7. Using the Theory of Planned Behavior to Identify Predictors of Contraceptive Use Intentions and Behaviors in Adolescents

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<h3>Background</h3> Adolescent unintended pregnancy has dropped in the United States, while sexually transmitted infection (STI) prevalence in this population has increased. We utilize the Theory of Planned Behavior (TPB) to identify predictors of STI and pregnancy prevention intentions and behaviors in adolescents. <h3>Methods</h3> Baseline data were obtained from 2GETHER—The Dual Protection Project, a randomized clinical trial aiming to decrease STIs/pregnancy in African American adolescents. Participants were eligible if they engaged in vaginal sex in the past 3 months and finished the baseline survey (n=697). This secondary analysis examines the relationships between TPB constructs (attitudes, subjective norms, perceived behavioral control (PBC)) and contraceptive intentions and behaviors in three ways. First, we examined the relationship between TPB constructs related to pregnancy with intentions to use and use of contraception. Next, we examined TPB constructs related to STI prevention with intentions to use and use of condoms. Finally, we created composite TPB construct variables for dual protection (simultaneous prevention of pregnancy and STI) and examined the relationship between intention and contraceptive and condom use (dual method, condom alone, non-barrier contraception alone, no method). Chi square analysis and multinomial logistical regression were used to examine relationships. Institutional Review Board approval was obtained from both Emory University and the Centers for Disease Control and Prevention. <h3>Results</h3> The average age of participants was 17.35 years (range=14-19, SD=1.265). 50.2% of adolescents reported a STI diagnosis would be worse than pregnancy; 36.0% rated them equally bad. For pregnancy constructs, anti-pregnancy attitudes (p<.001) and subjective norms (p=.031) were associated with increased intentions to use contraception. Higher PBC (p<.001), intentions to use contraception (p<.001), and anti-pregnancy attitudes (p=.010) were associated with contraceptive use. For STI constructs, subjective norms were associated with intentions to use condoms (p=.014). Lower PBC was predictive of decreased condom use (p<.001). In multinomial regression analysis, participants with negative attitudes were 3.9 times more likely to intend to use dual methods compared to no protection (OR=3.900, CI=(1.477, 10.299)). Participants with higher PBC were more likely to have used dual methods (OR=1.997, CI=(1.146, 3.482)) and condoms only (OR=3.668, CI=(2.251, 5.975)) compared to no method. <h3>Conclusions</h3> Participants viewed STIs more negatively than pregnancy. However, attitudes, PBC and subjective norms for pregnancy prevention were more predictive of intentions and use of contraception than they were to predict intentions and use of condoms.