Reducing Adolescent Sexual Risk: A Theoretical - ETR Associates

chaperoned, they may not have the opportunity.Or, teens may intend to use condoms when havingsexual intercourse, but if they do not havereasonable access to condoms, then they may notuse them.In sum, intentions may have a large impact onbehavior, but for various reasons, the “best ofintentions” may not translate to behavior. Thus, itis important to increase intentions to avoid sexualrisk behaviors (discussed in this chapter), to providethe skills to implement the intentions (discussed inChapter 7) and to provide environmental support forthe intentions (beyond the scope of this book).When applying these concepts about the impact ofintentions on actual sexual behavior, three questionsshould be asked:1. Do teens’ intentions to engage or not engage inspecific sexual behaviors affect whether or notthey actually engage in those behaviors?2. Can we improve intentions?3. What are effective methods for improvingintentions?These questions are answered below.Do teens’ intentions to engage or not engage inspecific sexual behaviors affect whether or notthey actually engage in those behaviors?At least three studies have found that intendingor pledging to delay initiation of sexual activitywas related to subsequent delay in initiation of sex(Table 8-1) (Blum and Rinehart 1997; Kinsman,Romer et al. 1998; Bearman and Bruckner 2001;Kirby, Lepore et al. 2005). Conversely, one studyfound that intending to have sexual intercourse wasrelated to actually having sexual intercourse. Onlyone study found no relationship between intentionsabout sexual intercourse and actual behavior.Similarly, at least four studies have found thatintentions to use condoms or contraception wererelated to actual use of condoms or contraception(Table 8-2). None of the studies reviewed found alack of relationship or a negative relationship (Kirbyand Lepore 2007). Collectively, research in thefield of teen pregnancy and STD and research inother health areas strongly support the relationshipbetween intentions and behavior.On the other hand, intentions are not perfectlyrelated to behavior. Studies clearly demonstrate thatintentions typically explain considerably less thanhalf the variation in actual behavior; other factorssuch as environmental factors explain more thanhalf (Brown, DiClemente et al. 1992; Kinsman,Romer et al. 1998; Bearman and Brueckner 2001;Armitage and Conner 2001). As noted above, environmentalfactors include such factors as no opportunityto have sexual intercourse, extreme pressureto have sexual intercourse, lack of access to condomsor other forms of contraception and use of condomsor contraception by a partner without one’s knowledgeat the time.It is also true that an intention to engage in onebehavior may conflict with an intention to engagein another behavior. For example, in theory, theintention to abstain from sex may conflict with theintention to use contraception if sex does occur,and conversely, the intention to use contraceptionif sex occurs may conflict with the intention toabstain from sex. However, the review of studiessummarized in Tables 8-1 and 8-2 suggests there islittle evidence that the intention to use condoms orcontraception, if sex does occur, had an impact onabstaining from sex. On the other hand, the intentionto abstain from sex was associated with reduceduse of condoms or other forms of contraception inthree out of three studies (Bearman and Brueckner2001; Manlove, Ryan et al. 2003; Morrison,Gillmore et al. 2003; Kirby and Lepore 2007).Can we improve intentions?Studies provide evidence that it is possible toimprove intentions. Ten out of 18 programs(56 percent) increased intentions to abstain fromsex or to restrict sex or partners (Table 8-3) (Kirby2007). Similarly, 5 out of 11 programs (45 percent)increased intentions to use condoms or contraceptionif they do have sex. Although not every curriculumbasedintervention had a significant impact, abouthalf did so, clearly demonstrating that it is possible100 Reducing Adolescent Sexual Risk: A Theoretical Guide for Developing and Adapting Curriculum-Based Programs