Reducing Adolescent Sexual Risk: A Theoretical - ETR Associates

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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
Each of the following chapters focuses on an importantrisk and protective factor that affects thosebehaviors and can be changed by curriculum-basedsex and STD/HIV education programs. Withineach chapter, we:• Identify a risk or protective factor that has animpact on these sexual risk behaviors• Identify important theories that address eachfactor• Summarize the evidence for the impact of thatfactor on the sexual behaviors 2• Summarize the evidence for the ability of programsto change the factor3• Specify important instructional principles foreffectively changing each factor• Summarize examples of activities that have beenused in curricula that effectively changed eachfactor• Provide references to more detailed descriptionsof those activities in effective curricula• Provide a sampling of items used in studies tomeasure each factor (These items simply providemore detail about some of the concepts in eachfactor.)Consequently, this book can be used to help developcompletely new curricula, to add new activities toexisting curricula that may not have sufficientlypowerful activities to change particular factors,to improve the effectiveness of existing activitiesalready in curricula and to critically review curriculaactivities for possible adoption. When adaptingcurricula that have strong evidence of impact,all changes should be consistent with guidelinesfor adapting those curricula (Rolleri, Fuller et al.,unpublished).Reading this book from cover to cover may be challenging.Thus, readers may wish to:1. Read the first two chapters to obtain an overviewof the book, logic models and behavioralobjectives.2. Read and apply those chapters addressing thespecific factors that are in their own logic models.3. Read the final chapter and apply the principles totheir curricula.2 In each chapter, the evidence assessing the relationship betweenthe factor discussed in that chapter and sexual behavior is based ontabulations of the studies summarized in Sexual risk and protectivefactors: Factors affecting teen sexual behavior, pregnancy, childbearing andsexually transmitted disease: Which are important? Which can you change?(Kirby and Lepore 2007).3 In each chapter, the evidence assessing the impact of curriculumbasedprograms on the factor discussed in the chapter is based largelyon tables in Emerging answers 2007: Research findings on programs toreduce teen pregnancy and sexually transmitted diseases (Kirby 2007).Chapter 1 Introduction 7
Page 1: Reducing AdolescentSexual RiskA The
Page 4 and 5: ETR Associates (Education, Training
Page 6 and 7: AcknowledgmentsThis book evolved ou
Page 8 and 9: Activities, Boxes and FiguresActivi
Page 11 and 12: 1 IntroductionThis book was created
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Page 15: Table1-2 The 17 Characteristics of
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Page 26 and 27: Figure2-3 An Example of a Logic Mod
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Page 36 and 37: Table2-3Learning Objectives to Incr
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Page 45 and 46: Table3-1Number of Studies Reporting
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Theories ofAttitude ChangeAttitudes
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Although both quality and quantity
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• When arguments are presented by
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that it is possible to improve thes
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c. Use simulations to demonstrate p
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Table5-4Examples of Survey Items fr
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Table5-4Examples of Survey Items fr
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Activity 5-2Dreams, Goals and Value
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Activity 5-4“Dear Abby”Descript
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6CorrectingPerceptionsof Peer Norms
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Is there a gap between perceptions
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3. Use concepts, language, symbols,
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Table6-4Examples of Items That Have
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7 Increasing Self-Efficacy and Skil
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feelings may reduce their self-effi
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situations more difficult so that t
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paper (e.g., the air should be sque
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Activity 7-1Lines That People Use t
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Situations That May Lead to Unwante
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Roleplaying to Enhance Refusal Skil
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Activity 7-5Using Condoms Correctly
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chaperoned, they may not have the o
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attitudes about condoms and contrac
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Activity 8-1Description of Activity
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9IncreasingParent-ChildCommunicatio
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ehavior may be quite complex (Jacca
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5. Give students multiple homework
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and the activities suggested prior
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Activity 9-1Description of Activity
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Activity 9-3Human Sexuality Board G
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10 ConclusionsKeys to Reducing Sexu
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Figure10-1Assessing Factors in Curr
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sexual minority youth and pressure
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Table10-1Instructional Principles I
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Table10-1Instructional Principles I
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Incidence The number of new cases o
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ResourcesThree kinds of resources a
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Science-Based Practices: A Guide fo
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National Longitudinal Study of Adol
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Changing Social Normshttp://www.etr
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Advocates for Youth, Young Women of
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ReferencesAbelson, R., and Prentice
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Coyle, K. (2006). All4You2! Prevent
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Lapsey, D.K. (1993). Toward an inte
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Weed, S.E., Olsen, J.A., DeGaston,
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