A qualitative study of rural black adolescents' perspectives on primary STD prevention strategies.
BACKGROUND
Primary STD prevention relies on five key strategies: practicing abstinence, choosing low-risk partners, discussing partners' sexual history, using condoms consistently and not having multiple partners. Few studies have examined all of these strategies simultaneously, and few have focused on rural black adolescents, whose rates of early sexual initiation and STDs are among the highest in the nation.


METHODS
In 2006, a sample of 37 black adolescents (20 female, 17 male) from two rural North Carolina counties participated in focus groups that explored their understanding of how primary prevention strategies reduce STD transmission, the common barriers they encounter in trying to adopt these strategies and the risk reduction strategies that they employ. Transcripts were analyzed using a grounded theory approach.


RESULTS
Adolescents understood how primary prevention strategies reduce STD transmission. However, they perceived sex as normal and abstinence as unlikely during adolescence. Furthermore, they considered the remaining primary prevention strategies difficult to implement because these strategies depend on partner cooperation and incorrectly assume that STD prevention is paramount when adolescents make sexual decisions. Adolescents reported using alternative strategies to reduce their STD risk; the most commonly used approaches were indirect assessments of partner characteristics (e.g., evaluating partners' physical appearance and sexual history) and STD testing (to identify and treat infections).


CONCLUSIONS
Adolescents try to reduce their STD risk, but do so by using ineffective practices. Promoting primary prevention strategies requires helping adolescents to identify opportunities to successfully employ these strategies.
Department of Obstetrics, Gynecology and Reproductive Sciences, the University of Pittsburgh, USA. aakers@mail.magee.edu
Aletha Y
AY
Akers
Melanie A
MA
Gold
Tamera
T
Coyne-Beasley
Giselle
G
Corbie-Smith
D000293:Adolescent; D000294:Adolescent Behavior / Q000208:ethnology*; D001741:Black or African American / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D006801:Humans; D008297:Male; D009657:North Carolina; D012307:Risk Factors; D012309:Risk-Taking; D012424:Rural Population / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000208:ethnology*; D012749:Sexually Transmitted Diseases / Q000208:ethnology*