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Teens' sexual risk taking: early intervention a must.

Sexually risky behaviors on the part of adolescents is nothing new, but the age at which these behaviors begin is. In fact, new data suggest that sexual risk taking often begins in middle school.

Baseline data collected in spring 2005 from 4,457 middle school students aged 11-14 years at 14 urban schools participating in Project Connect, an 8-year multilevel intervention study, showed that more than 9% of the students surveyed reported ever having sexual intercourse, and 8% reported ever having oral sex. In total, about 12% reported any sexual activity. Of those students who reported having had intercourse, 36% were aged 11 or younger at first sex, 27% were 12 years old, 28% were 13 years old, and 9% were aged 14 or older. Additionally, of those who reported having had intercourse, 43% reported having had multiple sex partners.

Given their young age at sexual onset, "these youth are at very high risk for adverse health outcomes," Project Connect investigator Christine J. DeRosa, Ph.D., said earlier this year at the annual meeting of the Society for Adolescent Medicine in Boston. As such, "behavioral and health education are imperative for all youth beginning early in middle school, and the involvement of parents, health care providers, and community leaders is also critical."

The goal of such interventions should be to assist those youth who have already engaged in some sexual activity to return to abstinence, said Dr. DeRosa of Health Research Association Inc., a University of Southern California affiliate that is facilitating the Centers for Disease Control--sponsored project. "For the majority of youth who have not engaged in sexual activities, the goal should be to further delay the onset of sexual initiation."

How the interventions should look and be implemented is a matter of much debate. Should they focus on abstinence or contraception? Should they be school or clinic based? Should they be voluntary or mandatory?

In reality, the "best" intervention is one that identifies and targets the range of risk and protective factors that influence initiation of sex, number of partners, condom use, and contraception use, and this will vary depending on the individuals or populations being served, according to Douglas Kirby, Ph.D., a senior research scientist with ETR Associates in Scotts Valley, Calif.

In a 2001 report for the National Campaign to Prevent Teen Pregnancy called "Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy" (, Dr. Kirby reviewed the results of 300 studies on risk and protective factors across multiple domains, from which emerged a complex picture of the antecedents of adolescent sexual risk taking.

At the community level, education, employment, income, and crime rate are important predictive factors. At the family level, family structure, dynamics, and values play a role. And at the individual level, age, hormones, peers, emotional well-being, relationship history, sexual abuse history, and attachment to school, religious groups, and proactive community organizations have an impact.

In the review, Dr. Kirby identified four groups of effective intervention programs. These included sex and HIV education programs that not only stated the target norm clearly and frequently with factual information to support it, but also engaged the youth in activities, such as role playing, to model, practice, and personalize the norm. Also effective were some programs within health, family planning, or STD clinics that similarly expressed clear norms.

Certain service-learning programs that include both intensive voluntary service in various capacities (tutors, teachers' aides, nursing home assistants) and ongoing small group discussions about the service, with or without discussion about sexual or contraceptive behavior, also had a demonstrable impact. The last group was long-term intensive programs with multiple components--including family life support, sexuality education, academic guidance, employment, opportunity for self-expression, and health care--in which norms were clearly stated and staff consciously developed close relationships with the adolescents.

Most of the effective intervention strategies share a conceptual framework built on social norms and an adolescent's sense of connection to those expressing the norms, Dr. Kirby said.

Some identified protective and risk factors that don't easily fall within the norm/connectedness framework, such as poverty, hormone levels, self-efficacy, and emotional well-being, are also important intervention targets that must be considered to dramatically reduce sexual risk taking in adolescents, Dr. Kirby said.

By Diana Mahoney, New England bureau. Share your thoughts and suggestions at

RELATED ARTICLE: Making Males Part of the Solution

The catchphrase for a unique teen pregnancy and STD prevention program sums up the mission of the intervention perfectly: "Wise Guys Make Wise Decisions."

An intervention for adolescent males aged 10-19 years, the Wise Guys program was developed in 1990 by the Family Life Council of Greensboro, N.C., to prevent teen pregnancy by teaching young males sexual responsibility. The 10-lesson curriculum addresses personal and family values, the concept of masculinity, self-esteem, dating violence, sexuality, STDs, abstinence, disease prevention, decision making, and goal setting.

To date, the program has been implemented nationally in more than 250 communities--as well as in some African countries.

Wise Guys was one of the first interventions of its kind to target delivery of its message toward adolescent males--not only to dispel the myth among many adolescents that teen pregnancy is a "girl thing," but also to address some dangerous misconceptions and a pervasive lack of awareness. For example, in a recent study of more than 100 sexually active adolescent boys receiving treatment at a sexually transmitted disease clinic, 75% said they had no plans for getting someone pregnant, but more than half thought it might happen anyway, signaling a disconnect between intention and action--likely driven by a lack of pregnancy prevention information, according to the authors (Pediatrics 2005;116:e414-9).

In a 2002 study sponsored by the Kaiser Family Foundation, investigators found that 51% of teen males believed they were not at risk of contracting a sexually transmitted disease unless they had sex with more than seven partners. Only 20% of those surveyed understood that unprotected sex with a single partner presents an STD risk (

Wise Guys addresses such misconceptions in male-only group sessions directed by trained professionals in setting such as schools, community centers, group homes, and Boys Clubs. One key to the program's success, according to Wise Guys' director Rick Brown, is the absence of negative messages. "We don't approach [the boys] as bad guys. We approach them as guys who can be part of the solution," he said.

For the most part, the messages seem to be taking root. In a 6-month postintervention follow-up, Wise Guy participants saw improvements in the following measures, compared with a control group: communication with their parents about sexuality-related issues, knowledge about sexuality, support of abstinence, knowledge about and use of contraception, and improved attitudes toward sexuality and sex roles (Adolescence 2001;36:427-33).

In an effort to expand the reach of Wise Guys, additional manualized programs have been developed, including a Spanish-language version called Jovenes Sabios, and an intervention for older teens and young adults called Wise Guys: The Next Level, which focuses on providing men with information on healthy relationships, sexuality, fatherhood, and life choices.
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Author:Mahoney, Diana
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Jul 1, 2006
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