Predictors of Condom Use among Adolescents: A Meta-Analysis

项目总结 青少年的定义是10到19岁之间的年轻人，他们非常容易感染艾滋病毒和其他 性传播疾病，而且在艾滋病毒护理连续体系中，也比成年人更有可能出现不良结果。尽管在那里 在艾滋病毒防治策略方面取得了实质性进展，避孕套仍然是最多的 为性行为活跃的青少年提供可获得且具有成本效益的艾滋病毒和性传播疾病预防工具。此外，避孕套 是唯一既能减少艾滋病毒/性传播疾病传播又能防止意外传播的预防方法 怀孕了。然而，美国数据显示，只有54%的性活跃青少年在最后一次性行为中使用避孕套， 在世界其他许多地区，利率也同样很低。至关重要的是，我们要了解 大多数人强烈预测避孕套的使用，以便他们可能成为增加青少年避孕套使用的目标。 本R03项目的目的是对有关青春期性健康的文献进行元分析，以确定 当代年轻人使用避孕套的最强心理社会预测因子。而一个类似的荟萃分析 是由Sheeran和他的同事在1999年进行的，在这项研究的121项研究中，只有30项集中在 青少年，这项研究仅限于异性恋个人，结果现在已经超过20岁了。 青春期是一个独特的发展时期，在这个时期，青年正在经历快速的神经生物学，生理， 情感和性的变化，并开始谈判浪漫和性关系。因此，这些因素 最能预测成人使用避孕套的数据可能与预测成人使用避孕套的数据不同 青少年。此外，在过去二十年中，相当大的社会文化变化和技术进步 已经改变了青少年的性图景。在目标1中，我们将执行最新的荟萃分析 确定青少年(平均年龄19岁)中使用避孕套的最强烈的心理社会预测因素。 我们将集中在艾滋病风险的三个理论阶段中组织的50个心理社会变量 减少模式：标签阶段(例如，艾滋病毒/性病知识、威胁评估、性教育)；承诺 阶段(例如，使用其他生物医学预防艾滋病毒措施、使用避孕套的目的、伴侣态度、自我保护 有效性)；以及制定阶段(提供避孕套、性伴侣的性交流)。我们还包括几个 人口因素(例如，性别、种族/民族、社会经济地位、宗教信仰)、个性特征(例如，冲动、情感-- 以及可能影响青少年避孕套使用的环境因素(如IPV、物质使用)。然后 在目标2中，我们将检查几个潜在的调解人之间的关系确定 心理社会变量和避孕套的使用。具体地说，我们将检查这些关联是否基于 人口统计特征(年龄、性别、种族/族裔、性别认同)或方法特征 (研究设计、研究年度)。此外，我们将评估研究质量和偏向风险，以突出偏向， 现有文献的优点和缺点。这种荟萃分析的结果可以用来提供更多的信息 有效的艾滋病毒、性传播疾病和怀孕预防工作，并完善青年健康行为理论。

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.