Knowledge isn’t enough: What really predicts condom use in teens

A systematic review of studies on adolescents in the United States examined factors associated with condom use. The strongest predictor was condom use at first sex—adolescents who used a condom during their first sexual experience were more likely to continue using them in the future. Contrary to expectations, knowledge about safer sex was not associated with condom use. The findings were published in JAMA Pediatrics.

Adolescence, typically defined as the period between ages 10 and 19, is a stage of rapid physical, emotional, and cognitive development. It is marked by puberty, identity exploration, and growing independence. This period plays a critical role in shaping social skills, decision-making abilities, and long-term behavioral patterns.

It is also a time when many individuals begin engaging in sexual activity. While sex can be an important part of emotional intimacy and overall well-being, it also carries the risk of sexually transmitted infections if not practiced safely. Research has shown that adolescents are more likely than adults to experience unintended pregnancies.

Study author Laura Widman and her colleagues set out to identify the factors linked to condom use among adolescents. Although condoms are a simple and effective way to reduce the risk of sexually transmitted infections and unintended pregnancy, only 52% of sexually active high school students reported using a condom during their last sexual encounter, according to previous studies.

The researchers conducted a systematic review of the scientific literature. They searched databases including Medline, CINAHL, PsycINFO, and Communication Source using keywords related to adolescents, condom use, and various potential predictors of condom use.

They looked for studies conducted on U.S. adolescents with an average age under 19 and no participants older than 24. To be included, studies also had to report on condom use behaviors, be published in English after January 2000, and examine associations between condom use and at least one of 36 potential correlates.

The search initially yielded 1,597 articles. After review, 249 studies met the inclusion criteria. Together, these studies represented a total of 251,713 participants, with an average age of 16.

From these studies, the researchers identified 23 factors that were associated with adolescent condom use. The most consistent and strongest correlate was condom use at first sex. Adolescents who used a condom during their first sexual encounter were significantly more likely to use them in later sexual experiences. Intentions to use condoms and communication with partners about condom use were also strongly associated with actual condom use.

Surprisingly, knowledge about safer sex—a core component of most sex education programs—was not associated with condom use. This finding challenges the common assumption that increasing awareness alone will lead to safer sexual behavior.

“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,” the study authors concluded.

The study sheds light on the factors associated with condom use by adolescents. However, it should be noted that condom use depends on many factors and is a habit that can easily change. Because of this, results of future studies might not be the same.

The paper, “Identifying the Strongest Correlates of Condom Use Among US Adolescents A Systematic Review and Meta-Analysis,” was authored by Laura Widman, Reina Evans-Paulson, Anne J. Maheux, Jordyn McCrimmon, Julia Brasileiro, Claire D. Stout, Aaron Lankster, and Sophia Choukas-Bradley.