Examining individual and school-level predictors of positive attitudes towards condom use among adolescents in Tanzania: An exploratory analysis using hierarchical linear modeling
6 affiliations
- 1University of Chicago, Chicago, Illinois, United States of America
- 2University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- 3Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- 4Iris Group, Durham, North Carolina, United States of America
- 5Independent Consultant, Dar es Salaam, Tanzania
- 6Duke University, Durham, North Carolina, United States of America
Abstract
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.
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BibTeX
@article{bryk2026examining,
title = {{Examining individual and school-level predictors of positive attitudes towards condom use among adolescents in Tanzania: An exploratory analysis using hierarchical linear modeling}},
author = {Sara Bryk and Arisa Shichijo and Sylvia Kaaya and Isaac Lema and Anna Minja and Abby C. Cannon and Rachel Mtei and Magreat Somba and Eric van Praag and Joseph R. Egger and Joy Noel Baumgartner},
journal = {PLOS One},
year = {2026},
month = nov,
doi = {10.1371/journal.pone.0324856},
url = {https://doi.org/10.1371/journal.pone.0324856},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Examining individual and school-level predictors of positive attitudes towards condom use among adolescents in Tanzania: An exploratory analysis using hierarchical linear modeling
AU - Sara Bryk
AU - Arisa Shichijo
AU - Sylvia Kaaya
AU - Isaac Lema
AU - Anna Minja
AU - Abby C. Cannon
AU - Rachel Mtei
AU - Magreat Somba
AU - Eric van Praag
AU - Joseph R. Egger
AU - Joy Noel Baumgartner
PY - 2026
DA - 2026/11/03
JO - PLOS One
DO - 10.1371/journal.pone.0324856
UR - https://doi.org/10.1371/journal.pone.0324856
AB - 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.
SN - 1932-6203
ER -