Using a Social Ecological Framework to Understand Healthy Relationships and Unintended Pregnancy Risk Among Youth in Rural Communities and Youth Engaged in Systems

Abstract

Nearly 75% of adolescent pregnancies are unintended, putting those adolescents at risk for long-term physical, social, and mental health outcomes. Youth who live in rural areas and youth with system involvement are at increased risk of unplanned pregnancies and births. We used the social ecological framework to investigate the following known risks for unplanned pregnancies: early sexual onset, contraception non-use, and dating violence. First, we examined the behaviors and attitudes associated with early sexual onset and the intention to delay sex in rural middle school youth. Being older, having less agency for sexual refusal, system involvement, and more parent communication were associated with having sex and planning to have sex. This highlights the importance of early, comprehensive, and trauma-informed pregnancy prevention programs for younger adolescents. Second, we examined the impact of positive youth development (PYD) on the use of effective contraceptives for sexually active youth who are system involved. Only 13.9% used condoms alone and 41.5% hormonal contraception (+/- condoms) in the past three months. Multivariate ordinal logistic regression revealed that older age, female gender, and higher PYD skills were associated with the use of more effective contraceptives. The final study identified risk and protective factors for perpetration and victimization of dating violence among youth with system involvement. We observed high rates of dating violence across all participants, and gender differences in perpetration and victimization. Using Poisson regression models, both perpetration and victimization were related to higher levels of trauma, lower healthy relationship scores, having recent sex, and being a sexual minority. These studies indicate a need for early delivery of pregnancy prevention programs and services for higher risk youth that are trauma informed, sexually inclusive, and promote PYD and healthy relationships.