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Why Teens Don't Use Condoms

Consider the condom.

That little bit of latex has the power to curb the spread of HIV/AIDS and other sexually transmitted diseases (STDS) and to prevent transmission of the human papillomavirus (HPV), which can cause cervical cancer. (We wouldn't be debating giving our daughters the Gardasil vaccine if we could count on our girls to make sure their partners used a condom every time they had sex.) And, oh, yeah: Condoms can prevent unwanted pregnancies, too.

So why aren't sexually active adolescents using them every time they have sex?

A study in the September/October issue of the journal Public Health Reports (the study's accessible to suscribers only) has two answers: Young people don't use condoms because they think they make sex less pleasurable and because they think their partners will disapprove.

Those ideas are tough to counter.

Researchers at the Bradley Hasbro Children's Research Center in Providence, R.I., asked 1,410 sexually active people between the ages of 15 and 21 -- all of whom reported having had unprotected sex within the preceding 90 days -- about their experience with condom use. The participants, gleaned from three different cities, included 797 females and 613 males; about half were African American, a quarter Hispanic, and a fifth white.

They reported an average of two partners and about 15 incidents of unprotected sex during the preceding 90 days.

Nearly two-thirds reported they hadn't used a condom the last time they had sex. And more than a quarter hadn't used a condom during any of their sexual encounters during the three preceding months.

Surprisingly (to me, anyway), the older, more-educated participants were the least likely to have used condoms, especially those who were female and either white or Hispanic.

The study suggests that health-care professionals might encourage condom use by talking with kids during office visits, helping them figure out how to talk with sex partners about using condoms and which condoms might be most comfortable. Such interventions could also take place in community settings, the authors posit, such as workshops in which teens could role-play discussions about using condoms.

The study raises as many questions as it answers. For instance, is there any role for parents in this whole condom-use discussion? And if it's the kids who've finished high school -- where presumably they've been exposed to some sex education -- who are skipping the condoms, what does that say about that sex-education curriculum and its effectiveness?

Lead author Larry K. Brown, director of child and adolescent psychiatry research at the Bradley center and a professor at Brown University, says that parents may indeed play a role in fostering condom use, but that this study, aimed at a readership of public-health professionals, focused instead on "what happens in clinics and community-based settings."

As for sex education's impact on condom use, Brown notes that knowledge is only part of the equation when it comes to adolescents' engaging in risky behaviors. Kids are taught over and over again to use seat belts and not to smoke, he points out, yet they continue to ignore those lessons in droves.

So here's my proposal: Let's get the people who do marketing for cigarettes and hyper-caffeinated soft drinks to put their might behind marketing condoms. If condoms were presented as fun and cool, wouldn't kids be more likely to at least buy them, and perhaps even to use them?

You tell me.

By Jennifer LaRue Huget  |  September 12, 2008; 7:00 AM ET
Categories:  Teens  
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Comments

"If condoms were presented as fun and cool, wouldn't kids be more likely to at least buy them, and perhaps even to use them?"

Nope! As you mentioned above it reduces the physical pleasure of the sex act, it's application becomes an interruption to the spontaneous play between the couple, and quite literally, becomes a contradiction to the term "making love".

In other words, the use of a condom goes against natural law. You may as well try to convince water to flow upstream.

Posted by: Father of 4 | September 12, 2008 8:52 AM | Report abuse

I think you can market and teach condom use all you want, but there are some people who refuse to listen. I personally know a highly educated couple in their mid-30s who knew she was ovulating and still had sex. She had run out of the pill and for whatever unknown reason, they chose not to either abstain or use a condom. Of course, they freaked out the next day. They knew better and still did it (and he's a doctor!). Ridiculous.

Posted by: People are stupid | September 12, 2008 9:35 AM | Report abuse

The natural law argument by 'father of 4' cannot be ignored. Sex is a primary human drive that likely short-circuits the mental processes of judgment required for condom negotiation.

There are, however, many things that we do every day which are unnatural. People smoke. There's nothing 'natural' about purposely inhaling smoke from dried leaves. Animals run from smoke.

Yet - the bombardment of cigarette advertising in many cultures has, for all intents, turned an unnatural behavior into a natural behavior for humans. And the thing that most ex-smokers point to as critical in changing that behavior is the presence of a support network.

There is no support network for using condoms. I believe that we can come to accept the unnatural act of wrapping one's penis in plastic in the midst of passion. But not until it's as cool to don a condom as it is to smoke afterward.

Posted by: Tom in PA | September 12, 2008 9:54 AM | Report abuse

Teens are oblivious to common sense to begin with. They're going to live forever. They can drink until they pass out, drive 90+ miles an hour on dark roads, and smoke 3 packs a day. You can't tell them it's dangerous.

Oh, sorry, I'll get off my soapbox. There's no guarantee condoms will prevent all pregnancy, all VD, all AIDS. They can break. My sister's stepdaugher (married at the time) has a son who is the result of a broken condom. The whole family knows it. We call him 'The Leak' but not around her.

Posted by: NW DC | September 12, 2008 10:35 AM | Report abuse

well, teenage males are not going to use a condom unless someone makes them do it. and most teenage girls are not confident enough to make them. so, it is not at all surprising that so few use them.

Posted by: jen | September 12, 2008 11:06 AM | Report abuse

This article and subsequent comments tell a sad tale in this country.

When in Rome..do as the Romans.

They just dont see how weak our society is progressively getting.

Posted by: dcw | September 12, 2008 11:33 AM | Report abuse

Just wanted to remind the author and those reading the article that male latex condomns while lowering the risk of HPV do not fully prevent the spread of HPV OR HERPES. These STI's are not spread by fluid exchange, but are spread by genital contact. Use of the female condomn has a bit more protection because the condomn covers the vulvular area on the woman.

Posted by: Community Health Nurse | September 12, 2008 11:42 AM | Report abuse

Thanks for the reminder, Community Health Nurse!

Posted by: Jennifer Huget | September 12, 2008 11:48 AM | Report abuse

I reached back in my long-ago teen brain to think about why I didn't use condoms. Here's what I got:

I was embarrassed by nudity and didn't want to even touch a penis.

Drugstores did not make condoms accessible.

I didn't want to admit I was having sex.

I wanted it to b about "love", not sex. Romance. Spontaneity.

I had been taught to NOT use birth control - it was a sin.

I didn't really believe I would get pregnant!

Unless you can change and mature the teen brain faster than nature does, it is difficult to imagine getting your point across. Our culture promotes sex in clothing, movies, TV, music - all the things that obsess teens. Teens (and not so youngs) admire celebs who get pregnant sans marriage or even stable relationships.

I think parents have to develop a close relationship with their kids well before they reach the teens and discuss sex and its ramifications with them more than once. Ask your kids, n a conversation, what they would do if a pregnancy happened? How would it change their lives forever? How would they prevent pregnancy? And how would they prevent an incurable STD like AIDS or Herpes?

Posted by: reba | September 12, 2008 12:12 PM | Report abuse

"We call him 'The Leak' but not around her."


You're a horrible human being.

Posted by: TS | September 12, 2008 12:30 PM | Report abuse

Rebas says: "I was embarrassed by nudity and didn't want to even touch a penis.

"Drugstores did not make condoms accessible.

"I didn't want to admit I was having sex.

"I wanted it to b about 'love', not sex. Romance. Spontaneity.

"I had been taught to NOT use birth control - it was a sin.

"I didn't really believe I would get pregnant! "

ALL of this can be "cured" (OK, targeted) in adequate sex education. And should. We teach our kids to drive, don't we?

Posted by: Mark In Irvine | September 12, 2008 1:00 PM | Report abuse

People do not like using condoms. They are a drag -- for all the previously stated reasons. So what. So are unwanted pregnancy and STDs a really big drag. Grow up and deal with it -- no glove, no love!

But having no info about condoms or any other birth control or disease prevention is ridiculous. Real, comprehensive sex education is a much-challenged curriculum and not taught in every school. However, it includes information about proper, relatively effective condom use for birth control and STD prevention. Condom use is not taught even-handedly in (frequently government-funded) abstinence-only education. Of course condoms are not 100% effective, even when properly used -- and that is important information to present. But in abstinence-only education curriculum, "premarital sex" is completely and unrealistically condemned and condoms are derided as being highly ineffective. The realistic recognition of any "premarital" sexual activity is completely absent from this curriculum, so no birth control, STD prevention techniques or pregnancy scenarios would be discussed.

Religion and politics that rant against non-marital sex and birth control are just as much a problem as user reticence toward condoms.

I do wish that girls and women could be given confidence through training in how to say "You have to wear a condom, or I will not have sex with you." And, the now apparently rampant "intercourse alternatives," of oral and anal sex, seen pathetically by many abstinence students as ways of retaining virginity, are not a realistic work around for teens or anyone else -- they can both transmit STDs.

Also, there has to be a way to build greater female self-esteem, so that many girls and women would not be as dependent on male approval -- as expressed in sexual desirability and willingness to engage in sexual activity. Girls like sex, too, but we love "love." And, sadly, sexual attention, desirability and activity can be mistakenly interpreted as some form of "love" to someone, who for whatever reason, has that misplaced need.

Posted by: Anonymous | September 12, 2008 1:49 PM | Report abuse

My mother would have beaten the daylights out of me if she thought I was having sex as a teenager. Sex was never discussed; it wasn't offered in schools back in those days. Gardasil was not invented yet and no way would she allow her daughter to have sex. Mom had 4 kids and the words 'pregnant' or 'sex' were never mentioned. 'Nice' people don't discuss such things.

Posted by: Anonymous | September 12, 2008 1:51 PM | Report abuse

HPV can be spread with or without a condom. Because it is a skin virus, it can be spread from the testicles to the labia, and vice versa. Testicles and labia touch with a condom, hence, condoms cannot stop HPV.

Posted by: Eva Kelley | September 12, 2008 2:59 PM | Report abuse

I wonder why latex allergies weren't in question. Speaking from experience, being allergic to latex can cause very painful outcomes after using a condom; such as hives and UTIs. The risks in using either polyurethane or natural skin condoms are only slightly better than going solo. Really, maybe there should be more investment in finding latex alternatives that work. It could, at least, help solve SOME cases of unprotected sex.

Posted by: Anonymous | September 12, 2008 3:24 PM | Report abuse

It is true that many teens will take chances. But many will listen to reason. When I was at a small liberal arts college in the 70’s it was harder to get accurate information than it is now, but my circle of friends did get it and did act responsibly, even before AIDS. There was no chance that we were going to abstain, because we knew how to prevent unintended consequences and we rejected the shrill moralisms a portion of society directed toward us.

It helped that the woman who ran the college bookstore stocked thoughtful, medically accurate books on all subjects related to sex, and the health clinic staff would tell you anything you wanted to know. Looking back, I have no regrets, and my gang have all become well-adjusted, responsible, productive citizens, many in positions of prominence. I think our group was fairly typical of the whole student body. There were some unhappy parents from time to time (we thought we detected some jealousy behind those wagging fingers), but they got over it. It’s enough to drive poor Mr. Dobson entirely insane.

I think the key is to provide thorough, practical advice to young people, despite the fact that not all will heed. We had that advice, and acted accordingly.

I am glad that my friends and I did not face some of the psychological hurdles others did and still do. Among our peers, we did not try to hide the fact that we had lovers, so we were not troubled by having contraceptives beforehand. We did not feel the need to pretend that “it just happened” so as to excuse the girl involved. We did not have “walks of shame;” we went to breakfast together. We did not put some primitive tribal “price” on virginity until marriage, though many of our relationships, including mine, did end up in marriage. That freed us up to talk about health consequences honestly.

And yes, clever ad campaigns can help. Some time ago there was an anti-smoking ad that showed a beautiful young woman giving a come-on look to a handsome guy- until he took a cigarette from his pocket. As we saw him from her point of view, the cigarette went limp, drooping toward the floor. Not only clever, but medically accurate since smoking causes impotence. But they took that ad off the air because prudes began to complain- and thereby lies our problem. We can’t seem to have an honest conversation about the subject of sex. The failed “abstinence only” effort has been an expensive disaster, predictably. None of us back then would have listened to a word of that drivel. Why should we expect our children to?


Posted by: Virginia Reader | September 12, 2008 3:34 PM | Report abuse

Come on - give us some useful breakdown of the information and possibly answer the questions you raise. Is there a strong correlation between one partner and no condom? Are the older ones who are less likely to use them more likely to have one partner? Are the older ones more likely to be on other forms of birth control? Is there a high correlation between other forms of birth control and not using condoms? Ask some decent questions before you run off and tell the world how awful kids are today!

If you've been dating someone for a year, you're 20 years old, and on birth control, do you really think that they are going to use a condom? Would you? And yet in your grouping you use this person to suggest that kids are stupid, unsafe and promiscious. Is there a high correlation between more than two partners and regular condom use? Ask intelligent questions or go learn how!

Posted by: Chi | September 12, 2008 3:36 PM | Report abuse

let's make males equally responsible please. Men can also refuse to have sex with partners not using protection.

Posted by: c'mon | September 12, 2008 3:41 PM | Report abuse

"Surprisingly (to me, anyway), the older, more-educated participants were the least likely to have used condoms, especially those who were female and either white or Hispanic."

-- When I was in my teens and twenties, it became the norm to go through a period of condom use and then, if the woman was on the pill, nobody had an std, and the relationship was monogamous, stop using them.

So though I wouldn't have had your "average" of 2 partners in 90 days, I would have answered to plenty of "unprotected sex" in those 90 days. I don't think that scenario should be lumped in with the promiscuous crowd and used to buttress an argument that most teens are irrresponsible.

Perhaps the more educated people are using the same rationale I did.

Posted by: Anonymous | September 12, 2008 3:52 PM | Report abuse

Just for the record, polyurethane condoms are equally effective as latex condoms at preventing HIV transmission. Unfortunately, they are more expensive than latex condoms and are less readily available in the stores and via free handouts.

Posted by: DC | September 12, 2008 4:32 PM | Report abuse

Are American teenagers dumber than their European counterparts, or are American adults?

Why is it that the pregnancy rate of teenagers is lower there, than here? They're having sex at as great a rate, right? So what are they learning that we're not teaching?

Obviously, teenagers are just as hormone-addled in other parts of the world as they are here.

Posted by: Grouchy | September 12, 2008 10:28 PM | Report abuse

I'm a young man and I don't use condoms anymore.

First, they take the edge off sex: it's a bummer to put them on.

Second, it's one of the privileges of being in a stable relationship. No diseases involved.

Third, being gay, neither of us can get pregnant.

Posted by: stygyan | September 13, 2008 9:42 AM | Report abuse

Remember: every time you sleep with someone you are sleeping with every person they have ever been with.

As a 22 year old woman I have not always protected myself, but I am proud to say I have changed my ways, and I use a condom EVERY time and am not ashamed to buy them at wal-mart in front of men, women or children. Condoms may 'interrupt' the sex process-- but not if you get it in your brain that they are essential for maintaining health. Sex is not wrong, dirty, or a sin -- it's natural and we need to teach people to naturally think about protection!!

Posted by: LORI NIXON | September 14, 2008 9:40 PM | Report abuse

Teenagers do it their own way - and they would follow a cool ad.

But grown-ups here are prudish and ideological, and they have the funds and the power.

We will get the next generation that we deserve.

Alexa Fleckenstein M.D., physician, author.

Posted by: Alexa Fleckenstein M.D. | September 15, 2008 10:16 AM | Report abuse

The article was terribly incomplete in one respect: it didn't address what proportion of sexually-active teenagers used no contraception, just what proportion didn't use condoms. And it is entirely reasonable for any individual in a stable relationship to forgo condoms. Or is the implication that until you marry (or even afterwards) you must always assume your partner is cheating on you? Or is it just that teens cheat on each other more often than adults?

In any case, here's the other thing: the article didn't claim that teens were ignorant about condoms, or that they didn't know what to do or how to buy them. So sex "education" is irrelevant. What they're talking about is more like "sex indoctrination" -- extended sessions intended not to teach a subject but to modify behavior. And this is troublesome --
-Girls can learn to speak up for themselves without role-playing condom usage. If they're in a relationship where they don't stick up for themselves about condoms, there are certainly numerous other things wrong, too. They should probably be encouraged to get out of that relationship.
-Teens, in general, can be told about the risk of pregnancy and STDs without the "condom" message being drilled into them.
-But if you spend too much time on "Condom, Condom, Condom" sessions, to the point that you drill home two points -- that condom usage is expected, and that, yes, everybody really is having sex, get with the program, and if, as a result, teens use condoms more often, but do pretty much have sex at the same rate as adults, is that really better?

My personal opinion on the lower rates of teen pregancy in Europe is that, one, they don't have the same kind of "underclass" where girls are trapped in bad relationships and wouldn't mind a baby anyhow, and, two, they are more motivated: after all, look at the overall birth rate. If your whole culture doesn't want babies, then wouldn't you, even as a teen, be more motivated to not get pregnant?

(My personal preferance would be sex ed just like consumer education. Schools teach about checkbooks and credit cards even though teenagers don't have 'em, because it's a life skill. How about, "don't have sex 'til you're married, and when you do get married, here's what you need to know." Teens might snicker, but it would get information without being a mixed message.)

Posted by: Elizabeth | September 15, 2008 10:37 AM | Report abuse

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