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Determinants

of Condom

Use

Among

Junior

High

School

Students

in a

Minority,

Inner-City

School

District

Ralph

1.

DiClemente, PhD*; Meg Durbin, MD*; David Siegel, MD,

MPH*; Flora Krasnovsky, MA*; Nancy Lazarus, MD, MPHII; and

Terry Comacholl

ABSTRACT. Condoms reduce the risk of human

immu-nodeficiency virus (HIV) transmission; however, their

use among adolescents has been inconsistent. Little is

known about factors which motivate consistent condom

use, particularly among younger adolescents. In a study

designed to identify such factors, 1899 inner-city junior

high school students were surveyed. In June 1988,

stu-dents completed an anonymous self-report questionnaire

assessing HIV-related knowledge, attitudes, and

behav-iors. Among sexually active students (N 403), logistic

regression analysis evaluated the influence of demo-graphic, psychosocial, and behavioral factors on

fre-quency of condom use. Respondents who believe

con-doms are effective in preventing HIV transmission were

2.2 times more likely to report using condoms

consist-ently during sexual intercourse; those with low perceived

costs associated with condom use were 1.9 times more

likely to be consistent users. Number of lifetime sexual

partners was inversely related to frequency of condom

use. Respondents with a history of three or more sex

partners were half as likely to use condoms consistently.

Factors not associated with consistent condom use

in-dude age, age at sexual debut, ethnicity, HIV knowledge,

perceived efficacy to avoid HIV infection, and alcohol

and drug use. School- and community-based HIV

pre-vention programs will have to go beyond the didactic

transfer of factual information and include more

inter-active teaching strategies to improve adolescents’

atti-tudes toward condoms are self-efficacy to increase

con-dom use and to counter negative peer influences and

adolescents’ perceptions of invulnerability. Physicians

are an underutilized source of HIV prevention

informa-tion. They have an important role in counseling

adoles-cents about effective HIV-prevention methods and

dis-pelling misperceptions which hinder consistent condom

use. Pediatrics 1992;89:197-202; minority adolescents, hu-man immunodeficiency virus, condoms, risk behaviors.

ABBREVIATIONS. HIV, human immunodeficiency virus; AIDS,

acquired immunodeficiency syndrome; OR, odds ratio; CL,

confi-dence limit.

Many adolescents engage in sexual and

drug-re-lated behaviors which increase the risk for human

From the ‘Center for AIDS Prevention Studies, University of California, San

Francisco; Bayview-Hunter’s Point Foundation, San Francisco; §

Depart-ment of Medicine, University of California, San Francisco; and IIHuman

Population Laboratory. California Public Health Foundation, Berkeley, CA,

Received for publication Dec 3, 1990; accepted Mar 29, 1991.

Reprint requests to (R.J.D.) Center for AIDS Prevention Studies. University

of California, 74 New Montgomery St. Suite 600, San Francisco, CA 94105.

PEDIATRICS (ISSN 0031 4005). Copyright © 1992 by the American

Acad-emy of Pediatrics.

immunodeficiency virus (HIV) infection. Although

sexual abstinence is the most effective method to

prevent the transmission of HIV as well as other

sexually transmitted diseases, few adolescents adopt

this HIV-preventive behavior once they have become

sexually active. An alternative prevention strategy for

male adolescents who are sexually active is to use

condoms consistently during sexual intercourse and

for female adolescents to insist that their male

part-ners use condoms.6’7 While condoms prohibit the

transmission of viral pathogens, including HIV,8’9

their effectiveness as a risk-reduction strategy is de-pendent on appropriate and consistent use.

Unfortu-nately, increasing consistent condom use among

ad-olescents has been a formidable challenge which has

not yielded widespread success.

While a large proportion of adolescents are aware of the effectiveness of condoms to prevent transmis-sion of HIV,’#{176}a substantially smaller proportion re-port actually using condoms during sexual intercourse

or report using them consistently with each sexual

encounter.”2 Most alarming, recent findings indicate

that adolescents have not markedly changed their use

of condoms in response to the threat of AIDS.’3”4 The

National Academy of Sciences in a recent report has

recommended further research to understand the

fac-tors which influence adolescents’ use of HIV-preven-five behaviors, such as consistent condom use during sexual intercourse, as critical to developing effective programs that promote the adoption and maintenance of HIV-preventive behavior.’5

While a number of factors have been hypothesized as influencing condom use,’6 few studies have

specif-ically explored the determinants of condom use

among adolescents.’7 In one study among older,

pre-dominantly white female adolescents (mean age 17.9

years), Catania and colleagues’8 found that condom

use was associated with perceived enjoyment of

con-doms and sexual communication skills. In a random

telephone survey of Massachusetts adolescents 16

through 19 years of age, Hingson and colleagues’9

reported that adolescents were more likely to use

condoms if they believed that condoms prevent HIV

transmission and do not reduce sexual pleasure, are

not embarrassed about using condoms, and have a

higher perceived risk of contracting acquired

immu-nodeficiency syndrome (AIDS). Marijuana and

alco-hol were also identified as moderating variables

whose use also reduced adolescents’ likelihood of

using condoms.

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While informative, the relevance of these findings for minority or middle (12-15 years of age)

adoles-cents may be limited. It is particularly important to

identify the determinants of condom use among

mid-dle adolescents, whose development is marked by the

initiation and risk-taking, including sexual risk-taking

behaviors. As these behaviors become entrenched,

they become increasingly difficult to modify.20’2’ It is

also important to address HIV risks among minority

adolescents specifically, given the disproportionately high prevalence of HIV disease in blacks and Latinos overall22’23 and amon minority adolescent applicants

for military service.2 Similarly, lower prevalence of

consistent condom use among black adolescents25 and

the higher prevalence of sexual risk-taking and

sex-ually transmitted diseases among minority

adoles-cents compared with their white peers suggest that

this group is at increased risk of HIV infection.263#{176}

The present study examined the influence of

de-mographic, behavioral, and psychosocial factors on

the use of condoms among junior high school

adoles-cents, predominantly nonwhite, from an inner-city

school district in northern California.

METHODS

We conducted a baseline survey to assess adolescents’

know!-edge, attitudes, beliefs, and sexual and drug-related behaviors

related to HIV transmission in preparation for developing a school-based HIV prevention program for ethnically diverse junior high

school students in an inner-city school district in northern

Ca!ifor-nia. Students in three junior high schools (grades 7 through 9) participated after obtaining parental consent, completing an

82-item self-administered survey during a single class period. The

questionnaire assessed three general topic areas: (1)demographic

information; (2) knowledge, attitudes, and beliefs regarding HIV

disease and sexuality; and (3) sexual activity and drug use. Of the

students eligible to participate in the survey, greater than 95% at

each school returned completed questionnaires, yielding a total sample of I 899 students. Twenty-one percent of the students (403) who reported ever having had sexual intercourse comprise the sample for this report.

The Health Belief Model was used as a theoretical framework

to conceptualize variables for inclusion in the questionnaire. The

Health Belief Model has been used most often to understand factors associated with the adoption of preventive behaviors.3132 In addi-lion, this model has been reported to be useful in prior studies of

adolescents’ condom use.” According to the Health Belief Model,

the decision to adopt preventive health behaviors is the result of a

rational decision-making process in which the individual weighs

the costs and benefits associated with adopting the preventive health behavior and their health beliefs and perceptions about disease susceptibility and severity.

Measures

All measures were derived from the self-report questionnaire. Condom use, the outcome variable, was assessed using a

four-point Likert scale ranging from always’ to never.” Approximately

37% of the sample reported that condoms were “always’ used

during sexual intercourse. Those adolescents reporting condoms

‘always being used were classified as consistent condom users.

Adolescents reporting condoms “sometimes,’ “rarely.’ or “never”

being used were classified as infrequent condom users.

General AIDS knowledge was assessed by summing adolescents’ correct responses to five items (AIDS is a condition that destroys the body’s ability to fight disease; AIDS is caused by a virus; only homosexual men get AIDS; there is no cure for AIDS; and you can have AIDS and not know it). High and low AIDS knowledge

categories were determined based on a median split. The

standard-ized s coefficient for the scale is 0.53. This low level of internal

consistency may indicate that the items which comprise the general

AIDS knowledge scale were assessing different dimensions of AIDS

knowledge.

A scale assessing adolescents’ misconceptions about disease

transmission was also developed by summing adolescents’ incorrect

responses to seven items about modes of HIV transmission.

Ado-Iescents scoring in the upper third of the distribution were

catego-rized as having a “high” number of misconceptions about

trans-mission, those scoring within the middle third were classified as

having an “intermediate” number of misconceptions. and those

scoring in the lower third were classified as having “low”

miscon-ceptions of transmission. The standardized a coefficient for the

misconception of HIV transmission scale is 0.77.

Adolescents’ perceived costs of condom use was assessed using

an eight-item scale (sex doesn’t feel as good when you use a condom; having to stop sex to put on a condom takes the fun out

of sex; its embarrassing to buy condoms; condoms are physically

uncomfortable; its hard to find places to buy condoms; choosing

which kind of condom to buy can be confusing; its embarrassing

to talk about condoms with a sex partner; and sex partners often

disagree about whether or not to use condoms). Each scale item

reflects physical, emotional, or accessibility concerns with condom

use. Respondents evaluated each statement using a four-point scale

ranging from (1) “strongly agree,” (2) “agree,” (3) “disagree,” to (4)

“strongly disagree,”. Responses of “strongly disagree” and “disagree”

reflect low perceived costs; responses of “strongly agree” and

“agree” reflect high perceived costs associated with condom use.

Responses were summed across the eight items yielding a

sum-mary score for each respondent. Scores ranged from 8 to 32, with

higher scores reflecting greater perceived costs to the use of

con-doms. The distribution of scores was divided into three equal

groups: low, intermediate, and high perceived costs. Adolescents

categorized as being in the high perceived cost group were

signifi-cantly less likely to be consistent condom users relative to their

peers in the intermediate and low groups (P < .01); however, there

was no statistical difference in the proportion of consistent condom users in the intermediate and low perceived costs groups. Therefore,

the intermediate group was collapsed into the low perceived costs

group. The standardized a coefficient for the perceived costs of condom use scale is 0.61.

Adolescents’ perceptions of condoms’ effectiveness in

prevent-ing HIV transmission were assessed using a four-point Likert scale.

Adolescents’ responses were recoded into two categories: high

perceived condom efficacy (“condoms work very well” and

“con-doms work pretty well to prevent AIDS”) and low perceived

condom efficacy (“condoms work only slightly” and “condoms don’t

work at all”).

Behavioral Measures

Measures of sexual and drug-related risk behaviors were also

based on adolescents’ response to Likert scales or binary choice

questions (yes-no format) from the research questionnaire. These

measures assessed age at sexual debut (12 years of age or younger,

13 through 14, 15 years of age or older); number of lifetime sex

partners (only one, two, three to five, six or more); alcohol use in

the month preceding completion of the survey (“yes,” used alcohol;

“no,” did not use alcohol); history of using street drugs and

intra-venous drugs (“yes. did use drugs; “no,” did not use drugs).

Statistical Analysis

As a prelude to developing a multivariate logistic model

pre-dicting consistent condom use, bivariate tests of proportions

eval-uated whether individual factors were associated with condom

use.33 Prevalence ratios and their 95% confidence intervals were

also calculated to determine the magnitude of the relationship

between potential predictors and consistent condom use. Factors

identified as significantly associated with consistent condom use in

the bivariate analysis were entered into a multivariate logistic

regression analysis to assess the independent contribution of each

factor in predicting condom use.34 Adjusted odds ratios (ORs) and

confidence limits (CLs) were also calculated to assess magnitude of

association between factors and condom use.

RESULTS

The demographic characteristics and frequency of

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relative to the overall population are described in Table 1. The sexually active sample was

dispropor-tionately male and black. Frequency of condom use

was low; 36.6% of sexually active adolescents

re-ported using condoms “rarely” or “never” during

sex-ual intercourse.

Bivariate associations between demographic,

atti-tudinal, and behavior measures and frequency of

condom use are presented in Table 2.

Four factors were identified as significantly associ-ated with consistent condom use (the 95% confidence limits did not include unity): gender, perceived costs

of condom use, perceived effectiveness of condoms

to prevent AIDS, and number of lifetime sexual part-ners. Forty-four percent of girls reported that their

male sex partners always used condoms compared

with approximately 3 1 % of boys who reported that

they always used condoms (P = .015). Adolescents

with low perceived barrier to condom use scores were more likely to be consistent users (42.1%) compared

with peers in the high perceived bamers group (P =

.003), and those who perceived condoms as effective

at preventing AIDS were more likely to report

con-sistent condom use compared with those who

be-lieved that condoms were not effective (P = .001).

An inverse relationship was identified between the

number of lifetime sexual partners and frequency of

consistent condom use, with adolescents who

re-ported more partners less likely to be con5istent

con-dom users during sexual intercourse (P = .002).

Among adolescents reporting one, two, three to five,

or six or more lifetime sex partners, consistent condom

use was reported by approximately 50%, 39.0%,

27.4%, and 272%, respectively.

Factors not associated with consistent condom use

include age, ethnicity, general HIV knowledge,

knowledge of HIV transmission, adolescents’ percep-tion of their ability to protect themselves from

con-tracting AIDS, age at first sexual intercourse, and

alcohol and drug use. On the basis of bivariate anal-yses demonstrating that the proportion of adolescents

TABLE 1. Demographic Characteristics and Frequency of

Con-dom Use

Popu

%

lation

No.

Sexually Active Sample

% No.

Gender

Male 48.0 879 64.2 246

Female 52.0 951 35.8 137

Age, y

11-12 8.9 162 7.8 30

13-14 61.1 1108 59.5 228

15-16 30.0 543 32.6 125

Ethnicity

White 4.7 84 6.2 19

Black 31.3 555 57.6 215

Latino 23.9 425 20.6 77

Asian 33.4 592 10.5 39

Other 4.9 87 6.2 23

Frequency of condom use

Always Sometimes

. . . . . .

. . . . . .

37.1 144

26.3 102

Rarely Never

. . . . . .

. . . . . .

15.2 59 21.4 83

who reported consistent condom use with three to

five and six or more lifetime sex partners was similar,

number of lifetime partners was recoded into three

categories (one partner only, two partners, or three or more partners).

The factors identified in the bivariate analysis as

significantly associated with consistent condom use

were entered into a multivariate logistic regression analysis. The results of this analysis are presented in Table 3.

Three of the four factors-perceived costs of

con-dom use, perceived efficacy of condoms to prevent

AIDS, and having had three or more lifetime sexual

partners-are identified as independent determinants

of consistent condom use. Adolescents reporting low

perceived costs associated with condom use were

almost twice as likely to use condoms consistently

during sexual intercourse compared with peers

re-porting high perceived costs (OR = 1.9; 95% CL =

1 .1 to 3.3). Adolescents reporting three lifetime part-ners were less likely to use condoms consistently than

peers reporting one sex partner (OR = 0.46; 95% CL

= 0.21 to 0.88). Perception of condoms’ efficacy in

preventing AIDS was the most powerful determinant

of consistent condom use (OR = 2.21; 95% CL 1.2

to 4.2). In the logistic regression model, gender was no longer significant. Interaction effects between ad-olescents’ number of lifetime sex partners, perceived

barriers to condom use, and perceived condom

effi-cacy were examined and found not to be significant.

DISCUSSION

In this cross-sectional study of sexually active

ad-olescents from three inner-city, predominantly

non-white junior high schools in northern California, we

found that adolescents’ perceived costs associated

with condom use, the perception that condoms are

effective in preventing AIDS, and a history of fewer

than three sex partners were the most influential

determinants of consistent condom use. The finding

that adolescents with low perceived costs associated

with condom use and those who perceived condoms

as effectively preventing AIDS were more likely to

use condoms consistently corroborates and extends

previous research’8”9 to a minority, middle adolescent

population. Unlike previous studies, however, we did

identify a strong relationship between number of sex

partners and less frequent condom use. This finding is especially alarming since, all things being equal, a history of multiple sexual partners constitutes a sep-arate risk factor for HIV exposure above and beyond that degree of risk attributable to infrequent condom use alone.35

Many of the adolescents who never use condoms

report high perceived costs associated with condom

use, although they had no direct experience with

condoms. In this study, 48.7% of adolescents who

reported “never” using condoms during sexual

inter-course reported high perceived costs of condom use.

As the proportion of adolescents using condoms

in-creased, the proportion of adolescents reporting high

perceived costs decreased. For codom frequency of

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“al-Characteristic No. % Reporting PR# 95%

Consistent CL**

Condom Use

1.4 1.1-1.8

ai 1-12 years of age is the referent category.

t White is the referent ethnic category.

t Low human immunodeficiency virus (HIV) general knowledge is the referent category.

§Low misconceptions of HIV transmission is the referent category.

II

Younger than 13 years is the referent category.

II One lifetime sex partner is the referent category.

# Prevalence ratio.

** 95% confidence limits.

TABLE 2. Bivanate Association Between Potential Determinants and Consistent Condom Use

Gender

Female Male Age

11-12 y

13-14 y

15-16 y

Ethnicity White Asian Black Latino

General HIV knowledge Low

Intermediate High

Misconceptions about HIV transmission

Low

Intermediate High

Self-assessment of ability to protect themselves from contracting AIDS Can protect myself

Cannot protect myself Perceived costs of condom use

Low

High

Perceived condom efficacy to prevent AIDS

High

Low

Age at first intercourse II

12 y

13-14 y

15 y

Alcohol use (in past month)

Yes

No

No. of sex partners (lifetime)1!

1

2 3-5

History of using street drugs

Yes

No

History of injecting street drugs

Yes

No

132 43.9

240 31.3

27 44.4

224 36.2

122 32.0

19 47.4

38 29.0

207 35.8

76 32.9

101 33.7

117 35.0

173 39.9

145 41.4

144 30.6

103 38.8

340 36.8

49 34.7

235 42.1

109 25.7

260 43.5

128 22.2

237 35.0

114 37.7

37 43.2

125 38.4

171 42.7

121 49.6

100 39.0

84 27.4

81 27.2

37 37.8

243 39.5

15 33.3

262 39.7

0.8 0.5-1.3

0.7 0.4-1.2

0.6 0.3-1.2

0.8 0.4-1.3

0.7 0.4-1.2

1.0 0.7-1.5

1.2 0.8-1.6

0.7 0.5-1.0

0.9 0.7-1.3

1.0 0.7-1.6

1.6 1.2-2.3

2.0 1.3-2.9

1.1 0.8-1.4

1.2 0.8-1.8

0.9 0.7-1.2

0.8 0.6-1.1

0.5 0.4-0.8

0.5 0.4-0.8

1.0 0.6-1.5

0.8 0.4-1.7

ways,” the proportion at each category reporting high

perceived costs of condom use was 48.7%, 41.5%,

25.6%, and 22%, respectively. In the absence of direct

personal experience with condoms, adolescents’

neg-ative perceptions may be the result of peer influences and perceived social norms. Although we were unable to assess the influence of peer norms in this study, there are data suggesting that adolescents, particularly

middle adolescents, may be more likely to discount

adult authorities and rely more heavily on peer influ-ences in the formulation of beliefs and behaviors.36

The present findings were derived from a

school-based anonymous survey. While identifying

poten-tially important determinants of condom use, these

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TABLE 3. Results of Multivariate Logistic Analysis*

Characteristic OR Consistent Condom Use

95% CL PValue

Gender

Male 1.00

Female 1.33 0.8-2.2 .32

No. of lifetime sexual part-nerst

1 1.00

2 0.64 0.34-1.2 .24

3 or more 0.46 0.21-0.88 .02

Perceived costs of condom

use High

Low

1.00

1.90 1.1-3.3 .02

Perceived effectiveness of

condoms to prevent

AIDS

Low 1.00

High 2.21 1.2-4.2 .01

* Abbreviations: OR, adjusted odds ratio; 95% CL, 95%

confi-dence limits; AIDS, acquired immunodeficiency syndrome.

tOne sex partner is the referent category.

studies should also include objective surrogate

assess-ments of condom use, whenever possible, as one

means of validating adolescents’ self-report. One

ob-jective measure of condom use, for example, would

be to assess the prevalence of sexually transmitted diseases among adolescents.

IMPLICATIONS FOR PREVENTION

The present findings have several implications for

the development of HIV prevention programs. If

pre-venting the initiation of HIV risk behaviors is the

principal goal of such programs, then they must be

implemented early, before sexual risk behaviors

be-come entrenched. Given the proportion of

adoles-cents engaging in sexual risk-taking while still in

junior high school, prevention programs should be

initiated early, optimally before puberty, to facilitate the development of positive attitudes and self-esteem

as a foundation for reinforcing health-promoting

be-haviors.

The findings also suggest that school- and

com-munity-based HIV prevention programs which

pri-manly emphasize transfer of AIDS information will

not succeed in promoting adolescents’ use of

HIV-preventive measures based on the lack of a significant

influence for both general HIV knowledge and HIV

transmission. The finding of no association between

knowledge and preventive behavior has been

re-ported often’7 and suggests that prevention programs

should avoid relying strictly on didactic methods. To

be effective, prevention programs should employ a

broad spectrum of interactive health education and

communication strategies. Such strategies, including decision-making exercises, rehearsal of self-protective behaviors, and group discussions regarding the value of condoms, may be more effective in increasing

self-esteem and promoting positive attitudes and,

ulti-mately, greater self-efficacy regarding condom

use.37’38 While girls do not use condoms themselves, similar training and skills can be important in influ-encing their male partner to use condoms consistently or avoiding unprotected sexual intercourse.

While school- and community-based prevention

efforts are undoubtedly important, perhaps the most

underutilized prevention channel may be

pediatri-cians and adolescent medicine specialists because

many teenagers will become sexually active while still under their care.39 Further, because many adolescents perceive physicians as the most authoritative source of HIV information,40 they can capitalize on this trust

to enhance the link between the provision of health

care and HIV prevention education. However, a

re-cent survey found that while 80% of adolescents saw

a physician in the year prior to the study, only 13%

were counseled about AIDS.41 Recent findings also

indicate that adolescents who discussed AIDS with a

physician were significantly more likely to be consist-ent condom users.’9 Thus, more consistent assessment

of adolescents’ sexual behavior by physicians and

discussion of effective prevention methods, such as

condom use during sexual intercourse, may dispel

adolescents’ misperceptions and result in increased use of this HIV-preventive behavior. Moreover, while

physicians are an important source of AIDS and

contraception information, they can also serve to

stimulate adolescents to use the information they may

have already received from school- or

community-based programs and reinforce this information as well as clarify issues which remain ambiguous.

ACKNOWLEDGMENT

This research was supported by a grant from the University of

California Universitywide Task Force on AIDS.

REFERENCES

I. DiClemente RJ. The emergence of adolescents as a risk group for human immunodeficiency virus infection. IAdolesc Res. 1990;5:7-17

2. Kipke MD, Hem K. Acquired immunodeficiency syndrome (AIDS) in

adolescents. In: Schydlower M, Shafer MA, eds. AIDS and Other Sexually Transmitted Diseases. Philadelphia, PA: Hanley & Belfus, Inc; 1990;429-449

3, Hem K. AIDS in adolescence. J Adolesc Health Care. 1989;10:IOS-35S.

4. Hem K. Commentary on adolescent acquired immunodeficiency

syn-drome: the next wave of the human immunodeficiency virus epidemic.

IPediatr. 1989;114:144-149

5. Fullilove RE, Fullilove MT, Bowser BP, Gross SA. Risk of sexually

transmitted disease among black adolescent crack users in Oakland and

San Francisco, Calif. JAMA 1990;263:851-855

6. Goldsmith M. Sex in the age of AIDS calls for common sense and

‘condom sense.’ JAMA. 1987;257:2261-2266

7. Stone KM. Grimes DA, Magder LS. Primary prevention of sexually

transmitted diseases. JAMA. 1986;255: I 763-1766

8. Conant M, Hardy D, Sernatinger J, Spicer D, Levy JA. Condoms prevent

transmission of AIDS-associated retrovirus. JAMA. 1986;255:1706

9. Van de Perre P, Jacobs D, Sprecher-Goldberger S. The latex condom. an

efficient barrier against sexual transmission of AIDS-related viruses.

AIDS. 1987;1:49-52

10. DiClemente RJ. Adolescents and AIDS: current research, prevention

strategies and public policy. In: Temoshok L, Baum A, eds. Psychosocial Perspectives on AIDS: Etiology. Prevention, and Treatment. Hillsdale. NJ: Erlbaum Associates, Inc; 1990

1 1. Hayes CD. Risking the Future: Adolescent Sexuality, Pregnancy, and Child Bearing. Washington. DC: National Academy Press; 1987:33-74

12. Jay 5, Bridges CE, Gottlieb AA, DuRant RH. Adolescent contraception:

an overview. Adolesc Pediatr Gynecol. 1988;1:83-95

13. Cates W. The epidemiology and control of sexually transmitted diseases

in adolescents. In: Schydlower M, Shafer MA. eds. AIDS and Other Sexually Transmitted Diseases. Philadelphia, PA: Hanley & Belfus, Inc;

1990:409-427

14. Kegeles SM, Adler NE, Irwin CE. Sexually active adolescents and

con-doms: changes over the year in knowledge, attitudes and use. Am I

Public Health. 1988;78:460-461

at Viet Nam:AAP Sponsored on September 1, 2020

www.aappublications.org/news

(6)

15. Miller 11G. Turner CF. Moses LE. AIDS The Second Decade: Summary.

Washington. DC: National Academy Press; 1990

16. DiClemente RJ. Psychosocial determinants of condom use among

ado-lescents. ln: DiClemente Ri, ed., Adolescents and AIDS: A Generation in

Jeopardy. Newbury Park, CA: Sage Publications, Inc.; in press

17. Becker MH, Joseph JG. AIDS and behavioral change to reduce risk: a

review. An, JPublic Health. 1988;78:394-410

18. Catania JA, Dolcini MM, Coates TJ, et al. Predictors of condom use and

multiple partnered sex among sexually-active adolescent women:

impli-cations for AIDS-related health interventions. J Sex Res. 1989;26:514-524

19. Hingson RW, Strunin L, Berlin BM, Heeren T. Beliefs about AIDS, use

of alcohol and drugs, and unprotected sex among Massachusetts ado-lescents. Am I Public Health. 1990;80:295-299

20. DuRant RH, Sanders JM, Jay 5, Levinson R. Analysis of contraceptive

behavior of sexually active female adolescents in the United States.

Pediatr. 1988;1 13:930-936

21. Emans SJ, Grace E, Woods, ER, Smith DE, Klein K, Merola J. Adolescents compliance with the use of oral contraceptives. JAMA.

1987;257:3377-3381

22. Centers for Disease Control. Acquired immunodeficiency syndrome

(AIDS) among blacks and Hispanics: United States. MMWR.

1986;35:655-666

23. Selik RM, Castro KG, Pappaioanou M. Racial/ethnic differences in the

risk of AIDS in the United States. Am I Public Health. 1988;78:1539’-1545

24. Burke DS, Brundage JF, Goldenbaum M, et al. Human immunodeficiency

virus infections in teenagers. JAMA. 1990;263:2074-2077

25. Fullilove MT. Weinstein M, Fullilove RE, et al. Race/gender issues in

sexual transmission of AIDS. In: Volberding P. Jacobson MA, eds. AIDS Clinical Review. New York, NY: Marcel Dekker mc; 1990:25-62

26. O’Reilly KR, Aral SO. Adolescence and sexual behavior: trends and

implications for STD. /Adolesc Health Care. 1985;6:262-272

27. Guinan M. Sexually transmitted diseases may reverse the sexual

revo-Iution. JAMA. 1986;255:1665-1667

28. Lossick JG. Epidemiology of sexually transmitted diseases. In: Spagna

BA, Prior RB, eds. Sexually Transmitted Diseases: A Clinical Syndrome Approach. New York, NY: Marcel Decker Inc; 1985:21-62

29. Grimes DA. Deaths due to sexually transmitted diseases. JAMA.

1986;255:1 727-1729

30. Fichtner RR, Aral SO, Blount JH, Zaidi AA, Reynolds GH, Darrow WW.

Syphilis in the United States: 1967-1979. Sex Trans Dis. 1983;10:77-80

31. Janz NK, Becker MH. The Health Belief Model: a decade later. Health

Educ Q. 1984;11:1-47

32. Maiman LA, Becker MH. The Health Belief Model: origins and correlates in psychological theory. Health Educ Monogr. 1974;2:336-353

33. Fleiss JL. Statistical Methods for Rates and Proportions. New York, NY:

John Wiley & Sons; 1973

34. Hosmer DW, Lemeshow, S. Applied Logistic Regression. New York, NY:

John Wiley & Sons; 1989

35. Hearst N, Hulley SB. Preventing the heterosexual spread of AIDS. JAMA.

1988;259:2428-2432

36. Fisher JD. Possible effects of reference group-based social influence on

AIDS-risk behavior and AIDS prevention. Am Psycho!.

1988;43:914-920

37. DiClemente RJ, Boyer CB, Mills S. Prevention of AIDS among adoles-cents: strategies for the development of comprehensive risk-reduction

health education programs. Health Educ Res. 1987;2:287-291

38. Flora JA, Thoresen CE. Components of a comprehensive strategy for

reducing the risk of AIDS in adolescents. In: Mays VM, Albee GW,

Schneider SF, eds. Primary Prevention ofAIDS. Newbury Park, CA: Sage;

1989:374-389

39. American Academy of Pediatrics, Committee on Adolescence.

Contra-ception and adolescents. Pediatrics. 1990;86:134-138

40. Helgerson SD, Peterson LR, and the AIDS Education Study Group.

Acquired immunodeficiency syndrome and secondary school students:

their knowledge is limited and they want to learn more. Pediatrics.

1988;8 I :350-355

41. Hingson R, Strunin L, Berlin B. Acquired immunodeficiency syndrome transmission: changes in knowledge and behaviors among teenagers,

Massachusetts statewide surveys, 1986 to 1988. Pediatrics. 1990;85:24-29

OH! - RATS!

Some of the finest rats on the East Coast line up on the judging bench...

It’s the fall show sponsored by the Northeast Rat and Mouse Club, a group

beguiled by the rodents that most people love to loathe. Rat fanciers, especially, confess that until they found the club, theirs was a lonely and more or less secret passion. “We kind of soft-pedaled it because we didn’t want to be pegged as kooks,” says Elizabeth Fucci, club president.

Ms. Fucci. . . is an ardent rat booster. As pets, she explains, they are both loving

and low-maintenance. “Rats greet you, they interact, they try to please,” she says. “They are as close to a dog as you’re going to get in a rodent”...

Fancy rats. . . have been bred and shown in England for almost a century. Shows

in this country began about 20 years ago in Southern California. In 1988, Ms. Fucci

and four other fanciers started the Northeast Rat and Mouse Club. Today, it has

about 100 members, divided about evenly between “ratters” and “mousers,” as they

sometimes call themselves.

(7)

1992;89;197

Pediatrics

Terry Comacho

Ralph J. DiClemente, Meg Durbin, David Siegel, Flora Krasnovsky, Nancy Lazarus and

Inner-City School District

Determinants of Condom Use Among Junior High School Students in a Minority,

Services

Updated Information &

http://pediatrics.aappublications.org/content/89/2/197

including high resolution figures, can be found at:

Permissions & Licensing

http://www.aappublications.org/site/misc/Permissions.xhtml

entirety can be found online at:

Information about reproducing this article in parts (figures, tables) or in its

Reprints

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(8)

1992;89;197

Pediatrics

Terry Comacho

Ralph J. DiClemente, Meg Durbin, David Siegel, Flora Krasnovsky, Nancy Lazarus and

Inner-City School District

Determinants of Condom Use Among Junior High School Students in a Minority,

http://pediatrics.aappublications.org/content/89/2/197

the World Wide Web at:

The online version of this article, along with updated information and services, is located on

American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

References

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