A new meta-analysis evaluating condom use across 249 studies and more than a quarter million U.S. teens finds that simply having knowledge about safer sex practices is not enough to encourage condom use. The analysis suggests teens also need to feel confident about buying and using condoms, they need to plan to use them, and they need to be able to communicate effectively with their partners about condom use.

“Condoms are effective at preventing pregnancy and protecting against sexually transmitted infections, but only about half of sexually active teens in the U.S. used a condom the last time they had sex,” says Laura Widman, corresponding author of the meta-analysis and a professor of psychology at North Carolina State University. “Our goal with this work was to figure out exactly what predicts condom use among teens.

“This is important because sexually transmitted infections are on the rise among teens, and this study will help us understand which aspects of sexual health decision-making should be targeted in sex education programs. For example, our analysis really underscores the importance of effective communication between partners about condom use, which tells us that future programs should prioritize developing this skill set in teens.”

For this meta-analysis, the researchers drew on data from 249 studies published between 2000 and 2024. Collectively, those studies involved 251,713 study participants with a mean age of just over 16. The researchers synthesized the data from those studies using statistical techniques to examine 36 different predictors of condom use. The researchers then conducted a series of analyses designed to identify factors that were most closely associated with condom use.

“We found that having knowledge about safe sex, by itself, was not correlated with condom use across studies,” Widman says. “We know that just giving people knowledge alone is not enough to change their behavior.”

However, the researchers did identify several factors that are associated with condom use.

“Teens who used a condom the first time they had sex were far more likely to use condoms consistently over time,” Widman says. “This underscores the importance of early interventions, before teens have their first sexual experiences.”

Other notable predictors were whether teens planned to use condoms prior to having sex, whether teens were communicating with their partners about condom use, and teens’ confidence in their ability to engage in safer sex. The researchers found that all of these predictors held true across age, gender and sexual orientation.

“This meta-analysis combines more than 20 years of research to help us better understand how teens make decisions in sexual relationships,” Widman says. “The findings highlight the need to boost teens’ interpersonal skills and confidence, and to do so early in their development so they can make the best sexual choices for themselves.”

The paper, “Identifying the Strongest Correlates of Condom Use Among U.S. Adolescents: a Systematic Review and Meta-Analysis,” is published in the journal JAMA Pediatrics. The paper was co-authored by NC State Ph.D. students Jordyn McCrimmon and Aaron Lankster; Julia Brasieiro, a postdoctoral researcher at Florida State University and a Ph.D. graduate of NC State; Reina Evans-Paulson of Innovation Research and Training; Anne Maheux of the University of North Carolina at Chapel Hill; and Claire Stout and Sophia Choukas-Bradley of the University of Pittsburgh.

This research was done with support from the Eunice Kennedy Shriver National Institute of Child Health & Human Development under grant R03 HD105784; the National Institutes of Health under grants F31 MH126763 and F31 HD114366; and the National Science Foundation under grants 1940700 and 2139321.