Reducing Adolescent Sexual Risk: A Theoretical - ETR Associates

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Box3-2Important Topic Areas to Cover in Pregnancy and STD/HIV Prevention CurriculaRelationships• Qualities of healthyand unhealthy romanticrelationships• Gender equality andinequality in relationships• How to build healthyrelationships• How to get out ofunhealthy relationships• How to express love andaffection without havingsexPregnancy• How pregnancy occurs• Likelihood of gettingpregnant (or gettingsomeone pregnant)• Myths about chances ofgetting pregnant• Consequences of pregnancyand childbearing,both short term andlong term• Methods of reducing therisk of pregnancySTD/HIV• How STDs aretransmitted• HIV progression andincubation• Symptoms (and lack ofsymptoms)• Myths about STDs• Chances of contractingSTDs, including HIV• Consequences of contractingSTDs, includingHIV, both short term andlong term• Ways to reduce the riskof STDs, including HIV(including high-risk,low-risk and no-riskbehaviors)Influences onSexual Decisions• Internal desires andpressures• Personal values• Parental/family values• Peer pressures• Partner pressure (linespartners use to getpeople to have sex andmethods of resistingthem)• Sexual values portrayedin the media• Alcohol or drug use• Decision-making skillsand problem-solvingstepsValues/Norms• Personal values abouthaving sex and underwhat conditions to havesex• Personal attitudes aboutusing condoms andcontraception• Parents/family and communityvalues aboutteens having sex• Parents/family andcommunity values aboutteens using condoms andcontraception• Peer norms about teenshaving sex• Peer norms about teensusing condoms and contraceptionSituations That MightLead to Unwanted orUnprotected Sex• Their characteristics• How to recognize themin advance• How to avoid them• How to get out of themCommunication andCommunication Skills• Why partners might nottell you they have an STD• The importance of communicatingpersonalbeliefs about sex and useof protection• Aggressive, passive andassertive communicationstyles• How to effectively insiston not having sex—refusal skills• How to effectively insiston using condoms andcontraceptionAbstinence• Advantages of abstinence• Pressures to have sexand ways of overcomingthose pressures• Distorted views of peersexual activity• Ways to show affectionwithout having sexMutuallyMonogamousRelationships• Reasons to have mutuallymonogamous relationshipsinstead of multiplesexual partners• Risks of having multiplesexual partners• Additional risks ofsequential versusconcurrent partners 5Condoms• Reasons to use condoms,if having sex• Effectiveness (includingmyths)• Rights to access• Where to obtain• How to carry and haveavailable• How to use properly—correct steps for using• Barriers to obtaining andusing condoms and waysof overcoming thosebarriers (including waysto prevent condom usefrom ruining spontaneity,mood and pleasure)Contraception• Reasons to use contraception,if having sex• Rights to access• Where to obtain• Different types and theircharacteristics, includingtheir effectiveness rates• Criteria for selecting amethod• How to use properly• Myths aboutcontraceptives• Barriers to obtainingand using contraceptionand ways of overcomingthose barriers• Importance of dualmethodSTD/HIV Testingand Treatment• Importance• Rights to access• Where to obtain• ProceduresCommunity Resources• Counseling• Condoms• Contraception• Pregnancy and STD/HIVtests• Dating violence/sexualabuse• Types of condoms andtheir characteristics5 This topic is not commonly covered, but should be and increasingly is being covered.42 Reducing Adolescent Sexual Risk: A Theoretical Guide for Developing and Adapting Curriculum-Based Programs
4ImprovingPerceptions of Risks—Both Susceptibility and SeverityKeys to ImprovingPerceptions of RiskFocus on important risks (e.g., pregnancy andSTD/HIV) and situations that might lead torisk behavior. Help youth overcome a sense ofinvulnerability by visualizing and personalizingrisks, situations leading to risks and methodsof avoiding them.BackgroundAs we all observe daily, if people believe that somebehavior will greatly increase their likelihood of adeadly outcome, they are less likely to engage inthat behavior. For example, people do not intentionallydrive the wrong way down the freeway, because1) driving the wrong way increases the likelihood ofa head-on collision and 2) the severity of a head-oncollision is great.This basic principle of behavior is embedded in manysocio-psychological theories of human behavior,particularly those that assume that people generallyconsider alternative courses of action, identifythe possible consequences of each course of action,consider the probability of each consequence, assesseach consequence according to its desirability (orundesirability) and make a decision about whichcourse of action to follow.Many theories commonly used to design effectivehealth education programs incorporate thisprinciple. (See the “Health Education and HealthBehavior Theory” section in the resources at the endof this book.) According to the health belief model,individuals’ perceived susceptibility to a disease orhealth problem and their perceived severity of thatdisease or health problem affect their efforts to avoidit (Rosenstock 1974). For example, if people believethat 1) particular behaviors increase their likelihoodof contracting HIV and 2) HIV is a severe disease,then they are more likely to adopt behavior that willreduce their susceptibility to HIV.Similarly, in both the theory of planned behaviorand the theory of reasoned action, one of the threefactors most strongly affecting intentions to engagein any behavior is behavioral beliefs (Fishbein andAjzen 1975; Ajzen 1985; Ajzen and Madden 1986).These are beliefs about the likely outcomes of anybehavior (i.e., the probabilities of possible outcomes)and the evaluations of these outcomes (i.e., theextent to which they are positive or negative). Theseassessments of behavioral outcomes affect attitudestoward the behavior, which in turn affect intentionsand, ultimately, behavior.Finally, according to social cognitive theory, peopleevaluate alternative courses of action and develop“expectancies” (based on both expectations aboutthe consequences of courses of action and the valueattached to those consequences), which in turnaffect their decisions about behavior (Bandura 1986).Chapter 4 Improving Perceptions of Risks—Both Susceptibility and Severity 43
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
Page 13 and 14: • Children of teenage mothers are
Page 15 and 16: Table1-2 The 17 Characteristics of
Page 17: Each of the following chapters focu
Page 20 and 21: “determinants,” “behaviors,
Page 22 and 23: model, provide evidence regarding h
Page 24 and 25: to avoid unwanted sex and then synt
Page 26 and 27: Figure2-3 An Example of a Logic Mod
Page 32 and 33: Table2-2Learning Objectives to Redu
Page 34 and 35: Table2-2Learning Objectives to Redu
Page 36 and 37: Table2-3Learning Objectives to Incr
Page 43 and 44: 3 Increasing KnowledgeKeys to Incre
Page 45 and 46: Table3-1Number of Studies Reporting
Page 47 and 48: Box3-1Types of Activities to Increa
Page 49 and 50: partner does not mind using a condo
Page 51: methods more often. For example, th
Page 55 and 56: 1. Do teens’ perceptions of risk
Page 57 and 58: a. Presentations and discussions of
Page 59 and 60: Table4-5Examples of Items That Have
Page 61 and 62: Pregnancy Risk Activity and Follow-
Page 63 and 64: STD Handshake(Continued)Important C
Page 65 and 66: 5AddressingAttitudes,Values and Bel
Page 67 and 68: Theories ofAttitude ChangeAttitudes
Page 69 and 70: Although both quality and quantity
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Page 77 and 78: Table5-4Examples of Survey Items fr
Page 79 and 80: Table5-4Examples of Survey Items fr
Page 81 and 82: Activity 5-2Dreams, Goals and Value
Page 83 and 84: Activity 5-4“Dear Abby”Descript
Page 85 and 86: 6CorrectingPerceptionsof Peer Norms
Page 87 and 88: Is there a gap between perceptions
Page 89 and 90: 3. Use concepts, language, symbols,
Page 91 and 92: Table6-4Examples of Items That Have
Page 93 and 94: 7 Increasing Self-Efficacy and Skil
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Page 101 and 102: 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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