During the 1980 s, efforts increased to alert the public to the dangers of human immunodeficiency virus (HIV), other sexually transmitted diseases (STDs), and unintended pregnancy, yet these problems have increased. Adolescents and young adults have been especially hard hit. Pregnancy and birth rates among teenagers are at their highest levels in two decades. Research has demonstrated that consistent condom use is an effective way to prevent the transmission of HIV and other STDs and in the prevention of pregnancy. Analyses of the Urban Institute's National Survey of Adolescent Males (NSAM) show that although most sexually experienced teenage males have used condoms at least once, many do not use them consistently.

Only 35 percent reported using a condom every time they had sex in the past year. But teenage males use condoms more than older men, and between 1979 and 1988 reported condom use among male teenagers doubled. These patterns indicate that teenagers are a promising target population for condom promotion efforts since they appear more ready than older men to change their behaviors. Unfortunately, condom use among young men appears to have plateaued since 1988.

Comparisons of 1988 and 1991 NSAM data show no change in rates of use. Attitudes Related to Use Condom use is higher among young men who worry more frequently about AIDS when the effects of other factors are held constant. Between 1988 and 1991, however, sexually experienced teenagers showed declines in the frequency with which they worried about AIDS, how serious they thought AIDS was, and the likelihood they would get AIDS. These reductions were associated with lower levels of condom use. Male teenagers who think they will be embarrassed buying or using condoms, use them less consistently than those with higher embarrassment thresholds. If they think that the use of a condom will reduce the physical pleasure associated with intercourse, they are even less likely to use condoms.

Anticipated loss of pleasure is one of the strongest correlates of reduced condom use. Beliefs about male responsibility for contraception are also associated with condom use. Teenage males use condoms more often when they believe that men bear responsibility for initiating discussion of contraception with their female partners, refusing sexual intercourse if contraception is not used, helping to pay for the contraceptive pill, and assuming financial responsibility for any resulting children. Further work has shown that young men's views of their contraceptive responsibility are very much related to their beliefs about masculinity. Age Factors Several surveys, including the NSAM, have found that the younger teenagers are when they initiate sex, the less likely they are to use contraception at that time. As sexually experienced male teenagers grow older, their use of condoms declines.

Further analyses demonstrate that some of this decline is explained by changes in partner relationships. Influence of Female Partners As young men grow older, their female partners are more likely to use effective female methods of contraception, which appear to substitute for condoms. Indeed, pregnancy prevention, not STD prevention, appears to be the main reason that condoms are used when they are used. When young men who used a condom at last intercourse were asked why they did so, 83 percent said 'to prevent pregnancy.' Only 12 percent reported condom use to prevent disease and 2 percent to prevent both pregnancy and disease. Further work suggests that condom use in a relationship drops off the longer a relationship lasts, the greater the frequency of intercourse, and the closer the relationship.

It seems likely that over time the partners stop using condoms as the risk of STDs becomes less salient. However, there are two causes of concern. Informal assessment of a partner's STD risk may not be very accurate. Also, teenagers change partners frequently and may not resume the habit of condom use, once having abandoned the precaution. Another aspect of partner dynamics is the responsiveness of young men to their female partners' wish for them to use condoms. Indeed, one of the strongest predictors of condom use is the young man's belief that his partner would appreciate his doing so.

Implications for Prevention Efforts New strategies are needed to reach teenagers and change their behaviors. Based on the NSAM survey results, the researchers recommend that condom promotion efforts target teenagers before they become sexually active. The promotion efforts should encourage them to delay the start of sexual relations and to use condoms consistently when they do start. These campaigns should focus on both young men and young women because the female partners' views are important predictors of male behavior. In addition, such efforts should be designed to help teenagers deal with their embarrassment, at using condoms and with their concern about the reduced sensation associated with condom use. Finally, the condom promotion should seek to strengthen young men's beliefs about their contraceptive responsibility and address their views of masculinity..