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Am Fam Physician. 2005;72(11):2350-2352

Risky sexual behavior among adolescents can result in lasting consequences such as sexually transmitted infections (STIs) and unintended pregnancy. Condom use in adolescent males has become an important part of STI prevention. Therefore, understanding what knowledge components influence proper condom use at first intercourse among this group may improve the effectiveness of interventions targeting risky adolescent sexual behavior. Studies evaluating knowledge about sex and risky sexual behavior have not included the relationship between objective and perceived knowledge and have had inconsistent results. Rock and colleagues investigated how objective and perceived knowledge about condoms affects condom use by adolescent males at first intercourse.

The longitudinal analysis included survey data from the National Longitudinal Study of Adolescent Health. The authors focused on 7th- to 12th-grade males who were virgins at the time of the first interview and reported first intercourse by the first follow-up interview. The authors evaluated objective knowledge of condom use using five questions. They evaluated perceived knowledge using Likert-scale type questions about the participants’ confidence in the accuracy of their answers. Answers were grouped according to the level of objective and perceived knowledge the participant had (high objective/high perceived; high objective/low perceived; low objective/high perceived; and low objective/low perceived). The authors used these results to correlate knowledge with self-reported condom use at first intercourse.

Final analysis included 404 males between 15 and 17 years of age. The low objective/high perceived knowledge group was nearly three times less likely to use condoms at the time of first intercourse than those in the other groups. The other three groups reported similar condom use at first intercourse.

The authors conclude that previous studies about knowledge and high-risk sexual behavior, which have been inconclusive, may have overlooked perceived knowledge as an important predictor of risky behavior. The authors speculate that adolescents with high perceived knowledge may take more risks. The authors recommend that physicians use Likert scales or one-on-one discussions that focus on objective and perceived knowledge when assessing adolescent males. They also say that further research and additional programs promoting condom use are needed.

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