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Although research suggests that young people are more likely to have unprotected sex than adults, their reasons for doing so are not well-understood. Among a sample of young people accessing no-cost contraceptive services, we explored their reported reasons for having unprotected sex and their willingness to have unprotected sex in the future. We recruited sexually active assigned female at birth youth at 10 family planning clinics in the San Francisco Bay Area (n = 212). Participants completed a self-administered survey reporting their reasons for having unprotected sex and willingness to do so in the future. We used bivariate analyses to assess associations between reasons for unprotected sex and age group (adolescents ages 14–19 vs. young adults ages 20–25) and willingness to have unprotected sex in the future. Most young people (69%) had recently engaged in unprotected sex and 41% were willing to in the future. The most common reported reasons for having unprotected sex included not planning to have sex, a preference for unprotected sex, and difficulty using contraception. Worrying about contraceptive side effects and a preference for unprotected sex were significantly associated with a willingness to have unprotected sex in the future (p <.01). Age group was not associated with most reasons for having unprotected sex. Person-centered care should give attention to the range of reasons that may influence young people's sexual and contraceptive decision-making. [ABSTRACT FROM AUTHOR]

Emergency contraceptive pills (ECPs) are an underused resource among adolescent and young adult women who have unprotected sex. This analysis examines young women's attitudes about and willingness to use ECPs, with particular attention to their experiences with health care providers. Sexually active young women (ages 15–25, assigned female at birth, N = 212) completed a self-administered survey at 10 family planning clinics in the San Francisco Bay Area. Participants reported attitudes about ECP effectiveness, safety, effect on sex drive, and whether it should not be taken often, and their willingness to use ECPs in the next 3 months. The predictors of interest were past and current contraceptive experiences with health care providers. Data were analyzed through descriptive statistics and multivariable logistic regression analyses controlling for sociodemographic characteristics, prior contraceptive use, pregnancy history, and pregnancy intentions. Most young women agreed that ECPs are effective at preventing pregnancy (75%) and safe to use (71%); few reported that they reduce sex drive (11%). Yet, the majority (62%) believed ECPs should not be taken often and only 35% reported willingness to use ECPs. In multivariable analyses, more positive health care experiences were associated with more positive attitudes about ECP safety, less concern that ECPs should not be taken often, and greater willingness to use ECPs (p <.05). Health care providers play an important role in the acceptance and provision of ECPs, especially for young women who prefer ECPs over other contraceptive methods. In particular, providers can use the contraceptive visit as an opportunity to destigmatize repeat ECP use. [ABSTRACT FROM AUTHOR]