Factors Influencing Youth Sexual Activity: Conceptual Models for Sexual Risk Avoidance and Cessation

Publication Date: January 12, 2021
Cover image for the SRA-SRC refined conceptual models brief

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  • Published: 2021

Introduction

Research Questions

  1. What factors are associated with sexual risk avoidance, and how do they influence youth’s decisions to not engage in sexual activity?
  2. 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, developers, and public health officials as they develop and implement programming 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 illustrate the factors that influence behavioral outcomes related to sexual risk avoidance and cessation among youth. After an initial development period, Mathematica refined the two models based on additional information and analysis. 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.

Purpose

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. Building on an earlier brief that presented initial versions of the conceptual models, this brief describes refined versions of the conceptual models enhanced through additional information and analysis. 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 related to sexual risk avoidance or cessation. The influencing factors occur at the environmental, interpersonal, or individual level, and many can be modified through intervention. To this end, practitioners, developers, policymakers, and researchers may use the models to guide and support efforts to develop and refine programs, tailor educational messages to youth, and identify topics for future research.

Key Findings and Highlights

The refined conceptual models identified 51 factors with evidence (46 for sexual risk avoidance and 27 for sexual risk cessation) that influence outcomes related to sexual risk avoidance or cessation at different levels. In the conceptual model for sexual risk avoidance factors at the environmental level 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, which relate to parents and families, peers, romantic or sexual partners, and community connection, include, for example, connectedness to parents, communication with parents about sexuality, insecure attachment with parent or caregiver, presence of positive peer role models, risky peer behavior, being in a serious or steady relationship, having an older boyfriend or girlfriend, partner expectations and intentions to have sex, connection to teachers, and religiosity. Individual factors are organized into the following domains: biological, psychological well-being and skills, cognitive, health behaviors, and intentions and beliefs. Individual factors include early puberty or physical development, negative self-perception or body-objectification, self-determination, academic achievement, alcohol and drug use, and intention to avoid sex, among others.

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, partner expectations and intentions to have sex, and community engagement (interpersonal); and early puberty or physical development, sexual self-efficacy, sexual refusal skills, 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 and interpersonal levels are most prevalent than environmental factors for both sexual risk avoidance and cessation. The role of interpersonal factors related to parents and family is more pronounced for sexual risk avoidance than for sexual risk cessation, potentially due to limited research on sexual risk cessation. 

The brief also identified factors that were not included in one or both of the refined models either because no literature was identified, the evidence was inconclusive, or there was evidence of a null effect. Some of these potential factors may warrant further research. The brief discusses such potential areas for future research, as well as practical implications and limitations of the models.

Methods

Mathematica first developed initial conceptual models based on an in-depth, targeted 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 or 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 or 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. From this, Mathematica identified 38 distinct factors with evidence to include in one or both initial models (36 for sexual risk avoidance and 20 for sexual risk cessation).

Second, during the refinement process, the Mathematica team assessed additional research on factors omitted from the initial conceptual models. Included in this assessment was a secondary analysis of Add Health data on the age at sexual initiation, conducted by Mathematica as part of a separate HHS-funded study. The team also drew upon (1) a supplementary literature review to examine factors excluded from the initial models due to a lack of sufficient evidence, and (2) an economic analysis of the benefits of delayed sexual activity to confirm the appropriateness of the outcomes included in the refined conceptual models. Following the analysis, the team incorporated an additional 13 distinct factors with evidence into one or both of the refined models (10 for sexual risk avoidance and 7 for sexual risk cessation).

Citation

Hande Inanc, Alicia Meckstroth, Betsy Keating, Katie Adamek, Heather Zaveri, So O’Neil, Kim McDonald, and Lindsay Ochoa (2020). “Factors Influencing Youth Sexual Activity: Conceptual Models for Sexual Risk Avoidance and Cessation.” OPRE Research Brief #2020-153. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Glossary

Conceptual model:
A representation of factors, supported by evidence, that influence key outcomes of interest, along with an illustration and related narrative.
Sexual risk avoidance:
Not engaging in consensual sexual activity.
Sexual risk cessation:
Discontinuing consensual sexual activity after having engaged in it.