Exploring Multilevel Factors associated with Dual-Method Contraceptive use among Adolescent and Young Adult Women

Abstract

Sexually transmitted infections (STIs) continue to rise in the US, and adolescent and young adult women (AYAW) between ages 18 and 24 have some of the highest STI rates in the country. Further, AYAW who use prescribed contraceptives (commonly referred to as birth control) are less likely to use condoms and more likely to be diagnosed with an STI than non-prescribed contraceptive users. The purpose of this dissertation is to understand multilevel factors contributing to condom use decision-making and STI risk perception analysis among AYAW who use prescribed contraceptives. Data was using qualitative research methods in two separate studies. In one study, a grounded theory approach was used to explain the processes associated with STI risk perception and dual-method contraceptive decision-making. In a separate study, sex education policy experts in Texas were interviewed to identify barriers and facilitators to implementing comprehensive sex education at a local level. Additionally, legal and ethical issues in conducting sexual health research with AYAW were explored. The findings suggest that dual-method contraceptive decision-making is a complex process that is influenced by individual, relationship, community, and societal factors. Instead of having conversations about STIs, AYAW are making assumptions about the STI status of their partners based on partner and relationship factors and are deferring to their partners for dual-method contraceptive decision-making. Additionally, societal, community, and relationship factors influence how AYAW perceive STIs in comparison to pregnancy. To increase STI risk perception and dual-method contraceptive use a multilevel holistic approach is recommended.