School-Based Condom Education and Its Relations With Diagnoses of and Testing for Sexually Transmitted Infections Among Men in the United States

Abstract

An intense social and political debate continues in the United States regarding sexuality education. Included in the debate are those who favor comprehensive approaches, those who favor abstinence-only approaches, and those who favor no sexuality education. In this study, we showed that men who received school-based condom education were less likely to have been diagnosed with sexually transmitted infections (STIs) and were more likely to ever have been tested for sexually transmitted infections than were men without such education. School-based condom education is associated with less, rather than more, STI risk.

Despite rising rates of sexually transmitted infections (STIs) and unintended pregnancy, school-based sexuality education remains controversial in the United States relative to other industrialized nations.^1,2 Large, national studies have shown that most parents in the United States favor sexuality education approaches in schools that provide scientifically and medically accurate information on sexual health issues, including condom use; still, a minority of opponents have claimed that discussing condom use in and of itself will increase risky sexual behaviors.³ Several studies have documented the long-term positive effects of school-based sexuality education programs on STI-related knowledge, attitudes, and preventive behaviors.^4–7 However, potential relations between school-based condom education (i.e., specifically being taught how to use a condom in a school setting) and sexual health outcomes, including STI diagnoses, are not well understood. Therefore, the present study assessed associations between school-based condom education and one's likelihood of being tested for and diagnosed with an STI among a large sample of sexually active men in the United States.

METHODS

Recruitment advertisements for a study on male sexual health were placed in newspapers, on Web sites, and at organizations related to STIs and HIV in all 50 states. The present study was part of a larger experimental study of condom use via an Internet-based survey conducted in 2005 through 2006. Additional information on the study design is published elsewhere.⁸ Eligibility requirements included being a sexually active adult male aged 18 years or older. All study protocols were approved by the institutional review board of Indiana University–Bloomington.

Participants indicated whether they had ever been tested for or diagnosed with any of 6 commonly reported STIs, including HIV. Additionally, participants were asked, “Have you ever been taught to use a condom in a sex education or health education class in high school?” Data were analyzed by using descriptive, bivariate, and multivariate techniques in SPSS version 14.0 (SPSS Inc, Chicago, IL). We conducted a series of logistic regressions to determine the role of demographic variables that have been shown in previous studies to play a moderating role (including age, race/ethnicity, sexual orientation/identity, and sexual relationship status).

RESULTS

The mean age of the sample of 1152 men was 26 years (SD = 8.22). The participants identified themselves as White (84%; n = 949), Asian (7%; n = 83), Black (2%; n = 24), or other (7%; n = 96). Approximately 6% (n = 63) of the participants were of Latino ethnicity. Most of the participants identified themselves as heterosexual (87%; n = 1002), and the remainder identified themselves as gay, bisexual, or other (13%; n = 150). Most also reported currently being in a monogamous sexual relationship (74%; n = 849). Of the total sample, 81% (n = 937) reported receiving condom education in schools, and 19% (n = 215) reported that they had not received such education.

As shown in Table 1, the participants who received school-based condom education were significantly less likely to have ever been diagnosed with 5 of the 6 STIs that we assessed. Age was the only demographic variable that emerged as significant, specifically, the interaction term of age in relation to STI history (χ²[1, N = 1152] = 50.86; P < .001). When grouped into 3 categories (aged 18–25, 26–35, and ≥ 36 years), subsequent effect modification analyses of the age groups showed that older participants (those aged 35 years or older) were more likely to have been diagnosed with an STI and were also less likely to have received condom education in school.

TABLE 1.

Relations Between School-Based Condom Education and Sexually Transmitted Infection Diagnoses and Testing: 2005–2006

Variable	Received Condom Education,a No. (%)	Did Not Receive Condom Education,b No. (%)	Total, No. (%)	χ2
STI history	52 (6.5)	29 (15.6)	81 (8.2)	16.83***
Chlamydia	18 (1.9)	7 (3.3)	25 (2.2)	1.51
Gonorrhea	9 (1.0)	10 (4.7)	19 (1.7)	14.76***
Genital herpes	5 (0.6)	5 (2.6)	10 (1.0)	6.61**
HIV	5 (0.5)	4 (1.9)	9 (0.8)	4.02*
HPV	17 (2.0)	10 (4.9)	27 (2.4)	6.42**
Trichomonas	8 (0.9)	5 (2.3)	13 (1.1)	3.40*
STI testing	430 (49.3)	85 (39.4)	515 (44.7)	11.28***
HIV testing	459 (51.8)	94 (43.7)	553 (48.0)	9.27***

Note. STI = sexually transmitted infection; HPV = human papillomavirus. The total sample size was N = 1152.

^an = 937.

^bn = 215.

*P < .05; **P < .01; ***P < .001.

DISCUSSION

Our results are compelling and show several significant differences in terms of the relations between school-based condom education and histories of STI diagnosis and testing. It is noteworthy that school-based condom education was associated with fewer reports of diagnoses of most STIs, as well as with a greater likelihood of STI testing. Additionally, the relations between condom education and STI diagnosis were not explained by elevated levels of HIV or STI testing among participants who had not received condom education in school. Indeed, the inverse was true. These findings are particularly important for public health prevention specialists. Although age emerged as an additional predictor of STI history, the nature of the findings fit with our overall framework that those participants with less condom education were more likely to have been diagnosed with an STI.

Our results must be interpreted while considering the study's limitations. Because we used a cross-sectional method, it is possible that the survey may not have fully assessed complex and dynamic factors that are reflective of concepts such as “condom education.” The questionnaire did not allow us to assess the content and quality of such education. Future research endeavors may benefit from more in-depth investigation of condom education in schools through ongoing qualitative research.⁹ Retrospective reports of STI diagnoses may be prone to reporting error that may be differential in relation to actual exposure, facilitating underestimation of potential associations. Additionally, the increased time of exposure may weaken the associations we found.

A central argument of some who oppose sexuality education is that giving information about methods of sexual protection such as condoms, in and of itself, may increase sexual risk; however, the outcomes of our study indicate the opposite. These findings show the continuing need for further policy efforts that ensure condom education in schools.¹⁰