Adolescent Sexual Decision-making Research Articles

Adaptation and psychometric assessment of a sexual and reproductive empowerment scale in Arabic among refugee and non-refugee adolescent girls.

Sexual and reproductive empowerment (SRE) is an important determinant of women's and girls' health yet measuring it is complex due to cultural and domain-specific variations. This study describes the process of adapting an SRE scale consisting of four domains (self-efficacy; future orientation; social support; and safety) and testing its psychometric properties among Arabic speaking adolescent girls in Lebanon. An SRE scale developed in a Western context was adapted in four steps: (1) reviewing the scale and selecting culturally appropriate domains for translation to standard Arabic; (2) conducting cognitive interviews with 30 11-17-year-old adolescent girls in Lebanon; (3) administering the scale to 339 refugee adolescent girls who participated in an early marriage intervention; and (4) conducting confirmatory factor analysis (CFA) on the data to assess the scale's psychometric properties. The original model for the 13-item, four-domain adapted scale demonstrated poor fit in CFA. After iteratively removing two items, scale properties were improved, albeit were not optimal. The validity and reliability results for the self-efficacy domain were acceptable. Cognitive interview data revealed that Arab adolescent girls understood self-efficacy in relational terms, recognizing that autonomous decision-making is not necessarily favored but is influenced by parents and family. This study presents an effort to customize an SRE scale for use in studies on the health of adolescent girls in an Arab cultural context. Findings from cognitive interviews highlight the importance of taking into consideration relationality in adolescent sexual and reproductive decision-making. The self-efficacy domain in the adapted scale demonstrates acceptable psychometric properties and is recommended for use in health studies to capture SRE.

Gender and Sexual Health-Related Knowledge Gaps and Educational Needs of Parents of Transgender and Non-Binary Youth

Parents can have a substantial impact on adolescent sexual decision-making, but few studies have explored the role of parents in providing sexual health information to transgender and non-binary (TNB) youth, a population that experiences significant sexual and mental health disparities and lower levels of perceived family support compared with other youth. This study aimed to elucidate existing knowledge gaps and content deemed important for a sexual health curriculum and educational materials for parents of TNB youth. We conducted 21 qualitative interviews with five parents of TNB youth, 11 TNB youth aged 18+, and five healthcare affiliates to identify parents’ educational needs. We analyzed the data using theoretical thematic analysis and consensus coding. Parents self-reported multiple knowledge deficits regarding gender/sexual health for TNB individuals and were primarily concerned with long-term impacts of medical interventions. Youth goals for parents included greater understanding of gender/sexuality and sufficient knowledge to support youth through social transition to their affirmed gender identity. Content areas suggested for a future curriculum for parents of TNB youth included: basics of gender/sexuality, diverse narratives of TNB experiences/identities, gender dysphoria, non-medical gender-affirming interventions, medical gender-affirming interventions, and resources for peer support. Parents desired access to accurate information and wanted to feel equipped to facilitate affirming conversations with their child, something that could combat health disparities among TNB youth. An educational curriculum for parents has the potential to provide a trusted information source, expose parents to positive representations of TNB individuals, and help parents support their TNB child through decisions about potential gender-affirming interventions.

Relations between peer influence, perceived costs versus benefits, and sexual offending among adolescents aware of sex offender registration risk

A policy's general deterrent effect requires would-be offenders to be aware of the policy, yet many adolescents do not know they could be registered as sex offenders, and even adolescents who do know may still commit registerable sexual offenses. We tested whether peer influences shape the perceived costs/benefits of certain sexual offenses and, subsequently, registration policy's general deterrent potential in a sample of policy-aware adolescents. The more adolescents believed their peers approve of sexting of nude images, the more likely they were to have sexted. For forcible touching, having more positive peer expectations about sex and perceiving forcible touching as more prevalent among peers related to adolescents' likelihood of engaging in that behavior. Perceiving registration as a possible consequence was unrelated to sexual offending. Findings highlight the nuanced roles peers play in adolescent sexual decision-making and support emerging evidence that juvenile registration policy has limited general deterrent efficacy.

Parent-child communication and adolescent sexual decision making: An application of family communication patterns theory.

Family communication patterns theory proposes two dimensions of family communication-conversation orientation and conformity orientation-that can impact adolescent decision making. The purpose of this study is to examine how family communication patterns, above and beyond the frequency of parent-child sexual communication, are associated with adolescents' (a) sexual self-efficacy, (b) intentions to communicate about sex with partners, and (c) intentions to use condoms. Participants were 452 U.S. adolescents (Mage = 15.06; 59% girls; 35% White, 33% Latinx, 25% Black). Controlling for the frequency of parent-child sexual communication and gender, we found the interaction between conversation and conformity orientation was associated with adolescent sexual self-efficacy and intentions to communicate about sex with partners. When families were high on conversation and low on conformity, adolescents had statistically significantly higher sexual self-efficacy than any other family communication patterns. When families were low on conversation and low on conformity, adolescents had statistically significantly lower intentions to communicate with future sex partners than any other family communication pattern. Findings highlight the importance of understanding general communication processes beyond the frequency of parent-child sexual communication. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

230. Adolescent Male Perspectives On Sex And Reproductive Health

In recent decades, sexual health education and prevention have focused disproportionately on female adolescents due to both their higher burden from risky sexual behavior and their bundled sexual and reproductive healthcare. Young men have been relatively ignored by these efforts, and their utilization of sexual and reproductive health services in general remains low due to barriers including shame, fear, stigma, denial, lack of social support, and not knowing where to go for care. Further, young men are exposed to pervasive toxic masculinity in American culture that may reward them for making risky sexual choices. The goal of this project is to better understand male adolescent sexual decision making In order to identify areas where we might intervene in the future. Expert Model Development - We used a mental models approach from decision science to create an expert model of male adolescent sexual decision making with the input of ten leading experts in male sexual and reproductive health from multiple disciplines, such as medicine, psychology, sociology, public health, and intervention development, implementation, and evaluation. We organized input conceptually, identified and analyzed key concepts, and determined agreement among experts. We synthesized these results into a conceptual model describing young men’s sexual decision. Interviews - We used this expert model of male sexual decision making to guide in-depth, semi-structured interviews with racially diverse male adolescents ages 12-17 on topics related to their emerging sexual identities and decisions, including puberty, relationships, and knowledge of sexual consequences and risk. Expert Model Development - Expert opinion extended existing findings from the literature, providing context and experience related to the idea of toxic masculinity. A point of divergence was how widely endorsed experts believed these norms to be, with some arguing that adolescents feel constrained by the norms but secretly desire the love and intimacy normatively associated with females, indicative of pluralistic ignorance. There was broad consensus among experts about the power of this norm, with disagreement only about degree of internalization. Interviews - Participants spoke candidly, describing lying about virginity to impress a partner, the crude sexual joking and social posturing among young men, and their experiences with pornography. Many expressed frustration with limited sex education, the use of “scare tactics” such as graphic presentation of STIs, the lack of candid discussion by teachers, and the neglect of healthy communication and relationships. There was discussion of norms and peer influence. For example, participants described a “hunter/prey mentality” around sex, identifying each girl as a conquest, and explicitly or implicitly endorsing an objectified view of female partners. Peers were important for communicating norms and conveying reputation. Sexually experienced peers hold considerable social capital. Few described mutual, collaborative decision making around sex beyond cursory statements about consent. Adolescent males confirm our experts’ conceptualization of the power of toxic masculinity norms on their goals and behavior. Future research can explore then for phenomenon further to identify opportunities for intervention.

Sexual risk-taking and subcortical brain volume in adolescence.

The developmental period of adolescence marks the initiation of new socioemotional and physical behaviors, including sexual intercourse. However, little is known about neurodevelopmental influences on adolescent sexual decision-making. We sought to determine how subcortical brain volume correlated with condom use, and whether those associations differed by gender and pubertal development. We used FreeSurfer to extract subcortical volume among N = 169 sexually experienced youth (mean age 16.07 years; 31.95% female). We conducted multiple linear regressions to examine the relationship between frequency of condom use and subcortical volume, and whether these associations would be moderated by gender and pubertal development. We found that the relationship between brain volume and condom use was better accounted for by pubertal development than by gender, and moderated the association between limbic brain volume and condom use. No significant relationships were observed in reward areas (e.g., nucleus accumbens) or prefrontal cortical control areas. These data highlight the potential relevance of subcortical socioemotional processing structures in adolescents' sexual decision-making.

Addressing a Critical Gap in U.S. National Teen Pregnancy Prevention Programs: The Acceptability and Feasibility of Father-Based Sexual and Reproductive Health Interventions for Latino Adolescent Males

The purpose of the research was to examine the feasibility and acceptability of a father-based sexual and reproductive health intervention designed to reduce sexual and reproductive (SRH) disparities and increase correct and consistent condom use among Latino adolescent males. The current study conducted in-depth semi-structured interviews with Latino father-son dyads (N=30) designed to elicit perspectives on communication regarding sex and condom use. In addition, the interview protocol included father-son preferences regarding paternal involvement in condom instruction and perceived obstacles and advantages of father direct involvement in education efforts designed to increase correct and consistent condom use among their adolescent sons. Three independent coders conducted both vertical and horizontal analyses of the data to identify emergent themes and reach theoretical saturation. The main findings from this study suggest that Latino fathers can be impactful in shaping Latino adolescent male sexual decision-making and correct and consistent condom use. However, our data highlight that while both feasible and acceptable, Latino fathers identify needing additional support in how best to communicate and seek opportunities to master their own knowledge and skills regarding condom use and effective communication with their adolescent sons about sex. Latino father-based interventions represent an acceptable and feasible option for building upon the recent success of U.S. national efforts to reduce teen pregnancy rates and STI disparities among Latino youth. However, there exists a need for father-based programs that will support Latino fathers in best educating their sons about condom use and better addressing their SRH. Ongoing national efforts to reduce Latino teen SRH disparities warrant the consideration of father-son interventions for Latino adolescent males in the United States.

Making plans for future success: a timeline tool feasibility study

ABSTRACTMany adolescents have hopes of college graduation, independent living, and satisfying careers. Career preparation is an important component that can facilitate these desires. However, many adolescents do not achieve these hopes in their desired timeframes due to interruptions, such as unplanned pregnancies. As illustrated by the Theory of Adolescent Sexual Decision-Making Influencing Teen Pregnancy (Weiss, 2012. Who will listen? Rural teen pregnancy reflections. The Journal for Nurse Practitioners, 8, 804–809. doi:10.1016/j.nurpra.2012.02.028), desiring future success can promote low-risk decision-making. Based on this theory, a Getting Plans Started (GPS) Timeline Tool (GPS Timeline©) was developed to help adolescents plan for future success by using a time perspective and, thereby, avoid interruptions. The purpose of this paper is to describe the GPS Tool©, how it might be used, and a study to determine the feasibility of using the GPS Tool©. Thirty adolescents found the tool easy to use and effective in helping them plan for the future. Their responses indicated almost unanimous desires for college graduation and independence with strong confidence in achieving their plans, but their responses also indicated a need for more effective planning to achieve their desired goals.

Multiple levels of social influence on adolescent sexual and reproductive health decision-making and behaviors in Ghana

ABSTRACTLittle is known about the multilevel social determinants of adolescent sexual and reproductive health (SRH) that shape the use of family planning (FP) among young women in Africa. We conducted in-depth, semi-structured, qualitative interviews with 63 women aged 15–24 years in Accra and Kumasi, Ghana. We used purposive, stratified sampling to recruit women from community-based sites. Interviews were conducted in English or local languages, recorded, and transcribed verbatim. Grounded theory-guided thematic analysis identified salient themes. Three primary levels of influence emerged as shaping young women’s SRH experiences, decision-making, and behaviors. Interpersonal influences (peers, partners, and parents) were both supportive and unsupportive influences on sexual debut, contraceptive (non) use, and pregnancy resolution. Community influences included perceived norms about acceptability/unacceptability of adolescent sexual activity and its consequences (pregnancy, childbearing, abortion). Macro-social influences involved religion and abstinence and teachings about premarital sex, lack of comprehensive sex education, and limited access to confidential, quality SRH care. The willingness and ability of young women in our study to use FP methods and services were affected, often negatively, by factors operating within and across each level. These findings have implications for research, programs, and policies to address social determinants of adolescent SRH.

Heterosexual female adolescents' decision-making about sexual intercourse and pregnancy in rural Ontario, Canada

Rural female adolescents experience unique circumstances to sexual health care and information as compared to urban adolescents. These circumstances are largely due to their more isolated geographical location and rural sociocultural factors. These circumstances may be contributing factors to an incidence of adolescent pregnancy that is higher in rural areas than in urban cities. Thus, this higher incidence of pregnancy may be due to the ways in which rural adolescents make decisions regarding engagement in sexual intercourse. However, the rural female adolescent sexual decision-making process has rarely, if ever, been studied, and further investigation of this process is necessary. Focusing on rural female adolescents aged 16-19 years is especially significant as this age range is used for reporting most pregnancy and birth statistics in Ontario. Charmaz's guidelines for a constructivist grounded theory methodology were used to gain an in-depth understanding of eight Ontario rural female adolescents' decision-making process regarding sexual intercourse and pregnancy, and how they viewed rural factors and circumstances influencing this process. Research participants were obtained through initial sampling (from criteria developed prior to the study) and theoretical sampling (by collecting data that better inform the categories emerging from the data). Eight participants, aged 16-19 years, were invited to each take part in 1-2-hour individual interviews, and four of these participants were interviewed a second time to verify and elaborate on emerging constructed concepts, conceptual relationships, and the developing process. Data collection and analysis included both field notes and individual interviews in person and over the telephone. Data were analyzed for emerging themes to construct a theory to understand the participants' experiences making sexual decisions in a rural environment. The adolescent sexual decision-making process, Prioritizing Influences, that emerged from the analysis was a complex and non-linear process that involved prioritizing four influences within the rural context. The influences that participants of this study described as being part of their sexual decision-making process were personal values and circumstances, family values and expectations, friends' influences, and community influences. When influences coincided, they strengthened participants' sexual decisions, whereas when influences opposed each other, participants felt conflicted and prioritized the influence that had the most effect on their personal lives and future goals. Although these influences may be common to all adolescents, they impact the rural female adolescent sexual decision-making process by influencing and being influenced by geographical and sociocultural factors that make up the rural context. This study reveals important new and preliminary information about rural female adolescents' sexual decision-making process and factors that affect it. Findings improve understanding of how rural female adolescents make choices regarding sexual intercourse and pregnancy and can be used to guide future research projects that could facilitate effective development of sexual health promotion initiatives, inform rural health policy and practices, and enhance existing sexual education programs in rural communities.

A Question of Love and Trust? The Role of Relationship Factors in Adolescent Sexual Decision Making.

While representing only 25% of the sexually active population, 50% of all new sexually transmitted infections occur among young people mostly because of inconsistent condom use. Critically, the majority of adolescent sexual activity takes place in the context of romantic relationships; thus, it is important to understand how relationship factors may influence decision making about the use of protection. We used a mixed-method approach to investigate the extent to which relationship length, degree of trust or love in the relationship, and frequency of intercourse influence both perceptions of the probability of condom use and self-reported condom use in the context of relationships among a diverse sample of high-risk adolescents (age 12-19 yr). Participants were least likely to use condoms if they were in relationships with high trust or love and high frequency of intercourse. Importantly, sexual experience status was a strong moderator of primary effects. The perspective of motivated cognition provides a useful theoretical framework to better understand adolescent decision making about condom use, particularly for sexually experienced youth.

From disease to desire, pleasure to the pill: A qualitative study of adolescent learning about sexual health and sexuality in Chile.

BackgroundSexual and reproductive rights include access to accurate and appropriate information in order to make informed decisions. In the current age of media globalization and Internet, adolescents are exposed to information about sexual health and sexuality from a myriad of sources. The objective of this study was to explore sources of information and adolescent learning about sexual health and sexuality in Santiago, Chile.MethodsData collection included four focus group discussions with a total of 24 adolescents 18–19 years old, 20 semi-structured interviews with adolescents 16–19 years old, and seven interviews with key informants working with adolescents. Audio recordings were transcribed verbatim and analysed using content analysis.ResultsThe primary sources of sexual health and sexuality information were parents, teachers and friends, whilst secondary sources included health professionals for females and Internet for males. Information provided by the trusted sources of parents, teachers and health professionals tended to focus on biological aspects of sexuality, particularly pregnancy and sexually transmitted infections. Limited emphasis was placed on topics such as love, attraction, pleasure, relationships, abstinence and sexual violence. Information focused primarily on heterosexual relations and reproduction. Adolescents learnt about relationships and sexual acts through friends, partners and, for many males, pornography. Findings indicate a lack of available information on partner communication, setting personal limits, and contraception, including morally neutral and medically correct information about emergency contraception.ConclusionsThis study highlights numerous gaps between adolescent information needs and information provided by parents, teachers and health professionals. The priority these trusted sources place on providing biological information overshadows learning about emotional and relational aspects of sexuality. This biological rationalization of adolescent sexual behaviour neglects the way gender inequality, peer-pressure, coercion, media eroticization and religion influence adolescent sexual decision-making. The heteronormativity of information excludes other sexual orientations and disregards the diverse spectrum of human sexual behaviours. Finally, the limited provision of practical information hinders development of skills necessary for ensuring safe, consensual and pleasurable sexual relations. Trusted adults are encouraged to engage adolescents in critical reflection on a broad range of sexuality topics, dispelling myths, and building knowledge and skills necessary to make informed decisions.

Family functionality and parental characteristics as determinants of sexual decision-making of in-school youths in a semi-urban area of Southwest Nigeria.

Though research findings have indicated that family characteristics have a bearing on sexual behavior, there is a paucity of published literature on the role of family functionality and parental characteristics on adolescent sexual decision-making. This study was designed to assess the role of family function and parental influence on sexual behavior of in-school youths in secondary schools in a sub-urban area of Southwest Nigeria. A descriptive cross-sectional study was conducted among secondary school students using semi-structured interviewer-assisted questionnaire. Information was obtained on the sexual behavior and parent-child characteristics. Family functionality was assessed using family APGAR standardized instrument. Association was established using χ2-test for qualitative variables and t-test for quantitative variables at p=0.05. Mean age of respondents was 14.8±2.2 years. Majority were from monogamous family setting (70.7%) and lived with their families (75.6%). About a quarter (26.8%) was from dysfunctional families and 9.2% had ever had sexual intercourse. Recent sexual engagement in the preceding 1 month was reported (47.4%). The mean score for parental monitoring, father-child communication, mother-child communication, and parental disapproval of sex were 10.4±2.2, 9.3±2.3, 9.8±2.4, and 10.4±2.3, respectively. There was a significant association between parental monitoring (t=3.9, p≤0.001), mother-child communication (t=3.03, p=0.003), and parental disapproval of sex (t=5, p≤0.001); and sexual experience. This study showed that parental influence had a vital role in the sexual behavior of young persons. Advocacy and health education interventions are needed among parents regarding their role in the sexual behavior of in-school youths.

Influence of sexual sensation-seeking on factors associated with risky sexual behaviour among African-American female adolescents.

Background The identification of antecedents to sexual risk among youth is critical to the development and dissemination of multilevel interventions. Therefore, the aim of the present study was to examine the effect of sexual sensation-seeking on partner age, partner communication, and the sexual attitudes and behaviours of African-American female youth. This study examined survey data collected by audio computer-assisted self-interviews from 701 young African-American females between 14 and 20 years of age. The survey consisted of items designed to measure adolescents' sexual risk and preventive behaviours. The results of this study suggest that sexual sensation-seeking is associated with condom use among adolescent African-American females. For adolescents who reported greater sexual sensation-seeking, lower levels of sexual happiness were associated with a decreased likelihood of condom use at last intercourse (β=1.01, P≤0.05). For those reporting lower levels of sexual sensation-seeking, greater sexual enjoyment was associated with a greater likelihood of condom use at last intercourse (β=0.93, P≤0.01). Adolescents with younger sexual partners and lower levels of sexual sensation-seeking reported a higher proportion of condom use in the past 6 months (β=0.70, P=0.01). Higher partner communication self-efficacy and decreasing levels of sexual sensation-seeking were associated with fewer lifetime sexual partners (β=-0.54, P≤0.05). Future research should address the impact of these variables on adolescent relationship dynamics and sexual decision-making.

Sexual Communication Between Early Adolescents and Their Dating Partners, Parents, and Best Friends

This study assessed early adolescents’ sexual communication with dating partners, parents, and best friends about six sexual health topics: condoms, birth control, sexually transmitted diseases (STDs), human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), pregnancy, and abstinence/waiting. Using a school-based sample of 603 youth (ages 12 to 15; 57% female; 46% Caucasian), we examined communication differences across demographic and developmental factors, tested whether communication with parents and best friends was associated with greater communication with partners, and examined associations between communication and condom use. More than half of participants had not discussed any sexual topics with their dating partners (54%), and many had not communicated with parents (29%) or best friends (25%). On average, communication was more frequent among adolescents who were female, African American, older, and sexually active, despite some variation in subgroups across partner, parent, and friend communication. Importantly, communication with parents and friends—and the interaction between parent and friend communication—was associated with increased communication with dating partners. Further, among sexually active youth, increased sexual communication with partners was associated with more frequent condom use. Results highlight the importance of understanding the broader family and peer context surrounding adolescent sexual decision making and suggest a possible need to tailor sexual communication interventions.

The Role of Parents and Families in Teen Pregnancy Prevention

Parent involvement (PI) is considered necessary in teen pregnancy prevention (TPP) and preventing other adolescent risk behaviors. However, controversy exists regarding the extent to which families are responsible for adolescent sexual decision making. We adapted two frameworks (Kirby’s risk and protective factors and the Parent–Child Connectedness model) to examine parent- and family-based programs and policies relevant to TPP. There is evidence that PI is an important and effective component of TPP; however, the evidence for PI programs is less strong. Although the United States has legislated various PI-related policies in the context of adolescent sexuality, most have hindered the health of adolescents. Furthermore, the United States falls behind other Western industrialized nations when it comes to healthy family-based policies. PI in TPP is important; however, TPP requires multiple levels of intervention beyond the involvement of parents. We make recommendations for how various stakeholders can effectively use healthy family-based interventions in TPP.

The Potential Impacts of Religion and Spirituality on First Nation Teenage Fertility

After reviewing some American research on the impacts religion has on adolescent sexual decision making and teenage pregnancy, this article considered the few instances of Canadian research addressing this topic. With this contextual information in place, it then moves on to report on analysis comparing the 2001 Census figures on religions declared by Canadian First Nation communities to teen fertility rates and the Community Well-Being Index (CWB). It finds that First Nations teen fertility rates are related to relative socio-economic deprivation, but also that religion has impacts on sexual decision making at the individual level and those First Nations communities showing no major religious adherence have teenage fertility rates of up to 140 per 1000, as compared to those communities showing one major tradition whose fertility rates are closer to 109 per 1000 adolescent First Nation women.

Socio-cultural and economic antecedents of adolescent sexual decision-making and HIV-risk in rural Uganda

With more than half of new infections occurring among youth, HIV/AIDS remains a major contributor to morbidity and mortality in Uganda. Semi-structured interviews were performed with 48 adolescents and 15 adult key informants in a rural Ugandan community to identify influences on adolescent sexual decision-making. Inductive data analytic methods revealed five thematic influences: (1) social pressure, (2) decline of the Senga (a familial figure who traditionally taught female adolescents about how to run a household), (3) cultural barriers to condom use, (4) knowledge of HIV transmission and modes of prevention, and (5) a moral injunction against sex before marriage. Influences were classified as HIV/AIDS risk and protective factors and organized to form an explanatory framework of adolescent sexual risk-taking. Risk factors pull youth toward risky behavior, while protective factors push them away. Predominance of risk over protective influences explains persistent sexual risk-taking by Ugandan youth. HIV prevention programs designed for Ugandan adolescents should take competing factors and sociocultural and economic influences into account.

Discussing Adolescent Sexual Health in African-American Churches

This study describes the ways in which two African-American churches discuss adolescent sexual health topics. Six focus groups were conducted in two churches in Flint, Michigan, that reported no formal sexual health programming for their congregants. Three themes emerged to highlight the different perspectives about the role of churches in adolescent sexual decision-making and sexual health education: (1) churches as sources of sexual information, (2) churches as complex communities, and (3) recommendations for sexual education in churches. Participant responses suggest that churches can and should serve a resource for sexual health information. Implications for practice and research are discussed.

Influences of Social Norms and Context on Sexual Decision Making Among Adolescent Women

The aim of this study was to explore women's decisions to initiate and continue sexual activity in late adolescence. Narrative inquiry was the qualitative methodology used to research the perceptions of factors that influence the sexual decision making of women in late adolescence. Single interviews were conducted with 10 late-adolescence women between the ages of 18 and 22. Both purposive and snowball sampling were used, and recruitment ended when data saturation was achieved. The main findings that emerged as the story contained 3 distinct and influential components: the influence of social context provided the introduction to the story, perceptions of the expected social norm for sex and relationships formed the plot, and the narratives concluded with a discussion of how these adolescents' decision-making processes evolved in the years since coital debut. The results of this study provide evidence that adolescent sexual decision making is a multifaceted process with many layers of influence that reflect the complex world adolescents must navigate as they make decisions about their sexual behaviors. Detailed assessment of adolescent sexual activity and anticipatory guidance by health care providers will lay the foundation for risk reduction behavior and safer sexual encounters.