Perceptions of sexual abstinence among high-risk early and middle adolescents.

PURPOSE Sexual abstinence has become the primary response to adolescent pregnancy and sexually transmitted infection (STI) prevention. However, most abstinence programs are based on adult ideas of abstinence, and little is known about how adolescents themselves conceptualize sexual abstinence. METHODS In this qualitative study, we conducted semi-structured exploratory interviews with 42 adolescents aged 11-17 years recruited from primary care clinics. RESULTS We observed marked confusion over the term "abstinence." However, the concept of abstinence, or choosing not to have sex, was clear and relevant. Participants viewed sexual abstinence as part of a normal developmental continuum. All adolescents were abstinent for a period of time, and then transitioned to sexual activity when they were ready. Readiness was determined by (1) individual factors, such as age, life events, physical maturity and social maturity, (2) relationship factors such as being with the "right" person, or having a committed relationship, (3) moral and religious beliefs, and (4) the balance of health, social, and family risks and benefits. Sex was considered something powerful, and the transition to first sex a rite of passage in which adolescents took on what they perceived to be adult roles. We observed differences by age, gender, and sexual experience in how adolescents determined readiness. CONCLUSIONS Adolescents conceptualize sexual abstinence differently than adults, with differences by age, gender and sexual experience. Rather than a simple behavioral decision, our participants viewed abstinence as a broader part of normal development and viewed the transition to sex as an important rite of passage to adulthood.