Background Native American youth experience the highest rates of teen pregnancy and sexually transmitted infections (STIs). Past research has demonstrated the influence of parents and peers on adolescent sexual health decision making. Yet few studies have explored how the threat of negative health outcomes, specifically STIs and unintended pregnancy, impact youth’s intentions, perceptions of reactions from peers and parents, and ultimate behaviors.

Methods This study used a mixed-methods approach. Quantitative and qualitative data was collected from Native, reservation-based youth ages 11–19. N=558 completed a survey and 62 participated in a focus group discussion (FGD). Multivariate logistic regression assessed associations between the perceived severity of STI and unintended pregnancy with the outcomes of lifetime sexual experience, sexual intention, condom use, and condom use intention (CUI). Qualitative data was analyzed using a descriptive, directed method.

Results Mean age was 13.4 and 51.6% were female. Youth who reported they would be upset (OR=2.43, p=0.001) or their parents would be upset (OR=2.95, p≤0.001) if they got pregnant/got someone pregnant had higher odds of CUI. FGD data differ slightly, with some youth (mostly females) saying they didn’t use condoms because they want to become pregnant. Youth saying friends would lose respect for them if they had an STI had higher odds of CUI (OR=2.37, p=0.001). FGD data endorse peers as major influencers on sexual activity, especially among males.

Conclusion Results show the perceived severity of STIs and unintended pregnancy combined with anticipated negative reactions from parents and peers are associated with Native youth’s intention to use condoms, but not actual condom use behavior or sexual initiation. To bridge this intention-behavior gap, future programming should engage both parents and peers, reinforce the severity of not using condoms, and develop Native youth’s skills for actual condom use.

Disclosure No significant relationships.