Intentions matter in reducing risk for teen sex

Findings from survey of Native teens add to the evidence on ways to lower risks

Behavioral Health, Sexual & Reproductive Health

Results from a baseline survey of Native American youth participating in a teen pregnancy prevention program in a rural reservation-based community show that young people’s intention to have sex is the strongest predictor of sexual initiation. The findings, published in The Journal of Primary Prevention, were collected from 267 American Indian youth ages 13-19 who participated in Respecting the Circle of Life, a program that aims to prevent teen pregnancy and sexually transmitted infections, including HIV.

The survey showed that a young person’s intention to remain abstinent until marriage, as well as their confidence in being able to correctly use condoms (self-efficacy), were the most significant factors among those who report never having had sex. The results also showed, unsurprisingly, that older youth and those with an intention to have sex are more likely to be sexually experienced. Findings suggest that teen pregnancy prevention programs for Native youth should focus on changing intentions to have sex and improving skills and confidence around condom use, in order to have the greatest impact on delaying sexual initiation. Survey results also indicate that teen pregnancy prevention programs may be more effective when they engage teens in groups according to their age, such as 13-15 and 16-19.

About Respecting the Circle of Life

Nationally, teen pregnancy rates have declined by 67% since peaking in 1991. Yet significant disparities remain. Native American youth have the highest teen birth rate of any U.S. group and 41% of Native American women begin childbearing in adolescence. Nationally, rates of some sexually transmitted infections are growing fastest in Native American communities.

Respecting the Circle of Life, developed by the Johns Hopkins Center for American Indian Health in partnership with Native communities, is a culturally grounded curriculum taught by Native American health educators from their own community. Educators deliver eight lessons at a summer basketball camp and a ninth lesson after camp to youth and parents together in their homes. Embedding the curriculum in a basketball camp helps engage equal numbers of girls and boys, who research shows are hard to reach and difficult to retain in teen pregnancy prevention programs.

Results from studies of Respecting the Circle of Life participants continue to inform the development of targeted teen pregnancy prevention programs that aim to delay sexual initiation and improve sexual health outcomes in Native American communities. ​

Learn more about Respecting the Circle of Life.

For more information, contact Lauren Tingey, email

“Risk and Protective Factors Associated with Lifetime Sexual Experience Among Rural, Reservation-Based American Indian Youth” was written by Lauren Tingey, Rachel Chambers, Summer Rosenstock, Francene Larzelere, Novalene Goklish, Angelita Lee, and Anne Rompalo. The Journal of Primary Prevention (2018) 39:401-420.

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