A Mixed Methods Examination of Pregnancy Attitudes and HIV Risk Behaviors Among Homeless Youth: The Role of Social Network Norms and Social Support
Date of Award
Kimberly Bender, Ph.D.
Homeless youth, Pregnancy, Reproductive health, Sexual health
Homeless young women become pregnant at exceptionally high rates, and such pregnancies often pose serious emotional, social, and physical health concerns. Perhaps surprisingly, many homeless youth intentionally seek to become pregnant or involved in pregnancy, as pregnancy and parenthood are viewed as conduits toward accessing social services and meaningful social connections to others that this group often lacks. However, most prevention efforts focus solely on young females' pregnancy attitudes and behaviors at the individual level. Such approaches fail to acknowledge contextual factors, such as desired pregnancy and pregnancy ambivalence, the influence of youths' social networks and perceived social norms regarding pregnancy, youths' desire for social connection, and their dire needs for tangible resources, each of which may influence youths' reproductive and sexual health behaviors. This study thus drew upon theoretical perspectives pertaining to social networks, social norms, and social support, to examine how youths' broader ecological contexts may play a role in shaping homeless youths' pregnancy attitudes and, subsequently, their engagement in unprotected (condomless) vaginal sex. Using a sequential mixed methods design, this study first quantitatively examined social network data previously collected from homeless youth in Los Angeles (N = 1,046). A series of multivariate logistic regressions assessed the association between social norms regarding pregnancy, perceived by youth as conveyed by members of their social networks, and homeless youths' pro-pregnancy attitude endorsements. A model also examined how specific forms of social support, provided by youths' social network members, were associated with homeless youths' pro-pregnancy attitude endorsements. A final quantitative model then analyzed the association between homeless youths' endorsements of pro-pregnancy attitudes and their engagement in unprotected vaginal sex, a known risk factor for not only pregnancy, but also HIV/STI acquisition and transmission. The project then built upon findings from the quantitative study strand to develop an original qualitative interview guide. In-depth, individual interviews were conducted with homeless youth (N = 30) staying at a youth-serving shelter in Denver, Colorado. This qualitative strand of the study explored how homeless young people develop their pregnancy attitudes and make reproductive and sexual health decisions in the context of their social networks. Broadly, this study found that homeless youth do not appear to form their pregnancy attitudes in isolation, and rather, there are many salient influences found in their social surroundings that are associated with their reproductive and sexual attitudes and behaviors. Moreover, results showed that this population is in urgent need of accurate information on reproductive and sexual health information and services, as well as opportunities to interact with caring, non-judgmental medical and service providers. As such, this dissertation presents recommendations for how policy-makers, service providers, and medical professionals may deliver reproductive and sexual health information and services to this uniquely vulnerable population with optimal effectiveness and cultural humility.
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Begun, Stephanie J., "A Mixed Methods Examination of Pregnancy Attitudes and HIV Risk Behaviors Among Homeless Youth: The Role of Social Network Norms and Social Support" (2017). Electronic Theses and Dissertations. 1293.
Received from ProQuest
Stephanie J. Begun