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Accounting for Failures May Improve Precision:Evidence Supporting Improved Validity of Self-Reported Condom Use

Crosby, Richard PhD*; Salazar, Laura F. PhD*; DiClemente, Ralph J. PhD†§∥; Yarber, William L. HSD‡¶#; Caliendo, Angela M. MD,PhD§; Staples-Horne, Michelle MD**

Sexually Transmitted Diseases: August 2005 - Volume 32 - Issue 8 - p 513-515
doi: 10.1097/01.olq.0000170442.10150.28

Objectives: To determine whether a measure of unprotected vaginal sex that is adjusted for condom failures would produce improved accuracy in predicting biologically confirmed STDs (chlamydia and gonorrhea) among female teens.

Methods: Self-reported measures were collected using audio-computer-assisted self-interviewing. DNA amplification for the presence of Chlamydia trachomatis and Neisseria gonorrhoeae was conducted.

Results: The unadjusted measure of unprotected vaginal sex was not significantly associated with biologically confirmed prevalence of STDs (prevalence ratio [PR] = 1.51; 95% CI = 0.71–3.21; P = 0.28). Alternatively, the adjusted measure achieved significance (PR = 3.59; 95% CI = 1.13–11.38; P = 0.014). More than one quarter (25.6%) of teens using condoms inconsistently and/or incorrectly tested positive for an STD compared to 7.1% among those reporting the consistent and correct use of condoms.

Conclusion: Findings demonstrate that studies of condom effectiveness should use an adjusted measure of condom use to achieve precision and rigor.

Findings from a study of teen females suggest that accounting for condom failures may substantially add to the rigor of studies designed to test condom effectiveness.

From the *College of Public Health, University of Kentucky, Lexington, Kentucky; †Rollins School of Public Health, Emory University, Atlanta, Georgia; ‡Rural Center for AIDS/STD Prevention at Indiana University, Bloomington, Indiana; §Emory University School of Medicine, Department of Pathology and Laboratory Medicine (Infectious Diseases), Atlanta, Georgia; ¶Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia; ∥Kinsey Institute for Research in Sex, Gender, and Reproduction, Bloomington, Indiana; #Applied Health Science and Gender Studies at Indiana University, Bloomington, Indiana; and the **Georgia Department of Juvenile Justice, Atlanta, Georgia

This research was supported by the Emory Center for AIDS Research (NIH/NIAID 2 P30 AI50409–04A1).

Correspondence: Richard Crosby, PhD, College of Public Health, University of Kentucky, 121 Washington Ave., Room 111C, Lexington, KY 40506-0003. E-mail:

Received for publication November 8, 2004, and accepted January 11, 2005.

© Copyright 2005 American Sexually Transmitted Diseases Association