhat," and "Not effective" (Eisenberg et al., 2004). Additionally, researchers asked participants about their own sex, age, race, ethnicity, income level, and political orientation (Eisenberg et al., 2004).

Eisenberg et al. (2004) found that a significant segment (over half) of participants underestimated the effectiveness of condoms in relation to STD transmission and pregnancy prevention. A significant portion of parents' also underestimated the effectiveness of oral contraceptives (Eisenberg et al., 2004). The majority believed that most teenagers were unable to use oral contraceptives correctly (Eisenberg et al., 2004). Eisenberg et al. (2004) found that differences in parental beliefs were the result of sex (men held more accurate beliefs about condoms, women held more accurate beliefs about the oral contraceptives), race, and amount of political conservatism.

Eisenberg et al. (2004) conclude that parents are often uncomfortable with talking to their teenagers about sexuality because they lack accurate information. As such, the authors suggest that society has an obligation to educate parents with accurate information (Eisenberg et al., 2004). More specifically, Eisenberg et al.'s (2004) study calls for parental education to be specially tailored for different population segments (mothers, fathers, whites, African-Americans, etc.).

"Condom Use Within Marriage: A Neglected HIV Intervention" by Ali, Cleland & Shah (2004) is concerned with the effectiveness of condoms vs. oral contraceptive pills in developing countries. Specifically, Ali, Cleland & Shah (2004) are concerned with promoting condom use within marriage as a means of protecting against STDs and pregnancy. The need for condom promotion within marriage comes from the fact that between 1990 to 2000, the number of countries affected by HIV epidemics have grown from 25 to 55, and there is an "almost exclusive emphasis on condom use for non-marital sexual contact" (Ali, Cleland & Shah, 2004, p. 180). Compounding the matter are the facts that the use of condoms often is a symbol of mistrust among spouses (and are thus avoided), and that family-planning services -- because they believe that oral and other contraceptive methods are more effective than condom usage -- have made little attempt to promote condom usage among married couples from a fear of a deluge of pregnancies and subsequent abortions (Ali, Cleland & Shah, 2004). Thus, the study addressed the actual effectiveness of condoms compared with the effectiveness in oral contraceptives for contraceptive purposes (Ali, Cleland & Shah, 2004).

Participants in Ali, Cleland & Shah's (2004) study were women of reproductive age (15-49) from 16 countries who had previously completed one or more nationally representative surveys (administered under the auspices of the Demographic and Health Survey project) in which detailed retrospective histories of contraceptive use were recorded (Ali, Cleland & Shah, 2004). These countries included the Dominican Republic, Guatemala, Kenya, Zimbabwe, Brazil, Columbia, Nicaragua, Paraguay, Peru, Bangladesh, Bolivia, Egypt, Indonesia, Morocco, Philippines, and Turkey (Ali, Cleland & Shah, 2004). All these countries are classified by the Joint United Nations Program on HIV / AIDS (UNAIDS) as having generalized, concentrated, or low-level HIV epidemics (Ali, Cleland & Shah, 2004).

To conduct their research, Ali, Cleland & Shah (2004) first did a comparison between discontinuation events for condoms and the pill -- events where women stopped using contraceptives. Discontinuation was the result of three categories: contraceptive failure (accidental pregnancy), dissatisfaction with the specific method, and other reasons that imply no further need for contraceptive use (i.e. desiring a pregnancy) (Ali, Cleland & Shah, 2004). Ali, Cleland & Shah (2004) then looked at the reproductive consequences of contraceptive failure, examining if it resulted in a live birth/current pregnancy that was wanted, mistimed, unwanted, or an abortion.

Ali, Cleland & Shah (2004) found that condom users were more likely than pill users to discontinue usage for any reason, experienced higher failure rates than pill users, and were more likely to discontinue condom usage because of dissatisfaction. The study found that failure most commonly resulted in unwanted or mistimed birth (Ali, Cleland & Shah, 2004).

Ali, Cleland & Shah, (2004) found the results "disappointing," as there is a need for "vastly increased condom use in countries with generalized HIV epidemics" (p. 183). They contest that abandoning condom use can have dire consequences (namely, the increased spread of HIV) (Ali, Cleland & Shah, 2004). Ali, Cleland & Shah (2004) feel that it is not likely that condom use will replace hormonal methods in the short-term, but that the expansion of HIV epidemics may force people to begin using condoms (Ali, Cleland & Shah, 2004). Many instances of disease could be prevented from "legitimizing the condom as a method of family planning" (Ali, Cleland & Shah, 2004).

"A Rose by Any Other Name? Objective Knowledge, Perceived Knowledge, and Adolescent Male Condom Use" by Rock et al. (2005) gathered information about male adolescent's perceived and objective knowledge about condom use, and how this knowledge related to frequency of risky sexual behavior. Rock et al. (2005) cite a number of reasons for this investigation: risky sexual behavior occurs at a high frequency among adolescents, efforts to reduce sexually risky behavior has thus far been focused on adolescent females, rather than males, and one-third of adolescent males report not using a condom the last time they had intercourse. Most importantly, Rock et al. (2005) mention a number of theories that suggest that perceived knowledge, rather than objective knowledge, is often a better indicator of general behavior. Moreover, few studies have addressed perceived knowledge of sex as a precursor to adolescent behavior (Rock et al., 2005).

Participants of the study were extracted from the first two waves of data from the National Longitudinal Study of Adolescent Health (Rock et al., 2005). Participants in said study were 7th to 12th grade students from every high school in the United States that had an 11th grade. The first wave of testing involved a 90-minute in-home computer-assisted interview, in which participants responded to queries regarding "health, risk behaviors, protective factors, family dynamics and attitudes, knowledge and expectations" (Rock et al., 2005, p. 668). The second wave was conducted a year later, coming back to original participants and asking the same questions in an in-home interview (Rock et al., 2005). Rock et al. (2005) restricted their data to that obtained from male adolescents who participated in both wave 1 and wave 2, and who were virgins in wave 1 and had their sexual debut by wave 2.

As predicted by their hypothesis, adolescent males with high perceived knowledge of condom use were more likely to engage in high-risk sexual behavior (Rock et al., 2005). The study found that those with high perceived knowledge but low objective knowledge were more likely than participants with low perceived knowledge and low objective knowledge to report having not used a condom during their last instance of intercourse (Rock et al., 2005).