CAPs: Things to Consider
One of the most effective actions sexually active youth can take to reduce their risk for HIV and STD infection and unintended pregnancy is to use condoms correctly every time they have sex.
However, despite an increase in condom use during the 1990s and early 2000s, condom use among sexually active youth has decreased to levels similar to the early 1990s.1
Research shows that condom availability programs (CAPs) do not increase sexual activity and can be an appropriate and relevant school-based intervention for increasing condom use among teens who are sexually active.2
The Centers for Disease Control and Prevention (CDC) has identified action steps for schools and districts considering CAPs. These steps can be effective whether your program is for the entire school district or just one school and can be used to start a new program or improve an existing one. The strategies are based on research literature, expert experience, and successful program examples.
Action Steps to Start or Improve CAPs
Before implementing a new CAP or improving an existing program, school administrators need to determine if students, parents and caregivers, the community, and other stakeholders would support the program. Additionally, administrators must understand local, state, and county policies that can impact CAPs in schools. For example, state and school-level policies and laws limit nearly half of all school-based health clinics from dispensing contraception, including condoms, to students.3 Suggested steps for assessing support for CAPs include:
- Reviewing state and local policies on CAPs and condom distribution in schools.
- Obtaining administrative support and seeking support from others in the school and community (including parents and caregivers).
- Determining student interest in the program and supporting students who will help start or promote a CAP.
- Working with the local school board to develop and adopt written policies and procedures for a CAP.
It is important to designate the appropriate people to take on both the initial set-up and day-to-day implementation of a CAP. This might be done by engaging an existing advisory or decision-making group to help establish a CAP, as well as a school-level designee and support staff to handle the logistics of condom distribution. Suggested steps for establishing management and oversight include:
- Establishing or identifying a committee to oversee the implementation and manage the program.
- Designating a person to order and store condoms and informational material.
- Evaluating CAP strategies and policies annually. Use this information to improve programs.
A successful CAP requires a team effort. CAPs can benefit from early and consistent coordination and input from various stakeholders including community healthcare providers, students, and parents and caregivers by:
- Establishing or strengthening partnerships with the local health department or health service providers in the community to obtain support, assess community burden of STD/HIV, and leverage resources.
- Considering parental/caregiver involvement strategies that support CAPs. Schools can recruit important allies by educating parents and other stakeholders about the importance of CAPs and addressing any fears. School administrators should consider procedures that would best inform their students’ parents and caregivers.
- Requesting student input on what may increase student awareness and use of CAPs, such as distribution locations and marketing.
Successful CAPs are incorporated into broader sexual health education2 provided at the school. Researchers have found that teens who receive comprehensive sexual health education are at lower risk for teen pregnancy. 4 Many studies also demonstrate that sexual health education is linked to decreased sexual risk taking and increased condom use.5 Suggested steps for coordinating CAPs with broader sexual health education include:
- Providing educational information with the condoms, such as a brochure or a pocket-sized pamphlet, or a counseling message.
- Implementing the program in conjunction with other school-based sexual health promotion activities such as school-based screening events or health fairs.
- Training interested students to share information with their peers (e.g., through a peer-education program).
- Providing skills-based sexual health education that includes information on the importance of using condoms correctly every time they have sex, and where to obtain condoms.
All programs should provide at least one confidential location for students to obtain condoms. Researchers found that many students were concerned about being embarrassed if someone saw them take a condom at school and most students wanted condoms available in more locations throughout their school. 6 Suggested steps to make condoms available include:
- Asking students where they would feel comfortable obtaining condoms.
- Considering multiple locations to provide condoms, such as the nurse’s office and health resource room.
- Identifying and providing training for condom distributers.
- Providing condoms to students free of charge.
- Determining what consent procedure fits the needs of parents/caregivers, students, and local policy requirements.
- Establishing procedures for parent notification and consent, if applicable.
- Disseminating parental/caregiver notification information, if applicable.
Research suggests that marketing of or educating about a CAP to staff and students increases awareness of the program, including condom locations, as well as use of the CAP for obtaining and using condoms.7 Suggested steps for promoting CAPS include:
- Providing professional development and training for designated school-level staff on the benefits of using condoms, where students can obtain them, and important school policies and procedures, including how to maintain student confidentiality.
- Designing and disseminating promotional materials, such as posters and flyers.
- Sharing information about the program in student newspapers and/or morning announcements.
- Conducting student-led marketing of the program during observance days or other significant dates, such as National Youth HIV/AIDS Awareness Day, National STD Awareness Month, and Valentine’s Day, which is also National Condom Awareness Day.
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Trends in the prevalence of sexual behavior and HIV testing National YRBS: 1991–2015. Atlanta, GA: Centers for Disease Control and Prevention. Accessed May 22, 2019.
- Andrzejewski J, Liddon N, Leonard S. Condom availability programs in schools: A review of the literature. Am J Health Promotion. 2019;33(3):457-467.
- School-Based Health Alliance. (2015). National School-Based Health Care Census, 2013-2014. Washington, DC: School-Based Health Alliance; 2015. Accessed May 22, 2019.
- Kohler PK, Manhart LE, Lafferty WE. Abstinence-only and comprehensive sex education in the initiation of sexual activity and teen pregnancy. J Adolesc Health. 2008;42:344-351.
- Kirby DB, Laris BA, Rolleri LA. Sex and HIV education programs: Their impact on sexual behaviors of young people throughout the world. J Adolesc Health. 2007;40:206-217.
- Schuster MA, Bell RM, Berry SH, Kanouse DE. Students’ acquisition and use of school condoms in a high school condom availability program. Pediatrics. 1997;100(4):689-694.
- De Rosa CJ, Jeffries RA, Afifi AA, Cumberland WG, Chung EQ, Kerndt PR, Dittus PJ. Improving the implementation of a condom availability program in urban high schools. J Adolesc Health. 2012;51(6):572-579.