Reduction of Risk Behaviors in Youth: 
 
Adolescent Sexuality
 
Bibliography 
Theory/Models Relating to Sexuality

Balassone, M.L.(1991). A social learning model of adolescent contraceptive behavior. Journal of Youth and Adolescence, 20, 593-616. A social learning model of contraceptive use is proposed. This model includes environmental context, cognitive influence, and constraints in executing the behavior. The model emphasizes the need for adolescents to feel they have mastered the skills necessary to engage in the behavior, which in this case is using contraception.

Brooks-Gunn, J. & Paikoff, R. (1997). Sexuality and developmental transitions during adolescence. In J. Schulenberg, J.L. Maggs & K. Hurrelman (Eds.) Health risks and developmental trajectories during adolescence. New York: Cambridge University Press. This chapter examines adolescent sexuality from a developmental perspective. The authors detail those aspects of sexuality associated with healthy adolescent sexual development. Topics discussed include sexual well-being, gender and sexuality, sexual decision-making, and the meaning of sexuality to adolescents.

Catania, J.A., Kegeles, S.M. & Coates, T.J. (1990). Towards an understanding of risk behavior: An AIDS risk reduction model(ARRM). Health Education Quarterly, 17, 53-72. This article describes the Aids Risk Reduction Model (ARRM). This model is an extension of the Health Belief Model (HBM). According to this model, behavior change is based upon the occurrence of three processes: problem recognition, commitment to change high risk behavior and enactment of this change. This article discusses results of preliminary findings of studies done on gay men and heterosexual college students. But this model has since been used with many diverse populations.

Caldas,S.J. (1993). Current theoretical perspectives on adolescent pregnancy and childbearing in the United States. Journal of Adolescent Research, 8, 4-20. Six prominent theories or explanations for teenage pregnancy are discussed and evaluated. These include theories which argue that teen pregnancy is caused by; a lack of knowledge about reproduction, an unfulfilled psychological need of the mother, a desire to receive welfare, a lack of parental supervision, the mothers internalization of mixed messages about sexuality, and hormonal drives. Caldas concludes that while each explanation may hold some validity, it is more probably an interaction of multiple factors associated with each theory that account for high rates of adolescent pregnancy.

DeLamater, J.. & MacCorquodale, P. (1979). Premarital Sexuality. Madison, WI: University of Wisconsin Press. A conceptual model of premarital sexuality is developed and tested. This model includes social as well as individual characteristics. Measures developed to test this model, include a Guttman scale of sexual behavior. In a study of college aged individuals, the model is supported.

Miller, B.C. & Fox, G.L. (1987). Theories of adolescent heterosexual behavior. Journal of Adolescent Research,2, 2269-282. The two predominant paradigms of adolescent sexuality are discussed. The first paradigm explains sexuality as an emerging, often uncontrollable need. Much of the research in this area stems from the work of Freud. The second strand of theories argue that sexuality is a socially learned behavior. The authors argue for the utility of both schools of thought and express the need for further research using multiple perspectives.

Hovell, M.F., Hillman, E.R., Blumberg, E. Sipan, C., Atkins, C. Hofstetter, C.F., & Myers, C.A. (1994). A behavioral-ecological model of adolescent sexual development: A template for AIDS prevention. Journal of Sex Research,31, 267-281. A new model for preventing the spread of HIV is introduced. This model improves upon the rational/cognitive models, by targeting those institutions which can be changed such that they reinforce condom use. Each of these environmental factors are considered important because they can influence an adolescent either to use or not to use contraception. According to the behavioral-ecological model each of these factors must be changed in such a way as to promote use of contraception by the adolescent.

Trad, P.V. (1994). A developmental model for risk avoidance in adolescents confronting AIDS. AIDS Education and Prevention, 6, 322-338. A model based on the concept of previewing is described as a possible technique to be used in HIV prevention programs targeting adolescents. Previewing involves envisioning the event of significance (for example the opportunity to have unprotected intercourse) and then exploring various possible outcomes based upon an adolescent's response. This article discusses the way in which previewing can be used to help prevent HIV infection.

A Developmental View of Sexuality

Chilman, C.S. (1990). Promoting Healthy Adolescent Sexuality. Family Relations, 39,123-131. This article broadly defines sexuality as a normal and healthy part of adolescent development. A biopsychosocial approach is used to understand those factors which influence sexuality. Some correlates of contraceptive use are also outlined and implications for future research are discussed.

Fine, M. (1988). Sexuality, schooling and adolescent females: The missing discourse of desire. Harvard Educational Review,58, 29-53. This article discusses the results of qualitative research on sexuality with inner-city girls. The author argues for change in sexuality education, based on findings that current programming denies the role of female desire in sexuality and views it through a lens of victimization. She further argues that sexuality education in schools is lacking in a variety of domains and makes recommendations for improvement

Koch, P.B. (1993). Promoting healthy sexual development during early adolescence. In R.M. Lerner (Ed.) Early adolescence: Perspectives on research, policy and intervention. Hillsdale, NJ: Lawrence Erlbaum Associates. This chapter discusses the need to look beyond simply intercourse when studying adolescent sexuality. A developmental approach is encouraged. Problems with the sexuality curriculum currently in use are discussed and guidelines for a life-span approach that is sensitive to sexual identity and cultural issues are included.

Peterson, A.C., Leffert, N. & Graham, B.L. (1995). Adolescent development and the emergence of sexuality. Suicide and Life-Threatening Behavior, 25, 4-17. This paper discusses the biopsychosocial changes that occur during adolescence. Sexual development is discussed as a normative process influenced by these other types of transitions, that can be potentially stressful. The potential stressors associated with these transitions can lead to depression. The importance of context in helping to decrease possible problems with sexual development is also discussed.

Predictors of Sexual Behavior

Capaldi, D.M., Crosby, L. & Stoolmiller, M. (1996). Predicting the timing of first intercourse for at-risk adolescent males. Child Development, 67, 344-359. A longitudinal investigation of the relationship of psychosocial factors to the timing of first intercourse for males. Participants were 201 mostly white, lower class boys. All were from high crime areas of the city. Anti-social behavior, physical maturity and greater numbers of transitions in the life of the parent predicted to early sexual activity. Anti-social behavior was not a significant predictor of initiation of sexual activity in late adolescence. This emphasizes the need to take a developmental approach when examining adolescent sexuality.

Christopher, F.S., Johnson, D.C. & Roosa, M.W. (1993). Family, individual and social correlates of early Hispanic adolescent sexual expression. Journal of Sex Research, 30, 54-61. This article examines family, individual and social variables to determine their effects on the sexual behavior of 489 Hispanic adolescents. Sexual behavior is examined as a continuous variable. In other words an emphasis was placed on sexual activities other than intercourse. To do this the authors asked adolescents what sexual activities they had engaged in and included those activities such as petting and kissing in their analyses. Results indicate that perceived peer sexual involvement is a stronger predictor of adolescent sexual behavior than are family influences.

Crockett, L.J. Bingham, C.R., Chopak, J.S. & Vicary, J.R. (1996). Timing of first sexual intercourse: The role of social control, social learning and problem behavior. Journal of Youth and Adolescence, 25, 89-111. A longitudinal study, examines those factors which predict the timing of first intercourse. Family socialization, problem behavior, biological factors and social control are all found to impact the timing of first intercourse. Factors differentially impact boys and girls. This study reconfirms the importance of examining multiple domains in the study of adolescent sexuality.

Hayes, C.D. (Ed.)(1987). Risking the Future: Adolescent Sexuality, Pregnancy and Childbearing, National Academy Press; Washington DC. This 2 volume work includes the findings of the Panel on Adolescent Pregnancy and Childbearing. Their findings include detailed assessments of various trends as they relate to pregnancy and sexual activity, along with a comprehensive review of the relevant research until 1987.

Ohannessian, C.M. & Crockett, L.J. (1993). A longitudinal investigation of the relationship between educational investment and adolescent sexual activity. Journal of Adolescent Research, 8, 167-182. This longitudinal study examines the relationship between adolescent sexual activity and the adolescent's investment in their own education. This study deals specifically with white, rural adolescents and indicates that different relationships between the variables exist for male and female adolescents. For females lower academic investment predicted sexual activity while for males amount of sexual activity at Time 1 predicted academic activities at Time 2.

Paikoff, R.L. (1995). Early heterosexual debut: Situations of sexual possibility during the transition to adolescence. American Journal of Orthopsychiatry, 63, 389-401. This study examines some of the settings which may place a pre-adolescent at risk for early sexual activity. Low-income African-American fourth and fifth graders are interviewed and results indicate that the availability of relatively private, unsupervised settings allows for increased knowledge and earlier participation in sexual behaviors (although not necessarily intercourse). These findings are examined in light of developmental research on peer relationships and intimacy as well as parental monitoring.

Scott-Jones, D. & White, A.B. (1990). Correlates of sexual activity in early adolescence. Journal of Early Adolescence, 10, 221-238. The demographic, social and social-cognitive correlates to early initiation into sexual intercourse are examined. Results indicate no race or gender differences in sexual activity. Age, educational expectations, mothers education level and dating status are among those factors that appear to effect sexual behavior. Results further indicate racial differences in contraceptive use.

Predictors of Contraceptive Use and/or Safer Sex

Biglan, A, Metzler, C.W., Wirt, R., Ary, D., Noell, J., Ochs, L., French, C., & Hood, D. (1990). Social and behavioral factors associated with high-risk sexual behavior among adolescents. Journal of Behavioral Medicine, 13, 245-261. This study examines the relationship between social and behavioral factors and engagement in sexual risk behaviors. Results indicate a relationship between engaging in risky behaviors in other areas and low levels of condom use. Family relations and peer behaviors are also predictive of non-use of condoms.

Bryne, D & Fisher, W.A. (Eds.)(1983). Adolescents, Sex and Contraception. Hillsdale, NJ: Lawrence Erlbaum. This book gives an overview of the determinants of contraceptive use. The authors pay special attention to informational, ideological and emotional barriers to contraceptive use.

DiClemente, R.J. (Ed).(1992). Adolescents and AIDS: A Generation in Jeopardy. Newbury Park, CA: Sage. This book contains chapters which describe AIDS risk behaviors and correlates to those behaviors. Issues include demographic and psychosocial characteristics of adolescents at risk for HIV.

Galvotti, C, & Lovick, S.R. (1989). School-based clinic use and other factors affecting adolescent contraceptive behavior. Journal of Adolescent Health Care, 10, 506-512. This study of black and Mexican-American inner city teens with access to an adolescent health clinic examines factors affecting sexual activity and contraceptive use. Results indicate a correlation between greater amounts of risk taking and sexual activity. Clinic use is found to be a predictor of contraceptive use. Gender and racial differences are also discussed.

Jemmott, L.S. & Jemmott, J.B. (1990) Sexual knowledge, attitudes and risky sexual behavior among inner city black male adolescents. Journal of Adolescent Research, 5, 346-369. This study examines the relationship of sexual knowledge and attitudes to sexual behavior in black male adolescents from the inner city. The behaviors in the current study include, frequency of both vaginal and oral sex, contraceptive use and number of concurrent sexual partners. Results indicate that adolescent's with more sexual knowledge are more likely to have used birth control during most recent intercourse and that positive attitudes toward birth control is associated with more frequent birth control use during the previous year.

Sacco, W.P., Levine, B., Reed, D.L., & Thompson, K. (1991). Attitudes about condom use as an AIDS-relevant behavior: Their factor structure and relation to condom use. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 3, 265-272. Two studies of college student's attitudes indicate a relationship between attitudes and both past behavior and intended future behaviors. The behaviors studied include carrying and keeping condoms in the home, as well as condom use. The creation of the Condom Attitude Scale (CAS) is a result of this study.

St. Lawrence, J.S., Brasfield, T.L., Jefferson, K.W., Allyene, E. & Shirley, A. (1994). Social support as a factor in African-American adolescents' sexual risk behavior. Journal of Adolescent Research, 9, 292-310. Differences in sexual risk behavior of high and low social support African-American adolescents are examined. Most adolescents are from low income families and are sexually active. Results indicate social support may be a factor in sexual risk taking. Adolescents with lower levels of social support tend to engage in more risky sexual behavior. This effect is stronger for males than for females.

Treboux, D. & Busch-Rossnagel, N.A. (1990). Social network influences on adolescent sexual attitudes and behavior. Journal of Adolescent Research, 5, 175-189. This study examines the effect of both, the discussion of sexual topics and parents' and friends' approval of sexual behavior, on the sexual and contraceptive attitudes and behaviors of primarily white high school students. Social network influences are shown to have an effect on sexual and contraceptive behaviors of adolescents. Results indicate that males attitudes and behaviors are more likely to be influenced by those of their parents while females attitudes and behaviors were more likely to be influenced by those of their peers.

Wight, D. (1992). Impediments to safer heterosexual sex: A review of research with young people. AIDS Care, 4,11-23. A review of mostly British qualitative studies explored the micro-social details of the sexual experiences of adolescents. The six issues discussed are difficulties in talking about sex, gender-role expectations of the couple, reasons for condom use by adolescents, problems with buying, carrying and using condoms, issues surrounding relationship stage, and gendered power relations. This paper indicates the advantage of using qualitative research to help better understand adolescent sexuality and sexual behavior.

Abstinence Only Programming

Christopher, F.S. & Roosa, M.W. (1990). An evaluation of an adolescent pregnancy prevention program: Is "just say no" enough? Family Relations, 39, 68-72. An abstinence based, AFLA (Adolescent Family Life Act) program designed to teach behaviors attitudes and skills to mostly Hispanic and Black middle school aged children is described and evaluated. Following the intervention the treatment group showed a slight increase in sexual behaviors but not intercourse. No effect was seen for the control group. The authors argue that these results indicate the need to question the value of programs which exclusively teach abstinence as a means of preventing teenage pregnancy.

Department of Health and Human Services. (1990). Adolescent family life demonstration projects: Program and evaluation summaries. Washington, DC: Author. This volume contains summaries of all Adolescent Family Life Act (AFLA) programs which were funded from the fiscal years 1982-1989. Included in the volume are results of all evaluations from each site where the programs have been in effect. Brief descriptions of the programs and names of contact people are also included.

Olsen, J.A., Weed, S.E., Ritz, G.M. & Jensen, L.C. (1991). The effects of three abstinence sex education programs on student attitudes toward sexual activity. Adolescence, 26 (103), 631-641. The evaluations of three intervention programs promoting abstinence are reported. The first program, Values and Choices is mainly an instructional program, Teen Aid, the second program has a health education focus, while the final program, Sex Respect focuses on teen sexuality and dating. Results indicated the greatest change in attitudes and behavior from those teens involved in the Sex Respect program. Interactions were also found for program, gender and age.

Postrado, L.T. & Nicholson, H.J. (1992). Effectiveness of delaying the initiation of sexual intercourse of girls aged 12-14: Two components of the Girls Incorporated Preventing Adolescent Pregnancy Program. Youth and Society, 23, 356-379. An evaluation of two components of the Girls Incorporated Program is described. The components that are discussed consist of a program designed to increase the skills necessary for girls to avoid early sexual involvement and a program designed to increase communication between parents and their daughters about sexual issues and behaviors. The skill building component appears to be effective at reducing the initiation of intercourse but only for those girls who attended at least 80% of the sessions. The parent-daughter communication component is shown to reduce the liklihood of the initiation of sexual intercourse for all girls who participate in the program.

Saltz, E., Perry, A.& Cabral, R. (1994). Attacking the personal fable: Role-play and its effect on teen attitudes toward sexual abstinence. Youth & Society, 26, 223-242. This article describes the use of a role-playing intervention in changing attitudes toward abstinence in 9th grade students. Results indicate that both role-playing and watching peers engage in role-playing is an effective method for changing attitudes toward abstinence in girls. Following the intervention boys attitudes toward abstinence also changed but not in the predicted direction. Boys actually developed less positive attitudes toward abstinence following the role-play.

White, C.P. & White, M.B. (1991) The Adolescent Family Life Act (AFLA): Content, findings and policy recommendations for pregnancy prevention programs. Journal of Clinical Child Psychology, 20, 58-70. Authors review the curricula and effectiveness of the 24 AFLA funded pregnancy prevention programs. Descriptions include information regarding target population, content areas covered and the design and results of evaluation efforts. All AFLA programs are required to have abstinence as their primary goal.

Other Programming (not abstinence-only)

Caceres, C.F., Rosasco, A.M., Mandel, J.S., & Hearst, N. (1994). Evaluating a school-based intervention for STD/AIDS Prevention in Peru. Journal of Adolescent Health, 15, 582-591. An intervention program designed to increase knowledge and improve attitudes toward both sexuality and AIDS, and teach skills needed for safer sex behaviors that was implemented in Peru is reported on. The program is based in the secondary schools and is interactive. The evaluation following the program shows a change in some of the determinants of high risk sexual behavior. Actual sexual behavior was not measured, so change in behavior cannot be determined.

Christopher, F.S. (1995). Adolescent pregnancy prevention. Family Relations, 44, 384-391. This article reviews research on pregnancy prevention programming. Specifically it discusses abstinence-only programs, school-based clinics with family planning services, multidimensional programs and theory based programs. Implications for intervention are also discussed. The effectiveness of each type of program on delaying sexual activity and increasing contraceptive use are also addressed.

Fisher, W.A. (1990). All together now: An integrated approach to preventing adolescent pregnancy and STD/HIV infection. SIECUS Report, 18(4), 1-11. This article outlines some basic risk behaviors that are associated with both STD/HIV transmission and adolescent pregnancy. The seven step preventive behavior sequence, a model for intervention that targets both of these domains is described. An argument is made for integrated intervention programs. Results of an evaluation of a university program that was designed using this model, show a significant decrease in the number of positive pregnancy tests at a campus health center since the program was introduced.

Grunseit, A., Kippax, S., Aggleton, P., Blado, M. & Slutin, G. (1997). Sexuality education and young people's sexual behavior: A review of studies. Journal of Adolescent Research, 12, 421-453. This article reviewed the effects of 52 sexuality education and HIV/AIDS prevention programs for teens. Results indicate that sexuality education programs do not increase sexual activity. If there is any effect of the programs, they tend to delay the onset of sexual activity, reduce the number of sexual partners or reduce the rates of STD and/or pregnancy. Specific aspects of the programs are discussed.

Hofferth, S. (1991). Programs for high risk adolescents: What works? Evaluation and Program Planning, 14, 3-16. This article reviews the current research regarding pregnancy prevention programs for adolescents. Programs that aim to delay sexual activity, increase contraceptive use or provide meaningful life options are highlighted.

Jemmott, J.B.III, Jemmott, L.S. & Fong, G.T. (1992). Reductions in HIV risk associated sexual behavior among black male adolescents: Effects of an AIDS prevention intervention. American Journal of Public Health, 82, 372-377. This article describes a HIV prevention program and the results of the evaluation done on that program. 157 Black male adolescents receive either a 5 hour intervention designed to increase knowledge of HIV or a 5 hour control intervention on career opportunities. Both interventions were designed to give the boys a chance to actively participate and both were developmentally appropriate. Boys in the HIV prevention group reported a decrease in HIV risk behaviors 3 months after the intervention, as compared to boys in the control condition.

Kipke, M.D., Boyer, C. & Hein, K. (1993). An evaluation of an AIDS risk reduction education and skills training (Arrest) program. Journal of Adolescent Health, 14, 533-539. This article describes an intervention program designed to help reduce adolescents risk of HIV infection. The intervention utilizes cognitive and behavioral change strategies in order to teach adolescents to avoid risky behavior. The intervention impacts upon factors which appear to be related to high risk sexual behavior, but it does not appear to actually reduce the amount of unprotected intercourse the adolescents are involved in.

Sanderson, C.A. & Cantor, N. (1995). Social dating goals in late adolescence: Implications for safer sexual activity. Journal of Personality and Social Psychology, 68, 1121-1134. This study finds an effect of the adolescent's goal in their dating relationships on the type of intervention which is most useful in changing sexual behavior. Adolescents are asked about their goals in dating relationships and then are classified as either seeking intimacy or seeking identity in those relationships. Intervention programs that focus on interpersonal communication are more effective with adolescents seeking intimacy, while intervention programs that focus on the technical skills (of condom use) are more effective for adolescents who are seeking identity. The study emphasizes the need to target interventions to suit the needs of the individual.

Seitz,V. & Apfel, N.H. (1993). Adolescent mothers and repeated childbearing: Effects of school-based intervention program. American Journal of Orthopsychiatry, 63, 572-581. This paper describes a program for teenage mothers that aims to reduce the number of repeat adolescent pregnancies. Low income African-American teenage girls who are pregnant or parenting are sent to a special school prior to delivering their baby. The length of time the mothers spent in the program varied by situation. Results of an evaluation indicate that longer involvement in the program may lead to lower rates of repeat pregnancy.

Sellers, D.E., McGraw, S.A. & McKinlay, J.B. (1994). Does the promotion and distribution of condoms increase teen sexual activity? Evidence from an HIV prevention program for Latino youth. American Journal of Public Health, 84, 1952-1959. An assessment of rates of sexual activity following an intervention that included the distribution of condoms is described. Comparisons between Latino teens, who participated in an intervention that was designed to prevent the spread of HIV, and Latino teens from a comparison city indicated that rates of sexual activity does not increase with the distribution of condoms.

Visser, A.P. & Van Bilsen, P. (1994). Effectiveness of sex education provided to adolescents. Patient Education and Counseling, 23, 147-160. A review of the research done regarding the impact of sex education on adolescents is included. Most research seems to indicate that sex education has little impact on sexual activity but does have a positive impact on contraceptive use. A thorough discussion of the literature follows.

Weisse, C.S., Turbiasz, A.A. & Whitney, D.J. (1995). Behavioral training and AIDS risk reduction: Overcoming barriers to condom use. AIDS Education and Prevention, 7, 50-59. A behavioral training program that attempts to change attitudes toward condoms and condom use in male college students is described and evaluated. Participants are required to actually purchase condoms as part of the intervention. Results of the evaluation show immediate effects of the intervention in terms of increasing knowledge, positive attitudes, and intentions to use condoms. It also shows a significant decrease in embarrassment in purchasing condoms. Three months after the intervention only the effect on embarrassment to purchase condoms remained. These results indicate the utility of long-term follow-up assessments, in order to determine how long a program remains effective.

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