Conceptual Models to Depict the Factors that Influence the Avoidance and Cessation of Sexual Risk Behaviors Among Youth

This brief presents two, complementary conceptual models—one for sexual risk avoidance and a second for sexual risk cessation—that aim to guide efforts to prevent youth risk behaviors and promote optimal health. Each model focuses on a set of outcomes that reflect the behavioral context for the target population of youth. The sexual risk avoidance model focuses on outcomes for sexually inexperienced youth related to delaying sexual initiation. The sexual risk cessation model focuses on outcomes for sexually experienced youth related to discontinuing sexual activity.

The models identify a range of factors that research shows may influence youth decision making, sexual behavior, and related outcomes. The conceptual models include only those factors with empirical evidence linking them to relevant outcomes. The influencing factors occur at the environmental, interpersonal, or individual level, and many can be modified through intervention. To this end, the models may be used to guide and support efforts to develop and refine programs, tailor educational messages to youth, and empower parents and other adults to help youth avoid or cease sexual and nonsexual risk behaviors.

The conceptual model for sexual risk avoidance identified environmental, interpersonal, and individual factors that influence behavioral outcomes related to sexual risk avoidance. Environmental factors include media exposure, use of and exposure to Internet pornography, the safety of one’s community, the level of neighborhood poverty, and availability of sexual health education programs. Interpersonal factors relate to parents, peers, and romantic partners and include factors such as connectedness to parents, communication with parents about sexuality, presence of positive peer role models, risky peer behavior, being in a serious or steady relationship, having an older boyfriend or girlfriend, and partner expectations and intentions to have sex. Individual factors are organized into biological, emotional, cognitive, and health behavior factors, such as early puberty or physical development, negative self-perception or body objectification, academic achievement, and alcohol and drug use.

The conceptual model for sexual risk cessation also identified environmental, interpersonal, and individual factors that influence related behavioral outcomes. Examples of factors include media exposure (environmental), living with two biological parents at age 14, higher parental education, risky peer behavior, and partner expectations and intentions to have sex (interpersonal), and community engagement and negative self-perception or body objectification (individual).

There are similarities and differences between the sexual risk avoidance and sexual risk cessation conceptual models. More factors are associated with sexual risk avoidance outcomes than sexual risk cessation outcomes. Factors at the individual level are most prevalent for both sexual risk avoidance and cessation. The role of parents and family is more pronounced for sexual risk avoidance than for sexual risk cessation.

Mathematica developed the conceptual models based on an in-depth, targeted literature review of the empirical and theoreti­cal literature, and input from experts from across the fields of youth sexual risk prevention program­ming, developmental psychology, and health behavior research. To identify specific factors that influence outcomes related to sexual risk avoidance and cessation among youth, the Mathematica team identified, reviewed, and assessed literature that provided evidence for whether specific factors influenced outcomes related to sexual risk avoidance and cessation. The analysis process included assessing the relevance and rigor of each article, assigning an evidence rating score to each factor, reviewing and synthesizing the evidence for factors, and incorporating factors with evidence into the models.

Adamek, Katie, Alicia Meckstroth, Hande Inanc, Lindsay Ochoa, So O’Neil, Kim McDonald, and Heather Zaveri (2019). “Conceptual Models to Depict the Factors that Influence the Avoidance and Cessation of Sexual Risk Behaviors Among Youth.” OPRE Research Brief #2020-02. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.