title: Risk evaluations and condom use decisions of homeless youth: a multi-level qualitative investigation.
abstract: BACKGROUND
  Homeless youth are at higher risk for sexually transmitted infections and unwanted pregnancy than non-homeless youth. However, little is known about how they evaluate risk within the context of their sexual relationships. It is important to understand homeless youths' condom use decisions in light of their sexual relationships because condom use decisions are influenced by relationship dynamics in addition to individual attitudes and event circumstances. It is also important to understand how relationship level factors, sexual event circumstances, and individual characteristics compare and intersect.
  
  
  METHODS
  To explore these issues, we conducted semi-structured interviews with 37 homeless youth in Los Angeles County in 2011 concerning their recent sexual relationships and analyzed the data using systematic methods of team-based qualitative data analysis.
  
  
  RESULTS
  We identified themes of risk-related evaluations and decisions at the relationship/partner, event, and individual level. We also identified three different risk profiles that emerged from analyzing how different levels of risk intersected across individual respondents. The three profiles included 1) Risk Takers, who consistently engage in risk and have low concern about consequences of risk behavior, 2) Risk Avoiders, who consistently show high concern about protection and consistently avoid risk, and 3) Risk Reactors, those who are inconsistent in their concerns about risk and protection and mainly take risks in reaction to relationship and event circumstances.
  
  
  CONCLUSIONS
  Interventions targeting homeless youth should reflect multiple levels of risk behavior and evaluation in order to address the diversity of risk profiles. Relationship/partner-, event-, and individual-level factors are all important but have different levels of importance for different homeless youth. Interventions should be tailored to address the most important factor contributing to homeless youth reproductive needs.
authors: RAND Health, RAND Corporation, P.O. Box 2138, 1776 Main Street, Santa Monica, CA, 90407, USA. davidk@rand.org.
authors: David P
authors: DP
authors: Kennedy
authors: RAND Health, RAND Corporation, P.O. Box 2138, 1776 Main Street, Santa Monica, CA, 90407, USA. rbrown@rand.org.
authors: Ryan A
authors: RA
authors: Brown
authors: The RAND-University of Pittsburgh Health Institute, Pittsburgh, PA, USA. morrisonpk@upmc.edu.
authors: Penelope
authors: P
authors: Morrison
authors: The Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA. lvie001@ucr.edu.|The Department of Psychology, University of California, Riverside, CA, USA. lvie001@ucr.edu.
authors: Loryana
authors: L
authors: Vie
authors: RAND Health, RAND Corporation, P.O. Box 2138, 1776 Main Street, Santa Monica, CA, 90407, USA. gery@rand.org.
authors: Gery W
authors: GW
authors: Ryan
authors: RAND Health, RAND Corporation, P.O. Box 2138, 1776 Main Street, Santa Monica, CA, 90407, USA. jtucker@rand.org.
authors: Joan S
authors: JS
authors: Tucker
mesh_terms: D000293:Adolescent; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D018453:Homeless Youth / Q000523:psychology*; D006801:Humans; D015141:Los Angeles; D008297:Male; D011247:Pregnancy; D018570:Risk Assessment; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology*; D012747:Sexual Partners / Q000523:psychology*; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D012959:Socioeconomic Factors; D055815:Young Adult
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