Beginning Too Soon: Adolescent Sexual Behavior, Pregnancy and Parenthood. A Review of Research and Interventions.. Conclusions

06/01/1995

Adolescence is usually too young an age to become a parent in the contemporary United States. This is largely because raising a child takes patience and resources that are acquired in advanced societies gradually with age, education, and experience. Moreover, among adolescents, it is those who are least well prepared to nurture and raise a child who are most likely to become parents. That is, adolescents who have substance abuse and behavior problems, who are not doing well in school, who have low aspirations for their own educational attainment, and who live in economically disadvantaged families and communities tend to initiate sexual intercourse at younger ages, contracept less effectively, and have unintended pregnancies. When pregnancy occurs, higher risk adolescents are also the most likely to bear children, particularly outside of marriage.

Research in the 1990s has recognized the complexity of the problem of adolescent pregnancy and the multiplicity of factors that place adolescents at risk. Recent studies have highlighted several related issues in particular. One of the most noted changes in research emphasis in the 1990s is that there is greater concern about higher risk sexual behaviors. Current research also tends to focus on studying virgin/nonvirgin status, to consider the early age of onset of sexual intercourse, non-voluntary sex, the number and characteristics of sexual partners, the frequency of sex, and the use of alcohol and other drugs that increase risky sexual behavior. While earlier studies tended only to examine the use or non-use of condoms, current research regarding contraceptive use has sharpened the question, examining the use of contraception at first and most recent intercourse, as well as on consistent contraceptive use. Given the high incidence of sexually transmitted infections, research has focussed on strategies to prevent both pregnancy and sexually transmitted infections.

The long-term effects of early interventions designed to enhance school readiness and academic achievement only rarely have been assessed for their impact on early childbearing. The Perry Pre-School Program is one of few studies to examine long-term impacts. Such research is costly, but addresses an important question about which we currently know very little.

Current research also has made use of more diverse and representative samples. This is most evident with longitudinal national surveys of adolescent males' sexual and fertility-related behaviors, begun in 1988, which have added substantially to our understanding. Increasing attention is being paid to Hispanic youth, who also need to be studied as a unique group. Additional studies are needed on Hispanic subgroups (e.g. Mexicans and Puerto Ricans), as well as other immigrant subgroups.

Further research is needed to add to our understanding of key antecedents of the timing of first sexual intercourse and adolescents' early and consistent use of effective contraception. For example, media messages about adolescent sexual behavior are pervasive whereas contraceptive media messages are rare; both types of media messages are potentially influential. Media effects on teens' sexual behavior are poorly understood, however, partly because little rigorous research has been conducted on this topic.

Many kinds of adolescent pregnancy prevention programs have been implemented in recent years. Unfortunately, many of them have had very limited evaluations or, if evaluated credibly, they tend to show only slight or moderate effects. There is a great need for prevention programs that have clear, concrete, and attainable objectives, such as delaying sexual involvement and increasing contraceptive use. Programs need to be established on the foundation of previous research and theory, and promising approaches should incorporate a scientifically rigorous evaluation plan.

For example, recent evidence from behavioral skills-oriented sex education programs suggest the practical utility of emphasizing two fundamental and specific messages in a social learning theory paradigm. First, adolescents should delay sexual intercourse and, second, when adolescents become sexually active they should consistently use an effective method of contraception. Research evidence has also shown that the dual message encouraging adolescents to delay intercourse, but to use contraception if and when they have sex, is more effective than approaches that focus solely on abstinence or solely on contraception. The younger adolescents are when they begin having sex, the greater their risks of negative consequences, and early sexual intercourse experiences often are psychologically or physically coercive. Evidence suggests that by learning more about social pressures, negotiation, and refusal skills, many adolescents will be capable of postponing their sexual involvement.

Adolescents who begin having sexual intercourse need to understand the importance of using an effective contraceptive every time they have sex. This requires convincing sexually active teens who have never used contraception to do so. In addition, sexually active teens who sometimes use contraceptives need to use them more consistently (every time they have sex) and use them correctly. Finally, sexually active teens need to take actions to prevent sexually transmitted infections, as well as unintended pregnancy.

Another body of mostly consistent evidence and theory shows that family disadvantage, poverty, low educational aspirations, and limited economic opportunities are related to earlier unprotected sexual intercourse, unintended pregnancy, and unmarried adolescent parenthood. At the contextual or social level, these factors often reflect limited future opportunities or life options. Life options (or opportunity cost) theory suggests that adolescents engage in risky sexual behaviors because they believe that they have little to lose. Adolescents who experience educational and job success and perceive positive future opportunities for themselves should have stronger motivation for avoiding early pregnancy and parenthood. To some extent interventions that focus on enhancing educational achievement and providing apprenticeships and employment appear to be effective, though the research base available to assess causality is fairly thin. More long-term rigorous studies of these types of interventions should be a high priority.

Another limit of current interventions is their lack of attention to males. The majority of interventions are female-focussed, and either fail to include males in the intervention, or fail to consider the role of males in teen pregnancy at all. In addition, sexual coercion has been linked with early sexual activity among females; however, few programs take this into account in designing interventions. It is difficult to prevent pregnancy by increasing a female's knowledge and motivation to prevent pregnancy if the female is becoming pregnant as a result of a non-voluntary sexual experience.

Major reductions in adolescent pregnancy and childbearing at the national level are not likely to occur without more systematic, sustained, and coordinated approaches to program design and implementation. While small-scale, short-term, ad hoc interventions can be helpful for identifying and developing improved strategies, carefully documented demonstration projects accompanied by rigorous evaluations are greatly needed. The strongest possible evidence of the effectiveness of pregnancy prevention programs will come from randomized experimental designs. In some instances, quasi-experimental designs, without random assignment, might be justified. Whenever possible, evaluation designs should allow for the comparison of the relative effects of various program components. National programmatic efforts need to be based on the most promising theoretical models, including the life options and social learning theories outlined above. Evidence from existing program evaluations suggests that prevention models should build on these theories, employ intervention strategies consistent with them, and use systematic and scientifically rigorous evaluation designs to assess their effectiveness.

There is no shortage of opinions as to what will reduce adolescent pregnancy, nor is there a shortage of program models or model programs. What is in short supply is objective, empirical evidence identifying programs and policies that reduce pregnancy and childbearing among teenagers, the components of the program or policy that are effective, and the populations among whom particular approaches have impacts.