Issues related to the sexual decision-making of inner-city adolescent girls

Adolescence, Fall, 1996 by Susan L. Rosenthal, Lisa M. Lewis, Sheila S. Cohen

Psychosexual development for adolescent girls includes decisions regarding sexual activity, the partner relationship, and the use of condoms for the sexually active. In order to intervene successfully in any aspect of an adolescent's sexual behavior, one must understand the context in which adolescent girls make sexual decisions. For example, girls may not be encouraged to think about their own sexual desires (Fine, 1988), and finding sex personally pleasurable may not be a reason they engage in intercourse (Beck, Bozman, & Qualtrough, 1991; Stanton, Black, Kalijee, & Ricardo, 1993). However, engaging in intercourse because it pleases their partner (Beck et al., 1991) or is considered an important part of a relationship may be important reasons why they do choose to engage in intercourse (Stanton et al., 1993). The amount of power the woman feels she has in a relationship has been linked to her ability to make sexual decisions. However, researchers have difficulty defining women's perceptions of power. For example, in regard to minority adult woman, it has been suggested that they feel independent in their sexual decision-making, and that African-American women make decisions about condom use based on their own needs (Kline, Kline, & Oken, 1992). However, others have suggested that as African-American men have lost economic status, they have gained power in relationships with women (Fullilove, Fullilove, Haynes, & Gross, 1990). Other groups of women have described the negative impact that their pervasive experiences of victimization, both psychological and physical, have had on their sexuality (Daniluk, 1993). For adolescent girls, partner insistence on condom use was the one reason for using or not using condoms that was related to actual rates of sexually transmitted diseases (STDs) (Rosenthal, Biro, & Stanberry, 1994). A further complicating issue is the role that fear about sexual coercion plays in a female's willingness to ask her partner to use a condom (Fullilove et al., 1990; Rosenthal & Cohen, 1994).

Since the developmental process during adolescence and the process of sexual decision-making are linked (Biro & Rosenthal, 1992), one cannot assume that findings from studies of adult women will generalize to adolescents. Thus, focus groups were organized to better understand the contextual and multiple variables which contribute to the sexual decision-making of high-risk inner-city adolescent girls. Focus groups have been used previously to discuss sexuality and contraceptive use (Folch-Lyon, de la Macorra, & Shearer, 1981; Kisker, 1985; Fullilove et al., 1990; Kline, Kline, & Oken, 1992; Suyono, Piet, Stirling, & Ross, 1981). This qualitative approach allows for interaction between participants and provides an opportunity for issues to be raised that may be novel to the investigators; however, the data need to be interpreted cautiously, as the method and number of subjects do not guarantee reliability (Fullilove et al., 1990).

METHOD

Eleven adolescent girls (15 to 16 years of age) were recruited from their source of primary care to participate in two different focus groups on sexual decision-making. They were paid $10 for their participation. The study was approved by the hospital's Institutional Review Board. The 90-minute groups were run by an African-American psychology graduate student and a Caucasian pediatric psychologist and were held at the primary care clinic. At the beginning of each session, the importance of respecting the confidentiality of the information shared by group members was discussed. The sessions were videotaped and than transcribed. The transcripts were reviewed by the first two authors for recurrent themes discussed by the girls in regard to sexual decision-making. The themes identified were: factors involved in sexual decision-making, views of relationships, and images of men. Verbatim samples were then selected to exemplify each category. All authors independently coded the transcripts for the three categories. When there were disagreements about the codes, consensus was reached by all three raters.

Subjects

The two groups were made up of seven girls in one group and four in the other. Eight of the girls were African-American and three were Caucasian. All but one of the girls had experienced consensual intercourse; the mean age of sexual debut was 13.7 years. The one girl who had not engaged in sexual intercourse consensually had been abused by at least two adult men. Ten of these girls had a history of at least one STD or pregnancy documented in their medical charts. The mean age of sexual debut and sexual histories of these girls were typical of the girls who receive medical care at this site.

Factors Involved in Sexual Decision-Making

An important factor in making any decision is the degree to which the person feels in control (Bandura, 1989), and the girls did discuss concern about the risk of being out of control of sexual situations either because of their own or the boy's behavior. For example, one girl stated, "I heard a guy say he raped somebody because they made him hot and she said, 'No,' and he took it anyway." While this type of behavior was not considered acceptable, it was perceived as a significant risk. Other research has suggested that forced sex is sometimes viewed as justifiable (Muehlenhard, 1988; Shotland & Goodstein, 1983). Another reason situations got out of control was related to the use of drugs or alcohol. For example, one girl said, "And you know, weed and alcohol don't mix. So I was messed up . . . and he was like, 'Come on down to the car with me' . . . and I just said, 'Fuck it,' and I just went down there."