Widman Laura, Evans-Paulson Reina, Maheux Anne J, McCrimmon Jordyn, Brasileiro Julia, Stout Claire D, Lankster Aaron, Choukas-Bradley Sophia
Department of Psychology, North Carolina State University, Raleigh.
Innovation Research and Training, Durham, North Carolina.
JAMA Pediatr. 2025 Mar 1;179(3):273-281. doi: 10.1001/jamapediatrics.2024.5594.
Condoms are effective at preventing sexually transmitted infections and pregnancy; however, only 52% of sexually active US adolescents used a condom at last intercourse.
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.
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February 2024 using Medline, CINAHL, PsycINFO, and Communication Source databases, plus relevant review articles and unpublished data.
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.
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.
The primary outcome was adolescent-reported condom use behavior.
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.
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.
避孕套在预防性传播感染和怀孕方面很有效；然而，在美国性活跃的青少年中，只有52%的人在最近一次性交时使用了避孕套。
研究（1）36个社会心理变量与青少年使用避孕套之间的关联，以确定文献中避孕套使用行为的最强相关因素；（2）这些效应的异质性；（3）年龄性别/性别、种族/族裔、性取向和研究年份的调节作用。
对2000年1月至2024年2月发表的研究进行了系统检索，使用了Medline、CINAHL、PsycINFO和Communication Source数据库，以及相关综述文章和未发表的数据。
纳入的研究需满足以下条件：（1）是对美国青少年（平均样本年龄<19岁）的观察性研究；（2）包括青少年关于避孕套使用行为的报告以及一个感兴趣的相关因素；（3）2000年1月后有英文版本。
研究人员提取了关于参与者特征、研究方法、环境、相关因素、避孕套使用结果和研究质量的数据。相关系数和95%置信区间由各研究计算得出，并使用随机效应模型进行荟萃分析。
主要结局是青少年报告的避孕套使用行为。
共综合了249项研究，包含283个独立样本（251713名青少年；加权平均年龄为16.2岁）。23个相关因素与青少年使用避孕套显著相关。加权平均效应最大的避孕套使用相关因素是首次性行为时使用避孕套（Pearson r = 0.47；95%置信区间为0.36 - 0.56）、使用避孕套的意图（Pearson r = 0.42；95%置信区间为0.35 - 0.48）以及与伴侣关于避孕套的沟通（Pearson r = 0.41；95%置信区间为0.29 - 0.52）。安全性行为知识（许多性教育努力的主要重点）与避孕套使用无显著关联（Pearson r = -0.03；95%置信区间为 -0.10至0.05）。大多数效应（31个中的24个[77%]）在统计学上具有显著异质性；年龄、性别/性别、性取向和研究年份仅在少数效应中解释了异质性。
这项系统综述和荟萃分析确定了近25年研究中青少年使用避孕套的最强和最弱相关因素。这些结果可用于完善性行为理论，并为青少年更有针对性的循证干预努力提供指导。
