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- What factors are associated with sexual risk avoidance, and how do they influence youth’s decisions to not engage in sexual activity?
- What factors are associated with sexual risk cessation, and how do they influence youth’s decisions to discontinue sexual activity after having engaged in it?
Policymakers and practitioners are interested in identifying strategies and approaches to empower youth to make informed decisions that promote optimal health. Such decisions include the avoidance and cessation of sexual risk. Identifying the factors that influence youth’s decisions to avoid or cease sexual activity can support policymakers, practitioners, and public health officials as they develop programming and policy to improve risk-related outcomes. To explore the factors that influence youth’s sexual decision making and behavior, the Administration for Children and Families (ACF), within the U.S. Department of Health and Human Services (HHS), directed Mathematica to develop two complementary conceptual models to graphically illustrate the factors that influence behavioral outcomes related to sexual risk avoidance and cessation among youth. This work is sponsored by the Office of the Assistant Secretary for Health at HHS and overseen by ACF’s Office of Planning, Research, and Evaluation.
This brief presents two, complementary conceptual models—one for sexual risk avoidance and a second for sexual risk cessation—that aim to guide efforts to prevent youth risk behaviors and promote optimal health. Each model focuses on a set of outcomes that reflect the behavioral context for the target population of youth. The sexual risk avoidance model focuses on outcomes for sexually inexperienced youth related to delaying sexual initiation. The sexual risk cessation model focuses on outcomes for sexually experienced youth related to discontinuing sexual activity.
The models identify a range of factors that research shows may influence youth decision making, sexual behavior, and related outcomes. The conceptual models include only those factors with empirical evidence linking them to relevant outcomes. The influencing factors occur at the environmental, interpersonal, or individual level, and many can be modified through intervention. To this end, the models may be used to guide and support efforts to develop and refine programs, tailor educational messages to youth, and empower parents and other adults to help youth avoid or cease sexual and nonsexual risk behaviors.
Key Findings and Highlights
The conceptual model for sexual risk avoidance identified environmental, interpersonal, and individual factors that influence behavioral outcomes related to sexual risk avoidance. Environmental factors include media exposure, use of and exposure to Internet pornography, the safety of one’s community, the level of neighborhood poverty, and availability of sexual health education programs. Interpersonal factors relate to parents, peers, and romantic partners and include factors such as connectedness to parents, communication with parents about sexuality, presence of positive peer role models, risky peer behavior, being in a serious or steady relationship, having an older boyfriend or girlfriend, and partner expectations and intentions to have sex. Individual factors are organized into biological, emotional, cognitive, and health behavior factors, such as early puberty or physical development, negative self-perception or body objectification, academic achievement, and alcohol and drug use.
The conceptual model for sexual risk cessation also identified environmental, interpersonal, and individual factors that influence related behavioral outcomes. Examples of factors include media exposure (environmental), living with two biological parents at age 14, higher parental education, risky peer behavior, and partner expectations and intentions to have sex (interpersonal), and community engagement and negative self-perception or body objectification (individual).
There are similarities and differences between the sexual risk avoidance and sexual risk cessation conceptual models. More factors are associated with sexual risk avoidance outcomes than sexual risk cessation outcomes. Factors at the individual level are most prevalent for both sexual risk avoidance and cessation. The role of parents and family is more pronounced for sexual risk avoidance than for sexual risk cessation.
Mathematica developed the conceptual models based on an in-depth, targeted literature review of the empirical and theoretical literature, and input from experts from across the fields of youth sexual risk prevention programming, developmental psychology, and health behavior research. To identify specific factors that influence outcomes related to sexual risk avoidance and cessation among youth, the Mathematica team identified, reviewed, and assessed literature that provided evidence for whether specific factors influenced outcomes related to sexual risk avoidance and cessation. The analysis process included assessing the relevance and rigor of each article, assigning an evidence rating score to each factor, reviewing and synthesizing the evidence for factors, and incorporating factors with evidence into the models.
Adamek, Katie, Alicia Meckstroth, Hande Inanc, Lindsay Ochoa, So O’Neil, Kim McDonald, and Heather Zaveri (2019). “Conceptual Models to Depict the Factors that Influence the Avoidance and Cessation of Sexual Risk Behaviors Among Youth.” OPRE Research Brief #2020-02. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.
- Conceptual model:
- A representation of the factors that influence key outcomes of interest. It includes an illustration supported by a narrative.
- Sexual risk avoidance:
- Not engaging in consensual sexual activity.
- Sexual risk cessation:
- Discontinuing consensual sexual activity after having engaged in it.