Sexually Transmitted Disease Prevention: Adolescents' Perceptions of Possible Side Effects
Furby, Lita, Ochs, Linda M., Thomas, Catherine W., Adolescence
Sexually active individuals face the risk of contracting sexually transmitted diseases (STDs), and this risk is especially high for adolescents, who have the highest incidence rates of any age group for many STDs (Cates & Rauh, 1985; Hein, 1989; Mosher, 1985). Although AIDS has captured much more attention than have other STDs during the past decade, efforts at preventing AIDS would benefit from an encompassing approach aimed at preventing not only AIDS but other STDs as well (Rothenberg, 1991).
A recent study identified more than 100 possible prevention measures which individuals and society collectively might use to reduce an adolescent's chances of contracting an STD (Furby, Thomas, & Ochs, 1995). When deciding which of those measures to implement, adolescents should consider how much each measure does to reduce their risk. However, most measures have other possible consequences. For example, purchasing condoms might result in less money available for other things; abstaining from all sexual activity might elicit negative reactions from potential partner(s); and trying to discuss STD prevention with a sex partner might result in embarrassment. In addition to such negative consequences, there may be positive side effects. For example, discussing STD prevention with a sex partner may create a stronger emotional bond; using a condom may reduce the risk of pregnancy; insisting that the partner be tested for STDs before engaging in sexual activity may eliminate considerable worry.
These secondary consequences may be heavily influential when adolescents decide which, if any, prevention measures to use. Kegeles, Adler, and Irwin (1988) reported that beliefs about a number of different side effects of condom use were more strongly associated with intention to use condoms than were beliefs about their effectiveness in preventing either STDs or pregnancy.
To date there has been little empirical research on how adolescents (or adults) make decisions about STD prevention. A theoretical basis for making such decisions has been articulated in the theory of decision making under uncertainty (Edwards & yon Winterfeldt, 1986; Raiffa, 1968). That theory specifies the following steps: (a) identify all possible options feasible for the individual (i.e., STD prevention measures); (b) identify the possible consequences that may follow from each of those options; (c) assess the likelihood of those consequences occurring, as well as their desirability to that individual; and (d) combine all of the above considerations according to some "decision rule" so as to choose the option(s) most beneficial for the individual.
Behavioral decision theory (Slovic, Lichtenstein, & Fischhoff, 1988) attempts to describe how people actually perform each of these tasks (consciously or unconsciously), with the goal of helping people build on their strengths and compensate for their weaknesses. As part of a larger, exploratory study using behavioral decision theory to determine how adolescents perceive and choose STD prevention measures, this study examined adolescents' perceptions of the possible side effects of implementing various STD prevention measures.
The importance of consequence perception to STD prevention is emphasized by the theory of reasoned action (Ajzen & Fishbein, 1980; Fishbein & Ajzen, 1975; Fishbein & Middlestadt, 1989; Fisher & Fisher, 1992) and by the health belief model (Becker & Joseph, 1988). Each of these formulations attempts to explain when people will actually engage in disease prevention behaviors. According to both formulations, one of the determinants of STD prevention behaviors is beliefs about their positive and negative consequences. Several studies have examined the degree to which perception of the consequences of AIDS prevention measures predicts preventive behaviors (e.g., Catania, Coates, Greenblatt, Dolcini, Kegeles, & Pluckett, 1989; Emmons, Joseph, Kessler, Montgomery, & Ostrow, 1986; Fisher & Misovich, 1990; Hingson, Strunin, Berlin, & Heeren, 1990; Joseph, Montgomery, Emmons, Kirscht, Kessler, & Ostrow, 1987; Kegeles, Adler, & Irwin, 1988; Moore & Rosenthal, 1991; Walter, Vaughn, Gladis, Ragin, Kasen, & Cohal, 1992). …