Reducing Adolescent Sexual Risk: A Theoretical - ETR Associates

used psychological theory and research to identifythe cognitive risk and protective factors that affectbehavior and then developed program activities tochange those factors, gave clear messages aboutbehavior and taught skills to avoid undesired andunprotected sexual activity. Table 1-2 lists all thedistinguishing characteristics.5. Some programs for parents also have been foundto be effective at increasing communicationbetween parents and their adolescents and atreducing adolescent sexual risk behavior(Kirby 2007).Identifying and ImprovingImportant Risk andProtective FactorsAs stated above, curriculum-based sex andSTD/HIV programs, as well as other programs,cannot directly control whether young peopleengage in sexual activity or whether they useprotection; instead, young people make their owndecisions about sexual behavior and use of protection.Thus, to be effective, programs must markedlyimprove those risk and protective factors that havean important impact on youths’ decision makingabout sexual behavior.Logically, if programs correctly identify the factorsthat have a clear impact on behavior and if programactivities markedly change those factors, then theprogram will have an impact on behavior. However,if programs identify factors that only weakly affectbehavior or fail to change the factors sufficiently,then they may not affect behavior. Consequently,it is critical both to identify the important factorsaffecting behavior and to implement programsdesigned to change those factors.Factors that have a large impact on behavior includeinternal cognitive factors (such as knowledge, attitudes,skills and intentions) and external factors suchas access to adolescent-friendly reproductive healthservices. Curriculum-based programs, especiallythose in schools, typically focus on internal cognitivefactors. These factors are very proximal (closelyTable1-1The Number of Curriculum-Based SexEducation Programs with IndicatedEffects on Sexual BehaviorsUnitedStates(N=47)OtherDevelopedCountries(N=11)DevelopingCountries(N=29)AllCountriesin the World(N=87)Initiation of Sex➤ Delayed initiation 15 2 6 23➤ Had no significant impact 17 7 16 40➤ Hastened initiation 0 0 0 0Frequency of Sex➤ Decreased frequency 6 0 4 10➤ Had no significant impact 15 1 5 21➤ Increased frequency 0 1 0 1Number of Sex Partners➤ Decreased number 11 0 5 16➤ Had no significant impact 12 0 8 20➤ Increased number 0 0 0 0Use of Condoms➤ Increased use 14 2 7 23➤ Had no significant impact 17 4 14 35➤ Decreased use 0 0 0 0Use of Contraception➤ Increased use 4 1 1 6➤ Had no significant impact 4 1 3 8➤ Decreased use 1 0 0 1Sexual Risk-Taking➤ Reduced risk 15 0 1 16➤ Had no significant impact 9 1 3 13➤ Increased risk 0 0 1 1linked to behavior conceptually) and are related tobehavior.Previous studies of curriculum-based sex and STD/HIV education programs have demonstrated thatthose programs that effectively delayed the initiationof sex, reduced the frequency of sex, or reduced thenumber of sexual partners sometimes focused onand improved the following cognitive factors (Kirby2007):1. Knowledge, including knowledge of sexual issues,pregnancy, HIV and other STDs (includingmethods of prevention)2. Perception of pregnancy risk, HIV risk, and otherSTD risk3. Personal values about sexuality and abstinence4. Perception of peer norms and behavior about sex5. Self-efficacy to refuse sexual activity and to usecondoms and contraception4 Reducing Adolescent Sexual Risk: A Theoretical Guide for Developing and Adapting Curriculum-Based Programs