Sexually transmitted infections (STIs) and unintended pregnancy often affect adolescents as well as adults, and the younger age group is particularly vulnerable to each of these; both STIs and unintended pregnancies have significant health implications for adolescents. The only contraceptive method available to adolescents that can prevent both of these conditions is the use of condoms, but data show that only 52% of sexually active high school students used a condom at last intercourse. There is little evidence to date summarizing the psychosocial factors that most strongly influence condom use in adolescents. This study is a systematic review and meta-analysis of the available evidence on psychosocial factors that influence adolescent condom use, aiming to characterize the strongest associations and document heterogeneity across studies and identify moderators of heterogenous effects. The literature review for this study was performed using Medline, CINAHL, PsycINFO, and Communication Source databases, locating publications between January 2000 and February 2024. Inclusion criteria for studies were a study sample with a mean age less than 19 years and a range not exceeding 24 years, reporting condom use, reporting one or more of the psychosocial factors of interest, and available in English. Exclusion criteria were using composite variables for sexual risk-taking, implementing interventions, experimental designs, or manipulating study variables. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Final analysis included 249 studies with 251,713 participants, showing 23 of 36 factors being significantly associated with adolescent condom use. Of the 5 sociodemographic and structural variables, 3 were associated with condom use: gender/sex, sexual orientation, and age. Boys reported using condoms more frequently than girls (Pearson r =0.11, 95% CI: 0.09-0.13), and LGBQ+ adolescents reported using condoms less frequently than their heterosexual peers (Pearson r =−0.06, 95% CI: −0.10 to −0.03). Of the 8 personality and individual difference variables, 6 were statistically significant, with the most studies focusing on substance use/abuse. The largest effect from this set of factors was condom use at first sex (Pearson r =0.47, 95% CI: 0.36-0.56). A total of 4 of 6 social variables were significantly associated with condom use, with the largest effects including condom use intentions, condom attitude, and safer sex self-efficacy. Of 6 social environmental variables, 5 were significant, and the largest effect was that of condom sexual communication with a partner (Pearson r =0.41, 95% CI: 0.29-0.52). Parent sexual communication was the most studied factor in this group, and had a small positive correlation with condom use. Lastly, of the 6 situational/contextual variables, 5 were significantly associated with the use of condoms; substance use before sex was the most studied of these factors, and the strongest correlation was found in partner attitudes (Pearson r =0.25, 95% CI: 0.12-0.38). Heterogeneity was determined to be significant in 24 variables, and further analysis revealed 4 moderators that differed by gender, including depression, parent sexual communication, substance use prior to sex, and interpersonal violence. Of these, the association between condom use and depression was stronger for boys, and all the others were stronger for girls. These results indicate 23 significant psychosocial factors correlated with condom use in adolescents. Some factors that were not significant received a lot of attention in research, such as safer sex knowledge. One of the strongest associations was that of condom use at first sex and subsequent condom use, suggesting that early habits likely become consistent and thus early comprehensive sexual education is important. Future research is needed to better understand the processes behind this, as only a few studies have quantified this association. This could also be integrated more fully into evidence-based sexual health education and interventions. Notably, many of the effects seen in this meta-analysis had significant heterogeneity, meaning that future research should also evaluate other potential sources of variance that could contribute to this effect. (Summarized from Widman L, Evans-Paulson R, Maheux AJ, et al. Identifying the strongest correlates of condom use among US adolescents: A systematic review and meta-analysis. JAMA Pediatr. 2025;179(3):273-281. doi: https://doi.org/10.1001/jamapediatrics.2024.5594)
Heather Sankey (Sun,) studied this question.