BEHAVIORAL INTERVENTION TO INCREASE CONDOM USE AMONG HIGH-RISK FEMALEADOLESCENTS

Objective: To determine whether condom use among high-risk female adol escents could be increased by a behavioral intervention, with the use of infection with Chlamydia trachomatis as a biomarker of condom pract ices. Design: Prospective, randomized, controlled intervention. Settin g: Urban family planning and sexually transmitted disease clinics. Par ticipants: Two hundred nine female adolescents, aged 15 through 19 yea rs, who were treated for C. trachomatis genitourinary infection, were randomly assigned to standard (control) or experimental (behavioral in tervention) groups. One hundred twelve subjects returned for follow-up 5 to 7 months after enrollment and comprise the study subjects. Measu rements: Subjects completed a multiinstrument questionnaire measuring sexual behavior, condom practices, attitudes and beliefs, cognitive co mplexity, sociodemographics, and motivation at enrollment and follow-u p. Endourethral and endocervical sites were sampled for C. trachomatis . Results: Among the 112 subjects who returned for repeated examinatio n, those who had received the experimental intervention reported incre ased use of condoms by their sexual partners for protection against se xually transmitted diseases (odds ratio = 2.4; p = 0.02) and for vagin al intercourse (odds ratio = 3.1; p = 0.005) at the 6-month follow-up. Multivariable logistic regression analysis controlling for condom use at enrollment demonstrated that the experimental intervention (odds r atio = 2.8; p = 0.03) and the higher cognitive complexity (odds ratio = 4.6; p = 0.02) independently contributed to greater condom use at fo llow-up. Despite greater use of condoms among the group who had receiv ed the intervention, use remained inconsistent and rates of reinfectio n with C. trachomatis were not significantly different (26% vs 17%; p = 0.3). Conclusion: Although a brief behavioral intervention among hig h-risk female adolescents can increase condom use by their sexual part ners, incident infection does not appear to be reduced, because condom use remained inconsistent.