The Pros and Cons of Substance Use and Risky Sexual Behavior Among Adolescent Females in the Juvenile Justice System: A Thematic Analysis

Background and Purpose:Compared to adult women, adolescent females are at a higher risk of unplanned pregnancy, and more likely to continue tobacco and alcohol use during pregnancy. Female youth in the juvenile justice system are more likely than their non-detained peers to be sexually active, and less than half of those reporting sexual activity use contraception. With high alcohol use and smoking rates, juvenile justice involved female youth are in need of innovative programming aimed at reducing the risks of unintended pregnancy, sexually transmitted infections, and alcohol and tobacco exposed pregnancies in a multi-risk or “bundled” approach.  Choices-Teen is a 3-session Motivational Interviewing intervention designed to address these high-risk behaviors in adolescent females in the juvenile justice system. While the results of the pilot study have been reported elsewhere, the current study presents a thematic analysis of the pros and cons elicited from female youth regarding each risk behavior during the intervention.

Methods:Participants were referred to the CHOICES-TEEN program from four community probation sites and were screened for alcohol, tobacco, and risk of unplanned pregnancy/HIV. Twenty-two participants were enrolled in the pilot study. As part of a “workbook” component of the intervention participants were asked to provide pros and cons they recognized for alcohol, tobacco, condom, and contraceptive use in their own words.  These qualitative data - written in the youth’s own words during a decisional balance exercise - were analyzed using thematic analysis to detect specific recurring themes and frequent individual entries. The pros and cons were also coded into factors driven by interactions with others, and those driven by purely personal motivations.

Results:The number of pros or cons varied by participant and included a variety of anecdotes as well as overall statements about the benefits or drawbacks of a specific behavior. The most recurrent pros and cons were factors that affected these adolescents directly instead of factors that involved others. For tobacco use a majority (n=12 of 16) identified tobacco being “relaxing” as a pro with many (n=6 of 16) also or alternatively listing “stress relieving,” while only 3 of 16 listed smoking as a social behavior as a pro. Comparably, the most frequent cons listed for tobacco use were “side effects” (n=14 of 16), while partner (n=2 of 16) or parental (n=1 of 16) disapproval were infrequently cited as cons. These types of results were consistent for all behaviors for which the participants made pro/con lists: tobacco use, alcohol use, condom use, and contraceptive use.

Conclusions and Implications: By examining what these young women felt were the biggest motivations and barriers to behavior changes in their own words, the intervention can be more specifically tailored to this population in the future. The results provided by the participants’ answers also supply crucial insight into the motivation for changing high-risk behaviors. This information can also be used to identify specific recurrent beliefs within a population that act as barriers to behavior change that are misconceptions and can be combatted with further education.