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Am Fam Physician. 2002;66(7):1311-1314

Early sexual activity can have a substantial negative impact on adolescents. Currently in the United States, more than 900,000 teenagers become pregnant each year. Those who give birth tend to have more academic deficiencies, poorer socioeconomic outcomes, and repeat pregnancies, and they are more likely to be single parents. In addition, adolescents who engage in early sexual activity expose themselves to sexually transmitted diseases (STDs). Of all STD cases reported in the United States, more than two thirds occur in adolescents and young adults. Prevention strategies should be established to reduce early sexual activity in adolescents. Lonczak and associates studied the impact of the Seattle Social Development Project (SSDP) intervention on sexual behaviors and associated outcomes.

The participants in the study were 21-year-olds who had been enrolled in the SSDP as elementary school students. These persons were compared with members of a control group that had no intervention. The SSDP consisted of three components (see accompanying table): teacher education, including proactive classroom management, interactive teaching, and cooperative learning; child social and emotional-skill development; and parent training. These interventions were conducted during the first through sixth grades. Outcomes that were measured when participants were 21 years of age included sexual activities and rates of pregnancy.

Data were collected in 93 percent of students enrolled in the SSDP during the fifth grade. There were 144 participants in the project and 205 in the control group. Participants in the SSDP reported significantly fewer sexual partners and reduced risk for initiating intercourse by 21 years of age. Females in the SSDP were substantially less likely to become pregnant or give birth by age 21 when compared with the control group. When data were evaluated according to ethnic groups, single blacks involved in the project were less likely to develop STDs by age 21 when compared with persons in the control group.

The authors conclude that a social-development program that promotes academic success, social competencies, and bonding to school during the elementary-school years can prevent risky sexual behaviors in adolescents. This reduction in high-risk sexual practices can decrease the likelihood that teenagers will suffer the negative consequences of early sexual activity, including unintended pregnancies and STDs.

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editor's note: The problem of adolescents' participation in risky sexual activities is difficult to resolve. The SSDP tackled the difficult task of trying to prevent these behaviors. What is unique about this project is that the intervention did not include sex education or any discussion of sex. The program provided training to teachers and parents, and fostered children's social and emotional-development skills. It appears that this combination had a substantial positive impact on the study participants, lasting even to the age of 21. It is important for us as family physicians to review this information and assist our local schools in developing similar programs.—k.e.m.

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