A Program Model for Encouraging Sexually Experienced Youth to Cease Sexual Activity

Publication Date: January 12, 2021
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  • Published: 2020

Introduction

Sexually active adolescents are vulnerable to adverse health outcomes, such as sexually transmitted infections (STIs) and unintended pregnancy. Empowering youth to make informed decisions, specifically decisions to avoid sexual risks, helps them avoid the potential negative consequences of adolescent sexual activity and contributes to their optimal health and well-being. Programming that helps youth cease sexual activity is one approach to helping youth avoid the negative consequences of adolescent sexual activity. To encourage sexual risk cessation among youth, the Administration for Children and Families (ACF), within the U.S. Department of Health and Human Services (HHS), directed Mathematica to develop a program model that outlines an approach for teaching youth about cessation. We developed this model to guide policymakers, program and curriculum developers, and program implementers in creating and delivering programming to influence sexual risk cessation. The Office of the Assistant Secretary for Health at HHS sponsors this work and ACF’s Office of Planning, Research, and Evaluation oversees it.

Purpose

This brief presents a program model for sexual risk cessation. The model describes program inputs—the overall design, program features, and the infrastructure needed to support implementation—and implementation outputs—that is, aspects of staff, service delivery, and youth responsiveness that can be assessed to know whether implementation occurred as expected. In addition, the program model specifies youth outcomes it intends to affect and presents considerations regarding the context of implementation.

Key Findings and Highlights

The program model for sexual risk cessation identifies program inputs, implementation outputs, and youth outcomes the model aims to affect, as well as the context for implementation. The overarching objective for the program model is to encourage youth to cease or continue to avoid sexual activity. The model recommends instruction in 10 content areas, including sexual cessation and sexual consent, and communication, negotiation, and refusal skills. The recommended approach is that programs can start by offering group sessions to help identify youth considering ceasing sexual activity, but we expect youth will benefit from individualized services to support cessation. Program features include a target population of youth with sexual experience (however, some content and messages are applicable to general youth populations); teaching strategies such as motivational interviewing and mentoring; and use of a curriculum that aligns with the model’s content and objectives. Organizations need a well-defined implementation system and infrastructure to support implementing their programs. Such systems or infrastructure include processes for selecting, training, and supporting staff; recruiting and engaging participants; engaging with partners; and collecting data to assess program implementation. The program model includes implementation outputs related to staff, service delivery, and participants’ responsiveness. Outcomes fall into two categories: (1) nonbehavioral changes in knowledge, attitudes, and intentions; and (2) changes in skills and behavior.

Methods

Mathematica developed the sexual risk cessation program model based on four data sources. First, the team reviewed the refined conceptual model for sexual risk cessation (described in Inanc et al. 2020). The conceptual model identified 30 factors that can influence outcomes related to risk cessation for sexually experienced youth. Fifteen of the factors are considered modifiable, meaning parents, schools, or community organization staff might be able to change or modify them through an intervention. We identified ways in which the program model could address these 15 modifiable factors, as well as applicable outcomes. In addition, the Mathematica team reviewed literature relevant to programming for sexual risk cessation among sexually experienced youth. The team held a virtual meeting with eight experts to get input on the relevant knowledge, skills, and messages that encourage youth to cease sexual activity; the types of educational strategies to use in the model; and program and implementation features. Finally, the team reviewed 15 curricula for avoiding sexual risk or preventing pregnancy and STIs in youth to extract information related to content, program features, and educational methods that might be relevant to sexually experienced youth.

Citation

Crowley, Jacqueline, Betsy Keating, and Heather Zaveri. (2020). “A Program Model for Encouraging Sexually Experienced Youth to Cease Sexual Activity.” OPRE Report Number 2020-149. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.