What Teens Hear and How They React: Adolescent Perspectives on Substance Use, Sexual Risk, and Sexual Violence Prevention in Primary Care

Abstract

Primary care clinics represent a promising, yet underutilized, setting for delivering health-focused prevention programming targeting adolescent substance use, sexual assault, and sexual risk behaviors; however, little is known about adolescents’ prior exposure to such messaging. Therefore, the present study examined adolescents’ prior prevention exposure, their perceptions of prevention content, and recommendations for future programs. Semi-structured qualitative interviews were conducted with 25 adolescents (ages 14–18; 56% female, 36% male, 8% gender fluid or Two-Spirit) recruited from primary care and community settings in the southeastern United States. Thematic analysis was used to examine youth exposure to and perspectives on prevention programming. Three core themes emerged: (1) prior exposure to prevention content across topics; (2) appraisal of strengths and limitations within previous programming; and (3) recommendations for what adolescents believe their same-aged peers should know. Participants reported a preference for technology-based programs, criticized interventions exclusively promoting abstinence and negative consequences, and emphasized needing additional information on sexual consent. Adolescents in primary care settings report inconsistent exposure to prior prevention, most centering abstinence and negative consequences, rather than inclusive harm-reduction approaches. Findings highlight a structural gap in exposure to comprehensive adolescent prevention programming and position pediatric primary care as a uniquely flexible and developmentally congruent setting for delivering integrated, harm-reduction-oriented prevention interventions. These findings also further support the development of scalable, technology-driven prevention tools that can be implemented within pediatric primary care settings to improve accessibility reach, engagement, and relevance.