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## Complete Summary

#### GUIDELINE TITLE

Condom use by adolescents.

#### BIBLIOGRAPHIC SOURCE(S)

Kaplan DW, Feinstein RA, Fisher MM, Klein JD, Olmedo LF, Rome ES, Yancy
WS, Adams Hillard PJ, Sacks D, Pearson G, Frankowski BL, Piazza Hurley
T. Condom use by adolescents. Pediatrics 2001 Jun;107(6):1463-9. \[88
references\]

#### GUIDELINE STATUS

This is the current release of the guideline. This guideline updates a
previously issued version (American Academy of Pediatrics (AAP),
Committee on Adolescence. Condom availability for youth. Pediatrics
1995;95:281-5).

American Academy of Pediatrics (AAP) Policies are reviewed every 3 years
by the authoring body. The AAP review process involves an evaluation of
new literature that has emerged since the original publication date.
Following this review, a recommendation is made that the policy be
retired, revised, or reaffirmed without change. Until the Board of
Directors approves a revision or reaffirmation, or retires a statement,
the current policy remains in effect.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

-   Unintended pregnancy

-   Sexually transmitted diseases (STDs)

-   Human immune deficiency virus (HIV) infection

#### GUIDELINE CATEGORY

Counseling\
Prevention

#### CLINICAL SPECIALTY

Family Practice\
Infectious Diseases\
Pediatrics\
Preventive Medicine

#### INTENDED USERS

Advanced Practice Nurses\
Nurses\
Physician Assistants\
Physicians\
Public Health Departments

#### GUIDELINE OBJECTIVE(S)

-   To evaluate the use of male condoms as part of the secondary
    prevention of unintended pregnancies and sexually transmitted
    diseases (STDs) in adolescents

-   To review current pregnancy, STD, and human immune deficiency virus
    (HIV) infection rates; recent changes in condom use by adolescents
    and factors affecting condom use; the types of condoms, their proper
    use, and their breakage rates; the effectiveness of condoms in
    pregnancy, STD, and HIV prevention; and the roles that schools are
    playing in condom education and availability for youth

#### TARGET POPULATION

Adolescents

#### INTERVENTIONS AND PRACTICES CONSIDERED

**Prevention**

1.  Counseling and education regarding the benefits of sexual abstinence
    (*primary prevention*)

2.  Counseling and education regarding the benefits, availability, and
    correct use of condoms\* (*secondary prevention*)

3.  Collaboration with community resources to decrease restrictions to
    condom availability

\*Note: this guideline refers only to the male condom; the female condom
was not included in the scope of this guideline.

#### MAJOR OUTCOMES CONSIDERED

-   Rates of condom use among adolescents

-   Factors influencing condom use

-   Efficacy of condoms in preventing pregnancy, sexually transmitted
    diseases (STDs) and human immunodeficiency virus (HIV)

-   Effectiveness of school-based condom availability programs

-   Rates of sexual activity, pregnancy, STDs, and HIV among adolescents

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Not stated

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Not stated

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

1.  Abstaining from intercourse should be encouraged for adolescents,
    because it is the surest way to prevent sexually transmitted
    diseases (STDs), including human immune deficiency virus (HIV), and
    pregnancy. Adolescents who have been sexually active previously
    should also be counseled regarding the benefits of postponing future
    sexual relationships.

2.  Pediatricians are urged to actively support and encourage the
    correct and consistent use of reliable contraception and condoms by
    adolescents who are sexually active or contemplating sexual
    activity. The responsibility of males as well as females in
    preventing unwanted pregnancies and STDs should be emphasized.
    Pediatricians need to be actively involved in community programs
    directed toward this goal.

3.  In the interest of public health, restrictions and barriers to
    condom availability should be removed.

4.  Schools should be considered appropriate sites for the availability
    of condoms, because they contain large adolescent populations and
    may potentially provide a comprehensive array of related educational
    and health care resources.

5.  To be most effective, condom availability programs should be
    developed through a collaborative community process and accompanied
    by comprehensive sequential sexuality education, which is ideally
    part of a K-12 health education program, with parental involvement,
    counseling, and positive peer support.

6.  Pediatricians can actively help raise awareness among parents and
    communities that making condoms available to adolescents does not
    increase the rate of adolescent sexual activity and that condoms,
    despite their limitations, can decrease rates of unintended
    pregnancy and acquisition of STDs and HIV infection.

7.  Research is encouraged to identify methods to increase correct and
    consistent condom use by sexually active adolescents and to evaluate
    effectiveness of strategies to promote condom use, including condom
    education and availability programs in schools.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence supporting each recommendation is not specifically
stated.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

From a public health perspective, condoms, especially if used
consistently and correctly, can be expected to decrease the rates of
unintended pregnancy and sexually transmitted diseases (STDs) and human
immune deficiency virus (HIV) acquisition among sexually active
adolescents.

**Subgroups Most Likely to Benefit**:

Sexually active adolescents are most likely to benefit from counseling
and education regarding condom use.

#### POTENTIAL HARMS

Problems with condom use include latex allergy, decreased glans
sensitivity, and condom failure.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

The recommendations in this statement do not indicate an exclusive
course of treatment or serve as a standard of medical care. Variations,
taking into account individual circumstances, may be appropriate.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Kaplan DW, Feinstein RA, Fisher MM, Klein JD, Olmedo LF, Rome ES, Yancy
WS, Adams Hillard PJ, Sacks D, Pearson G, Frankowski BL, Piazza Hurley
T. Condom use by adolescents. Pediatrics 2001 Jun;107(6):1463-9. \[88
references\]

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2001 Jun (reaffirmed 2004 Oct)

#### GUIDELINE DEVELOPER(S)

American Academy of Pediatrics - Medical Specialty Society

#### SOURCE(S) OF FUNDING

American Academy of Pediatrics (AAP)

#### GUIDELINE COMMITTEE

Committee on Adolescence

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Committee on Adolescence (2000-2001)*: David W. Kaplan, MD, MPH,
Chairperson, Ronald A. Feinstein, MD; Martin M. Fisher, MD; Jonathan D.
Klein, MD, MPH; Luis F. Olmedo, MD; Ellen S. Rome, MD, MPH; W. Samuel
Yancy, MD

*Liaisons*: Paula J. Adams Hillard, MD, American College of
Obstetricians and Gynecologists; Diane Sacks, MD, Canadian Paediatric
Society; Glen Pearson, MD, American Academy of Child and Adolescent
Psychiatry

*Section Liaison*: Barbara L. Frankowski, MD, MPH, Section on School
Health

*Staff*: Tammy Piazza Hurley

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline. This guideline updates a
previously issued version (American Academy of Pediatrics (AAP),
Committee on Adolescence. Condom availability for youth. Pediatrics
1995;95:281-5).

American Academy of Pediatrics (AAP) Policies are reviewed every 3 years
by the authoring body. The AAP review process involves an evaluation of
new literature that has emerged since the original publication date.
Following this review, a recommendation is made that the policy be
retired, revised, or reaffirmed without change. Until the Board of
Directors approves a revision or reaffirmation, or retires a statement,
the current policy remains in effect.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [American Academy of Pediatrics
(AAP) Policy Web
site](http://aappolicy.aappublications.org/cgi/content/full/pediatrics;107/6/1463).

Print copies: Available from American Academy of Pediatrics, 141
Northwest Point Blvd., P.O. Box 927, Elk Grove Village, IL 60009-0927.

#### AVAILABILITY OF COMPANION DOCUMENTS

None available

#### PATIENT RESOURCES

None available

#### NGC STATUS

This summary was completed by ECRI on May 7, 2002. The information was
verified by the guideline developer on June 11, 2002.

#### COPYRIGHT STATEMENT

This National Guideline Clearinghouse summary is based on the original
guideline, which is subject to the guideline developer\'s copyright
restrictions. Please contact the Permissions Editor, American Academy of
Pediatrics (AAP), 141 Northwest Point Blvd, Elk Grove Village, IL 60007.

### DISCLAIMER

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Date Modified: 11/3/2008