College students fail the grade in condom use

CDC, college groups target behavior

College students may need a refresher course when it comes to the basics of sexually transmitted disease (STD) protection. Findings from the first national study of priority risk behaviors among all undergraduates found that while 80% used some form of contraception, only 29.6% used a condom during their last sexual intercourse.1

The prevalence of high-risk sexual practices among college students remains high, according to The Hidden Epidemic,2 the 1996 report from the Institute of Medicine in Washington, DC. And a recent review of national statistics shows that while condom use may have increased since the 1980s, the theory of dual protection against pregnancy and STDs has not been put into practice.3

The National College Health Risk Behavior Survey is the first-ever study of a nationally representative sample of college students that looks at a number of health risk behaviors, says Laura Kann, PhD, who heads the surveillance research section of the Atlanta-based Centers for Disease Control and Prevention's Division of Adoles cent and School Health. The report covers injury-related behaviors; drug, alcohol and tobacco use; dietary habits; and physical inactivity; all which may lead to adverse health outcomes. The survey represents all undergraduates ages 18 and older in public and private two- and four-year U.S. colleges and universities. About 5,000 students completed questionnaires for the report.

Look at the survey

Only a third of the sexually active students in the survey reported birth control pill use at last sexual intercourse, Kann says. Condom use was even lower, with only three of 10 saying they used the method. (See p. 64 for a table of survey findings.)

"While condoms can prevent pregnancies and STDs, that's precious few college students who are reporting consistent condom use or any kind of use at all at last intercourse," she observes. "That means many sexually active college students are at risk for unintended pregnancy, HIV, STDs - the whole works."

Among those surveyed, 86.1% reported ever having intercourse, with 34.5% reporting six or more partners during their lifetime. Female students were more likely to have ever had intercourse, but male students were significantly more likely than their female counterparts to list six or more partners in their sexual history.4

The CDC monitors similar behaviors among high school students in its Youth Risk Behavior Surveillance Summary. In a comparison of the two groups, college students had significantly higher rates of unprotected sexual activity. Slightly more than half of sexually active high school students reported condom use, compared with 29.6% in the college survey.5 "Previous studies6 have suggested that condom use is higher at first sexual intercourse, among persons in newer relationships, and among those whose sexual activity is sporadic rather than regular," state authors of a recent study of young adults.3 "All of these situations are more common among younger adolescents. With increased age and time, many couples switch to female-controlled methods."7

The CDC is targeting the risk for HIV and other STDs among college students through a cooperative program with nine national higher education organizations. Funded through the Division of Adolescent and School Health, the program is approaching its third year of operation, says John Moore, PhD, RN, associate director for planning, evaluation, and legislation.

Each organization participating in the program is funded under one of three priority areas:

· educating policy and decision-making members of postsecondary institutions to support programs to prevent HIV/STD infection among students;

· supporting institutionwide health promotion programs;

· aiding preservice education.

Participating groups include the Association of American Colleges and Universities, the National Associa tion for Equal Opportunity in Higher Education, the National Association of Student Person nel Administrators, the American Association of Community Colleges, and the American Associa tion of Colleges for Teacher Education, all in Washington, DC; the American College Health Association in Baltimore, MD; the Bacchus and Gamma Peer Education Network in Denver; the American Associa tion for Health Education in Reston, VA; and The College Fund/United Negro College Fund in Fairfax, VA.

By funding the national organizations, which work with their affiliated institutions, the CDC creates maximum benefits, Moore says. With the findings of the first college health survey now issued, the need for such programs is underscored, he notes.

Survey scheduled for 2005

The CDC plans to repeat the survey by 2005 to obtain another measure of college student risk behaviors, Kann says. The results provide an important tool in identifying where the need exists and how and where programs should be directed, she says.

The Division of Adolescent and School Health also is working with its cooperative partners in developing indicators of progress to measure program success, Moore says. Reports from these indicators will provide evidence of the programs' impact. (See story on community colleges' and universities' efforts to step up HIV/STD awareness through their partnership with the CDC program, at right.)


1. Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance National College Health Risk Behavior Survey - United States, 1995. CDC Surveillance Summaries. Nov. 14, 1997; 46(SS-6.)

2. The Institute of Medicine. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: National Academy Press; 1996.

3. Santelli JS, Warren CW, Lowry R, et al. The use of condoms with other contraceptive methods among young men and women. Fam Plann Perspect 1997; 29:261-267.

4. Douglas KA, Collins JL, Warren C, et al. Results from the 1995 National College Health Risk Behavior Survey. J Am Coll Health 1997; 46:55-66.

5. SIECUS. CDC college-youth risk behavior study shows failure to protect against STDs. SHOP Talk (School Health Opportunities and Progress) Bulletin 1998; 2(20).

6. Ku L, Sonenstein FL, Pleck JH, Patterns of HIV risk and preventive behaviors among teen-age men. Public Health Rep 1992; 107:131-138.

7. Galavotti C, Schnell DJ. Relationship between contraceptive method choice and beliefs about HIV and pregnancy prevention. Sex Transm Dis 1994; 21:5-7.