By Anita Brakman, MS
Director of Education, Research & Training
Physicians for Reproductive Health
New York City
Melanie Gold, DO, DABMA, FAAP, FACOP
Medical Director
School-Based Health Centers
Columbia University MedicalCenter
New York Presbyterian Hospital
New York City
Latex condoms have been long proven to be critical tools in reducing the risk of pregnancy and sexually transmitted infections (STIs). However, condoms need to be used consistently and correctly to provide protection.
On the most recent Youth Risk Behavior Survey (YRBS), 40% of sexually active U.S. high school students reported that they did not use a condom at last intercourse. This percentage has significantly declined since 1991 when the survey began but has increased since a low of 37% in 2003.1 Additionally, in 2013 less than 10% of students reported dual use of condoms plus a hormonal method.1
Why don’t more teens consistently use condoms? One of the reasons teens cite most frequently is lack of availability of condoms.2 While adolescents legally can purchase condoms in many places, young people cite embarrassment as a major barrier.3 Cost also might be an issue. Health departments and community organizations might offer free condoms, but young people often don’t know about these programs or aren’t able to access them.
School-based condom availability programs have the potential to be the best venue for providing a large number of diverse young people with the protection they need. Unfortunately, while condom availability programs are in cities such as New York, they are sorely lacking in most schools across the country. The last major survey of condom availability programs in the country reported in 1996 that approximately 2% of U.S. schools have a program on site, which translates to about 50 school districts or 418 individual schools.4 Even schools with onsite health centers that offer STI screening and treatment often don’t offer condoms to students.5
Schools without condom availability programs are missing a huge opportunity to reduce infections and unintended pregnancy among adolescents in their communities. Studies of existing condom availability programs show that they increase students’ likelihood of using condoms at last intercourse and can significantly improve sexual health outcomes.6-9
For example, a 2011 study in Massachusetts showed gonorrhea and chlamydia rates declined significantly among male adolescents in schools that had a condom availability program, whereas rates increased among those in school without such a program.10
Health interventions in schools are broadly supported, with vaccination programs being perhaps the best example.11-12 However, critics of sexual health education and services such as condom availability argue that increased availability of condoms will lead to an increase in sexual activity among teens. In truth, no studies have shown such an increase to occur due to condom availability, and evidence indicates the opposite might be true. Condom availability programs, which usually are accompanied by an educational component, might be associated with decreases or delays in sexual activity.6,9,13
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Kann L, Kinchen S, Shanklin S, et al. Youth Risk Behavior Surveillance 2013. MMWR 2014; 63(26):576.
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Bauman LJ, Berman R. Adolescent relationships and condom use: trust, love and commitment. AIDS Behav 2005; 9(2):211-222.
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Dahl DW, Gorn GJ, Weinberg CB. The impact of embarrassment on condom purchase behaviour. Can J Public Health 1998; 89(6):368-370.
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Kirby DB, Brown NL. Condom availability programs in U.S. schools. Fam Plann Perspect 1996; 28(5):196-202..
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Santelli JS, Nystrom RJ, Brindis C, et al. Reproductive health in school-based health centers: findings from the 1998-99 census of school-based health centers. J Adolesc Health 2003; 32(6):443-451.
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Furstenberg FF Jr., Geitz LM, Teitler JO, et al. Does condom availability make a difference? An evaluation of Philadelphia’s health resource centers. Fam Plann Perspect 1997; 29(3):123-127.
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Kirby D, Brener ND, Brown NL, et al. The impact of condom availability [correction of distribution] in Seattle schools on sexual behavior and condom use. Am J Public Health 1999; 89(2):182-187.
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Wolk LI, Rosenbaum R. The benefits of school-based condom availability: cross-sectional analysis of a comprehensive high school-based program. J Adolesc Health 1995; 17(3):184-188.
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Blake SM, Ledsky R, Goodenow C, et al. Condom availability programs in Massachusetts high schools: relationships with condom use and sexual behavior. Am J Public Health 2003; 93(6):955-962.
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Wretzel SR, Visintainer PF, Pinkston Koenigs LM. Condom availability program in an inner city public school: effect on the rates of gonorrhea and chlamydia infection. J Adolesc Health 2011; 49(3):324-326.
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Daley MF, Kempe A, Pyrzanowski J, et al. School-located vaccination of adolescents with insurance billing: cost, reimbursement, and vaccination outcomes. J Adolesc Health 2014; 54(3):282-288.
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Kelminson K, Saville A, Seewald L, et al. Parental views of school-located delivery of adolescent vaccines. J Adolesc Health 2012; 51(2):190-196.
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Charania MR, Crepaz N, Guenther-Gray C, et al. Efficacy of structural-level condom distribution interventions: a meta-analysis of U.S. and international studies, 1998-2007. AIDS Behav 2011; 15(7):1283-
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