Multilevel Barriers to Sexual Health Behavior Among Vulnerable Adolescent Girls in the USA

Introduction Most sexual health interventions focus on individual-level predictors of sexual behavior. Given the considerable influence of environmental factors on adolescent girls' sexual health, current interventions may be insufficient to promote safer sex. In this study, we aimed to understand adolescent girls' anticipated barriers to engaging in safer sex behavior after completing a brief, web-based sexual health intervention called HEART. Methods This study used qualitative interviews with 50 adolescent girls who were recruited from community-based organizations that serve vulnerable youth. All participants were 12 to 19 years old (mean age = 15.62, SD = 1.83), and identified with a marginalized racial/ethnic group (58% Black; 18% Latinx; 24% Asian, biracial, or multiracial). Further, 24% identified as LGBTQ + , and 58% were sexually active. Results Guided by the social ecological model, we delineate six unique barriers to safer sex discussed by adolescents: partner manipulation, slut shaming, unclear sexual values, present time orientation, embarrassment, and access to sexual and reproductive health services. Discussion We conclude with recommendations for addressing these barriers to optimize adolescent girls' sexual health.