Predictors of Condom Use among Adolescents: A Meta-Analysis

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PROJECT SUMMARY Adolescents, defined as young people between the ages of 10 to 19, are highly vulnerable to HIV and other STDs and also more likely than adults to have poor outcomes along the HIV care continuum. Although there have been substantial advances in HIV prevention and treatment strategies, condoms remain the most accessible and cost-effective HIV and STD prevention tool for sexually active adolescents. Further, condoms are the only prevention method that can both reduce the transmission of HIV/STDs and prevent unintended pregnancy. Yet, U.S. data show only 54% of sexually active adolescents used a condom at last intercourse, and rates are similarly low in many other parts of the world. It is critical that we understand the factors that most strongly predict condom use so that they may be targeted to increase condom use among adolescents. The purpose of this R03 project is to meta-analyze the literature on adolescent sexual health to identify the strongest psychosocial predictors of condom use among contemporary youth. While a similar meta-analysis was conducted by Sheeran and colleagues in 1999, only 30 of 121 studies in this study focused on adolescents, the study was limited to heterosexual individuals, and results are now over 20 years old. Adolescence is a unique developmental period, whereby youth are undergoing rapid neurobiological, physical, emotional, and sexual changes and beginning to negotiate romantic and sexual relationships. Thus, the factors that are most predictive of condom use for adults may not be the same as those that predict condom use for adolescents. Further, in the past two decades, sizeable sociocultural changes and technological advances have shifted the sexual landscape for adolescents. In Aim 1, we will perform an up-to-date meta-analysis to identify the strongest psychosocial predictors of condom use among adolescents (mean age < 19). We will focus on 50 psychosocial variables organized within the three theory-based stages of the AIDS Risk Reduction Model: labeling stage (e.g., HIV/STD knowledge, threat appraisal, sex education); commitment stage (e.g., use of other biomedical HIV prevention measures, purpose of condom use, partner attitudes, self- efficacy); and enactment stage (condom availability, partner sexual communication). We also include several demographic factors (e.g., gender, race/ethnicity, SES, religiosity), personality traits (e.g., impulsivity, emotion- regulation), and contextual factors (e.g., IPV, substance use) that may affect adolescents’ condom use. Then in Aim 2, we will examine several potential moderators of the relationship between the identified psychosocial variables and condom use. Specifically, we will examine if the associations differ based on demographic characteristics (age, gender, race/ethnicity, sexual identity) or methodological characteristics (research design, study year). In addition, we will assess study quality and risk of bias to highlight the biases, strengths, and weaknesses of the existing literature. Results of this meta-analysis can be used to inform more effective HIV, STD, and pregnancy prevention efforts and refine health behavior theory among youth.