Journal of Counseling Psychology Copyright 1981 by the American Psychological Association, Inc.

1981, Vol. 28, No. 5, 451-454 0022-0167/81/280S-0451$00.75

Brief Reports
Cognitive-Behavioral Prevention
of Adolescent Pregnancy
Steven Paul Schinke, Betty J. Blythe,
and Lewayne Dorman Gilchrist
University of Washington

Cognitive and behavioral methods were applied to assist adolescents with

avoidance of unplanned pregnancy. Small group training gave high-school
sophomores contraceptive information, steps for solving problems, and prac-
tice in communicating decisions about sexual behavior. Compared with un-
trained, control-condition teenagers, trained teenagers had more positive
posttest scores on measures of sexual knowledge, interpersonal problem solv-
ing, and in vivo performance. At 6-month follow-up, young women and young
men who participated in training groups had better attitudes toward family
planning and were practicing more effective contraception than were young
people in control conditions. Research findings have implications for cogni-
tive and behavioral counseling aimed at the primary prevention of personal
and social difficulties faced by young people.

Each year in this country, 1.3 million adoles-
cents become pregnant (Tietze, 1978). With the
annual number of births to teenagers growing at
16%, members of this age cohort are responsible
for one of every five deliveries (National Center
for Health Statistics, 1979). Abortions to young
people are also on the rise. The over 500,000
teenagers opting to prematurely terminate their
pregnancies represent a disproportionate one-
third of legal and reported abortions in the United
States (National Center for Health Statistics,
1980). Although most young people neither in-
tend nor want to get pregnant (National Center
for Health Statistics, 1978), fewer than 7% relin-
quish their babies for adoption or substitute care
(Zelnik & Kantner, 1978). Such statistics, com-
bined with a disappointing legacy of attempts to
Funding was provided by Grants HD 11095 and HD
02274 from the National Institute of Child Health and
Human Development (National Institutes of Health)
and by Maternal and Child Health Training Project 913
from the Bureau of Community Health Services (Health
Services Administration), all awarded to the University
of Washington Child Development and Mental Retar-
dation Center and administered through the United
States Public Health Service, Department of Health
and Human Services.
Gratefully thanked are Anna Bolstad, Gloria Burt,
Leona Eggert, Joan Hiltner, Charles Gelso, Lois Holt,
Andrew Renggli, Edith Watson, and our anonymous
reviewers.
Requests for reprints should be sent to Steven Paul
Schinke, School of Social Work, University of Wash-
ington, Seattle, Washington 98195.
reduce early childbearing (Schinke, 1978,1979),
mandate innovative approaches to help adoles-
cents avoid unplanned pregnancy.
One primary prevention approach, which is
advanced by the present team, includes cognitive
and behavioral factors that influence knowledge
acquisition and use (Schinke & Gilchrist, 1977;
Schinke, Gilchrist, & Small, 1979). In relation to
preventing pregnancy, this means adolescents
must possess factual information about human
reproduction and contraception. Also, they need
to solve problems when relating birth-control
information to themselves. Responsible sexual
behavior involves interpersonal communication
so young people can obtain contraception, regu-
late sexual encounters, and negotiate the use of
birth control. Indeed, survey and exploratory
data from Campbell and Barnlund (1977), Cvet-
kovich, Grote, Lieberman, and Miller (1978), and
Dembo and Lundell (1979) correlate contracep-
tive failure among young people with deficient
cognitive and behavioral skills. This conceptual
framework was the basis of a prospective test of
cognitive-behavioral training aimed at preventing
unplanned adolescent pregnancy.
Method
Participants and Design
The study took place in a large public high
school. A sample of 36 students (19 women, 17
men; mean age = 15.89 years) was drawn from the
sophomore class. After they and their parents

451
452 BRIEF REPORTS
gave written consent, students were assigned
randomly to one condition of a Solomon four-
group research design: pretest, training, and
posttest; training and posttest; pretest and
posttest; and posttest only.
Procedure
Trainers for the two contact conditions were a
female and a male graduate student in second-
year internships of a M.S.W. program. Their
ages were 29 and 28; they had 3 and 4 years
counseling experience and had not previously
counseled teenagers on sexual matters.
The pair carried out cognitive and behavioral
training in 14 50-minute group sessions. Re-
productive biology and contraceptive methods
were covered by guest speakers, audiovisual aids,
and Socratic discussions. Problem solving fol-
lowed Goldfried and Goldfried's (1980) schema
and encompassed specifying problems, coming up
with ways to deal with problems, judging the
worth and payoffs of these options, and planning
how to apply selected options in demand situa-
tions. The young people were guided through the
sequence as they confronted decisions about
dating, sexuality, birth control, pregnancy,
abortion, childbearing, and parenthood.
Leaders taught components of verbal and
nonverbal communication via modeling, role play,
and rehearsal (Schinke, 1981; Schinke, Gilchrist,
Smith, & Wong, 1979). Young people acted as
one another's antagonist, coach, and feedback
source as they practiced communicating contra-
ceptive decisions. Training groups concluded
with teenagers' contracting to exercise acquired
knowledge and actions during the intervening
week (Schinke & Rose, 1976). Outside applica-
tions were monitored at the next group
meeting.
Measures and Analyses
By design, half of the young people completed
pretest measures; all of them took identical
measures at the end of prevention training.
Measures encompassed reproductive and birth-
control knowledge, problem solving, and inter-
personal performance.
Schedules from Miller and Lief (1979) and from
Schinke (in press) quantified young people's
awareness of sexual facts, myths, probabilities,
and sequelae. Problem-solving instruments were
variants of the Perspective Taking Test (Shure
& Spivack, Note 1), Means-End Thinking Test
(Shure & Spivack, 1972), and Anticipation of
Consequences Test (Spivack, Platt, & Shure,
1976). The three instruments were given orally,
and youths' answers were recorded and tran-
scribed for scoring. The performance test, pre-
pared in pilot work (Blythe, Gilchrist, & Schinke,
in press; Schinke, Gilchrist, & Blythe, 1980), en-
gaged individual young women and young men in
videorecorded interactions with an opposite-sex,
agemate confederate. A series of vignettes re-
quired youths to instigate and respond in stressful
dating situations (e.g., being asked to spend the
night with a date even though neither person uses
birth control, having to broach the topic of con-
traception with a reluctant partner). Tapes
were indexed with elapsed time and code de-
scriptors and randomly arranged for blind scoring
(Schinke & Smith, 1979). Follow-up 6 months
after training measured adolescents' attitudes
about family planning and birth control prac-
tices.
Measures were scored by two assistants, naive
to study conditions and hypotheses. Computed
with the Pearson product-moment correlation
coefficient, r, scoring reliability for problem-
solving instruments ranged from .926 to .988 (M
= .973, SD = .026). Performance test scoring
reliability went from .874 to 1.000 (M = .931, SD
= .022). Analyses of resultant scores revealed no
pretest or within-condition differences. Ac-
cordingly, between-conditions analyses were done
on posttest and follow-up data summed sepa-
rately across training and control conditions.
Stochastic differences were examined by the t
statistic.
Results
Knowledge test scores differentiated young
people in cognitive-behavioral prevention con-
ditions from those in control conditions. Young
people given pregnancy prevention training an-
swered correctly more questions on human re-
production, £(34) = 3.40, p < .002, and birth
control, £(34) = 2.63, p < .02, than did control-
condition adolescents. Problem-solving mea-
sures characterized cognitive-behavioral condi-
tion youths as more skilled than those in control
conditions when they specified interpersonal
problems, £(34) = 2.48, p < .02, identified obsta-
cles to solving them, £(34) = 2.28, p < .05, and
generated potential solutions to them, £(34) =
2.31, p<.05.
Teenagers' performance in videotaped inter-
actions distinguished between cognitive-behav-
ioral and control conditions. Retrospective rat-
ings of videotapes favored youths in the former
condition on use of eye contact with the oppo-
site-sex interpersonal partner, £(34) = 4.43, p <
.001, the declarative "No" in response to social
pressure, £(34) = 3.04, p < .005, statements ex-
pressing refusal to risk pregnancy, £(34) = 2.19,
p < .05, and requests that partners share re-
 BRIEF REPORTS
sponsibility for birth control and cognate sexual
decisions, t(34) = 2.46, p < .05.
Six-month follow-up data signified the carry-
over of pregnancy prevention training. Be-
tween-conditions analyses evidenced better at-
titudes toward family planning, t(32) = 2.08, p <
.05, more habitual contraception, t(32) = 2.38, p
< .05, greater protection at last intercourse, t (32)
= 3.26, p < .005, and less reliance on inadequate
birth control, i(32) = 4.35, p < .001, for trained
than for untrained, control-condition teen-
agers.
Subjective clinical reports lend warmth to ob-
jective outcomes (Kazdin, 1977; Wolf, 1978).
Obtained from anonymous end-of-session ques-
tionnaires, feedback from training condition
participants praised group process and content.
Illuminating were "This is neat stuff!" "Hearing
other guys having a hard time talking about sex
is great." "I like role playing." "Let's keep doing
like you have to do on dates when you get has-
sled." "I really use what we talk about. I even
tell my sister about it." In the same vein,
teachers and parents expressed the value of cog-
nitive-behavioral training. Just a single com-
plaint was voiced, due to an apparent inconsis-
tency between a parent's prior understanding of
the study and a young person's description of one
group session.
Discussion
Results of this study are promising. Group
cognitive and behavioral training let young
women and young men acquire skills to prevent
unplanned pregnancy. High-school sophomores
who participated in cognitive-behavioral training,
compared to classmates assigned to assessment-
only conditions, gained sexual knowledge, prob-
lem-solving abilities, and persuasive patterns of
interpersonal communication. Six months after
group training, cognitive-behavioral condition
adolescents were more favorably disposed toward
family planning and were practicing more effec-
tive contraception than were control-condition
adolescents.
The described approach to counseling adoles-
cents has several advantages. Doubtless, the
untoward consequences of early pregnancy are
best avoided through primary prevention (Gil-
christ, Schinke, & Blythe, 1979). Group contexts
enable human services workers to reach greater
numbers of young people. Cognitive and be-
havioral methods tap synergetic skills for com-
petently handling adolescent sexuality (Dembo
& Lundell, 1979). The cognitive-behavioral
approach seems equally suited to alleviate teen-
age struggles with alcohol and drug abuse, delin-
quency, family conflicts, and vocation choices and
453
to equip youths for stresses of independent living,
money management, marriage, and parenting
(Hawkins, Bradley, & White, 1977; Little &
Kendall, 1979; Robin, in press).
Future investigations might bridge gaps left by
the present research. The contribution of each
cognitive and behavioral component—informa-
tion, problem solving, interpersonal communi-
cation—could be studied in factorial designs.
Longitudinal follow-up data with larger samples
would test the maintenance of posttraining
changes and would quantify additional benefits
of generalized learning. Since first intercourse
is happening early (Zabin, Kantner, & Zelnik,
1979), pregnancy prevention could profit pre-
teenagers. Sorely needed are formats sensitive
to young members of ethnic and racial minorities
(Fry, Kropf, & Coe, 1980; Sue & Sue, 1977).
Cognitive-behavioral pregnancy prevention
counseling seems a promising approach to help
young people deal with sexual issues and related
dilemmas.
Reference Note
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solving skills, adjustment, and social class (Re-
search and Evaluation Report No. 22). Philadel-
phia, Pa.: Department of Mental Health Services,
Hahnemann Community Mental Health/Mental
Retardation Center, 1970.
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Received July 14,1980 •