Understanding the “Why” for High Risk Behavior: Adolescent Girls Motivations for Sex

Research Article

Ann Nurs Res Pract. 2017; 2(1): 1013.

Understanding the “Why” for High Risk Behavior: Adolescent Girls Motivations for Sex

Morrison-Beedy D1*, Grove L2, Ming Ji1 and Elizabeth Baker1

1College of Nursing, University of South Florida, USA

2College of Public Health, University of South Florida, USA

*Corresponding author: Dianne Morrison-Beedy, University of South Florida, College of Nursing, Professor of Nursing, Public Health, and Global Health College of Nursing 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA

Received: November 29, 2016; Accepted: January 19, 2017; Published: January 20, 2017


Aims: Adolescent girls continue to face negative health consequences of sexual risk behaviors. Tested in a randomized controlled trial, the Health Improvement Project for Teens (HIP Teens) is a CDC- and Dept. of HHSrecognized HIV/STI/pregnancy prevention evidence-based intervention. Identifying why girls participate in safe and risky sexual behaviors is key to developing successful intervention strategies. This study identified motivations for sex in the 738 girls enrolled in the RCT and analyzed differences in sex motives among at-risk subgroups.

Methods: Sexually-active girls, ages 15-19 (n=738) were recruited from urban community-based settings and enrolled in the gender-specific intervention. Baseline data were collected via audio computer-assisted selfinterview surveys including a modified Sex Motives Scale based on six domains (intimacy, enhancement, self-affirmation, coping, peer pressure, and partner approval), assessing drivers of both protective and risk-promoting motivations. Descriptive and inferential analyses were used to describe the distribution of sex motives as well as differences in subgroups with different risk profiles.

Results: Participants were predominantly African American and impoverished with reported risk behaviors. The predominant sex motives identified across the sample were enhancement and intimacy. Statistically significant motive differences across domains were identified among mental health variables (depression, drug and alcohol use) as well as demographic group characteristics (race, age, and parental status).

Conclusion: Understanding sex motives in girls and their relationship to modifiable and unmodifiable factors can improve tailoring of evidence-based risk reduction interventions to target specific subgroups. Understanding why girls have sex provides an opportunity to address motivation-focused strategies that may augment intervention efficacy.

Keywords: Sexual health; Adolescents; HIV; Sexually transmitted disease; Evidence-based interventions; Reproductive health; Minority women; Substance abuse; Mental health; Risk behavior


Adolescent sexual and reproductive health risks continue to pose challenges to overall improvement of adolescent well-being. The Centers for Disease Control and Prevention estimate that almost 1 in 4 adolescents have contracted an STI [1]. Despite gains in reducing unintended pregnancy over the past decade, disparities in STIs and unintended pregnancies persist in vulnerable groups 15-24 years of age with minority adolescents [1]. In 2014, African American females had the highest number of estimated new HIV diagnoses than any other female racial group [2]. Hispanic and non-Hispanic black adolescent females have the highest teen pregnancy rates compared among other racial and ethnic groups [3]. Other demographic and biological factors (e.g. age, pregnancy, race, parental status) have been associated with risk behaviors as well. For example, younger sexually active females are at more likely to engage in unprotected sex and have multiple sexual partners [4] as well as experience sexual coercion from older partners [5,6]. Having ever been pregnant can also put teen girls at risk for continued negative health outcomes [7]; with almost 20% of teen births reported as repeat pregnancies [8]. Additional risk is faced by teen mothers compounding the negative health, social and economic outcomes; they are less likely to graduate high school and find stable employment thus impacting future quality of life [9].

Adolescence is a time of tremendous biological and personal development and for some teens, this time can be marked with the challenges of depression, substance use and alcohol abuse. A 2012 study by the Center for Behavioral Health Statistics and Quality found that girls ages 12 to 17 are almost three times more likely than their male peers to experience a major depressive event in the span of a year [10]. The 2015 Youth Risk Behavior Surveillance results indicated that adolescent girls were more likely to feel sad or hopeless almost every day for two weeks or more, drink at least one alcoholic beverage, and smoke marijuana in the past 30 days before the survey [11]. These factors are not only associated with negative sexual health outcomes but they can exacerbate them [12-14] One study found that a higher dependence on marijuana was associated with a decreased use in condoms among adolescents and higher frequencies of sex were associated with increased marijuana use [15]. African American adolescent girls that use marijuana and alcohol had higher rates of STI diagnoses, unprotected vaginal sex, and unintended pregnancy [16]. Substance use and depression have been linked with sexual risk behaviors including decreased condom use and substance use cooccurrence with sexual activities [13]. In a study by Lee, O’Riordan, and Lazbenik, 64% of the girls that exhibited a history of depression symptoms had a history of STIs and 12% had experienced an unintended pregnancy [17]. Binge drinking, like substance abuse, can compound the negative effects of depression and sexual risk behavior [13,18].

Understanding what motivates adolescents to participate in risk behaviors and their interactions with other risk factors can help researchers develop interventions to reduce risk among specific atrisk subgroups. As such, many theoretically-driven interventions targeting risk behaviors have highlighted motivation as a critical construct for integration (e.g. Information Motivation Behavioral Skills Model, Self-Determination Theory) [19-21]. Studies have shown that varying motives for having sex influence risk behavior among adolescents. The relationship between motives for sex and condom use was examined in a study by 277 female adolescents [22]. Those whose motivations attached meaning or intimacy to sex were less likely to use condoms [22]. Those who reported low scores on the motive “to express love” (intimacy) with steady partners were more likely to have protected sex [22]. Similarly, sex motives were examined in 133 adolescent girls with more effective condom use identified in girls who scored low in the motive to have sex to express love [23]. For example, Paradise and colleagues reported inexperienced and sexually active adolescent girls with sexual motives based on personal values and, in some cases, religious influence [24]. Ozer and colleagues assert that there are gender and social nuances that may have a greater yet less understood impact on sex motives among adolescents [25]. In a study by Cooper, Shapiro, and Powers, motivations for sex were categorized into four areas related to self-focused or socially-focused interactions with positive or negative reinforcement [26].

Understanding that motivation for sex is multi-faceted, Cooper et al. [26] developed a 29-item Likert scale questionnaire consisting of six sex motive domains (Enhancement, Intimacy, Coping, Selfaffirmation, Partner approval, and Peer approval). These domains were theoretically constructed from the four areas of motivation (Social Aversive, Social Approach, Self-Focused Aversive, and Self- Focused) [26].

These “drivers” of behavior choice can be classified into four areas (Figure 1); the horizontal spectrum ranging from risk-taking (averse) or protective (favorable) outcomes, specifically whether sexual behavior is driven by escaping negative outcomes or seeking positive outcomes [26]. Across a vertical spectrum ranging from internally focused (self) to externally focused (social) motivations for sex, specifically whether choices motivating sex behaviors are focused on the self or the desire to interact with others. These components helped shape the six sex motive domains: social approach, social aversive, self-focused or intrapersonal, and self-focused intrapersonal aversive motives [26].