Impact of a high school condom availability program on sexual attitudes and behaviors.

CONTEXT: While making condoms available in high schools has provoked much debate, evidence on the actual effects of such programs on students' attitudes and behavior is sparse.

METHODS: Prior to implementation of a condom availability program in a Los Angeles County high school, 1,945 students in grades 9-12 (98% of eligible students) completed a self-administered anonymous survey on their sexual behavior and on related knowledge and attitudes; one year later, 1,110 students (59% of eligible students) completed a follow-up survey.

RESULTS: There was no significant change over time in the percentage of males or females who had ever had vaginal intercourse or who had had vaginal intercourse during the year prior to the survey. The percentage of males who reported using condoms every time they engaged in vaginal intercourse during the past year increased significantly, from 37% to 50%, and the percentage of males who reported condom use at recently initiated first vaginal intercourse increased from 65% to 80%. On the other hand, female respondents showed no significant change in their condom use. The self-reported likelihood of using a condom for vaginal intercourse during the following year did not change significantly for students who had had vaginal intercourse, but it increased dramatically for those who, had never had vaginal intercourse. The students' attitudes toward sex and condom use either remained the same between surveys or changed in a direction favoring less sexual behavior and greater risk prevention.

CONCLUSIONS: The condom availability program appears not to have produced an increase in sexual activity among high school students, and it appears to have led to improved condom use among males. The apparent strong effect on students' intention to use condoms and on males' use at first vaginal intercourse suggests that such programs may have a particular impact on the least sexually experienced adolescents.