American Journal of Epidemiology Advance Access originally published online on November 5, 2007
American Journal of Epidemiology 2008 167(3):341-349; doi:10.1093/aje/kwm300
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ORIGINAL CONTRIBUTIONS |
Problems with Condom Use among Patients Attending Sexually Transmitted Disease Clinics: Prevalence, Predictors, and Relation to Incident Gonorrhea and Chlamydia
1 National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
2 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
3 Annenberg Public Policy Center, Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA
4 Baltimore City Health Department, Baltimore, MD
5 Infectious Diseases Division, Johns Hopkins University School of Medicine, Baltimore, MD
6 California State University Long Beach, Long Beach, CA
7 San Francisco Department of Health, San Francisco, CA
8 Newark Department of Public Health, Newark, NJ
Correspondence to Dr. Lee Warner, Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-34, Atlanta, GA 30341 (e-mail: dlw7{at}cdc.gov).
Received for publication March 8, 2007. Accepted for publication September 19, 2007.
Condom use remains important for sexually transmitted disease (STD) prevention. This analysis examined the prevalence of problems with condoms among 1,152 participants who completed a supplemental questionnaire as part of Project RESPECT, a counseling intervention trial conducted at five publicly funded STD clinics between 1993 and 1997. Altogether, 336 participants (41%, 95% confidence interval: 38, 45) reporting condom use indicated that condoms broke, slipped off, leaked, or were not used throughout intercourse in the previous 3 months. Correspondingly, 8.9% (95% confidence interval: 7.0, 9.5) of uses resulted in STD exposure if partners were infected because of delayed application of condoms (4.3% of uses), breakage (2.0%), early removal (1.4%), slippage (1.3%), or leakage (0.4%). Use problems were significantly associated with reporting inconsistent condom use, multiple partners, and other condom problems. One-hundred thirty participants completing the questionnaire were tested for gonorrhea and chlamydia at this time and also 3 months earlier. Twenty-one (16.2%) were infected with incident gonorrhea and chlamydia, with no infections among consistent users reporting no use problems. Exact logistic regression revealed a significant dose-response relation between increased protection from condom use and reduced gonorrhea and chlamydia risk (ptrend = 0.032). Both consistency of use and use problems must be considered in studies of highly infectious STD to avoid underestimating condom effectiveness.
chlamydia; contraceptive devices, male; gonorrhea; HIV infections; sexual behavior; sexually transmitted diseases
Abbreviations: aPOR, adjusted prevalence odds ratio; STD, sexually transmitted disease