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
A Contextual Model
Macrolevel
Environmental
Factors
Proximal Level
Environmental
Individual
Factors
Factors
Response
Outcome
Biological
Factors
Neighborhood
Involuntary
Response
Family
Poverty
Peers
Early Sexual
Engagement
Individual
Response
Discrimination
School
Voluntary
Response
Inequality
Temperament
& Cognitive
Factors
A Contextual Model
Outcome
Individual
Response
Early Sexual
Engagement
A Contextual Model
Macrolevel
Environmental
Factors
Outcome
Policies
Neighborhood
Individual
Response
Customs
Social change
Early Sexual
engagement
Neighborhood Factors: Poverty
 Lower
grades
 Lower educational attainment
 More school drop out
 More precocious sexual
activity/child bearing
How does Poverty Impact
Outcomes?
Less social and financial capital
 More social disorganization
 Less collective efficiency
 More discrimination
 More inequality

A Contextual Model
Macrolevel
Environmental
Factors
Proximal Level
Environmental
Factors
Outcome
Policies
Family
Neighborhood
Individual
Response
Customs
Social Change
Early sexual
engagement
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
Behavioral Monitoring
 Closeness and Connectedness
 Emotional Responsiveness
 Knowing child’s friends, their friends’
parents, their teachers
 Setting high behavioral and educational
expectations

A Contextual Model
Macrolevel
Environmental
Factors
Proximal Level
Environmental
Factors
Outcome
Policies
Family
Neighborhood
Early Sexual
engagement
Individual
Response
Customs
School
Social change
School Factors
Young girls who are attached to
school marry later and delay first
sexual encounters.
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)








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
A Contextual Model
Macrolevel
Environmental
Factors
Proximal Level
Environmental
Factors
Outcome
Policies
Family
Neighborhood
Peers
Individual
Response
customs
School
Social change
Early sexual
engagement
Peers
Peers tend to be a positive
socializing force.
Close Prosocial Peer Relationships
are associated with:

Later age first sex
 Less
tobacco use,
Less depression
 Less drug use
 Better academic performance

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.
A Contextual Moel
Macrolevel
Environmental
Factors
Proximal Level
Environmental
Individual
Factors
Factors
Outcome
Biological
Factors
Policies
Family
Neighborhood
Peers
Individual
Response
Customs
School
Social change
Early Sexual
engagement
Brain development occurs within
the context of the environment.
Environments have both direct
and indirect effects.
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
A Contextual Model
Macrolevel
Environmental
Factors
Proximal Level
Environmental
Individual
Factors
Factors
Response
Outcome
Biological
Factors
Policies
Involuntary
Response
Family
Neighborhood
Peers
Early Sexual
engagement
Individual
Response
Customs
School
Voluntary
Response
Social change
Temperament
& Cognitive
Factors