Understanding Condom Use Decision-Making among Homeless Youth using Event-Level Data

This is one of the first qualitative event-based studies to understand the various mechanisms through which multiple factors influence condom use decision-making among homeless youth. 

Event-level interviews which explore characteristics of the environment surrounding sexual events were conducted with 29 youth, who were asked to describe two recent sexual encounters. In thematic analyses of data across events, reasons that youth gave for engaging in unprotected sex included the expectation of having sex and use of alternative methods of protection against pregnancy. 

Other non-event factors that influenced condom use decision-making were related to attributes of the partnership (e.g., testing, trust and love, and assessments of risk) and attributes of the youth (e.g., perceptions of diseases, concerns over pregnancy, and discomfort using condoms). Additional event analyses conducted within the same individuals found that decision-making was influenced by multiple interacting factors, with different pathways operating for event and non-event factors. 

Future interventions should consider taking a multilevel and individualized approach that focuses on event-based determinants of risky sex in this population.

Table 1

Example of Quotes under Parent codes and Sub-codes

	Short Description	Exemplary Quotes
Parent Code 1: Event-Based
Sex expectation	Prior to the sexual event, whether individual knew/ felt/ thought that he/ she was going to have sex	“I didn't have none [condoms] . . . because I didn't know it was going to happen.”
Use of alternative methods of protection against pregnancy	Either prior or at the time of the sexual event, individual used any form of protection except for condoms	“Yeah, but he knows when to pull out and stuff.”
Location	Location where the sexual event occurred	“Outside you have to be very careful. We’ve been waiting a long time, so it wasn’t as planned as much as when we’re in a room, where like, we can just go at it.”
Substance use	Whether the individual or partner consumed alcohol, drugs or both either just prior or during the sexual event	“This is the worst thing about crystal meth, the memory while having sex is horrible”
Parent Code 2: Partnership
Testing	Ideas, beliefs, thoughts, perceptions, communication and behaviors related to testing	“When we first met, until we got tested. And then once I found out that he was negative, that's when we stopped using condoms.”
Trust and love for partner	Romantic feelings for partner	“I really liked him a lot, and I trusted him, and that's pretty much all. Like, I trusted that he didn't have anything wrong with him.”
Partner risk assessments	Clues or strategies to assess risk from sexual partner	“If she was a dirty person or if everybody knew her in town. What we call those is a Hollywood Ho.”
Parent Code 3: Individual
Concerns about diseases	Individual concerns about contracting diseases such as STDs and HIV/ AIDs	“Because I didn't know them that well, so I didn't know what kind of STDs they had or nothing like that”
Pregnancy ambivalence	Feelings, desires and decisions concerning pregnancy in relationships	“I really like him, and if I were to get pregnant, I'd get my life under control. . . Yeah, because then I would have to take care of something besides myself.”
Discomfort using condoms	Reasons why individuals find using contraception inconvenient or uncomfortable	“Because you know sometimes when you have a condom on, you can't feel shit.”

Below:  Multiple Levels of Influence on Condom use Decision-making at the time of the Sexual Event

Section 1: Individual is influenced by factors operating at all three levels.

Section 2: Individual is influenced by factors operating at the individual and event levels.

Section 3: Individual is influenced by factors operating at the event and partnership levels.

Section 4: Individual is influenced by factors operating at the individual and partnership levels.

Full article at:   http://goo.gl/rvm0Mx

By:   Yashodhara Rana,¹ Ryan A. Brown,¹ David P. Kennedy,¹ Gery W. Ryan,¹ Stefanie Stern,¹ and Joan S. Tucker¹

¹RAND Health, RAND Corporation, Santa Monica, California, USA

Corresponding Author: Joan S. Tucker, RAND Corporation, 1776 Main Street, Santa Monica, California 90407-2138, USA, Email:gro.dnar@rekcutj, Fax: (310) 393-4818, Phone Number: (310) 393-0411 (X7519)

 

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