Sexual Risk
Children at Risk
Spring 2013
Melissa Boone
February 26, 2013
Who are we talking about here?
People aged approximately 11 to 24.
Most studies of “adolescent” risk behavior define adolescents as
between roughly 14 and 19 – “middle adolescence”
Many studies have focused on late adolescence or “emerging
adulthood,” looking at young people between the ages of 18 and
Researchers may use these terms interchangeable or
Adolescents (usually reserved for 13-19-year-olds)
Young adults (usually reserved for 18-25-year-olds)
Emerging adults (usually reserved for 18-25-year-olds)
Young people
Average age of sexual initiation: 17.3
Why should we care?
 46%
of all adolescents will have sex before
they graduate from high school.
 Young
people aged 15-29 make up 21% of
the US population, but 39% of all new HIV
infections in the US
 The
pregnancy rate for young women 15-19
was 6.8% in 2008.
 Although
15-24-year-olds are only 25% of
the sexually active population, they acquire
nearly half of all new STDs.
CDC, 2009
What is sexual risk behavior?
 Penile-vaginal
 Penile-anal
 PV
intercourse without condoms
intercourse without condoms
intercourse without contraceptive birth control
 Drug
and alcohol use before and during sexual
 Multiple
 Partner
sexual partners
 HIV-positive
 Injection drug user
 Age of partner
Factors Influencing Risky Sex
in Adolescents
Economic System
Sex, age, race,
mental health
Stigma, stereotyping,
+ Biopsychosocial Model of Health
+ Race
Sexual initiation in high school
Race contributes to:
 Age differences in sexual
 Differences in condom use
and contraceptive behavior
 Different number of sexual
It’s theorized that culture,
stereotyping, stigma, and
systemic discrimination
contribute to some of these
Very little research has been
done on Asian American,
Pacific Islander, and Native
American adolescents!
Ethnicity Males
Remember this?
+ Mental health & stress
Adolescents with depressive symptoms are more likely to not
use birth control than those who do not have those symptoms.
Adolescents who were sexually active were much more likely to
experience suicidal ideation than lower risk adolescents.
Adolescents who have been psychiatrically hospitalized are
more likely to be sexually active, not use condoms, and have a
history of STDs.
Researchers aren’t sure of the direction of this relationship
Most studies done are cross-sectional – done only at one time.
More recent longitudinal studies seem to indicate that depression
leads to more risky behavior.
Several hypotheses:
Risky sex as a coping technique
Psychiatric disorders contribute to cognitive deficits
Psychiatric disorders are associated with abuse
Suicidal Ideation and Alcohol Use in Teens
Suicidal Ideation
High-Risk Sexually Active
Low-Risk Sexually Active
Sexual Abstainers
+ Suicidal ideation was measured on a scale from 0-4
+ The low-risk and sexual abstainers weren’t significantly different from each other, but the
high-risk group was significantly different from the other two.
+ LGB adolescents and mental health
There’s no evidence that healthy LGB adolescents are
inherently more risky than comparable heterosexual
However, studies show that lesbian, gay, and bisexual
adolescents have higher rates of every day depressive and
anxious symptoms.
LGB adolescents are more likely to use drugs and alcohol
before and during sexual encounters.
They were also at increased risk for major depressive
disorder, generalized anxiety disorder, drug dependence,
and suicidal ideation.
Minority stress has been hypothesized as one reason why this
may be.
+ Drug and alcohol use
Drug use has been
consistently linked to risky
sexual behavior
Both overall drug use and
drug use before sexual
situations is risky.
Alcohol and cigarettes contribute to risk, but illicit drugs
(cocaine, marijuana, etc.) are the riskiest.
Researchers are not sure of a causal direction in the relationship
…but recent research makes it looks as if it’s substance use that
causes risky sex, and not the other way around.
Drug Use and Sexual Risk Behavior
Youth Risk Behavior Study
Media exposure
Adolescents who watched more sex on TV started having sex
at earlier ages than adolescents who watched less sex.
The reverse is also true – adolescents who were sexually
active watched more sex on TV.
Sexual media makes adolescents perceive media and
societal support for teen sexual behavior.
Media that glamorizes sexual behavior was more strongly
associated with adolescent sexual risk behavior.
Adolescents also reported getting the majority of their
information about sex and sexuality from media sources.
+ …and plenty of other things
Sex and gender
Family structure
 Number of parents in the home
 Older siblings
Socioeconomic status
Personality characteristics
 Sensation-seeking
 Impulsivity
 Risk proneness
Biological development
 Age at menarche
Media exposure
Cognitive competence/academic achievement
Other problem behaviors
Intervention Science
How do we decrease risk behavior, and increase safe sexual
practices, in adolescents?
The problem is…
Interventions that just impart knowledge
don’t work.
Simply informing adolescents about the
effects of risky behaviors isn’t very effective.
Theory of Planned Behavior
Stigma, stereotyping,
Personality and emotions
Perceived risk,
sensation-seeking, etc.
Exposure to media
Fishbein & Yzer, 2003
+ Self-efficacy
(the perception that one can successfully execute some kind of skill)
Adolescents need to feel like they actually can protect
themselves when needed in order to actually practice safer sex.
Self-efficacy is better at predicting condom use than sexual
attitudes, HIV knowledge, and perceived vulnerability to HIV.
Many of the previous named factors are associated with selfefficacy, making it a mediator in most relationships:
Psychological disorders/distress
Race and sexual orientation
Drug use
There actually has not been a lot of research on this, even though
current indications show that it may be one of the best
predictors of problem behaviors.
The most effective intervention programs target self-efficacy in
Effective intervention strategies
 Four
overall factors
impact program
Specific skills for
reducing sexual risk
 Program duration and
 Content of the program
 Training the facilitators
+ Federal Guidelines on Sex Ed
In 1996, Congress began to shift
funding to programs that taught
only abstinence. This was
strengthened in 2000.
The federal government funds
community-based organizations
directly, and prohibits
disseminating information on
contraception, sexual orientation
and gender identity, and other
aspects of sexuality.
Choosing the Best
The most popular abstinence-only
Fits the federal guidelines for
Has modules for elementary through
high school children, focusing on
healthy relationships and abstinence
until marriage
Medically accurate
Example of a Lesson Plan:
…but it doesn’t work.
There have been numerous studies indicating that abstinence-only
programs do not work to protect adolescents.
A few of them are moderately successful in delaying sexual initiation, but
adolescents who do go on to have sex are less likely to use condoms or
contraception. when they do.
Most non-peer-reviewed studies of abstinence-only programs have
methodological flaws or flawed interpretation of data.
States that have only abstinence-only programs have the highest rates of
teen pregnancy in the country.
Many abstinence only programs have been found to have medically
inaccurate information.
Abstinence-only programs also ignore large swaths of the adolescent
Sexually experienced teenagers who don’t wish to stop
Teenagers who want to have sex
LGB adolescents, especially those who live in states where their marriage is
+ Comprehensive sex education
Covers abstinence as well as condom use and other
contraceptive use
Comprehensive sex education has consistently shown
evidence of effectiveness
Delays sexual initiation
Makes adolescents more likely to use protection when they do
have sex
Cultural relevance is a new wave in CSE
Delivered in a wide variety of places
Community clinics
Churches and community centers
BART: Becoming a Responsible Teen
Rated “Best” by the CDC for
sexual risk reduction in
Targeted towards African
American adolescents.
8 1.5-2 hour sessions delivered
over 8 weeks
Uses theories of learning and
science to drive its development
Sample Lesson plan:
+ Scarleteen
An “inclusive, healthy, and sex-positive sex ed resource for
teens” created in 1998