Stages of Sexual Readiness and Six-Month Stage Progression among African American Pre-Teens

Butler, Terry H., Miller, Kim S., Holtgrave, David R., Forehand, Rex, Long, Nicholas, The Journal of Sex Research

The negative consequences of unsafe sexual intercourse among adolescents have been well-documented and represent a significant public health problem in the United States (Alan Guttmacher Institute, 2004; Centers for Disease Control and Prevention [CDC], 2000, 2005; Valleroy, MacKellar, Karon, Janssen, & Hayman, 1998; Weinstock, Berman, & Cates, 2004). National data indicate that nearly half of all high school students initiate sexual intercourse prior to graduation, and a significant minority initiate prior to age 13 (CDC, 2006). African American students are more likely to report sexual initiation by age 13 than Hispanics or Whites (16.5%, compared to 7.3% and 4.0%, respectively). Because these are school-based data, they are probably a minimum estimate of the proportion of young people engaging in sex prior to or very early in adolescence.

Early age of sexual debut has been identified as a significant predictor of both initial and subsequent sexual risk behaviors and related health outcomes, including lack of condom use, multiple and high-risk sexual partners later in life, recurrent STDs, and cervical cancer (Brooks-Gunn & Furstenberg, 1989; Coker et al., 1994; Greenberg, Magder, & Aral, 1992; Kotchick, Shaffer, Forehand, & Miller, 2001; National Campaign to Prevent Teen Pregnancy, 2003; Rosenthal, Biro, Succop, Cohen, & Stanberry, 1994; St. Lawrence & Scott, 1996). Behavior at first intercourse has also been shown to be an important determinant of subsequent behavior, as condom use at first intercourse has been associated with a 20-fold increase in lifetime condom use (Miller, Levin, Whittaker, & Xu, 1998).

While the age and circumstances of sexual initiation appear to be important predictors of lifetime sexual health, the pathways by which individuals establish sexual activity are not well understood. In fact, very little is known about the process of sexual initiation among adolescents (Brooks-Gunn & Furstenberg, 1989; di Mauro, 1995; Goodson, Evans, & Edmundson, 1997; Miller & Moore, 1990). There has been limited prospective research on the development of sexual attitudes, intentions, and behaviors among children and adolescents (for exceptions, see Kinsman, Romer, Furstenberg, & Schwarz, 1998; O'Sullivan & Brooks-Gunn, 2005; Rosenthal et al., 2001). The majority of research has focused on correlates of established sexual risk behavior (Brooks-Gunn & Furstenberg; Goodson et al.). Little is known regarding how these factors interact to influence, directly and indirectly, the development of adolescent risk or health behavior (Kotchick et al., 2001). Furthermore, studies have principally focused on the single outcome of "sexually active" verses "sexually inactive" and have largely failed to capture the attitudes and behaviors that precede initiation (Miller et al., 1997).

Recent data suggest that this dichotomy is insufficient for understanding the range of adolescent behavior, and that contrary to earlier beliefs (Brooks-Gunn & Furstenberg, 1989), sexual initiation is a process. Miller et al. (1997) identified five distinct patterns of sexual experience among a sample of nearly 900 African American and Latino 14- to 17-year-olds. Adolescents in this study who would have traditionally been characterized simply as "sexually inactive" actually comprised two different groups in terms of behaviors and expectations: delayers and anticipators. Neither group had engaged in sexual intercourse, but anticipators reported a greater than 50% expectation of doing so within the next year. Anticipators were significantly more likely than delayers to have engaged in pre-coital sexual activities, such as kissing, rubbing, and touching. Because this study was cross-sectional, researchers could not determine if either expectations or behaviors were predictive of subsequent behavior.

A 1998 prospective study conducted among sixth grade students found that adolescents' intention to initiate sexual activity within the next year was the strongest predictor of initiation (Kinsman et al., 1998). Further, in one of the few studies that has examined adolescent decision-making, Rosenthal et al. (2001) found that both the variables influencing sexual initiation and self-reported reasons for initiation vary significantly between females who initiate sex prior to age 15 and those who initiate at age 17 or older. A separate prospective study with 12- to 15-year-old females found that changes in sexual thoughts precede the initiation of a range of new sexual activities, including breast fondling, genital contact, and intercourse (O'Sullivan & Brooks-Gunn, 2005). The most significant changes in sexual cognitions in this study occurred prior to initiation of the pre-coital behaviors examined, rather than coitus. Taken together, these findings suggest that sexual initiation is a process which may vary by age and involves an evolution of attitudes and behaviors.

Research on sexual initiation among adolescents has suffered from two principal methodological limitations. First, the majority of studies have been cross-sectional, precluding conclusions about causal relationships between risk or protective factors and behaviors (Brooks-Gunn & Furstenberg, 1989; Goodson et al., 1997; Kotchick et al., 2001). Second, research has been conducted largely in the absence of a theoretical or conceptual framework (Goodson et al.; Kotchick et al.). Because of the complexity of adolescent sexual behavior and the need to understand the longitudinal process of sexual initiation, the theoretical framework for exploring these behaviors must be both comprehensive and dynamic.

The Transtheoretical Model (TTM), which integrates principles of behavior change from over 300 theories of psychotherapy, may provide a useful framework for examining the adoption of sexual behavior (Prochaska, Redding, & Evers, 2002). The TTM and its precursors propose that behavior change is a process that involves progression through a predictable series of steps. Horn (1976), in one of the earliest models of behavior change, posited that there were four overall processes related to personal choice behaviors: initiation, establishment, maintenance, and cessation. The model proposed several phases of the cessation process, which were further explored and developed by Prochaska, DiClemente, & Norcross (1992) into the construct of "stages of change." The TTM posits that when attempting to modify behavior, individuals progress through five stages of change:

1. precontemplation, the period when the individual has no intent to change;

2. contemplation, the period when the individual is seriously thinking about change, but has not made a commitment to act;

3. preparation, the period when the individual combines intention to change with small behavioral changes;

4. action, the period when people change behavior; and

5. maintenance, the period when people have maintained behavior change for more than 6 months.

When applying the TTM to the modification of risk behaviors, researchers have found that movement through these stages does not always occur in a linear manner, as individuals often recycle through stages before maintenance is reached. The time an individual spends in each stage may also vary. Generally, precontemplation and maintenance have been found to be the most stable stages, with people typically remaining in these stages for much longer periods of time than they spend in the intermediate stages, when behavior change is actively occurring (Prochaska et al., 1992; Prochaska et al., 2002).

Although the TTM has been applied successfully to the modification of a wide range of problem behaviors, including smoking, substance abuse, high-fat diets, unsafe sex, and sedentary lifestyles (Grimley, Riley, Bellis, & Prochaska, 1993; Nigg et al., 1999; Prochaska et al., 1992; Schnell, Galavotti, Fishbein, …

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Publication information: Article title: Stages of Sexual Readiness and Six-Month Stage Progression among African American Pre-Teens. Contributors: Butler, Terry H. - Author, Miller, Kim S. - Author, Holtgrave, David R. - Author, Forehand, Rex - Author, Long, Nicholas - Author. Journal title: The Journal of Sex Research. Volume: 43. Issue: 4 Publication date: November 2006. Page number: 378+. © 2007 Taylor & Francis Group, LLC. COPYRIGHT 2006 Gale Group.

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