The Validity of Teens' and Young Adults' Self-reported Condom Use | Adolescent Medicine | JAMA Pediatrics | JAMA Network
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January 5, 2009

The Validity of Teens' and Young Adults' Self-reported Condom Use

Author Affiliations

Author Affiliations: Rollins School of Public Health (Ms Rose, Drs DiClemente, Wingood, and Sales, and Ms Latham), Emory Center for AIDS Research (Ms Rose, Drs DiClemente, Wingood, and Sales, and Ms Latham), Department of Pediatrics, Division of Infectious Diseases, Epidemiology, and Immunology, and Department of Medicine (Infectious Diseases) (Dr DiClemente), Emory University School of Medicine, Atlanta, Georgia; College of Public Health, University of Kentucky, Lexington (Dr Crosby); Rural Center for AIDS and STD Prevention, Indiana University, Bloomington (Dr Crosby); Division of Infectious Diseases, Johns Hopkins Bayview Medical Center (Dr Zenilman and Mr Melendez) and Division of Infectious Diseases and Obstetrics & Gynecology, Department of Medicine, Johns Hopkins University, Departments of Molecular Medicine & Immunology, International Health, Epidemiology, School of Medicine and Johns Hopkins Bloomberg School of Public Health (Dr Zenilman), Baltimore, Maryland; and Department of Epidemiology and Biostatistics, University of South Carolina, Columbia (Dr Hardin).

Arch Pediatr Adolesc Med. 2009;163(1):61-64. doi:10.1001/archpediatrics.2008.509

Objective  To examine the concordance between teens’ and young adults' self-reported condom use, assessed by audio-computer–assisted self-interviewing, and Y-chromosome polymerase chain reaction (Yc-PCR) assay, a nondisease marker for detecting the presence of sperm in vaginal fluid for 14 days after unprotected vaginal sex.

Design  Randomized trial of a human immunodeficiency virus prevention program. Only data from baseline (before randomization) were used for this analysis.

Setting  A clinic-based sample in Atlanta, Georgia.

Participants  Eligible teens and young adults were African American female teens and young adults 15 to 21 years old who had reported sexual activity in the previous 60 days. Of 1558 teens and young adults screened from March 1, 2002, through August 31, 2004, 847 were eligible and 715 (84.4%) participated at baseline.

Main Outcome Measures  Self-reported consistent condom use in the 14 days before baseline and Yc-PCR results.

Results  Of participants who reported vaginal sex in the past 14 days, 186 reported consistent condom use, defined as 100% condom use. Of these, 63 had a positive Yc-PCR result, indicating detection of the Y chromosome in the vaginal fluid. Participants who reported consistent condom use with a self-reported history of sexually transmitted diseases were 2.4 times more likely to have a positive Yc-PCR result (adjusted odds ratio, 2.4; 95% confidence interval, 1.2-4.8; P = .01).

Conclusions  A significant degree of discordance between self-reports of consistent condom use and Yc-PCR positivity was observed. Several rival explanations for the observed discordance exist, including (1) teens and young adults inaccurately reported condom use; (2) teens and young adults used condoms consistently but used them incorrectly, resulting in user error; and (3) teens and young adults responded with socially desirable answers. Using an objective biological measure may provide one strategy for validating teens' and young adults' self-reported condom use.