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CSU 78/2009: NEW YORK CONDOMS

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.