Adolescent sexual health communication and condom use: A meta-analysis

Objective: Condom use is critical for the health of sexually active adolescents, and yet many adolescents fail to use condoms consistently. One interpersonal factor that may be key to condom use is sexual communication between sexual partners; however, the association between communication and condom use has varied considerably in prior studies of youth. The purpose of this meta-analysis was to synthesize the growing body of research linking adolescents' sexual communication to condom use, and to examine several moderators of this association. Method: A total of 41 independent effect sizes from 34 studies with 15,046 adolescent participants (M_age = 16.8, age range = 12-23) were meta-analyzed. Results: Results revealed a weighted mean effect size of the sexual communication-condom use relationship of r = .24, which was statistically heterogeneous (Q = 618.86, p < .001, I² = 93.54). Effect sizes did not differ significantly by gender, age, recruitment setting, country of study, or condom measurement timeframe; however, communication topic and communication format were statistically significant moderators (p < .001). Larger effect sizes were found for communication about condom use (r = .34) than communication about sexual history (r = .15) or general safer sex topics (r = .14). Effect sizes were also larger for communication behavior formats (r = .27) and self-efficacy formats (r = .28), than for fear/concern (r = .18), future intention (r = .15), or communication comfort (r = -.15) formats. Conclusions: Results highlight the urgency of emphasizing communication skills, particularly about condom use, in HIV/STI prevention work for youth. Implications for the future study of sexual communication are discussed.