A qualitative study of contraceptive understanding among young adults.

BACKGROUND: This study describes contraceptive understanding, sources of information and consequences of contraceptive misunderstandings among urban, young adults. STUDY DESIGN: We used qualitative data from 16 focus groups and 53 interviews with Puerto Rican and African American men and women aged 18-25 years from Philadelphia and Hartford. We categorized and compared assertions made about all contraceptive methods' side effects, effectiveness and use using an iterative process. RESULTS: Participants considered contraceptive use worthwhile but felt that it carried risks of problematic side effects and contraceptive failure, with variation among methods. Men knew most about condoms and withdrawal and trusted both more than women. Personal or second-hand experience was the dominant source of information on contraceptive understanding. Misunderstandings about contraception affected their relationships and risk of unintended pregnancy. CONCLUSION: Contraceptive understanding is a powerful determinant of contraceptive use and limits the options perceived by young adults to prevent pregnancy. Research is needed to strengthen contraceptive counseling and outreach in ways that better leverage peer influence.

Strategies for managing the dual risk of sexually transmitted infections and unintended pregnancy among Puerto Rican and African American young adults.

Although young adults in the United States are at increased risk for sexually transmitted infections (STIs) and unintended pregnancy, they do not report high rates of dual-method use (condoms plus other contraception) for prevention. We used prospective qualitative data from 69 urban Puerto Rican and African American individuals aged 18 to 25 years to determine how they managed these risks in their heterosexual relationships during a 4- to 8-week period. Hormonal or long-acting contraceptive use, condoms, and withdrawal were the most common unintended pregnancy prevention strategies; condoms, STI testing, and perceived fidelity were dominant among STI prevention strategies. We need to shift the focus from dual-method use toward a broader concept of dual protection to be more responsive to young adults' concerns, perceptions, and priorities.

Heterosexual anal sex experiences among Puerto Rican and black young adults.

CONTEXT: Heterosexual anal sex is not uncommon in the United States, and it poses risk for STDs. However, who engages in it and why are not well understood, particularly among young adults. METHODS: In 2006-2008, data on sexual health-related topics were collected in surveys (483 respondents) and qualitative interviews (70 participants) with black and Puerto Rican 18-25-year-olds in Hartford and Philadelphia. Bivariate and multivariate analyses of survey data assessed predictors of anal sex with the most recent serious heterosexual partner. Interview transcripts were analyzed for anal sex experiences and reasons for and against engaging in this behavior. RESULTS: Some 34% of survey respondents had had anal sex; this behavior was more common with serious partners than with casual partners (22% vs. 8%). Black respondents were less likely than Puerto Ricans to report anal sex (odds ratio, 0.3); women were more likely to do so than were men (2.9). In the qualitative cohort, perceptions of anal sex as painful and unappealing were the predominant reasons for not having anal sex, whereas sexual pleasure and, in serious relationships, intimacy were the main reasons for engaging in it. Condom use during anal sex was rare and was motivated by STD or hygiene concerns. CONCLUSIONS: Heterosexual anal sex is not an infrequent behavior and should be considered in a broad sexual health context, not simply as an indicator of STD risk. Health providers should address it openly and, when appropriate, as a positive sexual and emotional experience.