The number of youth in the United States who participate in activities that are considered health risks is truly alarming (Centers for Disease Control and Prevention [CDC], 2008
; National Institute on Drug Abuse [NIDA], 2008b
). Adolescent alcohol and drug use and unprotected sex presents a major public health concern in the United States (Substance Abuse and Mental Health Services Administration [SAMHSA], 2009
). Both the incidence and prevalence of unplanned pregnancy, sexually transmitted infections (STIs), and HIV/AIDS reveal the negative results of the aforementioned behaviors in adolescents, especially in the Hispanic population (National Institute of Drug Abuse [NIDA], 2008a
). Hispanics represent not only the largest but also the most rapidly increasing minority ethnic population in the United States, with the median age of this population being 27.7 years in 2008, compared with 36.8 years for the overall U.S. population (U.S. Census Bureau [USCB], 2009
). The rates of sexual activity, alcohol and drug use, pregnancy and STIs including HIV/AIDS, are significantly higher among Hispanic high-school-age adolescents as compared to non-Hispanic White adolescents (NIDA, 2008b
). Although HIV disparities are narrowing, HIV remains the fourth leading cause of death among Hispanics between the ages of 35 and 44. Moreover, HIV/AIDS is listed as one of the top 10 reasons for the death of Hispanics between the ages of 15 and 54. Improving the health of Hispanic youth in the United States requires reducing the incidence and prevalence of risk behaviors (e.g., risky sexual behavior and alcohol and drug use) within this population. However, understanding the processes associated with these risky behaviors is a prerequisite to decreasing their incidence.
Although an extant amount of research has examined the risk and protective factors related to adolescent risky behaviors in non-Hispanic Whites (O’Sullivan, Meyer-Bahlburg, & Watkins, 2001
; Stueve & O’Donnell, 2005
), only a limited amount of research of this nature has been conducted on Hispanic youth (Prado et al., 2009
). Protective factors that can influence adolescent HIV risk behaviors include parents’ and adolescent’s level of acculturation, parents’ HIV knowledge, parent–adolescent communication about sex, family functioning, and adolescents’ self-efficacy (Ajzen & Fishbein, 1980
; Castrucci & Martin, 2002
; Leigh & Stall, 1993
; Pantin, Schwartz, Sullivan, Prado, & Szapocznik, 2004
; Prado et al., 2010
; Santelli, Robin, Brener, & Lowry, 2001
; Szapocznik & Coatsworth, 1999
). Integrating and combining the multiple social–ecological systems within which an individual resides (ecodevelopmental theory) and the motivational influences that affect individual behavior (theory of reasoned action) would lead to an increased understanding of the risk and protective factors that influence adolescent decision making, with special emphasis on HIV/STI risk in this population. We now briefly review the literature on risk/protective factors, and then we will describe how the two theories are being integrated in this study.
Parents play a significant role in the prevention of HIV/AIDS among adolescents. Knowledge regarding sexuality and the communication skills to effectively facilitate the sharing of this knowledge and other values are important tools for parents in increasing the usefulness of the advice they give to their children. Multiple studies have demonstrated that if mothers believed they possessed the knowledge to respond to questions and the skills set to explain matters clearly, they were more likely to talk to their children about sexual topics, which in turn is associated with reduced HIV risk behaviors (DiClemente et al., 2001
; Miller & Whitaker, 2001
; Teitelman, Ratcliffe, & Cederbaum, 2008
Parent–adolescent communication about sex and sexuality appears to be an important determinant of adolescents’ sexual behavior (Blake, Simkin, Ledsky, Perkins, & Calabrese, 2001
). In another study, DiClemente et al. (2001)
investigated the association between parent–adolescent communications regarding sex and the sexual practices of sexually active African American females (n
= 522) between the ages of 14 and 18. The findings revealed that less frequency in parent–adolescent communication regarding sex was associated with lack of contraceptive use among these adolescents within the preceding 6 months. Less frequent communications between parents and adolescents were also associated with a higher frequency of not having used condoms at all within the preceding month at last incidence of sexual intercourse and during the preceding five sexual encounters among these adolescents.
The experience of immigration tends to be stressful for children and families (Szapocznik, Prado, Burlew, Williams, & Santisteban, 2007
). The immigrant experience begins in a cultural mismatch between the immigrating individual and his or her new society, and the effects of this mismatch can have a significant impact on all levels of a family’s or adolescent’s social environment (Pantin, Schwartz, Sullivan, Coatsworth, & Szapocznik, 2003
). The difference between the parents’ and adolescents’ degree of acculturation is known as differential acculturation
(Szapocznik & Kurtines, 1980
). Adolescents tend to quickly adopt the host culture’s values and norms, whereas parents’ tendency is to remain faithful to those of their birth countries (De la Rosa, Vega, & Radisch, 2000
Chung et al. (2007)
investigated whether acculturation is related to parent–adolescent communications regarding sex in a sample of Filipino American families. Pairs of Filipino American parents (n
= 120) and their adolescents at one high school were surveyed. Two measures of acculturation were used: preferential use of the English language and lack of agreement with conventional Asian values. Parents and adolescents who showed larger acculturation gaps communicated less regarding sex.
Acculturation has been found to be associated with HIV knowledge. Loue, Cooper, and Fiedler (2003)
conducted a study to measure HIV knowledge levels and to detect factors correlating with HIV knowledge in a sample consisting of heterosexual Mexican and Puerto Rican women and men between the ages of 18 and 45 living in Ohio and in San Diego, California. Greater levels of U.S. acculturation were found to be predictive of higher levels of HIV knowledge (Loue et al., 2003
). Similar findings were found by So, Wong, and Deleon (2005)
, in a study of Asian American students (n
= 248) between the ages of 18 and 21. In this study, acculturation was positively correlated with HIV knowledge scores.
A substantial amount of research has been conducted on the relationship between sexual behavior in adolescents and family process variables (e.g., parent–child closeness or connectedness, parental support; Miller, Benson, & Galbraith, 2001
). It is apparent that family functioning serves as a mechanism which might account for the probability of the onset of sexual behavior and substance use. Schwartz, Mason, Pantin, and Szapocznik (2008)
investigated the relationship between family functioning and the onset of sexual behavior and substance use in Hispanic adolescents (n
= 250). Results suggested that positive family functioning is associated with adolescent’s abstinence from sexual behavior and substance use.
Self-efficacy can be defined as a person’s belief in his or her capability to perform the actions needed to attain specific performance goals (Bandura, 1977
). Some studies have showed that adolescents who possess this belief in the efficacy of their own behavior can be more prone to take steps to avoid substance use, STIs, and accidental pregnancies (Halpern-Felsher, Kropp, Boyer, Tschann, & Ellen, 2004
; Nash, McQueen, & Bray, 2005
; Pearson, 2006
). Other studies have found a weak effect of self-efficacy on risk behaviors. For example, Kinard and Webster (2010)
conducted a study to explore self-efficacy beliefs as predictors of adolescent unhealthy consumption behavior (alcohol use) in a sample of 101 adolescents from Illinois, Texas, and Washington, DC. Self-efficacy was found as a weak predictor of risk behaviors, more specifically alcohol use.
Researchers have employed several theoretical frameworks in their attempts to organize the risk and protective processes related to STIs and HIV mentioned previously. For example, the theory of planned behavior (Ajzen, 1991
), social cognitive theory (Bandura, 1989
), Jessor’s (1991)
theory of adolescent risk behavior, and the theory of reproductive development (Belsky, Steinberg, & Draper, 1991
) have been used in multiple studies (Astatke & Serpell, 2000
; Kang, Deren, Andia, Colón, & Robles, 2004
; Tremblay & Frigon, 2004
; Villarruel, Jemmott, Jemmott, & Ronis, 2007
). The majority of the studies found in the literature have focused on examining risk and protection factors from one theoretical perspective. In this study, we examined the risk and protective factors by integrating elements from two perspectives, the ecodevelopmental theory (Szapocznik & Coatsworth, 1999
) and the theory of reasoned action (Ajzen & Fishbein, 1980
). We now briefly describe each of these theoretical frameworks.
Ecodevelopmental theory (Szapocznik & Coatsworth, 1999
) is composed of three integrated elements: (a) social–ecological theory, (b) developmental theory, and (c) an emphasis on social interactions. The first element of ecodevelopmental theory, social–ecological theory, is based on Urie Bronfenbrenner’s (1979)
social–ecological model. Bronfenbrenner’s theory conceptualizes the social ecology of the individual as a set of four interacting systems and is usually represented as a series of concentric circles, with the adolescent at the center. The four systems are known as the microsystem, mesosystem, exosystem, and macrosystem.
At the first or innermost level are the microsystems, which are the immediate social settings or contexts inhabited by the adolescent, as well as the adolescent’s relationships within these contexts. These relationships have the power to impact the adolescent’s values or behaviors either in a healthy or dysfunctional direction. Family and peer systems are highly influential microsystems in the life of the adolescent. At the next level of the social ecology are the mesosystems, which represent the interface or sphere of interactions between two or more microsystems. Examples of mesosystems are the overlap between the family and the school microsystems (e.g., parental involvement in schools) or the family and peer microsystems (e.g., parental monitoring of peers). The exosystem is the next level of the social ecology. The exosystem is the system in which the adolescent does not participate in directly, but in which members of the adolescent’s microsystems (e.g., parents) participate in directly (e.g., highly stressful workplaces and limited social support networks could make it very difficult for parents to engage in their adolescents’ school activities or to effectively monitor their adolescents’ peer groups). The outer level of individuals’ social ecology is the macrosystem. The macrosystem may be defined as the philosophical and social ideas that describe a particular culture or subculture (Pantin et al., 2004
). In the case of Hispanic immigrant families, the predominant difficulty at the macrosystemic level centers around the incompatibilities between American and Hispanic culture (e.g., acculturation gap between parents and adolescents).
The second element of ecodevelopmental theory (Szapocznik & Coatsworth, 1999
) is composed of a developmental perception that stresses the tendency of adolescents to evolve across time, as a function not only of their current social contexts but also as a function of evolving factors within these youths’ social existence. For example, substance abuse among adolescents, which is predictive of risky sexual behavior (NIDA, 2008a
), is influenced not only by an adolescent’s current social context but also by former levels of family support that have existed in the individual’s life (Prado et al., 2007
The third element of ecodevelopmental theory (Szapocznik & Coatsworth, 1999
) consists of social interactions. According to this perspective, individuals express risk and protection via their relationship patterns, as well as by their direct transactions across and within the various contextual levels that characterize their social ecology (Szapocznik & Coatsworth, 1999
). For example, acculturation gap is an important construct of ecodevelopmental theory (Prado, Szapocznik, Schwartz, Maldonado-Molina, & Patin, 2008
The theory of reasoned action (Ajzen & Fishbein, 1980
) is based on four key constructs that help to explain how and why individuals, including adolescents, engage in specific behaviors in response to specific situations. These four constructs are behaviors, intentions, attitudes, and subjective norms. The theory postulates that a person’s intention to engage in a specific behavior is based on two factors: (a) the attitude the individual holds about the behavior, and (b) the subjective norms that he or she associates with the behavior (Albarracín, Johnson, Fishbein, & Muellerleile, 2001
). For example, an adolescent who believes that his or her friends approve of using condoms (subjective norm), and who values the opinion of these friends, is more likely to form a strong intention to use condoms when engaging in sexual activity (Albarracín et al., 2001
). At the same time, if the adolescent knows that using a condom can protect him or her from contracting HIV or another STI, and understands that such protection is important, he or she is more likely to hold a positive attitude regarding the use of condoms.
Clearly, both ecodevelopmental theory (Szapocznik & Coatsworth, 1999
; Pantin et al., 2004
; Prado et al., 2010
) and Ajzen and Fishbein’s (1980)
theory of reasoned action have made important contributions to the literature in terms of providing theoretical frameworks for organizing risk and protective factors related to HIV and STIs. Ecodevelopmental theory’s focus on the multiple social–ecological systems within which an individual resides, provides a useful and important context from which to analyze adolescent risk behaviors (Pantin et al., 2003
; Pantin et al., 2004
; Prado et al., 2007
). The theory of reasoned action, with its emphasis on the motivational influences that affect individual behavior, has also been extensively referenced by social psychologists attempting to arrive at an understanding of decision making regarding healthy or unhealthy behaviors (Madden, Ellen, & Ajzen, 1992
). In this study, for first time, both theories are combined to explore the risk and protective factors that can influence adolescent HIV risk behaviors.