Adolescents who engage in unprotected intercourse are at risk of pregnancy and sexually transmitted infection (STI). Although adolescents in rural areas participate in levels of sexual risk taking similar to that of nonrural youth, few data are available identifying factors that influence condom use among rural adolescents. The purpose of this study is to determine the predictive value of selected personal, environmental, and behavioral factors for condom use among rural adolescents in grades 9–12. A cross-sectional survey was conducted among sexually active youth (N = 613), ages 14–19, in three rural school districts in the Northeast. Using logistic regression, identified predictors for condom use include personal standards (odds ratio [OR] = 2.45; confidence interval [CI]: [2.39, 6.47]), condom use goals (OR = 1.32; CI [1.21, 1.45]), condom use at first intercourse (OR = 3.93; CI [2.39, 6.47]) and male gender. School nurses are encouraged to incorporate identified predictors of condom use when considering interventions promoting safer sexual behaviors among rural youth.
AdimoraA.SchoenbachV.MartinsonF.DonaldsonK.FulliloveR.AralS. (2001). Social context of sexual relationships among rural African Americans. Sexually Transmitted Disease, 28, 69–76.
2.
AliM.DwyerD. (2011). Estimating peer effects in sexual behavior among Adolescents. Journal of Adolescence, 34, 183–190.
3.
AlvarezC.VillarruelA.ZhouY. (2010). Predictors of condom use among Mexican adolescents. Research and Theory for Nursing Practice, 24, 187–196.
4.
American Academy of Pediatrics Committee on Adolescence. (2001). Condom use in adolescents (policy statement). Pediatrics, 107, 1463–1469.
5.
AtavS.SpencerG. (2002). Health risk behaviors among adolescents attending rural, suburban, and urban schools: A comparative study. Family and Community Health, 25, 53–64.
6.
BanduraA. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.
7.
BanduraA. (1994). Social cognitive theory and exercise of control over HIV infection. In DiClementeR. (Ed.), Preventing AIDS theories and methods of behavioral interventions (pp. 25–59). New York, NY: Plenum Press.
8.
BanduraA. (2004). Health promotion by social cognitive means. Health Education and Behavior, 31, 143–164.
9.
Basen-EngquistK.MasseL.CoyleK.KirbyD.ParcelG.BanspachS.NodoraJ. (1999). Validity of scales measuring the psychosocial determinants of HIV/STD-related risk behavior in adolescents. Health Education Research, 14, 25–38.
10.
BellJ. (2009). Why embarrassment inhibits the acquisition and use of condoms: A qualitative approach to understanding risky sexual behavior. Journal of Adolescence, 32, 379–391.
11.
BermudezM.CastroA.Buela-CasalG. (2011). Psychosocial correlates of condom use and their relationship with worry about STI and HIV in native and immigrant adolescents in Spain. The Spanish Journal of Psychology, 14, 746–754.
12.
BlakeS.LedskyR.GoodenowC.SawyerR.LohrmannD.WindsorR. (2003). Condom availability programs in Massachusetts high-schools: Relationships with condom use and sexual behavior. American Journal of Public Health, 93, 955–962.
13.
BrenerN.KannL.McManusT.KinchenS.SundbergE.RossJ. (2002). Reliability of the 1999 youth risk behavior survey questionnaire. Journal of Adolescent Health, 31, 336–342. doi:S1054139X02003397
Centers for Disease Control and Prevention. (2011a). Sexually transmitted disease surveillance 2010. Atlanta, GA: US Department of Health and Human Services. Retrieved fromhttp://www.cdc.gov/std/stats10/default.htm
Centers for Disease Control and Prevention. (2012). Youth risk behavior surveillance—United States, 2011. Morbidity and Mortality Weekly Report, 61, SS-4, 24–29.
19.
ChewningB.DouglasJ.KokotailoP.LacourtJ.St. ClairD.WilsonD. (2001). Protective factors associated with American Indian adolescents' safer sexual patterns. Journal of Maternal Child Health, 5, 273–280.
20.
CohenJ. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.
21.
Committee on Adolescence. (2007). Contraception and adolescents. Pediatrics, 120, 1135–1148.
22.
CrandalR. (1973). The measurement of self-esteem and related constructs: Rosenberg self-esteem scale. In RobinsonJ. P.ShaverP. R. (Eds.), Measures of Social Psychological Attitudes (pp. 80–82). Ann Arbor: Institute for Social Research, University of Michigan.
23.
CrosbyR.YarberW. (2001). Perceived versus actual knowledge about correct condom use among U.S. adolescents: Results from a national study. Journal of Adolescent Health, 28, 415–420.
24.
CrosbyR.YarberW.KanuA., (1998). Relationship of HIV/STD sexual risk behaviors to other health behaviors among a sample of Indiana rural youth. The Health Education Monograph Series, 16, 51–59.
25.
DelaneyM.LangilleD.RichardsonH.BeazleyR., (1997). Factors influencing condom use among students attending high school in Nova Scotia. The Canadian Journal of Human Sexuality, 6, 185–196.
26.
DeNavas-WaltCProctorB.SmithJ. (2010). Income, poverty, and health insurance coverage in the United States: 2009. (U.S. Census Bureau, Current Population Reports, P60-238). Washington, DC: US Government Printing Office.
27.
DiClementeR. J.BrownL.BeausoleilN.LodicoM. (1993). Comparison of AIDS knowledge and HIV-related sexual risk behaviors among adolescents in low and high AIDS prevalence communities. Journal of Adolescent Health, 14, 231–236.
28.
DiIorioC.PluharE.BelcherL. (2003). Parent-child communication about sexuality: A review of the literature from 1980-2002. Journal of HIV/AIDS Prevention & Education for Adolescents & Children, 5, 7–32.
29.
DriesbachS. (2011). Rural HIV and STD prevention in challenging economic times. The Health Education Monograph Series, 28, 1–9.
30.
DyeC.UpchurchD. (2006). Moderating effects of gender on alcohol use: Implications for condom use at first intercourse. Journal of School Health, 76, 111–116.
31.
ElliottB.LarsonT. (2004). Adolescents in mid-sized and rural communities: Foregone care, perceived barriers, and risk factors. Journal of Adolescent Health, 35, 303–309.
32.
ForhanS.GottliebS.SternbergM.XuF.DattaS.McQuillanG.BermanS.MarkowitzL., (2009). Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States. Pediatrics, 124, 1505.
33.
FosterP. (2007). Use of stigma, fear, and denial in development of a framework for prevention of HIV/AIDS in rural African American communities. Family and Community Health, 30, 318–327.
34.
GarsideR.AyresR.OwenM.PearsonV.RozenJ. (2002). Anonymity and confidentiality: Rural teenagers' concerns when accessing sexual health services. Journal of Family Planning and Reproductive Health Care, 28, 23–26.
35.
GuttmacherS.LiebermanL.WardD.FreeudenbergN.RadoshA.JarlaisD., (1997). Condom availability in New York City public schools: Relationships to condom use and sexual behavior. American Journal of Public Health, 87, 1427–1433.
36.
HallH.LiJ.McKennaM. (2005). HIV in predominantly rural areas of the United States. Journal of Rural Health, 21, 245–253.
37.
Hamdan-MansourA.PuskarK.SereikaS. (2007). Perceived social support, coping strategies and alcohol use among rural adolescents/USA sample. International Journal of Mental Health Addiction, 5, 53–64.
38.
HenryD.SchoenyM.DeptulaD.SlavickJ. (2007). Peer selection and socialization effects on adolescent intercourse without a condom and attitudes about the costs of sex. Child Development, 78, 825–838.
39.
HenselD.AndersonJ. (2006). Comparing trends in sexual risk taking among rural and non-rural high-school students: 1997-2003. Paper presented at the annual meeting of the American Sociological Association, Montreal Convention Center, Montreal, Quebec, Canada. Retrieved fromhttp://www.allacademic.com/meta/p103469_index.html
40.
HuebnerA.HowellL., (2003). Examining the relationship between adolescent sexual risk-taking and perceptions of monitoring, communication, and parenting styles. Journal of Adolescent Health, 33, 71–78.
KannL.TelljohannS.WooleyS. (2007). Health education: Results from the school health policies and programs study 2006. Journal of School Health, 77, 408–434.
43.
KirbyD. (2007). Emerging answers 2007: Research findings on programs to teen pregnancy and sexually transmitted disease. Washington, DC: National campaign to prevent teen and unplanned pregnancy.
44.
LusterT.SmallS. (1994). Factors associated with sexual risk-taking behaviors among adolescents. Journal of Marriage and Family, 56, 622–632.
45.
ManloveJ.IkramullahE.Terry-HumenE. (2008). Condom use and consistency among male adolescents in the United States. Journal of Adolescent Health, 43, 325–333.
46.
MilhausenR.CrosbyR.YarberW.DiClementeR.WingoodG.DingK. (2003). Rural and nonrural African American high school students and STD/HIV sexual –risk behaviors. American Journal of Health Behavior, 27, 373–379.
ProchaskaJ.DiClementeC. (1983). Stages and processes of self-change of smoking toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390–395.
54.
PuskarK.BernardoL.RenD.HaleyT.StarkK.SwitalaJ.SiemonL. (2010). Self-esteem and optimism in rural youth: Gender differences. Contemporary Nurse, 34, 190–198.
55.
PuskarK.Tusaie-MumfordK.SereikaS.LambJ. (1999). Health concerns and risk behaviors of rural adolescents. Journal of Community Health Nursing, 16, 109–119.
56.
RobertsonA.SteinJ.Baird-ThomasC. (2006). Gender differences in the prediction of condom use among incarcerated juvenile offenders; Testing the information-motivation-behavior skills model. Journal of Adolescent Health, 38, 18–25.
57.
RosenstockI.StretcherV.BeckerM. (1988). Social learning theory and the health belief model. Health Education Quarterly, 15, 175–183.
58.
Rural HIV/STD Prevention Workgroup. (2009). Tearing down fences: HIV/STD prevention in rural America. Bloomington, IN: Rural Center for AIDS/STD Prevention.
59.
SalesJ. M.MilhausenR.WingoodG.DiClementeR.SalazarL.CrosbyR. (2008).Validation of a parent-adolescent communication scale for use in STD/HIV prevention interventions. Health Education and Behavior, 35, 332–345.
60.
SalesJ. M.SpitalnickJ.MilhausenR.WingoodG.DiClementeR.SalazarL.CrosbyR. A. (2009). Validation of the worry about sexual outcomes scale for use in STI/HIV prevention interventions for adolescent females. Health Education Research, 24, 140–152.
61.
SchusterM.BellR.BerryS.KanouseD. (1998). Impact of a high school condom availability program on sexual attitudes and behaviors. Family Planning Perspectives, 30, 67–72, 88.
62.
ShafiiT.StovelK.HolmesK. (2007). Association between condom use at sexual debut and subsequent sexual trajectories: A longitudinal study using biomarkers. American Journal of Public Health, 97, 1090–1095.
63.
ShrierL.AnchetaR.GoodmanE.ChiouV.LydenM.EmansJ. (2001). Randomized controlled trial of a safer sex intervention for high-risk adolescent girls. Archives of Pediatric & Adolescent Medicine, 155, 73–79.
64.
SmithM.DiClementeR. (2000). STAND: A peer educator training curriculum for sexual risk reduction in the rural South. Students together against negative decisions. Preventive Medicine, 30, 441–449.
65.
StantonB.GuoJ.CottrellL.GalbraithJ.LiX.GibsonC.HarrisC. (2005). The complex business of adapting effective interventions to new populations: An urban to rural transfer. Journal of Adolescent Health, 37, 163.
66.
StantonB.HarrisC.CottrellL.LiX.GibsonC.GuoJ.MarshallS. (2006). Trial of an urban adolescent sexual risk-reduction intervention for rural youth: A promising but imperfect fit. Journal of Adolescent Health, 38, 55.
67.
VenturaS.HamiltonB. (2011). U.S. teenage birth rate resumes decline. NCHS data brief, U.S. Department of Health and Human Services, National Center for Health Statistics. Retrieved fromhttp://www.cdc.gov/nchs/data/databriefs/db58.htm
68.
VillarruelA.JemmottJ.JemmottL.RonisD. (2007). Predicting condom use among sexually experienced Latino adolescents. Western Journal of Nursing Research, 29, 724–738.
69.
YanA.ChiuY.StoesenC.WangM. (2007). STD/HIV related sexual risk behaviors and substance use among U.S. rural adolescents. Journal of the National Medical Association, 99, 1386–1394.
70.
YarberW.CrosbyR. (2011). Rural and non-rural Indiana residents’ opinion about condoms for HIV/STD prevention. The Health Education Monograph Series, 28, 46–53.
71.
YoungeS.SalazarL.CrosbyR.DiClementeR.WingoodG.RoseE. (2008). Condom use at last sex as proxy for other measures of condom use: Is it good enough?Adolescence, 43, 927–931.
72.
YoungkinE.DavisM. (2004).Women's health: A primary care clinical guide. (3rd ed.)Stanford, CT: Appleton & Lange.
73.
U. S. Department of Health and Human Services. (2000). Healthy people 2010: Understanding and improving health. Washington, DC: U.S. Government Printing Office.
ZimetG.PowellS.FarleyG.WerkmanS.BerkoffK. (1990). Psychometric characteristics of the multidimensional scale of perceived social support. Journal of Personality Assessment, 55, 610–617.
