Reducing Adolescent Sexual Risk: A Theoretical - ETR Associates

condom and contraceptive use (Table 5-2). Thescales include items about condom effectiveness inreducing pregnancy or STD, perceived impact ofcondom use on sexual pleasure, partner supportof condom use, embarrassment using condoms,accessibility of condoms and other attitudes towardcondoms and other forms of contraception. Of the46 studies, 30 found that the attitudes were significantlyrelated to actual condom or contraceptive use,16 failed to find significant relationships and nonefound significant relationships in the unexpecteddirection. As above, the failure of 16 studies (againabout one-third of the total) to find significant relationshipsmay reflect methodological limitations ormay indicate that attitudes about condoms and contraceptionare not always related to use of condoms/contraception in all groups of teens.Although research demonstrates that attitudes arerelated to sexual behavior, many different attitudesTable5-2Number of Studies Reporting Effects ofAttitudes About Condom/ContraceptiveUse on Teens’ Own Condom/Contraceptive UseStronger belief thatcondoms are effective inreducing pregnancy orSTD (N=7)IncreasedCondom orContraceptiveUseNoSignificantEffectsDecreasedCondom orContraceptiveUse2 5 0might affect each sexual behavior. Some are moregeneral, some are more specific, and some target differentaspects of condom or contraceptive use. Table5-4 on page 67 lists examples of attitudes that mayaffect the decision to have sex and to use condomsor contraception. Note the diversity of the attitudesthat may apply to a single behavior.Given this diversity and given that sex educationprograms cannot address all potentially relevant attitudes,when designing programs, it is very importantto determine which attitudes are most importantin a given population. The importance of differentattitudes can be gleaned from focus groups withyouth, interviews with reproductive health professionalsworking with youth and survey research withthe youth being addressed.Can we change attitudes about sex and condom/contraceptive use?A review of curriculum-based studies of sex andSTD/HIV education programs found that 8 out of13 programs significantly improved attitudes towardabstinence and 5 had no significant impact (Table5-3) (Kirby 2007). These studies demonstrate clearlythat not all programs significantly improved attitudes,but a majority did so. Ten out of 24 studiesimproved attitudes towards condoms and contraceptives,13 had no significant impact and one had anegative impact. These results demonstrate clearlyStronger belief thatcondoms do not reducepleasure (N=8)Greater value orperception of partnersupport of condom use(N=6)More positive attitudestoward condoms andother forms of contraception(N=17)Decreased embarrassmentusing condoms(N=6)Greater perceivedaccessibility of condoms(N=2)7 1 04 2 013 4 03 3 01 1 0Table5-3Number of Programs Having Effectson Attitudes Toward Sex and Condom/Contraceptive UseAttitudes toward havingsex and abstinence(N=13)Attitudes toward usingcondoms (N=12)Belief that condomsare a hassle and reducepleasure (N=7)Perceived barriers tousing condoms (N=5)Had aPositiveEffectNoSignificantEffectsHad aNegativeEffect8 5 06 5 12 5 02 3 062 Reducing Adolescent Sexual Risk: A Theoretical Guide for Developing and Adapting Curriculum-Based Programs