Abstract
While school-based sex education is one of the key program and policy solutions to improve adolescent sexual health outcomes, new efforts are needed to strengthen its overall impact. The cognitive, hormonal, emotional, and physical changes that accompany the onset of puberty and occur throughout the teenage years play a significant role in aspects of adolescent sexual risk taking. Thus, one approach to advancing current understanding of these complex issues is to leverage emerging knowledge in developmental affective neuroscience over the past 15 years, which suggests some potentially promising innovations that may inform new educational directions to improve adolescent sexual health. Exploring the conceptual and empirical advances in understanding adolescent brain development through the lens of the conceptualization, implementation, and evaluation of sex education, this article provides new perspectives that encourage the testing of innovative approaches to sex education policy and practice.
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References
Ajzen, I. (1985). From intentions to actions: a theory of planned behavior. In J. Kuhl & J. Bechmann (Eds.), Action-control: from cognition to behavior (pp. 11–39). New York: Springer.
Ali, M. M., & Dwyer, D. S. (2011). Estimating peer effects in sexual behavior among adolescents. Journal of Adolescence, 34(1), 183–190.
Allen, J. P., & Philliber, S. (2001). Who benefits most from a broadly targeted prevention program? Differential efficacy across populations in the teen outreach program. Journal of Community Psychology, 29(6), 637–655.
Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological Review, 84(2), 191.
Bandura, A. (1991). Social cognitive theory of self-regulation. Organizational Behavior and Human Decision Processes, 50(2), 248–287.
Baumeister, R. F., Vohs, K. D., DeWall, C. N., & Zhang, L. (2007). How emotion shapes behavior: feedback, anticipation, and reflection, rather than direct causation. Personality and Social Psychology Review, 11(2), 167–203.
Beauchamp, M., & Beauchamp, C. (2012). Understanding the neuroscience and education connection: themes emerging from a review of the literature. In S. Dell Salla & M. Anderson (Eds.), Neuroscience in education: the good, the bad, and the ugly (pp. 13–30). Oxford: Oxford University.
Beebe, D. W., Rose, D., & Amin, R. (2010). Attention, learning, and arousal of experimentally sleep-restricted adolescents in a simulated classroom. Journal of Adolescent Health, 47(5), 523–525.
Bell, K., Terzian, M. A., & Moore, K. A. (2012). What works for female children and adolescents: Lessons from experimental evaluations of programs and interventions. Fact sheet. Publication #2012–23. Child Trends.
Blakemore, S. J., & Choudhury, S. (2006). Development of the adolescent brain: implications for executive function and social cognition. Journal of Child Psychology and Psychiatry, 47(3–4), 296–312.
Bleakley, A., Hennessy, M., & Fishbein, M. (2006). Public opinion on sex education in US schools. Archives of Pediatrics & Adolescent Medicine, 160(11), 1151.
Brindis, C. D. (2006). A public health success: understanding policy changes related to teen sexual activity and pregnancy. Annual Review of Public Health, 27(1), 277–295. doi:10.1146/annurev.publhealth.27.021405.102244.
Brindis, C., Sattley, D., & Mamo, L. (2005). From theory to action: frameworks for implementing community-wide adolescent pregnancy prevention strategies. San Francisco: UCSF Bixby Center for Reproductive Health Research and Policy, Department of Obstetrics, Gynecology & Reproductive Sciences, and the Institute for Health Policy Studies.
Campbell, F. A., Ramey, C. T., Pungello, E., Sparling, J., & Miller-Johnson, S. (2002). Early childhood education: young adult outcomes from the abecedarian project. Applied Developmental Science, 6(1), 42–57.
Casey, B. J., Jones, R. M., & Hare, T. A. (2008). The adolescent brain. Annals of the New York Academy of Sciences, 1124(1), 111–126.
Cavazos-Rehg, P. A., Krauss, M. J., Spitznagel, E. L., Iguchi, M., Schootman, M., Cottler, L., et al. (2012). Associations between sexuality education in schools and adolescent birthrates: a state-level longitudinal model. Archives of Pediatrics & Adolescent Medicine, 166(2), 134.
Centers for Disease Control and Prevention. (2010). Social media guidelines and best practices. Atlanta: Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/SocialMedia/Tools/guidelines/pdf/virtualworld.pdf.
Centers for Disease Control and Prevention. (2012). 2011 sexually transmitted diseases surveillance. Atlanta: Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/std/stats11/toc.htm.
Checkoway, B., & Richards-Schuster, K. (2003). Youth participation in community evaluation research. American Journal of Evaluation, 24(1), 21–33.
Chein, J., Albert, D., O’Brien, L., Uckert, K., & Steinberg, L. (2011). Peers increase adolescent risk taking by enhancing activity in the brain’s reward circuitry. Developmental Science, 14(2), F1–F10.
Constantine, N. (2012). Intervention effectiveness research in adolescent health psychology: methodological issues and strategies. In W. O’Donohue, L. Benuto, & L. Woodward (Eds.), Handbook of adolescent health psychology. New York: Springer.
Cowan, N. (2005). Working memory capacity. New York: Psychology.
Crone, E. A., & Dahl, R. E. (2012). Understanding adolescence as a period of social–affective engagement and goal flexibility. Nature Reviews Neuroscience, 13(9), 636–650.
Dahl, R. E. (2004). Adolescent brain development: a period of vulnerabilities and opportunities. Annals of the New York Academy of Sciences, 1021, 1–22. doi:10.1196/annals.1308.001.
Dart, J., & Davies, R. (2003). A dialogical, story-based evaluation tool: the most significant change technique. American Journal of Evaluation, 24(2), 137–155.
Davidson, R. J. (2004). What does the prefrontal cortex “do” in affect: perspectives on frontal EEG asymmetry research. Biological Psychology, 67(1), 219–234.
Davis, R., & Dart, J. (2005). The ‘most significant change’ (MSC) technique: a guide to it's use. Retrieved from www.mande.co.uk/docs/MSCGuide.htm
Department of Health and Human Services. (2012). Affordable care act (ACA) personal responsibility education program (PREP) [The Patient Protection and Affordable Care Act, Title II Role Of Public Programs, Subtitle L, Maternal and Child Health Services. Title V, Section 2953, Public Law 111–148, 42 U.S.C 713(c)(1)] (The Patient Protection and Affordable Care Act, Title II Role Of Public Programs, Subtitle L, Maternal and Child Health Services, Title V, Section 2953, Public Law 111–148, 42 U.S.C 713(c)(1)). Retrieved from https://www.cfda.gov/?s=program&mode=form&tab=step1&id=e9085baafbd785d09c9e4e52f9ec4ac4.
Devaney, B. L., Johnson, A., Maynard, R., & Trenholm, C. (2002). The evaluation of abstinence education programs funded under title V Section 510: interim report. Princeton: Mathematica Policy Research.
DiCenso, A., Guyatt, G., Willan, A., & Griffith, L. (2002). Interventions to reduce unintended pregnancies among adolescents: systematic review of randomised controlled trials. BMJ, 324(7351), 1426.
Dishion, T. J., & Tipsord, J. M. (2011). Peer contagion in child and adolescent social and emotional development. Annual Review of Psychology, 62, 189–214.
Downs, J. S., Murray, P. J., Bruine de Bruin, W., Penrose, J., Palmgren, C., & Fischhoff, B. (2004). Interactive video behavioral intervention to reduce adolescent females’ STD risk: a randomized controlled trial. Social Science & Medicine, 59(8), 1561–1572.
Eisenberg, N., Fabes, R. A., & Spinrad, T. L. (2007). Prosocial development: handbook of child psychology. New York: Wiley.
Falk, E. B., Berkman, E. T., & Lieberman, M. D. (2012). From neural responses to population behavior neural focus group predicts population-level media effects. Psychological Science, 23(5), 439–445.
Finer, L. B., & Zolna, M. R. (2011). Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception, 84(5), 478–485.
Fishbein, M. (1979). A theory of reasoned action: some applications and implications. Nebraska Symposium on Motivation, 27, 65–116.
Fisher, J. D., & Fisher, W. A. (1992). Changing AIDS-risk behavior. Psychological Bulletin, 111(3), 455.
Forbes, E. E., & Dahl, R. E. (2010). Pubertal development and behavior: hormonal activation of social and motivational tendencies. Brain and Cognition, 72(1), 66–72. doi:10.1016/j.bandc.2009.10.007.
Future of Sex Education Initiative. (2012). National sexuality education standards: core content and skills, K–12 (a special publication of the journal of school health). Retrieved from http://www.futureofsexeducation.org/documents/josh-fose-standards-web.pdf.
Galván, A. (2010). Neural plasticity of development and learning. Human Brain Mapping, 31(6), 879–890.
Gardner, M., & Steinberg, L. (2005). Peer influence on risk taking, risk preference, and risky decision making in adolescence and adulthood: an experimental study. Developmental Psychology, 41(4), 625–635.
Gavin, L. E., Catalano, R. F., David-Ferdon, C., Gloppen, K. M., & Markham, C. M. (2010). A review of positive youth development programs that promote adolescent sexual and reproductive health. Journal of Adolescent Health, 46(3), S75–S91.
Gawronski, B., & Creighton, L. (2013). Dual process theories. In D. Carlston (Ed.), The Oxford handbook of social cognition (pp. 282–312). New York: Oxford University.
Geake, J., & Cooper, P. (2003). Cognitive neuroscience: implications for education? Westminster Studies in Education, 26(1), 7–20.
Gerrard, M., Gibbons, F., Houlihan, A., Stock, M., & Pomery, E. (2008). A dual-process approach to health risk decision making: the prototype willingness model. Developmental Review, 28(1), 29–61. doi:10.1016/j.dr.2007.10.001.
Gibbons, F. X., Gerrard, M., Reimer, R. A., & Pomery, E. A. (2006). Unintentional behavior: a subrational approach to health risk. In D. de Ridder & J. de Wit (Eds.), Self regulation in health behavior (pp. 45–69). West Sussex: Wiley.
Gibbons, F. X., Houlihan, A. E., & Gerrard, M. (2009). Reason and reaction: the utility of a dual-focus, dual-processing perspective on promotion and prevention of adolescent health risk behaviour. British Journal of Health Psychology, 14(2), 231–248.
Goldenberg, D., Telzer, E. H., Lieberman, M. D., Fuligni, A., & Galván, A. (2013). Neural mechanisms of impulse control in sexually risky adolescents. Developmental Cognitive Neuroscience, 6, 23–29.
Goldfarb, E., & Constantine, N. A. (2011). Sexuality education. In B. Brown & M. Prinstine (Eds.), Encyclopedia of adolescence: normative processes in development (pp. 322–331). San Diego: Academic.
Guttmacher Institute. (2013a). Facts on American teens’ sexual and reproductive health. In Brief. Retrieved from http://www.guttmacher.org/pubs/FB-ATSRH.pdf
Guttmacher Institute. (2013b). State policies in brief: sex and HIV education. Washington, DC: Guttmacher Institute.
Hauser, D. (2004). Five years of abstinence-only-until-marriage education: assessing the impact. Washington, DC: Advocates for Youth.
Jemmott, J. B., III, Jemmott, L. S., & Fong, G. T. (2010). Efficacy of a theory-based abstinence-only intervention over 24 months: a randomized controlled trial with young adolescents. Archives of Pediatrics & Adolescent Medicine, 164(2), 152.
Johnson, S. B., Blum, R. W., & Giedd, J. N. (2009). Adolescent maturity and the brain: the promise and pitfalls of neuroscience research in adolescent health policy. Journal of Adolescent Health, 45(3), 216–221.
Kamel Boulos, M. N., & Toth-Cohen, S. (2009). The University of Plymouth sexual health SIM experience in Second Life®: evaluation and reflections after 1 year. Health Information and Libraries Journal, 26(4), 279–288.
Kirby, D. (2002). Effective approaches to reducing adolescent unprotected sex, pregnancy, and childbearing. The Journal of Sex Research, 39(1), 51–57.
Kirby, D. B. (2008). The impact of abstinence and comprehensive sex and STD/HIV education programs on adolescent sexual behavior. Sexuality Research & Social Policy, 5(3), 18–27.
Kirby, D., & Laris, B. A. (2009). Effective curriculum based sex and STD/HIV education programs for adolescents. Child Development Perspectives, 3(1), 21–29.
Kirby, D. B., Laris, B. A., & Rolleri, L. A. (2007). Sex and HIV education programs: their impact on sexual behaviors of young people throughout the world. Journal of Adolescent Health, 40(3), 206–217.
Kohler, P. K., Manhart, L. E., & Lafferty, W. E. (2008). Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. Journal of Adolescent Health, 42(4), 344–351.
Lindberg, L. D., & Maddow-Zimet, I. (2012). Consequences of sex education on teen and young adult sexual behaviors and outcomes. Journal of Adolescent Health, 51, 332–338.
London, J. K., Zimmerman, K., & Erbstein, N. (2003). Youth-Led research and evaluation: tools for youth, organizational, and community development. New Directions for Evaluation, 2003(98), 33–45.
Luciana, M., Conklin, H. M., Hooper, C. J., & Yarger, R. S. (2005). The development of nonverbal working memory and executive control processes in adolescents. Child Development, 76(3), 697–712.
Martin, S., Rector, R., & Pardue, M. G. (2004). Comprehensive sex education vs. authentic abstinence: a study of competing curricula. Washington, DC: The Heritage Foundation.
Mills, B., Reyna, V. F., & Estrada, S. (2008). Explaining contradictory relations between risk perception and risk taking. Psychological Science, 19(5), 429–433. doi:10.1111/j.1467-9280.2008.02104.x.
Mueller, T. E., Gavin, L. E., & Kulkarni, A. (2008). The association between sex education and youth’s engagement in sexual intercourse, age at first intercourse, and birth control use at first sex. Journal of Adolescent Health, 42(1), 89–96.
Nagy, Z., Westerberg, H., & Klingberg, T. (2004). Maturation of white matter is associated with the development of cognitive functions during childhood. Journal of Cognitive Neuroscience, 16(7), 1227–1233.
Nichols, T. R., Birnel, S., Graber, J. A., Brooks-Gunn, J., & Botvin, G. J. (2010). Refusal skill ability: an examination of adolescent perceptions of effectiveness. The Journal of Primary Prevention, 31(3), 127–137.
Pan, Z., Cheok, A. D., Yang, H., Zhu, J., & Shi, J. (2006). Virtual reality and mixed reality for virtual learning environments. Computers & Graphics, 30(1), 20–28.
Pfeifer, J. H., Masten, C. L., Moore, W. E., Oswald, T. M., Mazziotta, J. C., Iacoboni, M., et al. (2011). Entering adolescence: resistance to peer influence, risky behavior, and neural changes in emotion reactivity. Neuron, 69(5), 1029–1036.
Pfeifer, J. H., Kahn, L. E., Merchant, J. S., Peake, S. J., Veroude, K., Masten, C. L., et al. (2013). Longitudinal change in the neural bases of adolescent social self-evaluations: effects of age and pubertal development. The Journal of Neuroscience, 33(17), 7415–7419.
Philliber, S., Kaye, J. W., Herrling, S., & West, E. (2002). Preventing pregnancy and improving health care access among teenagers: an evaluation of the Children's Aid Society–Carrera Program. Perspectives on Sexual and Reproductive Health, 34(5), 244–251.
Realityworks. (2013). Reality works experiential learning. [Web page] Retrieved from http://www.realityworks.com/products/realcare-baby
Reyna, V. F. (2004). How people make decisions that involve risk. A dual-processes approach. Current Directions in Psychological Science, 13(2), 60–66. doi:10.1111/j.0963-7214.2004.00275.x.
Reyna, V., & Farley, F. (2006). Risk and rationality in adolescent decision making: implications for theory, practice and public policy. Psychological Science in the Public Interest, 7(1), 1–44.
Reyna, V., & Rivers, S. (2008). Current theories of risk and rational decision making. Developmental Review, 28(1), 1–11. doi:10.1016/j.dr.2008.01.002.
Riva, G., Mantovani, F., Capideville, C. S., Preziosa, A., Morganti, F., Villani, D., et al. (2007). Affective interactions using virtual reality: the link between presence and emotions. CyberPsychology & Behavior, 10(1), 45–56.
Rivers, S., Reyna, V., & Mills, B. (2008). Risk taking under the influence: a fuzzy-trace theory of emotion in adolescence. Developmental Review, 28(1), 107–144. doi:10.1016/j.dr.2007.11.002.
Rogow, D., Haberland, N., Del Valle, A., Lee, N., Osakue, G., Sa, Z., et al. (2013). Integrating gender and rights into sexuality education: field reports on using “It’s All One”. Reproductive Health Matters, 21(41), 154–166.
Rosenstock, I. M. (1974). The health belief model and preventive health behavior. Health Education Monographs, 2(Winter), 354–386.
Rotter, J. B. (1954). Social learning and clinical psychology. New York: Prentice-Hall.
Sallis, J. F., Owen, N., & Fisher, E. B. (2008). Ecological models of health behavior. In K. Glanz, B. Rimer, & K. Viswanath (Eds.), Health behavior and health education: theory, research and practice (4th ed., pp. 465–486). San Francisco: Jossey-Bass.
Sapouna, M., Wolke, D., Vannini, N., Watson, S., Woods, S., Schneider, W., et al. (2010). Virtual learning intervention to reduce bullying victimization in primary school: a controlled trial. Journal of Child Psychology and Psychiatry, 51(1), 104–112.
Schalet, A. T. (2011). Beyond abstinence and risk: a new paradigm for adolescent sexual health. Women’s Health Issues, 21(3), S5–S7.
SIECUS. (2012). Sexuality education Q & A. [Web page] Retrieved from http://www.siecus.org/index.cfm?fuseaction=page.viewpage&pageid=521&grandparentID=477&parentID=514.
Smith, A. R., Chein, J., & Steinberg, L. (2013). Impact of socio-emotional context, brain development, and pubertal maturation on adolescent risk-taking. Hormones and Behavior, 64(2), 323–332.
Society for Neuroscience. (2013). Neuroscience funding through NIH. [Web page] Retrieved from http://www.sfn.org/Advocacy/Neuroscience-Funding/US-Funding-Priorities/Neuroscience-Funding-Through-NIH.
Somers, C. L., & Fahlman, M. M. (2001). Effectiveness of the “Baby think it over” teen pregnancy prevention program. Journal of School Health, 71(5), 188–195.
Steinberg, L. (2005). Cognitive and affective development in adolescence. Trends in Cognitive Sciences, 9(2), 69–74. doi:10.1016/j.tics.2004.12.005.
Steinberg, L. (2009). Should the science of adolescent brain development inform public policy. American Psychologist, 739–750.
Steinberg, L., Cauffman, E., Woolard, J., Graham, S., & Banich, M. (2009). Are adolescents less mature than adults?: minors’ access to abortion, the juvenile death penalty, and the alleged APA “flip-flop”. American Psychologist, 64(7), 583–594. doi:10.1037/a0014763.
Suellentrop, K. (2011). What works 2011–2012: curriculum-based programs that help prevent teen pregnancy. Washington, DC: The National Campaign to Prevent Teen and Unplanned Pregnancy.
Sunstein, C. (2008). Adolescent risk-taking and social meaning: a commentary. Developmental Review, 28(1), 145–152. doi:10.1016/j.dr.2007.11.003.
Tallal, P. (2000). Experimental studies of language learning impairments: from research to remediation. In D. V. M. Bishop & L. B. Leonard (Eds.), Speech and language impairments in children: causes, characteristics, intervention and outcome (pp. 131–155). Hove: Psychology.
Telzer, E. H., Fuligni, A. J., Lieberman, M. D., & Galván, A. (2012). Ventral striatum activation to prosocial rewards predicts longitudinal declines in adolescent risk taking. Developmental Cognitive Neuroscience, 3, 45–52.
The Administration for Children and Families Department of Health and Human Services. (2007). Review of comprehensive sex education curricula. Washington, DC: The Administration for Children and Families Department of Health and Human Services.
Tingle, L. R. (2002). Evaluation of the North Carolina “Baby think it over” project. Journal of School Health, 72(5), 178–183.
US Department of Health and Human Services. (2011). Teenage pregnancy prevention: Grantees (Vol. 2011). Washington, DC: US Department of Health and Human Services.
Van Duijvenvoorde, A. C., & Crone, E. A. (2013). The teenage brain: a neuroeconomic approach to adolescent decision making. Current Directions in Psychological Science, 22(2), 108–113.
van Empelen, P., & Kok, G. (2006). Condom use in steady and casual sexual relationships: planning, preparation and willingness to take risks among adolescents. Psychology and Health, 21(2), 165–181. doi:10.1080/14768320500229898.
van Goethem, A. A. J., Scholte, R. H. J., & Wiers, R. W. (2010). Explicit- and implicit bullying attitudes in relation to bullying behavior. Journal of Abnormal Child Psychology, 1–14.
Wiers, R. W., Van De Luitgaarden, J., Van Den Wildenberg, E., & Smulders, F. T. Y. (2005). Challenging implicit and explicit alcohol-related cognitions in young heavy drinkers. Addiction, 100(6), 806–819.
Wiers, R. W., Cox, W. M., Field, M., Fadardi, J. S., Palfai, T. P., Schoenmakers, T., et al. (2006). The search for new ways to change implicit alcohol-related cognitions in heavy drinkers. Alcoholism, Clinical and Experimental Research, 30(2), 320–331.
Wiers, R. W., Houben, K., Roefs, A., Hofmann, W., & Stacy, A. W. (2010a). Implicit cognition in health psychology: why common sense goes out of the window. In B. Gawronski & B. K. Payne (Eds.), Handbook of implicit social cognition (pp. 463–488). New York: Guilford.
Wiers, R. W., Rinck, M., Kordts, R., Houben, K., & Strack, F. (2010b). Retraining automatic action-tendencies to approach alcohol in hazardous drinkers. Addiction, 105(2), 279–287.
World Health Organization. (2010). Developing sexual health programmes: a framework for action. Geneva: World Health Organization.
Acknowledgments
Dr. Ahna Ballonoff Suleiman was supported in part by the UC Berkeley Center for Child and Youth Policy. Dr. Claire D. Brindis was supported by grants U45MC 00002 & U45MC 00023 of the Maternal and Child Health Bureau, Health Services and Resources Administration, US Department of Health and Human Services. The authors would like to thank Ronald Dahl and Juliana Deardorff for their thoughtful feedback on this paper.
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Ballonoff Suleiman, A., Brindis, C.D. Adolescent School-Based Sex Education: Using Developmental Neuroscience to Guide New Directions for Policy and Practice. Sex Res Soc Policy 11, 137–152 (2014). https://doi.org/10.1007/s13178-014-0147-8
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DOI: https://doi.org/10.1007/s13178-014-0147-8