How Do Adolescent Boys Learn About Condoms? A Qualitative Study

Abstract

Purpose: While epidemiologic data tell us when adolescent boys use condoms, little is known about how boys initially learn about condoms. We examined aspects of learning, such as sources of information, attitudes, acquisition, practice, and early condom use among 14-16-year-old boys. Methods: As part of an ongoing IRB-approved longitudinal qualitative study of relational and contextual influences on STI, 21 14-16-year-old males were recruited from a teen clinic serving a low income community with high rates of STI. Sexual activity was not a requirement for participation. Twice a year participants completed 1 hour face-to-face semi-structured interviews and provided urine for STI testing. At baseline (16 participants) and/or the second interview (5) we asked open ended questions about condoms, including, “Where did you learn about condoms?”, “What are good/bad things about condoms?” and what situations did you/did you not, or would you/would you not, use condoms. Interviews were audio recorded, transcribed, and coded for all instances where condoms were mentioned. Using an open coding approach, we identified key concepts within the “condom” index code, organized these into tentative models and tested them against subsequently collected data. Results: Participants’ mean age was 14.9 years, ethnicities included African American (18), white (2), and Latino (1), and 12 were sexually experienced at baseline. Regardless of sexual experience, 14 participants said that sex feels or would feel different (less pleasurable) with condoms and 11 suggested that condoms often break; withdrawal was often offered as an alternative. No one mentioned lubricants or condom use during oral sex. Family (mostly male relatives) were the primary source of messages about condoms, and of condoms themselves. Information from family was limited to condom use and STIs, and no one described receiving information about healthy relationships or the decision to have sex in the first place (beyond abstinence). Other information sources about condom effectiveness and STI transmission, such as schools and peers, were often considered less trustworthy or less accurate. Nine participants described “checking out” condoms (opening them, touching them) and/or practicing putting on a condom before first use. The type of relationship influenced planned and actual condom use. Participants reported consistent condom use with casual partners, and a drop-off in condom use as relationships evolved or if they perceived themselves ready for fatherhood with that partner. Conclusions: Improved consistency and accuracy in adolescent male condom use may require addressing existing negative perceptions of condoms, the specific relationship contexts of condom use, and the developmental need to test and try on condoms before first use.