A Risk Avoidance Education Program Successfully Reduces Sexual Initiation/Experience.

Early initiation of sexual activity in adolescents is associated with consequences that include unintended pregnancies, sexually transmitted infections (STIs) and increased sexual risk behaviors such as multiple sexual partners.1,2 Risk avoidance has been shown to be effective in delaying initiation of sexual activity in teenagers and adolescents.3

A recent study was conducted to evaluate the effectiveness of the Heritage Keepers® Abstinence Education program. Researchers designed a testing predictive model to assess the efficacy and effectiveness of this abstinence education curriculum in delaying sexual initiation among youth in middle and high schools.4

The program is an interactive curriculum that was presented in 45-minute class periods over 10 sequential school days or 90-minute sessions over five consecutive school days, making up a total of 450 minutes of interactive program administration.

This curriculum provided a concise articulation of the benefits of sexual risk avoidance; addressing the immediate and long-term consequences of early sexual initiation such as STIs, unintended teenage pregnancies and the benefits of attaining a stable family formation in the future.4

This quasi-experimental study evaluated 2215 middle and high school students from 34 program schools and 7 comparison schools in South Carolina.

Pre-surveys, post-surveys and follow-up at 12-month post-completion of the program were administered to the participants. Pre-test data was collected from 5863 students in both the intervention and comparison schools. Of the 5,863 students who were given the pre-test questionnaires, 781 students provided pre-test data only, 2194 provided both pre- and post- test data but no follow-up data, 348 students provided pretest and 12 month follow up data, and 2,540 students provided completed surveys at all three data points during pre-test, post-test and 12-month follow-up data. The students who provided data at all three data points met the criteria to be included in the final analyses for the survey.4 To ensure similarities between the intervention and comparison groups, the researchers employed the use of a necessary statistical method known as propensity score matching. Following this matching procedure, 2215 students were included in the final analyses with 1828 students from the intervention group and 387 students from the comparison group. The students were followed for one year after the intervention to assess the outcomes of the program. The primary outcome of the study was sexual initiation 12 months after the intervention.4

The results showed that sexual experience increased from 29.1% to 33.7% for the program participants and from 29.2% to 43.2% among the comparison group. The study also demonstrated that these differences between program and comparison groups were because of the program effects on the cognitive constructs.4

Although programs have been previously designed with the goal of achieving teen pregnancy prevention; a number of these programs are based on certain theories on behavioral change, but the logic model that explains the relationship between the program constructs and the study outcomes have not been clearly explained. The researchers in this study sought to provide a clearer understanding of the mediators that lead to behavior change outcomes and how these mediating variables result in behavioral changes in adolescents. Additionally, they also did test the effectiveness of this intervention in reduction of teen sexual activity 12 months following participation in the program.

The researchers tested the theory that behavioral intention was the mediator that had the most influence on the adolescent sexual behavior. The other related mediators that were tested include self-efficacy (abstinence efficacy), outcomes expectancies (future impact of sex), rationalizations (justification of sex) and social norms (abstinence values). The Heritage Keepers program targeted these mediators in the development and implementation of the curriculum, teacher training and monitoring as well as program evaluation. Although this set of variables is not an exhaustive list; they provide a representative set of mediators against which predictors of sexual behavior can be tested.4

The program attempts to increase abstinent values and efficacy, to improve awareness of the negative future impact of early sexual initiation and to minimize justifications for engaging in sexual activity and intentions to initiate sexual activity.4

This study was essential in identifying the mediating variables that affect sexual behavior in adolescents and teenagers. These findings will help other program planners to design sexual health intervention programs that are effective in reducing the burden of early and risky sexual activity in young people.
Given this positive and encouraging results from a program focused on the primary prevention approach of risk avoidance, MI continues to advocate sexual risk avoidance in the prevention of STIs, teen pregnancies and emotional consequences of early sexual activity. By doing so, we hope to foster an environment that allows youth everywhere the opportunity to achieve their full potential and maintain the greatest measure of health.


1. Kaestle CE, Halpern CT, Miller WC, Ford CA. Young age at first sexual intercourse and sexually transmitted infections in adolescents and young adults. Am J Epidemiol 2005;161(8):774-780.

2. Sandfort TG, Orr M, Hirsch JS, Stantelli J. Long-term health correlates of timing of sexual debut: results from a national US study. Am J Public Health 2008;98(1):155-161.

3. Jemmott JB, Jemott LS, Fong GT. Efficacy of a theory-based abstinence-only intervention over 24 months: a randomized controlled trial with young adolescents. Arch Pediatr Adolesc Med 2010;164(2):152-159.

4. Weed SE, Birch PJ, Ericksen IH, Olsen JA. Testing a Predictive Model of Youth Sexual Intercourse Initiation. Salt Lake City: Institute for Research & Evaluation. May 2012. Available at: http://www.heritageservices.org/pdf/testingapredictivemodel.pdf

Reviewed: June 2012