Fellowship ForumThe association between adolescent spirituality and voluntary sexual activity
Introduction
American adolescents choosing to become sexually active face significant health risks primarily related to the social and medical morbidity associated with teenage pregnancy and sexually transmitted diseases (STDs) (1). Early efforts targeting the reduction of adolescent pregnancy and STD have emphasized primary prevention in the form of sexual abstinence and increased condom usage in general adolescent populations. These efforts, however, relied on a “Just say no!” approach or widespread condom distribution policies frequently in isolation from considerable psychodynamic and societal influences 2, 3. Other efforts utilized knowledge-based sexuality education, which found little impact on adolescent sexual risk behaviors (4). Subsequent focus turned to the evaluation of skills-building curricula, adolescent life options, and to identification of determinants of adolescent resiliency toward abstaining from engagement in health-risk behaviors 2, 3, 4, 5, 6, 7. Factors known to protect against risk behaviors include close parent-child relationships, high educational aspirations, high self-esteem, ties to a network of community supports, and aspects of adolescent spirituality 5, 6, 7, 8, 9.
Spirituality is a difficult concept to define and operationalize 10, 11. Furthermore, no consensus has been reached in the literature regarding the relationship between “spirituality” and the better studied “religiosity.” Nonetheless, a frequently used model asserts that spirituality refers to a subjective experience of the sacred while religion involves subscription to a set of institutionalized beliefs (12). For example, Steere (1997) defines spirituality as “the way we conceive of and express our relationship to God, others, and the world around us” (13). In this regard an individual may have a number of ways of being spiritual and one’s spirituality may or may not include religiosity.
In an attempt to operationalize spirituality, risk behavior studies in adults and adolescents have classically utilized “church attendance” as a predictor or control variable (14). Church attendance, however, fails to adequately address the broader concept and variability of the spirituality of adolescents. Frequency of attendance to a body of faith and perceived importance of religion reflect subjective notions of religious identification and comprise simple religiosity (15). While simple religiosity has been found to be inversely related with sexual activity in numerous nonclinical adolescent samples 15, 16, 17, 18, the effect of religiosity on adolescents in clinical care settings remains unknown. Furthermore, little information is available addressing the relationship between other spirituality domains and adolescent sexual behavior. Much of the effect of religiosity on adolescent sexual behavior may be explained by personal attitudes and beliefs concerning sexuality or other dimensions of spirituality (14).
Other dimensions of spirituality include intrinsic and extrinsic religious motivation, belief in God, divine support, spiritual questing, and spiritual interconnectedness. Intrinsic religious motivation is the degree to which religious attitudes and behavior proceed from a personal and internal locus and thus represent a central motivating force in individual decision-making 19, 20. Extrinsic religious motivation is the degree to which religion is pursued as the result of external social influences (20). Belief in God is the degree to which an individual adheres to theistic notions of a divine persona (21). Divine support is self-perceived supportive components of an individual’s relationship with God and is positively related to self-esteem and resiliency 22, 23. Questing refers to the existential and searching aspects of spirituality (24). Spiritual interconnectedness is the supportive components of an individual’s ties to friends and associates within a body of faith. Such positive peer and mentoring relationships are also highly associated with both self-esteem and resilience against engagement in health-risk behaviors 5, 6.
The present study was undertaken to begin to describe the spirituality of adolescents and to determine the possible association between adolescent spirituality and initiation of voluntary sexual activity. We hypothesized that adolescents with higher levels of spirituality would be less likely to report engaging in voluntary sexual activity.
Section snippets
Study protocol
The study group consisted of a convenience sample of 141 consecutive patients presenting to an adolescent primary and referral practice at an urban teaching children’s hospital who agreed to complete a 153-item questionnaire assessing demographics, psychosocial parameters, spiritual beliefs, and sexual practices. All items were obtained from standardized instruments except as noted below. Participants were recruited by medical providers and study personnel during weekly Friday clinic sessions
Demographics
Mean age of the 141 respondents was 16.04 ± 2.4 years (range 11–25 years). Demographic data are presented in Table 1. The sample was largely African-American, middle adolescent, and female, reflecting the demographic distribution of the clinic’s patient population. Over 50% of the subjects espoused one of four faith systems: Roman Catholic, Baptist, Church of God, and Pentecostal. Roman Catholicism was the predominant single religious faith reflecting the religious affiliation of the
Discussion
These data reveal that spirituality is a common trait in the lives of youth attending an urban medical practice and suggest that spiritual interconnectedness may be important with regard to delayed initiation of sexual activity.
A strength of the present study is that multiple dimensions of spirituality were measured in an attempt to begin to characterize the nature of spirituality in this sample of adolescents. In addition, over one-quarter of adolescents attended religious services of some
Conclusion
Despite these limitations, these data reveal that spirituality is a common factor in the lives of the urban youth in this sample. Spiritual interconnectedness was the only one of eight dimensions of spirituality that had an independent and positive association with sexual abstinence. These data suggest that spiritually interconnected relationships within communities of faith may represent an important factor in delaying sexual activity.
Acknowledgements
We are deeply indebted to Dr. S. Jean Emans for critically reviewing the manuscript, Maria Luoni for manuscript preparation, and to Pearl Christie and Amina Watson for their invaluable assistance with data management. This paper was supported in part by Project #MCJ-MA 259195 from the Maternal Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services.
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