Reducing Adolescent Sexual Risk: A Theoretical - ETR Associates

ut it does not focus on other important criteria forselecting curricula.We have structured the book around risk andprotective factors most likely to be changed by acurriculum-based program. Each chapter focuseson a different risk or protective factor, summarizingthe available evidence showing that the factor affectssexual behavior and discussing relevant behaviorchange theory and important instructional principlesfor improving the factor.Although most of the examples in this book comefrom activities used primarily with middle or highschool-aged youth, it also can be useful for peopledesigning curricula for younger or older youth.Finally, even though all the examples involve sexuality,the risk and protective factors, the theories andthe pedagogical principles may apply to many healthbehaviors other than sexual risk, such as eatingnutritiously, exercising and preventing substanceabuse. However, theories and research on the factorsaffecting these other behaviors should be thoroughlyreviewed before applying the instructional principlesdiscussed.Sexual Risk Behaviorand Its ConsequencesIn the United States, young people engage in considerablesexual risk behavior prior to or outside ofmarriage. For example:• Roughly half of all high school students reporthaving had sex at least once and close to twothirdsreport having sex before they graduatefrom high school (Centers for Disease Controland Prevention 2010b).• Although 80 to 90 percent of teens report usingcontraception during their most recent act ofsexual intercourse, many teenagers do not usecontraceptives correctly and consistently. Among15- to 19-year-old women relying upon oral contraceptives,only 70 percent take a pill every day(Abma et al. 1997). Among never-married men15-19 who had sex in the previous year, only47 percent used a condom every time they had sexin that year (Abma 2004).As a result, pregnancy rates and birth rates amongU.S. young adults remain very high relative to otherdeveloped countries.• In 2004, the latest year for which data are published,the rate of unplanned pregnancy was highestamong women 18-19 and 20-24 years of age.In these age groups, more than one unplannedpregnancy occurred for every 10 women, a ratetwice that for women overall (Finer and Henshaw2006; Ventura, Abma et al. 2008).• Among 15- to 19-year-old teens, about 72 ofevery 1,000 women became pregnant in 2006(the last year for which data are available)(Guttmacher Institute 2010). This means thatcumulatively, more than 30 percent of teenagewomen in the United States became pregnant atleast once by the age of 20.• These rates were much higher for Hispanics(127 per 1,000 women) and blacks (126 per1,000 women) than for non-Hispanic whites(44 per 1,000 women).• In absolute numbers, about 750,000 womenunder age 20 become pregnant each year(Guttmacher Institute 2010).• More than 80 percent of these pregnancies areunplanned (Finer and Henshaw 2006).• Among young women ages 20-24, each year1.7 million pregnancies occur, 58 percent ofwhich are unplanned. Among unmarried women20-24, 72 percent of their pregnancies areunplanned (Connor 2008).These unintended pregnancies have negative effectson the young adults involved, their children andsociety at large.• Teenage mothers are less likely to completeschool, less likely to go to college, more likely tohave large families and more likely to be singlethan their peers who are not teenage mothers,increasing the likelihood that they and their childrenwill live in poverty. Negative consequencesare particularly severe for younger mothers andtheir children (Hoffman 2006).2 Reducing Adolescent Sexual Risk: A Theoretical Guide for Developing and Adapting Curriculum-Based Programs