American adolescents commonly have misconceptions about proper condom use, according to a study of more than 15,000 U.S. teenagers.1 Between 15% and 52% of young people respond incorrectly when questioned on whether space should be left at the tip of a condom during use, on whether petroleum-based lubricants can be used safely with latex condoms and on whether lambskin condoms protect better than latex against transmission of HIV. In general, older adolescents, females and those with sexual experience are about 10-30% less likely than others to have misconceptions about proper condom use.
To assess the prevalence of three misconceptions teenagers have about correct condom use and whether these misconceptions vary with certain characteristics, the researchers analyzed data collected by the 1995 National Longitudinal Study of Adolescent Health. Survey participants were asked to answer "true," "false" or "I don't know" in response to the following three statements: "When putting on a condom, it is important to have it fit tightly, leaving no space at the tip"; "Vaseline can be used with condoms, and they will work just as well"; and "Natural skin (lambskin) condoms provide better protection against the AIDS virus than latex condoms." Researchers used logistic regression to analyze the answers in relation to respondents' age, race, gender, religious affiliation, sexual experience, experience with condoms and perceived knowledge of condom use.
In all, 16,677 young people aged 15-21 participated in the study's interview survey. The study population was almost equally composed of males and females. Nearly 61% of participants were white, 23% were black and the remainder belonged to other racial groups; 18% were Hispanic. Eighty-seven percent of respondents reported a religious affiliation. Forty-seven percent of adolescents reported having had sexual intercourse; of these, 29% reported having had four or more lifetime partners and 28% reported ever having used a condom.
In examining the prevalence of misconceptions, the investigators divided the sample into three groups: sexually experienced adolescents who had ever used condoms, sexually experienced teenagers who had never used condoms and sexually inexperienced respondents. They further divided each group by gender. Using chi-square analyses, they found that sexually experienced young people, regardless of whether they had used condoms, were less likely to have misconceptions about the need to leave space at the top of a condom during use (33-35% of females and 39-40% of males) than were their sexually inexperienced peers (52% of females and 45% of males). Similarly, misconceptions about the use of Vaseline with latex condoms were less prevalent among teenagers who had had sex (27-28% of females and 32-34% of males) than among those who had not (33% of females and 35% of males). All three groups, however, were equally likely to have misconceptions about the relative effectiveness of lambskin and latex condoms (15-20% of females and 21-24% of males). All gender differences were statistically significant.
Teenagers' perceptions of their knowledge of proper condom use did not necessarily correspond to their actual knowledge. Adolescents with experience using condoms who believed that they knew how to use them correctly were no more likely to respond accurately to the three statements than were those with sexual experience who had never used condoms or those without sexual experience. Perceived knowledge related to actual knowledge in the following instances: among males with sexual experience but no experience using condoms, in regard to lambskin versus latex condoms; among females with sexual experience but no experience using condoms, in regard to using Vaseline with latex condoms; and among males and females without sexual experience, in regard to leaving space at the tip of a condom during use.
Using logistic regression analysis, the researchers calculated teenagers' relative odds of having misconceptions about proper condom use. They found that teenagers who reported a religious affiliation were significantly more likely than those who did not to have misconceptions in regard to leaving space at the tip of a condom and whether lambskin is more protective than latex (odds ratios, 1.2 for each). Also, teenagers who reported being unsure about proper condom use were more likely than those who considered themselves highly knowledgeable to have misconceptions in regard to leaving space at the tip of a condom and whether Vaseline can be used with latex condoms (1.2 and 1.1, respectively).
Teenagers with sexual experience and those having four or more lifetime sexual partners were less likely than others to have misconceptions about whether to leave a space at the tip of a condom during use (0.7 and 0.8, respectively). Black teenagers, females and adolescents with sexual experience were less likely than others to have misconceptions about whether it is safe to use Vaseline with latex condoms (0.8-0.9). Female teenagers and those with four or more lifetime sexual partners were less likely than others to have misconceptions about whether lambskin condoms are as effective at preventing transmission of HIV as latex (0.8 for each). Older teenagers were less likely than younger ones to have misconceptions about each of the three statements (0.9 for each).
The researchers note, "The adolescents of this study unknowingly had misconceptions. This finding indicates that asking the target audience if they already know about STD/HIV/pregnancy prevention as an educational needs assessment strategy may not be wise." They add that "prevention education should be provided even if the target audience believes it is already knowledgeable."--J. Rosenberg
1. Crosby RA and Yarber WL, Perceived versus actual knowledge about correct condom use among U.S. adolescents: results from a national study, Journal of Adolescent Health, 2001, 128(5):415-420.