Kudos to Lauren Holt, PhD student, and her faculty sponsor Michael Relf, associate dean for Global and Community Health Affairs, for the submission of her NIH NRSA application entitled: “Understanding Sexual Health Decision-Making and Risk Perception Among Adolescent and Young Adult Cisgender Females using Prescribed Contraceptives: A Grounded Theory Study." This proposal requests funds for 33 months with a start date of September 1, 2021.

Adolescent and young adult cisgender females (AYACF) between the ages of 18 and 24 are using prescribed contraceptives but not condoms. While unintended pregnancy rates are at an all-time low in the US, sexually transmitted infection (STI) rates have increased over the last five years with 1 in 4 adolescent females currently having an STI. AYACF are disproportionately affected by STI’s with cisgender females belonging to structurally oppressed racial and ethnic groups being the most affected by, both, STIs and HIV. Social determinants of health such as socioeconomic status, neighborhood, access to care, and education can impact a woman’s likelihood of being diagnosed with an STI or HIV during her lifetime.

Pregnancy and STI prevention can simultaneously be achieved through dual-method contraceptive use which occurs when a prescribed contraceptive and a condom are used during vaginal, oral, or anal intercourse. While the risk of being diagnosed with an STI/ HIV can be reduced through condom use, less than 36% of AYACF report using a condom during every sexual encounter, and prescribed contraceptive users being less likely to use condoms than non-prescribed contraceptive users. Further, AYACF who use long- acting reversible contraceptives (LARCs) are less likely to practice dual contraceptive use than those who use short-acting reversible contraceptives (SARCs).

AYACF with a high STI/HIV risk perception are more likely to initiate dual contraceptive use than those who perceive themselves as low risk, and those who engage in high risk sexual behavior are less likely to use a condom during sexual intercourse. Risk perception analysis is an integral part of decision-making. Despite persistent age, gender, racial and ethnic, social, and environmental disparities, there is little understanding of the processes associated with STI/HIV risk perception and dual contraceptive use decision-making.

Thus, a grounded theory approach will be employed to gain insight into the interconnectedness of STI/HIV risk perception analysis and dual-method contraceptive decision making. The specific aims of this study are:

Aim 1: Conduct qualitative interviews with 25-30 sexually active AYACF using prescribed contraceptives to understand their STI/HIV risk perception and decision making related to dual-method contraceptive use.

Aim 2: To develop a conceptual model explaining the processes associated with risk perception analysis and decision-making related to dual-method contraceptive use among sexually active AYACF using prescribed contraceptives

• 2a. Describe the role of personal background and SDH in decision-making and risk perception
• 2b. Develop hypotheses related to contributing factors and pathways for determining risk for STIs/HIV