Review article
Behavioral interventions to reduce incidence of HIV, STD, and pregnancy among adolescents: a decade in review

https://doi.org/10.1016/S1054-139X(03)00244-1Get rights and content

Abstract

Purpose

To review adolescent sexual risk-reduction programs that were evaluated using quasi-experimental or experimental methods and published in the 1990s. We describe evaluated programs and identify program and evaluation issues for health educators and researchers.

Methods

We systematically searched seven electronic databases and hand-searched journals to identify evaluations of behavioral interventions to reduce sexual risk behaviors among adolescents. Articles were included if they were published in the 1990s, provided a theoretical basis for the program, information about the interventions, clear aims, and quasi-experimental or experimental evaluation methods. We identified 101 articles, and 24 met our criteria for inclusion.

Results

We reviewed these evaluations to assess their research and program characteristics. The majority of studies included randomized controlled designs and employed delayed follow-up measures. The most commonly measured outcomes were delay of initiation of sexual intercourse, condom use, contraceptive use, and frequency of sexual intercourse. Programs ranged from 1 to 80 sessions, most had adult facilitators, and commonly included skills-building activities about sexual communication, decision-making, and problem solving. The programs included a wide range of strategies for content delivery such as arts and crafts, school councils, and community service learning.

Conclusions

Analysis of these programs suggest four overall factors that may impact program effectiveness including the extent to which programs focus on specific skills for reducing sexual risk behaviors; program duration and intensity; what constitutes the content of a total evaluated program including researchers' assumptions of participants' exposure to prior and concurrent programs; and what kind of training is available for facilitators.

Section snippets

Literature searches

Literature searches were performed in six public research databases (Medline, Psychlit, Popline, ERIC, Sociofile, and CHID); in the Prevention Evaluation Research Registry for Youth (PERRY) at the Centers for Disease Control and Prevention (CDC); and through manual searches of journals. We searched during 1999 and 2000 for evaluations of interventions targeting youth and adolescents published in the 1990s.

Standards for inclusion

Because we aimed to review programs with well-designed evaluations, we set minimum

Population of interest

Studies were conducted in schools (n = 9), in community-based venues (n = 2), clinics (n = 2), detention centers (n = 2), participants' homes (n = 1), or some combination of venues (n = 4), which generally included schools and clinics or community-based organizations. Some studies focused on broad age ranges during adolescence (such as Focus on Kids 23, 24 which included youth aged 9–15 years, and Teen Talk [44] which included youth aged 13–19 years) and others focused on particular ages or

Discussion

Among frequently targeted behaviors, the least consistent impact was found for delayed initiation of sexual intercourse and the most consistent for condom use. Both the original evaluation of Postponing Sexual Involvement 41, 42 and the study replicating the evaluation [43] focused on delayed initiation of sexual intercourse and produced negative findings (although the original evaluation produced some positive findings as well). Only one program focusing primarily on delayed initiation of

Acknowledgements

We gratefully acknowledge the contributions of Dr. Janet Collins and Dr. Janet St. Lawrence, both of whose early guidance brought the authors together and shaped this project.

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