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Adolescent Decision-Making: A review of the literature

Adolescent Decision-Making: A review of the literature. Cindy Marucci-Bosley, CRNP-OB/GYN, MSN, LCCE, FNE-A (trained) Acting Director of Nursing Manager, Women’s Health Program Carroll County Health Department 410-876-4944 cbosley@dhmh.state.md.us. Adolescent Sexual Decision-Making.

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Adolescent Decision-Making: A review of the literature

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  1. Adolescent Decision-Making:A review of the literature Cindy Marucci-Bosley, CRNP-OB/GYN, MSN, LCCE, FNE-A (trained) Acting Director of Nursing Manager, Women’s Health Program Carroll County Health Department 410-876-4944 cbosley@dhmh.state.md.us

  2. Adolescent Sexual Decision-Making Based on: Fantasia, Heidi, C. Adolescent Sexual Decision-Making: A Review of the Literature. The American Journal For Nurse Practitioners. November/December 2009. Vol. 13 No. 11/12.

  3. Adolescent Sexual Decision-MakingScope of the problem • Decrease in the age of puberty • 12.3 years • Increase in the age of first marriage • 25.6 years • Changes in the definitions of relationships in current teen culture • Increased and changing societal influences

  4. Adolescent Sexual Decision-MakingScope of the problem • Increase in the number of sexually transmitted infections • >100 million cases contracted in persons younger than age 25 • Nearly 50% of the 4.9 million new HIV infections are in persons aged 15-24

  5. Adolescent Sexual Decision-MakingScope of the problem • Unintended pregnancy • In the United states, 50% of all pregnancies are unintended • 56% end in live birth, 30% end in abortion, and 14% end in miscarriage (National Campaign to Prevent Teen Pregnancy) • Among all developed countries the United States has the highest incidence or reported adolescent pregnancies, abortions, and births • Approximately, 750,000 adolescents become pregnant each year

  6. Adolescent Sexual Decision-MakingScope of the problem in Carroll County • Births to women CY 2008 • All ages 1,749 • Under age 15 1 • Ages 15-17 22 • Ages 18-19 84 • Ages 20-24 296

  7. Adolescent Sexual Decision-MakingScope of the problem in Carroll County • Negative Pregnancy tests FY 2009 • All ages 1,747 • Under age 15 27 • Ages 15-17 232 • Ages 18-19 358 • Ages 20-24 647

  8. Adolescent Sexual Decision-MakingScope of the problem in Carroll County • Positive Pregnancy tests FY 2009 • All ages 240 • Under age 15 2 • Ages 15-17 23 • Ages 18-19 44 • Ages 20-24 92

  9. Adolescent Sexual Decision-MakingScope of the problem in Carroll County • Family Planning patients FY 2009 • All ages 1,681 • Under age 15 21 • Ages 15-17 187 • Ages 18-19 316 • Ages 20-24 627 • Total number of visits 3,403

  10. Adolescent Sexual Decision-MakingScope of the problem in Carroll County • Emergency Contraception FY 2009 • All ages 296 • Under age 15 4 • Ages 15-17 61 • Ages 18-19 89 • Ages 20-24 94

  11. Adolescent Sexual Decision-MakingScope of the problem • Adolescent developmental model • Rapid physical growth • Progression from concrete to abstract, future-oriented thought • Establishment of life goals • Variable and often asynchronous developmental stages • Early (11-14 years) • Middle (15-17 years) • Late (18-22 years)

  12. Adolescent Sexual Decision-MakingFramework • Two theoretical models • Ecological focus - considers interpersonal, social, cultural, and environmental influences on an individual’s behavior and decision-making • Adolescent developmental model – based tenants that adolescence: • Spans more than a decade • Is characterized by rapid growth • Is the time of progression from concrete thought to abstract, future oriented thinking • Is the time of establishment of life goals

  13. Adolescent Sexual Decision-MakingFindings • Three broad categories • Misperceived risk • Risk and protective factors • Perceived relationship safety

  14. Adolescent Sexual Decision-MakingFindings • Misperceived risk • Role of optimistic bias – suggestion that individuals underestimate their own health hazards in relation to their peers • Adolescents equated long-term relationships with trust and safety • As involvement in risky sexual behavior increased, estimates of the adolescents risk decreased

  15. Adolescent Sexual Decision-MakingFindings • Misperceived risk – continued • Unplanned encounters, multiple partners, inconsistent condom use, and drug and alcohol use were not perceived as increased risks • Positive emotions (identified as gratification of sexual desire or attraction), even after a risk sexual encounter, may cause an underestimation of actual risk

  16. Adolescent Sexual Decision-MakingFindings • Risk and protective factors • In early and middle adolescents, sexual decision-making was swayed in the direction of the social norm • Strong peer influence with little regard for personal risk

  17. Adolescent Sexual Decision-MakingFindings • Risk and protective factors – continued • Particularly in early and middle adolescents, other influences are: • A need to feel important and cared about • Lack of parental supervision • Associated problem behaviors such as smoking, and alcohol and drug (marijuana) use • Sensation seeking behavior

  18. Adolescent Sexual Decision-MakingFindings • Risk and protective factors – continued • Protective factors were identified, but how they were acquired was not identified in these studies • Protective factors included: • Ability to recognize a partner’s motives • Better overall decision-making • Increased expectations for healthy relationships

  19. Adolescent Sexual Decision-MakingFindings • SEARCH Institute www.search-institute.org • Framework of Developmental Assets grounded in research in youth development, resiliency, and prevention • The more assets a youth has, the less likely they are to engage in a wide range of high-risk behaviors and the more likely to thrive • Average young person has less then half of the 40 assets, boys have fewer assets than girls

  20. Adolescent Sexual Decision-MakingFindings SEARCH Institute – continued • Developmental Assets List available for: • Adolescents • (ages 12-18) • Middle Childhood • (ages 8-12) • Grades K-3 • (ages 5-9) • Early Childhood • (ages 3-5) • Divided into groupings: • Support • Empowerment • Boundaries and Expectations • Constructive Use of Time • Commitment to Learning • Positive Values • Social Competencies • Positive Identity

  21. Adolescent Sexual Decision-MakingFindings • Risk and protective factors – continued • Decision-making about initializing early sexual activity was influenced by: • Perceived relationship • Personal characteristics of the partner

  22. Adolescent Sexual Decision-MakingFindings • Risk and protective factors – continued • Opportunity for unsupervised time alone • Often activity was spontaneous with little consideration to risk and consequences • Most sexual activity occurred after school in their own home, prior to the parents coming home • Adolescents with less parental supervision and greater amounts of time alone were more likely to be sexually active and have a greater number of partners

  23. Adolescent Sexual Decision-MakingFindings • Risk and protective factors – continued • Late adolescents reported perceived behavioral control and positive past sexual experience as the most important predictors of sexual activity • Other studies showed associated factors for late adolescents sexual decision-making to be: • Physically attractive partner • Comfortable atmosphere • Being in a steady relationship • Variable results support neuroscience research that cognitive processes and frontal-lobe brain development are not fully mature until young adulthood

  24. Adolescent Sexual Decision-MakingFindings • Perceived relationship safety • Of early and middle adolescents, 40% reported initiating sex within 1 month of the dating relationship • 50% of the above group reported seeing someone else or believed their partner was seeing someone else • Condom use was low which may indicate they believed they were safe because of the familiarity of their dating partners

  25. Adolescent Sexual Decision-MakingFindings • Perceived relationship safety – continued • Adolescents who presume they are in a mutually monogamous relationship often underestimate their risk • There is often discrepancies between perceptions of monogamy and self-reported behaviors • In middle and late adolescents, 50% used condoms with casual partners, and 30% used condoms with dating partners

  26. Adolescent Sexual Decision-MakingImplications for Practice • Perceived relationship safety – continued • Behavior is often studied, but not the effect of relationships • Trend of serial monogamy

  27. Adolescent Sexual Decision-MakingImplications for Practice • Perceived relationship safety – continued • Need to repeatedly explore and encourage behaviors such as: • Delaying sexual debut • Sexual acts • Consistent condom use • Limiting number of lifetime partners • Inquiring about partners sexual history • Avoidance of drug and alcohol use

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