Tuesday, 8th of December 2009 |
CSU 78/2009: NEW YORK CONDOMS
As a a former New Yorker, I am amazed that a public distribution scheme for
branded condoms could raise condom sales and use in what looked like a
saturated market.
Perhaps the New York branded condoms carried a cachet for potential
purchasers who would not otherwise have bought them.
Full text is at
http://ajph.aphapublications.org/cgi/content/full/99/12/2178?view=long&pmid=19834001
Good reading.
BD
December 2009, Vol 99, No. 12 | American Journal of Public Health 2178-2180
© 2009 American Public Health Association
DOI: 10.2105/AJPH.2008.152298
RESEARCH AND PRACTICE
The NYC Condom: Use and Acceptability of New York City's Branded Condom
Ryan C. Burke, MPH, Juliet Wilson, MSc, Kyle T. Bernstein, PhD, MPH,
Nicholas Grosskopf, EdD, CHES, Christopher Murrill, PhD, MPH, Blayne
Cutler, MD, PhD, Monica Sweeney, MD and Elizabeth M. Begier, MD, MPH
At the time of the study, all authors were with the New York City
Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and
Control, New York, NY.
Correspondence: Correspondence should be sent to Elizabeth Begier, MD, MPH,
Bureau of Vital Statistics, New York City Department of Health & Mental
Hygiene, 125 Worth, Room 204, New York, NY 10013 (e-mail:
ebegier@health.nyc.gov ).
We assessed awareness and experience with the NYC Condom via surveys at 7
public events targeting priority condom distribution populations during
2007. Most respondents (76%) were aware of NYC Condoms. Of those that had
obtained them, 69% had used them. Most (80%) wanted alternative condoms
offered for free: 22% wanted ultra-thin, 18% extra-strength, and 14%
larger-size. Six months after the NYC Condom launch, we found high levels
of awareness and use. Because many wanted alternative condoms, the
Department of Health and Mental Hygiene began distributing the 3
most-requested alternatives.
On February 14, 2007, via a high-profile media campaign, the New York City
Department of Health and Mental Hygiene (DOHMH) introduced the NYC Condom.
The NYC Condom, the first specially packaged condom unique to a
municipality (http://www.nyc.gov/condoms), is a lubricated, standard-size,
Lifestyles (Ansell Healthcare, Red Bank, NJ) brand male condom. The month
following the launch, DOHMH distributed 5 million NYC Condoms to city
organizations and businesses. Subsequently, average monthly distribution
stabilized at 3.4 million condoms.
The program began receiving anecdotal reports from organizations that the
public wanted DOHMH to also distribute larger-size condoms for free. To
inform programmatic decision-making, we conducted a survey of sexually
active New Yorkers to measure awareness of and experience with the NYC
Condom, and demand for and experience with other male condoms.
We conducted a street intercept survey during July through September 2007
at 7 large public events in New York City, where attendees largely
consisted of people of color and gay persons (e.g., Gay Pride Events,
African American Day Parade), to target groups with higher HIV prevalence.
New York City residents aged 18 years and older were eligible to
participate. For systematic recruiting, we used a time–space sampling
methodology.1 We identified a designated intercept line at each event, and
assigned each person crossing the line an interviewer. The anonymous
in-person questionnaires were administered onsite via handheld-assisted
personal interview Pocket PCs (Hewlett-Packard Development Company, LP,
Palo Alto, CA) and respondents were offered $4 transit card incentives.
We obtained NYC Condom awareness with the following question: "In the past
12 months, have you seen or heard about condoms in a black package with NYC
Condom written on it in colorful letters?" We obtained NYC Condom use with
the following question: "Have you used that condom in the black package
with NYC Condom written on it? By used I mean have you or any of your
partners ever used this condom when having sex together."
To ascertain information on the respondents' desire for an alternative
condom, we asked: "Condoms come in a variety of types, like color, feel or
touch, brand, and size. If the Health Department were to provide another
type of male condom for free, what type of condom would be your top
choice?" This was an open-ended question that was subsequently categorized
during data analysis. Respondents were asked to compare the NYC Condom to
other male condoms on a scale of 1 to 10 with 1 = NYC Condoms are much
worse than other male condoms and 10 = they are much better than other male
condoms. The current analysis includes respondents who reported sexual
activity in the past 12 months, excluding women who reported sexual
activity with only women.
We approached 933 people; 464 (50%) answered screening questions, 389 were
eligible (aged 18 years or older and a New York City resident by
self-report), and 361 completed the questionnaire and had a New York City
zip code (93% participation rate). We excluded 19 women who reported sexual
activity with only women and 49 respondents who were not sexually active in
the past 12 months for a final sample of 293 (81% of participants). Most
respondents were Black or Hispanic, and 29% were men reporting sexual
activity with 1 or more men in the past year (Table 1).
TABLE 1— Characteristics of Survey Respondents and NYC Condom
Awareness and Use by Demographic Category: New York City
Residents Aged 18 Years and Older, 2007
Six months after the NYC Condom launch, we found high levels of NYC Condom
awareness. Most participants (76%) had seen or heard of NYC Condoms, of
which 75% had picked up an NYC Condom (Table 2). NYC Condom use was 68.5%
among those that had picked one up, 52.7% among all those that had seen or
heard of NYC Condoms, and 40.1% among all respondents.
TABLE 2— Awareness and Experience With NYC Condoms Among
Survey Respondents: New York City Residents Aged 18 Years
and Older, 2007
On the scale of 1 to 10 (1 = NYC Condoms are much worse than other male
condoms and 10 = they are much better), the average rating was 6.55. When
asked what condom type DOHMH should offer for free besides the NYC Condom,
only 20% did not want any other condom distributed. The most common condom
types named were ultra-thin/extra-sensitive (22%), extra-strength (18%),
and larger-size (14%). Most who named ultra-thin/extra-sensitive condoms
selected them because they "felt better" (81.5%). Most respondents named
extra-strength condoms because they felt they provided better protection
against HIV and other sexually transmitted diseases (84.9%). Top reasons
for naming larger-size condoms were that they felt better (33.3%), were
more comfortable (31.0%), or standard-sized condoms were too small (14.3%).
We found high levels of NYC Condom awareness, and awareness translated into
use, as 68% of respondents who had picked up NYC Condoms had used them.
These results indicate that condom social marketing campaigns can
successfully translate into condom use. Despite high levels of use and
satisfaction, demand exists for alternatives to NYC Condoms.
Although this is the first large-scale condom distribution campaign
conducted in a US city, other campaigns have documented that distributing
free condoms promotes use. Louisiana's condom distribution campaign found
that women with more than 1 sexual partner were significantly more likely
to report condom use after the free condom program's introduction.2
Further, after initiating a $0.25 charge, condom use at most recent sexual
intercourse dropped from 77% to 64% statewide,3 indicating that cost is a
barrier to condom use. In a campaign in Cameroon, 21% of youths had
obtained free condoms, and 52% of the male youths who had obtained them had
used them.4
Currently, little is known about condom preferences and satisfaction with
free condoms. Respondents were satisfied with NYC Condoms, rating them
higher on average than other male condoms, but also expressed interest in
alternatives. Study respondents requested alternative condoms because they
perceived that alternate condoms felt better, were more comfortable,
provided better protection from HIV and other sexually transmitted
diseases, or fit better. We believe perceived needs should be considered
when designing condom distribution programs, as meeting perceived needs may
increase use.
One study limitation is that because we systematically chose attendees aged
18 years and older at public events targeting populations at elevated HIV
risk, our results are not generalizable to all New Yorkers. Additionally,
selection bias is a concern in this voluntary survey where 50% of people
selected during recruitment refused to be screened for eligibility.
Data on use, acceptability, and preferences for various condom types can
guide program planning and development. On the basis of these results,
DOHMH began distributing alternative condoms in November 2008, including
this study's most frequently named types—ultra-thin/extra-sensitive,
extra-strength, and larger-size.
This study was approved by the New York City Department of Health and
Mental Hygiene institutional review board.
Peer Reviewed
Contributors
R. C. Burke led the study, conducted statistical analysis, and led writing.
J. Wilson contributed to the study design, helped coordinate the study, and
coordinated the NYC Condom program. K. T. Bernstein developed the study
design and contributed to the statistical analysis and writing. N.
Grosskopf contributed to study implementation and survey instrument
development. C. Murrill provided guidance for the development of the survey
instrument and study design. B. Cutler contributed to the writing and
provided guidance to the NYC Condom program. M. Sweeney contributed to the
study design and writing. E. M. Begier oversaw and contributed to all
aspects of the study and writing. All authors reviewed drafts of the
article.
Accepted for publication March 19, 2009.
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