Identifying the Strongest Correlates of Condom Use Among US Adolescents

Importance Condoms are effective at preventing sexually transmitted infections and pregnancy; however, only 52% of sexually active US adolescents used a condom at last intercourse. Objective To examine (1) the association between 36 psychosocial variables and adolescent condom use to determine the strongest correlates of condom use behavior across the literature, (2) heterogeneity of these effects, and (3) the moderating roles of age, gender/sex, race/ethnicity, sexual orientation, and year of study. Data Sources A systematic search was conducted of studies published between January 2000 and February 2024 using Medline, CINAHL, PsycINFO, and Communication Source databases, plus relevant review articles and unpublished data. Study Selection Studies were included if they (1) were observational studies of US adolescents (mean sample age <19 years), (2) included adolescent reports of condom use behavior and a correlate of interest, and (3) were available in English after January 2000. Data Extraction and Synthesis Investigators extracted data on participant characteristics, study methods, settings, correlates, condom use outcomes, and study quality. Correlation coefficients and 95% CIs were computed from studies and meta-analyzed using random-effects models. Main Outcomes and Measures The primary outcome was adolescent-reported condom use behavior. Results A total of 249 studies with 283 independent samples (251 713 adolescents; weighted mean age, 16.2 years) were synthesized. Twenty-three correlates were significantly associated with adolescent condom use. The correlates of condom use with the largest weighted mean effects were condom use at first sex (Pearson r = 0.47; 95% CI, 0.36-0.56), condom use intentions (Pearson r = 0.42; 95% CI, 0.35-0.48), and condom communication with a partner (Pearson r = 0.41; 95% CI, 0.29-0.52). Safer sex knowledge—a primary focus of many sex education efforts—was not significantly associated with condom use (Pearson r = −0.03; 95% CI, −0.10 to 0.05). Most effects (24 of 31 [77%]) were statistically significantly heterogeneous; age, gender/sex, sexual orientation, and year of study explained heterogeneity in only a few effects. Conclusions and Relevance This systematic review and meta-analysis identified the strongest and weakest correlates of adolescent condom use across nearly 25 years of research. These results can be used to refine sexual behavior theory and guide more targeted evidence-based intervention efforts for adolescents.