Programs That Work for Reducing Sexual Risk Behaviors Among Adolescents

A recent article in Contemporary Pediatrics, by Douglas Kirby, PhD, Senior Research Scientist at ETR Associates, reviews effective adolescent pregnancy-prevention programs.   Kirby writes that many of the programs developed in the last two decades to reduce risky sexual behavior and pregnancy among adolescents were not very successful.    Sexuality and HIV education programs and youth development programs have proven to be effective.

Sexuality and HIV Education Programs

According to Kirby, sexuality and HIV education programs include courses that focus on reducing sexual risk-taking behavior and discuss not only abstinence but condoms and other methods of contraception that can protect against STDs or pregnancy. They include sexuality or HIV education classes during regular school classes, as well as after-school courses in the school or in other places in the community. 

Kirby examined 24 published studies of curriculum-based programs conducted in the United States or Canada that targeted adolescents14-18 years old and measured program impact on sexual or contraceptive behaviors. The studies' conclusions included:

• Sexuality and HIV education programs do not increase sexual activity.

• Sexuality and HIV education programs can delay the onset of intercourse, reduce the frequency of intercourse, and decrease the number of sexual partners of program participants.

• Some of these programs increase condom use or contraceptive use more generally.

Effective sexuality and HIV education programs share common characteristics. They:

• provide basic, accurate information about the risks of unprotected intercourse and methods of avoiding them;
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• focus on one or more sexual behaviors that lead to unintended pregnancy or HIV/STD infection;

• give a clear and consistent message;

• include activities that address social pressures on sexual behaviors; and

• provide modeling and practice of communication, negotiation, and refusal skills.

Youth Development Programs

Youth development programs, which may or may not discuss sexuality, offer another way to reduce teenage pregnancy. One of the underlying principles of such programs is to help prepare young people for adult life rather than just trying to keep them problem-free. They do this by improving life skills and increasing opportunities to boost young people's motivation to avoid early childbearing.

Kirby notes that sexual risk-taking has many nonsexual antecedents, such as poor school performance. When youth development programs address these antecedents, pregnancy and other risky behaviors may decrease.

Though there are fewer studies of youth development programs than those of sexuality and HIV education programs, certain interventions have research that demonstrate they are effective at reducing pregnancy or childbearing among adolescents. They include:

• Youth Incentive Entitlement Pilot Project
  Targeted youth from low income households who were still enrolled in high schools, and provided employment.

• Seattle Social Development Project
  Aimed at increasing adolescents' interaction with the school and family by targeting teachers, parents, and youth.

• The Teen Outreach Program
  Involved volunteer community service and regular small group discussions on issues such as personal values, decision-making skills, communication, parenting, and life options.

• The Quantum Opportunities Project
  Offered tutoring, computer-based instruction, homework assistance, community-service projects, paid jobs, and college and job planning throughout all four years of high school.

• The Children's Aid Society Program
  Involves comprehensive education on family life and sexuality for participants and their parents, and also provides access to medical and health services, a job club, tutoring, and help with homework. Program participants who complete high school are guaranteed college admission.

All of these programs increase participants' opportunity to interact positively with adults, which, research shows, reduces teen pregnancy. They also curtail participants' discretionary time, possibly decreasing opportunities for engaging in unprotected intercourse. Finally, all successful programs had the potential to increase adolescents' belief in a bright future.

Sexuality and HIV education and youth development programs "both have a significant impact on sexual risk-taking or pregnancy. It therefore seems likely that these programs will be more effective in combination than separately and that both types of program can be effective components in larger, more comprehensive efforts to reduce sexual risk-taking and pregnancy," Kirby said.

For more information:

D. Kirby, "Reducing Adolescent Pregnancy: Approaches That Work." Contemporary Pediatrics, Jan. 1, 1999.

Resources

• www.etr.org/recapp  -- ETR Associates' new adolescent pregnancy prevention Web site, ReCAPP (Resource Center for Adolescent Pregnancy Prevention), provides practical tools and information on reducing sexual risk-taking behaviors among teens. It offers information on programs and practices that change sexual risk-taking behavior; abstracts, 'news summaries,' statistics on teen pregnancy; authored papers on current research in the field; a database of educational resource materials; and a calendar of current events and information on news in the field of pregnancy prevention.

• School Health Starter Kit, developed by the Association of State and Territorial Health Officials (ASTHO) and the Council of Chief State School Officers (CCSSO), is designed to educate and mobilize key individuals and leaders in states and localities on the importance of school health programs that are coordinated with health services. It includes posters and ad slicks, an information booklet for policymakers and opinion leaders, handouts, case studies and worksheets for educating and evaluating community support, a CD-ROM to customize the kit, and evaluation materials.  Single kits cost $35 and posters are $3 per piece.

  For more information:

  Association of State and Territorial Health Officials (ASTHO)
  1275 K Street N.W., Suite 800
  Washington, DC 20005
  202/371-9090
  202/371-9797 fax
  e-mail: dsteinberg@astho.org