Researchers value-expectancy models also take account of

Researchers haveused several theories to explain adolescent sexual and fertility behavior and,to a lesser extent, to develop pregnancy prevention programs. Some theories arequite narrow and presume that a small set of individual or personal characteristicsare key to human behavior. For example, the social and cognitive skillsmodel that Gilchrist and Schinke (1983) developed and tested positsthat for behavior to change, individuals need specific cognitive and socialskills to resist pressures and to negotiate interpersonal interactionssuccessfully. They do not address personal values or attitudes toward thebehavior or whether other factors may influence behavior change.Other theoriesprovide a somewhat broader framework for how people learn varied behaviors.

Forexample, the social learning theory (Bandura, 1977,1986) assumes that whetheran individual will engage in or avoid a behavior is determined by a sequence offactors. First, the individual must understand the association of a behaviorwith an outcome, for example, that unprotected sex carries a high risk ofpregnancy. Second, the person must believe that he or she is capable of eitherengaging in or avoiding the behavior and that the specific strategy chosen canbe implemented effectively. For instance, individuals must believe that theyhave the capacity to abstain from sex and that they can effectively employ astrategy to avoid sex. Finally, people must believe that avoiding the outcomeis beneficial, for example, that delaying sex will make their lives better inways that matter to them. Individuals develop their specific attitudes andfeelings about behaviors for themselves by observing the behaviors of others,by observing the rewards and punishments the behavior (and the avoidance of thebehavior) elicits, and then by developing the necessary skills through practicethat enable them to behave in accordance with the beliefs they develop.A number ofother value-expectancy models also take account of the costsand benefits associated with engaging in or avoiding a specific type ofbehavior. According to the health belief model, for example, theprobability that persons will engage in a particular preventive behavior, suchas abstinence, is based on several personal perceptions (Janz & Becker,1984; Rosenstock, Strecher, & Becker, 1988).

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These include (1) theirperception of the probability of an outcome as a result of the behavior (forexample, pregnancy as a result of unprotected sex); (2) the perceivedseriousness of experiencing the outcome (for example, not being able tocomplete school); and (3) the perceived benefits minus the perceived costs ofavoiding the outcome (that is, completing school outweighs the difficulty ofsaying no). The health belief model proposes that a person considers each ofthese criteria before engaging in a protective or preventive behavior. Thus,protective behavior is most likely to occur if the adolescent perceives himselfor herself as vulnerable to an outcome, perceives the outcomes as negative, andperceives the benefits of protection to outweigh the costs of protection.Other theoriessuch as the theory of reasoned action, emphasize individualperceptions (Fishbein & Ajzen, 1980, 1975).

This theory emphasizes theimportance of an intention to engage in a behavior and attempts to explain thefactors that determine that intention. Factors presumed to influence such intentionsconsist 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) theindividual’s motivation to comply with the preferences of these significantothers. According to this model, an adolescent would have to believe thatavoiding sex will prevent pregnancy and sexually transmitted diseases, thatavoiding pregnancy and STDs is desirable, that the significant persons in theirlives want them to avoid pregnancy and STDs, and that they want to comply withthe views of the significant persons in their lives.The opportunity cost perspective also takes a cost-benefitaccounting approach and puts specific emphasis on whether an adolescent feels aparticular behavior will have negative consequences for him (Moore, Simms,& Betsey, 1986). This theory emphasizes the notion that adolescents indifferent segments of the socioeconomic distribution face very different coststo pregnancy if it occurs.

Thus, pregnancy represents a much more substantialcost to a college-bound adolescent than to an adolescent whose future does notrealistically include a good education, a good job, a good income, or a goodmarriage. The motivation to prevent parenthood is therefore substantially lowerfor 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 playand argues that early sex and childbearing among impoverished personsrepresents “both an adaptation and a reaction of the poor to their marginalposition in society” (Lewis, 1968, 168). The distinction of this theory,however, is the argument that such behavior becomes normative and is passed onfrom generation to generation.OnWhom Should an Intervention Focus?Data on trends inadolescent childbearing and sexual activity indicate that the age of first sexhas decreased substantially in the past two decades. In 1988 (the year forwhich most recent data are available), more than half of adolescent females andnearly two-thirds of adolescent males had had sex by age 18 (Alan GuttmacherInstitute, 1994).

Among some population subgroups, the average age at first sexis 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 reporthaving had sex by age 12, and roughly 40% have had sex by age 14. Such findingsindicate the need for abstinence programs to reach youth well beforeadolescence, perhaps even as early as elementary school age, especially forsome population subgroups.What Should Be the Focus of anIntervention?Dependingon the underlying assumptions of an intervention, programs may employ a varietyof approaches or strategies to foster abstinent behavior. For instance,interventions could include an education or information component, if onepresumes that knowledge and information about sexuality or sexual andreproductive health and the risks of sex is sufficient or helpful toadolescents to avoid engaging in intercourse.

In fact, many abstinence- focusedprograms (as well as teen pregnancy prevention programs in general) includeinformation-based instruction. Evaluation studies, however, clearly documentthat didactic approaches alone are not effective in changing behavior,particularly avoiding sex (Kirby, 1997). Rather, programs that combineinformation with skill building activities demonstrate somewhat stronger andmore sustained impacts. Thus, providing information can be an importantcomponent 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, isobjective empirical evidence identifying specific programs or policies that willreduce teen pregnancy, either through delaying sexual intercourse or improvingcontraceptive use among sexually active adolescents.

Furthermore, not only hasno one found a single silver-bullet program, but attention to previous researchand theory suggests that a single silver-bullet solution is unlikely. Programplanners, however, should take time to consider several factors beforeimplementing a pregnancy prevention initiative, irrespective of the desiredbehavioral outcome. First, it is important to define clearly what behavior isdesired (for example, no sex until marriage; no sex until mid-twenties), theprogram’s underlying assumptions about the behavior desired and the factorsthat influence the behavior, and which key factors the program will address.Second,one should decide whom the intervention should target. Will the interventionfocus on adolescents, preadolescents, or children of elementary school age?Will the intervention also include other individuals who may be important tothe teen’s behavior, such as peers, the teen’s family, or the teen’s potentialsexual partners? Will the intervention address the larger community orneighborhood context in which the adolescent lives, either by collaboratingwith local institutions such as youth service organizations or local churchesor by addressing socioeconomic or other opportunities that may influenceadolescent behavior?Third,which strategies and activities are most appropriate for securing behaviorchange given the desired behavior outcome and the target populations? Whichcomponents are most appropriate or most likely to be supported by the teens andtheir local community? What type of individuals should be involved in programimplementation to secure a reasonably high participation over time? What is theappropriate mixture of punitive and positive approaches that should beemployed?Fourth,how long should, or can, the intervention last? What is the appropriatedevelopmental stage to begin the intervention? Can occasional boosters maintaininitial effects, or is long-term, continuous involvement necessary?Finally,how should the intervention be evaluated? A management information system isbasic, and for really promising approaches a rigorous evaluation may bewarranted as well.

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