Skills-Based Approaches Affect STI Risk Behavior More Than Information
Interventions that emphasize STI risk reduction skills may be more effective at lowering the prevalence of risky behaviors and preventing infection among teenage women than programs that simply provide information about how to reduce risk.1 In a randomized controlled trial conducted in Philadelphia, a city in the northeastern United States, participants in a skills-based STI prevention intervention reported less unprotected sex one year later than did a control group, who received a general health promotion intervention. They also had a lower STI incidence and reported less involvement with multiple partners and less unprotected sex while drunk or high than controls. Outcomes among young women who received an information-based STI prevention intervention did not differ from those among controls.
The interventions were part of a project designed to lower the risk of health problems among inner-city black and Hispanic teenage women. Using group discussions, videotapes, games and exercises in a single 250-minute session, the STI prevention programs addressed the high rates of HIV and other STIs among black and Hispanic young women, personal vulnerability, substance use, and condom use and negotiation skills. They differed only in that the skills-based intervention had participants practice putting condoms on anatomical models and engage in role-playing exercises to increase condom negotiation skills. The trial was open to sexually experienced, nonpregnant 12-19-year-olds obtaining family planning care at a hospital adolescent medicine clinic.
In all, 682 young women (463 blacks and 219 Hispanics) enrolled. Participants completed a self-administered questionnaire before the intervention, immediately afterward, and at three-, six- and 12-month follow-up visits; they also provided biological specimens for STI testing at enrollment and at the six- and 12-month visits. According to data from the baseline surveys, in the three months before entering the study, 87% of the teenagers had had intercourse, 52% had had unprotected sex and 16% had had multiple partners; two in 10 tested positive for gonorrhea, chlamydia or trichomoniasis at baseline. Women in the three study groups did not differ on these characteristics or on any of a range of variables that might mediate the effects of the interventions.
For the primary outcome measure, the reported number of days on which respondents had had unprotected sex in the previous three months, no differences were observed between groups at the three- and six-month follow-up visits. However, at 12 months, women in the skills-based intervention reported significantly fewer such days (2.3, on average) than those in the information-based intervention (4.0) or in the control group (5.1); the difference between the information-based group and the controls was not statistically significant.
Twelve-month follow-up results also showed that significantly lower proportions of teenagers from the skills-based program than of controls tested positive for an STI (11% vs. 18%) and reported having had multiple partners in the past three months (7% vs. 17%). In addition, the average number of partners in the past three months was lower among the former than among the latter (0.9 vs. 1.0). At the three- and six-month visits, women who had received skills training reported having had sex while high on drugs or alcohol on fewer days than controls. At 12 months, this difference was no longer statistically significant, but the average number of days on which women reported having had unprotected sex while high was lower among skills-based intervention participants (0.1) than among controls (0.5). Again, no significant differences were observed between teenagers in the information-based intervention and controls.
After the intervention, participants from both STI prevention programs displayed greater knowledge than controls about condom use and risk reduction, as well as stronger intentions to use condoms and more beliefs and attitudes that would favor use. Teenagers who had participated in the skills-based intervention scored higher than those from the information-based program on knowledge about how to use condoms.
The researchers contend that their study "provides some of the strongest evidence that enhancing skills should be a critical goal for interventions designed to reduce [risky] sexual behavior." Pointing out that the intervention was delivered in a single session, they add that the results of this trial suggest the potential for effecting "significant long-term changes" in teenage women's sexual behavior "without great expenditure of time and effort."—D. Hollander
1. Jemmott JB III et al., HIV/STI risk reduction interventions for African American and Latino adolescent girls at an adolescent medicine clinic: a randomized controlled trial, Archives of Pediatrics and Adolescent Medicine, 2005, 159(5):440-449.