New programs improve outcomes for teens
By Melanie Gold, DO
Clinical Associate Professor of Pediatrics
University of Pittsburgh School of Medicine
University of Pittsburgh Student Health Service
and Kaiyti Duffy, MPH, Director of Education and Research
Anita Brakman, MS, Education & Research Manager
Physicians for Reproductive Choice and Health
New York City
Sexuality is a normal part of adolescent development. Though sexual behaviors can lead to adverse reproductive health outcomes, most adolescents will become sexually active during their teen-age years1, which makes interventions that promote or enhance sexual health in adolescents increasingly important.
Until recently, most programs addressing teen sexuality have endorsed abstinence-only until marriage or focused predominantly on education about safer sex. However, there is widespread recognition that exposure to even the most effective sex education program is not enough to promote and sustain healthy adolescent sexuality.2
Positive youth development (PYD) programs represent a third approach. The March 2010 issue of the Journal of Adolescent Health (JAH) examined PYD programs in terms of their effects on adolescent sexual and reproductive health (ASRH) outcomes. The authors assert, "It is possible that sexuality education programs provide youth the skills and knowledge needed to practice safe sexual behavior, whereas PYD programs provide them with the motivation to do so."3
While PYD programs vary widely in their content, and the definition of PYD differs among researchers, the JAH chose to examine programs that focused on one or more of 12 goals identified by Catalano et al in earlier research on positive youth development.4 These goals then were combined into four categories, described as the "4 C's": connectedness (bonding), competence (social, behavioral, cognitive, emotional, and moral), confidence (self-efficacy, belief in the future, self determination, and clear and positive identity), and character (pro-social norms and spirituality).5
Authors deemed individual goals or subconstructs protective when findings from two or more longitudinal studies showed a significant association between a goal or subconstruct and improvement in at least one ASRH outcome including: ever had sex, recent sex/current sexual activity, early sexual debut, use of contraception, use of condoms, number of sexual partners, frequency of sex, sexual risk index, contraction of a sexually transmitted infection, pregnancy/birth, and intentions to engage in sexual behaviors. Goals associated with a negative change were found to have risk associations.
Twelve goals and multiple subconstructs were examined. Several notable points emerged. Cognitive competence, mostly measured by academic achievement, had a protective association with ever having sex, contraceptive use, and pregnancy/birth.6 Social and behavioral competence were combined, and when measured by a variety of scales measuring communication skills or assertiveness, had a protective association with contraceptive use.6
Connectedness was broken down into several smaller subconstructs. Sexuality-specific parent communication was found to have the most protective associations with improving outcomes in rates of ever having sex, contraceptive and condom use, number of sexual partners, frequency of sex, and pregnancy/birth.7 Connectedness was the only category within which a risk association was found. Specifically, while the subconstruct "parental monitoring" had protective associations with various ASRH outcomes, parent overcontrol had a risk association with ever having sex.7
Two goals under the heading of "confidence" had protective associations. Belief in the future was protective for early sexual debut and pregnancy/birth. Self-determination had a protective association with ever having sex and pregnancy/birth.8 In examining "character," authors also found pro-social norms and spirituality to have protective associations.9
Although the findings had several limitations, these data offer many insights into the provision of sexual and reproductive healthcare to adolescents. Primarily, it is insufficient to solely ask a teen about sexual behaviors or to counsel only about contraception and condom use. Adolescent health providers must assess the various socio-cultural and interpersonal forces that affect an adolescent's determination to develop and sustain healthy sexual self. By incorporating the concepts presented through PYD programs, providers can screen more effectively for risk while, at the same time, promoting positive sexual development among teen patients.
- Centers for Disease Control and Prevention. Youth risk behavior surveillance United States, 2007. Surveillance Summaries, June 6, 2008. MMWR 2008; 57(No. SS-4).
- Mullen PD, Ramirez G, Strouse D, et al. Meta-analysis of the effects of behavioral HIV prevention interventions on the sexual risk behavior of sexually experienced adolescents in the United States. J Acquir Immune Defic Syndr 2002; 30:S94-105.
- Gavin LE, Catalano RF, David-Ferdon C, et al. A review of positive youth development programs that promote adolescent sexual and reproductive health outcomes. J Adolesc Health 2010; 46:S75-91.
- Catalano RF, Berglund ML, Ryan JAM, et al. Positive youth development in the United States. Research findings on evaluations of the positive youth development programs (Report to the US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation and the National Institute for Child Health and Human Development [Washington, DC], 1998). Prev Treat 2002; 5. Article 5.
- Pittman KJ, O'Brien, R, Kimball M. Youth development and resiliency research: Making connections to substance abuse prevention. Forum for Youth Investment. New York, NY: Center for Youth Development and Policy, Research/Academy for Educational Development. 1993.
- House LD, Bates J, Markham CM, Lesesne C. Competence as a predictor of sexual and reproductive health outcomes for youth: A systematic review. J Adolesc Health 2010; 46:S7-S22.
- Markham CM, Lormand D, Gloppen KM, et al. Connectedness as a predictor of sexual and reproductive health outcomes for youth. J Adolesc Health 2010; 46:S23-S41.
- Gloppen KM, David-Ferdon C, Bates J. Confidence as a predictor of sexual and reproductive health outcomes for youth. J Adolesc Health 2010; 46:S42-S58.
- House LD, Mueller T, Reininger B, et al. Character as a predictor of sexual and reproductive health outcomes for youth. J Adolesc Health 2010; 46:S59-S74.