Reducing Adolescent Sexual Risk: A Theoretical - ETR Associates

1. Do teens’ perceptions of risk of different sexualbehaviors affect whether they engage in thosebehaviors?2. Can we increase perceptions of risk, susceptibilityand severity of pregnancy and STDs, includingHIV?3. What are effective teaching methods for improvingperceptions of risk?These questions are answered below.Do teens’ perceptions of risk of different sexualbehaviors affect whether they engage in thosebehaviors?There are at least two kinds of quantitative evidenceassessing the impact of perceptions of risk onsexual behavior. First are the studies measuring therelationship between perceptions of risk and sexualbehavior (Kirby and Lepore 2007). The summaryof studies in Table 4-1 provides little consistentevidence that perceptions of risk are significantlyrelated to initiation of sex. Although three studiesfound that greater perception of risk of pregnancyor STD/HIV was related to later initiation of sex,14 studies found no significant impact and threestudies found that greater perception of risk wasrelated to earlier initiation of sex. These results arenot consistent with the second type of quantitativeevidence—the results of numerous studies of thereasons why young people do not have sex. Thosestudies consistently identify concern about the risksof pregnancy and concern about the risk of STD/HIV as being among the top few reasons that youngteens give for not having sex.Why do these two types of research produce suchdifferent results? Part of the answer is simple.Theory predicts that teens who believe that havingsex will place them at high risk of pregnancyor STD will therefore be less likely to have sex.This would produce a negative correlation betweenperceptions of risk and behavior (higher perceptionof risk is correlated with lower chance of having sex).However, teens who do not have sex are not at riskof pregnancy or STD. This fact produces a positivecorrelation (lower chance of having sex is correlatedwith lower perceived risk). Because it is often difficultto separate out the directions of causality, theresults from studies about the relationship betweenperceived risk and initiation of sex are mixed ornot significant. However, this does not mean thatincreasing perceptions of risk does not lead todelayed initiation of sex.In contrast, the evidence is both much stronger andmore consistent that perceptions of risk have animpact on contraceptive use and condom use specifically(Tables 4-2 and 4-3). Five out of eight studiesfound that concern about the risks of pregnancyhad an impact on contraceptive use, and 9 out of 27Table4-1Perceived severity ofpregnancy or concernabout risk of pregnancyPerceived risk of STD/HIV or concern aboutSTD/HIVTable4-2Number of Studies Reporting Effects ofPerceptions of Risks of Pregnancy orSTD/HIV on Initiation of SexPerceived consequencesof pregnancy andoverall concern aboutpregnancy and importanceof avoiding itTable4-3LaterInitiationof SexNoSignificantEffectsEarlierInitiationof Sex2 7 01 7 3Number of Studies Reporting Effects ofPerceptions of Consequences of Pregnancyand Concern About Pregnancy onContraceptive UseIncreasedContraceptiveUseNoSignificantEffectsDecreasedContraceptiveUse5 3 0Number of Studies Reporting Effects ofOverall Concern About Risks of STD/HIV onCondom UseOverall concern aboutrisks of STD/HIV andmotivation to avoid itIncreasedCondom UseNoSignificantEffectsDecreasedCondom Use9 17 1Chapter 4 Improving Perceptions of Risks—Both Susceptibility and Severity 45