Adolescent Decision-Making Research

Kan, M. L., & Ramirez, D. D. (2019). Preventing repeat teen pregnancy: A multisite analysis of the roles of goal orientation and social supports.

This study examined whether changes in goal orientation (e.g., future aspirations, decision-making, goal setting) or social supports would contribute to the positive effects of the federally-funded Title XX Adolescent Family Life Program, which aimed to prevent repeat teen pregnancies. While the study looked at the potential effects of orientation to goals and social supports on repeat teen pregnancies and the use of long-acting, reversible contraception (LARC), it did not find that either had any significant program effects. However, it did find that receiving support from the participant’s father was associated with higher LARC use. Associations between support from the child’s father and LARC use may reflect that teens in stable, long-term relationships were more likely to choose long-acting methods of contraception.

Widman, L., Evans, R. , Javidi, H., & Choukas-Bradley, S. (2019). Parent-based interventions to improve adolescent sexual health: A meta-analysis.

This meta-analysis focused on the question: Are parent-based sexual health interventions effective at improving adolescent sexual health outcomes? The main youth outcomes included were delayed sexual activity, condom use, and parent-child sexual communication. The analysis included 31 studies that examined parent-based sexual health interventions. Results showed modest evidence to support that parent-based sexual health programs can promote safer sex behavior and understanding in adolescents. In particular, parent-based interventions were shown to improve both adolescent condom use and parent-child sexual communication compared to control or comparison groups that did not receive these interventions. However, there was no significant effect of these parent-based interventions on delaying adolescents’ sexual activity. This study highlights several areas where future programs could place additional attention to enhance intervention effectiveness, such as focusing on younger adolescents, increasing cultural tailoring in programming, and ensuring delivery of a sufficient amount of programming.

Yarger, J., Berglas, N. F., Campa, M., Chabot, M., & Decker, M. J. (2019). Trends in adolescent birth rates: Examining the influence of community characteristics through geographic and temporal analysis.

his study documented the relationship between changes in community characteristics and the declining adolescent birth rate in California by examining the relationship between changes in demographic and economic characteristics and availability in sexual health services and changes in adolescent childbearing over three time periods: 2000-2002 (Time 1); 2006-2008 (Time 2) and 2012-2014 (Time 3). The community was defined as geographic areas smaller than the county level, known as Medical Service Study areas. The adolescent birth rate declined between Time 1 and Time 3 in 95% of the Medical Service Study areas. Between Time 1 and Time 2, the decline in the adolescent birth rate was smaller in those communities in which there was an increase in the percentage of the population that was black, Hispanic, unemployed, and foreign born, and an increase in the households receiving public assistance. There was a bigger decline in the adolescent birth rate in communities in which there was an increase in the percentage of households that were married and the percentage of young adults who completed high school. Between Time 2 and Time 3, there were smaller declines in the adolescent birth rate in communities in which there was an increase in the percentage of households receiving public assistance, and bigger declines in the adolescent birth rate in communities with an increase in the percentage of young adults who completed high school and attended college. The adolescent birth rate declined significantly more in Medical Service Study Areas that began offering publicly-funded long-acting contraception to adolescents. The adolescent birth rate declined more in urban than rural Medical Service Study Areas. However, the differences between rural and urban areas were no longer significant after controlling for access to long-acting contraception.

Maness, S., & Thompson, E. L. (2019). Associations between social determinants of health and adolescent contraceptive use: An analysis from the National Survey of Family Growth.

This study analyzed data from the 2015 National Survey of Family Growth and focused on sexually active males and females between ages 15 and 19. The main goal of this work was to increase understanding of sexual activity, teen births, and unintended pregnancy in adolescence by looking at social determinants of health that are linked to contraceptive use. Social determinants of health used in this study focused on domains such as economic stability (e.g., poverty, employment, food security), neighborhood and built environment, education (e.g., received high school diploma/GED), social and community context (e.g., family structure), and health and healthcare (e.g., access to healthcare). This study found high contraceptive use among participants at last sexual intercourse. The study found one link between contraceptive use and family structure, with significantly higher odds of using contraception at last sexual intercourse association for youth who had lived with the two biological or adoptive parents since birth. However, the study found low rates (4.5%) of participants using highly effective contraceptives to prevent pregnancy (i.e., IUD, implant). There were no significant relationships between social determinants and using highly effective contraception.

Ramos-Olazagasti, M. A., Elkington, K. S., Wainberg, M. L., Adams, C. M., Canino, G. J., Bird, H. R., Scorza, P., Wildsmith, E., Alegria, M., & Duarte, C. S. (2019). Does context and adversity shape sexual behavior in youth? Findings from two representative samples of Puerto Rican youth.

This study described patterns of sexual risk behaviors among Puerto Rican youth living in two contexts during a developmental period when sexual activity and risky behaviors are at their peak. Five behavior patterns were identified, ranging from current sexual inactivity to multiple, co-occurring sexual risk behaviors. The five behavior patterns were:

• Currently sexually inactive, defined as no sex in the last 3 months (16.5% of the youth)
• Single partner, low sexual activity (13.5% of the youth)
• Single partner, inconsistent condom use (32% of the youth)
• Single partner, no condom use (28% of the youth)
• Multiple sexual risk behaviors such as multiple partners, inconsistent condom use, having sex while intoxicated (10% of the youth)

None of the groups were characterized by consistent condom use, putting the adolescents at risk for sexually transmitted diseases. Patterns that included behaviors usually associated with risk for adverse outcomes (e.g., multiple sex partners, sex while intoxicated) were more common among youth in the South Bronx, males, and youth who experienced greater Adverse Childhood Experiences (ACEs) related to child maltreatment and exposure to violence. Compared to youth in Puerto Rico, those in South Bronx were more likely to be in the single partner, sex without condoms class. Higher child maltreatment/violence ACEs scores also increased the odds of being in the single partner, low activity class, perhaps indicating an avoidance to sexual activity. Differences in youth’s patterns of sexual risk behaviors between youth living in the South Bronx and youth living in Puerto Rico were not explained by ACEs.

Barker, D., Houck, C .D., Bala, K., Donenberg, G., & Brown, L. K. (2019). Emotional context as an influence on sexual decision-making among adolescents with mental health symptoms.

This study sought to identify patterns of emotions reported by adolescents proximal to sexual decisions, such as whether to have sex or utilize a condom. Data were from two clinical trials of sexual risk prevention programs for adolescents with mental health concerns. Both trials asked participants about distinct emotions prior to their last vaginal or anal sexual event, some of which were condom protected, and their last perceived sexual opportunity in which they decided not to have sex, for a total of 1343 reported events. The study identified six distinct emotional profiles prior to these events:

• No Emotion profile, in which adolescents denied experiencing any of the emotions on the survey prior to an event (n=369 participants)
• Low Emotion profile, in which adolescents described “a little” of all the emotions (n=270 participants)
• Mid-Emotion profile, in which adolescents endorsed the midpoint of the scale for all the emotions (n=62 participants)
• Positive Emotion profile, in which adolescents reported mostly positive emotions (e.g., happy, excited, proud) (n=390 participants)
• Anxious/Negative Emotion profile, in which adolescents reported feeling scared and nervous, with little positive emotion and moderate levels of negative emotions (n=95 participants)
• Anxious/Positive Emotion profile, in which adolescents reported feeling scared in combination with positive emotions (n=139 participants)

Positive emotions in the moments before a sexual decision were associated with deciding to have sex (VAS) across age and gender. Higher ratings of curiosity was associated with fewer sexual events. In addition, the absence of positive emotions, whether described as an undefined emotional experience (profiles none, low, mid) or the presence of negative emotions (profiles anxious/negative, anxious/positive), was more likely to be associated with an unused sexual opportunity compared to a sexual experience for both males and females and for younger and older youth. Among younger adolescents, feeling lonely was associated with vaginal or anal sex events. Emotions were not useful in predicting condom use in this study. Results suggest that adolescents perceive different emotional experiences prior to having vaginal or anal sex compared to deciding not to have sex when the opportunity was available.

Kendall, A. D., Young, C. B., Emerson, E. M., Freels, S., & Donenberg, G. R. (2019). Do improvements in externalizing symptoms protect against sexually transmitted infections? Results from a mother-daughter STI prevention program for African-American girls.

This study examined whether the evidence-based program IMARA, which is a group-based mother-daughter intervention designed to address the interrelated issues of mental health and sexual risk taking among African-American adolescent girls. This study specifically looked at whether the improvement of girls’ mental health would contribute to the protective effect of this program in preventing future sexually transmitted infection (STI). Participants received either the IMARA program or a control program that focused on health promotion (e.g., nutrition, exercise, violence prevention). The IMARA program was designed to address several factors that can lead to STI risk, including mental health problems. For example, mothers and daughters engaged in a “feelings thermometer” exercise where they learned to identify the effects of their own “hot” (i.e., very strong) emotions on their decision-making and risk behaviors. Daughters then developed personalized plans to bring “hot” emotions into the “cool” (i.e., less intense) zone. Results showed that participants who entered the program with high externalizing symptoms (e.g., aggression, poor impulse control) and who received the IMARA program, showed significantly reduced symptoms at their 6-month follow up and these participant results were still present at the one-year follow up. However, in this study the results did not show any impact of the IMARA program on internalizing behaviors (e.g., anxiety, depression). Among girls with a high baseline of externalizing symptoms who provided STI data, the risk of contracting a new STI by 12 months was on average 42% lower for those who participated in IMARA than the control group. This study provides valuable preliminary evidence for linking the potential of improving externalizing symptoms as a way to promote STI prevention.

Lantos, H., Moreau, C., & Hughes, M. E. (2019). Associations between experiences of community violence and sexual risk-taking in Baltimore: An analysis of the WAVE Study.

This study examined the relationship between perceived community violence — including fear of and witnessing violence — and sexual activity (including condom use) among teenagers in Baltimore, Maryland. The data from these analyses came from the Well-Being of Adolescents in Vulnerable Environments (WAVE) Study, which sought to understand the health and determinants of health among urban adolescents ages 15 to 19 living in low-income neighborhoods. While experiencing community-level violence in Baltimore is common for adolescents, the types of exposures to community violence are diverse and go beyond just direct victimization (i.e., directly experiencing an act of violence) to include fear of violence and witnessing violence. In this study, it was found that girls who reported a fear of violence and having witnessed violence were significantly more likely to engage in sexual intercourse over the last year, and those who were victimized were more likely to have used condoms. Boys who reported a fear of violence were less likely to have engaged in sexual activity whereas boys who witnessed violence were more likely to have engaged in sexual intercourse and where also less likely to have used condoms. Fear of violence seems to have a role distinct from witnessing violence or experiencing direct victimization. The results suggest that exposures to different forms of violence are related to unprotected intercourse and may put adolescents at risk for negative sexual health outcomes.

Song, W., & Qian, X. (2019). Adverse childhood experiences and teen sexual behaviors: The role of self-regulation and school-related factors.

This study examined whether individual and cumulative ACEs (adverse childhood experiences) increased the risk of unhealthy sexual behaviors and adolescent pregnancy. Participants included 9th and 11th grade students who completed the 2016 Minnesota Student Survey. The six ACEs studies were: psychological abuse, physical abuse, sexual abuse, parent or other household member substance abuse, witnessing intimate partner violence, and incarcerated parent or household member. In the sample, 65 percent of the students reported experiencing zero ACEs, 19 percent reported experiencing one ACE, 9 percent reported experiencing two ACEs, and 7 percent reported experiencing three or more ACEs. The study found that, for each category of adverse childhood experience, adolescents who had experienced that ACE were more likely than those who did not experience that ACE to initiate sex, have multiple sex partners, unprotected sex, and be involved in a pregnancy. Experiencing sexual abuse was most strongly associated with reporting sexual risk behaviors or pregnancy. Different youth assets, including self-regulation skills, connectedness to school, not skipping school, and academic performance, were linked to participants being less likely to initiate sexual activity and less likely to report sexual risk-taking. They served as important mechanisms in reducing the negative effects of ACEs on sexual initiation and adolescent pregnancy. These study results suggest that programs that focus on strengthening adolescent’s self-regulation, encouraging school connectedness, improving school engagement and performance may lessen the strong impact of ACEs on adolescent sexual risk behaviors and pregnancy.