Convincing adolescents to postpone sexual activity, or to become more responsible if they become sexually active, has long been a goal of public health efforts, and for good reason. Approximately 40% of all females will experience at least one pregnancy before the age of twenty (Kirby, 2001). About 25% of the twelve million new cases of sexually transmitted diseases in the United States each year occur among teenagers (Carter-Jessop, Franklin, Heath, Jimenez-Trizary, & Peace, 2000). Teen motherhood has been linked to a host of problems for the mother (such as increased probability of dropping out of school and/or living in poverty) and for the child (low birth weight and increased likelihood of being abused) (Card, 1999).
A variety of approaches to the prevention of teen pregnancies and sexually transmitted diseases have been attempted. These range from programs that focus directly on sexual behavior to those that foster career plans and life skills. Some programs promote abstinence, while others promote condom use. Some offer brief, stand-alone curricula, while others are integrated into health and biology classes. Literature reviews provide clear evidence that almost all programs increase student knowledge about reproduction (Kirby, 1997, 2000; Kirby et al., 1994; Card, 1999). Unfortunately, knowledge alone does not change adolescent sexual behavior (Kirby, 2000).
The political debate currently raging in regard to sexuality education centers on the teaching of morality; specifically, whether programs should have an abstinence-only philosophy. There is an important issue that is missing in this contentious debate: how adolescents think.
In Inhelder and Piaget's (1958) theory of cognitive development, individuals are hypothesized to experience qualitative changes in thinking at different stages of life. Thus, children and early adolescents may not think about sexual activity, pregnancy, and child rearing the same way adults do. Extending Inhelder and Piaget's work, Elkind (1981) described early adolescents as egocentric, with their reasoning and decision-making clouded by an imaginary audience (one that thinks much like the adolescent and observes everything the adolescent does) and a personal fable (the belief in a unique destiny that is linked to "it can't happen to me" thinking). One failing of most sexuality education programs is that they do not address adolescents' cognitive development (Gordon, 1990).
Early adolescents believe they are unlikely to become pregnant and underestimate the negative consequences that would follow if they did become pregnant (Henderson, 1980). They also underestimate the difficulty involved in caring for a child, believing they could be perfect parents and still continue to lead a normal teenage life (Holden, Nelson, Valasquez, & Ritchie, 1993). In an attempt to address these errors, Salz, Perry, and Cabral (1994) had adolescents role-play teenagers who became pregnant. Two interesting outcomes were observed. First, the role-playing did help adolescents see the negative side of pregnancy and increased their endorsement of abstinence until marriage (relative to a no role-playing control group). However, the second observation was that the role-playing focused on the adolescents findings out they were pregnant or telling their partner or their parents they were pregnant. None of the scenarios they constructed involved childbirth, bringing a child home from the hospital, or taking responsibility for a child. This seems to reinforce the notion that early adolescents think differently from adults.
Attempts have been made to simulate the experience of caring for an infant. Schools have required students to carry eggs in a basket or sacks of flour as "babies" to help students understand, in some small way, the investment of time and energy required to be a parent. Modern technology has improved upon these methods. Infant simulators, such as "Baby Think It Over" (BTIO), are constructed to be the size, weight, and appearance of real infants. …