Sexually-abstinent African-American teenage girls can help guide the development of successful interventions by sharing what they believe about sexuality and how their lives influence their decision to abstain. This qualitative descriptive study involved 14 participants (15-18 years, mean age 16) who were recruited from a pediatric primary care clinic and a high school clinic. Parental consent was secured. A life history method was used for two, 1-hour, semi-structured individual interviews that examined how people and events in these participants¡¯ lives influenced their beliefs and actions. Questions addressed family interactions, school activities, aspirations, religious faith and involvement, dating and romantic partners, what their friends think about sex, and what kinds of things help or make it difficult to stay abstinent.

Within this group, 12 reported having never had intercourse (11 had had a boyfriend), and two had stopped having intercourse at least 2 years earlier and considered themselves to be abstinent. All 14 had siblings (3 had a sibling who was a teenage parent), eight lived in poverty, and 13 belonged to a protestant Christian religion.

Analyses of the interviews identified two major themes: developing sexual identity and challenges to abstinence. Being abstinent was part of their identities as young women. They considered themselves faithful (deliberately living a ¡°Christian life¡±) and unique (having mature thoughts and actions, avoiding risky situations). They defied negative stereotypes (avoiding early pregnancy, setting a positive example as proud black women), wanted to be like their own mother and/or her mother who they considered strong, reliable, and responsible while they struggled to raise their families, and chose friends who are also abstinent.

Three common challenges to staying abstinent were related to interpersonal relationships: harassment (they do not think that the school punishes peers for offensive sexual comments), pressure from romantic partners, and pressure from other girls.

Abstinence requires an active choice and renewed commitment. These teens renewed their commitment to abstinence (at the risk of losing a friend), avoided or left risky situations, resisted peer pressure, and avoided group conversations about sex. While avoiding pregnancy to protect their future is a legitimate motivation for youth who have goals, interventions need to include practical content or ¡°how to¡± be abstinent. Nurses can use information from abstinent youth to develop effective interventions. Interventions can teach about supportive friendships, e.g., these girls¡¯ friends reminded each other to stay abstinent.

(Haglund K. Matern Child Nurs J 2006; 31(2):86-92)

Comment: School nurses should press for campus and district policies that have negative consequences for students who sexually harass others and include provisions for acting on students¡¯ reports, not requiring adult witnesses. --J.O.