Youth perceptions and concerns about sexually transmissible infections versus pregnancy: a qualitative comparative study in California
Martha J. Decker A B C * , Natasha Borgen B C , Abigail Gutmann-Gonzalez
B C and Claire D. Brindis B C D
+ Author Affiliations
- Author Affiliations
A Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
B Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.
C Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA.
D Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, San Francisco, CA, USA.
Sexual Health 19(5) 439-447 https://doi.org/10.1071/SH22037
Submitted: 24 February 2022 Accepted: 16 June 2022 Published: 8 July 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing
Abstract
Background: Although rates of adolescent pregnancy have been declining for decades, rates of sexually transmissible infections (STIs) continue to increase among youth. Little is known about youth’s comparative concern regarding pregnancy and STIs, particularly among marginalised populations. Therefore, this study compares concerns toward unplanned pregnancy and STIs and identifies underlying reasons for these differing concerns in youth populations with elevated rates of STIs.
Methods: Fourteen focus groups were held with 92 youth in two counties in California, USA. Youth were purposefully selected from community-based organisations and schools to represent a variety of backgrounds and populations with elevated rates of pregnancy and STIs. Qualitative coding and analysis were conducted using ATLAS.ti. 7.0.
Results: Almost all participants were youth of colour (86%), 27% identified as gay, lesbian or bisexual, and 21% had ever experienced homelessness. Although most youth were generally concerned about the consequences of contracting an STI, including the possible stigma associated with it, both males and females were more worried about an unplanned pregnancy. Emergent themes included varying concerns about the lasting consequences of unplanned pregnancies and STIs; greater visibility of pregnancy compared to infection; stigma; and limited STI prevention efforts compared to teen pregnancy prevention.
Conclusions: By addressing the underlying concerns and varying perceptions that different groups of youth have toward STIs and pregnancy, prevention approaches and messages can be tailored, including by age, gender, sexual orientation, and for those exposed to vulnerable living situations. Additional efforts are needed to address increasing rates of STIs among young people.
Keywords: concerns, health risk behaviours, pregnancy, prevention, qualitative, sexually transmitted diseases, stigma, youth.
References
[1] Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2018. Natl Vital Stat Rep 2019; 68 1–47.| 32501202PubMed |
[2] Shannon CL, Klausner JD. The growing epidemic of sexually transmitted infections in adolescents: a neglected population. Curr Opin Pediatr 2018; 30 137–143.
| The growing epidemic of sexually transmitted infections in adolescents: a neglected population.Crossref | GoogleScholarGoogle Scholar | 29315111PubMed |
[3] Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2017. Atlanta: U.S. Department of Health and Human Services; 2018. Available at https://www.cdc.gov/std/stats17/2017-STD-Surveillance-Report_CDC-clearance-9.10.18.pdf.
[4] Chabot M, Kwan K, Guenzburger G, Lavezzo M, Pressfield L. Adolescent births in California, 2000–2018. Sacramento: California Department of Public Health, Center for Family Health, Maternal, Child and Adolescent Health Division; 2021. Available at https://www.cdph.ca.gov/Programs/CFH/DMCAH/surveillance/CDPH%20Document%20Library/Adolescents/Adolescent-Births-in-CA-2018.pdf.
[5] California Department of Public Health. Sexually transmitted diseases in California: 2018 executive summary; 2019. Available at https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/STD-Surveillance-Executive-Summary.pdf.
[6] Brindis CD, Decker MJ, Gutmann-Gonzalez A, Berglas NF. Perspectives on adolescent pregnancy prevention strategies in the United States: looking back, looking forward. Adolesc Health Med Ther 2020; 11 135–45.
| Perspectives on adolescent pregnancy prevention strategies in the United States: looking back, looking forward.Crossref | GoogleScholarGoogle Scholar | 33117030PubMed |
[7] Boyer CB, Agénor M, Willoughby JF, Mead A, Geller A, Yang S, et al. A renewed call to action for addressing the alarming rising rates of sexually transmitted infections in US adolescents and young adults. J Adolesc Health 2021; 69 189–91.
| A renewed call to action for addressing the alarming rising rates of sexually transmitted infections in US adolescents and young adults.Crossref | GoogleScholarGoogle Scholar | 34099391PubMed |
[8] Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, Schootman M, Bucholz KK, Peipert JF, et al. Age of sexual debut among US adolescents. Contraception 2009; 80 158–62.
| Age of sexual debut among US adolescents.Crossref | GoogleScholarGoogle Scholar | 19631791PubMed |
[9] Halkitis PN, LoSchiavo C, Martino RJ, De La Cruz BM, Stults CB, Krause KD. Age of sexual debut among young gay-identified sexual minority men: the P18 Cohort study. J Sex Res 2021; 58 573–80.
| Age of sexual debut among young gay-identified sexual minority men: the P18 Cohort study.Crossref | GoogleScholarGoogle Scholar | 32609010PubMed |
[10] Dembo R, Belenko S, Childs K, Wareham J, Schmeidler J. Individual and community risk factors and sexually transmitted diseases among arrested youths: a two level analysis. J Behav Med 2009; 32 303–16.
| Individual and community risk factors and sexually transmitted diseases among arrested youths: a two level analysis.Crossref | GoogleScholarGoogle Scholar | 19224357PubMed |
[11] Tapert SF, Aarons GA, Sedlar GR, Brown SA. Adolescent substance use and sexual risk-taking behavior. J Adolesc Health 2001; 28 181–9.
| Adolescent substance use and sexual risk-taking behavior.Crossref | GoogleScholarGoogle Scholar | 11226840PubMed |
[12] Riskind RG, Tornello SL, Younger BC, Patterson CJ. Sexual identity, partner gender, and sexual health among adolescent girls in the United States. Am J Public Health 2014; 104 1957–63.
| Sexual identity, partner gender, and sexual health among adolescent girls in the United States.Crossref | GoogleScholarGoogle Scholar | 25121821PubMed |
[13] Tyler KA, Whitbeck LB, Chen X, Johnson K. Sexual health of homeless youth: prevalence and correlates of sexually transmissible infections. Sex Health 2007; 4 57–61.
| Sexual health of homeless youth: prevalence and correlates of sexually transmissible infections.Crossref | GoogleScholarGoogle Scholar | 17382040PubMed |
[14] Banks DE, Hensel DJ, Zapolski TCB. Integrating individual and contextual factors to explain disparities in HIV/STI among heterosexual African American youth: a contemporary literature review and social ecological model. Arch Sex Behav 2020; 49 1939–64.
| Integrating individual and contextual factors to explain disparities in HIV/STI among heterosexual African American youth: a contemporary literature review and social ecological model.Crossref | GoogleScholarGoogle Scholar | 32157486PubMed |
[15] Conron KJ, Wilson BD. A research agenda to reduce system involvement and promote positive outcomes with LGBTQ youth of color impacted by the child welfare and juvenile justice systems. Los Angeles: The Williams Institute; 2019. Available at https://escholarship.org/uc/item/6jf587wr
[16] Page M. Forgotten youth: homeless LGBT youth of color and the Runaway and Homeless Youth Act. Northwest J Law Soc Policy 2017; 12 17–45.
[17] Woodhams E, Sipsma H, Hill BJ, Gilliam M. Perceived responsibility for pregnancy and sexually transmitted infection prevention among young African American men: an exploratory focus group study. Sex Reprod Healthc 2018; 16 86–91.
| Perceived responsibility for pregnancy and sexually transmitted infection prevention among young African American men: an exploratory focus group study.Crossref | GoogleScholarGoogle Scholar | 29804783PubMed |
[18] Albert D, Chein J, Steinberg L. The teenage brain: Peer influences on adolescent decision making. Curr Dir Psychol Sci 2013; 22 114–20.
| The teenage brain: Peer influences on adolescent decision making.Crossref | GoogleScholarGoogle Scholar | 25544805PubMed |
[19] Duell N, Steinberg L. Adolescents take positive risks, too. Dev Rev 2021; 62 100984
| Adolescents take positive risks, too.Crossref | GoogleScholarGoogle Scholar |
[20] Ciranka S, van den Bos W. Adolescent risk-taking in the context of exploration and social influence. Dev Rev 2021; 61 100979
| Adolescent risk-taking in the context of exploration and social influence.Crossref | GoogleScholarGoogle Scholar |
[21] Defoe IN, Semon Dubas J, Romer D. Heightened adolescent risk-taking? Insights from lab studies on age differences in decision-making. Policy Insights Behav Brain Sci 2019; 6 56–63.
| Heightened adolescent risk-taking? Insights from lab studies on age differences in decision-making.Crossref | GoogleScholarGoogle Scholar |
[22] Andrews JL, Ahmed SP, Blakemore S-J. Navigating the social environment in adolescence: the role of social brain development. Biol Psychiatry 2021; 89 109–18.
| Navigating the social environment in adolescence: the role of social brain development.Crossref | GoogleScholarGoogle Scholar | 33190844PubMed |
[23] McNeilly EA, Peverill M, Jung J, McLaughlin KA. Executive function as a mechanism linking socioeconomic status to internalizing and externalizing psychopathology in children and adolescents. J Adolesc 2021; 89 149–60.
| Executive function as a mechanism linking socioeconomic status to internalizing and externalizing psychopathology in children and adolescents.Crossref | GoogleScholarGoogle Scholar | 33971502PubMed |
[24] Edidin JP, Ganim Z, Hunter SJ, Karnik NS. The mental and physical health of homeless youth: a literature review. Child Psychiatry Hum Dev 2012; 43 354–75.
| The mental and physical health of homeless youth: a literature review.Crossref | GoogleScholarGoogle Scholar | 22120422PubMed |
[25] Farah MJ, Shera DM, Savage JH, Betancourt L, Giannetta JM, Brodsky NL, et al. Childhood poverty: specific associations with neurocognitive development. Brain Res 2006; 1110 166–74.
| Childhood poverty: specific associations with neurocognitive development.Crossref | GoogleScholarGoogle Scholar | 16879809PubMed |
[26] O’Sullivan LF, Udell W, Montrose VA, Antoniello P, Hoffman S. A cognitive analysis of college students’ explanations for engaging in unprotected sexual intercourse. Arch Sex Behav 2010; 39 1121–31.
| A cognitive analysis of college students’ explanations for engaging in unprotected sexual intercourse.Crossref | GoogleScholarGoogle Scholar | 19365717PubMed |
[27] Smith JL, Fenwick J, Skinner R, Merriman G, Hallett J. Young males’ perspectives on pregnancy, fatherhood and condom use: where does responsibility for birth control lie? Sex Reprod Healthc 2011; 2 37–42.
| Young males’ perspectives on pregnancy, fatherhood and condom use: where does responsibility for birth control lie?Crossref | GoogleScholarGoogle Scholar | 21147457PubMed |
[28] Rosenberger JG, Bell DL, McBride KR, Fortenberry JD, Ott MA. Condoms and developmental contexts in younger adolescent boys. Sex Transm Infect 2010; 86 400–3.
| Condoms and developmental contexts in younger adolescent boys.Crossref | GoogleScholarGoogle Scholar | 20448100PubMed |
[29] Kershaw TS, Niccolai LM, Ethier KA, Lewis JB, Ickovics JR. Perceived susceptibility to pregnancy and sexually transmitted disease among pregnant and nonpregnant adolescents. J Community Psychol 2003; 31 419–34.
| Perceived susceptibility to pregnancy and sexually transmitted disease among pregnant and nonpregnant adolescents.Crossref | GoogleScholarGoogle Scholar |
[30] Whaley AL, Winfield EB. Correlates of African American college students’ condom use to prevent pregnancy, STDs, or both outcomes. J Natl Med Assoc 2003; 95 702–9.
| 12934866PubMed |
[31] Carter MW, Hock-Long L, Kraft JM, Henry-Moss D, Hatfield-Timajchy K, Singer M. Strategies for managing the dual risk of sexually transmitted infections and unintended pregnancy among Puerto Rican and African American young adults. Am J Public Health 2012; 102 449–56.
| Strategies for managing the dual risk of sexually transmitted infections and unintended pregnancy among Puerto Rican and African American young adults.Crossref | GoogleScholarGoogle Scholar | 22390507PubMed |
[32] Suleiman AB, Deardorff J. Multiple dimensions of peer influence in adolescent romantic and sexual relationships: a descriptive, qualitative perspective. Arch Sex Behav 2015; 44 765–75.
| Multiple dimensions of peer influence in adolescent romantic and sexual relationships: a descriptive, qualitative perspective.Crossref | GoogleScholarGoogle Scholar | 25501657PubMed |
[33] Hoefnagels C, Hospers HJ, Hosman C, Schouten L, Schaalma H. One measure, two motives. Prediction of condom use and interaction between two prevention goals among heterosexual young adults: preventing pregnancy and/or sexually transmitted diseases. Prev Sci 2006; 7 369–76.
| One measure, two motives. Prediction of condom use and interaction between two prevention goals among heterosexual young adults: preventing pregnancy and/or sexually transmitted diseases.Crossref | GoogleScholarGoogle Scholar | 16823634PubMed |
[34] Decker M, Lara D, Arons A, Maddock L, Gutmann-Gonzalez A. Youth community health assessment of resources and trends (CHART) project. San Francisco: Institute for Health Policy Studies; 2015. Available at https://www.co.fresno.ca.us/home/showdocument?id=20461
[35] Potter WJ, Levine-Donnerstein D. Rethinking validity and reliability in content analysis. J Appl Comm Res 1999; 27 258–84.
| Rethinking validity and reliability in content analysis.Crossref | GoogleScholarGoogle Scholar |
[36] Miles MB, Huberman AM. Qualitative data analysis: an expanded sourcebook. 2nd edn. Sage Publications, Inc.; 1994.
[37] Basit T. Manual or electronic? The role of coding in qualitative data analysis. Educ Res 2003; 45 143–54.
| Manual or electronic? The role of coding in qualitative data analysis.Crossref | GoogleScholarGoogle Scholar |
[38] Rice WS, Turan B, White K, Turan JM. Norms and stigma around unintended pregnancy in Alabama: associations with recent contraceptive use and dual method use among young women. Women Health 2018; 58 1151–66.
| Norms and stigma around unintended pregnancy in Alabama: associations with recent contraceptive use and dual method use among young women.Crossref | GoogleScholarGoogle Scholar | 29240532PubMed |
[39] Guzzo KB, Lang VW, Hayford SR. Teen girls’ reproductive attitudes and the timing and sequencing of sexual behaviors. J Adolesc Health 2019; 65 507–13.
| Teen girls’ reproductive attitudes and the timing and sequencing of sexual behaviors.Crossref | GoogleScholarGoogle Scholar | 31326249PubMed |
[40] Valentine JA, Delgado LF, Haderxhanaj LT, Hogben M. Improving sexual health in US rural communities: reducing the impact of stigma. AIDS Behav 2022; 26 90–9.
| Improving sexual health in US rural communities: reducing the impact of stigma.Crossref | GoogleScholarGoogle Scholar | 34436713PubMed |
[41] Cook RJ, Dickens BM. Reducing stigma in reproductive health. Int J Gynaecol Obstet 2014; 125 89–92.
| Reducing stigma in reproductive health.Crossref | GoogleScholarGoogle Scholar | 24513258PubMed |
[42] Moseson H, Mahanaimy M, Dehlendorf C, Gerdts C. “…Society is, at the end of the day, still going to stigmatize you no matter which way”: a qualitative study of the impact of stigma on social support during unintended pregnancy in early adulthood. PLoS ONE 2019; 14 e0217308
| “…Society is, at the end of the day, still going to stigmatize you no matter which way”: a qualitative study of the impact of stigma on social support during unintended pregnancy in early adulthood.Crossref | GoogleScholarGoogle Scholar | 31120984PubMed |
[43] Foster LR, Byers ES. Predictors of stigma and shame related to sexually transmitted infections: attitudes, education, and knowledge. Can J Hum Sex 2008; 17 193–202.
[44] Petrova D, Garcia-Retamero R. Effective evidence-based programs for preventing sexually-transmitted infections: a meta-analysis. Curr HIV Res 2015; 13 432–8.
| Effective evidence-based programs for preventing sexually-transmitted infections: a meta-analysis.Crossref | GoogleScholarGoogle Scholar | 26149164PubMed |
[45] McLaurin-Jones TL, Lashley M-B, Marshall VJ. Using qualitative methods to understand perceptions of risk and condom use in African American college women: implications for sexual health promotion. Health Educ Behav 2017; 44 805–14.
| Using qualitative methods to understand perceptions of risk and condom use in African American college women: implications for sexual health promotion.Crossref | GoogleScholarGoogle Scholar | 28882079PubMed |
[46] Combs KM, Aparicio EM, Prince DM, Grinnell-Davis C, Marra L, Faulkner M. Evidence-based sexual health programs for youth involved with juvenile justice and child welfare systems: outcomes across settings. Child Youth Serv Rev 2019; 100 64–9.
| Evidence-based sexual health programs for youth involved with juvenile justice and child welfare systems: outcomes across settings.Crossref | GoogleScholarGoogle Scholar |
[47] Oman RF, Vesely SK, Green J, Clements-Nolle K, Lu M. Adolescent pregnancy prevention among youths living in group care homes: a cluster randomized controlled trial. Am J Public Health 2018; 108 S38–44.
| Adolescent pregnancy prevention among youths living in group care homes: a cluster randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 29443557PubMed |
[48] Muessig KE, Baltierra NB, Pike EC, LeGrand S, Hightow-Weidman LB. Achieving HIV risk reduction through HealthMpowerment.org, a user-driven eHealth intervention for young Black men who have sex with men and transgender women who have sex with men. Digit Cult Educ 2014; 6 164–82.
| 25593616PubMed |
[49] Crosby RA, Mena L, Smith RV. Promoting positive condom use experiences among young black MSM: a randomized controlled trial of a brief, clinic-based intervention. Health Educ Res 2018; 33 197–204.
| Promoting positive condom use experiences among young black MSM: a randomized controlled trial of a brief, clinic-based intervention.Crossref | GoogleScholarGoogle Scholar | 29534210PubMed |
[50] Bowleg L. The problem with the phrase women and minorities: intersectionality—an important theoretical framework for public health. Am J Public Health 2012; 102 1267–73.
| The problem with the phrase women and minorities: intersectionality—an important theoretical framework for public health.Crossref | GoogleScholarGoogle Scholar | 22594719PubMed |
[51] Chambers BD, Erausquin JT. The promise of intersectional stigma to understand the complexities of adolescent pregnancy and motherhood. J Child Adolesc Behav 2015; 3 249
| The promise of intersectional stigma to understand the complexities of adolescent pregnancy and motherhood.Crossref | GoogleScholarGoogle Scholar |
[52] Crenshaw K. Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. U Chi Legal F 1989; 1989 139–67. http://chicagounbound.uchicago.edu/uclf/vol1989/iss1/8
[53] National Academies of Sciences Engineering and Medicine. Sexually transmitted infections: Adopting a sexual health paradigm. Washington: The National Academies Press; 2021.
| Crossref |
