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The Contexts for Adolescent Female Sexual Decision-making. Robert Wm. Blum, MD, MPH, PhD William H. Gates, Sr. Professor and Chair Department of Population, Family and Reproductive Health Johns Hopkins Bloomberg School of Public Health. Prepared for: Girls Decide Conference

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the contexts for adolescent female sexual decision making

The Contexts for Adolescent Female Sexual Decision-making

Robert Wm. Blum, MD, MPH, PhD

William H. Gates, Sr. Professor and Chair

Department of Population, Family and Reproductive Health

Johns Hopkins Bloomberg School of Public Health

Prepared for:

Girls Decide Conference

Amsterdam, The Netherlands

16-17 September 2010

slide2
A Contextual Model

Macrolevel

Environmental

Factors

Proximal Level

Environmental Individual

Factors Factors

Response

Outcome

Biological

Factors

Neighborhood

Involuntary

Response

Family

Individual

Response

Poverty

Early Sexual Engagement

Peers

Discrimination

School

Voluntary

Response

Inequality

Temperament & Cognitive Factors

slide3
A Contextual Model

Outcome

Individual

Response

Early Sexual Engagement

slide4
A Contextual Model

Macrolevel

Environmental

Factors

Outcome

Policies

Individual Response

Neighborhood

Early Sexual engagement

Customs

Social change

neighborhood factors poverty
Neighborhood Factors: Poverty
  • Lower grades
  • Lower educational attainment
  • More school drop out
  • More precocious sexual activity/child bearing
how does poverty impact outcomes
How does Poverty Impact Outcomes?
  • Less social and financial capital
  • More social disorganization
  • Less collective efficiency
  • More discrimination
  • More inequality
slide7
A Contextual Model

Macrolevel

Environmental

Factors

Proximal Level

Environmental

Factors

Outcome

Policies

Family

Individual Response

Neighborhood

Early sexual engagement

Customs

Social Change

family factors
Family Factors

Globally family has consistently been shown to be the most protective factor in the lives of young people.

When adolescent girls report connection to parents they are less likely to engage in early sexual behaviors

elements of positive parenting
Elements of Positive Parenting
  • Behavioral Monitoring
  • Closeness and Connectedness
  • Emotional Responsiveness
  • Knowing child’s friends, their friends’ parents, their teachers
  • Setting high behavioral and educational expectations
slide10
A Contextual Model

Macrolevel

Environmental

Factors

Proximal Level

Environmental

Factors

Outcome

Policies

Family

Individual

Response

Neighborhood

Early Sexual engagement

Customs

School

Social change

school factors
School Factors

Young girls who are attached to school marry later and delay first sexual encounters.

factors that appear to influence school attachment
Factors that Appear to Influence School Attachment
  • Perceiving teachers as emotionally caring
  • Experiencing academic support
  • Not experiencing discrimination based on gender or SES
  • Parental support for schooling
  • Believing that education will improve future prospects
behavioral consequences of low school engagement vietnam data
Behavioral Consequences of Low School Engagement (Vietnam data)
  • Ever smoked
  • Ever been drunk
  • Less likely to always wear a motorcycle a helmet
  • Low self esteem
  • More often hanging out on streets and causing public disorder
  • Less optimistic about the future
  • More likely to think of suicide
  • More often having premarital sex

Blum et al. 2010

slide14
A Contextual Model

Macrolevel

Environmental

Factors

Proximal Level

Environmental

Factors

Outcome

Policies

Family

Individual Response

Neighborhood

Early sexual engagement

Peers

customs

School

Social change

peers
Peers

Peers tend to be a positive socializing force.

close prosocial peer relationships are associated with
Close Prosocial Peer Relationships are associated with:
  • Later age first sex
  • Less tobacco use,
  • Less depression
  • Less drug use
  • Better academic performance
peer pressure
Peer Pressure

Youth are more likely to conform behaviorally to the views of peers than parents.

Additionally, they conform more to their perceptions of peer behaviors than what their friends actually do.

slide18
A Contextual Moel

Macrolevel

Environmental

Factors

Proximal Level

Environmental Individual

Factors Factors

Outcome

Biological

Factors

Policies

Family

Individual Response

Neighborhood

Early Sexual

engagement

Peers

Customs

School

Social change

slide19
Brain development occurs within the context of the environment.

Environments have both direct and indirect effects.

adolescent neurodevelopment and behavior
Adolescent Neurodevelopment and behavior
  • During adolescence the frontal lobe fully develops
  • Frontal lobe controls executive functioning: emotional reactivity, impulse control, reasoned actions
  • “Toxic” environments diminish emotional control
slide21
A Contextual Model

Macrolevel

Environmental

Factors

Proximal Level

Environmental Individual

Factors Factors

Response

Outcome

Biological

Factors

Policies

Involuntary

Response

Family

Individual Response

Neighborhood

Early Sexual engagement

Peers

Customs

School

Voluntary

Response

Social change

Temperament & Cognitive Factors

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