1. Positive Impact of a Structural Intervention on Knowledge of and Use of School-based Condom Availability Programs by Urban High School Students
Emily Q. Chung MPH, CHES, Patricia Dittus, PhD,
Christine J. De Rosa, PhD, Kathleen Ethier, PhD,
Esteban Martinez, Kathy Wong, MS,
Peter R. Kerndt, MD, MPH
For the PROJECT CONNECT Study Team
Funded by Centers for Disease Control and Prevention,
Cooperative Agreement U30/CCU

2. Condom Availability Program (CAP)
CAPs make condoms available in schools as part of a coordinated school health program
A 1996 report found 50 school districts, 431 schools with CAPs
CAPs provide opportunities
Direct interaction with students
Prevention counseling
Provision of information
CAPs vary substantially in number of condoms distributed and students served
In addition to providing condoms, CAPs provide opportunities for one-on-one adult contact and information dissemination on abstinence and STDs
Types of programs – fishbowls, active consent, etc

3. Los Angeles Unified School District (LAUSD) CAP
Implemented in 1992
All LAUSD high schools mandated to make condoms available to students
Schools set up a committee, including school nurse
Committee defines parameters
Condoms obtained from district coordinator
Prevention materials handed out with condoms
Passive parental consent
Board policy
Parameters include who will hand them out, how many can be handed out at one time, when they can be handed out (i.e., before school, during nutrition, during lunch, after school, any time).
Condoms come from county health department

4. Formative Research, LAUSD CAP
Most students (55%) unaware they could get condoms at schoola
Fewer than 1 in 4 sexually experienced students ever received condoms from CAPa
Multiple barriersb
Left to health clinics
Confusion/difficulty with consent
Administrative buy-in
Lack of awareness among school staff
Added logistical burdens
aBased on youth surveys
bBased on key informant interviews

5. CAP Intervention Goals
Enhance implementation of district-mandated CAP
Increase the number of students who are aware of the CAP
Increase the number of students who receive condoms from the CAP

6. CAP: Stages of Change GOAL: 1: Precontemplation
Condom Availability Program?
What’s that?
Do we have one?
5: Maintenance
Continuing and expanding
the program.
GOAL:
2: Contemplation
We ought to do that…
3: Preparation
How are we
going to do that?
Every school is different.
Want to see where they were with compliance
See where they where and what it would take to get them where we want them to be
4: Action
Starting up a program.

7. Activities by Stage
Stages 1 and 2: Educational meetings about policy and adolescent reproductive health
Stage 3: Self-assessment, plan and materials development
Stage 4: Implementing plan, follow-up
Stage 5: Outreach
Follow-up = point of contact. Just by showing up and asking questions, deadlines, how we can help to facilitate and touching base, we made an impact

8. Raising Awareness of CAP (Outreach)

9. Youth Survey Measures Research Question High school surveys only
Do our enhancements to the CAP result in increased knowledge of the program and increased use of the program?
High school surveys only
Does someone at your school (like a nurse or counselor) give out condoms to students who want them?
Have you ever gotten condoms from this person at your school?
Evaluating effect of intervention answers question
Going to School nurse for condoms is a sub-measure for CAP

10. Analysis Chi-square analyses
Outcomes by data collection wave
Analyses performed by condition and sexual experience (yes/no)
Logistic regression models included condition, waves, and condition X wave interaction terms
Analyses restricted to high school students

11. Change in Knowledge of CAP
Among all participants:
Increase in knowledge of CAP across waves was significantly greater for intervention than control participants
55.1% % % vs. 47.7% % %, wave X condition interactions p<.05
Driven by change among intervention females
51.2% % % vs. 45.8% % %, wave X condition interactions p<.05
Wave x condition interactions – explain

12. Knowledge of CAP, All Students by Condition
N=13,331 high school students over 3 waves
N=13,331

13. Knowledge of CAP, All Females by Condition

14. Change in Knowledge of CAP Among Sexually Experienced Participants
Knowledge of CAP increased across waves
62.6% % % vs. 51.4% % %, wave X condition interactions n.s.
Change was not significantly different for intervention vs. control participants
Bullet 3 Change in knowledge across waves is driven by change among females
Wave 2 – marginally significant interaction

15. *Wave 2 x condition interaction marginally significant, p<.10
Change in Knowledge of CAP Among Sexually Experienced Participants, All Females by Condition
70.2
*Wave 2 x condition interaction marginally significant, p<.10

16. Used CAP, All Students Who Knew of It*
Use of CAP did not differ between conditions
Use of CAP increased across waves in both conditions
Intervention: 27.0% % %
Control: 27.4% % %
Wave X condition interactions n.s.
*Among all students regardless of sexual experience

17. Went to School Nurse for Condoms
Among all participants, regardless of sexual experience:
Increase across waves significantly greater for intervention than control participants
6.7% - 7.9% - 9.6% vs. 7.0% – 6.7% - 7.2%, wave 3 X condition interaction p<.05
Driven by change among intervention males
10.7% % % vs. 10.9% % - 9.3%, wave 3 X condition interaction p<.05
Intervention males – among all students

18. Went to School Nurse for Condoms
Among sexually experienced students only, increase driven by intervention females
6.7% % % vs. 7.4% - 6.1% %, wave 2 X condition interaction p<.05

19. Went to School Nurse for Condoms, All Females by Condition*
Among sexually experienced students only, increase driven by intervention females
6.7% % % vs. 7.4% - 6.1% %, wave 2 X condition interaction p<.05
*Among sexually experienced students

20. Summary of Findings
Increase in knowledge of CAP greater in intervention schools
Going to School Nurse for condoms significantly greater for intervention than for control participants
Knowledge of CAP increased significantly among participants in both intervention and control schools
Females appear impacted more by interventions than males

21. Conclusions
Enhancements to implementation of CAP are feasible, practical, low-cost
Enhancements resulted in:
Greater increase in knowledge of program among students in intervention schools
Increase in seeing School Nurse for condoms among students in intervention schools

22. Implications for Interventions
Implementation of district-mandated CAP can vary:
Enforcement
Person responsible
Minor enhancements (i.e., moving personnel through stages of change) can result in substantial improvement in implementation
Improved implementation results in greater student knowledge of CAP and seeking condoms from School Nurse

23. Condom Availability Programs: Next Steps
Intervention:
Enlist student leadership groups in normalizing use of CAP
Increase outreach
Maintain functioning of programs
Evaluation:
Examine how changes in knowledge and use of CAP impact participant condom use
Examine relationship between number of condoms distributed and participant condom use
Long term

24. William Cumberland, PhD
Thank You!
Collaborators:
Peter Kerndt, MD, MPH
Kathleen Ethier, PhD
Patricia Dittus, PhD
Nicole Liddon, PhD
Abdelmonem Afifi, PhD
William Cumberland, PhD
Harlan Rotblatt
Ric Loya
Robin Jeffries, MPH
Sharon Hudson, PhD
Project Staff:
Christine J. De Rosa, PhD
Emily Q. Chung, MPH, CHES
Steve Martinez, BA
Kathy Wong, MS
Lindsay Du Plessis, MPH
…for the Project Connect Study Team