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Researchers value-expectancy models also take account of

Researchers have
used several theories to explain adolescent sexual and fertility behavior and,
to a lesser extent, to develop pregnancy prevention programs. Some theories are
quite narrow and presume that a small set of individual or personal characteristics
are key to human behavior. For example, the social and cognitive skills
model that Gilchrist and Schinke (1983) developed and tested posits
that for behavior to change, individuals need specific cognitive and social
skills to resist pressures and to negotiate interpersonal interactions
successfully. They do not address personal values or attitudes toward the
behavior or whether other factors may influence behavior change.

Other theories
provide a somewhat broader framework for how people learn varied behaviors. For
example, the social learning theory (Bandura, 1977,1986) assumes that whether
an individual will engage in or avoid a behavior is determined by a sequence of
factors. First, the individual must understand the association of a behavior
with an outcome, for example, that unprotected sex carries a high risk of
pregnancy. Second, the person must believe that he or she is capable of either
engaging in or avoiding the behavior and that the specific strategy chosen can
be implemented effectively. For instance, individuals must believe that they
have the capacity to abstain from sex and that they can effectively employ a
strategy to avoid sex. Finally, people must believe that avoiding the outcome
is beneficial, for example, that delaying sex will make their lives better in
ways that matter to them. Individuals develop their specific attitudes and
feelings about behaviors for themselves by observing the behaviors of others,
by observing the rewards and punishments the behavior (and the avoidance of the
behavior) elicits, and then by developing the necessary skills through practice
that enable them to behave in accordance with the beliefs they develop.

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A number of
other value-expectancy models also take account of the costs
and benefits associated with engaging in or avoiding a specific type of
behavior. According to the health belief model, for example, the
probability that persons will engage in a particular preventive behavior, such
as abstinence, is based on several personal perceptions (Janz & Becker,
1984; Rosenstock, Strecher, & Becker, 1988). These include (1) their
perception of the probability of an outcome as a result of the behavior (for
example, pregnancy as a result of unprotected sex); (2) the perceived
seriousness of experiencing the outcome (for example, not being able to
complete school); and (3) the perceived benefits minus the perceived costs of
avoiding the outcome (that is, completing school outweighs the difficulty of
saying no). The health belief model proposes that a person considers each of
these criteria before engaging in a protective or preventive behavior. Thus,
protective behavior is most likely to occur if the adolescent perceives himself
or herself as vulnerable to an outcome, perceives the outcomes as negative, and
perceives the benefits of protection to outweigh the costs of protection.

Other theories
such as the theory of reasoned action, emphasize individual
perceptions (Fishbein & Ajzen, 1980, 1975). This theory emphasizes the
importance of an intention to engage in a behavior and attempts to explain the
factors that determine that intention. Factors presumed to influence such intentions
consist of (1) one’s belief regarding the outcome of the behavior in question;
(2) one’s assessment that the outcome of the behavior is good or desirable; (3)
one’s assessment that the outcome is desired by significant others; and (4) the
individual’s motivation to comply with the preferences of these significant
others. According to this model, an adolescent would have to believe that
avoiding sex will prevent pregnancy and sexually transmitted diseases, that
avoiding pregnancy and STDs is desirable, that the significant persons in their
lives want them to avoid pregnancy and STDs, and that they want to comply with
the views of the significant persons in their lives.

The opportunity cost perspective also takes a cost-benefit
accounting approach and puts specific emphasis on whether an adolescent feels a
particular behavior will have negative consequences for him (Moore, Simms,
& Betsey, 1986). This theory emphasizes the notion that adolescents in
different segments of the socioeconomic distribution face very different costs
to pregnancy if it occurs. Thus, pregnancy represents a much more substantial
cost to a college-bound adolescent than to an adolescent whose future does not
realistically include a good education, a good job, a good income, or a good
marriage. The motivation to prevent parenthood is therefore substantially lower
for adolescents from disadvantaged families and communities.

The culture of poverty perspective (Lewis, 1959, 1961,
1966) also focuses on the role that poverty and socioeconomic disadvantage play
and argues that early sex and childbearing among impoverished persons
represents “both an adaptation and a reaction of the poor to their marginal
position in society” (Lewis, 1968, 168). The distinction of this theory,
however, is the argument that such behavior becomes normative and is passed on
from generation to generation.

On
Whom Should an Intervention Focus?

Data on trends in
adolescent childbearing and sexual activity indicate that the age of first sex
has decreased substantially in the past two decades. In 1988 (the year for
which most recent data are available), more than half of adolescent females and
nearly two-thirds of adolescent males had had sex by age 18 (Alan Guttmacher
Institute, 1994). Among some population subgroups, the average age at first sex
is even lower. For example, data tabulated from the Youth Risk Behavior Survey,
and the National Health Interview Survey (Moore, Miller, Glei, & Morrison,
1995a, Figure II-C) indicate that nearly 20% of non-Hispanic black males report
having had sex by age 12, and roughly 40% have had sex by age 14. Such findings
indicate the need for abstinence programs to reach youth well before
adolescence, perhaps even as early as elementary school age, especially for
some population subgroups.

What Should Be the Focus of an
Intervention?

Depending
on the underlying assumptions of an intervention, programs may employ a variety
of approaches or strategies to foster abstinent behavior. For instance,
interventions could include an education or information component, if one
presumes that knowledge and information about sexuality or sexual and
reproductive health and the risks of sex is sufficient or helpful to
adolescents to avoid engaging in intercourse. In fact, many abstinence- focused
programs (as well as teen pregnancy prevention programs in general) include
information-based instruction. Evaluation studies, however, clearly document
that didactic approaches alone are not effective in changing behavior,
particularly avoiding sex (Kirby, 1997). Rather, programs that combine
information with skill building activities demonstrate somewhat stronger and
more sustained impacts. Thus, providing information can be an important
component in an intervention, particularly when combined with other strategies.

Conclusion:
There is no shortage of opinions about what will reduce adolescent pregnancy,
nor is there a shortage of program models. What is in short supply, however, is
objective empirical evidence identifying specific programs or policies that will
reduce teen pregnancy, either through delaying sexual intercourse or improving
contraceptive use among sexually active adolescents. Furthermore, not only has
no one found a single silver-bullet program, but attention to previous research
and theory suggests that a single silver-bullet solution is unlikely. Program
planners, however, should take time to consider several factors before
implementing a pregnancy prevention initiative, irrespective of the desired
behavioral outcome. First, it is important to define clearly what behavior is
desired (for example, no sex until marriage; no sex until mid-twenties), the
program’s underlying assumptions about the behavior desired and the factors
that influence the behavior, and which key factors the program will address.

Second,
one should decide whom the intervention should target. Will the intervention
focus on adolescents, preadolescents, or children of elementary school age?
Will the intervention also include other individuals who may be important to
the teen’s behavior, such as peers, the teen’s family, or the teen’s potential
sexual partners? Will the intervention address the larger community or
neighborhood context in which the adolescent lives, either by collaborating
with local institutions such as youth service organizations or local churches
or by addressing socioeconomic or other opportunities that may influence
adolescent behavior?

Third,
which strategies and activities are most appropriate for securing behavior
change given the desired behavior outcome and the target populations? Which
components are most appropriate or most likely to be supported by the teens and
their local community? What type of individuals should be involved in program
implementation to secure a reasonably high participation over time? What is the
appropriate mixture of punitive and positive approaches that should be
employed?

Fourth,
how long should, or can, the intervention last? What is the appropriate
developmental stage to begin the intervention? Can occasional boosters maintain
initial effects, or is long-term, continuous involvement necessary?

Finally,
how should the intervention be evaluated? A management information system is
basic, and for really promising approaches a rigorous evaluation may be
warranted as well.

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