Examining individual and school-level predictors of positive attitudes towards condom use among adolescents in Tanzania: An exploratory analysis using hierarchical linear modeling

Introduction Adolescents shoulder a disproportionate burden of poor sexual and reproductive health (SRH) outcomes in many lower-income countries, including Tanzania. Availability, access, and use of contraception, including condoms, reduces unintended pregnancies and sexually transmitted infections. Research indicates that early attitudes can influence future behavior, yet little is known about young adolescents’ attitudes toward condom use. This study examines whether and how knowledge, beliefs, and sociodemographic factors influence attitudes toward condom use among adolescents in Tanzania. Methods Data are from a school-cluster randomized controlled trial with Standard 7 adolescents in two Tanzanian districts. Using an analytic sample of 1,057 adolescents from 20 primary schools, descriptive analysis and hierarchical linear modeling (HLM) were conducted to parse out individual- and school-level influences that shape attitudes towards condom use. Results Individual and aggregate characteristics of the school environment were associated with attitudes toward condom use. At the individual level, more positive attitudes were associated with being male, having access to condoms, and having knowledge about condom use and pregnancy prevention. At the school-level, more positive attitudes were associated with a larger male population in classes, greater breadth of pregnancy knowledge among students, and having relationships with trusted adults. Conclusions Findings suggest that adolescents largely turn to peers and adults for information and guidance regarding condoms. In turn, the views and beliefs of others can influence attitudes towards condom use. Schools might be an effective unit of change for interventions to facilitate more group-based education about the prevention of negative SRH outcomes.