Religiosity and risky sexual behavior in African-American adolescent females

Article Outline

• Abstract
• Methods
  • Participants
  • Procedures
  • Measures
    • Predictor variable
      • Religiosity
    • Moderator variables
      • Sociodemographic characteristics
      • Familial factors
    • Outcome variables (behaviors)
      • Age willingly first had sex
      • Frequency of sexual communication
      • Condom use
    • Self-efficacy beliefs
      • Sexual communication self-efficacy
      • Refusal self-efficacy
    • Attitudes
      • Attitudes about condoms
  • Data analysis
• Results
  • Univariate analyses
  • Bivariate analyses
  • Multivariable analyses
• Discussion
  • Limitations
• Acknowledgements
• References
• Copyright

Abstract 

Purpose

The full text of this article is available via JAH Online at www.elsevier.com/locate/jahonline To examine the association between religiosity (defined by frequency of engaging in religious/spiritual activities) and African-American adolescent females’ sexual behaviors, attitudes toward sex, and ability to negotiate safer sex.

Methods

Between December 1996 and April 1999, 1130 female adolescents were screened for eligibility in a sexually transmitted disease (STD)/human immunodeficiency virus (HIV) prevention trial. Data collection was achieved through a confidential self-administered questionnaire that examined religiosity and a structured interview regarding sexual behavior. Descriptive statistics were used to characterize the sociodemographics of the sample and logistic regression was used to measure the association between religiosity and the outcome variables.

Results

In the study sample (n = 522), 64% of the adolescents had higher religiosity scores based on a 4-item scale (α = .68). Results indicate that adolescents who had higher religiosity scores were significantly more likely to have higher self-efficacy in communicating with new, as well as steady male partners about sex; about STDs, HIV, and pregnancy prevention; and in refusing an unsafe sexual encounter. These adolescents were also more likely to have initiated sex at a later age, used a condom in the past 6 months, and possess more positive attitudes toward condom use.

Conclusions

Results from this study indicate a relationship between religiosity and sexual behaviors, attitudes toward sex, and ability to negotiate safer sex.

Keywords:  Adolescents, African-American, Female, Protective factors, Religiosity, Sexual behavior

In the United States, adolescents, especially ethnic minority females, are a population at increasing risk of HIV infection 1, 2, 3, 4, 5. Consequently, identifying factors associated with African-American female adolescents’ sexual risk behaviors is critical to the development of effective sexually transmitted disease (STD)/human immunodeficiency virus (HIV)-prevention strategies [6]. A number of psychosocial risk factors have been identified among this population [7]; however, few studies have examined the influence of protective factors in adolescents’ sexual health.

One of the most pervasive influences among African-Americans is religion. African-Americans are one of the most religious population subgroups in the industrialized world 8, 9. It has been suggested that this high level of religious involvement is beneficial in that it may modify the negative consequences of stress and promote psychological well-being 10, 11, 12. Studies have shown that adults’ participation in religious services by African-American congregants provides therapeutic benefits equal to those of formal psychotherapy 11, 12 .

African-American youth are significantly more involved in, and influenced by, religion than their Caucasian and Latino counterparts [13]. Further, Southern youth attend church more often, are more likely to report that religion is an important factor, and least likely to report not belonging to a religious group than youth residing in other geographical regions [13].

Having strong religious beliefs has been shown to be a protective factor against many risk behaviors, including tobacco, alcohol, drug use, violence, and initiation of sex 11, 14, 15. A small body of research has shown that religious service attendance, importance of religion, and denominational affiliation are significantly related to lower levels of sexual involvement [13]. The available research further suggests that highly religious adolescents tend to initiate sex later [15], have fewer sexual partners, and have sex less often than less religious adolescents 16, 17, 18, 19, 20. As a result, highly religious youth are less likely to experience the negative medical and social problems associated with early sexual involvement [13].

Although there is research on religiosity and sexual behavior among adolescents, relatively little is known about the relationship between religion and adolescent health, especially among African-American females residing in the South. The aim of this study was to examine the association between religiosity and STD/HIV-preventive behaviors, attitudes toward sex, and ability to negotiate safer sex, among African-American female adolescents.

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Methods 

Participants 

From December 1996 through April 1999, 1130 female adolescents who attended adolescent medicine clinics, health department clinics, and school health classes were screened for eligibility in an STD/HIV-prevention trial. The recruitment sites were in neighborhoods characterized by high rates of unemployment, substance abuse, and STDs. There were no statistically significant differences in sexual behavior (episodes of sexual intercourse and condom use in the last 6 months) or in prevalence of STDs for school-recruited or clinic-recruited samples.

Eligibility criteria included having willingly had vaginal intercourse with a male partner at least once in the past 6 months and being between the ages of 14 and 18 years. More than half of the adolescents screened (n = 609 [53.9%]) met the eligibility criteria. Of those who were ineligible to participate, the majority (98%) stated that they were not sexually active. Most (n = 522 [85.7%]) of the eligible adolescents elected to enroll in the study. The majority of the eligible teens who did not participate were unavailable owing to conflicts with their employment schedules.

The sample for this study is the 522 adolescents (85.7% of the eligible adolescents).

Procedures 

African-American female recruiters approached and screened potential participants. For the school-based population, recruitment was facilitated through 10-minute presentations delivered to each class by program recruiters. Interested adolescents were requested to complete a contact sheet. Program recruiters screened potential participants on site or by telephone.

After eligible participants were informed of the purpose of the study and procedures for confidentiality, written informed consent was obtained, after which each participant completed a confidential self-administered questionnaire in a group setting. Trained research associates monitored the survey process and provided assistance to those participants with limited literacy. Each participant underwent a structured interview by a trained African-American female interviewer regarding sexual behavior. A $20 reimbursement was provided to all study participants to compensate them for their time. The Institutional Review Board of the participating university approved the study.

Measures 

The predictor variable and several of the outcome variables were assessed with scales. Properties of these scales, including coefficient alpha and range, are included in Table 1. The study used instruments that had acceptable alpha values in prior research [21]. High and low scale scores are based on a median split of the data for each variable measured.

Table 1. Properties of Scales

Religiosity 

The main predictor variable, frequency of engaging in religious/spiritual activities, was assessed using a four-item scale. The scale items were: “How often do you…[1] Attend religious or spiritual services; [2] Pray or meditate; [3] Talk to others about religious or spiritual concerns; [4] Talk with a religious or spiritual leader (minister/priest).” Responses to these items were scored using a Likert scale ranging from (1) “Never” to (4) “Very Often.” Scale scores ranged from a low of 4 to a high of 16. The mean score was 10, SD = 2.74, and median = 10.4. Scores greater than the median indicated greater frequency of engaging in religious/spiritual activities and scores lower than the median indicated lower frequency of engaging in religious/spiritual activities. Given the markedly skewed distribution of scores on the religiosity scale, a median split was used to dichotomize scores into “high” and “low” religiosity scores. The survey also assessed adolescents’ religious affiliation by asking them to report to which church, if any, they belonged.

Sociodemographic characteristics 

The sociodemographic characteristics assessed are included in Table 2. These characteristics included age, school status (full-time or part-time), highest grade completed, religious affiliation, and residence. Residence was measured by asking adolescents with whom they live. Adolescents who reported living with both parents were defined as living in a dual-parent family, and adolescents who reported living with one parent or a grandparent were defined as living in a single-parent family.

Table 2. Sociodemographic and Sexual Behavior Characteristics of the Sample (N = 522)

Familial factors 

Several familial factors were assessed, including the adolescents’ primary caretaker, the degree of parental monitoring, and residence. The adolescent’ s primary caretaker was assessed by asking participants, “Who is the person who knows what you are doing most of the time?”. Responses to this question were “mother, father, grandmother, aunt, sister, brother,” and “other.” Parental monitoring was assessed with two questions about their primary caretaker: “When you are away from home and not at school or work, does this person know where you are?” and “When you are away from home and not at school or work, does this person know who you are with?”. Responses to these questions were “never/almost never, rarely, sometimes, usually,” and “almost always.” For these analyses, the highly skewed responses were dichotomized into “almost always” vs. “else” [22].

Age willingly first had sex 

Adolescents were asked to provide the age at which they first willingly had sexual intercourse with a male partner. Based on the distribution of the data, this variable was dichotomized into two categories, being aged 14 years and older or being less than aged 14 years.

Frequency of sexual communication 

The frequency with which adolescents communicated with their partners about STD/HIV-prevention was assessed with a 5-item scale. Adolescents responded using a 4-point scale ranging from (1) “Never” to (4) “7 or more times.” An example of a scale item is “During the past 6 months, how many times have you and your sex partner discussed how to prevent the AIDS virus?”

Condom use 

Adolescents were asked about their use of condoms during vaginal intercourse with a male partner in the past 6 months. Condom use was defined as using condoms during vaginal intercourse in the past 6 months. Adolescents were categorized into two groups, those who reported condom use in the prior 6 months and those who reported never using condoms in the prior 6 months.

Sexual communication self-efficacy 

Self-efficacy to communicate with a new partner about sex was assessed using a 7-item scale. Adolescents responded using a 4-point Likert scale ranging from (1) “Very hard” to (4) “Very easy.” An example of a scale item is “With a new sex partner (someone you are having sex with for the first time) how hard is it for you to ask if he would use a condom?” This same scale was used to assess sexual communication self-efficacy with a boyfriend/steady partner.

Refusal self-efficacy 

Self-efficacy to refuse an unsafe sexual encounter was assessed using a 4-item scale. Adolescents responded using a 4-point Likert scale ranging from (1) “Strongly disagree” to (4) “Strongly agree.” An example of a scale item is “I feel confident that I could easily persuade a sex partner to use a condom before we started having sex.”

Attitudes about condoms 

A 10-item scale assessed adolescents’ attitudes about condom use in areas of promiscuity, interpersonal affect, and safety. The scale is a modified version of Sacco’s Condom Attitude Scale [23] that was validated for use in adolescent population. Responses ranged from (1) “Strongly disagree” to (5) “Strongly agree.” An example of a scale item is “People who carry condoms would have sex with anyone.”

Data analysis 

The statistical analyses were conducted in several sequential steps. First, descriptive statistics were used to characterize adolescents’ sociodemographic characteristics and religious affiliation and to examine the distributions of the predictor variable, religiosity, and the outcome variables. Neither religiosity nor the outcomes were normally distributed. As these data violate the assumption of normality required for linear regression, multiple regression was used for the analyses. Therefore, the psychosocial scales were dichotomized into high and low scores based on a median split of the data.

Subsequently, in bivariate analyses, contingency table analyses were conducted comparing adolescents reporting greater religious involvement with adolescents reporting less religious involvement with respect to important mediators (i.e., attitudes and self-efficacy beliefs and sexual preventive behaviors) [24]. To assess the significance and magnitude of these bivariate associations, corresponding p values, 95% confidence intervals, and prevalence ratios were computed.

Next, to identify potential confounders, the relationships among religiosity, selected sociodemographic variables, and parental monitoring were examined. Finally, covariates found to be associated with greater religious involvement (p < .10) in the bivariate analyses were included in multivariable logistic regression models to assess the independent contribution of religiosity while adjusting for the effects of the covariates [25]. The adjusted ORs with their corresponding 95% confidence intervals (CI) were calculated to assess the significance and magnitude of the associations among religiosity, theoretically important mediators, and STD/HIV-preventive behavior.

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Results 

Univariate analyses 

This sample reported a high degree of religious involvement; 63.5% of the adolescents reported high religiosity scores (≥ 10). Almost two-thirds of the sample (71.5%) listed Baptist as their religious affiliation. The mean age of the participants was 16 years. Approximately 81% were full-time students, and the largest percentage (28%) reported having completed their freshman year of high school. Only 21.6% stated that they were living in a dual-parent household, whereas 57.5% reported living in a single-parent household headed by a mother.

Bivariate analyses 

Greater religious involvement was associated with less sexual risk-taking, greater self-efficacy, and more positive attitudes toward using condoms (Table 3). Additionally, greater parental monitoring (p < .02), having a mother as a primary caretaker (p < .10) and living in a dual parent family (p < .001) were all associated with having greater religious involvement. Because these variables are also associated with STD/HIV-preventive behaviors, they were considered as covariates in subsequent logistic regression analyses to control for their effects. No other significant associations were observed between religiosity and other sociodemographic variables.

Table 3. Association Between Religiosity and Female Adolescents’ Sexual Behavior, Self-efficacy, and Attitudes Toward Condoms

Multivariable analyses 

The results of the multivariable analyses are also in Table 3. The strongest associations were found between religiosity and the self-efficacy measures. Adolescents with greater religious involvement were 2.3 times more likely to have higher self-efficacy to communicate with a new partner and 1.9 times more likely to have higher self-efficacy to communicate with a steady partner about sex. Further, these adolescents were 2.5 times more likely to have communicated about STD, HIV, and pregnancy prevention with their partners; and 2.1 times more likely to have higher self-efficacy to refuse an unsafe sexual encounter. Additionally, adolescents with greater religious involvement had more positive and supportive attitudes toward condom use than those with lesser religious involvement. Those with higher religiosity scores were 1.5 times more likely to have positive attitudes toward using condoms, and 1.7 times more likely to be supportive of safer sex. Finally, a moderate association was found between religiosity and the sexual behavior measure. Adolescents with higher religiosity scores were 1.5 times more likely to initiate sex at a later age and 1.6 times more likely to have ever used condoms in the past 6 months.

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Discussion 

This study examined the associations between religiosity, defined as religious involvement and practices, and STD/HIV-preventive behaviors among African-American adolescent females. Findings suggest that greater religious involvement is a protective factor. Adolescents who had higher religiosity scores were significantly more likely to have higher self-efficacy in communicating with both new and steady partners about sex; communicating about STDs, HIV, and pregnancy prevention with their partners; and in refusing an unsafe sexual encounter. Additionally, these adolescents were also more likely to initiate sex at a later age, have ever used a condom in the last 6 months, and possess more favorable attitudes toward condom use. These results for southern African-American females corroborate the findings of past research on religion and risky sexual behavior among other adolescent groups 20, 26, 27, 28, 29, 30.

Wynn [30] found more frequent church attendance to be a strong predictor of later onset of coitus among adolescent females. Additionally, Zaleski and Schiaffino [15] also found religious identification to be a protective factor against initiating sexual activity among late adolescents. Further, Poulson et al. [29] found that women with strong religious convictions were less likely to engage in risky sexual behavior than women with weaker religious convictions. Lugoe and Biswalo [27] found religion to be an important buffer in a study that examined the extent to which the HIV/AIDS epidemic had enhanced self-restraining and condom use behavior among secondary school students in Tanzania. Belgrave et al. [26] examined the role of cultural factors in explaining sexual attitudes among urban African-American girls, aged 10–13 years. They found religiosity to be positively associated with less risky sexual attitudes. Additionally, using data from the 1988 National Family Growth Cycle IV, Murray McBride [28] found religiosity to be associated with late coital initiation among middle-income African-American adolescent females. In that study, adolescents who placed less value on their religious beliefs also reported lower self-restraining sexual behavior and less condom use.

These results also extend research in this area by describing a pattern of significant associations between religious involvement and a spectrum of risk and preventive behaviors. Although adolescents’ level of religiosity was examined as the primary predictor of adolescents’ sexual health, study analyses also examined the influence of other variables known to have a protective role in adolescent health. These include adolescents’ sociodemographic characteristics and parental factors [31].

Our data also support the importance of examining theoretically linked distal factors, like religion, in adolescent sexual health. Jessor et al. [32], in a study of protective behavior, found religiosity and church attendance to be protective factors.

Limitations 

This study has several limitations. First, the study used a cross-sectional research design. Therefore, assumptions about the temporal association between religiosity and the study outcomes cannot be determined. Second, because the data were self-reported, they are subject to under- and/or over-reporting, and to social desirability issues. Third, the sample for the study included only sexually active adolescents. No inferences can be made about sexually inexperienced adolescents. Additionally, almost three-fourths (72%) of the sample reported affiliation with a Baptist denomination. Therefore, differences in the outcome variables by religious affiliation cannot be assessed. Finally, the present study has limited generalizability. The study results may be only applicable to African-American female adolescents residing in high-risk social environments and not be applicable to adolescents of other ethnic/racial backgrounds or males.

These findings have important implications for designing faith-based STD/HIV-prevention programs for adolescent females in that they suggest a role for religiosity in STD/HIV prevention. Current literature shows that faith-based HIV-prevention programs may be more acceptable, credible, and potentially more effective ways to reach and educate African-Americans regarding HIV prevention 33, 34, 35.

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Acknowledgements 

This study was supported by grant 1R01 MH54412 from the Center for Mental Health Research on AIDS, National Institute of Mental Health, Rockville, Maryland (Drs. DiClemente, Wingood, and Davies, and Katherine Harrington); and an Association of Teachers of Preventive Medicine/CDC STD Prevention Fellowship (Dr. McCree).

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