AAP Policy Statement: Provide Condoms to Adolescents

Jennifer Garcia

October 28, 2013

A new policy statement by the American Academy of Pediatrics (AAP) highlights the prevalence of unintended pregnancy and sexually transmitted infections (STIs) among adolescents and provides updated recommendations to improve condom use in this population. The statement was published in the November issue of Pediatrics.

Rebecca F. O'Brien, MD, and colleagues from the AAP Committee on Adolescence note that despite strong evidence that condom use prevents many STIs, including HIV, rates of acquisition of STIs among adolescents remain high.

Latest Figures

In a review of the recent scientific literature and national surveys, the committee members found:

  • 15- to 24-year-olds acquire nearly half of all new STIs;

  • 20% of all new HIV infections in the United States in 2011 were in young people aged 13 to 24 years;

  • rates of infection with syphilis, gonorrhea, and chlamydia have continued to increase during the last decade in adolescents and young adults (of particular concern are increased infection rates, specifically among young women, for chlamydia and gonorrhea); and

  • although birth rates among adolescents in the United States are at the lowest rate in 70 years, the birth rate among teenagers remains higher than that of other developed countries;

Committee members also found that adolescents who do not receive formal sex education are half as likely to use a condom at the time of first intercourse as those who do receive formal sex education. Moreover, the deficit continues, as the same group is less likely to use condoms consistently in the future.

To develop the recommendations, the AAP committee members reviewed studies aimed at increasing condom use, including those that evaluated curriculum-based sex- and HIV-education programs among people younger than 25 years from all countries.

Unchanged from a 2001 policy statement, the AAP still recommends that adolescents be encouraged to abstain from sexual intercourse or counseled to postpone future sexual relationships. In addition, the new statement still emphasizes the important role pediatricians play in educating both boys and girls about responsible sexual activity and encouraging correct use of condoms among sexually active adolescents.

Key Recommendations for 2013

  • Pediatricians and other clinicians should encourage communication between parents and adolescents about sexual education with guidance from the AAP Bright Futures initiative, which offers resources to facilitate communication about a variety of health topics.

  • Pediatricians and other clinicians should provide educational programs for parents to help them develop the skills needed to talk to their adolescent children about STI prevention and condom use.

  • Pediatricians and other clinicians are encouraged to improve availability of condoms to adolescents by providing condoms within their offices as well as supporting condom availability within the community.

Other Important Recommendations

  • K-12 health education programs should provide education and counseling about sexual activity and be part of collaborative, community-based condom availability programs.

  • Schools should be considered suitable sites for condom distribution.

  • Pediatricians are encouraged to raise awareness that condom availability does not increase the onset or frequency of adolescent sexual activity: 42% of the studies reviewed found that sexual initiation was actually delayed for at least 6 months, and 55% of studies found that education had no effect at all on the timing of initiation of sex.

"The interventions that increase availability or accessibility to condoms are most efficacious when combined with additional individual, small-group, or community-level activities," write Dr. O'Brien and colleagues. Clinic-based interventions have also been shown to increase condom use and are endorsed by the Centers for Disease Control and Prevention.The AAP committee members encourage additional research to identify strategies to improve condom use for STI and pregnancy prevention.

Pediatrics. 2013;132:973-981.

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