And still we rise
To identify personal and social factors associated with performing oral sex among female adolescents. More than half reported performing oral sex. Controlling for age, performing oral sex was associated with relatively higher sexual sensation seeking, any UVS in past 60 days, relatively lower self-efficacy to refuse sex, and having peer norms supportive of risky sexual behaviors.
Given the potential for epidemic spread of orally acquired STIs to populations of female adolescents residing in communities with high rates of STI prevalence, this initial research provides guidance for intervention development and expanded research efforts.
A mong sexually active adolescentsoral sex has emerged as normative. Indeed, recent research has shown that oral sex may be more prevalent than vaginal intercourse. Little is known about the factors that influence adolescents' decision to engage in oral sex. Also, peer influence, that is, having the perception that their best friend engaged in oral sex, was ificantly associated with their own oral sex behavior.
Given the risk of STI acquisition, specifically for female adolescents when performing oral sex, more in-depth research is warranted to understand the influences of engaging in oral sex so that STI preventive interventions can be deed. Emerging evidence suggests that certain environmental factors may have an effect on adolescents' sexual behaviors.
The purpose of this study was to identify the personal and social i. Participants were African American female adolescents enrolled in a randomized trial of an HIV prevention program.
Differences in oral sexual behaviors by gender, age, and race explain observed differences in prevalence of oral human papillomavirus infection
Data collected at baseline were used for this study. Recruitment sites were an urban, publicly funded STI clinic, a teen clinic based in a large public hospital, and a family planning clinic all clinics were located in the same urban area of a major city located in the Southeastern United States.
The urban area selected for the study is one that experiences high prevalence rates of sexually transmitted diseases STDsthereby creating high-risk conditions for the transmission of STIs. From March through Augustproject recruiters screened female teens to assess eligibility. Adolescents were eligible to participate if they were African American females, 15—21 years old, who reported vaginal sexual activity in the 60 days. Exclusion criteria were being married or pregnant or attempting to become pregnant. Of screened, adolescents were eligible and were asked to participate in the study.
The Institutional Review Board at Emory University approved the study protocol before implementation. As part of the intervention trial, adolescents were asked to provide a self-collected vaginal swab, which was assayed using nucleic acid amplification technology to detect three prevalent sexually transmitted pathogens: Trichomonas vaginalisC.
Selection of scales was guided by the underlying theoretical model and by our prior research using valid measures that have shown satisfactory reliability in assessing relevant behaviors and constructs among African American female adolescents.
Sexual sensation seeking has been associated with engaging in sexual risk behaviors among various populations and was included as a personal characteristic in the present study.
Working at the intersection: what black women are up against
Each item required a response based on a 4-point Likert-type scale: 1 strongly disagree to 4 strongly agree. In a study with African American female adolescents, the SSSA demonstrated strong internal consistency and showed moderate stability and satisfactory construct validity. Low self-esteem was cited as a reason that adolescents perceived that other adolescents engaged in oral sex and was assessed as a personal characteristic that may influence female adolescents to perform oral sex in the present study.
The RSES has been used widely with diverse populations, including African American female adolescents, 32 and has demonstrated validity and reliability. In addition, we assessed a behavioral variable, that is, if adolescents engaged in unprotected vaginal sex UVS during the past 60 days.
Adolescents were asked how many times in the past 60 days they had penile-vaginal intercourse. Then, they were asked: Of those s of times you had sex, how many times did you use a male condom?
Systemic racism at work
Five distinct relational factors were assessed as social or environmental influences of female adolescents performing oral sex. A 6-item scale that was created for young African American women was used to assess adolescents' self-efficacy to communicate with their male sex partners about sex-related issues. With a sex partner, how hard is it for you to ask if he would use a condom?
Each item required a response based on a 4-point Likert-type scale: 1 very hard to 4 very easy. Adolescents' perceived power in their relationships with male sex partners was also assessed with the Sexual Relationship Power Scale.
The scale has been validated in a study specifically deed to establish its psychometric properties with young women. Sample items included: Most of the time we do what my partner wants to do. My partner won't let me wear certain clothes. This scale is intended to describe the frequency with which one feels fear or worry associated with negotiating the use of condoms with sex partners. This scale comprised 7 items and was validated with a sample of African American adolescents in a study.
Adolescents' self-efficacy to refuse sex was assessed using a 7-item subscale developed by Cecil and Pinkerton that assessed perceptions of individuals' ability to refuse sexual intercourse. How sure are you that you would be able to say NO to having sex with someone who you want to fall in love with you? How sure are you that you would be able to say NO to having sex with someone who is pressuring you to have sex?
Each item required a response based on a 4-point Likert-type scale: 1 I definitely can't say no to 4 I definitely can say no.
Finally, we also assessed whether adolescents believed their partner might have had vaginal sex with another girl concurrently. We asked them specifically: During your relationship with your boyfriend, has he had vaginal sex with another girl? The response was either yes or no. We anticipated that those having this perception might be more likely to perform oral sex, rather than engage in penile-vaginal sex, as an STI risk-reduction strategy. Normative beliefs or peer norms surrounding sexual risk behaviors were assessed with a scale developed by DiClemente and Wingood for the current study.
All continuous scale variables were assessed for normality. We conducted a visual inspection of data plots and examined estimates of skew and kurtosis. We also conducted Kolmogorov-Smirnov tests, which provide inferential statistics on normality.
None of the six assessed scales met tests of normality; all were ificantly skewed. Several transformations square root, log were performed; however, despite these efforts, transformations were not effective in correcting skewness to acceptable levels for any of the scale measures i. Because nonnormally distributed variables can distort relationships and ificance tests, we opted to dichotomize these variables by performing a median split.
According to MacCallum et al. The first block included only adolescents' age a control variable. Average age of the adolescents was The majority Nearly one third The median level of education fell between grades 10 and Overall, adolescents More than half Of those who had performed oral sex, Table 1 displays bivariate findings pertaining to performing oral sex. Table 1 also displays all relevant descriptive information.
Adolescents were more likely to perform oral sex if they reported 1 higher sexual sensation seeking, 2 lower self-esteem, 3 engaging in unprotected vaginal sex in the past 60 days, 4 lower sexual communication self-efficacy, 5 greater fears related to consequences of negotiating condoms, 6 lower self-efficacy to refuse sex, and 7 perceived peer norms supportive of unsafe sex behaviors.
Adolescents with lower self-efficacy scores to refuse sex were 1. Adolescents whose perceived peer norms were supportive of risky sexual behaviors were 1. The present study examined the prevalence of performing oral sex and the personal and social influences among a population at heightened risk for STIs, including HIV. The lifetime prevalence of performing oral sex observed in the present study is slightly higher than in most studies of adolescents.
This lifetime prevalence rate indicates that although these female adolescents are engaging in vaginal sex, they still engage in oral sex and are at risk of acquiring an oral STI. We acknowledge that in the present study, we assessed performing oral sex vs. However, research with adolescents suggests that few use condoms during oral sex. In age-adjusted, multivariate analyses, several factors were ificantly related to performing oral sex: greater sexual sensation seeking, having unprotected vaginal sex in the past 60 days, lower self-efficacy to refuse sex, and having the perception that peers endorse unsafe sexual behaviors.
The finding pertaining to the personality trait of sexual sensation seeking is particularly intriguing because it transcends traditional demographic and behavioral factors used to predict adolescents' sexual risk-taking practices. research with other populations e. An interesting point, however, is that we also found that female adolescents who engaged in oral sex were also more likely to engage in another sexual risk behavior, that is, unprotected vaginal sex. research has suggested that adolescents who engage in oral sex may be trying to avoid the risk of acquiring an STI or of getting pregnant.
Thus, although many adolescents perceive oral sex as a protective or safe behavior, this multivariate finding supports the possibility that they are not using this behavior to replace an ostensibly more risky behavior unprotected vaginal sex. This finding suggests that perhaps there is a subset of adolescents who engage in myriad sexual risk behaviors. Only one of the five assessed relational factors was retained in the final model. Adolescents who had lower self-efficacy to refuse sex were more likely to perform oral sex. It may be that for these female adolescents, because they lacked confidence to refuse sex, performing oral sex may be viewed as a strategy to avoid having vaginal sex.
This possibility, of course, lies in contrast to the speculation that oral sex is not a compensatory behavior for penile-vaginal sex. Indeed, neither possibility can be ruled out until more in-depth research is conducted. In addition to holding the perception that oral sex is less risky, many adolescents and some adults for that matter, tend to equate sex with penile vaginal intercourse.
research has supported this normative belief where adolescents viewed oral sex as Giving oral to black woman today acceptable and less of a threat to their values and beliefs than vaginal sex. Thus, lower self-efficacy to refuse sex may be a function of a generalized lack of confidence to refuse all forms of sex whether it is oral, vaginal, or anal sex.
More research is needed to explore these relations among this population to determine if giving oral sex is truly a risk-avoidance strategy, a compromise for vaginal or anal sex, or a behavior engaged in because they lack the confidence to say no to their sex partners for all types of sex.