What are the characteristics of ‘sexually ready’ adolescents? Exploring the sexual readiness of youth in urban poor Accra
Identifieur interne : 000124 ( Pmc/Corpus ); précédent : 000123; suivant : 000125What are the characteristics of ‘sexually ready’ adolescents? Exploring the sexual readiness of youth in urban poor Accra
Auteurs : Adriana A. E. Biney ; F. Nii-Amoo DodooSource :
- BMC Public Health [ 1471-2458 ] ; 2016.
Abstract
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.
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.
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.
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.
Url:
DOI: 10.1186/s12889-015-2620-6
PubMed: 26728718
PubMed Central: 4700634
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PMC:4700634Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">What are the characteristics of ‘sexually ready’ adolescents? Exploring the sexual readiness of youth in urban poor Accra</title><author><name sortKey="Biney, Adriana A E" sort="Biney, Adriana A E" uniqKey="Biney A" first="Adriana A. E." last="Biney">Adriana A. E. Biney</name><affiliation><nlm:aff id="Aff1">Regional Institute for Population Studies, University of Ghana, P. O. Box LG96, Legon, Accra Ghana</nlm:aff></affiliation></author><author><name sortKey="Dodoo, F Nii Amoo" sort="Dodoo, F Nii Amoo" uniqKey="Dodoo F" first="F. Nii-Amoo" last="Dodoo">F. Nii-Amoo Dodoo</name><affiliation><nlm:aff id="Aff1">Regional Institute for Population Studies, University of Ghana, P. O. Box LG96, Legon, Accra Ghana</nlm:aff></affiliation><affiliation><nlm:aff id="Aff2">211 Oswald Tower, The Pennsylvania State University, University Park, PA 16802 USA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26728718</idno><idno type="pmc">4700634</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700634</idno><idno type="RBID">PMC:4700634</idno><idno type="doi">10.1186/s12889-015-2620-6</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000124</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000124</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">What are the characteristics of ‘sexually ready’ adolescents? Exploring the sexual readiness of youth in urban poor Accra</title><author><name sortKey="Biney, Adriana A E" sort="Biney, Adriana A E" uniqKey="Biney A" first="Adriana A. E." last="Biney">Adriana A. E. Biney</name><affiliation><nlm:aff id="Aff1">Regional Institute for Population Studies, University of Ghana, P. O. Box LG96, Legon, Accra Ghana</nlm:aff></affiliation></author><author><name sortKey="Dodoo, F Nii Amoo" sort="Dodoo, F Nii Amoo" uniqKey="Dodoo F" first="F. Nii-Amoo" last="Dodoo">F. Nii-Amoo Dodoo</name><affiliation><nlm:aff id="Aff1">Regional Institute for Population Studies, University of Ghana, P. O. Box LG96, Legon, Accra Ghana</nlm:aff></affiliation><affiliation><nlm:aff id="Aff2">211 Oswald Tower, The Pennsylvania State University, University Park, PA 16802 USA</nlm:aff></affiliation></author></analytic><series><title level="j">BMC Public Health</title><idno type="eISSN">1471-2458</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p id="Par1">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.</p></sec><sec><title>Methods</title><p id="Par2">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.</p></sec><sec><title>Results</title><p id="Par3">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.</p></sec><sec><title>Conclusion</title><p id="Par4">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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Meekers, D" uniqKey="Meekers D">D Meekers</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Glover, Ek" uniqKey="Glover E">EK Glover</name></author><author><name sortKey="Bannerman, A" uniqKey="Bannerman A">A Bannerman</name></author><author><name sortKey="Pence, Bw" uniqKey="Pence B">BW Pence</name></author><author><name sortKey="Jones, H" uniqKey="Jones H">H Jones</name></author><author><name sortKey="Miller, R" uniqKey="Miller R">R Miller</name></author><author><name sortKey="Weiss, E" uniqKey="Weiss E">E Weiss</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ringheim, K" uniqKey="Ringheim K">K Ringheim</name></author><author><name sortKey="Gribble, J" 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<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Public Health</journal-id><journal-id journal-id-type="iso-abbrev">BMC Public Health</journal-id><journal-title-group><journal-title>BMC Public Health</journal-title></journal-title-group><issn pub-type="epub">1471-2458</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26728718</article-id><article-id pub-id-type="pmc">4700634</article-id><article-id pub-id-type="publisher-id">2620</article-id><article-id pub-id-type="doi">10.1186/s12889-015-2620-6</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>What are the characteristics of ‘sexually ready’ adolescents? Exploring the sexual readiness of youth in urban poor Accra</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Biney</surname><given-names>Adriana A. E.</given-names></name><address><email>abiney@rips-ug.edu.gh</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Dodoo</surname><given-names>F. Nii-Amoo</given-names></name><address><email>duf2@psu.edu</email></address><xref ref-type="aff" rid="Aff1">1</xref><xref ref-type="aff" rid="Aff2">2</xref></contrib><aff id="Aff1"><label>1</label>Regional Institute for Population Studies, University of Ghana, P. O. Box LG96, Legon, Accra Ghana</aff><aff id="Aff2"><label>2</label>211 Oswald Tower, The Pennsylvania State University, University Park, PA 16802 USA</aff></contrib-group><pub-date pub-type="epub"><day>5</day><month>1</month><year>2016</year></pub-date><pub-date pub-type="pmc-release"><day>5</day><month>1</month><year>2016</year></pub-date><pub-date pub-type="collection"><year>2016</year></pub-date><volume>16</volume><elocation-id>9</elocation-id><history><date date-type="received"><day>15</day><month>8</month><year>2015</year></date><date date-type="accepted"><day>16</day><month>12</month><year>2015</year></date></history><permissions><copyright-statement>© Biney and Dodoo. 2015</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>), 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 (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p id="Par1">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.</p></sec><sec><title>Methods</title><p id="Par2">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.</p></sec><sec><title>Results</title><p id="Par3">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.</p></sec><sec><title>Conclusion</title><p id="Par4">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.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Sexual readiness</kwd><kwd>Sexual self-concept</kwd><kwd>Adolescent sexual health</kwd><kwd>Urban poverty</kwd><kwd>Ghana</kwd></kwd-group><funding-group><award-group><funding-source><institution>The RIPS Urban Health and Poverty Project was supported by joint funding from the Hewlett Foundation, the International Development Research Centre (IDRC) and Research on Obesity and Diabetes among African Migrants (RODAM)</institution></funding-source></award-group></funding-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2016</meta-value></custom-meta></custom-meta-group></article-meta></front><body><sec id="Sec1"><title>Background</title><p id="Par5">Adolescent sexual activity is “a fact of life in most African countries, as in many western societies” [<xref ref-type="bibr" rid="CR1">1</xref>]. However, despite the fact that early sex is a global phenomenon, African nations may be most affected by its consequences [<xref ref-type="bibr" rid="CR1">1</xref>–<xref ref-type="bibr" rid="CR3">3</xref>]. Early sexual initiation exposes adolescents to increased risks of STI/HIV infection, unintended pregnancy, and unsafe abortion. In addition, the health of young girls is compromised during childbirth as they are more prone to maternal morbidity and mortality due to their physiological immaturity [<xref ref-type="bibr" rid="CR4">4</xref>–<xref ref-type="bibr" rid="CR7">7</xref>]. Infant and child deaths are also likely to occur to adolescent mothers [<xref ref-type="bibr" rid="CR3">3</xref>]. Furthermore, there is a relationship between young girls’ sexual activity and their school dropout rates [<xref ref-type="bibr" rid="CR8">8</xref>]. Thus, additional consequences of early sex include female (and sometimes male) adolescents discontinuing school once a pregnancy occurs [<xref ref-type="bibr" rid="CR5">5</xref>, <xref ref-type="bibr" rid="CR9">9</xref>]. Low educational levels reduce the scope of employment opportunities for these adolescents rendering them eligible only for low-income occupations in future [<xref ref-type="bibr" rid="CR5">5</xref>, <xref ref-type="bibr" rid="CR10">10</xref>].</p><p id="Par6">A group of adolescents that requires special attention comprises those living in urban poor communities. This is a vulnerable group, especially susceptible to sexual and reproductive health challenges as a result of the combined effect of poverty and the urban environment [<xref ref-type="bibr" rid="CR11">11</xref>–<xref ref-type="bibr" rid="CR14">14</xref>]. In sub-Saharan Africa, studies conducted in urban poor communities in Kenya and Ghana have reported early ages at first sex, multiple sexual partnerships, teenage pregnancy, and youth resolving some of their unintended pregnancies with induced abortions [<xref ref-type="bibr" rid="CR11">11</xref>, <xref ref-type="bibr" rid="CR12">12</xref>, <xref ref-type="bibr" rid="CR15">15</xref>, <xref ref-type="bibr" rid="CR16">16</xref>]. In Ghana, the proportion of adolescent childbearing slightly increased from 13.3 % in 2008 to 14.2 % in 2014 [<xref ref-type="bibr" rid="CR6">6</xref>, <xref ref-type="bibr" rid="CR17">17</xref>]. The total abortion rate stands at 0.4 abortions per woman, with double the number of abortions occurring to women in the urban settings (0.6 abortions per woman) compared to rural women (0.3 abortions per woman). In addition to this, adolescents are more likely to terminate their pregnancies unsafely [<xref ref-type="bibr" rid="CR18">18</xref>, <xref ref-type="bibr" rid="CR19">19</xref>]. Results from the 2010 Edulink: Urban Health and Poverty study, conducted in urban poor localities in Accra, show that about four out of five women had their first sexual encounter during adolescence compared to 63 % of men. This is comparable to the proportions of women and men in Ghana who stated the same; about 77 % of females and 56 % of males [<xref ref-type="bibr" rid="CR6">6</xref>, <xref ref-type="bibr" rid="CR20">20</xref>]. Young women and men in this community also encountered unintended pregnancies, and half reported inducing or attempting to induce an abortion to resolve that pregnancy. As expected, condom usage among this group was low, with two-thirds reporting non-use the last time they had sex [<xref ref-type="bibr" rid="CR20">20</xref>]. As the high rate of urbanization continues to city populations in Africa, and the majority of adolescents settle in urban poor communities, these will have implications for the country’s population processes, and economic development. Thus, improving the reproductive health of adolescents in these communities is essential.</p><p id="Par7">To combat the ills of early entry into sexual activity, frequent sexual activity, multiple sexual partnerships, and thereby the risk of induced abortions among adolescents, numerous interventions have been effected in developing countries. Yet, the continuing prevalence of these problems signals the ineffectiveness of these interventions for eliminating these concerns in sub-Saharan Africa. One consideration is that, despite the clear adverse implications for their physical health, educational and occupational chances, and general wellbeing, we simply do not understand why adolescents conduct themselves in the manner they do. Indeed, it is difficult to change people’s behavior without an understanding of the logic that undergirds their actions. This would appear to be more critical when multiple and varied interventions have proven to have limited successes. In order to discern how the beneficiaries of the intended interventions see their sexual selves, which is a useful first step in intervening in their unsafe actions, this study attempts to explore which characteristics of adolescents are related to one dimension of their sexual self-concept, sexual readiness [<xref ref-type="bibr" rid="CR21">21</xref>–<xref ref-type="bibr" rid="CR28">28</xref>].</p><sec id="Sec2"><title>Sexual self-concept and sexual readiness</title><p id="Par8">The sexual self-concept is “an individual’s view of him- or herself as a sexual person” [<xref ref-type="bibr" rid="CR25">25</xref>] and has a cyclical relationship with one's sexual intentions, actions, experiences [<xref ref-type="bibr" rid="CR25">25</xref>], and mental health [<xref ref-type="bibr" rid="CR29">29</xref>]. Most research on sexual self-concept has been conducted among generally Caucasian, middle income, well-educated, suburban youth in developed countries. Few studies have assessed the sexual self-concepts (SSC) of adolescents in urban poor communities (exceptions to this are [<xref ref-type="bibr" rid="CR25">25</xref>, <xref ref-type="bibr" rid="CR30">30</xref>]) and very few have studied the sexual self-concepts of youth in developing countries (the few exceptions were conducted in Taiwan by [<xref ref-type="bibr" rid="CR31">31</xref>–<xref ref-type="bibr" rid="CR33">33</xref>]). Although its methods of measurement vary and can become complex [<xref ref-type="bibr" rid="CR34">34</xref>], the SSC is considered a useful means to aid in understanding adolescent sexual behavior.</p><p id="Par9">A variety of factors come together to shape young peoples’ sexual self-views [<xref ref-type="bibr" rid="CR35">35</xref>]. The literature suggests that certain "environmental influences" may be linked to the sexual self-concepts of adolescents and young adults [<xref ref-type="bibr" rid="CR36">36</xref>]. The influences can emanate from one’s social environment or from significant people [<xref ref-type="bibr" rid="CR36">36</xref>]. Demographic characteristics, such as gender and age, can lead to differences in sexual self-views. While boys and older adolescents report more sexually adventurous views, their female and younger counterparts exhibit more sexually naïve sexual self-concepts<xref ref-type="fn" rid="Fn1">1</xref> [<xref ref-type="bibr" rid="CR22">22</xref>]. Other’s state that males reported less sexual self-efficacious and -esteem views compared to females [<xref ref-type="bibr" rid="CR26">26</xref>]. Even more studies suggest no such differences between boys and girls, but highlight age differentials [<xref ref-type="bibr" rid="CR21">21</xref>, <xref ref-type="bibr" rid="CR25">25</xref>, <xref ref-type="bibr" rid="CR34">34</xref>]. Socio-cultural characteristics such as religion and ethnicity also play a role in shaping their sexual self-concept, through them developing a fear of sexual expression and exhibiting sexual anxiety, respectively [<xref ref-type="bibr" rid="CR26">26</xref>, <xref ref-type="bibr" rid="CR37">37</xref>].</p><p id="Par11">Significant people in adolescents’ lives include their parents or peers, who through conversation communicate their permissive views about sex, this can lead to them forming "arousable" and "agentic" sexual self-concepts that may result in risky sexual behaviors, including initiating sex early [<xref ref-type="bibr" rid="CR25">25</xref>]. Parents’ demographic characteristics (e.g. their marital status) and socioeconomic characteristics (e.g. their education and income) are linked to adolescents’ sexuality [<xref ref-type="bibr" rid="CR38">38</xref>]. In the literature, parents with high levels of education and/or income are seen to offer closeness, warmth, monitoring and protection [<xref ref-type="bibr" rid="CR38">38</xref>, <xref ref-type="bibr" rid="CR39">39</xref>]. This has been linked to less sexual activity among adolescents and accordingly suggests less “assertive” and “agentic” sexual self-views. The statement holds true for those residing with their parents, and especially in two-parent homes [<xref ref-type="bibr" rid="CR38">38</xref>].</p><p id="Par12">This paper is part of a larger study that sought to develop and assess a sexual self-concept scale for adolescents in an urban poor community in Accra [<xref ref-type="bibr" rid="CR20">20</xref>]. The paper seeks to answer one question: What are the correlates of one critical aspect of adolescent sexual self-concept: “sexual readiness”? Sexual readiness has been linked to motivations to either remain abstinent or initiate sex among adolescents [<xref ref-type="bibr" rid="CR40">40</xref>, <xref ref-type="bibr" rid="CR41">41</xref>]. In these qualitative studies, the subject of readiness emerges from discussions as an intermediary factor on the developmental continuum, providing that entry from abstinence into sexual activity [<xref ref-type="bibr" rid="CR40">40</xref>]. It is a multifaceted concept consisting of individual characteristics such as the adolescent’s mental, emotional and physical development, age, and social maturity; in essence, it suggests one's preparedness to engage in sex and handle the consequences that may arise. Relationship characteristics that equate one to being ready for sex include being with the right person, which could be either in marriage or in a committed or stable relationship [<xref ref-type="bibr" rid="CR40">40</xref>–<xref ref-type="bibr" rid="CR42">42</xref>]. Readiness also has a moral component, according to the adolescents, where the difference between remaining abstinent and initiating sexual activity lies in one’s beliefs about premarital and adolescent sex as being right or wrong. Although sexual readiness may determine whether one starts sex or not [<xref ref-type="bibr" rid="CR42">42</xref>], sexually experienced adolescents may also view themselves as “not ready”. These research works, typically conducted among African American, low income, urban dwelling boys and girls, provide a sense of what develops their sexual readiness.</p><p id="Par13">Other studies, using survey data, have defined and measured sexual readiness by adopting frameworks and approaches useful for those contexts. While some have assessed adolescents’ stages of sexual readiness and defined them as a function of sexual thoughts, intentions and actions [<xref ref-type="bibr" rid="CR7">7</xref>, <xref ref-type="bibr" rid="CR43">43</xref>], others took into account adolescents’ sexual willingness, autonomy, lack of regret and contraceptive use [<xref ref-type="bibr" rid="CR28">28</xref>], which is actually a reflection of their sexual competence. The concept of readiness encompasses an array of ideas and renders it a very broad topic that is difficult to define, and these complexities warrant further investigation on the subject. A major weakness in the literature is that sexual readiness has no set definition. In this study, we have identified and incorporated in our measure of readiness key concepts from the existing literature: their preparedness to engage in sex, maturity, and moral views, which are all critical elements that reflect adolescent sexual self-views. These three concepts together provide a more holistic understanding of their perceptions, further validating the measure, especially since solely asking about their readiness to engage in sexual intercourse, is not a comprehensive enough measure [<xref ref-type="bibr" rid="CR42">42</xref>]. If readiness is that gateway to sexual activity, it connotes an important function preceding their first sex, and if not addressed properly may prolong the harmful consequences of adolescent sex that youth in sub-Saharan Africa continue to experience. In addition, going further to identify characteristics related to their sexual preparedness should lead to ideas on who to target with further research and education, as well as appropriate interventions and programs. Other studies have failed to assess the range of social factors, whether demographic, economic, cultural, or family that may be associated with and ultimately contribute to sexual readiness. Therefore, the study seeks to investigate this as we contribute to the discussion on sexual readiness among a sample of adolescents residing in urban poor Accra. To our knowledge this is the first paper that examines this sexual readiness component of the sexual self-concepts of urban poor adolescents in sub-Saharan Africa.</p></sec></sec><sec id="Sec3"><title>Methods</title><sec id="Sec4"><title>Data</title><p id="Par14">This paper uses data from the 2011 RIPS Urban Health and Poverty Project.<xref ref-type="fn" rid="Fn2">2</xref> The main study was conducted in three urban poor localities in Accra (James Town, Ussher Town and Agbogbloshie) surveying men and women in their reproductive ages (15 to 49 years for women and 15 to 59 years for men). Adolescents between ages 12 and 14 residing in sampled households in James Town and Ussher Town were also interviewed as an appendage to the survey. These early adolescents were interviewed with a shortened version of the main questionnaire that focused on their background characteristics, sexual self-concept, and sexual experiences and behaviors.</p><p id="Par16">Sampling of respondents was conducted at two levels: first, 29 enumeration areas (EAs) in the three localities were selected, and from each of these 40 households were systematically sampled. This resulted in a total study sample of 806 households and 1055 individuals (with ages ranging from 12 to 59). However, for this paper, 196 male and female adolescents between ages 12 and 19, residing in James Town and Ussher Town,<xref ref-type="fn" rid="Fn3">3</xref> are used in our analyses. The majority of respondents residing in this setting affiliate with the Ga ethnic group. These are indigenous residents of the locality, a patrilineal people that were believed to have migrated from Nigeria to Ghana in the 14th century [<xref ref-type="bibr" rid="CR15">15</xref>]. The towns are by the coast, and thus, the major economic activities practiced include fishing, fish mongering, in addition to trading, and food vending. The second largest ethnic group in this community consists of the Akans, a matrilineal group, who form more than half of Ghana’s population [<xref ref-type="bibr" rid="CR15">15</xref>].</p><p id="Par18">Ethical clearance to conduct the study was provided by the Noguchi Memorial Institute for Medical Research—Institutional Review Board (NMIMR-IRB) at the University of Ghana, Legon in July 2011. We administered assent or consent forms to adolescents, and further obtained consent from parents or caregivers for adolescents below age 18, prior to the interviews. Our study protocol and practice in the field ensured we provide our respondents’ with privacy during the interview, their information was kept confidential, and small gifts consisting of household items worth about US$3 were distributed after interviews in the entire locality were completed.</p></sec><sec id="Sec5"><title>Measurements</title><p id="Par19">The dependent variable is sexual readiness, a composite of the following three items: (1) I think I am ready for sex; (2) I think I am too young to have sex; and (3) I think it is wrong for me to have sex.<xref ref-type="fn" rid="Fn4">4</xref> These three items were part of a 27 item sexual self-concept inventory, and all 27 items were carefully selected from 13 extant sexual self-concept scales. The initial five-category response for each item, ranging from 1 (strongly disagree) to 5 (strongly agree), was re-coded to create a three-category response indicating 0 (disagree), 1 (neutral) and 2 (agree). The three items loaded heavily (above the value 0.49) on one factor, ensuing exploratory factor analysis, and were summed to create the composite sexual readiness variable which ranges from 0 to 6. The scores indicate that the higher the response, the more the adolescent believes he or she is ready for sex. The ordinal alpha value for the scale was 0.81. For a more detailed process on how the sexual readiness construct was developed see Biney [<xref ref-type="bibr" rid="CR20">20</xref>]. Descriptive statistics of the latent variable and sexual readiness items are displayed in Tables <xref rid="Tab1" ref-type="table">1</xref> and <xref rid="Tab2" ref-type="table">2</xref>. Overall, the majority of adolescents were not ready for sex (54.1 % scored ‘0’), while 5.6 % scored ‘6’, indicating a readiness for sex.<table-wrap id="Tab1"><label>Table 1</label><caption><p>Percentage distribution of sexual readiness items</p></caption><table frame="hsides" rules="groups"><thead><tr><th>Items</th><th>Frequency</th><th>Percent (%)</th></tr></thead><tbody><tr><td>Ready for sex</td><td></td><td></td></tr><tr><td> 0</td><td>153</td><td>78.1</td></tr><tr><td> 1</td><td>13</td><td>6.6</td></tr><tr><td> 2</td><td>30</td><td>15.3</td></tr><tr><td>Not young for sex</td><td></td><td></td></tr><tr><td> 0</td><td>135</td><td>68.9</td></tr><tr><td> 1</td><td>8</td><td>4.1</td></tr><tr><td> 2</td><td>53</td><td>27.0</td></tr><tr><td>Not wrong for sex</td><td></td><td></td></tr><tr><td> 0</td><td>137</td><td>69.9</td></tr><tr><td> 1</td><td>12</td><td>6.1</td></tr><tr><td> 2</td><td>47</td><td>24.0</td></tr><tr><td>Total</td><td>196</td><td>100.0</td></tr></tbody></table><table-wrap-foot><p>Source: RIPS Urban Health and Poverty Project, 2011</p><p>0-disagree; 1-neutral; 2-agree</p></table-wrap-foot></table-wrap><table-wrap id="Tab2"><label>Table 2</label><caption><p>Percentage distribution of sexual readiness, background and sexual characteristics of respondents by gender</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2">Characteristics</th><th colspan="2">Total</th><th colspan="2">Female</th><th colspan="2">Male</th></tr><tr><th>Freq</th><th>%</th><th>Freq</th><th>%</th><th>Freq</th><th>%</th></tr></thead><tbody><tr><td colspan="7">Sexual readiness (Dependent variable)</td></tr><tr><td> 0</td><td>106</td><td>54.1</td><td>57</td><td>55.9</td><td>49</td><td>52.1</td></tr><tr><td> 1</td><td>5</td><td>2.6</td><td>2</td><td>2.0</td><td>3</td><td>3.2</td></tr><tr><td> 2</td><td>37</td><td>18.9</td><td>20</td><td>19.6</td><td>17</td><td>18.1</td></tr><tr><td> 3</td><td>5</td><td>2.6</td><td>3</td><td>2.9</td><td>2</td><td>2.1</td></tr><tr><td> 4</td><td>27</td><td>13.8</td><td>15</td><td>14.7</td><td>12</td><td>12.8</td></tr><tr><td> 5</td><td>5</td><td>2.6</td><td>3</td><td>2.9</td><td>2</td><td>2.1</td></tr><tr><td> 6</td><td>11</td><td>5.6</td><td>2</td><td>2.0</td><td>9</td><td>9.6</td></tr><tr><td colspan="7">Socio-demographic Characteristics</td></tr><tr><td colspan="7">Age</td></tr><tr><td> 12–14</td><td>68</td><td>34.7</td><td>38</td><td>37.3</td><td>30</td><td>31.9</td></tr><tr><td> 15–17</td><td>66</td><td>33.7</td><td>31</td><td>30.4</td><td>35</td><td>37.2</td></tr><tr><td> 18–19</td><td>62</td><td>31.6</td><td>33</td><td>32.4</td><td>29</td><td>30.9</td></tr><tr><td colspan="7">Highest educational level attained</td></tr><tr><td> Primary and below</td><td>65</td><td>33.2</td><td>36</td><td>35.3</td><td>29</td><td>30.9</td></tr><tr><td> Junior High School (JHS)</td><td>88</td><td>44.9</td><td>49</td><td>48.0</td><td>39</td><td>41.5</td></tr><tr><td> Senior High School (SHS)</td><td>43</td><td>21.9</td><td>17</td><td>16.7</td><td>26</td><td>27.7</td></tr><tr><td colspan="7">Socio-cultural Characteristics</td></tr><tr><td colspan="7">Religious service attendance in past month</td></tr><tr><td> At least once a week</td><td>113</td><td>57.6</td><td>56</td><td>54.9</td><td>57</td><td>60.6</td></tr><tr><td> At least once a month</td><td>39</td><td>19.9</td><td>23</td><td>22.6</td><td>16</td><td>17.0</td></tr><tr><td> Never</td><td>44</td><td>22.5</td><td>23</td><td>22.6</td><td>21</td><td>22.3</td></tr><tr><td colspan="7">Ethnicity</td></tr><tr><td> Akan</td><td>43</td><td>21.9</td><td>23</td><td>22.6</td><td>20</td><td>21.3</td></tr><tr><td> Ga/Dangme</td><td>131</td><td>66.8</td><td>65</td><td>63.7</td><td>66</td><td>70.2</td></tr><tr><td> Other</td><td>22</td><td>11.3</td><td>14</td><td>13.7</td><td>8</td><td>8.5</td></tr><tr><td colspan="7">Locality</td></tr><tr><td> James Town</td><td>78</td><td>39.8</td><td>41</td><td>40.2</td><td>37</td><td>39.4</td></tr><tr><td> Ussher Town</td><td>118</td><td>60.2</td><td>61</td><td>59.8</td><td>57</td><td>60.6</td></tr><tr><td colspan="7">Family Characteristics</td></tr><tr><td colspan="7">Mother's highest educational level attained</td></tr><tr><td> None/Pre-school</td><td>30</td><td>15.3</td><td>17</td><td>16.7</td><td>13</td><td>13.8</td></tr><tr><td> Primary</td><td>28</td><td>14.3</td><td>12</td><td>11.8</td><td>16</td><td>17.0</td></tr><tr><td> Secondary</td><td>82</td><td>41.8</td><td>41</td><td>40.2</td><td>41</td><td>43.6</td></tr><tr><td> Don't Know</td><td>56</td><td>28.6</td><td>32</td><td>31.4</td><td>24</td><td>25.5</td></tr><tr><td colspan="7">Living arrangements</td></tr><tr><td> Parent/parent & relative</td><td>146</td><td>74.5</td><td>74</td><td>72.6</td><td>72</td><td>76.6</td></tr><tr><td> Other relative/non-relative/alone</td><td>47</td><td>24.0</td><td>26</td><td>25.5</td><td>21</td><td>22.3</td></tr><tr><td>
<italic>Missing</italic></td><td><italic>3</italic></td><td><italic>1.5</italic></td><td><italic>2</italic></td><td><italic>2.0</italic></td><td><italic>1</italic></td><td><italic>1.1</italic></td></tr><tr><td colspan="7">Parents’ marital status</td></tr><tr><td> Currently married</td><td>72</td><td>36.7</td><td>37</td><td>36.3</td><td>35</td><td>37.2</td></tr><tr><td> Not currently married</td><td>61</td><td>31.1</td><td>29</td><td>28.4</td><td>32</td><td>34.0</td></tr><tr><td> Never married</td><td>22</td><td>11.2</td><td>13</td><td>12.8</td><td>9</td><td>9.6</td></tr><tr><td> Parent(s) dead</td><td>39</td><td>19.9</td><td>22</td><td>21.6</td><td>17</td><td>18.1</td></tr><tr><td>
<italic>Missing</italic></td><td><italic>2</italic></td><td><italic>1.0</italic></td><td><italic>1</italic></td><td><italic>1.0</italic></td><td><italic>1</italic></td><td><italic>1.1</italic></td></tr><tr><td colspan="7">Wealth index</td></tr><tr><td> Poorest</td><td>39</td><td>19.9</td><td>17</td><td>16.7</td><td>22</td><td>23.4</td></tr><tr><td> Poorer</td><td>42</td><td>21.4</td><td>22</td><td>21.6</td><td>20</td><td>21.3</td></tr><tr><td> Middle</td><td>39</td><td>19.9</td><td>18</td><td>17.6</td><td>21</td><td>22.3</td></tr><tr><td> Richer</td><td>37</td><td>18.9</td><td>22</td><td>21.6</td><td>15</td><td>16.0</td></tr><tr><td> Richest</td><td>34</td><td>17.4</td><td>20</td><td>19.6</td><td>14</td><td>14.9</td></tr><tr><td>
<italic>Missing</italic></td><td><italic>5</italic></td><td><italic>2.6</italic></td><td><italic>3</italic></td><td><italic>2.9</italic></td><td><italic>2</italic></td><td><italic>2.1</italic></td></tr><tr><td colspan="7">Sexual communication</td></tr><tr><td> With parents only</td><td>101</td><td>51.5</td><td>54</td><td>52.9</td><td>47</td><td>50.0</td></tr><tr><td> With friends only</td><td>42</td><td>21.4</td><td>27</td><td>26.5</td><td>15</td><td>16.0</td></tr><tr><td> With both parents and friends</td><td>19</td><td>9.7</td><td>8</td><td>7.8</td><td>11</td><td>11.7</td></tr><tr><td> With other(s)</td><td>34</td><td>17.4</td><td>13</td><td>12.8</td><td>21</td><td>22.3</td></tr><tr><td colspan="7">Sexual Characteristics</td></tr><tr><td colspan="7">Coital experience<sup>a</sup></td></tr><tr><td> No</td><td>156</td><td>79.6</td><td>75</td><td>73.5</td><td>81</td><td>86.2</td></tr><tr><td> Yes</td><td>40</td><td>20.4</td><td>27</td><td>26.5</td><td>13</td><td>13.8</td></tr><tr><td colspan="7">Negative sexual experience</td></tr><tr><td> No</td><td>158</td><td>80.6</td><td>77</td><td>75.5</td><td>81</td><td>86.2</td></tr><tr><td> Yes</td><td>38</td><td>19.4</td><td>25</td><td>24.5</td><td>13</td><td>13.8</td></tr><tr><td colspan="7">Exposure to pornographic movies<sup>a</sup></td></tr><tr><td> No</td><td>121</td><td>61.7</td><td>73</td><td>71.6</td><td>48</td><td>51.1</td></tr><tr><td> Yes</td><td>73</td><td>37.3</td><td>28</td><td>27.4</td><td>45</td><td>47.9</td></tr><tr><td>
<italic>Missing</italic></td><td><italic>2</italic></td><td><italic>1.0</italic></td><td><italic>1</italic></td><td><italic>1.0</italic></td><td><italic>1</italic></td><td><italic>1.1</italic></td></tr><tr><td>Total</td><td>196</td><td>100.0</td><td>102</td><td>100.0</td><td>94</td><td>100.0</td></tr></tbody></table><table-wrap-foot><p>Source: RIPS Urban Health and Poverty Project, 2011</p><p><sup>a</sup>Significantly different by gender at <italic>p</italic> < 0.05</p></table-wrap-foot></table-wrap></p><p id="Par21">The sexual characteristics of respondents include their coital experiences (whether they ever had sexual intercourse with a member of the opposite sex) and negative sexual encounters (whether they were forced to have sex or forced to engage in a sex act but not have sexual intercourse). In addition, their exposure to pornographic movies denotes whether the respondent ever watched a pornographic movie or not.</p><p id="Par22">Socio-demographic characteristics include the age, gender and highest educational level of the respondent. Socio-cultural variables comprise of their religiosity, measured by number of religious services attended in a month, the locality the respondent resides in, and his/her ethnicity, which was categorized as Ga/Dangme, Akan, and Other. Significant people influences were measured by family characteristics which include the respondent’s mother’s highest educational level, his/her current living arrangement, parents’ current marital status, the sexual communication (or lack thereof) that takes place in the household, and the household wealth. This wealth measure was computed using assets owned by each household (for example, a radio, television, car, mobile phone, fishing net, etc…), in addition to the materials used to construct the homes they dwelled in. The items underwent principle components analysis (PCA) and a wealth index was created using the first factor. The index was then grouped into quintiles, and the lowest 20 % in the index were labeled as the poorest respondents, the poorer respondents were the next lowest 20 %, this ran through to the richest being the top 20 % in the index.</p></sec><sec id="Sec6"><title>Analyses techniques</title><p id="Par23">Descriptive statistics were used to assess the characteristics of respondents using percentages along with cross-tabulations by gender. Pearson chi-square tests were employed to indicate the factors that differed significantly with gender. Ordinal (or ordered) logistic regression analysis was the main statistical technique used since the dependent variable was an ordered scale ranging from 0 (not sexually ready) to 6 (very sexually ready). We examined associations between the socio-demographic, socio-cultural, family, and sexual characteristics of adolescents, and the sexual readiness dimension of their sexual self-concept. Results are displayed as odds ratios. The statistical software package STATA was employed to undertake the analyses.</p></sec></sec><sec id="Sec7"><title>Results</title><sec id="Sec8"><title>Participants’ characteristics</title><p id="Par24">A total of 196 youth, ages 12–19 years, residing in James Town and Ussher Town, participated in the study. The background characteristics of the adolescents are shown in Table <xref rid="Tab2" ref-type="table">2</xref>, and include gender differences which aids in simple comparisons of their characteristics by gender. The majority of the respondents were students (73.4 %) and they were either in (or had completed) junior high school (JHS). Gender differences reveal that more boys than girls were still in school. Also, a higher proportion of males compared to females had completed—or were currently in—senior high school. About four-fifths of the respondents were Christians; and the majority reported being ‘religious’, that is, they attended a religious service at least once a week in the month preceding the survey (57.6 %). They mostly resided in Ussher Town (60.6 %) and were from the Ga/Dangme ethnic group.</p><p id="Par25">As indicated in Table <xref rid="Tab2" ref-type="table">2</xref>, the majority of respondents had mothers who had completed secondary school. Just over a quarter of respondents did not know the highest educational levels attained by their mothers. More respondents stated that their parents were currently married (36.7 %), while a similar proportion (31.1 %) stated they were currently not married. Most of the respondents lived with their parent(s) and more households were categorized into the poorer wealth quintile. In relation to sexual discussions with parents, more than half of the adolescents talked to their parents when they had sexually related questions or issues. Gender patterns 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 proportion of boys were reported to reside in the poorest households than girls (23.4 vs 16.7 %). Finally, a smaller percentage of boys cited discussing their sexual concerns with friends only compared to girls (16.0 vs 26.5 %).</p><p id="Par26">The sexual characteristics of adolescents indicate that while one-fifth of them had experienced sexual intercourse, a similar proportion stated that they had ever been forced to engage in a sex act (not necessarily sexual intercourse) or to have sex. Of the 19.4 % who stated this occurring, about 58 % had been forced to engage in a sex act only, 15.8 % had been raped only, and 26.3 % had experienced both negative sexual encounters (see Table <xref rid="Tab3" ref-type="table">3</xref>). A higher percentage of females stated this (24.5 vs 13.8 %). Also, while close to one-half of the boys had ever watched a pornographic movie, only just over a quarter of the girls stated the same (Table <xref rid="Tab2" ref-type="table">2</xref>). Their engagement in sexual intercourse and their exposure to pornography were the only characteristics significantly different by gender.<table-wrap id="Tab3"><label>Table 3</label><caption><p>Percentage distribution of adolescents who ever encountered a negative sexual experience; were forced to have sex, engage in a sex act or both</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2">Characteristic</th><th colspan="2">All</th><th colspan="2">Girls</th><th colspan="2">Boys</th></tr><tr><th>Freq</th><th>%</th><th>Freq</th><th>%</th><th>Freq</th><th>%</th></tr></thead><tbody><tr><td colspan="7">Negative sexual experience</td></tr><tr><td> No</td><td>158</td><td>80.6</td><td>77</td><td>75.5</td><td>81</td><td>86.2</td></tr><tr><td> Yes</td><td>38</td><td>19.4</td><td>25</td><td>24.5</td><td>13</td><td>13.8</td></tr><tr><td> Total</td><td>196</td><td>100.0</td><td>102</td><td>100.0</td><td>94</td><td>100.0</td></tr><tr><td colspan="7">Negative sexual experience categories</td></tr><tr><td> Forced sex only</td><td>6</td><td>15.8</td><td>5</td><td>20.0</td><td>1</td><td>7.7</td></tr><tr><td> Forced into sex act only</td><td>22</td><td>57.9</td><td>12</td><td>48.0</td><td>10</td><td>76.9</td></tr><tr><td> Forced into both</td><td>10</td><td>26.3</td><td>8</td><td>32.0</td><td>2</td><td>15.4</td></tr><tr><td> Total</td><td>38</td><td>100.0</td><td>25</td><td>100.0</td><td>13</td><td>100.00</td></tr></tbody></table><table-wrap-foot><p>Source: RIPS Urban Health and Poverty Project, 2011</p></table-wrap-foot></table-wrap></p><p id="Par27">In summary, the backgrounds of the respondents indicate that they are educated, “religious”, Ga-Dangme adolescents. They reside with one or both parents in homes categorized as poorer on the wealth index. One out of every five adolescents had ever had sex or ever been coerced into sex or a sexual act. Results also suggest that in this community, females are sexually experienced at earlier ages than males, while males have more exposure to sexually explicit movies. These outcomes speak to the vulnerability of young women in the community who are experiencing higher rates of sexual coercion and risky behavior than their male counterparts.<xref ref-type="fn" rid="Fn5">5</xref></p></sec><sec id="Sec9"><title>Multivariate analyses</title><p id="Par29">Ordered logistic regression results are displayed in Table <xref rid="Tab4" ref-type="table">4</xref>. Two models were conducted; the first solely incorporated the three sexual variables and the second included the background variables. Although regression models may be used to predict and establish causality, this feature was not important to the study. Rather, multivariate analyses were conducted to determine correlates of sexual readiness upon testing for associations. Results from Model 1 show that sexually active respondents see themselves as significantly more sexually ready than their abstinent counterparts. In addition, adolescents with exposure to pornographic movies were more ready than those with none. After including their background characteristics, the outcomes still hold for coital experience and pornographic exposure, where these respondents were also significantly more ready for sex than their peers.<table-wrap id="Tab4"><label>Table 4</label><caption><p>Ordered regression models displaying sexual, socio-demographic, −cultural and family correlates of adolescents’ sexual readiness</p></caption><table frame="hsides" rules="groups"><thead><tr><th></th><th colspan="2">Model 1</th><th colspan="2">Model 2</th></tr><tr><th>Characteristic</th><th>Odds Ratio</th><th>95 % Confidence Interval</th><th>Odds Ratio</th><th>95 % Confidence Interval</th></tr></thead><tbody><tr><td>Coital experience</td><td></td><td></td><td></td><td></td></tr><tr><td> No (RC)</td><td>1.000</td><td></td><td>1.000</td><td></td></tr><tr><td> Yes</td><td>9.339***</td><td>4.18–20.88</td><td>19.585***</td><td>6.85–56.03</td></tr><tr><td>Negative sexual experience</td><td></td><td></td><td></td><td></td></tr><tr><td> No (RC)</td><td>1.000</td><td></td><td>1.000</td><td></td></tr><tr><td> Yes</td><td>1.014</td><td>0.47–2.17</td><td>1.362</td><td>0.58–3.19</td></tr><tr><td>Exposure to pornography</td><td></td><td></td><td></td><td></td></tr><tr><td> No (RC)</td><td>1.000</td><td></td><td>1.000</td><td></td></tr><tr><td> Yes</td><td>2.043*</td><td>1.12–3.73</td><td>2.355*</td><td>1.07–5.19</td></tr><tr><td>Gender</td><td></td><td></td><td></td><td></td></tr><tr><td> Male (RC)</td><td></td><td></td><td>1.000</td><td></td></tr><tr><td> Female</td><td></td><td></td><td>0.420*</td><td>0.20–0.87</td></tr><tr><td>Age group</td><td></td><td></td><td></td><td></td></tr><tr><td> 12–14 (RC)</td><td></td><td></td><td>1.000</td><td></td></tr><tr><td> 15–17</td><td></td><td></td><td>1.031</td><td>0.39–2.74</td></tr><tr><td> 18–19</td><td></td><td></td><td>0.825</td><td>0.26–2.56</td></tr><tr><td>Highest educational level attained</td><td></td><td></td><td></td><td></td></tr><tr><td> Primary and below (RC)</td><td></td><td></td><td>1.000</td><td></td></tr><tr><td> JHS</td><td></td><td></td><td>0.790</td><td>0.33–1.90</td></tr><tr><td> SHS</td><td></td><td></td><td>0.493</td><td>0.16–1.52</td></tr><tr><td>Religious service attendance in past month</td><td></td><td></td><td></td><td></td></tr><tr><td> At least once a week (RC)</td><td></td><td></td><td>1.000</td><td></td></tr><tr><td> At least once a month</td><td></td><td></td><td>0.914</td><td>0.38–2.19</td></tr><tr><td> Never</td><td></td><td></td><td>1.301</td><td>0.56–3.01</td></tr><tr><td>Ethnicity</td><td></td><td></td><td></td><td></td></tr><tr><td> Akan (RC)</td><td></td><td></td><td>1.000</td><td></td></tr><tr><td> Ga/Dangme</td><td></td><td></td><td>3.427*</td><td>1.29–9.07</td></tr><tr><td> Other</td><td></td><td></td><td>4.212*</td><td>1.11–16.04</td></tr><tr><td>Locality</td><td></td><td></td><td></td><td></td></tr><tr><td> James Town (RC)</td><td></td><td></td><td>1.000</td><td></td></tr><tr><td> Ussher Town</td><td></td><td></td><td>1.776</td><td>0.86–3.651</td></tr><tr><td>Mother's highest educational level attained</td><td></td><td></td><td></td><td></td></tr><tr><td> None/Pre-school (RC)</td><td></td><td></td><td>1.000</td><td></td></tr><tr><td> Primary</td><td></td><td></td><td>2.276</td><td>0.65–7.99</td></tr><tr><td> Secondary</td><td></td><td></td><td>1.805</td><td>0.65–5.02</td></tr><tr><td> Don't know</td><td></td><td></td><td>0.961</td><td>0.32–2.84</td></tr><tr><td>Living arrangements</td><td></td><td></td><td></td><td></td></tr><tr><td> Parent(s)/parent & relative (RC)</td><td></td><td></td><td>1.000</td><td></td></tr><tr><td> Other relative/non-relative/alone</td><td></td><td></td><td>1.251</td><td>0.57–2.76</td></tr><tr><td>Household wealth quintile</td><td></td><td></td><td></td><td></td></tr><tr><td> Poorest (RC)</td><td></td><td></td><td>1.000</td><td></td></tr><tr><td> Poorer</td><td></td><td></td><td>3.574*</td><td>1.27–10.06</td></tr><tr><td> Middle</td><td></td><td></td><td>1.905</td><td>0.65–5.61</td></tr><tr><td> Richer</td><td></td><td></td><td>0.996</td><td>0.29–3.39</td></tr><tr><td> Richest</td><td></td><td></td><td>0.821</td><td>0.24–2.78</td></tr><tr><td>Parents' marital status</td><td></td><td></td><td></td><td></td></tr><tr><td> Currently married (RC)</td><td></td><td></td><td>1.000</td><td></td></tr><tr><td> Not currently married</td><td></td><td></td><td>0.452+</td><td>0.18–1.12</td></tr><tr><td> Never married</td><td></td><td></td><td>0.670</td><td>0.21–2.11</td></tr><tr><td> Parent(s) dead</td><td></td><td></td><td>1.261</td><td>0.46–3.44</td></tr><tr><td>Sexual Communication</td><td></td><td></td><td></td><td></td></tr><tr><td> With parent(s) only (RC)</td><td></td><td></td><td>1.000</td><td></td></tr><tr><td> With friend only</td><td></td><td></td><td>0.433+</td><td>0.18–1.06</td></tr><tr><td> With both parents and friends</td><td></td><td></td><td>0.645</td><td>0.18–2.29</td></tr><tr><td> With other(s)</td><td></td><td></td><td>2.268+</td><td>0.90–5.71</td></tr><tr><td>/cut1</td><td>0.859</td><td>0.45-1.26</td><td>2.422</td><td>0.54-4.30</td></tr><tr><td>/cut2</td><td>0.990</td><td>0.58-1.40</td><td>2.601</td><td>0.71-4.49</td></tr><tr><td>/cut3</td><td>2.143</td><td>1.63-2.66</td><td>4.030</td><td>2.06-6.00</td></tr><tr><td>/cut4</td><td>2.342</td><td>1.81-2.88</td><td>4.293</td><td>2.32-6.27</td></tr><tr><td>/cut5</td><td>3.698</td><td>2.98-4.42</td><td>5.770</td><td>3.72-7.82</td></tr><tr><td>/cut6</td><td>4.151</td><td>3.35-4.95</td><td>6.276</td><td>4.18-8.37</td></tr></tbody></table><table-wrap-foot><p>Source: RIPS Urban Health and Poverty Project, 2011</p><p>***<italic>p</italic> < 0.001; **<italic>p</italic> < 0.01; *<italic>p</italic> < 0.05; +p < 0.10; RC = Reference Category</p><p>Model 1: Pseudo R<sup>2</sup> = 0.1063, <italic>n</italic> = 194; Model 2: Pseudo R<sup>2</sup> = 0.2085, <italic>n</italic> = 184</p><p>Proportionality of odds test: Model 1: p > chi2 = 0.9474; Model 2: p > chi2 = 0. 4705</p></table-wrap-foot></table-wrap></p><p id="Par30">Three other factors were associated with their sexual readiness. Gender was significantly related to one’s sexual self-view, where girls were less ready for sex than boys. Ethnicity was also a significant correlate of sexual readiness. The matrilineal Akan ethnic group, found across middle and southern Ghana, was significantly less ready compared to the patrilineal Ga/Dangmes and Other ethnic groups (consisting mostly of the Guans, Ewes and Mole-Dagbanis). In addition, respondents in the poorer household wealth quintile were more sexually ready than their poorest colleagues. This suggests that the poorest youth in this community are not as ready for sex when compared to the poorer ones.</p><p id="Par31">Furthermore, as shown in Table <xref rid="Tab5" ref-type="table">5</xref>, the predicted probability of an adolescent falling into a particular sexual readiness category was assessed following regression analysis. The selected respondents were those with characteristics that indicated a significantly higher degree of sexual readiness; specifically, sexually active, pornography viewing, poorer, non-Akan males. The probability of these adolescents falling into the highest category of ‘6’ on the readiness scale was high at 0.8724, further indicating, to an extent, that the identified group exhibits an extreme amount of sexual readiness.<table-wrap id="Tab5"><label>Table 5</label><caption><p>Distribution of predicted probabilities of adolescents at their various degrees of sexual readiness for significant variables in the model</p></caption><table frame="hsides" rules="groups"><thead><tr><th>Sexual Readiness Categories</th><th>‘Sexually active’ only</th><th>‘Exposed to pornography’ only</th><th>‘Males’ only</th><th>‘Ga/Dangme’ only</th><th>‘Other ethnicity’ only</th><th>‘Poorer wealth’ only</th><th>All significant characteristics</th></tr></thead><tbody><tr><td>0</td><td char="." align="char">0.1074</td><td char="." align="char">0.4246</td><td char="." align="char">0.4449</td><td char="." align="char">0.4547</td><td char="." align="char">0.2583</td><td char="." align="char">0.3180</td><td char="." align="char">0.0031</td></tr><tr><td>1</td><td char="." align="char">0.0185</td><td char="." align="char">0.0444</td><td char="." align="char">0.0447</td><td char="." align="char">0.0448</td><td char="." align="char">0.0359</td><td char="." align="char">0.0402</td><td char="." align="char">0.0006</td></tr><tr><td>2</td><td char="." align="char">0.2495</td><td char="." align="char">0.3176</td><td char="." align="char">0.3105</td><td char="." align="char">0.3069</td><td char="." align="char">0.3407</td><td char="." align="char">0.3414</td><td char="." align="char">0.0116</td></tr><tr><td>3</td><td char="." align="char">0.0635</td><td char="." align="char">0.0409</td><td char="." align="char">0.0389</td><td char="." align="char">0.0379</td><td char="." align="char">0.0587</td><td char="." align="char">0.0523</td><td char="." align="char">0.0045</td></tr><tr><td>4</td><td char="." align="char">0.3351</td><td char="." align="char">0.1271</td><td char="." align="char">0.1190</td><td char="." align="char">0.1153</td><td char="." align="char">0.2147</td><td char="." align="char">0.1780</td><td char="." align="char">0.0613</td></tr><tr><td>5</td><td char="." align="char">0.0763</td><td char="." align="char">0.0175</td><td char="." align="char">0.0162</td><td char="." align="char">0.0156</td><td char="." align="char">0.0343</td><td char="." align="char">0.0266</td><td char="." align="char">0.0465</td></tr><tr><td>6</td><td char="." align="char">0.1498</td><td char="." align="char">0.0279</td><td char="." align="char">0.0258</td><td char="." align="char">0.0248</td><td char="." align="char">0.0574</td><td char="." align="char">0.0435</td><td char="." align="char">0.8724</td></tr></tbody></table><table-wrap-foot><p>Source: RIPS Urban Health and Poverty Project, 2011</p></table-wrap-foot></table-wrap></p></sec></sec><sec id="Sec10"><title>Discussion</title><p id="Par32">This study sought to identify factors that were significantly associated with an adolescent’s sexual readiness. In this context, sexual readiness brought together concepts of being ready, being right and not being too young to have sex, indicating that views about preparedness, morality, and maturity are key components used to assess the readiness dimension of their sexual self-views. These are also individual characteristics that youth in an inner city US based study mentioned as “defining” readiness for sex [<xref ref-type="bibr" rid="CR40">40</xref>]. More specifically, the question that explicitly asks their views on how ready they are for sex gives clear indication of how “set” they are to initiate sex [<xref ref-type="bibr" rid="CR27">27</xref>]. However, results show that not too many adolescents in the study community identified with this sexual self-view as more than half reported no readiness whatsoever. An element of culture and societal norms could be driving this perception since there is some societal disapproval and shame associated with premarital sex in most cultures [<xref ref-type="bibr" rid="CR39">39</xref>]. But, we do not consider this to fully explain these views since Ga Mashie is known to be a community where sexual activity among young people is not harshly criticized. It is subtly encouraged, especially among girls, as a survival strategy, which is typical in most urban poor settings [<xref ref-type="bibr" rid="CR11">11</xref>, <xref ref-type="bibr" rid="CR15">15</xref>]. This result needs further examination.</p><p id="Par33">Our findings show that sexual experience—whether through media exposure or from practical experience—denotes greater readiness. The result that coital experience is a predictor of sexual preparedness is similar to those found in the sexual self-concept literature. These studies highlight adolescent and young adults’ sexual experiences as being significantly linked to sexual self-concepts that denote sexual assertiveness, agency, arousability, adventure and drive [<xref ref-type="bibr" rid="CR22">22</xref>, <xref ref-type="bibr" rid="CR23">23</xref>, <xref ref-type="bibr" rid="CR25">25</xref>]. Since it was not an aim to establish causality, the issue of time sequencing was not considered in assessing the correlates. However, the concept of sexual readiness and coital experience most likely relate bi-directionally. Thus, one’s readiness views could bring about initiation into sex and having had sex could provide that feeling of readiness. The influence of sexually explicit media on adolescents' sexual self-views also emerged. In her longitudinal study, Aubrey [<xref ref-type="bibr" rid="CR40">40</xref>], discovered that among young women, the number of hours of TV watched a day, watching primetime dramas and watching soap operas were linked to a worsening of their sexual self-concept [<xref ref-type="bibr" rid="CR44">44</xref>]. Although her results speak to the influence of less sexually explicit forms of media, it does give insight into the role of the media in portraying sexual scripts that educate adolescents on how to behave in these situations. This instruction could leave them “better equipped” to engage in sexual behavior, with the level of risk they are engaging in resembling what they have been exposed to. Again, the inverse relationship could exist where exposure may result in a feeling of readiness or pre-existing readiness could foster the impulse to view pornographic material. In addition, those who faced negative encounters with sex were not more ready than their peers, which could suggest that their forced exposure to sexual acts and/or sexual intercourse had no effect on perceptions about their readiness.</p><p id="Par34">Adolescent sexual activity (and pregnancy), according to the rational adaptation theory [<xref ref-type="bibr" rid="CR45">45</xref>], is a means through which adolescents derive benefits. It provides an escape from poverty, and gets them into stable relationships, gives them a home and a family for those who lack parental monitoring and control [<xref ref-type="bibr" rid="CR1">1</xref>]. Finding that the poorer adolescents had these mindsets was expected; however, it is surprising that the poorest adolescents were not as ready as their less poor counterparts. This outcome implies that respondents who are just above being the most worse off in their community may behave differently from those in the other groups by indication of their sexually ready attitudes. Thus, in targeting youth with programs to improve their reproductive health, this group should be addressed differently from the others. However, to fully ascertain this, other variables that can best measure the adolescent’s household’s wealth and socio-economic status must be used. Another outcome that needs further clarification is this relationship between ethnicity and sexual readiness. The finding that Akans are the ethnic group least ready for sex raises questions about assimilation and acculturation of the Akans into an indigenous Ga society. The localities under study consist mostly of respondents with Ga ethnic heritage. In the confines of Accra, this group is seen as a people with a pro-natalist affinity, thus the societal norm would be for them to start relationships and childbearing earlier [<xref ref-type="bibr" rid="CR15">15</xref>]. Apart from their lineage differences, certain customs and traditions also differ. For example, the Ga tend to practice a duolocal residential system among married people, where husbands and wives may still reside in their family homes [<xref ref-type="bibr" rid="CR15">15</xref>]. This and other cultural differences could result in socialization that renders some adolescents more sexually ready than others. The Akans and other ethnic groups can be considered migrants, although some may have settled for years in Accra. It could be that Akan adolescents may not have ascribed to the same ideals as their Ga counterparts, while the Others consisting of smaller ethnic groups may have. In order to test this idea further, variables related to migration such as duration of stay in the localities as well as parents’ migration status and attitudes in relation to sexual readiness need to be examined.</p><p id="Par35">Knowing that males consider themselves more sexually ready than females speaks to the gender differentials in the community, which are similar to global views [<xref ref-type="bibr" rid="CR7">7</xref>, <xref ref-type="bibr" rid="CR27">27</xref>]. Butler et al. [<xref ref-type="bibr" rid="CR37">37</xref>] noticed that among a sample of mostly African American preadolescent boys and girls, larger proportions of boys progressed across the stages of sexual readiness after six months while more girls remained stable or retrogressed. In that setting boys initiated sex earlier than girls; however, this is not the case for youth in the localities under study (as well as across Ghana) where generally higher proportions of girls start sex prematurely compared to boys. Despite the later sexual debut of boys in our sample, they still deemed themselves to be more sexually ready than girls. Nonetheless this outcome was expected since societal norms indicate that girls are raised to think about sex negatively as well as be sexually passive and indifferent [<xref ref-type="bibr" rid="CR23">23</xref>, <xref ref-type="bibr" rid="CR46">46</xref>, <xref ref-type="bibr" rid="CR47">47</xref>]. For boys, on the other hand, the sexual is “central to the validation of their masculinity” [<xref ref-type="bibr" rid="CR23">23</xref>].</p><p id="Par36">Various dimensions of the sexual self-concept, including sexual readiness, are thought to be predicated on one’s age [<xref ref-type="bibr" rid="CR7">7</xref>, <xref ref-type="bibr" rid="CR22">22</xref>, <xref ref-type="bibr" rid="CR27">27</xref>]. The surprising finding that age was not significantly associated with their preparedness to engage in sex indicates similar states of sexual readiness among this sample of early (12 to 14 year olds), middle (15 to 17 year olds) and late (18 to 19 year olds) adolescents. Indeed, key unobserved characteristics may circumvent age to influence their sexual self-views. A few that we consider as important for this context are parental (or familial) attitudes, and financial and physical presence variables such as, their permissive views about sex, financial support, monitoring, etc… may suggest "normative standards" for the youth to follow [<xref ref-type="bibr" rid="CR48">48</xref>]. These factors could be masking the effect of age and may ultimately play a role in shaping their sexual self-views [<xref ref-type="bibr" rid="CR39">39</xref>]. With this being the case, the issue of their social maturity, defined in this context as being prepared for adult experiences and consequences, suggests another important predictor of their sexual self-views other than age. Despite age, adolescents may have reached certain milestones that could warrant them the right to deem themselves sexually ready in their societies.</p><p id="Par37">The strengths of the study are many. We derived a new ordinal measure of sexual readiness, that incorporated a new means of assessing the readiness sexual self-view of both virgins and non-virgins. Our study also went further to relate their readiness to adolescents’ characteristics using multivariate analysis, and this provided the chance to control for the effects of other characteristics in our models. We find that net of the other factors, sexual experience, exposure to pornography, gender, ethnicity, and wealth were related to their self-views. Apart from statistically significant gender differences among pre-teens’ readiness to learn about sex and engage in sex, no other studies report the findings that we do. Due to these gender differences which seem to be almost universal, they must be considered as important when considering the needed development programs targeted at adolescents’ sexual readiness. However, additional studies are needed in order to state further comparisons between our findings and those conducted in the US and UK on sexual readiness. Despite this, our study advances the literature on sexual readiness through assessing this new measure appropriate for the Ghanaian context and identifying which characteristics of urban poor adolescents are ascribed to a particular readiness self-concept.</p><p id="Par38">This study is not without its limitations. The small sample size limited any additional analyses to explore the correlates separately by age or gender, which could have shed more light on the factors associated with adolescents’ sexual readiness. Therefore, extensions to this study include administering the sexual readiness scale to a larger sample as well as to youth in similar urban poor localities in Accra to broaden our understanding of this dimension. However, our limited sample size does not discount this study’s contribution to the literature. It provided exploration of an arena that we know little about. Given that it is just as possible to commit a type I error in a small sample as in a large one, the fact that we find something interesting in our results warrants the need for further work in this area. Nevertheless, we recognize that we cannot draw any definitive conclusions from our results. Overall, the results helped, to an extent, explore the ‘who is ready for sex’ question; however, further research through qualitative means is needed to understand why adolescents with these characteristics perceive their readiness for sex. In addition, longitudinal data, through panel studies, could provide the appropriate time sequencing to aid inference of causality, further ascertaining the relationships between the correlates and their preparedness for sex.</p></sec><sec id="Sec11"><title>Conclusion</title><p id="Par39">Although the majority of adolescents residing in this urban poor community in Accra report not being sexually ready, characteristics of those that are, include them being sexually experienced and having some exposure to sexually explicit material. Other correlates of their sexual readiness include being male, non-Akan and in the poorer household wealth quintile. Since these adolescents vary in their degree of sexual readiness, any programs or interventions developed to improve their sexual and reproductive health by targeting the sexual readiness dimension must be tailored according to adolescents’ diverse characteristics. It is imperative that gender differences in sexual readiness are emphasized since they are relevant in varied settings, with boys exhibiting higher levels of readiness than girls. It also behooves us to further explore this issue of young people’s sexual readiness, which will extend the literature on protective and risk factors of adolescents sexual behavior, and the eventual development of appropriate programs for at-risk adolescents.</p></sec></body><back><fn-group><fn id="Fn1"><label>1</label><p id="Par10">Buzwell and Rosenthal [<xref ref-type="bibr" rid="CR22">22</xref>] determined five clusters representing five distinct sexual self-concept dimensions/styles of adolescents. They were categorized into sexually naïve, sexually unassured, sexually adventurous, sexually competent and sexually driven groups. They styles were a reflection of their responses on the sexual self-esteem, sexual self-efficacy and sexual attitude scales. For example, the sexually naïve adolescents exhibited low sexual self-esteem, low sexual self-efficacy, and high sexual commitment and anxiety attitudes, while the sexually adventurous youth exhibited the opposite.</p></fn><fn id="Fn2"><label>2</label><p id="Par15">These data are from the second of three waves of a project conducted by the Regional Institute for Population Studies (RIPS), on urban poverty, population and health issues. Two of the localities (James Town and Ussher Town) are considered urban poor settings with indigenous Ga residents, while Agbogbloshie is more of an informal (slum) settlement consisting of more transient dwellers.</p></fn><fn id="Fn3"><label>3</label><p id="Par17">Adolescents between ages 12 and 14 were not interviewed in Agbogbloshie, hence the 15 to 19 year olds that were interviewed were also not included in this sample.</p></fn><fn id="Fn4"><label>4</label><p id="Par20">Items 2 and 3 were reverse coded into ‘I do not think I am too young to have sex’ and ‘I do not think it is wrong for me to have sex’. This was done to suggest that agreement meant adolescents “owned” their sexuality.</p></fn><fn id="Fn5"><label>5</label><p id="Par28">Further analyses show that a significantly higher proportion of girls state their first sexual encounter was with a boyfriend who was older than them. In addition, with the exception of males engaging in sex with more casual partners, females were more likely to exhibit risky sexual behavior which was largely characterized by their non- or inconsistent use of condoms with sexual partners.</p></fn><fn><p><bold>Competing interests</bold></p><p>The authors declare that they have no competing interests.</p></fn><fn><p><bold>Authors’ contributions</bold></p><p>AAEB drafted the manuscript. AAEB and FNAD conceptualized the study, made revisions of the manuscript, and approved of the final draft.</p></fn></fn-group><ack><title>Acknowledgements</title><p>Earlier versions were presented at the 2013 Population Association of America (PAA) Meeting in New Orleans, Louisiana, and the 2014 University of Ghana Social Science Colloquium in Legon, Accra. 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