Adolescent and provider perspectives on fatalism and adolescent sexual risk behavior: Results from a national qualitative study and implications for theory and practice

Researchers have devoted considerable attention to identifying demographic, behavioral, and psychological covariates of adolescent sexual risk behavior (SRB) in the United States. The attention is warranted, as the U.S. continues to have higher rates of adolescent pregnancy and sexually transmitted infections (STIs) than other industrialized nations. To-date, however, few qualitative studies have examined the underlying mechanisms that influence adolescent sexual behavior in the U.S.. Furthermore, few attempts have been made to link psychological approaches that examine individual-level risk correlates with approaches that focus on the social determinants of health. The present study addresses these gaps in research through a qualitative examination of adolescent and provider perspectives on factors associated with adolescent SRB, specifically on the association between fatalistic attitudes and sexual risk amongst adolescents. Qualitative interview data was collected between 2011-2013 with 58 adolescents and 52 providers, as part of larger research and evaluation projects funded through the Centers for Disease Control and Prevention, the Office of Adolescent Health, and the Health Resources and Services Administration, HIV/AIDS Bureau. A grounded theory analysis of interview data elucidates the connections between poverty and a lack of resources/opportunities, fatalistic attitudes, and adolescent SRB. The study concludes by calling for the need to develop integrative theoretical models that link social determinants of health to individual-level health behaviors and outcomes, as well as the need for health systems and community-level interventions that address fatalistic attitudes in adolescents and young adults.