Reducing Adolescent Sexual Risk: A Theoretical - ETR Associates

• Children of teenage mothers are likely to haveless supportive and stimulating home environments,lower cognitive development, less education,more behavior problems and higher ratesof both incarceration (for boys) and adolescentchildbearing than children of non-teenage mothers(Hoffman 2006).STDs are also a large problem. Compared to olderadults, sexually active adolescents and young adultsages 24 and younger are at higher risk for acquiringSTDs. For example:• The most common STDs among young peopleare human papillomavirus (HPV), trichomoniasisand chlamydia. Although young adults (24 andunder) represent only 25% of the sexually activepopulation, they account for nearly half (48 percent)of the new STD cases every year. In 2004,there were more than nine million cases of STDreported in this age group (Weinstock, Berman etal. 2004).• In addition, more than 7,000 young adults 24 andunder were diagnosed with HIV in 2008 (Centersfor Disease Control and Prevention 2010a).• The prevalence of STDs are typically muchhigher among African-American young peoplethan non-Hispanic whites (Centers for DiseaseControl and Prevention 2008a). In 2006,for example, the rates of gonorrhea amongAfrican-American 15- to 19-year-old womenwere 15 times greater than those for white womenin the same age group. The rate for African-American men ages 15-19 was 39 times higherthan for 15- to 19-year-old white men (Centersfor Disease Control and Prevention 2008).Impact of Curriculum-BasedSex and STD/HIV EducationProgramsIn response to these high rates of unintended pregnancyand STDs, many people concerned aboutadolescent reproductive health have implementeda wide variety of programs to reduce sexual risk.Aside from contraceptive services, STD testing andtreatment and other reproductive health servicesprovided in clinics, the most commonly implementedtypes of prevention programs are curriculum-basedsex and STD/HIV education programs.These programs are based on a written curriculumand are implemented among groups of youth. Theyare in contrast to one-on-one peer programs; healthfairs; youth development programs and other kindsof programs that also have an impact on adolescentsexual behavior. They are commonly implemented inschools where very large numbers of young peoplecan be reached before and after they have initiatedsexual activity. However, curriculum-based sexand STD/HIV education programs also have beenimplemented effectively after school and in nonschoolsettings such as clinics, community centers,housing projects and elsewhere.Multiple reviews of sex and STD/HIV educationprograms have been conducted in the United Statesand elsewhere (Johnson, Carey et al. 2003; Robin,Dittus et al. 2004; Kirby 2007; Underhill, Operarioet al. 2007, UNESCO 2009). They consistently supportthe following conclusions (see Table 1-1):1. Sex and STD/HIV education programs do notincrease sexual behavior, even when they encouragesexually active young people to use condomsor other forms of contraception.2. Some programs delay the onset of sexual intercourse,reduce the frequency of sex, reduce thenumber of sexual partners, increase condom use,increase other contraceptive use, and/or reducesexual risk.3. Not all programs are effective at changingbehavior. According to one review (Kirby 2008),about two-thirds of the programs had a positivesignificant impact on one or more sexual behaviorsamong the entire sample or among importantsub-groups within the sample (e.g., males orfemales). About one-third did not. And one-thirdof the programs improved two or more behaviors;the remainder did not.4. Numerous characteristics distinguish theeffective programs from the ineffective ones(Kirby 2007). For example, the effective programsChapter 1 Introduction 3