Reducing Adolescent Sexual Risk: A Theoretical - ETR Associates

e shaped more by their peers and the media andthey may be more likely to engage in sexual activityat an earlier age. If youth do not know that condomsprovide considerable protection against pregnancyand STDs, their attitudes towards condoms maybe more negative and they may be less likely to usecondoms during sexual activity. If youth know howto use condoms or other methods of contraceptionproperly, they are more likely to feel confident usingcondoms or other methods of contraception andactually use them properly.When applying these general concepts to sexualbehavior, four questions should be asked:1. Does teens’ knowledge about different aspects ofsexuality affect their sexual behavior?2. Can we increase knowledge?3. What are the most effective teaching methods forincreasing knowledge?4. What topic areas are most commonly covered incurricula that effectively change sexual behavior?These questions are answered below.Does teens’ knowledge about different aspects ofsexuality affect their sexual behavior?Contrary to what many sexuality educators typicallybelieve, knowledge about sexuality is not allthat highly related to behavior (Tables 3-1 and 3-2).In particular, there is little evidence that knowledgeabout sexuality in general, knowledge about sexuallytransmitted disease (including HIV), or knowledgeabout condoms and contraception is significantlyrelated to the initiation of sex (Table 3-1) (Kirby andLepore 2007). There is very mixed evidence thatknowledge about STD and HIV is related to condomuse (Table 3-2). Finally, there is some evidence,but not always consistent evidence, that knowledgeabout condoms and contraception and their effectivenessis related to condom or contraceptive use.What do these findings mean? How can these findingsbe so inconsistent with the very plausible beliefthat knowledge is needed to provide a foundation forbehavior change?There are at least three partial answers to thesequestions.1. Most young people already know the basics aboutsexual behavior, condoms, contraception, pregnancyand STD, so greater knowledge may notmarkedly affect their behavior.2. The knowledge tests used in these studies may notmeasure the particular facts that are most importantin changing behavior.3. Greater knowledge may improve attitudes, perceptionsof peer norms or skills. These mediatingfactors in turn may affect behavior, but the statisticalanalyses may not always capture this indirectimpact of knowledge on behavior.Nevertheless, the conclusion from these studies isquite clear: if the goal of a program is to changebehavior, it is important to focus on knowledge thatmost directly relates to values, attitudes, perceptionsof peer norms and skills of a specific behavior, ratherthan general knowledge. For example, accurateknowledge about the risk of pregnancy and STDsand the effectiveness of prevention methods mayimprove attitudes about use of condoms and otherforms of contraception, and, in turn, increase theiruse, but general knowledge about sexuality may nothave an impact on sexual behavior.This conclusion is consistent with other kinds ofresearch. In particular, multiple studies have demonstratedthat presenting a clear message about sexualbehavior is an important characteristic of effectiveprograms (Kirby, Laris et al. 2006). A common,clear message is:“Always avoid unprotected sexual activity.Abstinence is the safest choice. If you engagein sexual activity, always use protection againstpregnancy and STDs.”One way that programs can make a compelling casefor a particular behavioral message is by emphasizingall the facts and concepts that support thatmessage.In sum, the overall message from all of these studiesis: Knowledge should be taught, but 1) it should be34 Reducing Adolescent Sexual Risk: A Theoretical Guide for Developing and Adapting Curriculum-Based Programs