Current Research on Sexual Health and Teenagers

Kerry Mckellar BSC, MRES, PHD , Elizabeth Sillence BSC (HONS), MSC, PHD , in Teenagers, Sexual Health Information and the Digital Age, 2020

Problem behavior theory

Problem behavior theory (PBT) is a social-psychological framework that helps to explain the development and nature of problem behaviors, for example, risky sex or alcohol use (Jessor & Jessor, 1977a; Jessor, 2001). Jessor (1987) described problem behavior as any behavior that deviates from both social and legal norms. The model comprises three systems of psychosocial influences: personality system (all social cognitions, personal values, expectations, beliefs, and values), perceived environmental system (family and peer expectations), and the behavior system (problem and conventional behavioral structures that work in opposition to each other). Demographic and socialization variables affect the personality and perceived environmental systems and have an indirect impact on behavior. The personality and perceived environment systems are viewed as proximal or more direct determinants of behavior than are demographic and socialization variables.

The three systems of the PBT each utilize different variables that either influence the problem (such as risky sex) to occur or decrease the likelihood of the behavior taking place. For each individual, when predicting a problem behavior, the conventional-unconventional behaviors of the individual are taken into consideration (Donovan, Jessor, & Costa, 1991). Donovan et al. (1991) defined conventional behaviors as actions that are socially approved behaviors; while unconventional behaviors are defined as any behavior that deviates from social norms. By analyzing conventional-unconventional behaviors in each of the three psychosocial systems in an individual, it allows a prediction on future behaviors to be made. A schematic representation of the original model is shown in Fig. 2.3.

Fig. 2.3. A schematic representation of the original problem behavior theory model.

Early research has supported this theory as multiple factors as a cluster can influence risky sexual behaviors. Protective factors such as self-esteem and cognition may play important roles in teenage decision-making and are embedded within social and community contexts (Norman & Turner, 1993). Teenagers with low self-esteem may become sexually active at an early age to help fill a void left by feelings of inadequacy and fear of failure (Bloom, 1990). This cluster of behaviors has also carried into recent research; teenagers who engage in earlier alcohol use significantly predicted risky sex with multiple partners with inconsistent condom use (Mason, Hitch, & Kosterman, 2010). Furthermore, social norms are all related to sexual risk behavior and cluster together; risky sexual behaviors in older adolescents can be predicted by higher sensation seeking (personality), lack of communication with parents (perceived environment), and engagement in alcohol use (behavioral factors) (Whitaker & Miller, 2015).

However, most studies investigating PBT have only accounted for one of the three systems, or looked at the three systems individually (Davis, 2002). This means it is difficult to predict future behavior, if all three systems are not investigated together. PBT also does not work for all cultures (Deutsch, Slutske, Heath, Madden, & Martin, 2014). The basis of this theory is that it works for all groups who engage in deviant behavior; however, research and development of this theory was originally conducted in a community composed of white individuals with middle-class backgrounds (Jessor, 2001). Therefore, it is difficult to generalize the theory to other subcultures. Despite this, the PBT has been shown to account for variation in a number of different problem behaviors, and can help explain risky sexual behaviors for teenagers.

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SUBSTANCE USE, ABUSE, AND DEPENDENCE AND OTHER RISK-TAKING BEHAVIORS

John R. Knight , in Developmental-Behavioral Pediatrics (Fourth Edition), 2009

RISK AND PROBLEM BEHAVIORS

Problem behavior theory and social cognitive theory provide a conceptual framework for understanding risk behaviors during adolescence. Problem behavior theory defines risk behavior as anything that can interfere with successful psychosocial development and problem behavior as risk behaviors that elicit either formal or informal social responses designed to control them (Jessor and Jessor, 1977). These may cluster to form a "risk behavior syndrome" when they serve a common social or psychological developmental function (e.g., affirming individuation from parents, helping to achieve adult status, gaining acceptance from peers). These behaviors may help the adolescent cope with failure, boredom, social anxiety, unhappiness, rejection, social isolation, low self-esteem, or lack of self-efficacy. Adolescents who are poor students may use drugs as a way of achieving social status among their peers.

Social cognitive theory posits a "triadic reciprocal causation," in which behavior, personal determinants, and environmental influences all interact to determine behavior (Bandura, 1977). According to this theory, individuals learn how to behave through a process of modeling and reinforcement, imitating behaviors observed in others that are perceived to have positive consequences. Therefore, exposure to successful, high-status role models who use drugs will likely influence adolescents. Health risk and problem behaviors are both purposeful and functional. Peer influences may suggest to adolescents that drug use and sexual behaviors are necessary if one is to become popular, cool, sexy, grown-up, sophisticated, macho, or tough.

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Peer Influences on Addiction

Clayton Neighbors , ... Nicole Fossos , in Principles of Addiction, 2013

Problem Behavior Theory and Peer Cluster Theory

Problem Behavior Theory and Peer Cluster theories have both had significant impact on our understanding of adolescent substance use and have been influential in shaping more recent perspectives. Problem Behavior Theory was originally proposed by Richard Jessor as a way of predicting proneness to deviance (unconventionality) and suggests multiple variables that instigate or prevent problem behaviors, and the balance between these variables predict engagement in problem behavior. Variables which instigate deviance have been defined as risk factors, whereas those which prevent or reduce the likelihood of problematic behaviors have been defined as protective factors. Problem behaviors are defined by age and societal norms. For example, consuming two beers at the age of 10 is conceptualized as problem behavior and a social norms transgression; however, consuming two beers at the age of 26 is typically not considered problematic. Deviance proneness leads to a wide range of problem behaviors, and these behaviors positively relate to each other and negatively correlate with conventional or prosocial behaviors. In addition, deviant behaviors in youth are a predictor of behavior problems in adulthood.

Peer Cluster Theory proposes that engagement in behaviors such as substance use is supported or discouraged by interactions with peers. The peer cluster is distinct from the peer group and is defined as a small unit of peers that shape attitudes and influence behaviors to a greater extent than other social network factors. The peer cluster has a powerful effect on an individual and interventions targeting risky behaviors such as addiction to illicit drugs are effective when the individual is separated from the peer cluster or the intervention targets the peer cluster directly.

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Risk-Taking Behavior

A. Haydon , ... C.T. Halpern , in Encyclopedia of Adolescence, 2011

Problem Behavior Theory

Problem Behavior Theory (PBT), first proposed by Richard Jessor, is perhaps the most widely applied theoretical model of adolescent risk behavior. It defines 'problem behavior' as those behaviors that are viewed as problematic or undesirable during adolescence by adult society; thus, any behavior may be deemed a 'problem behavior' depending on the context in which it occurs and the personal and social consequences with which it is associated. Some problem behaviors such as sexual activity are age-graded; that is, they are expected and seen as normative during adulthood but proscribed during adolescence. Jessor and colleagues argue that involvement in such behaviors signals – to both self and to others – the transition from adolescent to adult status. When viewed from this perspective, adolescent risk behavior is purposive and even functional.

Problem Behavior Theory also specifies that there is significant covariation among adolescent risk behaviors; that is, adolescents who engage in one problem behavior such as early sexual activity will likely engage in other problem behaviors such as substance use or abuse. Empirical evidence supports the idea that risk behaviors in adolescence do covary, at least to a certain extent. However, it is unclear whether these covarying behaviors form a stable underlying personality trait or syndrome. Available research suggests instead that the extent of covariation among risk behaviors depends on the types of behaviors studied and the population in which these behaviors are measured, and whether or not other variables that might account for associations between risk behaviors are statistically controlled. For example, risk behaviors may appear to cluster together because they share a common environmental cause (e.g., poverty and socioeconomic disadvantage may be a common cause of multiple risk behaviors), not because they necessarily reflect stable, individual tendencies toward risk taking.

Problem Behavior Theory is based on the assumption that behavior results from dynamic and continuous interactions between the person and the environment. Three major systems define this relationship and predict involvement in problem behavior: the personality system, which includes expectations of achievement, locus of control, intolerance of deviance, self-efficacy, and religiosity; the perceived environment system, which includes perceived support, control, and expectations from parents and peers; and the behavior system, which includes both conventional (e.g., church attendance) and unconventional (e.g., substance use and abuse) behaviors. The balance between instigations (factors that increase the likelihood of risk-taking behavior) and controls (factors that decrease the likelihood of risk-taking behavior), within and across these three systems, determines an individual's 'proneness' for engaging in behaviors that violate social norms and are deemed problematic by society. This overall level of proneness is termed psychosocial conventionality and reflects an individual's commitment to the attitudes, values, and expectations of conventional society.

Psychosocial conventionality has been examined in relation to a wide range of risk behaviors, such as failure to use contraceptives, substance use, and delinquency, as well as health-promoting behaviors such as physical activity, seat belt use, healthy diet, and adequate sleep. In general, individuals who report high levels of psychosocial conventionality as adolescents are less likely to engage in sexual risk behaviors, use substances, and commit delinquent acts. They are also more likely to report physical activity, seat belt use, healthy diets, and adequate sleep.

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The Teen Intervention Project: A School-Based Intervention for Adolescents with Substance Use Problems

Eric F. Wagner , ... Staci Leon Morris , in Innovations in Adolescent Substance Abuse Interventions, 2001

Theoretical Background

The theoretical basis for the standardized group counseling (GC) program includes social learning theory (Bandura, 1977 ) and problem behavior theory ( Jessor & Jessor, 1977). Consistent with these models, we believe multiple domains contribute to the development of substance use problems among adolescents (i.e., the biopsychosocial model), though we emphasize potentially modifiable environmental influences and learned beliefs and behaviors associated with substance misuse throughout the intervention (Wagner, Myers & Brown, 1994).

Within this conceptualization, it is assumed that adolescents develop expectancies about the effects of substance use by observing parental, peer, and, more broadly, societal/cultural modeling of substance use (Christiansen, Goldman & Inn, 1982; Goldman, Brown & Christiansen, 1987). These expectancies often are found to predict later substance abuse (Christiansen et al., 1989). Teens' expectancies about the effects of substance use include beliefs that using alcohol will provide stress relief, facilitate social interaction, or make them feel good (Wagner et al., 1994).

In considering the etiology and treatment of adolescent substance use problems, developmental factors relating to substance use also are taken into consideration. Therefore, we recognize that some experimentation with drugs and/or alcohol may be normative (Shedler & Block, 1990). However, teens who lack coping skills to handle negative moods, to engage in comfortable social interactions, to generate positive feelings in the absence of alcohol and drug use, or to effectively manage social pressures for substance involvement are at a greater risk for developing problems related to their alcohol or other drug use (e.g., Bentler, 1992; Pandina & Schuele, 1983).

The GC program also incorporates material from motivational interventions that recognize the importance of client motivation to change in determining treatment outcome (Miller & Rollnick, 1991). One way to bolster substance abusers' commitment for treatment (i.e., motivation) is to allow them choices in approaches to, and goals for, treatment (Sobell & Sobell, 1995). Given adolescents' concern with the degree to which they, rather than others, are making choices about their lives, such involvement with determining aspects of treatment may be especially important for increasing motivation to change. Thus, group members not only assess where they believe they are in terms of their current readiness to change their substance use behavior, but also set both short- and long-term goals for themselves in regard to changing substance use as well as managing other areas of their lives (e.g., relationships, academics, career goals).

In addition, we provide teens with a session-by-session workbook that is used throughout the intervention. This workbook allows for continuing, active involvement with the program's material. In completing the workbook's material in sessions, group members' ideas are constantly solicited. Such active involvement maintains students' attention and enhances self-esteem, thereby heightening their sense of personally shaping their efforts at behavior change (Wagner, Brown & Myers, 1994). In essence, each group member creates a personal record of what they have learned and achieved which they keep at the end of the program. Thus, the manual provides a good, individualized resource for ways to manage any future substance-related difficulties.

In summary, several sources inform our skills-based, group intervention: social learning theory; motivational interventions; and consideration of adolescent development. The program assumes that modeling of substance use behavior, and the concomitant growth of expectancies regarding use, along with skills deficits, such as poor stress management, put teens at risk for substance use and misuse. Adhering to this framework, the GC program focuses on educating teens about alcohol, drugs, and the development of substance use problems, and provides skills training to strengthen functioning in deficit areas. Therapeutically, a motivational stance is taken which advocates helping group members to ascertain their current desire to make changes in their behavior and to set goals for making these changes. Such an approach is especially well suited for adolescents who may respond well to the sense of increased control in their lives imparted by active involvement in the treatment process (Tober, 1991).

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Alcohol Use Disorders

K.J. Sher , M.R. Lee , in Encyclopedia of Mental Health (Second Edition), 2016

Deviance Proneness

In deviance proneness models, problem drinking is considered part of a general pattern of deviant behavior that develops in childhood and is partially attributable to deficient socialization. One theoretical explanation for deviance proneness is Jessor's problem–behavior theory, in which the environment, personality, and behavior work in conjunction to either increase or decrease risk for problem behaviors, and where the presence of one problem behavior increases the likelihood of others, thus causing various problem behaviors to cluster together among at-risk individuals. Deviance proneness models are supported by evidence that AUDs are predicted by a number of early childhood risk factors and other problem behaviors (e.g., impulsivity, aggression, defiance, achievement problems, poor interpersonal relations, and inadequate parenting), and by evidence that a broad 'externalizing spectrum' subsumes AUD and other related disorders (e.g., drug disorders and antisociality) due to common etiological risk factors shared across these conditions.

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College Student Gambling

Ty W. Lostutter , ... Mary E. Larimer , in Interventions for Addiction, 2013

Social Influences

Normative beliefs, also called social norms, have been significantly influential and central to several theories of behavior and behavioral change based on social psychology concepts, such as Bandura's Social Learning Theory, Jessor and Jessor's Problem Behavior Theory, and Ajzen's Theory of Planned Behavior. The common thread between these psychological theories is the central tenet that cognitive processing of normative information or beliefs drives individual behavior and decisions to change that behavior. The term "social norms" often has two different ways of use in the literature. Descriptive norms refer to perceptions of actual behavior of others, whereas injunctive norms refer to perceptions of the appropriateness of a behavior. Research suggests that both types of norms are related to individual risk behaviors, and research further indicates that these norms are often misperceived. In particular, individuals tend to misperceive the descriptive norm as being higher than it actually is across a wide variety of health risk behaviors, including alcohol use, tobacco use, and a variety of other substances. Larimer and Neighbors examined college students' perceptions of peer gambling (descriptive norms) and their views on the acceptance of this behavior (injunctive norms) and found a similar pattern of misperception. Findings indicated that gamblers overestimated the descriptive norm, assuming that other students gambled more often and with more money than students actually engaged. Both descriptive and injunctive perceived norms were related to self-reported gambling quantity, frequency, and negative gambling consequences in this study.

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Some (But Not Much) Progress Toward Understanding Teenage Childbearing

Claire A. Coyne , Brian M. D'Onofrio , in Advances in Child Development and Behavior, 2012

1 Problem-Behavior Theory

Growing up within a high-risk context of a single-parent home with high levels of poverty and family chaos or poor school performance may set the ground work for teenage childbearing by increasing a teenage girl's exposure to deviant peer behavior. Problem-behavior theory provides a framework for understanding the multiple psychosocial risks for engagement in problem behaviors (Jessor & Jessor, 1977). Problem-behavior theory specifies that the likelihood of engaging in problem behavior depends on interrelated domains of influence including personality characteristics, social environmental factors, and involvement with conventional values or institutions (Costa et al., 1995; Jessor, 1992). Engagement in problem behavior is seen as the result of the interaction of both individual personality characteristics and the environment (Jessor & Jessor, 1977).

The tremendous overlap in risk factors shared by teenage childbearing and adolescent antisocial behavior suggests that etiological models used to explain the development of adolescent antisocial behavior may also explain teenage childbearing (Fergusson & Horwood, 2002; Fergusson & Woodward, 1999; Woodward & Fergusson, 1999; Woodward et al., 2001; Zoccolillo, Paquette, & Tremblay, 2005; Zoccolillo et al., 2004). The social and emotional changes characteristic of early adolescence also occur within the larger context of biological changes associated with pubertal maturation. The association between pubertal maturation and antisocial behavior is supported by a number of studies (Caspi, Lynam, Moffitt, & Silva, 1993; Ge, 1996; Moffitt & Caspi, 2001; Nichols, Graber, Brooks-Gunn, & Botvin, 2006), with early maturing girls showing higher levels of antisocial behavior. The common explanation for this association is that girls who develop early tend to seek out older peers, and, because older peer groups tend to fall within the mid-adolescent age range (when antisocial behavior is at its peak), these girls are exposed to and engage in more antisocial behavior with these older peers. In the home, changes in parental monitoring (i.e., decreases in supervision as children become adolescents) are associated with delinquency in adolescence (Lahey, Van Hulle, D'Onofrio, Rodgers, & Waldman, 2008; Patterson & Yoerger, 1997), as well as teenage childbearing (Meade et al., 2008; Woodward et al., 2001).

Teenage childbearing may be another "problem behavior" associated with developmental trajectories of antisocial behavior. One widely accepted developmental model presupposes two trajectories of antisocial behavior: the life-course persistent (LCP) and adolescent-limited (AL) (Moffitt, 1993, 2003) pathways. The LCP pathway is marked by an early-childhood onset of behavior problems attributable to family, social, and neurodevelopmental deficits. The AL pathway is less persistent and represents the more common profile of antisocial behaviors that emerge in early adolescence as a product of the maturity gap—the mismatch between biological maturation and rights to adult privileges and responsibilities. Antisocial behavior is a way to relieve the dysphoria caused by the mismatch between adolescents' developmental stage and their social environment and to assert autonomy (Moffitt, 2007). Peer relationships and peer-group dynamics provide a context in which adolescents can engage in antisocial behaviors that assert their autonomy. Social interactions with peers provide opportunities to learn and practice antisocial behaviors together. For adolescent girls, romantic and sexual relationships are thought to be of particular importance in the development of antisocial behavior. Older boyfriends draw adolescent girls into more advanced and deviant peer groups, contributing to the girls' own antisocial behavior (Kerr, Stattin, & Kiesner, 2007; Stattin, Ken, Mahoney, Persson, & Magnusson, 2005).Therefore, teenage pregnancy and childbearing may be the consequence of engaging in risky sexual behavior, substance use, and other antisocial behaviors with deviant peers, and teenage childbirth may represent a female-specific manifestation of adolescent antisocial behavior.

Problem-behavior theory (Costa et al., 1995; Jessor & Jessor, 1977) suggests that engaging in one problem behavior (e.g., problem drinking, substance use, deviant behavior, risky driving) increases the likelihood of involvement in other problem behaviors (e.g., risky sexual behavior). Therefore, early antisocial behavior—perhaps affiliation with deviant peers—may lead to early and risky sexual behavior, which is necessary in order for teenage childbearing to occur. A certain level of antisocial behavior during adolescence may be normative (Lahey, Moffitt, & Caspi, 2003) and in some situations associated with higher social status (Bukowski, Brendgen, & Vitaro, 2007; Mayeux & Cillessen, 2007). Teenage sexual behavior, therefore, may fall in the normative range of antisocial behavior, although the increased likelihood of risky sexual behavior during adolescence may increase the likelihood of teenage childbearing as an unintended consequence (Costa et al., 1995).

Although problem-behavior theory can explain why a young woman might become pregnant after engaging in risky sexual behavior, it does not completely explain why a young woman would chose to give birth to the child. Problem behaviors are identified as problematic relative to age-related norms and expectations (e.g., underage drinking) (Jessor, 1992) and serve as signs to other members of the peer group that a teenager is independent from conventional norms or parental control (Jessor & Jessor, 1977; Jessor, Turbin, & Costa, 1998). Therefore, teenage childbearing is problematic because it occurs earlier in development than expected, and teen mothers are underprepared to cope with the consequences of early motherhood. However, it is also possible that teenage childbearing is problematic because of individual-level and family-level characteristics that themselves increase the likelihood of teenage childbearing and also make teen mothers particularly ill-equipped to parent. Perhaps deciding to give birth to the child may reflect a desire to prove independence from parents and conventional expectations of adolescent behavior. Overall, it is likely that there are multiple developmental processes—both normative and impairing/pathological—that are associated with antisocial behavior that also influence teenage childbearing.

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Motivation in Chronic Cannabis Use

R. Hirst , ... L. Rathke , in Handbook of Cannabis and Related Pathologies, 2017

Propensity for Problem Behaviors Leads to Both Cannabis Use and Educational Underachievement

The third and final theory explaining the link between low motivation for academic achievement and chronic cannabis use is that a tendency toward anticonventional behaviors, and association with peer groups engaging in these behaviors, leads to lower prioritization of education and occupation and the selection of an alternative lifestyle. Jessor and Jessor (1977 ) first proposed this problem behavior theory, stating that adolescents exhibit one common syndrome representing a penchant for a range of problem behaviors, including relationships with deviant peers. Donovan and Jessor (1985) suggested that this represents general unconventionality, assumed to stem from both personal and environmental influences that increase problem behavior in general. In other words, individuals with this syndrome exhibit many problematic behaviors that may or may not include cannabis use.

Although this theory is vulnerable to the risk of circular logic, it is generally supported, and suggests that the effects of early cannabis use are more strongly related to the social context of cannabis use, rather than true physiological effects of the drug (eg, Fergusson & Horwood, 1997; for review, see Lynskey & Hall, 2000).

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Influence of Alcohol and Illicit Drug Use on Sexual Behavior

Michael Windle , ... Rebecca C. Windle , in Handbook of Child and Adolescent Sexuality, 2013

Conclusions and Future Directions

Epidemiologic findings clearly indicate high rates both of alcohol and other substance use and sexual behaviors among adolescents, and significant intersections between these two domains of risky behavior. The causal nature of this intersection and specific mechanisms remain to be determined, though several theories and mechanisms have been proposed, including general theories that suggest co-occurring syndrome behaviors with common antecedents (e.g., problem behavior theory), and mechanisms such as alcohol-induced disinhibition that increases risky sexual behavior. Evidence also supports strong interrelationships between IPV, substance use, and sexual behaviors among adolescents, with long-term consequences into adulthood.

While not exhaustive, we now highlight four areas of high priority for subsequent research on substance use and risky sexual behaviors and adverse outcomes. First, within alcohol and drug use studies there has been an increase in early, and very early, onset substance use behaviors (Zucker, Donovan, Masten, Mattson, & Moss, 2008). Further, early onset of alcohol and drug use is associated with earlier sexual debut, risky adolescent sexual behavior, and adverse outcomes (e.g., STDs). It will be important in future research to determine how these early-onset substance use and sexually risky behaviors impact, and are impacted by, the range of other ongoing biological, psychological, and social changes occurring during adolescence (Windle et al. 2008). For example, how might early-onset substance use impact ongoing maturational brain processes that are critical to inhibitory responses and decision-making that may influence sexual risk-taking? Second, it would be beneficial to expand the range of etiologic and preventive intervention studies to include both peer influences (e.g., social network analysis; peer group dynamics) and dating behavior/romantic relationships to separate sexual risk behaviors from more constructive, health-promoting behaviors surrounding romantic relationships.

Third, both etiologic and preventive intervention studies would benefit from a greater focus on critical individual difference variables such as participant's biological sex, ethnicity, personality variables, and sexual identity, and to broaden studies to the global scale by including international studies. Understanding sources of variation among these individual difference variables may facilitate more tailored preventive interventions. And fourth, preventive intervention and treatment studies need to focus more on common and unique components of comprehensive, multi-component interventions that may simultaneously address both reductions in alcohol and other substance use and risky sexual behaviors. Such multi-targeted interventions may prove to be both more efficacious and cost-effective to deter adolescent substance use and risky sexual behavior, and better able to promote positive health outcomes in adolescence and beyond.

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