Health Promotion International, Vol. 14, No. 3, 211-220,
September 1999
© Oxford University Press 1999
How are attitudes towards condoms related to gender and sexual experiences among adolescents in Finland?
Department of Health Sciences, University of Jyväskylä, P.O. Box 35, FIN-40351 Jyväskylä, and 1 The Family Federation of Finland, The Population Research Institute, P.O. Box 849, FIN-00101 Helsinki, Finland
Address for correspondence: Riikka Pätsänen Department of Health Sciences University of Jyväskylä PO Box 35 FIN-40351 Jyväskylä Finland E-mail: potsonen{at}pallo.jyu.fi
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SUMMARY |
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This survey is a part of the international HBSC Study (Health Behaviour in School-aged Children). The purpose of this study was to investigate 15-year-old adolescents' condom attitudes. In 1990, data were compiled from 928 students and in 1994 from 1183 students. In 1994, 70% of boys and 55% of girls reported that they had used a condom with their partner in past intercourse. The percentage of adolescents who did not use any contraceptive method decreased from 26% to ~13% between 1990 and 1994. The attitudes of the adolescents who did not use any contraceptive method were, on average, somewhat more negative towards purchasing condoms than the attitudes of those who used condoms or pills as their contraceptive method. Adolescents were well aware that condoms prevented unwanted pregnancies and protected against sexually transmitted disease. Boys reported more frequently than girls that it was easy to use a condom and that a condom diminished sexual pleasure. Generally speaking, adolescents were still quite embarrassed to buy condoms. Adolescents who had experienced sexual intercourse reported more often than those who had not that it was easy to purchase and carry condoms. A majority of adolescents reported that it was easy for them to purchase condoms when necessary. The major change between 1990 and 1994 occurred in the attitudes of girls who had experienced sexual intercourse. In 1990, the attitudes of girls towards purchasing and carrying condoms were more negative than those of boys, but in 1994 they were similar to those of sexually experienced boys.
Key words: adolescent; attitudes; condom; Finland; gender; sexual experiences
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INTRODUCTION |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONACKNOWLEDGEMENTSREFERENCES |
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The use of condoms has increased in Finland since the 1960s when it was relatively rare even among adults (Kontula and Haavio-Mannila, 1995
). Recently, ~50% of 15-year-old girls and 70% of boys mentioned that they had used a condom in their past sexual intercourse (Kontula and Meriläinen, 1988; Liinamo et al., 1997).
Attitudes involve what people think about, feel about, and how they would like to behave toward an attitude object. Behaviour is not only what people would like to do but also what they think they should do, i.e. social norms, habits and expected consequences of one's behaviour. An attitude contains beliefs, evaluations and action intentions that may affect behaviour (Rosenberg and Hovland, 1960; Triandis, 1971). How one feels about using condoms, what one believes about purchasing and using condoms, and the persons' intentions to use condoms are all important components of one's attitudes towards using condoms.
Despite the advantages of using condoms, there are a number of factors that work against them. For example: negative attitudes towards condoms (Hebert et al., 1989; Hingson et al., 1990; MacDonald et al., 1990; Weisman et al., 1991); neglecting personal risk (DiClemente et al., 1990); using alcohol or drugs (Keeling, 1987; Noell et al., 1993); low self-confidence (Keeling, 1987); sexual fears (Edgar and Fitzpatrick, 1988; Goodwin and Roscoe, 1988); and reliance on other contraceptive methods (DeBuono et al., 1990) have been the most common reasons for not using condoms. On the other hand, self-confidence regarding the ability to purchase and use condoms (Hingson et al., 1990; MacDonald et al., 1990; Weisman et al., 1991; Schaalma et al., 1993); general commitment to using condoms (Catania et al., 1990); positive subjective norms (Ross and McLaws, 1992); communication with the partner (Pendergrast et al., 1992); and availability of condoms (Freimuth et al., 1992) seem to be important determinants of intended use of condoms.
Until now, the frequency of using condoms as the principal means of contraception has been linked with gender. Men have traditionally been leaders in using condoms, and the condoms which have been developed for women are still in need of improvements. In earlier international studies, women have had more positive attitudes towards using condoms than men have, while men have had fewer difficulties in buying and carrying a condom (Abraham et al., 1992; Sacco et al., 1993; Schaalma et al., 1993; Grimley et al., 1995).
Koniak-Griffin's team (Koniak-Griffin et al., 1994) identified in their focus groups that lack of power and male dominance influenced girls' use of condoms. They were also embarrassed to buy condoms and were afraid that their partner might think they were promiscuous. Sacco et al. (1993) had similar findings. They noticed that it was not part of girls' role expectations that they could carry a condom. Koniak-Griffin et al. (1994) discovered that negative attitudes towards condoms stemmed primarily from a belief about natural sex. The desirability of using condoms appeared to be influenced by such factors as trust in your partner and the nature of the relationship (e.g. length and intimacy). Finally, the comments of participants suggested that lack of knowledge or skill in the application of condoms may influence beliefs about their effectiveness and the resulting choice of contraceptive methods.
The purpose of this study is to investigate 15-year-old girls' and boys' attitudes towards using and purchasing condoms in 1990 and 1994, and to find out how attitudes towards condoms are related to their sexual experiences and the contraceptive methods used in their past sexual intercourse, and how these relationships have changed between 1990 and 1994.
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METHODS |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONACKNOWLEDGEMENTSREFERENCES |
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Health behaviour in school-aged children study
This study is a part of the international Health Behaviour in School-aged Children, i.e. HBSC study (Wold et al., 1994
). The overall goal of the survey is to gain new insights into and to increase our understanding of health behaviour, lifestyles and their context among adolescents. The international standard questionnaire consists of two sections: core (demographic questions, behavioural questions); and special foci. The core questions are repeated every time so that it is possible to compare health habits across different age groups, countries and years. The special focus section of the questionnaire changes over time. In 1990, sexual experiences, knowledge and attitudes about HIV and AIDS (‘AIDS questionnaire’) were one of the special foci. The survey was carried out in eight European countries (see Currie et al., 1997). In Finland, the ‘AIDS survey’ was redone in 1994.
Sampling and statistics
The population in the main HBSC study consisted of pupils in 5th, 7th and 9th grades, but in this article only 9th graders (n = 2111) are included. The samples were chosen from the Finnish school register by using a special sampling program. The sample frame was the number of pupils at each class level. This computer program picked the schools out by using cluster sampling in such a way that the size of schools was taken into consideration. Within each school a class was randomly selected. Samples were representative of the whole country. The strata of schools were based on province division, and on the division between urban and rural areas. Additional samples were made, in case some selected schools would not want to participate in the survey, by choosing an additional school which was from a similar municipality and the same province.
The students had 1 h to anonymously fill in their questionnaire. In each school the teacher who was responsible for the survey was guided beforehand by the means of written instructions on how to handle the situation when the students filled the questionnaires. The respondents in this study were from 46 schools in 1990 and 64 schools in 1994. The mean age of the respondents was ~15 years and 7 months in 1990 and ~15 years and 9 months in 1994. The response rate in 1990 was ~91% and in 1994 it was 86%. The loss of data resulted from students who were absent from school and from rejected responses.
Data were analysed by cross-tabulation, using 
2 tests, Student's and Mann—Whitney mean test, and variance analysis. The significance of p values is mentioned only when in excess of 0.05. Statistical significance is reported as follows: p < 0.05(*), p < 0.01(**) and p < 0.001(***). All statistical analyses were performed by employing SPSS/PC Win 6.1.
Measurements
In this study, seven attitude variables were analysed, of which two mapped how effective adolescents considered condoms to be, two described the beliefs about using condoms, and three of the attitudes related to purchasing and carrying condoms. In all items, there were five alternatives: strongly agree, agree, do not know, disagree and strongly disagree. The first four statements are treated as individual variables (Table 1). The three statements related to purchasing condoms were combined as a sum variable (min 3—max 15) whose Cronbach alpha was 0.60.
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Sexual experiences were studied using the item ‘Have you already engaged in sexual intercourse?’. The contraceptive method used was studied by the item ‘If you have already engaged in sexual intercourse, did you use contraception in your past intercourse?’. In further analyses, the reported contraceptive method was encoded to three categories: not at all; condom; and contraceptive pills.
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RESULTS |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONACKNOWLEDGEMENTSREFERENCES |
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The number of sexual experiences and the use of contraception changed slightly in Finland among 15-year-olds between 1990 and 1994. In both years the same numbers of girls and boys had had equally frequent sexual experiences; 26% of 15-year-olds had already experienced their first sexual intercourse.
The condom was the most popular contraceptive method among 15-year-old respondents. In 1990, 60% of boys and 44% of girls reported that they had used condoms with their partner in their past sexual intercourse. In 1994, the numbers were 70% among boys and 55% among girls. The popularity of contraceptive pills did not change between 1990 and 1994. More than 20% of the girls and 8% of the boys reported that they or their partner used contraceptive pills. The major change between the years of study was a decrease in the number of adolescents who did not use a contraceptive method. In 1990, ~26% of girls and boys reported that they had experienced sexual intercourse without using any contraceptive method at all. Four years later, 11% of boys and 15% of girls reported that they had used no contraception.
Condoms are perceived effective
Adolescents thought that condoms were effective protection against both unwanted pregnancy (~90%) and sexually transmitted disease (>70%). The number of respondents who considered that condoms are effective in preventing disease decreased between the research years, although the sole statistically significant difference between 1990 and 1994 was found among sexually experienced girls (p = 0.007). Sexually experienced adolescents depended more frequently on condoms as protection against sexually transmitted disease than sexually inexperienced adolescents did (Table 1
).
The contraceptive method used in the past sexual intercourse was not related either to attitudes about the effectiveness of condoms against unwanted pregnancy or against sexually transmitted diseases.
Attitudes towards using condoms
Adolescents felt that using condoms was fairly easy. Boys and sexually experienced respondents regarded using condoms to be easier than girls and inexperienced respondents. While 96% of sexually experienced boys and 88% of girls agreed that condoms were easy to use, 77% of inexperienced boys and 59% of girls came to the same conclusion. Sexually inexperienced girls and boys responded in a fairly similar manner to the statement that condoms make sex less enjoyable. Sexually experienced girls (50%) reported more often than sexually experienced boys (40%) that using condoms does not make sex less enjoyable (Table 1).
The relationship between the contraceptive method used in the past sexual intercourse and the opinions about how condoms influenced sexual pleasure was significant only among girls. In both years, those girls who had used condoms with their partner answered more frequently that condoms do not decrease sexual pleasure (1990, p = 0.001; 1994, p = 0.004) than those who had used contraceptive pills or had used no contraceptive methods at all. Among boys there were no significant differences.
Attitudes related to purchasing condoms
The attitudes related to purchasing condoms changed between the study years only among girls, the attitudes of boys remained unchanged. The greatest differences were found between sexually experienced and sexually inexperienced adolescents; at both research periods the differences between the two groups were statistically significant among both boys and girls.
Purchasing condoms appeared to be relatively difficult for sexually inexperienced adolescents, at both research periods ~40% of adolescents considered that purchasing condoms was embarrassing. Only ~20% of sexually inexperienced and ~40% of sexually experienced adolescents considered that purchasing condoms was not embarrassing. Carrying a condom was regarded to be easier than buying them. Most of the respondents did not feel embarrassed about carrying a condom. Half of the sexually inexperienced and 80% of the experienced boys disagreed that it was embarrassing.
The greatest change between the years 1990 and 1994 was found among girls. In 1990, ~20% of inexperienced girls answered that it was not embarrassing to buy a condom, the number of similar answers in 1994 was 44% (the significance between years, p = 0.000). The same trend was noted with the item concerning carrying condoms with sexually experienced girls. The number of girls who were not embarrassed to carry a condom increased from 63 to 82% between the study years (p = 0.000).
More than half of the respondents felt that it was quite easy to find a condom if necessary. Differences were greater between inexperienced and experienced respondents than between sexes or between the years of study. The greatest number of those who found it easy to buy condoms was found among sexually experienced boys (84%), after them came experienced girls (in 1990, 71%; in 1994, 82%, the significance between years p = 0.028), inexperienced boys (66%) and inexperienced girls (50%).
Figure 1 describes the attitudes of boys and girls towards condoms, buying condoms, carrying them and acquiring them when necessary. In Figure 1, the responses ‘strongly agree’ and ‘agree’ (likewise, ‘strongly disagree’ and ‘disagree’) have been combined under ‘agree’ (‘disagree’).
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Adolescents' attitudes towards purchasing and carrying condoms were examined by means of a sum variable as well. There was a statistically significant difference (p = 0.000) between sexually experienced and inexperienced adolescents at both research periods. There were differences between girls and boys (p = 0.000) among sexually inexperienced adolescents in 1990 only. Between 1990 and 1994, there were differences among girls only. The mean of the sum variable was higher in 1994 both among sexually inexperienced (9.1 versus 9.7) and experienced (10.6 versus 11.2) girls (Table 2
).
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The relationship between attitudes related to purchasing condoms and the contraceptive method used in the past sexual intercourse was significant among girls (p = 0.003) in 1994 only. Those sexually experienced respondents who had used no contraceptive methods at all had the most negative attitudes, then came those who had used condoms. Those girls who had used contraceptive pills in their past sexual intercourse had the most positive attitudes towards purchasing condoms.
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DISCUSSION |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONACKNOWLEDGEMENTSREFERENCES |
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The first main finding in this research was that many adolescents still reported difficulties in purchasing condoms. Another finding was that attitudes towards purchasing condoms had changed among girls between 1990 and 1994. Sexually experienced girls reported that for them it was as easy as for sexually experienced boys to buy or carry a condom.
Difficulties in purchasing condoms
Adolescents still have difficulties in purchasing condoms. On one hand, 40% of the respondents felt that purchasing condoms was embarrassing (cf. Schaalma et al., 1993; Currie et al., 1997). On the other hand, 20% of sexually inexperienced and 40% of sexually experienced adolescents reported that purchasing condoms was not embarrassing for them. A majority of respondents reported that they could easily acquire condoms when necessary. In this study, the difficulties related to acquiring condoms seemed to be more dependent on the respondents' own attitudes and the attitudes of their environment than on the availability of condoms. Finnish adolescents expressed similar opinions in focus group discussions, for both boys and girls emphasized the role of adults as gatekeepers—disapproving glances at pharmacies and shops embarrassed adolescents, even though they regarded themselves to be responsible enough for taking care of their contraceptive needs and buying condoms (Pätsänen and Välimaa, 1995).
In earlier studies, negative attitudes towards condoms (Hebert et al., 1989; Hingson et al., 1990; MacDonald et al., 1990; Weisman et al., 1991), neglecting personal risk (DiClemente et al., 1990), low self-confidence (Keeling, 1987) and sexual fears (Edgar and Fitzpatrick, 1988; Goodwin and Roscoe, 1988) have been found to be the factors that work against using condoms. Furthermore, studies of the use of contraceptive methods have shown that discussions between the partners and perceiving a willingness to communicate are important predictors of effective contraception (Gold and Berger, 1983; Polit-O'Hara and Kahn, 1985; Abraham et al., 1992). Tschann and Adler (1997) found that women who had a negative attitude towards their own sexuality were more likely to rely on men to use a contraceptive method and used condoms less frequently than other groups, whereas women who approved of their own sexuality reported that they discussed sex and contraceptive methods more frequently than the women who did not approve of their own sexuality.
In order to remove the obstacles to using condoms, a new type of holistic sex education should be developed in schools to address the above-mentioned topics. Sex education could, e.g. involve discussing how adolescents view their own sexuality, where adolescents' attitudes towards condoms originate and how they assess their personal risk, and could serve as the means of dispelling unwarranted fear and prejudice. It would also be advantageous to practice during classes situations which would allow the students to discuss sexual behaviour in an informal atmosphere. For example, role-playing games and computer programs (see Noell et al., 1997; Thomas et al., 1997) could help adolescents test their decision-making and consultation skills in a safe environment.
Attitudes towards condoms and gender
The difficulties in purchasing condoms have in many ways been related to traditional attitudes and cultural expectations about male and female sexual behaviour and gender roles. In earlier studies, boys were more likely to be experienced in purchasing of condoms and carrying them (Sneddon and Kremer, 1992; Sacco et al., 1993; Schaalma et al., 1993). Gender expectations may imply that it is illegitimate for young women to publicly plan sexual behaviour (Holland et al., 1990).
According to this study, in 1994 there were differences between girls and boys only among sexually inexperienced adolescents. Sexually experienced girls and boys had similar attitudes towards purchasing and carrying condoms. Do these results signify changes in gender roles in Finland only or do they signify broader changes? In Finland, there is a high level of equality between women and men. Girls' opportunities for proper education and economic and sexual equality are now better than ever. Youth researchers (Näre and Lähteenmaa, 1992; Puuronen, 1995) have found that gender differences in Finland are diminishing; girls are occupying more and more of the public space, and they are adopting new behavioural patterns which were formerly acceptable for boys only.
Among boys, attitudes towards purchasing condoms were more positive among those who had used a contraceptive method (condoms or pills) than among those who had used no contraceptive method at all. In other words, those respondents who had difficulties in purchasing condoms were also likely to ignore contraception —if condoms are not available it will be difficult to use them. Surprisingly, among girls, those who had used contraceptive pills during their past sexual intercourse had slightly more positive attitudes towards condoms than those girls who had used condoms. One explanation for this can be the intimacy and length of the girls' sexual relationship; the longer they have had a satisfying and secure sexual relationship the more positive their attitudes towards sexuality can be, including using condoms (see also Koniak-Griffin et al., 1994). In a stable relationship it can be easier to discuss with one's partner and solve the technical and psychological problems which using condoms might have caused previously.
Condoms are perceived effective
Finnish adolescents were quite confident about the effectiveness of condoms in preventing unwanted pregnancies and sexually transmitted disease. Approximately 90% of the respondents felt that condoms prevented pregnancies and more than 70% felt that they protected against sexually transmitted disease. In a corresponding Scottish study (Currie et al., 1997), the opinions of 15-year-old adolescents about the effectiveness of condoms against unwanted pregnancies were identical to those of Finnish adolescents. In contrast, Scottish adolescents were more sceptical about the effectiveness of condoms against sexually transmitted disease than Finnish adolescents. While more than 70% of the respondents in Finland felt that condoms (when properly used) were effective in preventing sexually transmitted disease, not more than ~45% of the respondents in Scotland agreed.
One of the reasons why Finnish adolescents are confident about condoms may be the high quality and universal availability of condoms. Another reason may be the fairly prominent public education about the advantages of condoms, and yet another the sex education in schools, as it largely concentrates on preventing pregnancies and sexually transmitted disease (Pätsänen and Välimaa, 1995; Kontula, 1997). On one hand it is a good thing that adolescents are provided with information; on the other, they should also be educated in how to control their emotions and fears, and how to act and manage in sexual situations.
Discussion of the material and suggestions for further study
Although the data were representative for the whole country, the method of selection and the meaning of the items deserves to be discussed. Those students who were absent on the day of the survey could also be selected. But then, they were less motivated to go to school and possibly had more sexual experiences. In any case, the numbers of missing students and rejected responses were quite small. Therefore, it can be proposed that the absent respondents are less significant here than they would be in mainstream youth research.
One of the constraints of this study was the research method employed. A survey provides a limited amount of data and, consequently, qualitative research methods are more frequently being applied to the study of attitudes. It is easy to report positive opinions in a survey because you will not be asked to explain yourself and there is no one to request substantiation. In contrast, an interview situation requires that the respondent considers his/her opinions more carefully and justifies them. In future it would be of interest to interview adolescents and learn what they have to say about their attitudes, what their attitudes are based on (peer group, mass media, public sources, etc.), and what factors influence using or not using condoms.
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ACKNOWLEDGEMENTS |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONACKNOWLEDGEMENTSREFERENCES |
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This research was supported by funds from the Finnish Ministry of Social and Health Affairs and The Finnish Cultural Fund.
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