Exploring Secondary Abstinence among African-American Females at Risk for HIV/STIs: A Mixed-Methods Investigation Open Access

Abstract

African-American adolescent females are contracting HIV/STIs at alarming rates, making reducing infections in this population a public health priority. Some sexually experienced adolescents choose to refrain from sex following sexual debut, a practice known as secondary abstinence. However, little is known about this practice. The purpose of this mixed-methods study was to begin addressing research gaps by exploring motivations for secondary abstinence and identifying barriers that hinder motivated adolescent females from becoming or remaining abstinent. The first component of this research included a qualitative investigation of motivations for secondary abstinence as well as individual and contextual barriers that impede the practice of secondary abstinence. Respondents were 20 adolescent females, ages 18 - 23, who had recently participated in a randomized controlled trial (RCT) of an HIV prevention intervention and expressed interest in secondary abstinence. Several motivations, including HIV/STI and pregnancy prevention, desiring to delay sex until married or in a committed relationship, and personal goal attainment were similar to those identified in previous research. Reasons not previously identified included feeling used for sex and partner infidelity. Respondents also provided insight about barriers to secondary abstinence within young women and in their physical and/or social environment. Individual-level barriers, such as thinking about sex often, made becoming or remaining abstinent difficult. Interpersonal-level barriers such as imbalances in sexual decision-making power, and environmental barriers, such as being alone with a partner presented the greatest challenges for young women. The second component consisted of a quantitative analysis examining the utility of barriers identified in the qualitative phase for explaining dissonance between interest in secondary abstinence and continued sex. Secondary analysis were conducted using baseline data from 701 African-American females, ages 14 - 20, participating in the aforementioned RCT. Results showed thinking about sex often, receiving more pleasure from sex, being older, and having lower abstinence self-efficacy were associated with continued sex. Believing one's partner was not interested in abstinence and having less relationship power also decreased the likelihood of practicing secondary abstinence. Findings from this mixed-methods study can be used to refine measurement and inform intervention development to strengthen the abstinence component of HIV/STI prevention interventions.

Table of Contents

CHAPTER 1: Introductory Literature Review

1

Sexual Risk Reduction Approaches

2

Evaluating Evidence for Behavior Change

9

Secondary Abstinence Research

15 Motivations for secondary abstinence 16 Barriers to practicing secondary abstinence 19

Significance of the Proposed Research

23 References 26

CHAPTER 2: Measuring African-American Females' Motivations for Secondary Abstinence

39 Abstract 39 Introduction 40 Methods 43 Results 46 Discussion 56 References 64

CHAPTER 3: Understanding the Dissonance between African-American Females' Interest in Practicing Secondary Abstinence and Continued

Sexual Activity

67 Abstract 67 Introduction 68 Methods 72 Results 74 Discussion 90 References 95

CHAPTER 4: Closing the Gap: Exploring Barriers that Impede Secondary Abstinence among Sexually Experienced African-American Females

98 Abstract 98 Introduction 99 Methods 101 Results 108 Discussion 110 References 116

CHAPTER 5: Summary and Conclusions

124 References 132

LIST OF FIGURES

Figure 1: Model of barriers that impede the practice of secondary abstinence

76 LIST OF TABLES

Table 1: Bivariate relationships between secondary abstinence and individual- and interpersonal-level factors

122

Table 2: Odds ratios for barriers to practicing secondary abstinence

123

About this Dissertation

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School	Laney Graduate School
Department	Behavioral Sciences and Health Education
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Public Health Education, Health
Keyword	Mixed-Methods African-American females HIV prevention Secondary Abstinence Sexual health Adolescent
Committee Chair / Thesis Advisor	Diclemente, Ralph Joseph, Emory University
Committee Members	Elifson, Kirk, Emory University Sales, Jessica, Emory University

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