Prevention Science, Vol. 5, No. 3, September 2004 (
Self-Concept and Adolescents’ Refusal of Unprotected Sex: A
Test of Mediating Mechanisms Among African American Girls
Laura F. Salazar,
Ralph J. DiClemente,
Gina M. Wingood,
Richard A. Crosby,
Edward W. Hook, III,
and M. Kim Oh
During adolescence, girls form self-concepts that facilitate the transition to adulthood. This
process may entail engaging in risky sexual behaviors resulting in STD infection and pregnancy.
This study assessed the relation between self-concept and unwanted, unprotected sex refusal
among 335 African American adolescent girls. The second aim was to determine whether
attributes of partner communication about sex would act as a mediating mechanism on this
hypothesized relationship. These assessments were made within the context of several the-
oretical models (social cognitive theory and theory of gender and power). Self-concept was
composed of self-esteem, ethnic identity, and body image, whereas attributes of partner com-
munication about sex was conceptualized as frequency of communication, fear of condom use
negotiation, and self-efﬁcacy of condom use negotiation. Structural equation modeling was
used to analyze data. The results showed that self-concept was associated with partner com-
munication attributes about sex, which in turn, was associated with frequency of unprotected
sex refusal. The hypothesized mediating role of partner communication was also supported.
STD-HIV preventive interventions for this population may be more effective if they target
self-concept as opposed to only self-esteem, incorporate an Afrocentric approach, and focus
on enhancing several attributes of partner communication about sex.
KEY WORDS: STDs; pregnancy; self-concept; African American females; sexual behavior.
Sexually transmitted diseases (STDs), includ-
ing human immunodeﬁciency virus infection (HIV),
among teenagers represent a serious public health
problem in the United States (Boyer & Kegeles,
1991; Eng & Butler, 1997). Teenagers are more likely
Department of Psychiatry and Behavioral Sciences, School of
Medicine, Emory University, Atlanta, Georgia.
Department of Behavioral Sciences and Health Education,
Rollins School of Public Health, Emory University, Atlanta,
Department of Pediatrics, School of Medicine, University of
Alabama at Birmingham.
Department of Health Behavior, School of Public Health, Univer-
sity of Alabama at Birmingham.
Division of Infectious Diseases, Department of Medicine, School
of Medicine, University of Alabama at Birmingham.
Correspondence should be directed to Laura F. Salazar, Behav-
ioral Sciences and Health Education, Rollins School of Pub-
lic Health, 1518 Clifton Road, N.E., Emory University Atlanta,
Georgia 30322; e-mail: firstname.lastname@example.org.
than other age groups to have unprotected sex, to
have multiple sex partners, and particularly for young
women, to choose older sex partners (Centers for
Disease Control and Prevention [CDC], 2001; Valois
et al., 1999). Estimated prevalence rates for speciﬁc
STDs among teens and young adults (i.e., <25 years
old) vary markedly; from 5 to 10% for chlamydia, 28
to 46% for human papillomavirus (HPV), and 15 to
20% for genital herpes (CDC, 2001).
Although STD rates among adolescents are
higher relative to other age groups, they are not uni-
form among adolescents. STD rates tend to be dispro-
portionately higher among African American adoles-
cent girls relative to same-age Caucasian counterparts
attributable, in some degree, to higher rates of poverty
and lack of access to quality health care (Boyer &
Kegeles, 1991; CDC, 2002). Because the sequelae of
STD infection in females are especially problematic
and costly (Berman & Hein, 1999; Bolan et al., 1999;
2004 Society for Prevention Research