Multi-contextual influences on adolescent pregnancy and sexually transmitted infections in the United States

Rationale: Rates of adolescent pregnancy and sexually transmitted infections (STIs) in the United States remain high. Norms and beliefs about sex and the use of contraception have been identified as potential contributors to these. Objective: The current study examined multi-contextual links between norms and beliefs about sex and contraception, and adolescent pregnancies and STIs. Method: Hierarchical linear modeling (HLM) was used to test the study questions in the historical data from Add Health dataset (Wave I, 1994–1995, and Wave II, 1995–1996). Measures of beliefs about sex and contraception were administered to adolescents and their caregivers; pregnancies and STIs were reported by adolescents (N = 13,568; level 1). School-reported data (N = 132; level 2) included sexuality education and prevalence of pregnancies at schools. Community data included the density of family planning providers in each county. Results: Adolescents negative beliefs about contraception were associated with a higher likelihood of pregnancies and STIs via their association with contraception use. The opposite effect was found for negative beliefs about sex. Parental disapproval of contraception was associated with a decreased likelihood of STIs, but with an increased likelihood of pregnancies. A greater number of pregnancies at school was associated with a greater likelihood of STIs. Unexpectedly, the number of county-level family planning providers was associated with a higher likelihood of STIs. Conclusion: Adolescent individual beliefs emerged as the most salient predictors of both pregnancies and STIs.