Introduction

In recent years, more and more research has been published showing the importance of parent-child connectedness as a protective factor related to several youth health outcomes including pregnancy, HIV/STD, drug abuse, tobacco use, and delinquency. In fact, at a recent World Health Organization (WHO) meeting in Geneva, family connectedness was identified as one of the top five protective factors related to youth well-being.

Definition

Parent-child connectedness can be defined as the degree of closeness/warmth experienced in the relationship that children have with their parents. According to research, how children experience the connection with their parents seems to be more important than how the parent reports or perceives the level of connection.

The concept of “parent-child connectedness” takes traditional parent-child communication strategies a step further. Although parent-child communication is certainly part of “connection,” it is not the only factor that supports closeness in a relationship. In fact, in the recently released report titled “Mothers’ Influence on Teen Sex: Connections that Promote Postponing Sexual Intercourse” (Blum, 2002), the author states, “Simply encouraging parents to talk more to their teens about the risks of early sex without being more involved in their lives is unlikely to have much impact.”

An Overview of Parent-Child Connectedness Research

Recent reports from the University of Minnesota, Child Trends, and the National Campaign to Prevent Teen Pregnancy describe the important role that parent-child connectedness plays in the health and well-being of young people. For example, in 1997 researchers from the University of Minnesota analyzed data from the National Longitudinal Study of Adolescent Health (Add Health) and found parent-family connectedness to be protective against early initiation of sex, as well as cigarette use and alcohol use (Resnick M., Bearman P., Blum R., et. Al. 1997).

Seven months later, the role of parent-child connectedness in preventing adolescent risk behaviour figured prominently in “Families Matter: A Research Synthesis of Family Influences on Adolescent Pregnancy” (Miller, 1998). In this research review, author Brent C. Miller, PhD states that “while parents cannot determine whether their children have sex, use contraception, or become pregnant, the quality of their relationships with their children can make a real difference.” (Miller, 1998)

In terms of influences on adolescent sexual behaviour, Miller puts parent-child connectedness on an equal footing with other parental influences, such as supervision and communication, with regards to its influence on adolescent sexual behaviour. Miller goes on to say, “The overwhelming majority of studies indicate that parent/child closeness is associated with reduced teen pregnancy risk.”

The current research literature suggests that parent-child connectedness plays a protective role in relation to a wide spectrum of risk behaviours beyond teen pregnancy. The above-mentioned “Families Matter” report demonstrates the protective value of parent-child connectedness in relation to cigarette and alcohol use.

The conclusions from this report have been supported more recently in Positive Parenting of Teens, a University of Minnesota Extension Service quarterly publication. In the Winter 2002 edition of this publication, in her article titled “A Happy, Healthy Home Life Helps Prevent Teen Drinking and Smoking,” author Laurie L. Meschke, PhD identifies aspects of parent-child connectedness such as “parents provide lots of support” and “teens feel connected to family” as factors associated with preventing adolescent substance abuse. Such parent-child connectedness factors are as important as factors such as “parents don’t use substances” and “communication.”

In April 1999, the Office of Juvenile Justice and Delinquency Prevention (OJJDP) recognized the importance of parent-child connectedness for preventing juvenile crime and delinquency when it identified and promoted the use of effective family interventions under its Strengthening America’s Families Programs.

Evidence provided by the most recent research continues the trend of identifying the importance of parent-child connectedness. Family Strengths: Often Overlooked, But Real (Moore, K.A., Chalk, R., Scarpa, J., & Vandivere, S., 2002), published as a Child Trends Research Brief, lists “parent-child warmth and supportiveness” as one of six “family strengths” that significantly influence positive outcomes for youth. The authors of Family Strengths point out that: “Parent-child interactions can affect children’s behaviour over and above the influence of socioeconomic and demographic factors, such as income, family structure and parent education. High parental warmth and supportiveness contribute to healthy development.”

A conclusion of “Mothers’ Influences on Teen Sex: Connections that Promote Postponing Sexual Intercourse” (Blum, R.W., 2002) is that aspects of parent-child connectedness, such as “parents knowing their children’s friends and their friends’ parents” are likely to be among the greatest influences affecting children’s sexual behaviour.

A distinguishing feature of this recent research is how emphatically it underscores the need to translate research findings into interventions. In its “Implications” section, this report asserts that: “Youth-serving agencies need to develop strategies that promote high levels of parent-child connectedness, encourage parent-child relationships that may help delay early sexual intercourse, protect teens against a variety of other adverse outcomes and promote healthy adolescent development.”

Family Behaviors Leading to Family Connection

Below is a list of family behaviours that may lead to an increased sense of connection between parents and their children. Following is a possible list of determinants of those behaviours — an important list to consider in developing interventions designed to increase parent-child connection.

Parent Behaviors:

• Provide appropriate monitoring and supervision of teen
• Participate or “be involved” in teen’s activities (e.g., school, sports, play, music, etc.)
• Use active listening
• Ask questions about teen’s activities, interests, concerns (e.g., friends, teachers, where teen spends time)
• Show interest in child’s opinion
• Provide encouragement and praise to child
• Establish structure and predictability in home (e.g. chores, meal times, errands)
• Create opportunity for quality time and follow through on plans
• Use constructive discipline; avoid use of unreasonable discipline
• Communicate high expectations for school performance
• Clarify and communicate personal values, especially those related to health
• Communicate information related to healthy and unhealthy behaviors
• Model healthy behaviors

Teen Behaviors:

• Inform and invite parent participation in activities
• Participate in the decision-making regarding family’s structure and rules
• Abide by family rules and structure
• Use active listening
• Provide suggestions and planning for quality family time activities
• Participate in quality family time activities

Determinants of Family Behaviors:

• Time availability
• Employment responsibilities of parents
• Skills for monitoring and supervising, active listening, giving praise, constructive discipline, etc.
• Perception of need for monitoring, active listening, praise, etc.
• Knowledge of child’s activities, friends, interests
• Personality characteristics of parent and child
• Parents’ mental health
• Parent upbringing, values, beliefs about connectedness behaviors
• Clear values around health behaviors on the part of parents and skill to express them
• Parent knowledge of information related to healthy behaviors
• Skills for communicating healthy behaviors messages
• Parent and teen motivation
• Available transportation
• Available financial resources
• Language abilities
• Number of parents and number of children in the family

There are complicated, even dangerous, connections between the use of drugs and alcohol and sexual behaviours. Yet the effects of most drug prevention efforts have been modest at best. Risky behaviours are not going away, and neither is our responsibility to face them squarely. Perhaps now is the time for educators to try new strategies to counter the ever-increasing challenges of teen alcohol and drug abuse and the impact on their sexual risk-taking behaviour. Some experts advocate programs that offer comprehensive and realistic information about the effects of alcohol and other drugs … along with the assumption that young people can be trusted to make responsible decisions to stay safe.

Definitions

Drugs are chemical substances that have a direct effect on the structure or function of the body. A drug is any substance that causes a physical or mental change in the body. Some of the common types of drugs and their effects are listed below:

More detailed descriptions and health effects of various substances can be found on many websites, (see Websites to Check Out, below) including the National Institute on Drug Abuse: http://www.drugabuse.gov/ and The Do It Now Foundation, a non-profit organization committed to drug abuse prevention: http://www.doitnow.org.

Overview of the Issues

Sexual activity can be risky behaviour for teens. Unintended pregnancy, STIs including HIV, non-consensual sex, and the potentially negative emotional consequences are a few of the risky outcomes teens experience when they become sexually active. However, sexual activity under the influence of drugs, including alcohol, can raise the stakes even higher. Consider the following:

• Teens often drink or use other drugs when they engage in sexual activity. So perhaps it’s not surprising that many young people lose their virginity while drunk. Unfortunately, many teens who get drunk and have sex also become pregnant because they aren’t thinking about or able to use protection at the time. (National Campaign to Prevent Teen Pregnancy’s “Fact Sheet: Sobering Facts on Alcohol and Teen Pregnancy,” April, 2000)
  
• Thirteen percent of teens say they’ve done something sexual while using alcohol and other drugs that they might not have done if they had been sober. (“National survey of teens: Teens talk about dating, intimacy, and their sexual experiences,” Kaiser Family Foundation and YM Magazine, 1998)
  
• Teens who drink and smoke are more likely to hang out with teens they perceive to be sexually “advanced” — which usually results in a higher level of sexual activity among those teens themselves. (Whitbeck, et al., 1993)

What Educators Can Do

Drug and alcohol education has been practised by educators in schools and other youth settings for decades. However, despite the $2.1 billion spent on “prevention,” (abstinence from drugs) in 1999, government surveys indicate that many teenagers still experiment with drugs.

Marsha Rosenbaum, PhD, of the Drug Policy Alliance — an institute dedicated to broadening the debate and advancing a harm reduction perspective regarding drugs, drug abuse, and drug policy — believes that abstinence-only drug education is unrealistic. She and others fear an abstinence-only approach leaves teachers and parents with little to say to the 50% of teens who, despite admonitions, have tried marijuana, and the 80% of teens who use alcohol by the time they graduate from high school.

Rosenbaum offers an alternative, a safety-first approach to drug education, which requires reality-based assumptions about drug use. Safety-first drug education stresses abstinence from drugs, but it doesn’t stop there. It also includes a fallback strategy for risk reduction. This strategy consists of providing students with information and resources so they do the least possible harm to themselves and others.

Safety-first drug education assumes that teenagers can make responsible decisions if given honest, science-based drug education. Another assumption of safety-first drug education is that total abstinence may not be a realistic alternative for all teenagers. One more assumption of safety-first drug education is that the use of mind-altering substances does not necessarily constitute abuse. With sexual activity and alcohol use, for example, teenagers must understand the importance of context so that they can make wise decisions, control their use, and stay safe and healthy.

Rosenbaum’s “How To’s” of safety-first drug education include the following:

• Communication is key in safety-first drug education. The channels of communication must be open, and listening to what teens have to say is crucial. Rosenbaum is insistent in her belief that, if adults become indignant and punitive, teenagers will stop talking.
  
• Discussions of drugs in safety-first drug education must include observations and experience of the teens themselves if the program is to be credible. Teens should feel safe from negative repercussions for their input and honesty.
  
• Safety-first drug education should be age-specific, beginning in middle- school, when teens are actually confronted with drugs. It should engage students in the broad study of how drugs affect the body and mind. They should also learn about the social context of drugs in America.
  
• Safety-first drug education teaches students the legal consequences of drug use in America, acknowledging illegality as a risk factor in and of itself. There are real, lasting consequences of using drugs and being caught, including expulsion from school, denial of college loans, a criminal record, and lasting stigma.
  
• The goals of realistic drug education focus on safety. Safety-first education separates the real from the imagined dangers of substance use.
  
• A comprehensive, reality-based drug education curriculum will equip students with information they trust, which is the basis for making responsible decisions.

As the demand for reality-based drug education grows, programs are being developed in the U.S. and abroad. A listing of such programs can be found at the website of the Drug Policy Alliance: www.drugpolicy.org.

According to Rosenbaum, it’s our responsibility as parents and teachers to engage students and provide them with credible information so they can make responsible decisions, avoid drug abuse, and stay safe. To download pdf versions of Safety First: A Reality-Based Approach to Teens, Drugs, and Drug Education, in four different languages or order up to 50 copies in English or Spanish, go to: safety1st.org/.

Web Sites to Check Out

• Drug Policy Alliance www.drugpolicy.org
  
• Harm Reduction Coalition www.harmreduction.org
  
• The Addiction Helpline from RecoveryConnection.org www.recoveryconnect.org
  
• DanceSafe: Promoting health and safety within the rave and nightclub community www.dancesafe.org
  
• The Do It Now Foundation, a 30-year old non-profit organization working to prevent youth drug abuse www.doitnow.org
  
• Join Together Online www.drugfree.org/join-together
  
• Erowid, a small, not-for-profit organization dedicated to studying and providing information about mind-altering substances www.erowid.org
  
• The Centre for Education and Information on Drugs and Alcohol (Australia) www.ceida.net.au/
  
• Substance Abuse & Mental Health Services Administration (SAMHSA) www.samhsa.gov
  
• National Institute on Alcohol Abuse and Alcoholism Keeping Kids Alcohol Free Campaign www.niaaa.nih.gov

by William F. Bacon and Robert M. Becker

Social norms are an important topic in adolescent reproductive and sexual health because adolescents tend to match their own attitudes and behaviour to what they perceive to be the norm among their peers. Since norms are often misperceived as being riskier than they really are, correcting misperceptions may be a powerful new tool for helping adolescents avoid risky behaviour

Definitions of Terms Related to Social Norms

Social norms are standards of acceptable behaviour or attitudes within a community or peer group. Social norms come in two varieties — actual norms and perceived norms.

Actual norms are the true social norms for a particular attitude or behaviour. For example, if the majority of a group of sexually active individuals use some form of birth control, then the actual norm for the group is to use birth control. Going without birth control is “non-normative” in that group.

Perceived norms are what someone believes to be the social norm for a group. If, for example, a young man believes that most of his peers do not use condoms, for that young man the perceived norm is for non-use of condoms.

Misperceptions of norms occur when there is a discrepancy between the actual norm and the perceived norm. For example, adolescents typically have misperceptions about the normative age of sexual initiation, believing that it is earlier than it actually is.

Social Marketing is the application of commercial marketing techniques to programs designed to influence the behaviour of people in order to improve their personal welfare and that of their society. (Andreason, 1995)

Social norms prevention strategies are any of a variety of approaches designed to decrease risky behaviour or increase protective behaviour by reducing misperceptions of healthy norms. Among these strategies are social norms marketing campaigns, which publicize actual norms through messages disseminated on posters or other media.

Overview of the Issues

The social norms model represents a positive new approach to reducing risky behaviour and increasing protective behaviour. In this overview, we will explain the logic and theory behind the model, describe how it was first successfully applied in the area of alcohol abuse prevention, and finally discuss how it relates to promoting adolescent sexual health.

The Logic of Social Norms

The principles behind the social norms approach are simple. The first principle is that all communities, even those frequently labelled as “at risk,” have largely protective and healthy social norms. “Problem” behaviour and attitudes within a community, even if common enough to be of great concern, are nevertheless almost always non-normative. That is, they are associated with a part of the community, not the whole. This has implications that we’ll get to in a moment.

The second principle of social norms theory is that these positive, healthy norms are frequently misperceived. For a variety of reasons, people tend to overestimate the amount of negative or unhealthy behaviour that is going on in their own (and others) communities and underestimate the number of positive, healthy decisions and actions that their peers take every day. For example, young people tend to greatly overestimate the number of their peers who engage in risky behaviour like smoking, drinking, or having sex at an early age. Why? Partly, these misperceptions are a result of the way our attention and memory works. We tend to notice and remember exciting things (like peers bragging about a risky thing they did last weekend) rather than the mundane things that most peers are involved in. This bias in what we remember creates a bias in our beliefs about what is “typical” among our peers.

Misperceptions of actual, healthy norms are common, but they are also harmful, for a simple reason — people, especially adolescents and young adults, tend to match their own attitudes and behaviour to what they perceive to be the norm in their peers community. Thus, misperceptions set up a dangerous situation in which individuals are making unhealthy choices in order to conform to an incorrectly perceived norm. This situation can create a “reign of terror,” in which misperceptions contribute to increased risky behaviour, which further shifts the perceived norm.

The implication for programs is that we may be able to do enormous good by reducing misperceptions through feeding back information to young people about the actual, healthy norms of their peer group. This has been the approach taken successfully in the field of alcohol abuse prevention, described next.

Early Applications

The social norms approach had its beginnings almost 20 years ago with a study finding that college students misperceived the norms related to drinking on their campus (Perkins and Berkowitz, 1986). A few years later, college health officials at Northern Illinois University (NIU) began using social marketing methods to attempt to reduce problem drinking by publicizing the actual drinking norms. Student surveys indicated that most NIU students consumed five or fewer drinks when they went out drinking, but many students thought the norm was much higher. To correct this misperception, buttons and posters were developed conveying the message, “Most of us drink five or fewer when we party.”

Many other messages were developed in subsequent years, some of which combined a statement of the norm with other helpful information about protective behaviours. The campaigns achieved dramatic success reducing misperceptions as well as reducing heavy drinking and drinking-related injuries (Haines & Barker, 2003).

The idea of reducing heavy drinking by publicizing social norms spread to many college campuses, and more recently the approach has been used in high schools and in statewide media campaigns. The targets of the campaigns have grown from alcohol issues to smoking, drug use, and sexual assault. Along with campaigns attempting to reduce a particular risk behaviour, the approach has also been used to promote protective behaviours, such as safe drinking practices (e.g., using designated drivers), condom use, and seat belt use. Many of these campaigns are described in a recent book on the approach, The Social Norms Approach to Preventing School and College Age Substance Abuse: A Handbook for Educators, Counselors, and Clinicians (Perkins, 2003).

As reports of success have emerged, the ideas behind social norms have taken hold as a potentially powerful force for positive social change. For example, a recent editorial article in the New York Times suggested that the approach might be used to encourage people to increase their donations to charity, by having the IRS publicize the actual norms for donations by people at varying income levels (Ayres & Nalebuff, 2003).

Social Norms and Sexual Health

Although relatively little social norms work has been conducted to date in the area of sexual health, there is reason to believe that the approach has great promise in this area. Indeed, sexual risk-taking would appear to be an ideal case for the application of social norms theory. By its nature, sexual behaviour usually occurs in private. Adolescents generally don’t learn about their peers’ sexual behaviour by observation, but indirectly, from their peers’ own reports or boasts. Thus, perhaps more than any other risk behaviour, sexual risk-taking is susceptible to distortions of reality and misperceptions of peer norms.

Previous research bears this premise out. In studies of urban 6th graders, Robinson and colleagues (1999) found that young people generally overestimated the proportion of their peers having sex. More importantly, the youth whose misperceptions were the largest were much more likely to initiate sex themselves over the next year (see also Kinsman et al., 1998). Another study found that whether or not a young person used condoms consistently was related to their perception of whether their peers did so (Romer et al., 1994).

Planned Parenthood of New York City (PPNYC) conducted research with middle school students and identified large discrepancies between what young adolescents actually believe and what they think the norm is for their peers (Bacon, Cleland & Kantor, 2002). PPNYC found, for example, that most participants in its urban, public middle school programs believed that this is not the time in their lives for them to be having sex. Clear majorities said that they thought sex was not okay at their age and that they don’t intend to have sex in the near future. However, these same young people reported that they thought “most kids” in their grade were much different from themselves — that they believed sex was fine at their age and were likely to be having sex currently or in the near future.

Thus, there is good evidence both that substantial misperceptions exist in the area of adolescent sexual health and that these misperceptions can have negative consequences. PPNYC has begun implementing programs — both classroom-based activities and social marketing campaigns — designed to reduce these misperceptions and thereby promote healthier behaviour. The success of these efforts is by no means assured, but the effectiveness of similar programs in other areas of health promotion is encouraging.

Tips for Educators

The application of social norms theory to teen pregnancy prevention efforts is a new and evolving approach. Most social norms interventions have relied on poster campaigns and traditional prevention education. However, it is possible to incorporate social norms theory into existing curricula so that healthy normative messages are infused holistically into a program. In order for educators to successfully utilize this approach in their programs, they will need to be well-versed in the following five areas:

1. Social Norms Theory, Terms, and Application

Educators will need to be able to identify the relationship between actual norms, perceived norms, and misperceptions. Social norms theory states that adolescents will tend to match their own behaviours to what they perceive to be the norm among their peers. Since adolescents, like adults, tend to overestimate unhealthy behaviours and underestimate protective behaviours, they may tend to be negatively influenced by their misperceptions of the behavioural norms and engage in risky activities.

For example, a group of middle-school-aged participants are administered a survey asking them to respond yes or no to the statement: “It’s okay for kids my age to have sex.” To get at a misperception, the survey would have to ask the participants for both their own opinions (“What I Think”) and for their perceptions of how they think others might respond (“What I Think My Friends Would Say”).

In this example, with only 25% responding yes, the norm is it’s not okay for kids to have sex. However, since 75% of the respondents thought that their friends would say it was okay for kids to have sex, there is a large misperception. In this case, educators would let participants know that “while it may seem that everyone else thinks it’s okay to have sex, most of you actually believe you should wait until you are older.” In theory, the promotion of the actual norm of delaying the onset of sexual activity would work toward “normalizing” the belief among young people that sex should wait, while reducing the pressure some young people may be feeling based on the misperception or mistaken belief that others think it’s okay to have sex now.

2. Collecting Social Norms Data

The promotion of healthy norms about young people’s behavior relies on collecting data both on actual norms and perceived norms. Three ways to do this include collecting data through formal evaluation, through “in-class” paper surveys (or on-line surveys), and on the spot, in-class voting surveys. Audio-CASI (computer assisted self interview), a computer and voice assisted methodology to collect data, has also been used to collect social norms data. This method can help with participants who have low literacy.

Focus groups are not a traditional way at getting at norms, especially if other participants can hear responses — part of the methodology relies on respondents not being biased by other people’s choices — and interviews might also jeopardize the confidentiality of responses, making it more likely that there would be respondent-bias toward providing “right answers.”

One strategic approach to collecting data on norms is through administering surveys prior to a program. A pre-test survey can provide useful baseline information about adolescent normative attitudes and/or behaviors related to pregnancy prevention.

Norms-related questions can be written to reveal misperceptions about sexual activity, sexual behavior, dating, harassment in schools, or any other issue that may be addressed in the program. The results could then be incorporated into the program lessons through key messages or in a social norms marketing campaign.

At the end of the program, a post-test could reveal if program participants’ misperceptions were reduced, a possible indication that the program successfully worked toward generating awareness about young people’s healthy attitudes and/or behaviors.

If time or resource constraints are an issue, data can be collected and processed during program session time, either through paper surveys or through informal voting surveys. Simple anonymous surveys could be designed to ask participants how their own attitudes and behaviors compare to how they perceive their peers’ attitudes or behaviors (like the “what I think”/”what my friends think” question above). These surveys could either be tabulated and discussed during the session or tabulated later to be processed at a future session.

Educators could also conduct an anonymous survey on the spot through a “heads down, hands up” voting activity. For example, the educator can ask participants to put their heads down and close their eyes. Next, the educator would ask participants to raise their hand if they thought it was okay for kids their age to have sex. The educator would tally the votes and then ask participants to raise their hands if they thought their friends or peers would say it was okay for kids their age to have sex. Results would then be presented to the participants and misperceptions would be discussed.

3. Interpreting Social Norms Data

Once data has been collected, educators will need to accurately interpret the numbers in order to make assessments about how to incorporate the data into the program.

When interpreting data it is important to remember the following:

• Actual norm = Self reported attitudes or behaviors
• Perceived norm = Perceptions of others’ attitudes or behaviors (what people think the norm is)
• When there is a difference between the actual norm and the perceived norm, a misperception exists.
• The more respondents who misperceive the norm, the more likely people will be influenced by the misperception.

When looking at a risky attitude or behaviour, if more people perceive others engaging in a risk, even if they are not engaging in the risky activity themselves, they are more likely to feel pressure to engage in the risky activity.

Here is an example of how this might play out in a sample survey question for adolescents:

In this example, the risky attitude = Sex is okay for kids my age.

The norm in this example is “sex is for adults.” Seventy-five percent of adolescents self-reported that they personally believed that it is okay to have sexual intercourse “when you are an adult.” Yet these same adolescents perceive that 60% of their friends would say sex is okay at their age. So while the reality is that most adolescents believe sex is for adults, the misperception is that “most kids my age think it is okay.” Since perceived norms influence behaviour, pressure exists to engage in sexual intercourse.

The goal of the social norm approach, in this case, would be to reduce this misperception. And of course, the ultimate goal of any pregnancy prevention program will be to reduce adolescent sexual risk-taking.

Social norms data may also be presented in as a pie chart in order to help facilitate interpretation.

In the example above, the blue colour represents protective attitudes (sex okay for adults) and the tan colour represents riskier attitudes (sex okay for kids my age). The chart on the left represents perceived attitudes of friends; the chart on the right represents self-reported attitudes. With tan representing the riskier “sex is okay for kids my age” attitude, it is clear that the tan area on the perceived attitudes pie (60%) represents a large number of young people who misperceive the norm. Conversely, the good news in the pie chart on the right in the self-report is that most kids (75%), represented by the large blue slice, actually believe (actual norm) that sex is for adults.

It should be noted that adolescents might misperceive the extent to how their own unhealthy behaviour does not match the norm of their peers’ healthy behaviour. For example, a norm might be most adolescents use condoms. An adolescent who doesn’t use condoms and misperceives this norm, believing that most of his/her peers do not use condoms, may be positively influenced or pressured to use condoms when awareness is generated about the norm that most adolescents do use condoms.

4. Translating Norms Data into Concrete Concepts

One of the biggest challenges to incorporating social norms theory into sexuality education lies in translating terms, concepts, and data into a digestible form for an audience. The theory, terms, and data are abstract, making it difficult for younger audiences to comprehend.

One way to try to make the terms more concrete for an audience is by translating the definitions into terms more accessible for an audience. Examples include:

• “Actual norms” are what’s really going on around us, the reality.
• “Perceived norms” are what we think is going on around us.
• “Misperceptions” are when we make mistakes about what we think is going on around us.

A concrete example of translating terms for adolescents might be disseminating the message, “While most of you thought your friends would say it’s okay to have sex, we can see that this belief is a mistake. In reality, most of you believe that it is best to wait until you are an adult.”

When literacy is an issue, using photos or cartoons can help bring clarity to the issue. For example, to help clarify the concept of the impact misperceptions have on decision-making, here is a smoking example:

When trying to translate norms and data, it is best to try to utilize language, images, and concepts that are culturally and linguistically appropriate for your audience. Testing the messages and receiving feedback from your audience is imperative for both educational lessons or social marketing campaigns.

5. Promoting Healthy Social Norms

Once the data has been collected and interpreted, and key messages have been abstracted, the most important step is to promote the healthy normative message to the audience.

As mentioned earlier, traditionally this is accomplished through social norms marketing campaign posters. While poster campaigns can be quite effective and reach large audiences, healthy normative messages can also be promoted through classroom activities and through reinforcement of social norm key messages. Reinforcement may occur in the processing of activities or informally by key staff members’ interactions with program participants.

Ways to incorporate and promote your social norms data into pregnancy prevention curricula might include voicing the healthy norms within activities on sexual decision-making, abstinence, contraception, STDs/HIV/AIDS, etc. Healthy norms might include:

• Delaying the onset of sexual activity until you are an adult, i.e. “Most of you think you should wait until you are an adult before having sex…”
• Motivation to use condoms and another method of contraception if sexually active, i.e., “Most of you know that you should use a condom if you decide to be sexually active…”
• Accurate perception of risk for sexually transmitted diseases, including HIV, i.e. “Most of you know that you cannot tell if someone might have an STD by looking at them…”
• Desire to seek out a parent, caregiver, or trusted adult to ask questions about sex, i.e. “Most of you said you have talked to your parents or another trusted adult when you had a question about sex…”

Additionally, educators might spark discussion and confirm understanding by asking processing questions such as:

• If a teen believes that it is best to wait until he is an adult before having sex, but thinks everyone else believes it’s okay to have sex now, how might that affect his decision to be sexually active?
• What happens when we make mistakes about what we think our friends or peers are doing?
• How are misperceptions harmful?

Some sample key messages that may be infused within a curriculum and voiced throughout a program include:

• “When we misperceive or make a mistake about what we believe our peers are doing, we may feel pressure to do things that go against our values or beliefs.”
• “Knowing the reality of what our peers really do or believe helps us to make good decisions about dating, relationships, and sex.”
• “Most of you think that it is best to wait until you are an adult before having sexual intercourse.”

And finally, educators and key program staff can reinforce healthy normative messages by borrowing a page from media training. As program participants ask questions during an activity or in an interaction with a program staff member, key healthy normative messages can always be delivered. “I’m glad you asked about when’s the right time to have sex. It is best to wait until you are an adult. And the good news is that when we asked you on the surveys, most of you agreed that sex is for adults.”

About the Authors
William F. Bacon, PhD, is Associate Vice President for Planning, Research and Evaluation at Planned Parenthood of New York City (PPNYC). He is responsible for designing and conducting evaluations of the teen pregnancy prevention programs in the Education and Training Department and also leads research and evaluation efforts across the agency.

Robert M. Becker, M.S., is the Associate Vice President of Education and Training at PPNYC. He has been involved in the field of sexuality and sexual health for more than 10 years and has helped write curricula that address the sexual and reproductive health needs of adolescents.

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