Understanding the Intersection of Adolescent Girls' Motives for Sex and Risk Profiles

Thursday, 27 July 2017: 3:50 PM

Dianne Morrison-Beedy, PhD, MSN, BSN, RN, WHNP-BC, FNAP, FAANP, FAAN1
Linsey Grove, MPH2
Ming Ji, PhD3
Elizabeth Baker, PhD, MPH3
(1)College of Nursing, The Ohio State University, Columbus, OH, USA
(2)College of Public Health, University of South Florida, Tampa, FL, USA
(3)College of Nursing, University of South Florida, Tampa, FL, USA

Purpose: Sexual risk behaviors resulting in HIV, STIs and unplanned pregnancy continue to pose a significant health risk to adolescent girls globally. Tested in a randomized controlled trial, the Health Improvement Project Teens (HIPTeens) is recognized by the Department of Health and Human Services (DHHS) and the Centers for Disease Control (CDC) as an HIV/STI and teen pregnancy prevention evidence-based intervention (EBI) (Morrison-Beedy, Jones, et al., 2013). Understanding what motivates girls to participate in safe and risky sex is important to developing and tailoring behavioral interventions to increase their utility across the globe. The purpose of this study was to examine the baseline sex motives of HIPTeenparticipants and the intersection of these motives with demographic, sexual and mental health risk profiles. These findings can be used to identify vulnerable subgroups for future health promotion interventions.

Background/Literature: In 2015, The CDC estimate that approximately 25% of adolescents have acquired an STI (Prevention, 2015). Although U.S. teen pregnancy rates have fallen in the past decade, disparities in STIs and unintended pregnancies continue among minority groups and those with a history of risk behaviors (CDC, 2015). Young women of color accounted for the highest number of estimated new HIV diagnoses compared to all other racial groups (CDC, 2016). Reproductive history and demographic variables have been linked with sexual risk behaviors as well; for example, younger sexually active females experience higher rates of unprotected sex and multiple sexual partners (Vasilenko, Kugler, & Rice, 2016) and face sexual coercion from older partners (Morrison-Beedy, Xia, & Passmore, 2013; Volpe, Hardie, Cerulli, Sommers, & Morrison-Beedy, 2013). A history of pregnancy, especially repeat pregnancy, is associated with negative long-term health implications (Meade & Ickovics, 2005) as well as having other negative impacts as teen moms are less likely to graduate high school and find stable employment (Hoffman & Maynard, 2008; Seth, Wingood, DiClemente, & Robinson, 2011; Shrier, Walls, Lops, Kendall, & Blood, 2012).

For most teens, adolescence is a time of great biological and psychosocial change. Unfortunately for some, this can mean facing mental health and substance abuse challenges. A recent study found that over the course of a year 12-17 year old girls experienced nearly three times more major depressive events than their male peers (Substance Abuse and Mental Health Services Administration, 2012). Adolescent girls were more likely to feel sad or hopeless almost every day for two weeks or more, drink at least one alcoholic beverage, and smoke marijuana in the past month (Kann et al., 2015). Struggling with mental health and substance abuse issues can increase sexual risk as well as compound it (Mazzaferro et al., 2006; Jackson, Seth, DiClemente, & Lin, 2015). Substance use and depression have been linked with sexual risk behaviors including decreased condom use and substance use co-occurrence with sexual activities (Shrier et al., 2012). Studies have shown that varying motives for having sex influence risk behavior among adolescents. The relationship between motives for sex and condom use was examined in a study by 277 females; intimacy motives were associated with a reduction in condom use (Gebhardt, Kuyper, & Greunsven, 2003). Conversely, participants with low scores on the motive “to express love” (intimacy) with steady partners were more likely to have protected sex (Gebhardt et al., 2003;Gebhardt, Kuyper, & Dusseldorp, 2006). In another study, inexperienced and sexually active adolescent girls motivations to have sex were driven differently by personal values and religious influence (Paradise, Cote, Minsky, Lourenco, & Howland, 2001). Cooper, Shapiro and Powers, investigated motivations for sex categorized into four areas: self-focused or socially-focused interactions with positive or negative reinforcement (1998) identifying differences among subsets of respondents across genders. Still, limited information exists on the motivations of why vulnerable or disenfranchised adolescent girls have sex. Understanding their motives to participate in sexual risk behaviors taking into account their risk profiles can help us tailor interventions to at-risk subgroups.

Methods: Sexually-active girls, ages 15-19 (n=738) were recruited from urban community-based settings and provided a gender-specific intervention in small group sessions. This intervention was theoretically-driven from the Information-Motivation-Behavioral Skills model which highlights these three constructs in successful behavioral approaches (Fisher & Fisher, 1992). Data were collected via audio computer-assisted self-interview surveys (ACASI) including a 17-item sex motives 5-point scale encompassing six domains: intimacy, enhancement, self-affirmation, coping, peer pressure, and partner approval (Morrison-Beedy, Carey, & Tu, 2006). Descriptive and inferential statistics and cluster analyses were used to describe the baseline distribution of sex motives in various subgroups defined by demographics and other risk factors and t-tests to determine differences between these subgroups.

Results:  Participants were predominantly African American, impoverished, and exhibited multiple sexual risk factors. The principal sex motives identified were enhanced (M=4.95, SD=3.09) and intimacy (M=7.69, SD=3.38) while partner approval, peer pressure, and self-affirmation were reported infrequently. Statistically significant motive differences across domains were identified among mental health risk profiles (depression, marijuana use, binge drinking) at baseline. Girls who reported high depressive symptoms had significantly higher peer pressure (M=0.30, SD=0.95), partner approval (M=2.06, SD=3.40), coping (M=2.15, SD=2.72), and self-affirmation (M=2.00, SD=3.07) motives mean scores. Coping (M=1.38, SD=2.18), self-affirmation (M=1.17, SD=2.28), and enhanced (M=5.43, SD=3.10) motives mean scores were significantly higher among participants that had ever used drugs. Sex motives also differed significantly among demographic and reproductive health characteristics including race, age, and parental status. No history of pregnancy (M=0.19, SD=0.68) or children (M=0.17, SD=0.65) were associated with significantly higher peer pressure motives mean scores. Significantly higher mean intimacy motive scores (protective factor) were found among girls who were older (M=8.01, SD=3.19), black (M=7.85, SD=3.36), had never been treated for an STI (M=8.00, SD=3.23), and were not depressed (M=7.87, SD=3.30).

Conclusion: Understanding sex motives in girls and their relationship to modifiable and unmodifiable factors can improve tailoring of evidence-based risk reduction interventions to target specific subgroups. Opportunities to address modifiable variables during pre-intervention may augment intervention efficacy. HIPTeensis a scientifically tested intervention translated to inform evidence-based practice (EBP) in at-risk communities and settings. Understanding the motivational context of decision-making in adolescent girls regarding sexual choices and the intersection with their risk profiles is an important next step in translational science.

Relevance to Conference Themes & Objectives: Furthering research on sex motives in adolescent girls and their interaction with different profiles of risk is a critical step in promoting the transformation of sexual risk knowledge and evidence-based practice to advance global health and nursing. Utilizing interprofessional environments and partnerships like Sigma Theta Tau International to disseminate evidence-based interventions can fuel meaningful discussion on implementation strategies, provide opportunities for interdisciplinary learning, and promote the exchange of ideas on how to integrate technology which accelerates the translation of research into evidence-based practice.