Gender Differences in Partner Influences and Barriers to Condom Use Among Heterosexual Adolescents Attending a Public Sexually Transmitted Infection Clinic in Singapore

Published:September 24, 2012DOI:


      To compare gender differences in the factors associated with condom use at most recent voluntary intercourse among heterosexual adolescents attending a public clinic for sexually transmitted infections (STIs).

      Study design

      Between 2008 and 2011, we conducted a cross-sectional survey on 964 never-married adolescents between 14 and 19 years of age who reported having engaged in voluntary intercourse for most recent sexual encounter and were attending the only public STI clinic in Singapore for screening or treatment of STIs. Data were collected using a self-administered questionnaire.


      The response rate to the questionnaire was 85.2%. In multivariate analysis, condom use at last intercourse for both genders was negatively associated with Malay race and peer connectedness and was positively associated with confidence in the ability to use a condom correctly. Being employed was positively associated with condom use for female respondents only. For male respondents only, condom use showed a positive association with living in better housing, older age at first intercourse, and engaging in sexual intercourse with commercial sex partners. Almost all (90%) commercial sex partners suggested condom use and provided condoms compared with 8.1% of non–sex worker partners. Condom use showed a negative association with inconvenience in its use among male respondents but not female respondents.


      STI prevention programs for adolescents must promote condom use with nonpaying partners, address barriers to condom use, and develop condom application skills, taking into account gender differences. Future research should explore condom use within dating relationships.
      EHBM ( Expanded Health Belief Model), STI ( Sexually transmitted infection)
      To read this article in full you will need to make a payment


        • Chan R.
        Sexually transmitted infections in Asia and the Pacific: an epidemiological snapshot.
        Sex Transm Infect. 2011; 87: ii14-ii15
        • Thato S.
        • Hanna K.M.
        • Rodcumdee B.
        Predictors of condom use among adolescent Thai vocational students.
        J Nurs Scholarsh. 2003; 35: 157-163
        • Holschneider S.
        • Alexander C.
        Social and psychological influences on HIV preventive behaviours of youth in Haiti.
        J Adolesc Health. 2003; 33: 31-40
        • Robertson A.A.
        • Stein J.A.
        • Baird-Thomas C.
        Gender differences in the prediction of condom use among incarcerated juvenile offenders: testing the information-motivation-behavior skills (IMB) model.
        J Adolesc Health. 2006; 38: 18-25
        • Jemmott III, J.B.
        • Heeren G.A.
        • Ngwane Z.
        • Hewitt N.
        • Jemmott L.S.
        • Shell R.
        • et al.
        Theory of planned behaviour predictors of intention to use condoms among Xhosa adolescents in South Africa.
        AIDS Care. 2007; 19: 677-684
        • Yi S.
        • Poudel K.C.
        • Yasuoka J.
        • Palmer P.H.
        • Yi S.
        • Jimba M.
        Role of risk and protective factors for risky sexual behaviours among high school students in Cambodia.
        BMC Public Health. 2010; 10: 477
        • Buzi R.S.
        • Smith P.B.
        • Weinman M.L.
        Parental communication as a protective factor in increasing condom use among minority adolescents.
        Int J Adolesc Med Health. 2009; 21: 51-59
        • DiClemente R.J.
        • Wingood G.M.
        • Crosby R.
        • Cobb B.K.
        • Harrington K.
        • Davies S.L.
        Parent-adolescent communication and sexual risk behaviors among African American adolescent females.
        J Pediatr. 2001; 139: 407-412
        • DiClemente R.J.
        • Wingood G.M.
        • Crosby R.
        • Sionean C.
        • Cobb B.K.
        • Harrington K.
        • et al.
        Parental monitoring: association with adolescents' risk behaviors.
        Pediatrics. 2001; 107: 1363-1368
        • Borawski E.A.
        • Ievers-Landis C.E.
        • Lovegreen L.D.
        • Trapl E.S.
        Parental monitoring negotiated unsupervised time and parental trust: the role of perceived parenting practices in adolescent health risk behaviors.
        J Adolesc Health. 2003; 33: 60-70
        • Stanton B.
        • Li X.
        • Pack R.
        • Cottrell L.
        • Harris C.
        • Burns J.M.
        Longitudinal influence of perceptions of peer and parental factors on African American adolescent risk involvement.
        J Urban Health. 2002; 79: 536-548
        • Adih W.
        • Alexander C.
        Determinants of condom use to prevent HIV infection among youth in Ghana.
        J Adolesc Health. 1999; 24: 63-72
        • Markham C.M.
        • Lormand D.
        • Gloppen K.M.
        • Peskin M.F.
        • Flores B.
        • Low B.
        • et al.
        Connectedness as a predictor of sexual and reproductive health outcomes for youth.
        J Adolesc Health. 2010; 46: S23-S41
        • Aalsma M.C.
        • Fortenberry J.D.
        • Sayegh M.A.
        • Orr D.P.
        Family and friend closeness to adolescent sexual partners in relationship to condom use.
        J Adolesc Health. 2006; 38: 173-178
        • Brown L.K.
        • DiClemente R.
        • Crosby R.
        • Fernandez M.I.
        • Pugatch D.
        • Cohn S.
        • et al.
        Condom use among high-risk adolescents: anticipation of partner disapproval and less pleasure with not using condoms.
        Public Health Rep. 2008; 123: 601-607
        • Juarez F.
        • Martín T.C.
        Safe sex versus safe love? Relationship context and condom use among male adolescents in the favelas of Recife, Brazil.
        Arch Sex Behav. 2006; 35: 25-35
        • Chatterjee N.
        • Hosain G.M.
        • Williams S.
        Condom use with steady and casual partners in inner city African-American communities.
        Sex Trans Infections. 2006; 82: 238-242
        • Zimmerman R.S.
        • Noar S.M.
        • Feist-Price S.
        • Dekthar O.
        • Cupp P.K.
        • Anderman E.
        • et al.
        Longitudinal test of a multiple domain model of adolescent condom use.
        J Sex Res. 2007; 44: 380-394
      1. World Health Organization. WHO global strategy for the prevention and control of sexually transmitted infections: 2006-15: Breaking the chain of transmission. 2007. Available from:

        • Jenkins R.A.
        • Manopaiboon C.
        • Samuel A.P.
        • Jeeyapant S.
        • Carey J.W.
        • Kilmarx P.H.
        • et al.
        Condom use among vocational school students in Chiang Rai, Thailand.
        AIDS Educ Prev. 2002; 14: 228-245
        • Douthwaite M.R.
        • Saroun L.
        Sexual behaviour and condom use among unmarried young men in Cambodia.
        AIDS Care. 2006; 18: 505-513
        • British Medical Association
        Medical ethics today.
        2nd ed. BMJ Publishing Group, London2004 (230-231)
        • Jackson C.
        • Henriksen L.
        • Foshee V.A.
        The authoritative parenting index: predicting health risk behaviors among children and adolescents.
        Health Educ Behav. 1998; 25: 319-337
        • Mirande A.M.
        Reference group theory and adolescent sexual behavior.
        J Marriage Family. 1968; 30: 572-577
        • Khumsaen N.
        • Gary F.A.
        Determinants of actual condom use among adolescents in Thailand.
        J Assoc Nurses AIDS Care. 2009; 20: 218-229
        • Bortot A.T.
        • Risser W.L.
        • Cromwell P.F.
        Condom use in incarcerated adolescent males: knowledge and practice.
        Sex Transm Dis. 2006; 331: 2-4
        • Sen P.
        • Chio M.T.
        • Tan H.H.
        • Chan R.K.
        Rising trends of STIs and HIV infection in Singapore: a review of epidemiology over the last 10 years (1994 to 2003).
        Ann Acad Med Singapore. 2006; 35: 229-235