1. 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.  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.  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.  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.  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.  Births to women CY 2008 All ages 1,749 Under age 15 1 Ages 15-17 22 Ages 18-19 84 Ages 20-24296

7.  Negative Pregnancy tests FY 2009 All ages 1,747 Under age 15 27 Ages 15-17232 Ages 18-19358 Ages 20-24647

8.  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.  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.  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 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.  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.  Three broad categories Misperceived risk Risk and protective factors Perceived relationship safety

14.  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.  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.  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.  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.  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.  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. 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.  Risk and protective factors – continued Decision-making about initializing early sexual activity was influenced by:  Perceived relationship  Personal characteristics of the partner

22.  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.  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.  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.  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.  Perceived relationship safety – continued Behavior is often studied, but not the effect of relationships Trend of serial monogamy

27.  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