Abstract: Condom Use and Co-Occurring Risk Context Among U.S. Adolescents (Society for Social Work and Research 31st Annual Conference)

Schedule:

Saturday, January 23, 2027

Golden Gate 2 (Hilton San Francisco Union Square)

* noted as presenting author

Silviya Nikolova, PhD, Associate Professor, Medical University of Varna, Bulgaria, Varna, Bulgaria

Eusebius Small, PhD, Professor, University of Texas at Arlington, Arlington, TX

Krishna Kiran Kota, PhD, Assistant Professor of Research, University of Texas at Arlington, Arlington, TX

Bonita Sharma, PhD, Associate Professor, University of Texas at San Antonio, San Antonio, TX

Background and Purpose:
Adolescents continue to experience disproportionate rates of sexually transmitted infections (STIs) in the United States, with inconsistent condom use contributing to ongoing transmission and varying across risk contexts. Theoretical frameworks central to social work, including ecological systems theory, problem behavior theory, and syndemic theory, conceptualize adolescent sexual behavior as embedded within interrelated behavioral, psychosocial, and social environments rather than as an isolated individual choice. Empirical evidence suggests that substance use, violence exposure, and psychosocial distress frequently cluster during adolescence and may jointly undermine condom negotiation and protective sexual decision‑making. This study examines the associations of substance use, violence exposure, and psychosocial factors with condom use among U.S. adolescents.

Methods:
Data were drawn from the 2023 Youth Risk Behavior Survey (YRBS), a nationally representative, cross-sectional, school-based survey of U.S. high school students. Analyses were restricted to adolescents reporting prior sexual intercourse (N = 3,259). Multivariable logistic regression models were used to examine associations between condom use at last sexual intercourse and substance use, exposure to sexual and dating violence, sexual identity, sexual behavior, and psychosocial factors, including suicidal ideation, parental conflict, and school connectedness. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) are reported. Analyses were conducted using Jamovi (version 2.6), with statistical significance set at p < .05.

Results:
The overall model was statistically significant (χ²(55) = 315.00, p < .001) and demonstrated modest explanatory power (McFadden’s R² = 0.070). Condom use was patterned within broader configurations of risk. Adolescents identifying as gay or lesbian had substantially lower odds of condom use compared with heterosexual peers (OR = 0.30, 95% CI [0.19, 0.48], p < .001). Male adolescents were more likely than females to report condom use (OR = 2.41, 95% CI [1.75, 3.31], p < .001). Increasing frequency of marijuana demonstrated a graded inverse association with condom use, as did a greater number of sexual partners. Higher exposure to sexual and dating violence was associated with reduced odds of condom use, particularly at greater levels of exposure. Adolescents who reported suicidal ideation had lower odds of condom use (OR = 0.76, 95% CI [0.63, 0.91], p = .002). Alcohol use was not independently associated with condom use after adjustment.

Conclusions and Implications:
Consistent with ecological, problem behavior, and syndemic perspectives, condom use among adolescents appears shaped by intersecting risk domains. Findings suggest that STI prevention approaches targeting condom use alone may be insufficient without addressing co-occurring substance use, violence exposure, and mental health risk. Social work-led prevention strategies should adopt integrated, trauma-informed, and developmentally responsive interventions that address clustered risks and structural vulnerabilities to improve adolescent sexual health outcomes.