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On the topic of behavioral triggers, Patel, Yoskowitz, and Kaufman (2007) presented a sexual encounter scenario to 56 heterosexual college students to assess
the relationship between comprehension of sexual situations and decisions about safer sex practices. Participants made decisions that were congruent with their prior beliefs and past behaviour and experiences, and they developed a hypothesis early in the scenario, then focused on selective scenario information to confirm their beliefs or to ignore or misinterpret information that did not correspond to their views. Indeed, participants inadvertently re-ordered the sequence of events to better fit a set of prior expectations. ...
Low-risk individuals ... processed the scenario focusing on cues related to "risks of unprotected sex". These participants have well-established and stable belief structures, and are more likely to change the information to fit their prior hypothesis than change their hypothesis to fit the information. High-risk individuals ... were more inconsistent regarding their sexual behaviour. Their decisions are dependent on context, and they largely rely on their emotions and gut reactions during sexual encounters. They selectively processed cues related to high emotional content. Emotion-related variables make up much of the evidence used by these individuals when making decisions, contributing to their lack of stability in their decisions and behaviour. Both low- and high-risk individuals are goal-directed, although their goals vary. Low-risk individuals have the goal of …["]take no risk at any time …["], whereas high-risk individuals have the goal of …["]immediate pleasure …["]. (pp. 921-922)
By developing profiles of thinking and behavior patterns, one can develop
a tailored educational intervention based on such a profile. One possibility is the use of interactive scenarios that are personalized to relate to individuals on a deeper level, congruent with their own beliefs and experiences. Specifically, the scenarios should bring an individual's beliefs to the surface in order to make them more explicit and show how they are not consistent with or congruent with reality. Although ... [Patel and colleagues] view this as a promising strategy, future research is needed to see if such an approach is viable. This argues for a customized approach, where the goal is to intervene at appropriate weak links in the decision-making process, including any contradictory or unjustified beliefs, to promote safer sex behaviour. (p. 922)
Mosack, Gore-Felton, Chartier, and McGarvey (2007) "examined individual, peer, and family variables associated with adolescent sexual risk behavior ... [among] 1008 adolescents (857 males and 151 females) incarcerated in Virginia juvenile correctional facilities" (p. 115). The investigators found that,
[f]or boys, in particular, it appears as though family relationships, family structure, and peer relationships are associated with the development of peer sexual relationships. For girls, peer-related factors appear to be more important correlates of risky sexual behavior than family factors.
For both boys and girls, externalizing behavior, which is defined as a combination of both delinquent and aggressive behaviors, was predictive of more lifetime sexual partners. ...
[P]erceived friend support was associated with more sexual partners for all groups. Although this bivariate association was suppressed in the multivariate analysis, this finding suggests that peers might encourage each other to have sexual intercourse with multiple sexual partners[,] particularly for adolescents who are engaging in antisocial behaviors ... .
Most important, ... [Mosack and colleagues] found that family-related factors were associated with sexual risk such that perceived family support was significantly associated with more sexual partners for boys but fewer partners for girls. ...
Multivariate analyses revealed that family structure was independently associated with sexual risk behavior for both the full sample and for the subsample of boys. Living in a two-parent household appeared to have a buffering effect for the sample as a whole. Compared with individuals living in a single-parent household with a biological parent, those living in a two-parent household with at least one biological parent had fewer lifetime sexual partners. ... [The investigators] also found that compared to living with a single biological parent, living with nonbiological parents was associated with a higher number of lifetime sexual partners for boys. Taken together, these results suggest that although living with two parents might improve parental monitoring of adolescent behavior, living with a single biological parent alone or with one biological parent and another parent might provide a greater degree of familial connectedness than living in a home without at least one biological parent. Therefore, both parental monitoring and parental support or attachment could have a protective effect on adolescent sexual risk behavior ... . (pp. 125-127)
Drawing on these findings, Mosack and colleagues speculate on the possibility that
incarcerated youth would be more receptive to interventions that provide them with the means to improve peer and family relationships than interventions that focus solely on HIV knowledge or dismiss the relative importance of sexual exploration and healthy sexual development ... . Thus, besides focusing efforts on decreasing sexual risk per se (defined by limiting the number of sexual partners one has, or decreasing the number of encounters in which condoms are not used), perhaps a more general relational communication skills-building intervention would be useful to indirectly influence sexual risk decision-making. For example, interventions that incorporate strategies to improve parent or guardian-adolescent communication on the one hand, and sexual partner perspective-taking and safer sexual negotiation on the other could be particularly powerful.
Moreover, given that perceived peer support was associated with more sexual partners, it is also important, particularly for girls, to address peer relationships that are destructive to healthy decision-making and facilitate the development of more supportive relationships. Likewise, it would also be important for the intervention to enhance coping skills so that adolescents can develop effective strategies to reduce impulsiveness and other externalizing behaviors.
Interventions at the parental level could be useful ... as well. Developing an environment which promotes honest communication while helping parents or guardians to set specific intergenerational boundaries and clear behavioral expectations could also have an impact on adolescent decision-making, perhaps for boys in particular. Evidenced-based interventions designed for general adolescent samples will need to be tailored to incarcerated adolescent populations in order to address the environmental contexts, which contribute to and are affected by adolescent sexual risk-taking behavior. For example, given these adolescents' already tenuous social position, it might be necessary to facilitate the development of relationships with trusted adult community mentors who will contribute to the monitoring of the adolescents once they leave detention. Attempting to involve family members in interventions provided at a detention center could prove complicated. Thus, developing partnerships with detention center staff and collaborating with family members are critical to the process of a family intervention delivered in such a context. (p. 129)
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Winter 2008 Newsletter / Volume 9, Issue 2
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