Positive attitudes toward condom use do not equal safer sex among teenagers.

Adolescents who have sex with casual partners tend to have riskier attitudes toward condom use than those who have only main partners, according to a survey of sexually active adolescents in three major U.S. cities. (1) However, risky sexual behavior is not limited to casual relationships: Respondents had used condoms in fewer than half of their reported sexual encounters, regardless of partner type.

The data come from a study of adolescents aged 15-21 in Atlanta, Providence and Miami. Primary care clinic patients and adolescents contacted through various outreach strategies were included if they had had heterosexual vaginal or anal intercourse in the past 90 days, had not given birth within that time period, were not pregnant or HIV-positive, and were not trying to become pregnant. The 1,316 participants were, on average, 18.2 years old; 43% were male, and 57% female. Forty-nine percent of participants were black, 23% white, 8% of another race and 20% multiracial; 24% were Hispanic.

The researchers collected information on participants' demographic characteristics, unprotected sexual behavior, drug and alcohol use, and attitudes toward and perceptions about condom use. For all analyses, participants were classified by whether they had had sex only with main partners (defined as people with whom they had an ongoing relationship) in the past 90 days or they had had sex with at least one casual partner (someone they did not classify as a main partner). Adolescents in the latter group may have also had sex with a main partner, but were asked about behavior with casual partners only.

Some 35% of adolescents in the study reported having had at least one casual sex partner. These adolescents had had an average of 3.2 sex partners in the past 90 days; by comparison, those in the main partner group had had 1.3 partners. Only participants' gender and living arrangements were associated with partner type: Males made up 61% of adolescents with casual partners and only 34% of those with main partners; and the proportion of adolescents living with their partner was twice as high among those with a main partner as among those with a casual one (21% vs. 10%).

In bivariate analyses, adolescents who had had sex with casual partners had used marijuana or alcohol significantly more often in the past 30 days than had adolescents who had had sex with main partners. Those reporting experience with casual partners also harbored riskier attitudes toward condom use than those with main partners, according to scales that measured how adolescents felt about using condoms; their perception of how their casual partners would react if they suggested using condoms; their perception of their partners' STD status; and their perception of peer attitudes toward abstinence, sexual activity and condom use.

Adolescents in the casual partner group used condoms during a significantly greater proportion of sex acts in the past 90 days than did those in the main partner group, though levels of use were low among both groups (47% and 37%, respectively). According to results of a multiple linear regression analysis, among adolescents in the main partner group, being older and living with a partner were negatively associated with the proportion of sex acts that were protected, while using alcohol or marijuana, having positive attitudes toward condoms and perceiving that main partners would react positively toward condoms were associated with using condoms in a higher proportion of sex acts. Among participants in the casual partner group, being male and the use of drugs other than marijuana were negatively associated with condom use; perceptions that a main partner would react positively toward condom use predicted a higher proportion of sex acts using a condom.

The average number of unprotected sex acts was 18.9 among those who had had main partners and 21.5 among those who had had casual partners. In a multiple linear regression analysis, living with a partner and using drugs other than marijuana were positively associated with the number of unprotected sex acts among adolescents reporting main partners. Unexpectedly, less risky attitudes toward condoms and perceptions of positive reactions toward condoms among main partners were also positively associated with unprotected sex acts among those in the main partner group. Among adolescents with casual partners, only living with a partner bore a significant (positive) relationship to unprotected sex.

The researchers point out that the frequency of condom use these adolescents reported with either partner type was not sufficient to prevent the spread of STDs. Furthermore, although the perception of main partners' attitudes about condoms was associated with behavior among participants in the main partner group, there was no apparent link among participants in the casual partner group between their perceptions and their behaviors with casual partners. The researchers encourage clinicians to emphasize the importance of condom use among "all partners regardless of the patient's feelings about the partner, the sense of commitment, or the length of relationship." They also note that their definitions of "main" and "casual" partners may not have captured important aspects of adolescents' relationships. Thus, they suggest that future research "continue to explore the definitions of partner type" in order to fully illuminate the association between risk behaviors and relationship type.

REFERENCE

(1.) Lescano CM et al., Condom use with "casual" and "main" partners: what's in a name? Journal of Adolescent Health, 39(3):443e.l-443e.7.