Reducing Adolescent Sexual Risk: A Theoretical - ETR Associates

Although a number of possible emotional, social andhealth risks are associated with sexual intercourse,the most commonly researched risks are thoseinvolving pregnancy and STDs. This chapter, andmore generally this book, focuses on those risks.Authors use a variety of related terms involvingrisks differently or even sometimes interchangeably.For example, the following words are allcommonly used: risks, susceptibility, vulnerability,severity and seriousness. In this chapter, the “risks”associated with some course of action will refer tothe negative consequences that may result froma course of action (e.g., unintended pregnancy orSTD). “Susceptibility” will refer to the likelihood ofthose negative consequences occurring and “severity”will refer to the negative assessments of thoseconsequences.It is widely believed that some young people (perhapsa minority) feel invulnerable and that thissense of invulnerability increases their risk behavior(Weinstein 1988; Weinstein 1993; Lapsey 2003).For example, some adolescents may not think thatit is likely that they will become pregnant (or getsomeone pregnant) or that they will contract anSTD; instead, they may believe it will only happento others. According to some psychologists, adolescentsare egocentric and create “personal fables”or modes of understanding that include themes ofinvulnerability, omnipotence and personal uniqueness(Elkind 1967) and these egocentric fables arerelated to sexual risk behavior (Arnett 1990). Otherpsychologists view the creation of personal fablesand adolescents’ sense of invulnerability as adaptivemechanisms to the many challenges they face astheir egos develop (Lapsey 1993).These beliefs about invulnerability are summarizedhere because they are held by many adults workingwith youth and by some psychologists. However, astrong body of research does not yet exist to supportthese beliefs about the role of invulnerability.It is definitely true that many adolescents engagein risk behaviors because they simply do not considerthe possible risks. That is, they may engage inrisk behaviors without even assessing the possibleconsequences (Steinberg 2003). This is especiallytrue when they encounter new situations, are withtheir peers, are more oriented to the present ratherthan the future and are less able to inhibit theirimpulses (Steinberg 2003).Adolescents’ failure to consider risks and plan effectivelymay have a biological basis. In recent years,neuroscientists have learned that adolescents’ brainscontinue to grow and change during the seconddecade of their lives. In particular, the prefrontalcortex, which affects judgment and impulse control,matures with age (Weinberger, Elvevåg et al. 2005).With a less developed prefrontal cortex, adolescentsare less likely to plan and consider risk and morelikely to be impulsive.Regardless of whether sense of invulnerability isadaptive or whether it is biologically based, manyprofessionals commonly accept that correcting adolescents’perceptions of invulnerability to pregnancyor STD has the potential to reduce their sexual riskbehavior.Perceiving risk involves recognizing the conditionsthat might lead to risk and then assessing personalrisk (Millstein 2003). The ability of teens to recognizethese situations, in turn, is affected both bytheir cognitive knowledge of the important characteristicsof the situation and by their experience withsimilar situations (Millstein 2003). Consequently,it is important for teens to review their own experiencesand those of their peers, to identify thosesituations that they or their peers encounteredthat could have led to undesired, unplanned orunprotected sex, and to describe those situationsaccurately.In sum, perceptions of risk play a central role inmany theories of health and risk behavior. Manyhealth education interventions focus on perceptionsof risk in order to improve health behaviors andreduce risk behaviors (Millstein 2003).When applying these concepts about perceptions ofrisk to sexual behavior, there are three questions thatshould be asked:44 Reducing Adolescent Sexual Risk: A Theoretical Guide for Developing and Adapting Curriculum-Based Programs