Does the Promotion and Distribution
of Condoms Increase Teen Sexual
Activity? Evidence from an HIV
Prevention Program for Latino Youth
Deborah E. Sellers, PhD, Sarah A. McGraw, PhD, and John B. McKinlay, PhD
Introduction
Proponents of contraception educa-
tion and condom availability programs
argue that teenagers are sexually active
and must be provided with the means to
protect themselves against pregnancy and
sexually transmitted diseases. Figures for
1988 indicated that about 50% of female
adolescents and 60% of male adolescents
15 to 19 years of age had engaged in
sexual intercourse,1-3 more than 1 in 10
teenage girls was pregnant,2'4 and 1 in 6
sexually experienced teens had a sexually
transmitted disease.5'6 The long incuba-
tion period of the human immunodefi-
ciency virus (HIV) and the number of
cases of acquired immunodeficiency syn-
drome (AIDS) among adults in their 20s
have also raised concern about the rate of
HIV infection among adolescents, even
though relatively few cases of AIDS have
occurred among teens.7 Opponents of
condom availability programs maintain
that the provision of condoms endorses
and thus promotes sexual activity.5'>'2
This issue was raised in the confirmation
hearings for Dr Joycelyn Elders as sur-
geon general of the United States when
Sen Dan Coates (R, Ind) expressed
concem that "just promoting condoms as
a solution to the problem can promote
promiscuity."'3 An even stronger position
was expressed by Phyllis Schlafly during
the debate over the distribution of con-
doms in the New York City public
schools: "condom distribution programs
produce an increase in teen-age sexual
activity."'14 The goal of this study was to
empirically evaluate the assertion that the
promotion and distribution of condoms
increases adolescent sexual activity.
Since the consistent and correct use
of condoms reduces the risk of HIV
infection,1"'15"16 HIV/AIDS prevention
programs often include the promotion
and distribution of condoms.'7'18 In devel-
oping countries, these programs target
both the general adult population and
high-risk populations such as prosti-
tutes.19'20 In the United States, such
programs are more likely to target high-
risk populations such as homosexual men,
intravenous drug users, and prostitutes,
although in some areas condoms are
distributed to a broader adult popula-
tion.2122 The controversy over condom
distribution arises primarily when general
adolescent populations are targeted."
The first school-based condom avail-
ability program in the United States was
implemented in a school district in Com-
merce City, Colo, in 1988.10 In 1991, the
New York City school board adopted a
condom availability program after a na-
tionally publicized debate.1023 Since that
time, similar programs have been imple-
mented or approved in at least 45 other
cities and towns throughout the United
States.24 In some of these programs,
access to condoms is provided in school-
based health clinics; in other programs,
specially trained faculty, staff, and/or
volunteers provide condoms at designated
times and places. Under both methods of
distribution, however, students who want
condoms must make some effort to
acquire them. Condoms are not automati-
cally given to every student. In addition,
most condom availability programs repre-
sent one component of a more comprehen-
sive HIV prevention or sexuality educa-
tion program.8
To date, little research has focused
on the question of whether programs that
The authors are with the New England
Research Institute, Watertown, Mass.
Requests for reprints should be sent to
John B. McKinlay, PhD, New England Re-
search Institute, 9 Galen St, Watertown, MA
02172.
This paper was accepted June 22, 1994.
December 1994, Vol. 84, No. 12

include the promotion and distribution of
condoms increase adolescent sexual activ-
ity. One study of three school-based
health clinics that dispensed contracep-
tives found that the percentage of stu-
dents who had ever had sex, the mean age
at first intercourse, and the frequency of
sex in the previous 4 weeks were no higher
among students in schools with clinics
than among students in matched compari-
son schools.25 Another study 'evaluated
the effect of a direct mailing about
condoms, including coupons for free
condoms, to 16- and 17-year-old low-
income boys.26 This study found no differ-
ence between the experimental and con-
trol groups in the percentage who had
ever had sex or the mean number of acts
of coitus; however, the method of interven-
tion, the short time period between the
intervention and follow-up, and the focus
on lifetime sexual activity limit the utility
of this study.
A recent evaluation of an HIV
prevention program among Latino teenag-
ers in two northeastern cities provides
data with which to empirically examine
the question of whether the promotion
and distribution of condoms increases
sexual activity in a population-based
sample of adolescents. Three specific
questions were addressed: (1) Were ado-
lescents who had not initiated sexual
activity prior to the prevention program
more likely to initiate activity as a result of
the intervention? (2) Were adolescents
who were sexually active by the end of the
intervention more likely to have multiple
partners as a result of the intervention?
and (3) Were adolescents who were
sexually active by the end of the interven-
tion having sex more frequently as a result
of the intervention?
Methods
Study Design
In 1990 in Boston, Mass, an 18-
month community-based AIDS preven-
tion program was initiated among Latino
youth,27 a group at high risk of HIV
infection.28 The multifaceted community
intervention, which was designed to in-
crease HIV/AIDS awareness and to
reduce the risk of HIV infection by
increasing the use of condoms among
sexually active teens, included both the
promotion and distribution of condoms.
Intervention activities, which were con-
ducted by specially trained peer leaders,
included workshops in schools, commu-
nity organizations, and health centers;
group discussions in the homes of youth;
December 1994, Vol. 84, No. 12
presentations at large community events;
and door-to-door and street corner can-
vassing. This canvassing included distribu-
tion of a kit that provided condoms and
pamphlets on how to use them. Condoms
were also freely available at the interven-
tion office and at all intervention activi-
ties. Project messages promoting the use
of condoms were disseminated through-
out the intervention neighborhood via
radio and television public service an-
nouncements, posters in local businesses
and public transit facilities, and a quar-
terly newsletter produced by the peer
leaders. Use of a variety of channels for
the distribution and promotion of con-
doms, as well as other project messages,
ensured relatively easy access to condoms
and rather pervasive saturation of the
project message in the target neighbor-
hood. A more comprehensive description
of the intervention is available else-
where.27
Evaluation of the intervention con-
sisted of a longitudinal comparison of
probability samples of Latino youth from
the intervention city (Boston) and a
comparison city (Hartford, Conn). Hart-
ford was selected as the comparison city
because it provided a comparable inner-
city Latino population and because its
160-km (100-mile) distance from Boston
minimized the possibility of intervention
activities affecting the comparison site.
Areal probability samples, rather than
school- or participant-based samples, were
used because the intervention targeted
the general adolescent population. To
draw a representative, probability sample
of Hispanic adolescents in each city,
census blocks in which at least 20% of the
population was of Spanish origin were
selected as target neighborhoods. In these
target neighborhoods, standard block sam-
pling and household enumeration proce-
dures were used to identify eligible His-
panic adolescents. A detailed description
of the enumeration and sampling proce-
dures has been provided elsewhere.27 29
Trained, bilingual staff completed
baseline interviews before and follow-up
interviews after the intervention activities,
which took place between June 1990 and
December 1991. Interviewers, who were
paired with respondents of the same sex,
protected confidentiality in both inter-
views by conducting them in private
places. Interviews covered sociodemo-
graphic information, AIDS knowledge
and attitudes, and sexual activity and
condom use.
The HIV prevention program in-
creased the likelihood that a teen would
Condoms and Teen Sex
have a condom in his or her possession.27
After adjustment for covariates, the odds
of possessing a condom at the time of the
follow-up interview were 2.3 (P < .01)
and 2.0 (P = .07) times greater for boys
and girls, respectively, in the intervention
city. The intervention also lowered the
risk of HIV infection in males and females
by 9% and 15%, respectively, after adjust-
ment for baseline risk and other covari-
ates; however, these differences did not
achieve statistical significance (Ps = .20
and' .15, respectively).27 More details
about the measurement of HIV risk and
the effects of the intervention are avail-
able elsewhere.27'29
Analysis
To assess whether this HIV preven-
tion program that included the promotion
and distribution of condoms increased the
level of sexual activity in the target
population of Latino adolescents, the
intervention and comparison samples were
compared on three outcomes: the percent-
age experiencing the onset of sexual
activity between the baseline and fol-
low-up interviews, the change in the
percentage with multiple partners be-
tween the baseline and follow-up inter-
views, and the change in the mean
frequency of sex between the baseline and
follow-up interviews. If the intervention
increased adolescent sexual activity, then
the rate of onset of sexual activity, the
change in the percentage with multiple
partners, and/or the change in the fre-
quency of sex between the baseline and
follow-up interviews in the intervention
group would be greater than that in the
comparison group.
Sexual activity was defined as vaginal
or anal intercourse. Muliple partners was
defined as two or more sex partners in the
6 months prior to the interview. Frequency
ofse was the respondents' estimate of the
number of times they had had sex in the
previous 6 months.
The onset of sexual activity analysis
included only respondents who were not
sexually active at the baseline interview.
The multiple partner and frequency of sex
analyses included only respondents who
were sexually active by the follow-up
interview.
The comparison of unadjusted rates,
however, did not take into account any
baseline differences between the compari-
son and intervention samples. The quasi-
experimental design of the evaluation
required that baseline differences be-
tween the intervention and comparison
groups on factors related to the outcome
American Journal of Public Health 1953
Sellers et al.

ties in the comparison city, which took

place because of the general attention to
Boys Girls HIV education and prevention during the
80 80 Intervention period under study. The percentage of
70 _ # 70 I CComparison respondents who reported participating
Percent Sexually Active 60 _
Among Respondents ,/ 60 in AIDS programs and workshops was
Who were Not Sexually Active 50 - 50 -
similar in both cities, but a significantly
by the Baseline Interview 40 - , 40
30 - 30 larger proportion of the intervention
20 - 20 group reported receiving either a condom
10 _ 10 - kit or free condoms (62% vs 42% of
0 0 females and 90% vs 73% of males). In the
Baseline Follow-up Baseline Follow-up intervention city, 75% of respondents
responded positively to one or more of
80 80 three questions during the follow-up inter-
Percent with 70 70 view that inquired about exposure to items
Multiple (2+) Sex Partners 60 (posters, newsletter, condom kit) specifi-
in the Six Months Prior 60
to the Follow-up Interview 50 50 cally associated with the intervention pro-
Among Respondents 40 40 gram, indicating that exposure to the
Who were Sexually Active 30 30 intervention activities was rather extensive.
by the Follow-up Interview 20 20 In evaluations of the effects of the
10 10
0 0 intervention, analytic attention focused
Baseline Follow-up Baseline Follow-up on residence in the intervention city
rather than documented participation in
specific activities because the goal was to
40 40 reach the entire population of Latino
Mean Frequency of Sex 35 35 adolescents in the target neighborhoods
in the Six Months Prior tO 30 30 of the intervention city. The intervention
the Follow-up Interview 25 n
B .o 25
Among Respondents 20 20
included some formally organized presen-
Who were Sexually Active 15 15 tations and workshops that teens could
by the Follow-up Interview 10 10 attend, but much of the activity involved
5 5 more diffuse efforts-including public
0 0 service announcements on local radio
Bascline Follow-up Baseline Follow-up stations, posters in businesses and public
transit facilities, and outreach workers on
FIGURE 1-Unadjusted value of outcome measures for intervention and street corners and at community
comparison groups, by gender and time of interview. events-to expose the target population
to project messages. Thus, similar to
intention-to-treat analyses in clinical tri-
als, residence in the intervention city
of interest be statistically controlled.30 set of covariates that included artifacts of constituted exposure to the intervention,
Consequently, multivariate regression the study design, competing HIV preven- and the effect of the intervention on
methods were used to determine the tion activities, and factors related to sexual behavior was captured via an
effect of the intervention on each out- adolescent sexual activity, as well as an indicator for such residence.
come after any differences between the indicator for intervention city. The mul- For all three outcomes, the regres-
intervention and comparison samples on tiple partners and frequency of sex analy- sion analysis was completed in three steps.
factors related to that outcome had been ses also included the baseline level of the First, respondent's age and the study
controlled. Logistic regression was used outcome and thus constituted an analysis design covariates were forced into the
for the onset of sexual activity and of change between baseline and follow- model. Second, a backward stepwise
multiple partner analyses. Ordinary least up.32 The appendix provides a complete procedure including all other covariates
squares regression analysis was used for description of the covariates and their (except the intervention indicator) was
frequency of sex. In order to satisfy the operationalization. Factors related to ado- completed. The backward procedure, with
assumption of homoscedasticity in ordi- lescent sexual activity were culled from a conservative criterion for removal
nary least squares regression, a natural log previous research.33-50 Male respondents (P = .2), permitted control of influential
transformation was applied to frequency and female respondents were analyzed covariates, even if not strictly statistically
of sex in the previous 6 months.31 To separately since previous research indi- significant. Finally, the indicator for inter-
permit retention of respondents who cates that different factors influence the vention city was forced into the model to
reported no sex in the previous 6 months, sexual activity of young men and young assess-the effect of the intervention after
a constant (1) was added to each score women.33,34,4l other covariates had been controlled.
prior to this transformation. The measures of participation in Model fit was checked with the Hosmer-
The onset of sexual activity, multiple HIV prevention activities similar to those Lemeshow goodness-of-fit statistic for
partners at follow-up, and frequency of of the intervention were included to logistic regressions51 and residual analysis
sex at follow-up were each regressed on a control for the effect of prevention activi- for linear regressions.52

1954 American Journal of Public Health December 1994, Vol. 84, No. 12

The influence of sampling proce-
dures on the survey estimates was as-
sessed by calculating sample weights and
design effects.53 The sample weights var-
ied little across respondents (2.79 to 3.67),
and the distributions of weighted and
unweighted outcome variables were essen-
tially the same. Design effects, which
incorporated the influence of clustering of
respondents within households, were close
to one (0.96 to 1.06). Consequently,
unweighted results involving standard
variance estimates are reported.
Results
Baseline interviews were completed
with 586 Latino adolescents who were 14
to 20 years of age and were primarily
Puerto Rican (94%). The baseline re-
sponse rate was 84.4%. Follow-up inter-
views were completed with 536 of these
respondents, for a follow-up response rate
of 91.5%. The attrition rates (7.2% and
9.3% in the intervention and comparison
cities, respectively) were minimized by
contacting each respondent at 3-month
intervals between baseline and follow-up
to obtain current address and telephone
information.
Of the 536 respondents who re-
sponded to both the baseline and the
follow-up interviews, 256 (47.8%) re-
ported no sexual activity prior to the
baseline interview. Of these, 227 (88.7%)
provided responses to all covariates in the
model for onset of sexual activity and thus
constituted the analytic sample for that
analysis. By the follow-up interview, 433
respondents (80.8%) reported sexual ac-
tivity. Of these, 403 (93.1%) provided
valid responses to all covariates and thus
constituted the analytic sample for the
frequency of sex and multiple partner
analyses.
Unadjusted Intervention Effects
Figure 1 illustrates the unadjusted
intervention effects for both males and
females by presenting the outcome mea-
sures for the intervention and comparison
groups. The top panel provides the rate of
onset of sexual activity; the middle and
lower panels provide the change between
the baseline and follow-up interview in
the proportion with multiple partners and
in the frequency of sex, respectively, in the
6 months prior to the interview.
For female respondents, the rate of
onset of sexual activity was the same in the
intervention group as in the comparison
group. Similarly, the increase in the
frequency of sex between baseline and
December 1994, Vol. 84, No. 12
Condoms and Teen Sex
TABLE 1-Effect of the Intervention on the Level of Sexual Activity after
Adjustment for Covariates Related to Adolescent Sexual Activity,
Competing HIV Prevention Activities, and Artifacts of the Study
Design
Outcome Males Females
Onset of sexual activity between baseline and
follow-up interviewsa (logistic regressionb)
Odds ratio 0.08* 1.24
95% confidence interval 0.01, 0.57 0.44, 3.46
Hosmer-Lemeshow goodness of fit (P level) 6.08 (.638) 4.95 (.763)
No. 89 138
Multiple (2+) sexual partners in the 6 months
prior to the follow-up interviewc (logistic
regressionb)
Odds ratio 0.90 0.06**
95% confidence interval 0.43,1.91 0.01, 0.43
Hosmer-Lemeshow goodness of fit (P level) 5.51 (.702) 4.60 (.800)
No. 211 192
Frequency of sexd in the 6 months prior to the
follow-up interviewc (ordinary least
squares regressionb)
Regression coefficient .21 -.11
95% confidence interval -0.20, 0.62 -1.74, 4.26
Adjusted R2 .276 .380
No. 211 192
Note. See Appendix for a description of the covariates and their operationalization.
aAmong respondents who were not sexually active at baseline.
bThe regression analysis was completed in three steps. First, respondent's age and two covariates
measuring artifacts of the study design were forced into the equation. Second, a backward
stepwise procedure with a conservative criterion for removal (P = .20) was applied to all other
covariates. Finally, the intervention indicator was forced into the equation. The resuits for this final
step are reported.
CAmong respondents who were sexually active by the follow-up interview.
din order to satisfy the assumption of homoscedasticity in ordinary least squares regression, a
natural log transformation was applied to frequency of sex in the previous 6 months.31 To permit
retention of respondents who reported no sex in the previous 6 months, a constant (1) was added
to each score prior to this transformation.
*P < .05; **P < .01.
follow-up was the same for females in Adjusted Intervention Effects
both groups, even though the frequency
was slightly higher in the comparison
The unadjusted results presented in
Figure 1 do not control for baseline
group. In addition, for females, the in-
crease in the percentage with multiple
differences between the intervention and
comparison samples. As mentioned ear-
partners in the 6 months prior to the
interview between the baseline and fol- lier, the lack of experimental control in
low-up interviews was lower in the inter- the quasi-experimental evaluation design
vention group than in the comparison required that any differences between the
intervention and comparison groups on
group. For male respondents, the onset of
sexual activity between the baseline and factors related to the outcome of interest
be statistically controlled.30 Table 1 and
follow-up interviews and the increase in
the frequency of sex between baseline and Figure 2 present the results of the
follow-up were lower in the intervention multivariate regression analysis applied to
than in the comparison group. However, each outcome to provide this statistical
the increase in the percentage with mul- control. Since the covariate results were
tiple partners was greater in the interven- not central to the question of interest,
tion group than in the comparison group. only the results obtained from forcing the
Thus, with the exception of the propor- intervention indicator into the model (the
tion of males with multiple partners, the last step in each regression analysis) are
intervention did not accelerate the natu- reported.
rally occurring increase in the level of After control for the influence of
sexual activity among either males or other covariates, males in the intervention
females. city were less likely to become sexually
American Journal of Public Health 1955
Sellers et al.

than those in the comparison city. In fact,

*ODDS RATIO (Intervention:Comparison) male respondents in the intervention city
were less likely than those in the compari-
0.01 0.02 0.05 0.1 0.2 0.5 1 2 5 10 son city to experience the onset of sexual
activity. Among teens who were sexually
ONSET OF SEXUAL ACTIVITY* active by the end of the intervention, the
BOYS I * number of sexual partners and the fre-
quency of sex in the previous 6 months
GIRLS were no higher in the intervention city
than in the comparison city. Indeed,
MULTIPLE PARTNERS* female respondents in the intervention
BOYS city were less likely than those in the
comparison city to have had multiple sex
GIRLS I * l partners.
This lack of an increase in sexual
FREQUENCY OF SEX** activity as a result of promoting and
BOYS distributing condoms is consistent with
previous research. Generally, providing
GIRLS adolescents with information about repro-
duction and contraception has not in-
-2.0 -1.5 -1.0 -0.50.5 0.0 1.0 creased sexual activity.54 60 Instead, recent
programs that have combined reproduc-
**REGRESSION COEFFICIENT tive and contraceptive information with a
Note. The estimated effect of the intervention is shown after adjustment for differences between the message to delay early sexual involvement
intervention and comparison groups. Error limits indicate 95% confidence intervals. The onset of and the skills with which to achieve that
sexual activity analyses used logistic regression and were restricted to those not sexually active goal have documented a decrease in
before the baseline interview. The multiple partner analyses used logistic regression and were
restricted to those who were sexually active by the follow-up interview. The frequency of sex sexual involvement and activity.6063 An
analyses, which were also restricted to those sexually active by the follow-up interview, used evaluation of school-based health clinics
ordinary least squares linear regression. A natural log transformation was applied to frequency of that distributed contraceptives found no
sex after adding a constant (1) to each score.
increase in sexual activity.25
The lack of an increase in sexual
FIGURE 2-Effect of HIV prevention program, which includes the promotion activity as a result of providing adoles-
and distribution of condoms, on the sexual behavior of Latino cents with access to contraceptives is also
adolescents after adjustment for differences between the consistent with the experience in other
intervention and comparison groups.
developed nations. In countries such as
Sweden, the Netherlands, and England,
easy, confidential access to contraceptives
active than were males in the comparison among male respondents in the interven- for adolescents has been institutionalized.
city (odds ratio [OR] = 0.08, P = .011). tion group based on the unadjusted Yet levels of sexual activity among adoles-
For females, the intervention did not results was insignificant after adjustment cents in those countries are similar to
significantly increase or decrease the for differences between the intervention those in the United States, and, despite
chances of becoming sexually active and comparison groups. the similarity in the level of sexual activity,
(OR= 1.24, P = .692). Hosmer-Lem- The intervention did not significantly the teen pregnancy rate in those countries
eshow statistics of 6.08 (P = .638) and affect the frequency of sex for either male is generally considerably lower than that
4.95 (P = .763) for males and females, or female respondents. Residual analysis in the United States.64
respectively, indicate that the fit of both indicated no problems with the fit of This investigation was limited in
models was very good. either model. About 28% and 38% of the several ways. First, the power to detect
In terms of multiple partners, the variance was explained by the covariates differences between the comparison and
indicator for the intervention had an odds in the model for males and females, intervention cities was limited by the
ratio of 0.902 (P = .790) for males and an respectively. sample sizes available. For the onset of
odds ratio of 0.06 (P = .005) for females, sexual activity analysis for females and the
after the influence of the covariates had Discussion multiple partner analysis for males, the
been controlled. For both males and minimum detectable differences in the
females, the fit of the model was good, Evaluation of an HIV prevention unadjusted rates for the available sample
with Hosmer-Lemeshow statistics of 5.51 program that included the promotion and sizes (in a one-sided test with an alpha
(P = .702) and 4.60 (P = .800), respec- distribution of condoms provided no level of .10 and a power of .80) were about
tively. Thus, female respondents in the evidence to suggest that the availability of 18 and 15 percentage points, respec-
intervention city were significantly less condoms increased sexual activity or pro- tively.65 For both males and females, the
likely to have multiple partners at the moted promiscuity in the target popula- minimum detectable difference in the
follow-up interview than were their coun- tion of Latino adolescents. Adolescents in unadjusted frequency of sex in the previ-
terparts in the comparison city. In addi- the intervention city who were not sexu- ous 6 months was 13 contacts for a similar
tion, the apparently greater increase in ally active prior to the intervention were test. However, the multivariate analysis
the propensity to have multiple partners no more likely to become sexually active improved the power to detect differences

1956 American Journal of Public Health December 1994, Vol. 84, No. 12

by reducing within-group variances.32 In
addition to this limitation due to the
number of individuals, the study was also
limited by the use of only one intervention
and one comparison site.
Second, since this AIDS prevention
program focused on Latino adolescents,
the results cannot be immediately extrapo-
lated to non-Hispanic Whites or African-
American teenagers. Unique cultural fac-
tors that vary with education, socioeco-
nomic status, and acculturation may influ-
ence the effect of messages promoting the
use of condoms on Latino adoles-
cents.4950'66 However, attention to the
effects of HIV prevention programs among
Latino adolescents is important because
the cumulative incidence of AIDS among
15- to 24-year-old Latinos is at least twice
as high as it is for other groups.28
In summary, the results of this
investigation, as well as previous research
and the experience with providing contra-
ceptives to adolescents in other developed
nations, suggest that the concern that
providing adolescents with condoms and
information about condoms promotes
promiscuity and increases sexual activity
is not justified. Although additional re-
search efforts should include attention to
this question, particularly in instances in
which data are readily available as part of
other investigations, the magnitude of the
crisis presented for adolescents and soci-
ety by both teen pregnancy and the HIV
epidemic dictate that we provide adoles-
cents with the information, skills, and
material goods required to combat these
problems. O
Acknowledgments
This research was supported by grant RO1
HD25026 from the National Institute of Child
Health and Development.
We would like to acknowledge the impor-
tant work of Jose Duran, Heriberto Crespo,
Haner Jemandez, Antonieta Gimeno, the
Poder Latino peer leaders, and other staff at
the Hispanic Office for Planning and Evalua-
tion. We would like to thank Eleanor Weber,
MA, Peter H. Rossi, PhD, Sybil L. Crawford,
PhD, and Kevin W. Smith, MA, for their
helpful comments on earlier versions of this
manuscript and Henry Feldman, PhD, for his
assistance with Figure 2.
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 Condoms and Teen Sex

APPENDIX-Description of Covarlates
Factors related to adolescent sexual activity
Parental supervision: 1 = parents always "know where you are and what you are doing"; 0 = otherwise.
Parental attachment: Sum of responses (5 categories, never to always, coded so that high score indicates greater attachment) to 4
items: Do parents act fair and reasonable? Do parents act as if they don't care? Do parents blame or criticize you when you don't
deserve it? and Do you respect parents' opinion about important things in life?
Peer influence: 1 = respect friends' opinions more often than parents'; 0 = otherwise.
Importance of friends: 1 = responded very or fairly important to 2 items: importance of friends in life and importance of time spent with
friends: 0 = otherwise.
Normative environment: Product of number of best friends (0-5) who had sex in last 6 months with 5-category response (never = 1,
always = 5) to "How often would you like to be the kind of person your best friends are?"
Family intact: 1 = 2 parents (stepparents or natural parents) living in home at baseline; 0 = otherwise.
Socioeconomic status: Green's 2-factor index. 67
Age: respondent's age in years at baseline.
Changed residence: 1 = moved between baseline and follow-up interviews; 0 = otherwise.
Employment: 1 = employed at baseline; 0 = otherwise.
Dropout-follow-up: 1 = withdrew from school without high school degree by follow-up; 0 = otherwise.
Self-esteem: Rossenberg's 5-item scale.68
Church attendance per month: number of times attending church each month (12 = 12 or more).
Ever smoked: 1 = ever smoked even one puff of a cigarette; 0 = otherwise.
Ever consumed alcohol: 1 = 12 or more drinks of alcohol in lifetime; 0 = otherwise.
Drunk: 1 = 5 or more drinks in 1 day in past 12 months; 0 = otherwise.
Medium and high acculturation: Sample was divided into three levels of acculturation (0-7 = low, 8-9 = medium, and 10-15 = high)
based on the sum of the 5-category responses (1 = Spanish only, 5 = English only) to questions about language use with friends,
language use with family, and the language of the interview; indicators (1 = yes, 0 = no) for the medium and high levels of accultura-
tion were used as covariates.
Medium acculturation-socioeconomic status: Product of indicator for medium level of acculturation and socioeconomic status.
High acculturation-socioeconomic status: product of indicator for high level of acculturation and socioeconomic status.
Worry about AIDS: response (1 = not at all, 4 = a great deal) to "How much do you worry that you could get AIDS?"
AIDS knowledge: scale measuring AIDS knowledge constructed from 13 yes/no items about the mechanisms of transmission, means
of lowering risk of infection, and cure or prevention of the virus.
Living with partner-follow-up: 1 = living with partner at time of follow-up interview; 0 = otherwise.
Multiple partners-baseline: 1 = 2 or more sex partners in 6 months prior to baseline interview; 0 = otherwise.
Frequency of sex-baseline: frequency of sex in 6 months prior to baseline interview.

Intervention activities
AIDS program: 1 = hosted AIDS discussion group in home; 0 = otherwise.
AIDS workshop: 1 = attended AIDS workshop or forum outside of home; 0 = otherwise.
Condom kit: 1 = received condom kit, including condoms and information about how to use them; 0 = otherwise.
Free condom: 1 = received free condom in the last 6 months; 0 = otherwise.

Study design
Smoking study participant: 1 = participant in previous smoking study; 0 = otherwise.
Months to follow-up: number of months between the baseline and follow-up interviews.

December 1994, Vol. 84, No. 12 American Journal of Public Health 1959