Using Behavioral Theories to Design Abstinence Programs

Abstract

If adolescents abstain from sex, or delay having sex, the risk of pregnancy is essentially zero, and the sexual transmission of a communicable disease is diminished substantially. Whatever other, nonpublic health reasons one may have for preferring abstinence as an approach to the prevention of teen pregnancy, the potential for a sizable reduction in rates of adolescent pregnancy supports abstinence as a reasonable strategy. The issue of abstinence as an approach has less to do with the desirability of the goal than with figuring out successful ways to persuade adolescents to comply. While numerous abstinence programs have been implemented, no “silver-bullet” strategies have been identified to date. Abstinence interventions (like most efforts to prevent teen pregnancy) are usually ad hoc, implemented opportunistically, or designed on the basis of a personal hunch. Few programs have been evaluated, and among those with evaluations, most have shown very little effect on the timing of sexual debut. When effects are found, they have been fairly small, with teens delaying sex for a matter of months, when the goal is to delay sex for years. While hunches and experience in the field provide useful insights, it is time to be more systematic in developing new intervention approaches and incorporating research knowledge and theory. This paper highlights scientific evidence regarding the factors most likely to influence the onset of sexual activity during adolescence and examines program strategies with the greatest potential to affect adolescent sexual behavior given research findings. The importance of rigorous evaluations, and suggestions for strengthening the evaluation of abstinence- focused interventions and adolescent pregnancy prevention programs in general, is discussed.