Elsevier

Journal of Adolescent Health

Volume 49, Issue 3, September 2011, Pages 244-251
Journal of Adolescent Health

Original article
Using Culturally Sensitive Media Messages to Reduce HIV-Associated Sexual Behavior in High-Risk African American Adolescents: Results From a Randomized Trial

https://doi.org/10.1016/j.jadohealth.2010.12.007Get rights and content

Abstract

Purpose

To test the long-term effects of a mass media intervention that used culturally and developmentally appropriate messages to enhance human immunodeficiency virus (HIV)-preventive beliefs and behavior of high-risk African American adolescents.

Methods

Television and radio messages were delivered for more than 3 years in two cities (Syracuse, NY; and Macon, GA) that were randomly selected within each of the two regionally matched city pairs, with the other cities (Providence, RI; and Columbia, SC) serving as controls. African American adolescents, aged 14–17 years (N = 1,710), recruited in the four cities over a 16-month period, completed audio computer-assisted self-interviews at recruitment and again at 3, 6, 12, and 18-months postrecruitment to assess the long-term effects of the media program. To identify the unique effects of the media intervention, youth who completed at least one follow-up and who did not test positive for any of the three sexually transmitted infections at recruitment or at 6-and 12-month follow-up were retained for analysis (N = 1,346).

Results

The media intervention reached virtually all the adolescents in the trial and produced a range of effects including improved normative condom-use negotiation expectancies and increased sex refusal self-efficacy. Most importantly, older adolescents (aged 16–17 years) exposed to the media program showed a less risky age trajectory of unprotected sex than those in the nonmedia cities.

Conclusion

Culturally tailored mass media messages that are delivered consistently over time have the potential to reach a large audience of high-risk adolescents, to support changes in HIV-preventive beliefs, and to reduce HIV-associated risk behaviors among older youth.

Section snippets

Methods

The study was approved by the Institutional Review Boards of the participating universities. We previously described the recruitment procedure depicted in Figure 1 [16], [18]. Briefly, 1,710 African American adolescents were recruited at a constant monthly rate from community-based organizations and street outreach as well as by peer nomination and respondent-driven sampling in two northeast (Providence, RI; and Syracuse, NY) and two southeast U.S. cities (Columbia, SC; and Macon, GA) that were

Media exposure

As reported previously, the media program achieved high exposure during the recruitment period [16]. On average, from 48% to 87% of the adolescents in media cities reported having seen one of the intervention TV advertisements, whereas only 10% to 14% of youth in nonmedia cities reported (mistakenly) seeing those advertisements, a level of false recognition that is common for advertising [29]. Recognition of radio advertisements was also greater in the media cities but at lower levels (22%–50%

Discussion

This study presents results from the first large-scale test of a mass media program designed to reduce sexual risk-taking behavior among at-risk African American adolescents. Although mass media campaigns have been found to augment HIV/STI prevention efforts [6], little research has been conducted in the United States regarding the efficacy of mass media messages alone to alter sexual behavior in high-risk youth. We previously reported very limited results from the 16-month recruitment phase of

Limitations

One limitation of the study design is the reliance on self-report, which can be influenced by memory or motivational biases; however, the use of computer-assisted self-interview should have reduced this potential bias [34]. Second, we did not assess adolescents before the introduction of the media intervention, and we observed only four cities, making it difficult to control random effects. However, we compensated by using propensity score weighting [35] and by examining risk behavior and

Conclusions

With African American youth disproportionately affected by STDs and HIV, mass media interventions offer a potentially powerful prevention approach because of their ability to reach this audience at a low cost [36]. Media may also reach adolescents who cannot be influenced through face-to-face interventions or in clinical settings. In addition, mass media programs have the potential to be far more engaging than commonly believed [37]. The program studied in this intervention used dramatic

Acknowledgments

The data stem from a cooperative agreement funded by the US National Institute of Mental Health, Office on AIDS, Pim Brouwers, Project Officer. The following sites and investigators contributed to the project: Columbia, SC (MH66802), Robert Valois (PI), Naomi Farber, and Andure Walker; Macon, GA (MH66807), Ralph DiClemente (PI), Laura Salazar, Rachel Joseph, and Angela Caliendo; Philadelphia, PA (MH66809), Daniel Romer (PI), Sharon Sznitman, Bonita Stanton, Michael Hennessy, Ivan Juzang, and

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