The Centers for Disease Control and Prevention say up to one in four teens in the United States will contract a sexually transmitted disease (STD), and experts believe a major contributing factor is the failure of many teens to use condoms consistently and routinely. A new study provides some insight into some of the factors that influence condom use among teenagers.

Researchers from the Bradley Hasbro Children's Research Center and three other institutions surveyed more than 1,400 adolescents and young adults between the ages of 15 and 21 who had unprotected sex in the previous 90 days. They found that teens who did not use condoms were significantly more likely to believe that condoms reduce sexual pleasure and were also more concerned that their partner would not approve of condom use. The findings appear in the September/October issue of Public Health Reports.

"It's clear that we have to address these attitudes, fears and concerns that many teens have regarding condom use, if we want to reduce their risk for contracting a sexually transmitted infection," says lead author Larry K. Brown, MD, of the Bradley Hasbro Children's Research Center. "The good news is that these attitudes may be easily influenced and changed through clinical and community-based interventions."

Study participants in Atlanta, Miami and Providence completed an audio computer-assisted interview to gather information about sexual risk behaviors including condom use within the previous 90 days. Questions included attitudes and perceptions about condom use, and communication and negotiation with partners about condom use. The group included 797 females and 613 males. Approximately half were African American, 24 percent were Hispanic and 19 percent were white.

Nearly two-thirds of adolescents did not use a condom the last time they had sex. Participants also reported an average of two partners and about 15 incidents of unprotected sexual activity within the 90-day period. In addition to concerns about reduced sexual pleasure and partner disapproval, teens who did not use condoms were also less likely to discuss condom use with their partners. These findings held true across racial/ethnic groups, gender and geographic locations.

Based on the study's findings, the authors recommend clinicians carefully monitor and routinely assess the sexual risk behaviors of adolescents and address some of the common attitudes and concerns influencing condom use. For example, clinicians can teach teens how to effectively and respectfully communicate with their partners about using condoms or counsel them about finding condom brands and sizes that provide optimal fit, comfort and sensation.

"These kinds of interventions, including community-based programs, can play a major role in increasing condom use, particularly among high-risk adolescents, and promote their sexual health," says Brown, who is also a professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University.

The study was sponsored by the Substance Abuse & Mental Health Services Administration (SAMHSA). Co-authors are Celia Lescano of the Bradley Hasbro Children's Research Center and Alpert Medical School; David Pugatch of The Miriam Hospital and Alpert Medical School; Ralph DiClemente and Richard Crosby from Emory University, Atlanta; M. Isabel Fernandez from the University of Miami; Sylvia Cohn, Scott Royal, Jacqueline R. Murphy and William E. Schlenger from Research Triangle Institute, Research Triangle Park, NC; and Barbara Silver from SAMHSA.

This research was conducted with the support of the Project SHIELD Study Group – a federally-funded prevention/intervention program aimed at developing and testing ways to encourage and enable behavior change among two subgroups at high risk for HIV infection: adolescents/young adults and women.