29 patterns and predictors of condom use. 2 Differences by race and education exist in knowledge of and attitudes toward HIV and other STDs, and in self-reported con- dom use. 3 The extent of acculturation also has been shown to be related to one’s per- ceived HIV risk and high-risk behavior. For example, less acculturated Hispanic men have more positive attitudes toward condoms and carry them more frequent- ly than do more acculturated Hispanic men; 4 however, Hispanics in general may be less likely than non-Hispanic whites or blacks to use condoms. 5 For immigrants from English-speaking countries, to whom the standard language measure of acculturation does not apply, their length of residence in the United States may also influence condom acceptability. Individuals who are at the greatest risk for HIV and STD infection—such as STD clinic clients—are unlikely to report con- sistent condom use. 6 Furthermore, the use of contraceptive methods other than the condom has been negatively associated with condom use. 7 Several studies have documented the relationship between psychosocial factors and self-reported condom use. While these factors may all play some role in pre- dicting condom use, the findings across studies have been inconsistent. 8 Although some studies have shown that gender and cultural background influence psychoso- cial predictors of condom use, 9 few have been based on samples that were suffi- ciently large and diverse to fully explore Lydia O’Donnell is senior scientist, Alexi San Doval is se- nior project director, Richard Duran is senior research as- sociate and Carl R. O’Donnell is statistical consultant, all at the Education Development Center, Newton, Mass. The authors are grateful for the support provided by the New York City Department of Health and the Morrisania Clin- ic throughout this study. They also thank Magali Calderón for her assistance in data collection and the project offi- cers from the Centers for Disease Control and Prevention (CDC), Richard Conlon and Mary Neumann. Funding for this study was provided under an STD demonstration grant from the Behavioral and Prevention Research Branch, Division of Sexually Transmitted Diseases, CDC. Predictors of Condom Acquisition After an STD Clinic Visit By Lydia O’Donnell, Alexi San Doval, Richard Duran and Carl R. O’Donnell A better understanding of the pre- dictors of condom acquisition among individuals at high risk of acquiring and transmitting sexually trans- mitted diseases (STDs) is needed to plan interventions in the sexual and reproduc- tive health care settings they use. Inner-city public STD clinics treat large numbers of individuals with multiple risk factors for STDs, including frequent unprotected sex, multiple sexual partners, history of an STD and residence in communities with ex- ceptionally high rates of infection with the human immunodeficiency virus (HIV) and other STDs, as well as high rates of un- intended pregnancies. 1 Such clinics serve primarily low-income residents, many of whom are recent immigrants to the Unit- ed States. Specially targeted and cultural- ly appropriate prevention programs are needed to educate different groups with- in this clinic population and promote con- sistent condom use, for protection from both disease and pregnancy. A number of studies have examined the relationship. Further, most of these studies have been limited by reliance on self-reports of condom use, instead of on behavioral measures. In this article we use an innovative proxy measure—a strategy of dispensing coupons for condoms that was first em- ployed by Solomon and DeJong 10 —to identify factors that predict condom ac- quisition following patient visits to a large STD clinic in New York City. Women and recent immigrants to the United States constitute significant proportions of this clinic populaiton. Thus, the gender and cultural diversity of the patient popula- tion make it an ideal sample with which to examine the characteristics of individ- uals who are sufficiently motivated to re- deem the coupon at a local pharmacy. Specifically, we were interested in learn- ing whether there were differences in con- dom acquisition that would suggest tar- geting interventions to special population groups. We were also interested in learn- ing the risk profiles of clients who re- deemed their coupons—that is, whether motivated clients were at a relatively high or low risk for acquiring an STD. Methods From December 1991 through December 1992, all men and women who attended one of the largest STD clinics in New York City were enrolled in a study designed to evaluate a video-based educational in- tervention to promote condom use. We re- port on a proportionate random sample of 691 black and Hispanic recipients of regular clinic services who served as the control group for a planned test of the in- tervention at the clinic. The proportionate random sampling strategy was based on the gender and eth- nic distributions of the patient population as determined from a review of clinic records. Typically, patients arrive before or during the first hour of clinic operation on any given day, and each patient is reg- istered and assigned a number in the order of their arrival. For this study, on random days of clinic operation throughout the study period, all patients over age 18 were approached in consecutive order to fill predetermined gender and ethnic cells. Data from a survey of 691 men and women who made patient visits to an inner-city, sexually transmitted disease (STD) clinic and were given coupons to redeem for condoms at a neigh- borhood pharmacy show that only 22% of the sample did so. Gender, ethnicity, marital status and education were not significant predictors of whether study participants redeemed their coupons. Factors that significantly predicted coupon redemption included the extent of acculturation and age, with those who were older and less acculturated more likely to do so. Other significant fac- tors were having a primary sexual partner and having had more than one sexual partner in the last month; having ever had an STD was negatively associated with coupon redemption. A per- ception of being at high STD risk and a favorable attitude about condoms also significantly pre- dicted condom acquisition. All these variables, except for attitude toward condoms and a histo- ry of an STD, remained significant when entered into a logistic regression controlling for the influence of all independently significant predictors. (Family Planning Perspectives, 27:29–33, 1995) Volume 27, Number 1, January/February 1995