Abstract
Although school-based sex education remains an important tool to improve adolescent health outcomes, new efforts are needed to improve its impacts. A primary reason that school-based sex education falls short may stem from the fact that the current theoretical foundation of most curricula asserts that sexual decision-making is primarily a rational, deliberative process. Far from being only a rational process, a number of affective (emotional and motivational) factors also influence adolescent sexual decision-making. The cognitive, hormonal, emotional, and physical changes that accompany the onset of puberty and occur throughout the teenage years play a significant role in aspects of adolescent sexual risk taking. Emerging brain development research and neuroscience suggest that changes in rational, affective, and social processing play a critical role in influencing adolescent behavior. While the current understanding of the neuroscience may be too formative at this time to directly translate into policy and practice, this dissertation begins to explore how conceptual and empirical advances in understanding adolescent brain development may provide new perspectives that encourage the testing of innovative approaches to sex education, which in turn may lead to more effective behavioral interventions. The aim of this dissertation is to enhance policy and practices aimed to improve adolescent sexual health by expanding the theoretical scope of adolescent school-based sex education programs. In this body of work, I integrate concepts from the fields of neuroscience, behavioral science, public health and neuroeconomics in order to bring a better understanding to the role of emotions in adolescent sexual decision-making. To this end, in the first component of this dissertation, I explored how existing neuroscience research can be used to better inform sex education policies and practice. In the second portion of the dissertation, I tested how emotions impact adolescent risk taking in a computerized task and discuss the implications of the results in understanding the gap between intentions and behaviors in adolescent sexual decision-making. In the experiment, adolescents planned how they would wager their choices, and how they would advise a friend to wager, in three rounds based on the outcome from prior rounds. Not anticipating the negative emotional outcome of a loss in prior rounds, adolescents took greater risks than they had planned. In contrast, their advice to a peer did not reflect the same significant increase in risk-taking. In the final component of the dissertation, I conducted a qualitative assessment of the role of peer influence on adolescents' early experiences in romantic and sexual relationships and discuss how this interacts with the developmental factors contributing to adolescents' unique vulnerability to peer influence. Recognizing that this dissertation is only the first step in a long line of inquiry to better understand the role of affect in adolescent sexual decision-making, I propose directions for future research and ways to improve sex education practices and policies.