Biney and Dodoo BMC Public Health  (2016) 16:9 
DOI 10.1186/s12889-015-2620-6
RESEARCH ARTICLE Open Access
What are the characteristics of ‘sexually
ready’ adolescents? Exploring the sexual
readiness of youth in urban poor Accra
Adriana A. E. Biney1* and F. Nii-Amoo Dodoo1,2
Abstract
Background: Adolescent sexual activity, especially among the urban poor, remains a challenge. Despite
numerous interventions and programs to address the negative consequences arising from early and frequent
sexual activity among youth in sub-Saharan Africa, including Ghana, only slight progress has been made.
A plausible explanation is that our understanding of what adolescents think about sex and about their own
sexuality is poor. In that sense, examining how adolescents in urban poor communities think about their
sexual readiness, and identifying characteristics associated with that sexual self-concept dimension, should
deepen our understanding of this topical issue.
Methods: A total of 196 male and female adolescents, ages 12 to 19, were surveyed in the 2011 RIPS Urban
Health and Poverty Project in Accra, Ghana. The youth responded to three statements which determined their
levels of sexual readiness. Other background characteristics were also obtained enabling the assessment of
the correlates of their preparedness to engage in sex. The data were analyzed using ordered logistic
regression models.
Results: Overall, the majority of respondents did not consider themselves ready for sex. Multivariate analyses
indicated that sexual experience, exposure to pornographic movies, gender, ethnicity and household wealth
were significantly linked to their readiness for sex.
Conclusion: Sexual readiness is related to sexual activity as well as other characteristics of the adolescents,
suggesting the need to consider these factors in the design of programs and interventions to curb early sex.
The subject of sexual readiness has to be investigated further to ensure adolescents do not identify with any
negative effects of this sexual self-view.
Keywords: Sexual readiness, Sexual self-concept, Adolescent sexual health, Urban poverty, Ghana
Background childbirth as they are more prone to maternal mor-
Adolescent sexual activity is “a fact of life in most bidity and mortality due to their physiological imma-
African countries, as in many western societies” [1]. turity [4–7]. Infant and child deaths are also likely to
However, despite the fact that early sex is a global occur to adolescent mothers [3]. Furthermore, there
phenomenon, African nations may be most affected by is a relationship between young girls’ sexual activity
its consequences [1–3]. Early sexual initiation exposes and their school dropout rates [8]. Thus, additional
adolescents to increased risks of STI/HIV infection, consequences of early sex include female (and some-
unintended pregnancy, and unsafe abortion. In addition, times male) adolescents discontinuing school once a
the health of young girls is compromised during pregnancy occurs [5, 9]. Low educational levels re-
duce the scope of employment opportunities for these
adolescents rendering them eligible only for low-
* Correspondence: abiney@rips-ug.edu.gh
1Regional Institute for Population Studies, University of Ghana, P. O. Box income occupations in future [5, 10].
LG96, Legon, Accra, Ghana
Full list of author information is available at the end of the article
© 2015 Biney and Dodoo. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Biney and Dodoo BMC Public Health  (2016) 16:9 Page 2 of 11
A group of adolescents that requires special attention interventions see their sexual selves, which is a useful
comprises those living in urban poor communities. This first step in intervening in their unsafe actions, this
is a vulnerable group, especially susceptible to sexual study attempts to explore which characteristics of ado-
and reproductive health challenges as a result of the lescents are related to one dimension of their sexual
combined effect of poverty and the urban environment self-concept, sexual readiness [21–28].
[11–14]. In sub-Saharan Africa, studies conducted in
urban poor communities in Kenya and Ghana have re- Sexual self-concept and sexual readiness
ported early ages at first sex, multiple sexual partner- The sexual self-concept is “an individual’s view of him-
ships, teenage pregnancy, and youth resolving some of or herself as a sexual person” [25] and has a cyclical
their unintended pregnancies with induced abortions relationship with one's sexual intentions, actions, experi-
[11, 12, 15, 16]. In Ghana, the proportion of adolescent ences [25], and mental health [29]. Most research on
childbearing slightly increased from 13.3 % in 2008 to sexual self-concept has been conducted among generally
14.2 % in 2014 [6, 17]. The total abortion rate stands at Caucasian, middle income, well-educated, suburban
0.4 abortions per woman, with double the number of youth in developed countries. Few studies have assessed
abortions occurring to women in the urban settings (0.6 the sexual self-concepts (SSC) of adolescents in urban
abortions per woman) compared to rural women (0.3 poor communities (exceptions to this are [25, 30]) and
abortions per woman). In addition to this, adolescents very few have studied the sexual self-concepts of youth
are more likely to terminate their pregnancies unsafely in developing countries (the few exceptions were con-
[18, 19]. Results from the 2010 Edulink: Urban Health ducted in Taiwan by [31–33]). Although its methods of
and Poverty study, conducted in urban poor localities in measurement vary and can become complex [34], the
Accra, show that about four out of five women had their SSC is considered a useful means to aid in understand-
first sexual encounter during adolescence compared to ing adolescent sexual behavior.
63 % of men. This is comparable to the proportions of A variety of factors come together to shape young
women and men in Ghana who stated the same; about peoples’ sexual self-views [35]. The literature suggests
77 % of females and 56 % of males [6, 20]. Young that certain "environmental influences" may be linked to
women and men in this community also encountered the sexual self-concepts of adolescents and young adults
unintended pregnancies, and half reported inducing or [36]. The influences can emanate from one’s social envir-
attempting to induce an abortion to resolve that preg- onment or from significant people [36]. Demographic
nancy. As expected, condom usage among this group characteristics, such as gender and age, can lead to
was low, with two-thirds reporting non-use the last time differences in sexual self-views. While boys and older
they had sex [20]. As the high rate of urbanization con- adolescents report more sexually adventurous views,
tinues to city populations in Africa, and the majority of their female and younger counterparts exhibit more
adolescents settle in urban poor communities, these sexually naïve sexual self-concepts1 [22]. Other’s state
will have implications for the country’s population pro- that males reported less sexual self-efficacious and -es-
cesses, and economic development. Thus, improving teem views compared to females [26]. Even more studies
the reproductive health of adolescents in these commu- suggest no such differences between boys and girls, but
nities is essential. highlight age differentials [21, 25, 34]. Socio-cultural
To combat the ills of early entry into sexual activity, characteristics such as religion and ethnicity also play a
frequent sexual activity, multiple sexual partnerships, role in shaping their sexual self-concept, through them
and thereby the risk of induced abortions among adoles- developing a fear of sexual expression and exhibiting
cents, numerous interventions have been effected in sexual anxiety, respectively [26, 37].
developing countries. Yet, the continuing prevalence of Significant people in adolescents’ lives include their
these problems signals the ineffectiveness of these inter- parents or peers, who through conversation communi-
ventions for eliminating these concerns in sub-Saharan cate their permissive views about sex, this can lead to
Africa. One consideration is that, despite the clear ad- them forming "arousable" and "agentic" sexual self-
verse implications for their physical health, educational concepts that may result in risky sexual behaviors,
and occupational chances, and general wellbeing, we including initiating sex early [25]. Parents’ demographic
simply do not understand why adolescents conduct characteristics (e.g. their marital status) and socioeco-
themselves in the manner they do. Indeed, it is difficult nomic characteristics (e.g. their education and income)
to change people’s behavior without an understanding of are linked to adolescents’ sexuality [38]. In the literature,
the logic that undergirds their actions. This would parents with high levels of education and/or income are
appear to be more critical when multiple and varied in- seen to offer closeness, warmth, monitoring and protec-
terventions have proven to have limited successes. In tion [38, 39]. This has been linked to less sexual activity
order to discern how the beneficiaries of the intended among adolescents and accordingly suggests less “assertive”
Biney and Dodoo BMC Public Health  (2016) 16:9 Page 3 of 11
and “agentic” sexual self-views. The statement holds true engage in sexual intercourse, is not a comprehensive
for those residing with their parents, and especially in two- enough measure [42]. If readiness is that gateway to
parent homes [38]. sexual activity, it connotes an important function pre-
This paper is part of a larger study that sought to ceding their first sex, and if not addressed properly may
develop and assess a sexual self-concept scale for adoles- prolong the harmful consequences of adolescent sex that
cents in an urban poor community in Accra [20]. The youth in sub-Saharan Africa continue to experience. In
paper seeks to answer one question: What are the corre- addition, going further to identify characteristics related
lates of one critical aspect of adolescent sexual self- to their sexual preparedness should lead to ideas on who
concept: “sexual readiness”? Sexual readiness has been to target with further research and education, as well as
linked to motivations to either remain abstinent or initi- appropriate interventions and programs. Other studies
ate sex among adolescents [40, 41]. In these qualitative have failed to assess the range of social factors, whether
studies, the subject of readiness emerges from discus- demographic, economic, cultural, or family that may be
sions as an intermediary factor on the developmental associated with and ultimately contribute to sexual
continuum, providing that entry from abstinence into readiness. Therefore, the study seeks to investigate this
sexual activity [40]. It is a multifaceted concept consist- as we contribute to the discussion on sexual readiness
ing of individual characteristics such as the adolescent’s among a sample of adolescents residing in urban poor
mental, emotional and physical development, age, and Accra. To our knowledge this is the first paper that
social maturity; in essence, it suggests one's prepared- examines this sexual readiness component of the sex-
ness to engage in sex and handle the consequences that ual self-concepts of urban poor adolescents in sub-
may arise. Relationship characteristics that equate one to Saharan Africa.
being ready for sex include being with the right person,
which could be either in marriage or in a committed or
stable relationship [40–42]. Readiness also has a moral Methods
component, according to the adolescents, where the Data
difference between remaining abstinent and initiating This paper uses data from the 2011 RIPS Urban Health
sexual activity lies in one’s beliefs about premarital and and Poverty Project.2 The main study was conducted in
adolescent sex as being right or wrong. Although sexual three urban poor localities in Accra (James Town,
readiness may determine whether one starts sex or not Ussher Town and Agbogbloshie) surveying men and
[42], sexually experienced adolescents may also view women in their reproductive ages (15 to 49 years for
themselves as “not ready”. These research works, typic- women and 15 to 59 years for men). Adolescents
ally conducted among African American, low income, between ages 12 and 14 residing in sampled households
urban dwelling boys and girls, provide a sense of what in James Town and Ussher Town were also interviewed
develops their sexual readiness. as an appendage to the survey. These early adolescents
Other studies, using survey data, have defined and were interviewed with a shortened version of the
measured sexual readiness by adopting frameworks and main questionnaire that focused on their background
approaches useful for those contexts. While some have characteristics, sexual self-concept, and sexual experi-
assessed adolescents’ stages of sexual readiness and ences and behaviors.
defined them as a function of sexual thoughts, intentions Sampling of respondents was conducted at two levels:
and actions [7, 43], others took into account adolescents’ first, 29 enumeration areas (EAs) in the three localities
sexual willingness, autonomy, lack of regret and contra- were selected, and from each of these 40 households
ceptive use [28], which is actually a reflection of their were systematically sampled. This resulted in a total
sexual competence. The concept of readiness encom- study sample of 806 households and 1055 individuals
passes an array of ideas and renders it a very broad topic (with ages ranging from 12 to 59). However, for this
that is difficult to define, and these complexities warrant paper, 196 male and female adolescents between ages 12
further investigation on the subject. A major weakness and 19, residing in James Town and Ussher Town,3 are
in the literature is that sexual readiness has no set defin- used in our analyses. The majority of respondents resid-
ition. In this study, we have identified and incorporated ing in this setting affiliate with the Ga ethnic group.
in our measure of readiness key concepts from the exist- These are indigenous residents of the locality, a patrilin-
ing literature: their preparedness to engage in sex, eal people that were believed to have migrated from
maturity, and moral views, which are all critical elements Nigeria to Ghana in the 14th century [15]. The towns
that reflect adolescent sexual self-views. These three are by the coast, and thus, the major economic activ-
concepts together provide a more holistic understanding ities practiced include fishing, fish mongering, in
of their perceptions, further validating the measure, addition to trading, and food vending. The second
especially since solely asking about their readiness to largest ethnic group in this community consists of the
Biney and Dodoo BMC Public Health  (2016) 16:9 Page 4 of 11
Akans, a matrilineal group, who form more than half of Table 1 Percentage distribution of sexual readiness items
Ghana’s population [15]. Items Frequency Percent (%)
Ethical clearance to conduct the study was provided Ready for sex
by the Noguchi Memorial Institute for Medical 0 153 78.1
Research—Institutional Review Board (NMIMR-IRB) at
1 13 6.6
the University of Ghana, Legon in July 2011. We admin-
istered assent or consent forms to adolescents, and 2 30 15.3
further obtained consent from parents or caregivers for Not young for sex
adolescents below age 18, prior to the interviews. Our 0 135 68.9
study protocol and practice in the field ensured we 1 8 4.1
provide our respondents’ with privacy during the 2 53 27.0
interview, their information was kept confidential, and
Not wrong for sex
small gifts consisting of household items worth about
US$3 were distributed after interviews in the entire 0 137 69.9
locality were completed. 1 12 6.1
2 47 24.0
Measurements Total 196 100.0
The dependent variable is sexual readiness, a composite Source: RIPS Urban Health and Poverty Project, 2011
of the following three items: (1) I think I am ready for 0-disagree; 1-neutral; 2-agree
sex; (2) I think I am too young to have sex; and (3) I
think it is wrong for me to have sex.4 These three items Akan, and Other. Significant people influences were
were part of a 27 item sexual self-concept inventory, and measured by family characteristics which include the
all 27 items were carefully selected from 13 extant sexual respondent’s mother’s highest educational level, his/her
self-concept scales. The initial five-category response for current living arrangement, parents’ current marital
each item, ranging from 1 (strongly disagree) to 5 status, the sexual communication (or lack thereof ) that
(strongly agree), was re-coded to create a three-category takes place in the household, and the household wealth.
response indicating 0 (disagree), 1 (neutral) and 2 This wealth measure was computed using assets owned
(agree). The three items loaded heavily (above the value by each household (for example, a radio, television, car,
0.49) on one factor, ensuing exploratory factor analysis, mobile phone, fishing net, etc…), in addition to the ma-
and were summed to create the composite sexual readi- terials used to construct the homes they dwelled in. The
ness variable which ranges from 0 to 6. The scores items underwent principle components analysis (PCA)
indicate that the higher the response, the more the ado- and a wealth index was created using the first factor.
lescent believes he or she is ready for sex. The ordinal The index was then grouped into quintiles, and the low-
alpha value for the scale was 0.81. For a more detailed est 20 % in the index were labeled as the poorest respon-
process on how the sexual readiness construct was dents, the poorer respondents were the next lowest
developed see Biney [20]. Descriptive statistics of the 20 %, this ran through to the richest being the top 20 %
latent variable and sexual readiness items are displayed in the index.
in Tables 1 and 2. Overall, the majority of adolescents
were not ready for sex (54.1 % scored ‘0’), while 5.6 %
scored ‘6’, indicating a readiness for sex. Analyses techniques
The sexual characteristics of respondents include their Descriptive statistics were used to assess the characteris-
coital experiences (whether they ever had sexual inter- tics of respondents using percentages along with cross-
course with a member of the opposite sex) and negative tabulations by gender. Pearson chi-square tests were
sexual encounters (whether they were forced to have sex employed to indicate the factors that differed significantly
or forced to engage in a sex act but not have sexual with gender. Ordinal (or ordered) logistic regression
intercourse). In addition, their exposure to pornographic analysis was the main statistical technique used since the
movies denotes whether the respondent ever watched a dependent variable was an ordered scale ranging from 0
pornographic movie or not. (not sexually ready) to 6 (very sexually ready). We exam-
Socio-demographic characteristics include the age, ined associations between the socio-demographic, socio-
gender and highest educational level of the respondent. cultural, family, and sexual characteristics of adolescents,
Socio-cultural variables comprise of their religiosity, and the sexual readiness dimension of their sexual self-
measured by number of religious services attended in a concept. Results are displayed as odds ratios. The
month, the locality the respondent resides in, and his/ statistical software package STATA was employed to
her ethnicity, which was categorized as Ga/Dangme, undertake the analyses.
Biney and Dodoo BMC Public Health  (2016) 16:9 Page 5 of 11
Table 2 Percentage distribution of sexual readiness, background Table 2 Percentage distribution of sexual readiness, background
and sexual characteristics of respondents by gender and sexual characteristics of respondents by gender (Continued)
Characteristics Total Female Male Never married 22 11.2 13 12.8 9 9.6
Freq % Freq % Freq % Parent(s) dead 39 19.9 22 21.6 17 18.1
Sexual readiness (Dependent variable)
Missing 2 1.0 1 1.0 1 1.1
0 106 54.1 57 55.9 49 52.1
Wealth index
1 5 2.6 2 2.0 3 3.2
Poorest 39 19.9 17 16.7 22 23.4
2 37 18.9 20 19.6 17 18.1
Poorer 42 21.4 22 21.6 20 21.3
3 5 2.6 3 2.9 2 2.1
Middle 39 19.9 18 17.6 21 22.3
4 27 13.8 15 14.7 12 12.8
Richer 37 18.9 22 21.6 15 16.0
5 5 2.6 3 2.9 2 2.1
Richest 34 17.4 20 19.6 14 14.9
6 11 5.6 2 2.0 9 9.6
Missing 5 2.6 3 2.9 2 2.1
Socio-demographic Characteristics
Sexual communication
Age
With parents only 101 51.5 54 52.9 47 50.0
12–14 68 34.7 38 37.3 30 31.9
With friends only 42 21.4 27 26.5 15 16.0
15–17 66 33.7 31 30.4 35 37.2
With both parents and friends 19 9.7 8 7.8 11 11.7
18–19 62 31.6 33 32.4 29 30.9
With other(s) 34 17.4 13 12.8 21 22.3
Highest educational level attained
Sexual Characteristics
Primary and below 65 33.2 36 35.3 29 30.9
Coital experiencea
Junior High School (JHS) 88 44.9 49 48.0 39 41.5
No 156 79.6 75 73.5 81 86.2
Senior High School (SHS) 43 21.9 17 16.7 26 27.7
Yes 40 20.4 27 26.5 13 13.8
Socio-cultural Characteristics
Negative sexual experience
Religious service attendance in past month
No 158 80.6 77 75.5 81 86.2
At least once a week 113 57.6 56 54.9 57 60.6
Yes 38 19.4 25 24.5 13 13.8
At least once a month 39 19.9 23 22.6 16 17.0
Exposure to pornographic moviesa
Never 44 22.5 23 22.6 21 22.3
No 121 61.7 73 71.6 48 51.1
Ethnicity
Yes 73 37.3 28 27.4 45 47.9
Akan 43 21.9 23 22.6 20 21.3
Missing 2 1.0 1 1.0 1 1.1
Ga/Dangme 131 66.8 65 63.7 66 70.2
Total 196 100.0 102 100.0 94 100.0
Other 22 11.3 14 13.7 8 8.5 Source: RIPS Urban Health and Poverty Project, 2011
a
Locality Significantly different by gender at p < 0.05
James Town 78 39.8 41 40.2 37 39.4 Results
Ussher Town 118 60.2 61 59.8 57 60.6 Participants’ characteristics
Family Characteristics A total of 196 youth, ages 12–19 years, residing in James
Mother's highest educational level attained Town and Ussher Town, participated in the study. The
None/Pre-school 30 15.3 17 16.7 13 13.8 background characteristics of the adolescents are shown
in Table 2, and include gender differences which aids in
Primary 28 14.3 12 11.8 16 17.0
simple comparisons of their characteristics by gender.
Secondary 82 41.8 41 40.2 41 43.6 The majority of the respondents were students (73.4 %)
Don't Know 56 28.6 32 31.4 24 25.5 and they were either in (or had completed) junior high
Living arrangements school (JHS). Gender differences reveal that more boys
Parent/parent & relative 146 74.5 74 72.6 72 76.6 than girls were still in school. Also, a higher proportion
Other relative/non-relative/ 47 24.0 26 25.5 21 22.3 of males compared to females had completed—or were
alone currently in—senior high school. About four-fifths of the
Missing 3 1.5 2 2.0 1 1.1 respondents were Christians; and the majority reported
being ‘religious’, that is, they attended a religious service
Parents’ marital status
at least once a week in the month preceding the survey
Currently married 72 36.7 37 36.3 35 37.2 (57.6 %). They mostly resided in Ussher Town (60.6 %)
Not currently married 61 31.1 29 28.4 32 34.0 and were from the Ga/Dangme ethnic group.
Biney and Dodoo BMC Public Health  (2016) 16:9 Page 6 of 11
As indicated in Table 2, the majority of respondents In summary, the backgrounds of the respondents indi-
had mothers who had completed secondary school. Just cate that they are educated, “religious”, Ga-Dangme
over a quarter of respondents did not know the highest adolescents. They reside with one or both parents in
educational levels attained by their mothers. More re- homes categorized as poorer on the wealth index. One
spondents stated that their parents were currently mar- out of every five adolescents had ever had sex or ever
ried (36.7 %), while a similar proportion (31.1 %) stated been coerced into sex or a sexual act. Results also
they were currently not married. Most of the respon- suggest that in this community, females are sexually ex-
dents lived with their parent(s) and more households perienced at earlier ages than males, while males have
were categorized into the poorer wealth quintile. In rela- more exposure to sexually explicit movies. These out-
tion to sexual discussions with parents, more than half comes speak to the vulnerability of young women in the
of the adolescents talked to their parents when they had community who are experiencing higher rates of sexual
sexually related questions or issues. Gender patterns coercion and risky behavior than their male counterparts.5
were similar across the family characteristics, except that
most female respondents did not know their mothers’
educational levels compared to the males. Also, a higher Multivariate analyses
proportion of boys were reported to reside in the poor- Ordered logistic regression results are displayed in
est households than girls (23.4 vs 16.7 %). Finally, a Table 4. Two models were conducted; the first solely
smaller percentage of boys cited discussing their sexual incorporated the three sexual variables and the second
concerns with friends only compared to girls (16.0 vs included the background variables. Although regression
26.5 %). models may be used to predict and establish causality,
The sexual characteristics of adolescents indicate this feature was not important to the study. Rather,
that while one-fifth of them had experienced sexual multivariate analyses were conducted to determine cor-
intercourse, a similar proportion stated that they had relates of sexual readiness upon testing for associations.
ever been forced to engage in a sex act (not necessarily Results from Model 1 show that sexually active respon-
sexual intercourse) or to have sex. Of the 19.4 % who dents see themselves as significantly more sexually ready
stated this occurring, about 58 % had been forced to than their abstinent counterparts. In addition, adoles-
engage in a sex act only, 15.8 % had been raped only, cents with exposure to pornographic movies were more
and 26.3 % had experienced both negative sexual ready than those with none. After including their back-
encounters (see Table 3). A higher percentage of ground characteristics, the outcomes still hold for coital
females stated this (24.5 vs 13.8 %). Also, while close experience and pornographic exposure, where these
to one-half of the boys had ever watched a porno- respondents were also significantly more ready for sex
graphic movie, only just over a quarter of the girls than their peers.
stated the same (Table 2). Their engagement in sexual Three other factors were associated with their sexual
intercourse and their exposure to pornography were readiness. Gender was significantly related to one’s sex-
the only characteristics significantly different by ual self-view, where girls were less ready for sex than
gender. boys. Ethnicity was also a significant correlate of sexual
readiness. The matrilineal Akan ethnic group, found
across middle and southern Ghana, was significantly less
Table 3 Percentage distribution of adolescents who ever
encountered a negative sexual experience; were forced to have ready compared to the patrilineal Ga/Dangmes and
sex, engage in a sex act or both Other ethnic groups (consisting mostly of the Guans,
Ewes and Mole-Dagbanis). In addition, respondents in
Characteristic All Girls Boys
the poorer household wealth quintile were more sexually
Freq % Freq % Freq %
ready than their poorest colleagues. This suggests that
Negative sexual experience the poorest youth in this community are not as ready for
No 158 80.6 77 75.5 81 86.2 sex when compared to the poorer ones.
Yes 38 19.4 25 24.5 13 13.8 Furthermore, as shown in Table 5, the predicted prob-
Total 196 100.0 102 100.0 94 100.0 ability of an adolescent falling into a particular sexual
Negative sexual experience categories readiness category was assessed following regression
analysis. The selected respondents were those with char-
Forced sex only 6 15.8 5 20.0 1 7.7
acteristics that indicated a significantly higher degree of
Forced into sex act only 22 57.9 12 48.0 10 76.9 sexual readiness; specifically, sexually active, pornog-
Forced into both 10 26.3 8 32.0 2 15.4 raphy viewing, poorer, non-Akan males. The probability
Total 38 100.0 25 100.0 13 100.00 of these adolescents falling into the highest category of
Source: RIPS Urban Health and Poverty Project, 2011 ‘6’ on the readiness scale was high at 0.8724, further
Biney and Dodoo BMC Public Health  (2016) 16:9 Page 7 of 11
Table 4 Ordered regression models displaying sexual, socio- Table 4 Ordered regression models displaying sexual, socio-
demographic, −cultural and family correlates of adolescents’ demographic, −cultural and family correlates of adolescents’
sexual readiness sexual readiness (Continued)
Model 1 Model 2 Primary 2.276 0.65–7.99
Characteristic Odds 95 % Odds 95 % Secondary 1.805 0.65–5.02
Ratio Confidence Ratio Confidence
Interval Interval Don't know 0.961 0.32–2.84
Coital experience Living arrangements
No (RC) 1.000 1.000 Parent(s)/parent & 1.000
Yes 9.339*** 4.18 20.88 19.585*** 6.85 56.03 relative (RC)– –
Negative sexual Other relative/non- 1.251 0.57–2.76
experience relative/alone
No (RC) 1.000 1.000 Household wealth
quintile
Yes 1.014 0.47–2.17 1.362 0.58–3.19
Poorest (RC) 1.000
Exposure to
Poorer 3.574* 1.27–10.06
pornography
Middle 1.905 0.65–5.61
No (RC) 1.000 1.000
Richer 0.996 0.29–3.39
Yes 2.043* 1.12–3.73 2.355* 1.07–5.19
Richest 0.821 0.24–2.78
Gender
Parents' marital status
Male (RC) 1.000
Female 0.420* 0.20 0.87 Currently married 1.000–
(RC)
Age group
Not currently 0.452+ 0.18–1.12
12–14 (RC) 1.000 married
15–17 1.031 0.39–2.74 Never married 0.670 0.21–2.11
18–19 0.825 0.26–2.56 Parent(s) dead 1.261 0.46–3.44
Highest educational Sexual
level attained Communication
Primary and below 1.000 With parent(s) only 1.000
(RC) (RC)
JHS 0.790 0.33–1.90 With friend only 0.433+ 0.18–1.06
SHS 0.493 0.16–1.52 With both parents 0.645 0.18–2.29
and friends
Religious service
attendance in past With other(s) 2.268+ 0.90–5.71
month
/cut1 0.859 0.45-1.26 2.422 0.54-4.30
At least once a 1.000
/cut2 0.990 0.58-1.40 2.601 0.71-4.49
week (RC)
/cut3 2.143 1.63-2.66 4.030 2.06-6.00
At least once a 0.914 0.38–2.19
month /cut4 2.342 1.81-2.88 4.293 2.32-6.27
Never 1.301 0.56–3.01 /cut5 3.698 2.98-4.42 5.770 3.72-7.82
Ethnicity /cut6 4.151 3.35-4.95 6.276 4.18-8.37
Akan (RC) 1.000 Source: RIPS Urban Health and Poverty Project, 2011
***p < 0.001; **p < 0.01; *p < 0.05; +p < 0.10; RC = Reference Category
Ga/Dangme 3.427* 1.29–9.07 Model 1: Pseudo R2 = 0.1063, n = 194; Model 2: Pseudo R2 = 0.2085, n = 184
Other 4.212* 1.11–16.04 Proportionality of odds test: Model 1: p > chi2 = 0.9474; Model 2:
p > chi2 = 0. 4705
Locality
James Town (RC) 1.000
indicating, to an extent, that the identified group ex-
Ussher Town 1.776 0.86–3.651 hibits an extreme amount of sexual readiness.
Mother's highest
educational level
attained Discussion
This study sought to identify factors that were signifi-
None/Pre-school 1.000
(RC) cantly associated with an adolescent’s sexual readiness.
In this context, sexual readiness brought together
Biney and Dodoo BMC Public Health  (2016) 16:9 Page 8 of 11
Table 5 Distribution of predicted probabilities of adolescents at their various degrees of sexual readiness for significant variables in
the model
Sexual Readiness ‘Sexually active’ ‘Exposed to ‘Males’ ‘Ga/Dangme’ ‘Other ethnicity’ ‘Poorer wealth’ All significant
Categories only pornography’ only only only only only characteristics
0 0.1074 0.4246 0.4449 0.4547 0.2583 0.3180 0.0031
1 0.0185 0.0444 0.0447 0.0448 0.0359 0.0402 0.0006
2 0.2495 0.3176 0.3105 0.3069 0.3407 0.3414 0.0116
3 0.0635 0.0409 0.0389 0.0379 0.0587 0.0523 0.0045
4 0.3351 0.1271 0.1190 0.1153 0.2147 0.1780 0.0613
5 0.0763 0.0175 0.0162 0.0156 0.0343 0.0266 0.0465
6 0.1498 0.0279 0.0258 0.0248 0.0574 0.0435 0.8724
Source: RIPS Urban Health and Poverty Project, 2011
concepts of being ready, being right and not being too adolescents' sexual self-views also emerged. In her
young to have sex, indicating that views about pre- longitudinal study, Aubrey [40], discovered that
paredness, morality, and maturity are key components among young women, the number of hours of TV
used to assess the readiness dimension of their sexual watched a day, watching primetime dramas and
self-views. These are also individual characteristics watching soap operas were linked to a worsening of
that youth in an inner city US based study mentioned their sexual self-concept [44]. Although her results
as “defining” readiness for sex [40]. More specifically, speak to the influence of less sexually explicit forms
the question that explicitly asks their views on how of media, it does give insight into the role of the
ready they are for sex gives clear indication of how media in portraying sexual scripts that educate ado-
“set” they are to initiate sex [27]. However, results lescents on how to behave in these situations. This
show that not too many adolescents in the study com- instruction could leave them “better equipped” to
munity identified with this sexual self-view as more engage in sexual behavior, with the level of risk they
than half reported no readiness whatsoever. An elem- are engaging in resembling what they have been
ent of culture and societal norms could be driving this exposed to. Again, the inverse relationship could
perception since there is some societal disapproval exist where exposure may result in a feeling of
and shame associated with premarital sex in most readiness or pre-existing readiness could foster the
cultures [39]. But, we do not consider this to fully impulse to view pornographic material. In addition,
explain these views since Ga Mashie is known to be a those who faced negative encounters with sex were
community where sexual activity among young people not more ready than their peers, which could sug-
is not harshly criticized. It is subtly encouraged, espe- gest that their forced exposure to sexual acts and/or
cially among girls, as a survival strategy, which is typ- sexual intercourse had no effect on perceptions
ical in most urban poor settings [11, 15]. This result about their readiness.
needs further examination. Adolescent sexual activity (and pregnancy), according
Our findings show that sexual experience—whether to the rational adaptation theory [45], is a means
through media exposure or from practical experien- through which adolescents derive benefits. It provides an
ce—denotes greater readiness. The result that coital escape from poverty, and gets them into stable relation-
experience is a predictor of sexual preparedness is ships, gives them a home and a family for those who
similar to those found in the sexual self-concept lack parental monitoring and control [1]. Finding that
literature. These studies highlight adolescent and the poorer adolescents had these mindsets was expected;
young adults’ sexual experiences as being signifi- however, it is surprising that the poorest adolescents
cantly linked to sexual self-concepts that denote were not as ready as their less poor counterparts. This
sexual assertiveness, agency, arousability, adventure outcome implies that respondents who are just above
and drive [22, 23, 25]. Since it was not an aim to es- being the most worse off in their community may
tablish causality, the issue of time sequencing was behave differently from those in the other groups by
not considered in assessing the correlates. However, indication of their sexually ready attitudes. Thus, in
the concept of sexual readiness and coital experience targeting youth with programs to improve their repro-
most likely relate bi-directionally. Thus, one’s readi- ductive health, this group should be addressed differ-
ness views could bring about initiation into sex and ently from the others. However, to fully ascertain this,
having had sex could provide that feeling of readi- other variables that can best measure the adolescent’s
ness. The influence of sexually explicit media on household’s wealth and socio-economic status must be
Biney and Dodoo BMC Public Health  (2016) 16:9 Page 9 of 11
used. Another outcome that needs further clarification is parental (or familial) attitudes, and financial and physical
this relationship between ethnicity and sexual readiness. presence variables such as, their permissive views about
The finding that Akans are the ethnic group least ready sex, financial support, monitoring, etc… may suggest
for sex raises questions about assimilation and accultur- "normative standards" for the youth to follow [48]. These
ation of the Akans into an indigenous Ga society. The factors could be masking the effect of age and may
localities under study consist mostly of respondents with ultimately play a role in shaping their sexual self-views
Ga ethnic heritage. In the confines of Accra, this group [39]. With this being the case, the issue of their social
is seen as a people with a pro-natalist affinity, thus the maturity, defined in this context as being prepared for
societal norm would be for them to start relationships adult experiences and consequences, suggests another
and childbearing earlier [15]. Apart from their lineage important predictor of their sexual self-views other than
differences, certain customs and traditions also differ. For age. Despite age, adolescents may have reached certain
example, the Ga tend to practice a duolocal residential milestones that could warrant them the right to deem
system among married people, where husbands and wives themselves sexually ready in their societies.
may still reside in their family homes [15]. This and other The strengths of the study are many. We derived a
cultural differences could result in socialization that new ordinal measure of sexual readiness, that incorpo-
renders some adolescents more sexually ready than others. rated a new means of assessing the readiness sexual self-
The Akans and other ethnic groups can be considered mi- view of both virgins and non-virgins. Our study also
grants, although some may have settled for years in Accra. went further to relate their readiness to adolescents’
It could be that Akan adolescents may not have ascribed characteristics using multivariate analysis, and this
to the same ideals as their Ga counterparts, while the provided the chance to control for the effects of other
Others consisting of smaller ethnic groups may have. In characteristics in our models. We find that net of the
order to test this idea further, variables related to other factors, sexual experience, exposure to pornog-
migration such as duration of stay in the localities as well raphy, gender, ethnicity, and wealth were related to their
as parents’ migration status and attitudes in relation to self-views. Apart from statistically significant gender
sexual readiness need to be examined. differences among pre-teens’ readiness to learn about
Knowing that males consider themselves more sexually sex and engage in sex, no other studies report the find-
ready than females speaks to the gender differentials in ings that we do. Due to these gender differences which
the community, which are similar to global views [7, 27]. seem to be almost universal, they must be considered as
Butler et al. [37] noticed that among a sample of mostly important when considering the needed development
African American preadolescent boys and girls, larger programs targeted at adolescents’ sexual readiness. How-
proportions of boys progressed across the stages of sex- ever, additional studies are needed in order to state
ual readiness after six months while more girls remained further comparisons between our findings and those
stable or retrogressed. In that setting boys initiated sex conducted in the US and UK on sexual readiness. Des-
earlier than girls; however, this is not the case for youth pite this, our study advances the literature on sexual
in the localities under study (as well as across Ghana) readiness through assessing this new measure appropri-
where generally higher proportions of girls start sex pre- ate for the Ghanaian context and identifying which
maturely compared to boys. Despite the later sexual characteristics of urban poor adolescents are ascribed to
debut of boys in our sample, they still deemed them- a particular readiness self-concept.
selves to be more sexually ready than girls. Nonetheless This study is not without its limitations. The small
this outcome was expected since societal norms indicate sample size limited any additional analyses to explore
that girls are raised to think about sex negatively as well the correlates separately by age or gender, which could
as be sexually passive and indifferent [23, 46, 47]. For have shed more light on the factors associated with
boys, on the other hand, the sexual is “central to the adolescents’ sexual readiness. Therefore, extensions to
validation of their masculinity” [23]. this study include administering the sexual readiness
Various dimensions of the sexual self-concept, includ- scale to a larger sample as well as to youth in similar
ing sexual readiness, are thought to be predicated on urban poor localities in Accra to broaden our under-
one’s age [7, 22, 27]. The surprising finding that age was standing of this dimension. However, our limited sample
not significantly associated with their preparedness to size does not discount this study’s contribution to the
engage in sex indicates similar states of sexual readiness literature. It provided exploration of an arena that we
among this sample of early (12 to 14 year olds), middle know little about. Given that it is just as possible to
(15 to 17 year olds) and late (18 to 19 year olds) adoles- commit a type I error in a small sample as in a large
cents. Indeed, key unobserved characteristics may one, the fact that we find something interesting in our
circumvent age to influence their sexual self-views. A results warrants the need for further work in this area.
few that we consider as important for this context are Nevertheless, we recognize that we cannot draw any
Biney and Dodoo BMC Public Health  (2016) 16:9 Page 10 of 11
definitive conclusions from our results. Overall, the re- 3Adolescents between ages 12 and 14 were not
sults helped, to an extent, explore the ‘who is ready for interviewed in Agbogbloshie, hence the 15 to 19 year
sex’ question; however, further research through olds that were interviewed were also not included in
qualitative means is needed to understand why ado- this sample.
lescents with these characteristics perceive their readi- 4Items 2 and 3 were reverse coded into ‘I do not think
ness for sex. In addition, longitudinal data, through I am too young to have sex’ and ‘I do not think it is
panel studies, could provide the appropriate time wrong for me to have sex’. This was done to suggest that
sequencing to aid inference of causality, further ascer- agreement meant adolescents “owned” their sexuality.
taining the relationships between the correlates and 5Further analyses show that a significantly higher
their preparedness for sex. proportion of girls state their first sexual encounter
was with a boyfriend who was older than them. In
Conclusion addition, with the exception of males engaging in sex
Although the majority of adolescents residing in this with more casual partners, females were more likely
urban poor community in Accra report not being sexu- to exhibit risky sexual behavior which was largely
ally ready, characteristics of those that are, include them characterized by their non- or inconsistent use of
being sexually experienced and having some exposure to condoms with sexual partners.
sexually explicit material. Other correlates of their sexual
readiness include being male, non-Akan and in the Competing interests
The authors declare that they have no competing interests.
poorer household wealth quintile. Since these adoles-
cents vary in their degree of sexual readiness, any pro- Authors’ contributions
grams or interventions developed to improve their AAEB drafted the manuscript. AAEB and FNAD conceptualized the study,
made revisions of the manuscript, and approved of the final draft.
sexual and reproductive health by targeting the sexual
readiness dimension must be tailored according to Acknowledgements
adolescents’ diverse characteristics. It is imperative that Earlier versions were presented at the 2013 Population Association of
gender differences in sexual readiness are emphasized America (PAA) Meeting in New Orleans, Louisiana, and the 2014 University of
Ghana Social Science Colloquium in Legon, Accra. The RIPS Urban Health
since they are relevant in varied settings, with boys exhi- and Poverty Project was supported by joint funding from the Hewlett
biting higher levels of readiness than girls. It also Foundation, the International Development Research Centre (IDRC) and
behooves us to further explore this issue of young peo- Research on Obesity and Diabetes among African Migrants (RODAM).
ple’s sexual readiness, which will extend the literature on Author details
protective and risk factors of adolescents sexual behav- 1Regional Institute for Population Studies, University of Ghana, P. O. Box
ior, and the eventual development of appropriate pro- LG96, Legon, Accra, Ghana.
2211 Oswald Tower, The Pennsylvania State
University, University Park, PA 16802, USA.
grams for at-risk adolescents.
Received: 15 August 2015 Accepted: 16 December 2015
Endnotes
1Buzwell and Rosenthal [22] determined five clusters References
representing five distinct sexual self-concept dimen- 1. Meekers D. Sexual Initiation and Premarital Sexual Initiation Childbearing
sions/styles of adolescents. They were categorized into Africa in Sub-Saharan. Popul Stud (NY). 1994;48(1):47–64.
2. Glover EK, Bannerman A, Pence BW, Jones H, Miller R, Weiss E, et al. Sexual
sexually naïve, sexually unassured, sexually adventurous, health experiences of adolescents in three Ghanaian towns. Int Fam Plan
sexually competent and sexually driven groups. They Perspect. 2003;29(1):32–40.
styles were a reflection of their responses on the sexual 3. Ringheim K, Gribble J. Improving the reproductive health of sub-Saharan
Africa’s youth: a route to achieve the millenium development goals
self-esteem, sexual self-efficacy and sexual attitude [Internet]. Washington, DC: Population Reference Bureau; 2010. Available
scales. For example, the sexually naïve adolescents ex- from: http://www.prb.org/pdf10/youthchartbook.pdf.
hibited low sexual self-esteem, low sexual self-efficacy, 4. Manzini N. Sexual initiation and childbearing among adolescent girls in
KwaZulu Natal, Reprod Health Matters. 2001;9:44–52.
and high sexual commitment and anxiety attitudes, 5. Gupta N, Mahy M. Sexual Initiation among Adolescent Girls and Boys: Trends
while the sexually adventurous youth exhibited the and Differentials in Sub-Saharan Africa. Arch Sex Behav. 2003;32(1):41–53.
opposite. 6. Ghana Statistical Service (GSS), Ghana Health Service (GHS), ICF Macro (IM).
2 Ghana Demographic and Health Survey, 2008 [Internet]. Accra, Ghana: GSS,These data are from the second of three waves of a GHS, and ICF Macro; 2009. Available from: http://pdf.usaid.gov/pdf_docs/
project conducted by the Regional Institute for Popula- Pnadq630.pdf.
tion Studies (RIPS), on urban poverty, population and 7. Butler TH, Miller KS, Holtgrave DR, Forehand R, Long N. Stages of sexual
readiness and six‐month stage progression among African American pre‐
health issues. Two of the localities (James Town and teens. J Sex Res Taylor & Francis. 2006;43(4):378–86.
Ussher Town) are considered urban poor settings with 8. Biddlecom A, Gregory R, Lloyd CB, Mensch BS. Associations Between
indigenous Ga residents, while Agbogbloshie is more of Premarital Sex and Leaving School in Four Sub‐Saharan African Countries.
Stud Fam Plann Wiley Online Library. 2008;39(4):337–50.
an informal (slum) settlement consisting of more transi- 9. Grant MJ. Girls’ schooling and the perceived threat of adolescent sexual
ent dwellers. activity in rural Malawi. Cult Health Sex. 2012;14(1):73–86.
Biney and Dodoo BMC Public Health  (2016) 16:9 Page 11 of 11
10. Meekers D, Gage A, Zhan L. Preparing adolescents for adulthood. Popul Res 35. Marston C, King E. Factors that shape young people’s sexual behaviour:
Policy Rev Springer. 1995;14(1):91–110. a systematic review. Lancet. 2006;368:1581–6.
11. Zulu EM, Dodoo FN-A, Ezeh AC. Sexual risk-taking in the slums of Nairobi, 36. Shavelson RJ, Hubner JJ, Stanton GC. Self-Concept: Validation of Construct
Kenya, 1993–8. Popul Stud (NY). 2002;56(3):311–23. Interpretations. Rev Educ Res. 1976;46(3):407–41.
12. Dodoo FN-A, Zulu EM, Ezeh AC. Urban–rural differences in the 37. Wagner J, Rehfuss M. Self-injury, sexual self-concept, and a conservative
socioeconomic deprivation-Sexual behavior link in Kenya. Soc Sci Med. Christian upbringing: An exploratory study of three young women’s
2007;64:1019–31. perspective. J Ment Heal Couns. 2008;30:173–88.
13. Morrison-Beedy D, Jones SH, Xia Y, Tu X, Crean HF, Carey MP. Reducing 38. Abbott DA, Dalla RL. “It”s a choice, simple as that’: youth reasoning for
sexual risk behavior in adolescent girls: results from a randomized sexual abstinence or activity. J Youth Stud. 2008;11(6):629–49.
controlled trial. J Adolesc Heal Elsevier. 2013;52(3):314–21. 39. Bingenheimer JB, Asante EA, Ahiadeke C. Reliability, Validity, and
14. Brahmbhatt H, Kågesten A, Emerson M, Decker MR, Olumide AO, Associations With Sexual Behavior Among Ghanaian Teenagers of Scales
Ojengbede O, et al. Prevalence and Determinants of Adolescent Measuring Four Dimensions of Relationships With Parents and Other Adults.
Pregnancy in Urban Disadvantaged Settings Across Five Cities. J J Fam Issues. 2015;36(5):647–68.
Adolesc Heal Elsevier. 2014;55(6):S48–57. 40. Ott MA, Pfeiffer EJ, Fortenberry JD. Perceptions of Sexual Abstinence among
15. Henry R, Fayorsey C. Coping with pregnancy: Experiences of High-Risk Early and Middle Adolescents. J Adolesc Heal. 2006;39:192–8.
adolescents in Ga Mashi, Accra [Internet]. ORC Macro: Calverton, 41. Long-Middleton ER, Burke PJ, Lawrence CAC, Blanchard LB, Amudala NH,
Maryland, USA; 2002. Available from: https://dhsprogram.com/pubs/pdf/ Rankin SH. Understanding motivations for abstinence among adolescent
QRS5/copingwithpregnancy.pdf#sthash.PETcT1Aw.dpuf. young women: Insights into effective sexual risk reduction strategies.
16. Ngom P, Magadi MA, Owuor T. Parental presence and adolescent J Pediatr Heal Care Elsevier. 2013;27(5):342–50.
reproductive health among the Nairobi urban poor. J Adolesc Heal Elsevier. 42. Ott MA, Pfeiffer EJ. “That’s nasty” to curiosity: Early adolescent cognitions
2003;33(5):369–77. about sexual abstinence. J Adolesc Heal. Elsevier. 2009;44(6):575–81.
17. Ghana Statistical Service (GSS), Ghana Health Service (GHS). ICF 43. Atwood KA, Zimmerman R, Cupp PK, Fongkaew W, Miller BA, Byrnes HF, et
International. Ghana Demographic and Health Survey 2014 [Internet]. al. Correlates of Precoital Behaviors, Intentions, and Sexual Initiation Among
Rockville, Maryland, USA: GSS, GHS, and ICF International; 2015. Available Thai Adolescents. J Early Adolesc. 2012;32:364–86.
from: http://dhsprogram.com/pubs/pdf/FR307/FR307.pdf. 44. Aubrey JS. Does television exposure influence college-aged women’s sexual
18. GSS GHS, International M. Ghana Maternal Health Survey 2007 [Internet]. self-concept? Media Psychol. 2007;10:157–81.
Calverton, Maryland, USA: GSS, GHS, and Macro International; 2009. 45. Djamba YK. Financial capital and premarital sexual activity: The case of
Available from: http://dhsprogram.com/pubs/pdf/FR227/FR227.pdf. Zambia. Popul Res Policy Rev. 1997;16(3):243–57.
19. Sundaram A, Juarez F, Bankole A, Singh S. Factors Associated with Abortion- 46. Tolman DL. Femininity as a barrier to positive sexual health for adolescent
Seeking and Obtaining a Safe Abortion in Ghana. Stud Fam Plann. 2012; girls. J Am Med Womens Assoc. 1999;54:133–8.
43(4):273–86. 47. Muhanguzi FK. Gender and sexual vulnerability of young women in Africa:
20. Biney AAE. Developing a Sexual Self-Concept Scale for Adolescents in Accra. experiences of young girls in secondary schools in Uganda. Cult Health Sex
University of Ghana, Legon: Ghana. Unpublished doctoral dissertation; 2013. Taylor & Francis. 2011;13(06):713–25.
21. Winter L. The role of sexual self-concept in the use of contraceptives. Fam 48. Biddle BJ, Bank BJ, Marlin MM. Parental and Peer Influence on Adolescents.
Plann Perspect. 1988;20(3):123–7. Soc Forces. 1980;58(4):1057–79.
22. Buzwell S, Rosenthal D. Constructing a sexual self: Adolescents’ sexual self-
perceptions and sexual risk-taking. J Res Adolesc. 1996;64(4):489–513.
23. Breakwell GM, Millward LJ. Sexual self-concept and sexual risk-taking.
J Adolesc. 1997;20:29–41.
24. Vickberg SMJ, Deaux K. Measuring the dimensions of women’s sexuality:
The women's sexual self-concept scale. Sex Roles. 2005;53(5–6):361–9.
25. O’Sullivan LF, Mckeague IW, Dudley C, Hearn KD, Varela Y, Miller K, et al.
The development of the sexual self-concept inventory for adolescent girls.
Psychol Women Q. 2006;30:139–49.
26. Rostosky SS, Dekhtyar O, Cupp PK, Anderman EM. Sexual self-concept and
sexual self-efficacy in adolescents: a possible clue to promoting sexual
health? J Sex Res. 2008;45(3):277–86.
27. Miller KS, Fasula AM, Lin CY, Levin ML, Wyckoff SC, Forehand R. Ready, set,
go African American preadolescents’ sexual thoughts, intentions, and
behaviors. J Early Adolesc SAGE Publications. 2012;32(2):293–307.
28. Heron J, Low N, Lewis G, Macleod J, Ness A, Waylen A. Social factors
associated with readiness for sexual activity in adolescents: a population-
based cohort study. Arch Sex Behav Springer. 2013;44(3):669–78.
29. Holmes MC. Mental health and sexual self-concept discrepancies in a
sample of young black women. J Black Psychol. 2002;28:347–70.
30. Salazar LF, Diclemente RJ, Wingood GM, Crosby RA, Harrington K,
Davies S, et al. Self-concept and adolescents’ refusal of unprotected
sex: A test of mediating mechanisms among African American girls. Submit your next manuscript to BioMed Central 
Prev Sci. 2004;5(3):137–49. and we will help you at every step:
31. Lou J, Chen S, Li R, Yu H. Relationships among sexual self‐concept, sexual
risk cognition and sexual communication in adolescents: a structural •  We accept pre-submission inquiries 
equation model. J Clin Nurs Wiley Online Library. 2011;20(11–12):1696–704. •  Our selector tool helps you to find the most relevant journal
32. Pai H-C, Lee S, Chang T. Sexual self-concept and intended sexual behavior
of young adolescent Taiwanese girls. Nurs Res LWW. 2010;59(6):433 40. •  We provide round the clock customer support –
33. Pai H, Lee S. Sexual self‐concept as influencing intended sexual health •  Convenient online submission
behaviour of young adolescent Taiwanese girls. J Clin Nurs Wiley Online •  Thorough peer review
Library. 2012;21(13–14):1988–97. •  Inclusion in PubMed and all major indexing services 
34. Deutsch AR. A test of a conceptual model of sexual self-concept and its
relation to other dimensions of sexuality [Internet]. Doctoral dissertation. •  Maximum visibility for your research
Lincoln: University of Nebraska; 2012. Available from: http://digitalcommons.
unl.edu/cgi/viewcontent.cgi?article=1048&context=psychdiss. Submit your manuscript at
www.biomedcentral.com/submit