***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND OBJECTIVES Mechanical failure may reduce the efficacy of condoms . Little is known about frequency and determinants of condom failure in groups at high risk of sexually transmitted diseases ( STD ) . GOAL To measure condom breakage and slippage rates and evaluate potential determinants of failure among women attending a public STD clinic . STUDY DESIGN Women attending an STD clinic participated in a 6-month prospect i ve study of barrier contraception for the prevention of STD . They completed sexual diaries that were review ed at monthly follow-up visits . No data were collected from the male partners . Baseline characteristics of the participants and time-dependent behaviors were evaluated as potential determinants of condom failure . RESULTS Of 21,852 condoms used by 892 women , 500 broke during intercourse ( 2.3 % ) and 290 slipped ( 1.3 % ) . Breakage was more common among young , black , single nulliparae who engaged in high-risk behavior .  Slippage was more common among married women with children . Failure rates decreased with condom use , with coital frequency , and with use of spermicides . CONCLUSION User characteristics and experience are determinants of breakage and slippage , which are often regarded only as the effect of product design flaws . Attention to modifiable determinants of failure may improve user counseling and product labeling Summary Background Sexual behaviour and relationships are key components of wellbeing and are affected by social norms , attitudes , and health . We present data on sexual behaviours and attitudes in Britain ( Engl and , Scotl and , and Wales ) from the three National Surveys of Sexual Attitudes and Lifestyles ( Natsal ) . Methods We used a multistage , clustered , and stratified probability sample design . Within each of the 1727 sample d postcode sectors for Natsal-3 , 30 or 36 addresses were r and omly selected and then assigned to interviewers . To over sample individuals aged 16–34 years , we r and omly allocated addresses to either the core sample ( in which individuals aged 16–74 years were eligible ) or the boost sample ( in which only individuals aged 16–34 years were eligible ) . Interviewers visited all sample d addresses between Sept 6 , 2010 , and Aug 31 , 2012 , and r and omly selected one eligible individual from each household to be invited to participate . Participants completed the survey in their own homes through computer-assisted face-to-face interviews and self-interview . We analysed data from this survey , weighted to account for unequal selection probabilities and non-response to correct for differences in sex , age group , and region according to 2011 Census figures . We then compared data from participants aged 16–44 years from Natsal-1 ( 1990–91 ) , Natsal-2 ( 1999–2001 ) , and Natsal-3 . Findings Interviews were completed with 15 162 participants ( 6293 men , 8869 women ) from 26 274 eligible addresses ( 57·7 % ) . 82·1 % ( 95 % CI 81·0–83·1 % ) of men and 77·7 % ( 76·7–78·7 % ) of women reported at least one sexual partner of the opposite sex in the past year . The proportion generally decreased with age , as did the range of sexual practice s with partners of the opposite sex , especially in women . The increased sexual activity and diversity reported in Natsal-2 in individuals aged 16–44 years when compared with Natsal-1 has generally been sustained in Natsal-3 , but in men has generally not risen further . However , in women , the number of male sexual partners over the lifetime ( age-adjusted odds ratio 1·18 , 95 % CI 1·08–1·28 ) , proportion reporting ever having had a sexual experience with genital contact with another woman ( 1·69 , 1·43–2·00 ) , and proportion reporting at least one female sexual partner in the past 5 years ( 2·00 , 1·59–2·51 ) increased in Natsal-3 compared with Natsal-2 . While reported number of occasions of heterosexual intercourse in the past 4 weeks had reduced since Natsal-2 , we recorded an expansion of heterosexual repertoires — particularly in oral and anal sex — over time . Acceptance of same-sex partnerships and intolerance of non-exclusivity in marriage increased in men and women in Natsal-3 . Interpretation Sexual lifestyles in Britain have changed substantially in the past 60 years , with changes in behaviour seeming greater in women than men . The continuation of sexual activity into later life — albeit reduced in range and frequency — emphasises that attention to sexual health and wellbeing is needed throughout the life course . Funding Grants from the UK Medical Research Council and the Wellcome Trust , with support from the Economic and Social Research Council and the Department of Health OBJECTIVE To evaluate the cost-effectiveness and cost benefit of Safer Choices , a school-based human immunodeficiency virus , other sexually transmitted diseases , and unintended pregnancy prevention intervention for high school students . METHODS The baseline cost-effectiveness and cost benefit were derived in 4 steps : ( 1 ) estimation of intervention costs ; ( 2 ) adaptation of the Bernoulli model to translate increases in condom use into cases of human immunodeficiency virus and other sexually transmitted diseases averted , and development of a model to translate increases in contraceptive use into cases of pregnancy averted ; ( 3 ) translation of cases averted into medical costs and social costs averted ; and ( 4 ) calculation of the net benefit of the program . Multivariable sensitivity analysis was performed to determine the robustness of the base-case results . RESULTS Under base-case assumptions , at an intervention cost of $ 105,243 , Safer Choices achieved a 15 % increase in condom use and an 11 % increase in contraceptive use within 1 year among 345 sexually active students . An estimated 0.12 cases of human immunodeficiency virus , 24.37 cases of chlamydia , 2.77 cases of gonorrhea , 5.86 cases of pelvic inflammatory disease , and 18.5 pregnancies were prevented . For every dollar invested in the program , $ 2.65 in total medical and social costs were saved . Results of most of the scenarios remained cost saving under a wide range of model variable estimates . CONCLUSIONS The Safer Choices program is cost-effective and cost saving in most scenarios considered . School-based prevention programs of this type warrant careful consideration by policy makers and program planners . Program cost data should be routinely collected in evaluations of adolescent prevention programs Objectives : This study investigated the impact of a small media campaign to reduce syphilis through testing , treatment , and condom use in two urban predominantly African-American communities with high syphilis rates . Methods : Data were collected from intervention and comparison zip codes using cross sectional street intercept interviews at baseline and 2 years later ( n = 1630 ) following a small media syphilis prevention campaign with role model story posters , billboards , and other merch and ise . Community businesses and a community based organisation served as partners , distributing condoms and small media . Results : Comparing intervention with comparison zip codes , there were significant increases in condom use in last sexual act , and some aspects of knowledge of syphilis . However , there was significant cross contamination of media impact , with respondents in the comparison zip code seeing an average of two media items compared with three in the intervention zip code . Media exposure was associated with significant increases in knowledge of syphilis , testing , and condom use . Conclusions : Targeted community based small media interventions using community partners for distribution are effective in increasing syphilis knowledge , testing , and condom use OBJECTIVES This study examines the impact of the condom availability program in New York City public high schools by comparing rates of sexual activity and condom use for New York students and similar students in Chicago . METHODS A total of 7119 students from 12 r and omly selected New York schools and 5738 students from 10 Chicago schools participated in a cross-sectional survey . RESULTS New York students , compared with Chicago students , reported equal rates of sexual activity but higher rates of condom use at last intercourse ( odds ratio [ OR ] = 1.36 ) . For higher-risk students ( those with three or more sexual partners in the past 6 months ) , condom use was greater in New York ( OR = 1.85 ) than in Chicago . CONCLUSIONS Condom availability has a modest but significant effect on condom use and does not increase rates of sexual activity . These findings suggest that school-based condom availability can lower the risk of HIV and other sexually transmitted diseases for urban teenagers in the United States CONTEXT Condoms made of latex are not comfortable or appropriate for all consumers . Polyurethane condoms may provide a needed alternative . METHODS In a double-masked study , 805 monogamous couples were r and omized to use either the polyurethane condom or the latex condom for six months . Couples recorded the frequency of intercourse , of condom use and of breakage and slippage throughout the trial in coital diaries and in detailed reports on the first five uses . Breakage and slippage rates were determined , and typical-use and consistent-use pregnancy rates were calculated using life-table analysis , adjusted for use of emergency contraception . RESULTS The six-month pregnancy rate during typical use ( adjusted for use of emergency contraception ) was 4.8 % for the polyurethane condom and 6.3 % for the latex condom . Similarly adjusted pregnancy rates during consistent use over six completed menstrual cycles--2.4 % for the polyurethane condom and 1.1 % for the latex condom -- did not differ significantly . Clinical failure rates ( including breakage and slippage occurring during either intercourse or withdrawal ) were 8.5 % for the polyurethane condom and 1.6 % for the latex condom . In general , male participants were more satisfied with the latex condom , and users of latex  were significantly less likely to drop out of the study for condom-related reasons than were users of polyurethane . CONCLUSIONS Although polyurethane and latex condoms provide equivalent levels of contraceptive protection , the polyurethane condom 's higher frequency of breakage and slippage suggests that this condom may confer less protection from sexually transmitted infections than does the latex condom OBJECTIVES This study examined the feasibility of using high-value coupons to induce condom purchase and evaluated execution factors that can influence the effectiveness of this form of promotion . METHODS Two levels of coupon discount value ( 10 % off and 75 % off ) were used to promote condom purchase among young adults .  Coupons were distributed according to a widespread strategy or a more focused in-store disbursement method . RESULTS Redemption of coupons distributed through the widespread disbursement strategy was negligible . In contrast , coupons from the in-store distribution method , particularly the higher value coupon , result ed in a high redemption rate . CONCLUSIONS This research provides strong evidence that discount coupons , particularly high-value ones distributed at the purchase location , can be used successfully as a condom promotional incentive 
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Schemes for black ethnic minorities and MSM could also be cost-effective even with relatively high costs and small effect sizes .
Conclusion CDPs for young people are likely to be cost-effective or cost-saving .
CDPs for other high-risk population s may also be cost-effective if they can increase condom use , since high HIV prevalence in these groups imposes a considerable health and cost burden