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© 2003 American Public Health Association
RESEARCH AND PRACTICE |
John E. Anderson is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Ga.
Correspondence: Requests for reprints should be sent to John E. Anderson, PhD, Division of HIV/AIDS Prevention, Mail Stop E-46, Centers for Disease Control and Prevention, Atlanta, GA 30333 (e-mail: jea1{at}cdc.gov).
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INTRODUCTION |
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 TOP INTRODUCTION METHODSRESULTSDISCUSSIONReferences |
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HIV prevention programs seek to increase the use of condoms among persons at risk for acquiring HIV.1 In recent years, the importance of condoms for prevention has remained high as the epidemic has shifted to have more impact on women and persons subject to infection through heterosexual contact.2 Data from surveys indicate increasing condom use among adolescents3–6 and adults7–8 since the 1980s.
I present data on condom use from a nationally representative survey of adults living in the United States—the General Social Survey—for 1996, 1998, and 2000, the first national data, available since the mid-1990s, on condom use among adults; the goal is to measure trends in condom use and to estimate the extent to which persons at increased risk for HIV report using condoms to protect their sexual partners and themselves.
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METHODS |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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The General Social Survey has collected information on a variety of topics of social importance annually or semiannually since 1972 from a national household-based probability sample of US adults aged 18 and older.9 Questions on sexual behavior and condom use were asked in 1996, 1998, and 2000 as part of a self-administered questionnaire, and drug use questions were added in 2000. The overall response rates for the main interview of the General Social Surveys have averaged 77%, and since 1996, an estimated 13.7% of the respondents did not complete the selfadministered questionnaire. The data presented here are for 5743 sexually active respondents aged 18 and older interviewed in 1996, 1998, and 2000; the more detailed analysis is for 1786 respondents from the 2000 General Social Survey.
The condom use measure is based on a question on condom use at last sexual intercourse (Table 1
), similar to questions used on several national surveys.3,5,10,11 Condom use is assessed separately by relationship to last sexual partner, contrasting regular, ongoing partners with other partners, and is presented for major population subgroups defined by demographic and socioeconomic factors as well as by sex- and drug-related HIV risk. Percentages have been computed for population groups, with t tests of differences between categories. Estimates based on survey weighting factors9 have been adjusted with an assumed design effect of 1.3.
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RESULTS |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Condom use during last sexual intercourse was reported by 19.5% of the adults in the 1996, 1998, and 2000 General Social Surveys (Table 1
). No increase in condom use from 1996 to 2000 was found. As noted in other studies,10–16 condom use was much higher with nonregular sexual partners: 42.9% versus 17.5% for sexual intercourse within ongoing relationships. Among persons whose last sexual intercourse was within a regular relationship, condom use was higher among those who were unmarried, were younger, were Black, had 2 or more sexual partners or not-well-known partners in the past year, or had some degree of HIV risk, whether from sexual or drug use behavior (Table 2). Condom use outside of regular relationships was higher among those with some degree of sex risk.
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An estimated 4.6% (95% confidence interval = 3.4%, 5.8%) of the 2000 General Social Survey respondents were at increased risk through either sexual or drug-use behavior. As Table 2
indicates, these at-risk persons were more likely to use condoms with their regular partners (35.8% vs 16.2% for those not at increased risk). This implies that most of the persons at risk (i.e., 64.2%) were not using condoms with their ongoing sexual partners and therefore were placing their partners or themselves at risk for acquiring or transmitting HIV. |
DISCUSSION |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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The 1996, 1998, and 2000 General Social Surveys provide the first national data on condom use for adults since the mid-1990s. The 2000 General Social Survey estimate of 35.1% condom use at last sexual intercourse by unmarried adults (95% confidence interval = 30.2%, 40.0%) suggests that Objective 18.4 of Healthy People 2000: National Health Promotion and Disease Prevention Objectives17—to increase this indicator to 50%—was not achieved.
The General Social Survey’s use-at-lastsexual-intercourse approach cannot answer all questions about condom use behavior, but it has some advantages over other techniques: it requires fewer questions, has been found to yield similar results to alternative methods,18 places fewer cognitive demands on respondents,19 and has been used by several national surveys.3,5,10,11 Sensitive behaviors are subject to underreporting on surveys, but the use of a self-administered questionnaire has been found to yield higher reporting than interviewer-administered interviews.20
The General Social Survey provides national estimates at frequent intervals data that is unavailable elsewhere. The picture regarding condom use among adults in the United States is clear. No trend toward greater condom use is apparent in the 1996 to 2000 period. Persons at increased behavioral risk for HIV are more likely than others to use condoms, but most of them are not using condoms with their regular partners. The General Social Survey estimates that 7 to 12 million adults are at increased risk for acquiring or transmitting HIV through risk behavior.21 Increasing safe-sex behavior for these individuals is a priority for prevention programs.1
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Acknowledgments |
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The data presented here are from the public use files of the General Social Survey, which are available from the National Opinion Research Center.
The author would like to acknowledge the contributions of Ronald W. Wilson and Tom Smith in developing the data on which this brief is based.
Human Participant Protection
The data were collected with the informed consent of the respondents following procedures approved by the institutional review board of the National Opinion Research Center.
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Footnotes |
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Peer Reviewed
Accepted for publication July 2, 2002.
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References |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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1. HIV Prevention Strategic Plan Through 2005. Atlanta, Ga: Centers for Disease Control and Prevention; January 2001.
2. Karon J, Fleming P, Steketee R, De Cock K. HIV in the United States at the turn of the century: an epidemic in transition. Am J Public Health. 2001;91:1060–1068.[Abstract]
3. Kann L, Kinchen SA, Williams BI, et al. Youth risk behavior surveillance—United States, 1999. MMWR CDC Surveill Summ. 2000;49(5):1–32.[Medline]
4. Everett S, Warren C, Santelli J, Kann L, Collins. JL, Kolbe LJ. Use of birth control pills, condoms, and withdrawal among US high school students. J Adolesc Health. 2000;27:112–118.[Web of Science][Medline]
5. Sonenstein FL, Ku L, Lindberg LD, Turner CF, Pleck JH. Changes in sexual behavior and condom use among teenaged males: 1988 to 1995. Am J Public Health. 1998;88:956–959.
6. Santelli J, Lindberg L, Abma J, McNeely C, Resnick M. Adolescent sexual behavior: estimates and trends from four nationally representative surveys. Fam Plann Perspect. 2000;32:156–165, 194.[Web of Science][Medline]
7. Piccinino L, Mosher W. Trends in contraceptive use in the United States. Fam Plann Perspect. 1998;30:4–10, 46.[Web of Science][Medline]
8. Catania J, Canchola J, Binson D, et al. National trends in condom use among at-risk heterosexuals in the United States. J Acquir Immune Defic Syndr Hum Retrovirol. 2001;27:176–182.
9. Davis JA, Smith TW. General Social Surveys, 1972–2000: Cumulative Codebook. Chicago, Ill: National Opinion Research Center; 2001.
10. Anderson J, Wilson R, Doll L, Jones T, Barker P. Condom use and HIV risk behaviors among U.S. adults: data from a national survey. Fam Plann Perspect. 1999;31:24–29.[Web of Science][Medline]
11. Laumann E, Gagnon J, Michael R, Michaels S. The Social Organization of Sexuality. Chicago, Ill: University of Chicago Press; 1994.
12. Tanfer K, Grady WR, Klepinger DH, Billy JOB. Condom use among men. Fam Plann Perspect. 1993;25:61–66.[Web of Science][Medline]
13. Leigh B, Temple M, Trocki K. The sexual behavior of U.S. adults: results of a national survey. Am J Public Health. 1993;83:1400–1407.
14. Anderson JE, Brackbill R, Mosher WD. Condom use for disease prevention among unmarried U.S. women. Fam Plann Perspect. 1996;28:25–28.[Web of Science][Medline]
15. Kost K, Forrest JD. American women’s sexual behavior and exposure to risk of sexually transmitted diseases. Fam Plann Perspect. 1992;24:244–254.[Web of Science][Medline]
16. Macaluso M, Demand M, Artz L, Hook E. Partner type and condom use. AIDS. 2000;14:537–546.[Web of Science][Medline]
17. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington, DC: US Dept of Health and Human Services; 1991. DHHS publication PHS 91-50212.
18. Anderson J, Rietmeijer C, Wilson R, Barker P. Asking about condom use: is there a standard approach that should be adopted across surveys? In: 1998 Proceedings, American Statistical Association, Section on Survey Research Methods. Alexandria, Va: American Statistical Association; 1998:873–877.
19. Sudman S, Bradburn N, Schwarz N. Thinking About Answers. San Francisco, Calif: Jossey-Bass; 1996:195–196.
20. Turner CF, Lessler J, Devore J. Effects of mode of administration and wording on reporting of drug use. In: Turner C, Lessler J, Gfroerer J, eds. Survey Measurement of Drug Use: Methodological Studies. Washington, DC: Government Printing Office; 1992:177–220. DHHS publication ADM-92-1929.
21. Anderson JE, Stall R. How many people are at risk for HIV in the United States? The need for behavioral surveys of at-risk populations. J Acquir Immune Defic Syndr Hum Retrovirol. 2002;29:104.
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