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CONTEXT: Better methods for investigating sexual risk before the initiation of sexual intercourse are needed to support programming for younger adolescents, especially for abstinent adolescents who are susceptible to initiating intercourse.

METHODS: A sample of 854 adolescents in seventh or eighth grade who had never had sexual intercourse completed sexuality surveys in 2002 and 2004. A five-item index that assessed beliefs and expectations about the onset of intercourse was created to indicate adolescents' cognitive susceptibility to initiating intercourse. Logistic regression analysis was used to assess associations between levels of susceptibility and initiation of intercourse by follow-up. The construct and predictive validity of the index were examined using a variety of tests.

RESULTS: Thirty-eight percent of respondents were classified as being nonsusceptible to initiating intercourse, 34% as having low susceptibility and 28% as being highly susceptible. Adolescents who were susceptible were more physically mature, had greater sexual feelings and competency, perceived that more peers were sexually active and had fewer positive connections with parents, school and religion than nonsusceptible respondents. Males, blacks and older adolescents were more susceptible than females, whites and younger adolescents, respectively. Compared with nonsusceptible respondents, those with low and high susceptibility had higher odds of initiating intercourse two years later (odds ratios, 2.5 and 8.1, respectively).

CONCLUSIONS: The cognitive susceptibility index provides a valid method for assessing sexual risk before the onset of intercourse. Assessing susceptibility among early adolescents could support efforts to delay the onset of intercourse through targeted research and health programming.