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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.