Reducing Adolescent Sexual Risk: A Theoretical - ETR Associates

ehavior (Kirby and Lepore 2007). These factors areamong the most important concepts in widely usedeffective psychosocial theories of health behaviorchange, such as social cognitive theory, theory ofreasoned action, theory of planned behavior, andthe information-motivation-behavioral skills model(Fishbein and Ajzen 1975; Ajzen 1985; Bandura1986; Fisher and Fisher 1992).In sum, there is considerable evidence that effectivesex and STD/HIV education programs actuallychanged behavior by first having an impact on thesefactors, which, in turn, positively affected youngpeople’s sexual behavior.Although there is evidence that all of these factorsaffect behavior, some of them affect each otherand only indirectly affect behavior. For example,it is commonly believed that intentions to performa behavior most directly affect that behavior. Inturn, relevant attitudes, perceptions of norms andself-efficacy affect intentions. Further, other factors(e.g., knowledge) may affect attitudes, perceptionsof norms and self-efficacy. Figure 1-1 provides anexample of how these factors may be related.Finally, although intentions to perform a behaviortend to be good predictors of whether or notthe behavior is then performed, many things candisrupt (or moderate) the intention–behavior link.For example, environmental constraints or habitsmay affect whether intentions translate into behavior,so even intentions do not completely determinebehavior.Organization of This BookThe organization of this book follows the frameworkof logic models, which are described in greater detailin Chapter 2.The primary health goals addressed in this bookare to reduce unintended pregnancy and STDs. Toreduce unintended pregnancy, young people need todelay sex or reduce the frequency of sex and increasethe consistent and correct use of effective contraception.To reduce STD transmission, young peopleneed to delay sexual activity, have sex less frequently,have fewer sexual partners, avoid concurrent sexualpartners, increase condom use, increase the timeperiod between sexual partners, be tested (andtreated if necessary) for STDs and be vaccinatedagainst human papilloma virus (HPV) and hepatitisB (Kirby 2007). Logic models for some of thesebehaviors are presented in the next chapter.Figure1-1Possible Logic Model of Psychosocial Factors Affecting BehaviorEnvironmentKey Risk and Protective Factors(Sexual Psychological Factors)Sexual BehaviorsHealth GoalsSex andSTD/HIVEducationParent-childcommunicationSupport fromenvironmentPerceptionof riskKnowledgeActualbehavioralcontrol(self-efficacy)AttitudestowardbehaviorsPerceivednormsPerceivedbehavioralcontrol(self-efficacy)Strength ofintention toperform eachsexual behavior• Delay onset of sex• Decreasefrequency of sex• Decrease numberof partners• Avoid concurrentpartners• Increase timebetween partners• Increase use ofcondoms or birthcontrol• Increase STDtesting andtreatmentDecreaserates of teenpregnancy,STD and HIV6 Reducing Adolescent Sexual Risk: A Theoretical Guide for Developing and Adapting Curriculum-Based Programs