Condom non-use among adolescents: Prevalence and associated factors among school-going adolescents from 58 countries

Objectives: Studies in several resource-limited settings have investigated the prevalence and potential factors associated with condom non-use among adolescents, showing inconsistent and varied findings, owing to methodological inconsistencies. Thus, this study aimed to investigate the prevalence and associated factors of condom non-use among a global sample of adolescents and their differences based on sex and region. Methods: We conducted a cross-sectional study using the 2009-2018 Global School-based Health Survey data from 58 countries which included 183,100 adolescents aged 12-15 years. Random-effects meta-analysis was used to estimate the overall and regional pooled prevalence of condom non-use. Multilevel mixed-effect logistic regressions were used to investigate the correlates of condom non-use. Results: Overall, 26.2% of the total sample reported being sexually active and of these, 27.6% did not use condoms during last intercourse, with boys reporting higher than girls (27.9% vs. 25.6%). The prevalence of condom non-use was the highest in the African region (29.2%) and the lowest in the South-East Asia region (21.1%). There were variations in prevalence across countries, regions, and sex. Female gender, older age, loneliness, suicidal ideation, being bullied, parental support and supervision, truancy, smoking, illicit drug use, early sexual initiation, and having multiple sex partners were associated with condom non-use. There was evidence of heterogeneity of correlates across regions and sex. Conclusions: In this analysis, we found variations in the prevalence and associated factors of condom non-use among adolescents by sex and region. These findings can shape effective sexual health initiatives and improve resource distribution across regions.