title: Abstinence and teenagers: prevention counseling practices of health care providers serving high-risk patients in the United States.
abstract: BACKGROUND
  Abstinence-only education has had little demonstrable impact on teenagers' sexual behaviors, despite significant policy and funding efforts. Given the struggle over resources to improve teenagers' reproductive health outcomes, the views of clinicians serving teenagers at high risk for unintended pregnancy and STDs merit particular attention.
  
  
  METHODS
  In 2005, a qualitative study with 31 clinicians serving low-income, at-risk patients was conducted. A semistructured interview guide was used to ask clinicians about adolescent pregnancy, HIV and STD prevention counseling, and when they include abstinence. Thematic content analysis was used to examine the content of the counseling and the techniques used in different situations.
  
  
  RESULTS
  Providers reported offering comprehensive counseling, presenting abstinence as a choice for teenagers, along with information about contraceptives and condoms. Several providers mentioned that with young, sexually inexperienced teenagers, they discuss delaying sexual activity and suggest other ways to be affectionate, while giving information on condoms. Providers explained how they assess whether teenagers feel ready to be sexually active and try to impart skills for healthy relationships. Some described abstinence as giving teenagers a way to opt out of unwanted sexual activity. Many support abstinence if that is the patient's desire, but routinely dispense condoms and contraceptives.
  
  
  CONCLUSIONS
  Overall, providers did not give abstinence counseling as a rigid categorical concept in their preventive practices, but as a health tool to give agency to teenagers within a harm reduction framework. Their approach may be informative for adolescent policies and programs in the future.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, USA. harperc@obgyn.ucsf.edu
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Harper
authors.forename: Jillian T
authors.initials: JT
authors.lastname: Henderson
authors.forename: Amy
authors.initials: A
authors.lastname: Schalet
authors.forename: Davida
authors.initials: D
authors.lastname: Becker
authors.forename: Laura
authors.initials: L
authors.lastname: Stratton
authors.forename: Tina R
authors.initials: TR
authors.lastname: Raine
mesh_terms: D000293:Adolescent; D003376:Counseling; D005260:Female; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D011203:Poverty; D011369:Professional-Patient Relations; D012746:Sexual Abstinence; D014481:United States