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Characteristics Related to Sexual Experience and Condom Use Among Jamaican Female Adolescents

Young women in Jamaica face significant risk for HIV and other STIs. A clearer understanding of the factors associated with sexual experience and unprotected intercourse is needed. Data were collected from 330 adolescent females aged 13 to 17 recruited through community based organizations in Kingston, Jamaica, from 2009-2011. Nearly one-third of sexually experienced participants reported not using a condom the last time they had sex. Characteristics associated with sexual experience included older age, marijuana use, and less comfort talking to mother about sexual topics. Characteristics associated with condom use included perceived importance of religion, positive attitudes toward condoms, and not-having multiple sexual partners. Sexually experienced Jamaican female adolescents were engaging in behaviors that made them vulnerable to HIV and other STIs. Interventions with young adolescent girls and their mothers are recommended to postpone sexual debut and promote safer sexual behaviors in those who do engage in sex.

Sexual experience, condom use, female adolescents, Jamaica

HIV seroprevalence in Jamaica is estimated to be approximately 1.6% (95% CI 1.1%-2.1%).1 The majority of HIV cases in Jamaica are attributed to heterosexual transmission.1 -4 Adolescent and young adult females have been identified as a group at particularly high risk for HIV/AIDS.5 ,6 The AIDS case rate among Jamaican adolescent females is almost three times that of male adolescents (51.8 and 18.2 per 100,000 population, respectively); among 20- to 29-year-olds, the AIDS rate is 16.4% higher among females than among males (570.7 and 490.1 per 100,000 population, respectively).1

Jamaican adolescents are also at high risk for other sexually transmitted infections (STIs). Sexually active adolescents have higher STI rates than other age groups.7 In a cross-sectional study of women aged 18-19 who presented at public and private family planning clinics in Kingston, Jamaica, 23.7% tested positive for gonorrhea, chlamydia, [End Page 220] or trichomoniasis.8 Infection rates among younger women (younger than 25) were significantly higher than rates among women aged 25 and older (30.6% and 20.7%, respectively).8 Nearly 20% of women under the age of 25 tested positive for gonorrhea or chlamydia.8 Having another STI has been shown to be a significant risk factor for HIV; the HIV infection rate among STI clinic attendees was 3.6% in 2007.1

A number of behavioral, socio-cultural, and economic factors have been cited as potential contributors to disproportionately high HIV/AIDS sexual health problems among young Jamaican women. As has also been seen in the U.S., behavioral characteristics that have been associated with HIV in Jamaican adolescent and young adult women include initiating sexual activity at young ages,1 ,2 ,9 having sex with older male partners,1 ,5 ,10 having multiple sexual partners,11 using condoms inconsistently,1 ,7 ,11 and engaging in transactional sexual relationships with older men.1 ,10 In contrast, personal attitudes such as religiosity12 and connectedness with parents13 -14 are thought to be protective of Jamaican adolescent girls.

At a socio-cultural level, normative sexual practices, gender roles, and male-dominated relationship dynamics have also been discussed as potential contributors to the HIV epidemic in Jamaica.1 ,10 ,15 ,16 Wood and associates10 found that Jamaican young women who engaged in sexual relationships with older male partners faced additional obstacles to implementing safer sex practices (e.g., condom use) in their relationships.

In addition to socio-cultural and partner influences, recent qualitative studies have shown that Jamaican youth identify family and parents as important influences in their lives, the development of their so-called sexual scripts, and their sexual behaviors.16 ,17 Mothers have been described as very influential, particularly for the sexual beliefs and behaviors of Jamaican adolescent girls.16 ,18 While most maternal influences were viewed as positive and protective, some were described as negative and risk-promoting.18 Although a number of rigorous quantitative studies in the U.S. have demonstrated parental influences on adolescent sexual risk-related beliefs and behaviors,19 -27 no such studies of family influences have been undertaken in Jamaica.

Thus, based on these multi-level factors which potentially influence adolescent sexual behaviors, as identified by prior research, the current study sought to simultaneously examine individual, partner and family characteristics and their associations with Jamaican adolescent females' HIV- and STI-related sexual risk behaviors, specifically sexual experience (vs. abstinence) and unprotected sexual intercourse (vs. condom use).



Data were collected as part of a randomized control trial evaluating a Jamaican mother-daughter HIV risk reduction intervention, "Mothers and Daughters Standing Strong Together" (R01 NR010478, M.K. Hutchinson, PI). The two-day intervention was culture-specific and based on the Parental and Dyadic Expansions of the Theory of Planned Behavior (TPB).28 ,29 The TPB and Expansions assert that behavioral intentions are the primary determinants of behaviors, and that intentions are influenced by attitudes, behavioral beliefs, normative beliefs and control beliefs toward the behavior.28 ,29 According to Ajzen,28 behavioral beliefs refer to beliefs about the likely consequences; normative beliefs refer to beliefs about the normative expectations of other people; and [End Page 221] control beliefs refer to beliefs about the presence of factors that may further hinder performance of the behavior. Condom use, for instance, is a function of the intention to use condoms. Condom use intentions are determined by behavioral, normative, and control beliefs regarding condom use.

Data were collected pre-intervention (baseline), immediately after the intervention, and at three-month and six-month follow-ups. The current study was limited to baseline data (collected from all study participants) in order to avoid potentially confounding effects from the intervention itself.

Sample and data collection

A total of 330 Jamaican adolescent females and their mothers or female guardians were recruited through community-based organizations in Kingston, St. Andrew, and St. Catherine, Jamaica. Inclusion criteria included: 1) adolescent's age 13 to 17-years; 2) resident of one of the three parishes in and around Kingston; 3) able to read, write, and understand English; 4) unmarried; and 5) both the adolescent girl and her mother/female guardian agree to participate. Exclusion criteria included: 1) pregnancy; and 2) no plan to reside in the same area for the next 12 months. All study protocols and instruments were reviewed and approved by the New York University Committee on Activities Involving Human Subjects and the Ethics Committee of the Faculty of Medical Sciences, University of the West Indies, prior to participant recruitment and data collection. Mothers provided signed written informed consents, while daughters signed written informed assent forms.

Data were collected via paper-and-pencil questionnaires. Due to literacy concerns, questionnaires were also projected in the front of the room and read aloud during data collection. Additional individualized reading assistance was provided as needed. The majority (82%) of adolescent participants did not require any individual assistance. The mean completion time for daughters' baseline questionnaires was 65 minutes (SD.13). Participants were provided with modest reimbursements for their participation in each session of the larger study. Daughters received gift cards worth the Jamaican equivalent of $70 U.S. for completing all sessions (two full-day intervention and data collection days and two half-day follow-up data collection sessions); mothers received supermarket vouchers and gift cards worth the equivalent of $140 U.S.


Variables in this study included individual factors (e.g., socio-demographic characteristics, sexual history, substance use, attitudes toward sex and condoms); partner-relationship factors (e.g., multiple partners, most recent partner age, age difference between partners); and family factors (e.g., mother-daughter relationship quality, maternal monitoring, comfort/discomfort with mother-daughter sexual communication). Nearly all of the data were collected from daughters' baseline self-reports. Three measures that relied upon mothers' reports included: mother's age, mother's level of education, and maternal monitoring.

Sexual risk behaviors

Outcome variables of interest included having ever had sexual intercourse (no vs. yes) and condom use at last sex (no vs. yes). Specifically, items were worded: "Have you ever had sex (a boy/man's penis in your vagina)?" and "The last time you had sex, did you use a condom?"

Individual characteristics

Socio-demographic variables of interest included adolescents' and mothers' age and education, adolescents' reports of their parents' marital status and the personal importance of religion. A single item assessed marital status, [End Page 222] "Are your parents currently married to each other?" A single item was also used to assess the importance of religion: "How important is religion to you?" Response choices ranged from 1 "not important" to 3 "very important." Sexual history items included reports of age at first sex (in years), sex within the past three months (no/yes), and number of sexual partners, "How many boys/men have you had sex with in your lifetime?" This item was later recoded to represent multiple sexual partners as 0 (none or one) and 1 (two or more).

A brief four-item scale was adapted from Jemmott, Jemmott and Fong30 and used to assess attitudes toward condom use. The four items were: 1) "Condoms reduce pleasure during sex"; 2) "If I say we have to use a condom, my partner/boyfriend will think I am having sex with other people"; 3) "Asking my partner/boyfriend to use a condom is like saying, 'I don't trust you'"; and 4) "If I had a condom with me, my partner/boyfriend would not like it." Respondents were asked to indicate their agreement with each item on a five-point scale ranging from 1 (disagree strongly) to 5 (agree strongly). Reverse-worded items were recoded prior to summing scores. Total possible scores ranged from 4-20, with higher scores indicating more positive attitudes toward condom use. A reasonable internal validity was found in the current study (α=.65).

Alcohol and drug use in the past three months was assessed using items adapted from the Risk Assessment Battery (RAB).31 The three questions used parallel phrasing: "In the past three months, how often did you drink beer, wine or liquor?," ". . . smoke marijuana or ganja?," and ". . . use cocaine, methamphetamines or other drugs?" The five response choices ranged from 1 "never" to 5 "every day." Responses were dichotomized as 0 "did not use" and 1 "used."

Partner characteristics

These included: having sex with older or 'Big' men, and most recent partner's age at last sex (in years). Age differences between the adolescent respondents and their most recent sexual partners were calculated. Respondents were asked: "who have you had sex with?" The response choices were: 1 "only with boys near my own age," 2 "only with older men or 'Big' men," and 3 "both—boys my own age and older men or 'Big' men." The responses 2 and 3 were combined for the analysis (0 = sex with boys only; 1 = sex with older or 'Big' men).

Parent/mother characteristics

The quality of the mother-daughter relationship was measured with two subscales (Involvement and Communication) adapted from the Parent-Child Relationship Inventory.32 These subscales have been used extensively and have shown consistent reliability. Coefficient alpha values reportedly range from .70 to .88 with a rest-retest reliability of .68 to .93.33 An example of an item was: "When I have a problem, I talk to my mother." A global item of relationship satisfaction was added, yielding a total of 14 items. Response choices for each of the items ranged from 1 (disagree strongly) to 5 (agree strongly). Reverse-worded items were recoded prior to summing the scale scores. Higher scores indicated more positive relationships. Good internal validity was found in this study (α=.88).

Maternal monitoring was assessed with a 10-item version of the Parental Monitoring Scale.34 The scale used a five-point Likert response format and items were summed. Higher scores indicated greater parental monitoring. A typical item was worded: "When my daughter goes out, I ask her where she is going." Response choices ranged from 1 (never) to 5 (always). Four additional items were added to the original scale based [End Page 223] upon early focus group work with Jamaican adolescents and parents. Internal validity for the 10-item version was acceptable in this study (α=.76).

Three questions measured how easy or comfortable it was for daughters to talk to their mothers about sexual topics including condom use: 1) "How hard or easy would it be for you to talk to your mother about getting and using condoms?"; 2) "How hard or easy would it be for you to talk to your mother about sex?"; and 3) "How comfortable are you when you talk to your mother about sexual topics?" Responses for the first two items ranged from 1 (very hard) to 5 (very easy); responses for the third item ranged from 1 (very uncomfortable) to 4 (very comfortable). Total possible scores ranged from 3-14; these summed total scores were included in the analyses. A higher score indicated greater ease or self-efficacy for communicating with mother. Good internal validity was found in the current study (α=.75).

Data analysis

Data were entered into a password-protected database and analyzed using IBM SPSS Statistics 20.0.35 Before conducting multiple logistic regression analyses, bivariate correlation coefficients between all variables were examined. The correlations were also examined to avoid using highly related predictor variables, which could potentially cause issues with multi-collinearity in logistic regression models. Predictors that were associated with the sexual behavior outcomes at p<.10 in bivariate analysis were included in multiple logistic regression models.


As is shown in Table 1, the average age of adolescent participants was slightly less than 15 years. The majority was in school or a training program and lived with their mother or female guardian most of the time. The average age for mothers was approximately 40 years. Most of the mothers (85%) were not currently married to their daughter's father.

Sexual risk and substance use behaviors

About one-third of adolescents reported that they ever had sexual intercourse (Table 1). Among those who reported having sex, the average age at first sex was 14.6 years. More than one-third (34.3%) of those who were sexually experienced reported having two or more sexual partners. Almost one-fifth (18.4%) reported having sex with older or 'Big' men. Nearly three-quarters (70%) of those who ever had sex reported that they had sex in the past three months. Sixty-nine percent reported using a condom at last sexual intercourse.

More than half (53%) of all participants reported using alcohol in the past three months; 10% reported using marijuana (ganja) during the same time period. Most (94%) of those who used marijuana also used alcohol; 0.6% used marijuana and other drugs.

Partner and family characteristics

As is shown in Table 1, the average age of the most recent sexual partner was slightly less than 18 years. Partners ranged in age from 12 to 31. Approximately one-fifth (17%) of participants reported that their most recent sexual partner was four or more years older than they were; age differences ranged from (-1 to 15). Negative age differences indicate that the male partner was younger than the female participant. This occurred in eight cases.

Table 1 also presents means and standard deviations for the reported quality of mother-daughter relationships, comfort talking to mothers about sexual topics and mothers' reports of monitoring. [End Page 224]

Sample Characteristics (N=330)
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Table 1. 

Sample Characteristics (N=330)

Bivariate associations between characteristics, ever having sex and condom use

As is shown in Table 2, there were several factors significantly associated with ever having had sexual intercourse. They included older age (r=.43, p<.001), alcohol use (r=.11, p<.04), marijuana use (r=.16, p<.001), discomfort talking to mother about sexual topics (r=-.17, p<.001), and lack of maternal monitoring (r=-.12, p=.03). Those who [End Page 225] had ever had sex also tended (p<.10) to have more positive attitudes toward condoms (r=.10, p<.07) and less positive mother-daughter relationships (r=-.10, p<.06).

There were significant bivariate associations between condom use at last sex and participants' perceived importance of religion (r=.21, p<.05) and attitudes toward condom use (r=.35, p<.001); negative associations were found with age (r=-.19, p<.05), multiple sex partners (r=-.35, p<.001), most recent partner's age (r=-.22, p<.05), and alcohol use (r=-.24, p<.01) (Table 2). Older teens, those who had multiple sexual partners, those with older partners, and those using alcohol were less likely than their counterparts to use condoms. Marijuana use was negatively and marginally (r=-.16, p<.10) related to condom use.

Multiple logistic regression models

Variables associated with each of the two dependent variables at p<.10 in bivariate analysis were entered into multiple logistic regression models (Table 3). After adjusting for the effects of other factors, older age (AOR=2.42, p<.001) and marijuana use (AOR=2.30, p<.05) were significantly related to adolescents' sexual experience (i.e., ever had sex). Comfort talking to the mother about sexual topics was significantly associated with less likelihood of being sexually experienced (AOR=.86, p<.01); maternal monitoring was moderately related to teens' sexual abstinence (AOR=.96, p<.06).

Bivariate Associations With Having Ever Had Sex and Condom Use at Last Sex
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Table 2. 

Bivariate Associations With Having Ever Had Sex and Condom Use at Last Sex

[End Page 226]

Logistic Regression on Having Ever Had Sex and Condom Use at Last Sex
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Table 3. 

Logistic Regression on Having Ever Had Sex and Condom Use at Last Sex

Condom use at last sex was significantly and positively related to importance of religion (AOR=5.81, p=.001) and attitudes toward condom use (AOR=1.32, p=.01), but negatively to multiple sex partners (AOR=.08, p=.01). Those who had multiple sexual partners were less likely than others to use a condom at last sex. Moderately (p=.10) negative relationships between condom use and partner's age at last sex (AOR=.83) and marijuana use (AOR=.27) were also found. Those with older sexual partners and those who used marijuana were less likely to use condoms the last time they had sex.


Sexual experience among Jamaican adolescent girls

Approximately one-third of the sample reported that they have ever had sexual intercourse, and nearly three-quarters of sexually experienced girls were currently sexually active. Among those who were sexually experienced, the average age at first sex was between the ages of 14 and 15. According to Figueroa and associates1 and the 2008 Hope Enterprise KAP Survey,36 the median age at first sex for Jamaican girls is just under age 17. However, these results are island-wide. The participants in this study all came from urban communities around Kingston, where sexual debut may occur earlier than in more rural areas. However, [End Page 227] given that two-thirds of our participants had not yet initiated sex, the results cannot be meaningfully compared to the national averages.

Characteristics that were associated with having engaged in sexual intercourse in the bivariate analysis included older age, alcohol use, marijuana use, discomfort in talking to mother about sexual topics and lower levels of maternal monitoring. The logistic regression findings were largely consistent with the bivariate analysis. While controlling for other characteristics, age, marijuana use, and discomfort talking to mothers about sexual topics were significantly associated with sexual experience. Maternal monitoring was only marginally significant.

The finding that older girls were more likely than younger girls to report having engaged in sexual intercourse was not at all surprising. The associations between marijuana use and sexual experience were consistent with earlier studies in the U.S.37 that have consistently linked substance use and sexual risk behavior. Alcohol use was no longer significantly associated with sexual debut when marijuana use was controlled; this may be due to the extensive overlap between marijuana and alcohol use (90% of marijuana users also drank alcohol).

Sexual experience was also significantly associated with maternal characteristics. Both monitoring and comfort with mother-daughter sexual communication were significant in bivariate analysis. A lack of parent monitoring has previously been found to be a significant factor in teens' risk-taking behaviors such as unprotected sexual intercourse,20 STI acquisition,20 and drug use.38 However, maternal monitoring was no longer significant at the p<.05 level when the multivariate model included comfort discussing sexual topics with the mother. Although this finding suggested that parental monitoring may assist adolescents to delay their sexual debut, any such benefits may have been mediated through comfort with mother-daughter sexual communication.

U.S. studies have found that mother-daughter sexual communication and comfort with sexual communication were associated with delays in sexual initiation and less sexual activity among adolescent girls,23 ,24 and may moderate peer influences to have sex.26 Comfort with parent-teen sexual communication has also been associated with sexual communication and negotiation with sexual partners.39

Condom use

Although older girls were more likely to be sexually experienced, they were not more likely to use condoms. Nearly one-third of those who were sexually experienced reported not using a condom the last time they had sex. Characteristics associated with unprotected sex in the bivariate analysis included alcohol use, multiple sexual partners, and older sexual partners. Religiosity and positive attitudes toward condoms were both associated with greater likelihood of condom use at last sex. In the multiple logistic regression analysis, the relationships between the dependent variable and religiosity, attitudes toward condom use, and multiple sex partners remained significant (p<.05). In addition, marijuana use and older sexual partner were marginally associated with unprotected sex.

Although mother/parenting characteristics (e.g., comfort with mother-daughter sexual communication) were associated with adolescent sexual experience (versus sexual abstinence), interestingly, none of the mother/parenting characteristics were associated with condom use. Maternal characteristics seemed influential in terms of whether sex [End Page 228] occurred; however, during sexual interactions with partners, maternal influences were absent. Although studies have found that parenting behaviors influence the likelihood of condom use in U.S. adolescents,19 ,24 ,40 the cultural norms and intradyadic gender-power dynamics within Jamaica may be significantly different than in the U.S. Thus, mothers may be able to exert more influence over their daughters' sexual debut and sexual activity, through communication and monitoring, rather than influence condom use once the adolescent is in a sexual situation. Besides parental influence, several studies have shown the importance of partners and peers, for example, partners' positive attitudes toward condom use41 and peer norms as supportive of condom use.42 The absence of significant maternal influences may also reflect a lack of analytic power, as only one-third of the participants (n=106) were sexual experienced and included in analyses of condom use.

The findings related to substance use were consistent with the existing literature. Previous research has consistently found relationships between sexual risk behaviors and substance use.37 As was the case for the model of sexual experience, alcohol use was no longer significant in the multivariate model that included marijuana use.

Similarly, associations between having older sexual partners, multiple sexual partners and unprotected sex have been reported in earlier U.S. studies.43 However, unlike U.S. studies that have found increases in sexual risk outcomes among adolescent girls whose partners are several years older than they,43 ,44 age differences were not significant in the current study. Rather, the partner's own age was associated with reductions in condom use in both bivariate and multiple logistic regression analyses, although the association in the latter was only marginally significant. This finding may reflect transactional relationships between the adolescent girls and "older" boys or men who have jobs, cars, and/or other resources.10 If the adolescent participant was about 15-years-old and the partner was 18, the age difference may not seem important. However, if the 18-year-old has a car and income, he could be viewed as a highly desirable partner or even a "Big Man."10 In this case, older partners or "Big" men imply men who could provide economic or other resources to girls, regardless of the partner's age. Given that gender inequalities and male-dominated relationship dynamics have already been cited as social contributors to the HIV/AIDS epidemic within Caribbean countries,2 ,10 ,15 ,45 a slightly older male partner with resources may be able to wield even more disproportionate power within a relationship with a young girl. These type of exacerbated power differential have been documented in young girls' transactional relationships with older men in Sub-Saharan Africa.46 ,47

The significant relationship of religiosity (i.e., importance of religion) to condom use found in this study is of interest as a cultural factor among Jamaican adolescent females. A similar finding of an association between reduced sexual risk behaviors and frequent attendance at religious services by Jamaican adolescents was recently reported.12 These findings highlight the potential for early interventions administered through religious organizations.


The data in this study were collected by self-reports. While self-reports are sometimes criticized for biased recall and social desirability in responses, they are the standard for collecting data related to sexual behavior, relationships and attitudes. [End Page 229] The current study employed several strategies to enhance the reliability of self-reports, including reporting drug use behaviors over short periods of time (e.g., three months) and reporting event-specific condom use (e.g., at last sex) to limit recall error and bias.48 In addition, confidentiality and social responsibility motivations were emphasized in data collection procedures to reduce social desirability in reporting.30

The use of a convenience sample of urban Jamaican adolescent girls may generate concerns regarding generalizability. However, the sample was large, diverse, and drawn from a variety of neighborhoods in Kingston, Jamaica and its adjacent parishes. As such it presents no threats to the internal validity of the study's findings.49 Most importantly, the cross-sectional nature of the data precludes any causative conclusions.

Although the present study was an analysis of cross-sectional data, it identified important risk-promoting and protective factors that were associated with Jamaican adolescent females' sexual experience and use of condoms. Although some of the results were consistent with earlier U.S. findings, notable differences were also found. For example, maternal characteristics were only associated with abstinence and sexual experience, not with condom use. The study findings highlighted the need for further investigation using longitudinal designs and identified individual, parent and partner characteristics that should be addressed in the design of multi-level interventions to reduce HIV-related sexual risk in Jamaican adolescent girls.

Sung-Yeon Kang, M. Katherine Hutchinson and Norman Waldron  

The authors are a Research Scientist [S-YK] and an Associate Professor [MKH] at New York University College of Nursing, 726 Broadway, New York, NY 10003; and a Lecturer in the Department of Community Health and Psychiatry, The University of the West Indies, Kingston 7, Jamaica [NW].

Please address correspondence to Sung-Yeon Kang, New York University College of Nursing, 726 Broadway, 10th Floor, New York, NY 10003; skg2@nyu.edu.


This study was supported by a grant from the National Institute of Nursing Research (R01 NR010478; M.K. Hutchinson, PI).


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