Abstract / Summary
Poppers (alkyl nitrites) are volatile inhalants that produce rapid vasodilation and feelings of euphoria. Poppers are frequently used in sexualized contexts, especially among men who have sex with men. Poppers use has been closely linked to high-risk sexual behaviors, including condomless anal intercourse, multiple sexual partnerships, and group sex, which may increase the risk of sexually transmitted infections and various clinical toxicities. Despite these risks, there is currently no systematic review that comprehensively synthesizes global evidence on poppers use in sexualized contexts. This gap limits understanding of its epidemiological patterns and health implications. This systematic review aims to synthesize global evidence on the prevalence, correlates, and health outcomes associated with poppers use in sexualized contexts among adults. We will conduct a comprehensive search across seven English databases (PubMed, Embase, Web of Science, Scopus, CINAHL, PsycINFO and APA PsycArticles) as well as four Chinese databases (CNKI, Wanfang Data, VIP, CBM) from inception to January 2026. Observational studies reporting quantitative data and published in English or Chinese will be eligible for inclusion. In addition, experimental and quasi-experimental studies will be eligible for extraction and descriptions of harm reduction strategies. Two reviewers will independently screen articles, extract data using a standardized form, and assess risk of bias using the Joanna Briggs Institute critical appraisal tools. The primary outcomes will include the prevalence of the use of poppers in sexualized contexts, correlates of their use, and health outcomes associated with poppers. Secondary outcomes will include descriptions of prevention and harm reduction strategies. Random-effects meta-analyses will be conducted using Stata software where data permit, and heterogeneity will be explored through subgroup and sensitivity analyses. Publication bias will be assessed using funnel plots and Egger’s test. The certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Ethical approval is not required as this review utilizes secondary data. Findings will be disseminated through publication in an open-access peer-reviewed journal and summary reports shared with relevant public health organizations. PROSPERO CRD42024608003