SEEING GREEN: GENDERED RELATIONSHIP EXPECTATIONS AND SEXUAL RISK AMONG ...

SEEING GREEN: GENDERED RELATIONSHIP EXPECTATIONS AND SEXUAL RISK AMONG ECONOMICALLY UNDERSERVED ADOLESCENTS IN BRADDOCK,

PENNSYLVANIA

by Kimberly Joy Rak B.S., Syracuse University, 1994 M.A., University of Colorado at Denver, 2003

Submitted to the Graduate Faculty of the Dietrich School of Arts and Sciences

in partial fulfillment of the requirements for the degree of

Doctor of Philosophy

University of Pittsburgh 2013

UNIVERSITY OF PITTSBURGH ARTS AND SCIENCES

This dissertation was presented By

Kimberly Joy Rak It was defended on February 28, 2013 and approved by Joseph S. Alter, PhD, Professor, Department of Anthropology Martha Ann Terry, PhD, Assistant Professor, Department of Behavioral and Community Health

Sciences Jessica G. Burke, PhD, Associate Professor, Department of Behavioral and Community Health

Sciences Michael Yonas, Dr. P.H., Assistant Professor, Department of Family Medicine Dissertation Advisor: Kathleen M. DeWalt, PhD, Professor, Department of Anthropology

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Copyright by Kimberly Rak 2013

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SEEING GREEN: GENDERED RELATIONSHIP EXPECTATIONS AND SEXUAL RISK AMONG

ECONOMICALLY UNDERSERVED ADOLESCENTS IN BRADDOCK, PENNSYLVANIA Kimberly J. Rak, PhD

University of Pittsburgh, 2013

This dissertation examines adolescent sexual health disparities from the perspective of economically underserved youth considered "at risk" living in the Mon Valley of southwestern Pennsylvania. Adolescent discussions of relationship and sexual risk highlight social relations and contexts in contrast to discrete behaviors and outcomes. While adolescents are aware of the possibility for contracting a sexually transmitted disease or pregnancy from engaging in sex, these risks are negated or mitigated in relation to other risks that threaten self esteem, group belonging, and a moderate sense of security. In addition, variation by age and gender contribute to complex constructions of romantic relationship expectations that inform the context for sexual risk taking beliefs and behaviors. Adolescent risk taking is social, symbolic, and subjective and not solely reducible to individualistic domains of knowledge or adoption of preventative measures. Therefore, this qualitative study examines the ways in which poverty structures the social meanings of risks.

This study is based on 18 months of ethnographic research including in-depth interviews, creative arts-based data collection sessions, participant observation, and on-going dialogue with

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community stakeholders. In addition, this qualitative research provided an opportunity to explore, investigate and document gender and age differences: there were two adolescent age cohorts each including male and female participants. Older adolescents detailed the scope and content of romantic relationships and perceptions of sexual risk while younger adolescents detailed relationship dynamics.

The qualitative approach broadens the scope of inquiry from acts (e.g. use of protection) or outcomes (e.g. STDs, teenage pregnancy) to include social and power dynamics influencing gendered expectations in relationships. Additionally, this dissertation explores relationship expectations among younger adolescents who are traditionally absent from research on sexual health. Furthermore, discussions of sexual risk need to be contextualized to incorporate larger social and cultural constructions of what is considered "risk" as well as the potential benefits incurred by risk taking. Policy suggestions would include an explicit recognition of the role of poverty in adolescent sexual health disparities (and health disparities more broadly), and a first step would be to track adolescent sexual health information by socioeconomic status in addition to geographic location and race/ethnicity.

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TABLE OF CONTENTS

PREFACE................................................................................................................................... xiii 0.0 INTRODUCTION................................................................................................................ 1

0.1 RESEARCH FOCUS.......................................................................................... 1 0.2 COMMUNITY ENGAGEMENT AND IDENTIFICATION OF PROBLEM .. 3 0.3 OUTLINE OF THE DISSERTATION............................................................... 5 1.0 CHAPTER 1: ADOLESCENT SEXUALITY................................................................... 8 1.1 POLITICAL DISCOURSES .................................................................................... 9 1.2 POPULAR DISCOURSES ..................................................................................... 12

1.2.1 Parents............................................................................................................. 12 1.2.2 Media .............................................................................................................. 13 1.3 THE STATE OF ADOLESCENT SEXUAL HEALTH IN THE U.S. .................. 15 1.4 INCLUDING YOUNGER ADOLESCENTS ........................................................ 19 1.5 CONTRIBUTIONS FROM THIS RESEARCH .................................................... 21 2.0 CHAPTER 2: REVIEW OF THE LITERATURE......................................................... 23 2.1 AN ANTHROPOLOGY OF CHILDHOOD .......................................................... 23 2.1.1 An Anthropology of Adolescence ................................................................. 26 2.1.2 Development of Sexual Scripts....................................................................... 29 2.2 ADOLESCENCE.................................................................................................... 30 2.2.1 Adolescent Development: The Dominant View ............................................. 31

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2.2.2 Positive Sexual Development: What Does This Mean? ................................. 35 2.2.3 Adolescent Risk Taking .................................................................................. 40 2.3 DEVELOPMENTAL CONSIDERATIONS .......................................................... 45 2.3.1 Gender Implications........................................................................................ 47 2.3.2 Social/Familial Influences .............................................................................. 48 2.3.3 Change Over Time .......................................................................................... 49 2.4 NEIGHBORHOOD CONTEXT............................................................................. 49 2.5 ART AND DEVELOPMENT ................................................................................ 53 2.6 MULTI-THEORETICAL FRAMING.................................................................... 55 2.6.1 Political Economy & Social Marginalization ................................................. 56 2.6.2 Construction of Phallocentric Privilege .......................................................... 57 2.6.3 Cross-Cultural Variation in Adolescent Sexuality.......................................... 58 2.6.4 Future-Oriented Prospects .............................................................................. 59 2.6.5 "Sojourner Syndrome".................................................................................... 60 2.6.6 "Kinscripts"..................................................................................................... 61 2.6.7 Theories of Sex(uality) ................................................................................... 62 2.7 LITERATURE REVIEW CONCLUSION............................................................. 65 3.0 CHAPTER 3: RESEARCH SETTING AND CONTEXT ............................................. 68 3.1 HISTORICAL INFORMATION............................................................................ 69 3.2 CURRENT SETTING ............................................................................................ 74 4.0 CHAPTER 4: METHODOLOGY ................................................................................... 79 4.1 COMMUNITY INVOLVEMENT ......................................................................... 79 4.2 METHODS ............................................................................................................. 79

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4.3 ETHICAL CONSIDERATIONS............................................................................ 89 4.4 SETTING THE STAGE ......................................................................................... 91 5.0 CHAPTER 5: RESULTS .................................................................................................. 92 5.1 RELATIONSHIPS.................................................................................................. 92

5.1.1 Types of "Relationships:" Hit it and Quit it, You're My Possession ............. 92 5.1.2 Good and Bad Relationships........................................................................... 97 5.1.3 Messages and Communication about Dating and Relationships .................. 109 5.2 BECOMING SEXUALLY ACTIVE ................................................................... 112 5.2.1 What is Sex? ................................................................................................. 112 5.2.2 Initiating Sex ................................................................................................. 113 5.2.3 Parental Communication............................................................................... 116 5.2.4 Peer Influence ............................................................................................... 118 5.2.5 Messages about Sex ...................................................................................... 119 5.2.6 Internet, Social Networking and Cell Phones ............................................... 123 5.2.7 Participant' Views of Messages that Would be Good to Hear about Sex .... 125 5.3 SEXUAL HEALTH CONCERNS ....................................................................... 129 5.3.1 STDs ............................................................................................................. 129 5.3.2 HIV/AIDS ..................................................................................................... 132 5.3.3 Teen Pregnancy............................................................................................. 135 5.4 HOPES AND DREAMS FOR THE FUTURE .................................................... 145 5.5 ADDITIONAL THEMES..................................................................................... 148 5.5.1 Gendered Scripts ........................................................................................... 149 5.5.2 Same-Sex Relationships................................................................................ 151

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