Sexuality in Adolescence (continued)

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More research is needed to identify the most effective ways to reduce risky sexual behavior. In general, education about health promotion and disease prevention is an important component. Some research demonstrates that abstinence-only programs are ineffective in delaying sexual activity, pregnancy, and STDs compared to comprehensive sex education that incorporates discussion of the benefits of abstinence with information about contraception (Starkman & Rajani, 2002). Schools that offer on-site clinic services and health counseling to students have lower rates of pregnancy when compared with schools without these services (Zabin, Hirsch, Smith, Streett, & Hardy, 1986).

Education, important as it is, appears to be less effective than the combination of education and appropriate counseling. St. Lawrence and associates (1995) report that youth enrolled in a cognitive-behavioral treatment program that trained them in refusal skills, problem solving, knowledge of contraceptive choices, and coping had lower rates of risky sexual activity than youth given education alone. Based upon their work with HIV prevention in adults, Schreibmen and Freidland (2003) suggest that clinicians should incorporate prevention-focused information in each counseling session when dealing with clients at risk. Their advice might be useful to adapt to at-risk adolescents as well. Counselors’ focus on prevention need not take the form of didactic messages but rather should be the basis for discussing practical steps toward risk reduction. Because topics of sexuality (or other risky behaviors, for that matter) may be difficult to broach, clinicians may use scripted phrases to introduce these issues sensitively. These are a series of questions that can draw clients into the conversation while minimizing discomfort. For example,

“Now that we’ve finished discussing your medications, I’d like to ask you some questions about your sex and drug behaviors. What behaviors are you involved in now? Would you feel comfortable discussing them? Can you think of anything you might like to change about these behaviors? . . . How important is reducing risk behavior to you (on a scale of 1 to 10) and how confident are you that you can do this (on a scale of 1 to 10)?” (p. 1174)