INTERPERSONAL RELATIONAL CHARACTERISTICS AND STAGES OF CONSISTENT CONDOM USE IN SEXUALLY ACTIVE ADOLESCENT FEMALES

Sexually Transmitted Infections (STI’s) continue to negatively affect young people in the United States, ages 15-24 years old, specifical ly impacting young woman at a disproportionately high rate. STI infection rates among young Black females are significantly higher than among their white counter parts, and this group continues to be identified as an at-risk population. Condom use has been assessed and encouraged as a prevention strategy for both STI's and uninten ded pregnancies. Previous research has identified a number of factors that influence c ondom use in adolescent females, however not enough research has focused on the impa ct of relational factors on condom use. The aim of this study was to assess int erpersonal relational factors and their influence on consistent condom use among sexu ally active adolescent females. Additionally, this study can begin to fill a gap in research regarding the relational experiences of urban, adolescent females and their condom use behavior. This study assessed how relational factors: relationship durat ion, sexual relationship duration, relationship status, and perceived power and contro l were related to consistent condom use. The sample included 831 sexually active, adole scent females, ages 14-17 years old. Results suggest that both relationship duratio n and sexual relation duration have a significant association with stage of condom use. R lationship status (steady/not) did not show a significant association with stage of co ndom use, in this sample. Perceived relational power/control over condom use was signif cantly associated with stage of condom useThese results are consistent with the literature in suggesting that as relationship duration increases, the perceived risk for STI prevention may decrease, explaining the increase in risky sex associated wit h longer relationships. Further research is needed to continue to assess the dynami cs of adolescent relationships along with the influence of interpersonal relational char acteristics on consistent condom use within this population.

Sexually transmitted infections (STIs) cause various health and community problems, and they threaten the health and wellbeing of adolescents at disproportionately high rates. In 2011 nearly half of new STI infections occurred among adolescents and young adults, aged 15-24 (CDC, 2011). While adolescents and young adults have the highest STI rates, young women in particular seem to be affected the most by this epidemic. Once infected, young women are at a heightened risk for other STI and HIV infection, and face more long-term health consequences such as infertility. African American adolescent females have been especially negatively affected as they bear a disproportionate burden of STI infection. In 2008, 48% of Black teenaged girls aged 13-17 years old had an STI (CDC, 2008). In 2011, Black adolescent females ages 15-19 held a chlamydia rate close to six times higher than their white counterparts (CDC, 2011). In that same year, gonorrhea rates were 16 times higher, and syphilis rates were 30 times higher in Black adolescent females compared to their white counterparts (CDC, 2011).
The purpose of this study was to increase our understanding of the relationship between consistent condom use and interpersonal relationship characteristics in an existing sample of sexually active adolescent females recruited in family planning clinics. The decision to use condoms or engage in risky sexual behavior is often negotiated between sex partners. Research efforts to better characterize and understand relational factors that influence adolescent condom use, attitudes, and behaviors can inform safer sex and STI prevention programs.
Adolescent females' readiness to engage in consistent condom use is likely influenced by relational and dyadic characteristics. Some research has focused primarily on the importance of partner communication and ways to improve it as a way to increase consistent condom use in adolescent females (Noar, Morokoff, & Redding, 2002). Other characteristics include perceived exclusivity and trust in relationships. Research has found that females in exclusive relationships with a main partner express lower intentions to use condoms consistently compared to females who do not identify one main partner (Matson, Adler, Millstein, Tschann, & Ellen, 2011). Consistent with this finding, females who express more investment and identify that they are in an established relationship are less likely to discuss condom use with partners (Saul et al., 2000). Another interpersonal characteristic is power, specifically perceptions of relational power and its influence to improve a female's ability to engage in safer sex practices (Gutierrez, Oh, & Gillmore, 2000). Relational power and control regarding condom use as a preventive strategy against STI's is heavily influenced by a women's self-efficacy for condom negotiation. Self-efficacy for condom negotiation is potentially threatened if a woman does not have or share relational power, increasing her risk for STIs. Closeness is another relational aspect of a female's decision to engage in risky sexual behavior. As relationship closeness increases, so do security and intimacy (Remple, Holmes, & Zanna, 1985), which may reduce a female's perceived need, desire and/or willingness to use condoms. These relational characteristics: partner communication, relationship status, perceived power and control, condom assertiveness, and closeness, are all factors that have been shown to influence consistent condom use in females. This study will further explore the associations between these interpersonal relationship characteristics and condom use attitudes and behaviors in sexually active adolescent females.

REVIEW OF LITERATURE
Research has identified some psychosocial factors such as, earlier age of sexual debut, more sexual partners, and more accepting attitudes towards sexual intercourse at younger ages, that put African American adolescent females at a greater risk for contracting STI's (Hipwell, Keenan, Loeber, & Battista, 2010). Some cultural factors can also heighten STI risk for this group. In one study with inner-city African American female teenagers, more frequent intercourse was associated with less cultural pride (Locke & Newcomb, 2008). Other factors such as sexual abuse also put adolescent females at a greater risk. The fact that African American adolescent females report higher rates of "non-voluntary first intercourse," compared to other racial groups, places them at higher risk for STI's (CDC, 2000). Furthermore, higher rates of poverty among African Americans pose specific barriers to accessing education and health care. This economic disadvantage influences sexual behavior, sexual health outcomes, increases STI risk, and makes it harder to attain optimal sexual health (Collins, 2005). In examining racial disparities in HIV infections, Adimora and colleagues (2009) identified sexual networks and concurrent sexual partnerships as factors that contribute to the transmission of HIV within this group at disproportionately high rates (Adimora, Schoenbach, & Floris-Moore, 2009).
Consistent condom use has been identified as an effective prevention strategy against STIs and continues to be assessed and intervened upon as a prevention tool (Crosby et al., 2013, Sales et al. 2012, Bull et al., 2012. While there has been a longstanding concern regarding the reliability of adolescents' self-reported sexual behavior, research has found that most adolescents provide reliable reports. Vanable and colleagues (2009) found moderate to high levels of reliability for age of sexual debut, number of sexual partners, and occurrence of oral and vaginal sex. Furthermore, this research found a moderate level of reliability (.62) for condom use at most recent occurrence of vaginal sex, and a lower but satisfactory reliability (.47) for noncondom use for vaginal sex in last 3 months (Vanable et al., 2009). In other research with adolescents reporting having sex in the past year, only 47% of males and 28% of females reported using a condom consistently (Abma et al., 2004). Developmental changes in adolescent females may also influence their condom use, such that generally as adolescent girls mature, their condom use declines (Matson et al., 2011).
Research has suggested that this decline in condom use is partly due to the concurrent changes in these young women's sexual relationships. Over time, adolescents' sexual relationships may shift from casual and/or multiple sex partners to a pattern better characterized as serial monogamy (Fergus et al., 2007).  (Crosby et al.,2000;Fortenberry et al., 2002;Sionean et al., 2002). Other relational characteristics associated with STI risk behaviors are less frequent partner communication about sexual topics (Noar et al, 2001), lower levels of sexual assertiveness Morokoff et al., 2009), lower levels of relationship power (Teitelman et al., 2008), and lower levels of partner support for condom use (Weisman et al., 1991). These relational and dyadic characteristics can prevent a sexually active adolescent female from using condoms consistently. Sexual partners influence each other mutually and an adolescent female's decision to use condoms is influenced by relational factors. These relational factors include communication between partners, characteristics of the relationship (length, perceived control, frequency of intercourse, perceived monogamy) and condom assertiveness.
There are several theoretical models of behavior and behavior change that have been used to explain condom use behavior. This secondary data analysis will integrate constructs from the Transtheoretical Model (Prochaska &Velicer, 1997;Prochaska, Redding & Evers, 2008), the Multifaceted Model of HIV Risk (Harlow et al., 1993;Morokoff et al., 2009) and the Theory of Gender and Power (Connell, 1987) to examine how relational characteristics are associated with condom use attitudes and behaviors in a sample of sexually active adolescent females recruited in family planning clinic settings. This study will focus on urban, mostly Black adolescent females given their heightened risk for STI and HIV infection. The interpersonal and relational characteristics this study will focus on are: relational power, perceptions of closeness, length of relationship, perceived exclusivity, initiation of sexual intercourse in current relationship, condom use communication, condom assertiveness, and perceived partner support for condom use. These interpersonal factors will be examined to see which of these is most highly associated with condom use attitudes and behaviors within this sample.
The Transtheoretical model (TTM) is a comprehensive model of behavior change that has been used to explore and understand the readiness to engage in health related behaviors (Prochaska &Velicer, 1997;Prochaska, Redding, & Evers, 2008).
The TTM describes behavior change with a five stage model that reflect a continuum of change, ranging from an individual not wanting to make a change, to an individual who has maintained adoption of a new health behavior. The five stages reflecting an individual's readiness to change are: Precontemplation (not intending to change behavior in the next six months), Contemplation (intending to change in the next 6 months), Preparation (planning to take action in the immediate future), Action (having changed behavior within the past 6 months) and Maintenance (maintaining the behavior change and preventing relapse). Progress across the stages of change is mediated by various psychosocial processes. Two TTM constructs are especially useful in studying condom use: decisional balance and self-efficacy. The decisional balance construct reflects individuals' positive and negative attitudes towards consistent condom use. An individual's assessment of the pros and cons of a behavior change has been systematically related to their stage of change across a range of health behaviors, including condom use (Hall & Rossi, 2008). Self-efficacy reflects the individual's belief that they can use condoms across a range of challenging situations.
Increased consistent condom use has been associated with higher levels of selfefficacy (Redding & Rossi, 1999;Sagerstano et al., 2005). Additionally, the TTM is especially important in research pertaining to women's sexual risk and population health. The TTM provides both a framework and specific constructs that support the notion that women have the ability to protect themselves from infection via condom use. The Transtheoretical model has also been the foundation for population-based TTM-tailored expert system interventions that can be widely disseminated and have been demonstrated effective across a range of behaviors, including condom use (Peipert et al., 2008;Redding et al., in press). The Transtheoretical model measures were used to assess stage of consistent condom use, decisional balance, efficacy, condom assertiveness, condom communication and partner support for condom use.
The Multifaceted Model of HIV Risk (MMOHR) is a comprehensive model developed to predict sexual risk behaviors in women, specifically HIV-related risky behavior (Harlow et al., 1993;Morokoff et al., 2009). The MMOHR proposes that relational experiences influence a woman's ability to protect herself from sexual risks.
Additionally, the model has been used to predict sexual risk by assessing multiple factors including interpersonal risk factors (Harlow et al., 1993;Morokoff et al., 2009). Such interpersonal factors include: anticipated partner reaction to condom use and sexual assertiveness. The MMOHR is an important framework in sexual risk behavior research, as it includes social and environmental influences on women's sexual choices, as well as advocating for women's ability to effectively assert and protect themselves. While the MMOHR proposes that there are many facets in better understanding HIV risk, "interpersonal and behavioral factors appear to be the most central" (Harlow et al., 1993). Last, the MMOHR can aid in research efforts by improving our understanding of the effect of women's social status and power on risk reduction, especially considering that condom use is a male-controlled behavior.
Along similar lines of reasoning, the Theory of Gender and Power (Connell, 1987) proposes that relationship power differentials that advantage men simultaneously pose health risks for women. According to this theory, a woman's disadvantaged power position in relation to her partner may prevent her from exercising condom assertiveness or engaging in condom use communication . In one study examining relationship power in sexual negotiation, results indicated that 17% of adolescent females felt as though they never had the right to make their own decisions about birth control, regardless of their partner's wishes (Rickert, Sanghvi, &Wiemann, 2002). These results also indicated that 9% of young women felt as though they never had the right to make their own decisions about sexual activity, and 15% reported feeling as though they never had the right to ask their partner if he had been tested for STD's (Rickert, Sanghvi, &Wiemann, 2002). In another study assessing relationship power, sexual assertiveness, and condom negotiation, Wingood and colleagues found that Black adolescent females with a history of dating violence were more likely to fear both talking to their partner about pregnancy prevention, and the consequences of condom negotiation (Wingood, DiClement, McCree, Harrington, & Davies 2001). The Theory of Gender and Power provides an important framework for the current study by highlighting disadvantaged power positions of women in our society and how that parallels their power disadvantages in sexual relationships, increasing their sexual risk.
Integrating across these theories, this study will examine specific relationship perceptions and factors in a sample of urban adolescent females, to examine how relationship factors are associated with healthier condom attitudes and behaviors.

Hypotheses:
Hypothesis 1: Those who report being in longer relationships with current partner, consistent with having a steady partner, will be earlier in the stages of consistent condom use (Crosby et al.,2000;Fortenberry et al., 2002).
Hypothesis 2: Those who report higher perceptions of relational power will be more likely to be further along in the stages of consistent condom use (Gutierrez et al, 2000).

Procedures:
Participants were recruited into a larger longitudinal study from four family planning clinics in Philadelphia serving inner-city, at-risk youth. Eligibility criteria included being: between 14-17 years old, not pregnant, English-speaking, and willing to participate in the study. Written informed assent was obtained from each adolescent, with parental consent waived to maintain clinic confidentiality.
Participants received small incentives for completion of study time points. This study will examine baseline information from study participants. The IRB at the University of Rhode Island approved all study procedures for human subjects protections.
At baseline, participants were asked to complete a 30 minute survey about demographic information, sexual history, current relationship, condom use behavior, assertiveness, and efficacy.

Measures:
Sociodemographic and sexual history variables: Participants reported age, year in high school, age of first sex, STI history, and pregnancy history. Recent sexual activity was measured through questions about sexual activity in the last 30-90 days.

Contraceptive Use:
Current use of contraception was assessed through a series of items about use of various methods. Participants were asked if they used these contraceptive methods in the last 30-90 days. Contraceptive methods included barrier methods, oral contraceptives, Depo-Provera, Norplant, and intrauterine device.

Condom Use Efficacy:
Participants rated their level of confidence that they could use condoms across five challenging situations. Confidence ratings ranged from 1-not at all confident to 5-very confident and psychometric properties of this 10-item measure were good with an alpha=0.95 (Redding et al., 1996a(Redding et al., , 1999. Items asked participants to rate their confidence that they would use condoms even when, for example: My partner pressures me to take a chance this time; or I am upset.

Pros and Cons of Condom Use:
Participants rated the importance of 12 items reflecting the benefits (Pros) and costs (Cons) of using condoms consistently. Importance ratings ranged from 1-not at all to 5-very important and psychometric properties of both 6-item subscales were good with alpha=0.81 for Pros and alpha=0.89 for Cons (Redding et al., 1996a(Redding et al., , 1999.
Participants rated each item's level of importance to their own decisions about using or not using condoms. Sample items reflecting the Pros of condom use include: I would feel more responsible; and Condoms would protect both of us. Sample items reflecting the Cons of condom use include: Sex would feel less natural; and Asking my partner to use condoms would be too embarrassing.

Condom Communication:
Participants were asked 3 items about condom use communication with current partner in the past 30 days. Frequency ratings ranged from 1-not at all to 5-frequently and the 3-item alpha=0.75 (Redding et al., 1996b;Noar et al., 2001). Items included: I talk about condom use with my partner; and My partner listens to me when I want to talk about using condoms; and My partner and I talk about using condoms together.

Condom Assertiveness:
Participants were asked 3 items about condom use assertiveness with current partner in the past 30 days. Frequency ratings ranged from 1-not at all to 5-frequently and the 3-item alpha=0.81 (Redding et al., 1996b;Noar et al., 2001). Items included: I refuse to have sex if condoms aren't available; If a partner does not want to use condoms, I insist that we do; and I insist on condom use with a partner before I will have sex.

Partner Support for Condom Use:
Participants were asked 3 items about partner support for condom use in the past 30 days. Frequency ratings ranged from 1-not at all to 5-frequently and the 3-item alpha=0.71 (Redding et al., 1996b;Noar et al., 2001

Relationship Duration and Sexual Relationship Duration:
Participants were asked one item to assess the length of their current relationship: "How long have you been dating your most recent partner". The duration dating their recent boyfriend included five response options: less than 30 days, 1-3 months, 4-6 months, 7-11 months, and 1 year or more. Sexual relationship duration with current partner was also assessed including the same five response options.

Condom Use Control:
Participants were asked how much power or 'say' they had in their relationship about using condoms. The item asked "When you have sex, who has the final say about using condoms?" and response options included four categories: my boyfriend has more say, we have equal say, I have more say, and I don't know/we don't talk about it.

Stages of Condom Use:
Consistent condom use was measured in five stages. Participants in Precontemplation, Contemplation, and Preparation included those who did not use condoms consistently, and who varied in their intentions to start using condoms consistently. Participants in reporting birth control pill use. Table 3 shows that most participants reported having had sex with their current boyfriend (91%). Most also reported that their current relationships were steady (83%). Furthermore, many participants reported that they were in long relationships with 41% reporting dating their current boyfriend for one year or more. Sexual relationship duration was slightly lower, with 31.5% reporting having sex for one year or more with their current boyfriend. About 50% reported that their current boyfriend was "extremely willing" to use condoms. When asked who has the final say about using condoms, 51% of females reported having "equal say".
Additional relationship variables are described in Table 3. Table 4 shows the associations between relationship status (steady/not) and relationship duration, closeness, how well they knew their partner, exclusivity, and condom final say. All associations, evaluated with Chi-squared statistics, were statistically significant, with Phi values indicated in Table 4.

Hypothesis 1: Those who report being in longer relationships with current partner will be earlier in the stages of change (Precontemplation, Contemplation, and
Preparation) for consistent condom use (Crosby et al.,2000;Fortenberry et al., 2002). This chi-squared also indicated a significant association between length of time being sexually active with current boyfriend and stage of change for consistent condom use,

Analysis 1c:
A Chi-squared test assessed the relationship between stages of change for consistent condom use and current relationship status (steady/not). No significant association between relationship status and stage of change for consistent condom use was found, .This showed that participants who reported their relationship as steady did not differ on their stage of condom use compared to participants who did not report their relationship as steady. In contrast, the Chisquared that assessed the association between relationship closeness and stage of change found a significant association, Hypothesis 2:Those who report higher perceptions of relational power will be further along in the stages of change for consistent condom use (Gutierrez et al, 2000).
Analysis 2: Table 5 shows the results of the Chi-squared test that assessed the relationship between participants' stages of change for consistent condom use and their perceptions of relational control/power. A significant association between relational control/power over condom use and stage of change for consistent condom use was found, .

Multivariate Results
For continuous relational variables, a MANOVA was conducted to assess if there were any significant group differences, based on the linear combination of the continuous dependent variables.  Table 6 shows the follow-up ANOVA results and proportions of variance accounted for (etasquared) for each dependent variable indicating significant differences on all, except on the Cons of condom use, which did not differ by stage group. The main effect for relationship status (steady/not) as the independent variable also showed some significant differences, F(6, 813.00)=7.88, Wilks' λ = .95, p<.000. These results indicate that there were significant mean differences between individuals with different relationship status (steady/not) on the linear combination of pros, cons, efficacy, assertiveness, communication, and partner support for condom use. Table 6 shows the follow-up ANOVA results that found significant differences by relationship status for cons of condom use, partner communication, and partner support for condom use, but not for the remaining dependent variables.

Discussion
This study examined associations between interpersonal relationship characteristics and condom use among at-risk sexually active adolescent females.
Some associations between specific relationship descriptors and stage of change for consistent condom use were found in this sample. While there was no association between relationship status and condom stage of change, a significant association between stage of condom use and relationship duration, sexual relationship duration, closeness, and condom final say was found. Adolescents in relationships for a year or longer were slightly more likely to be in the Precontemplation stage of condom use (52% vs. 42%; See Table 5), although a good proportion were in Action and Maintenance as well. Similar to this, sexual relationship duration also varied by stage of change. Participants reporting being sexually active with their partner for one year or more appeared slightly more likely to be in the Precontemplation stage of condom use (44% vs. 33%; See Table 5). This finding is consistent with the literature on the pattern between relationship longevity and condom non-use. As adolescent girls remain in relationships longer, trust builds, and perceived STI risk declines resulting in inconsistent condom use. Although condom use was lower among participants in longer relationships, these findings were encouraging since condom use rates were only slightly lower than those in shorter relationships. Such minimal differences suggest that despite relationship duration and sexual relationship duration, these participants are still protecting themselves from STI infection and unintended pregnancy. Participant's report on relationship closeness also varied by stage of change. Adolescents feeling closer to their partner were slightly more likely to be in the Precontemplation stage of condom use (55% vs. 47%; See Table 5). This pattern is consistent with the hypothesis that increased feelings of trust in the relationship decrease perceived risk for STI infection. Regarding condom use final say, most participants reported having "equal say" (n=425), followed by "I have more say" (n=216), and there was minimal variance across stage of change for both of these responses. For those reporting equal say, slightly more were in the Action stage of condom use versus Precontemplation (62% vs 51%; See Table 5). It was hypothesized that those who reported having the final say over condom use would be further along in the stages of change, and while the crosstabulation shows an almost equal range of percentages across stages for having more say, participants were more likely in the Preparation stage, compared to those in the Action stage (31% vs 22%; See Table 5).
Previous research findings have associated the lack of relational control and power with higher STI risk behaviors (Gutierrez et al. 2000;Teitelman et al., 2008).
Consistent with this literature, those participants who either reported their boyfriend had more say or reported not talking about it were slightly more likely to be in one of the Pre-Action stages of condom use (See Table 5).
Results from the multivariate analyses indicated a significant main effect for both stage of condom use and relationship status on the linear combination of pros, cons, efficacy, assertiveness, communication, and partner support for condom use.
Results from the follow up ANOVA for stage of change did reveal significant findings for all continuous relationship variables, except for cons of condom use (See Table 6).
Cons of condom use showed no significant mean differences across stages, suggesting that participants perceive cons for condom use, despite stage. The follow up ANOVA's for relationship status revealed significant mean differences for cons of condom use, partner communication, and partner support for condom use, but not for the remaining continuous dependent variables. Mean differences for partner communication and partner support for condom use were higher in those participants in steady relationships (See Table 6). Contrary to what was expected the mean for cons of condom use was higher in those not in a steady relationship (See Table 6).
This finding is inconsistent with previous studies in that it is often assumed that the cons of condom use are higher among those in steady relationships. This finding could be unique to this sample, or could reflect a different meaning than what was usually referred to as "steady". Perhaps future studies can begin to assess the meaning of "steady" as a relationship descriptor, and suggest another term that adolescents may prefer for describing their romantic and/or sexual relationships.
The current study was able to highlight both risk and protective factors for these participants that can further advance intervention strategies for sexually active adolescent females. In light of these results, there is a great need for preventive intervention efforts to increase condom consistency among sexually active female adolescents, as well as continued efforts to better understand the influence of relational characteristics. Since condom use is an interdependent, dyadic, and complex behavior that is dependent upon the intention and willingness of two individuals (VanderDrift, Agnew, Harvey, & Warren, 2012), research efforts should continue to assess the context of its use. Future intervention and prevention efforts should account for relationship duration as well as sexual relationship duration when looking for ways to increase condom use consistency among sexually active adolescent girls. Prevention efforts should encourage and educate adolescent girls currently in relationships about their continued STI and pregnancy risk, despite relationship longevity. This is especially important for young women who may believe that relationship longevity decreases their STI risk and switch their focus to contraceptive use to prevent pregnancy. This contraceptive switch leaves adolescent females vulnerable to STI and HIV infection, highlighting the need for future efforts to decrease these risks, especially for those reporting being in longer relationships.
Since sexual activity often times takes place in the context of a romantic relationship, the dynamics of this relationship should be further explored, especially as it relates to perceptions of relational power and control. Future studies are needed to further assess sexual behavior among adolescents, and specifically how relational power is associated with condom use. Future intervention efforts could focus on increasing adolescent girls' levels of confidence and power in their sexual relationships, specifically in advocating for safer sex practices with their partners. This may call for interventions that focus on strengthening condom influence strategies for young women that can aid them in getting their partners to use condoms. Teaching adolescent females communication strategies such as refusal skills and condom negotiation could empower them to make safer decisions regarding their sexual behavior. Additionally, future research is needed to better understand the associations of other interpersonal relational characteristics, such as intimacy, love, sense of security, and reciprocity, with condom use.
One possible barrier to this approach is that encouraging condom assertive behavior may challenge traditional gender roles for adolescent women (Tschann et. al, 2002). Given that the association between relational power and condom use is not clear, future preventive intervention efforts should make use of more items to assess perceptions of relational power and control. Lastly, it would be advantageous for future research efforts to clarify how relationship dynamics such as perceived power and control may change over time, specifically as they relate to condom use.
Furthermore, these results also suggest the need to continue to assess, increase knowledge about relationship experiences, and intervene upon condom use for Black female adolescents that are currently sexually active, given their heightened risk to STI infection and unintended pregnancy. In predicting condom use, future research should take into account the possible influence of cultural values that dictate attitudes about sexual behavior as well asassumptions regarding gender roles. Considering feminine gender socialization, adolescent females may at times submit to condom nonuse, despite their desire or intention, in order to adhere to prescribed gender roles.
Future research can assess the possible associations between condom nonuse and gender role adherence or investment in ideal womanhood (Katz and Tirone, 2009).
Finally, the historical sexual objectification and exploitation of black female bodies should not be ignored. The exoticizing of Black women, historically and currently, creates damaging sexual scripts that could impact how adolescent females see themselves as sexual beings (Stephens & Phillips, 2003). Future research would benefit from examining the influences of these sexual scripts and their relation to sexual identity development, sexual behavioral outcomes, and interpersonal relational characteristics. Due to the complex nature of STI risk among sexually active adolescent females, population based interventions are needed in order to move beyond the focus on individual risk behaviors (Sevgi, Adimora, & Fenton, 2008).
TTM-tailored interventions are well suited for entire populations and have been demonstrated effective in this sample (Redding et al., in press). Future interventions might evaluate the addition of a social justice framework as a way to respond to both structural and social determinants that address the unique vulnerabilities of this group (Sevgi, Adimora, & Fenton, 2008;Adimora, Schoenbach, &Floris-Moore, 2009).
Reducing STI and HIV risk among African American adolescent females, and the greater African American community, may require an integrative social and political movement on both a community and national level.

Limitations
This study has some limitations.