What drives condom use among teens?

Condom use during first sexual encounter, intentions to use condoms, and the ability to communicate with the partner about safe sex emerge as the strongest predictors of condom use among teens in the US, as reported in a meta-analysis.

Researchers searched multiple online databases for observational studies involving adolescents in the US (mean sample age <19 years) in which condom use behaviour and a correlate of interest were examined.

A total of 249 studies with 283 independent samples met the eligibility criteria and were included in the meta-analysis. Data were pooled from these studies, which involved 251,713 adolescents with a weighted mean age of 16.2 years.

Of the 31 correlates examined, 23 showed significant associations with condom use among teens. Condom use at first sex had the largest weighted mean effects (Pearson r, 0.47, 95 percent confidence interval [CI], 0.36–0.56). This was followed by condom use intentions (Pearson r, 0.42, 95 percent CI, 0.35–0.48) and condom communication with a partner (Pearson r, 0.41, 95 percent CI, 0.29–0.52).

Conversely, safer sex knowledge, which is a primary focus of many sex education efforts, showed no significant association with condom use (Pearson r, −0.03, 95 percent CI, −0.10 to 0.05).

Of note, significant heterogeneity was found in the effect sizes of 24 variables (77 percent). Factors such as age, gender/sex, sexual orientation, and year of study explained heterogeneity in only a few effects.

The findings may guide more targeted evidence-based intervention efforts for adolescents, according to the researchers.