Draw the Line/Respect the Line: A Randomized Trial of a Middle School Intervention to Reduce Sexual Risk Behaviors

Coyle, Karin; Kirby, Douglas; Marín, Bárbara VanOss; Gómez, Cynthia; Gregorich, Steven E.

doi:10.2105/ajph.94.5.843

Cited by 118 publications

(118 citation statements)

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“…This is the second randomized trial to demonstrate the efficacy of the risk reduction version of It's Your Game. [14] These findings corroborate evidence from previous studies that middle school programs emphasizing abstinence and condom skills-training can effectively delay sexual initiation [14,15] and may positively impact sexually experienced youth. [12,13,16] The RA program positively impacted Hispanic and female students.…”

Section: Discussionsupporting

confidence: 84%

Sexual Risk Avoidance and Sexual Risk Reduction Interventions for Middle School Youth: A Randomized Controlled Trial

Markham

Tortolero

Peskin

et al. 2012

Journal of Adolescent Health

126

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Purpose-To evaluate the efficacy of two, theory-based, multi-media, middle school sexual education programs in delaying sexual initiation.Methods-Three-armed, randomized controlled trial comprising fifteen urban middle schools; 1,258 predominantly African-American and Hispanic 7 th grade students followed into 9 th grade. Both programs included group and individualized, computer-based activities addressing psychosocial variables. The risk avoidance (RA) program met federal abstinence education guidelines; the risk reduction (RR) program emphasized abstinence and included computer-based condom skills-training. The primary outcome assessed program impact on delayed sexual initiation; secondary outcomes assessed other sexual behaviors and psychosocial outcomes.Results-Participants were 59.8% female, mean age 12.6 years. Relative to controls, the RR program delayed any type of sexual initiation (oral, vaginal or anal sex) in the overall sample (adjusted odds ratio [AOR]: 0.65, 95% CI: 0.54-0.77), among females (AOR: 0.43, 95% CI: 0.31-0.60) and African-Americans (AOR: 0.38, 95% CI: 0.18-0.79). RR students also reduced unprotected sex at last intercourse (AOR: 0.67, 95% CI: 0.47-0.96), past three months' frequency of anal sex (AOR: 0.53, 95% CI: 0.33-0.84) and unprotected vaginal sex (AOR: 0.59, 95% CI: 0.36-0.95). The RA program delayed any sexual initiation among Hispanics (AOR: 0.40, 95% CI: 0.19-0.86), reduced unprotected sex at last intercourse (AOR: 0.70, 95% CI: 0.52-0.93) but increased the number of recent vaginal sex partners (AOR: 1.69, 95% CI: 1.01-2.82). Both programs positively impacted psychosocial outcomes. program, comparable in duration, delivery, and theoretical framework, to further examine how both approaches impact middle school students. The primary hypothesis tested whether students, who received either the RR or the RA intervention, would delay sexual initiation into 9 th grade relative to controls. Secondary hypotheses tested intervention effects on other sexual behaviors and psychosocial factors. Conclusions-The METHODS Study Design and ParticipantsA randomized controlled trial was conducted from 2006-2010 in fifteen urban middle schools in a large south-central US school district. Seventy-eight percent of students were classified as economically disadvantaged. Assignment of schools to one of three conditions (5 to the RA condition, 5 to the RR condition, and 5 to a control condition) was conducted prior to baseline assessment using a multi-attribute randomization protocol, accounting for school size, racial/ethnic composition (percent of African-American and Hispanic students), and geographic location.[18]Assuming 15% of controls would initiate any type of sex by 9 th grade, 25% attrition, intraschool correlations=0.005, and α=0.05 (two-tailed), an initial sample size of 1,500 7 th grade students was estimated to provide 80% power to detect 10% pairwise differences in sexual Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript initiation between intervention and co...

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Section: Discussionsupporting

confidence: 84%

Sexual Risk Avoidance and Sexual Risk Reduction Interventions for Middle School Youth: A Randomized Controlled Trial

Markham

Tortolero

Peskin

et al. 2012

Journal of Adolescent Health

126

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“…Thus, making a pledge may lessen the likelihood of sexual initiation by almost 9 percentage points among this group of lowrisk youth. This size reduction is comparable to the reduction observed for other interventions that have been shown to impact adolescent sexual initiation (e.g., [27][28][29][30]; for a review, see [31]). Of course, since not all youth have characteristics that incline them to pledge, the reduction in rates of sexual initiation that are likely to be attainable in the broader youth population will be lower.…”

Section: Discussionsupporting

confidence: 68%

Virginity Pledges Among the Willing: Delays in First Intercourse and Consistency of Condom Use

Martino

Elliott

Collins

et al. 2008

Journal of Adolescent Health

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Purpose-We examine longitudinal relationships between virginity pledging in adolescence and both sexual initiation and condom use. Prior studies have had mixed results and may not adequately control for pre-pledge differences between pledgers and non-pledgers.Methods-Data came from a national sample of 12-17 year olds surveyed in 2001 and reinterviewed 1 and 3 years later. Logistic regression models estimated the association between making a pledge and each outcome. Selection bias was reduced through propensity-score weighting and a rich set of demographic and psychosocial covariates.Results-Pledgers and non-pledgers differed substantially in pre-existing characteristics. However, after propensity-weighting and statistical controls, pledging was still associated with delayed intercourse. We estimate that in the absence of pledging 42.4% of virgins with characteristics indicating an inclination to pledge initiate intercourse within 3 years; in the presence of the pledge, 33.6%of such youth initiate intercourse. Among those who had sex during this period, pledging was unassociated with condom use. Among those who did not have sex during this period, pledging was unassociated with engagement in noncoital sexual behavior.Conclusions-Making a virginity pledge appears to be an effective means of delaying sexual intercourse initiation among those inclined to pledge without influencing other sexual behavior; pledging does not appear to affect sexual safety among pledgers who fail to remain abstinent.Nearly 800,000 teenagers become pregnant in the U.S. each year [1] and half of the approximately 19 million new STD infections diagnosed annually are among youth 15 to 24 years old [ 2]. Unplanned pregnancies and STDs are more common among those who begin sexual activity earlier [3]. Delaying sexual activity might therefore have important public health consequences.One approach to delaying sexual activity is the virginity pledge -a public declaration to abstain from sex until marriage. The first virginity pledge program was True Love Waits, founded by the Southern Baptist Church in 1993. The movement has since grown to include hundreds of churches, schools, and colleges across the country. Among adolescents in the United States, it is estimated that 23% of females and 16% of males have made a virginity pledge [4]. From a theoretical perspective, pledging may work by enhancing social norms to abstain from sex [ 5]; pledgers may believe, more so than others, that they will be held responsible to their peers or important adults to follow through on their public commitment.Correspondence regarding this manuscript can be sent to Steven C. Martino, RAND, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665. Tel: 412-683-2300, ext. 4629. Fax: 412-683-2800 Through processes of cognitive dissonance or self-perception [6][7], pledging may also lead youth to internalize the commitment or values expressed in the pledge.Although these programs may delay sex, those who make a virginity pledge but fail to keep it may actually i...

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“…Keywords mass media campaign; public service announcement; safer sex HIV prevention intervention research over the past 15 years has begun to show impressive results. A number of studies have shown delay of onset of sexual initiation (e.g., Coyle, Kirby, Marin, Gómez, & Gregorish, 2004), whereas other programs have led to significant increases in condom use in populations including heterosexually active individuals (see Johnson, Carey, Marsh, Levin, & Scott-Sheldon, 2003;Neumann et al, 2002, for reviews). However, most of these interventions have been implemented in small-group (e.g., Belza et al, 2001), school (e.g., Blake et al, 2003;Gallant & Maticka-Tyndale, 2004), or individuallevel clinical settings (e.g., Morrison-Beedy & Lewis, 2001).…”

mentioning

confidence: 99%

Effects of a Televised Two-City Safer Sex Mass Media Campaign Targeting High-Sensation-Seeking and Impulsive-Decision-Making Young Adults

et al. 2007

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This study evaluates the ability of a safer sex televised public service announcement (PSA) campaign to increase safer sexual behavior among at-risk young adults. Independent, monthly random samples of 100 individuals were surveyed in each city for 21 months as part of an interrupted-time-series design with a control community. The 3-month high-audience-saturation campaign took place in Lexington, KY, with Knoxville, TN, as a comparison city. Messages were especially designed and selected for the target audience (those above the median on a composite sensation-seeking/impulsive-decision-making scale). Data indicate high campaign exposure among the target audience, with 85%-96% reporting viewing one or more PSAs. Analyses indicate significant 5-month increases in condom use, condom-use self-efficacy, and behavioral intentions among the target group in the campaign city with no changes in the comparison city. The results suggest that a carefully targeted, intensive mass media campaign using televised PSAs can change safer sexual behaviors. Keywords mass media campaign; public service announcement; safer sex HIV prevention intervention research over the past 15 years has begun to show impressive results. A number of studies have shown delay of onset of sexual initiation (e.g., Coyle, Kirby, Marin, Gómez, & Gregorish, 2004), whereas other programs have led to significant increases in condom use in populations including heterosexually active individuals (see Johnson, Carey, Marsh, Levin, & Scott-Sheldon, 2003;Neumann et al., 2002, for reviews). However, most of these interventions have been implemented in small-group (e.g., Belza et al., 2001), school (e.g., Blake et al., 2003;Gallant & Maticka-Tyndale, 2004), or individuallevel clinical settings (e.g., Morrison-Beedy & Lewis, 2001). Mass media campaigns, such as televised public service announcement (PSA) campaigns, have recently been shown to be highly effective in changing a variety of behaviors (Hornik, 2002;Noar, 2006) 2001). For a number of reasons, however, the full potential of these types of media campaigns in the HIV prevention area has not yet been realized (Dejong, Wolf, & Austin, 2001;Myhre & Flora, 2000). In fact, campaigns focused on safer sexual behavior to date have tended to yield modest campaign effects (Snyder & Hamilton, 2002). Thus, we raise the following question: Can a televised PSA campaign based on formative research and sophisticated targeting principles change safer sexual beliefs and behaviors in at-risk young adults? The current study is a rigorous evaluation of a two-city, televised safer sex mass media campaign targeted toward increasing safer sex in young adults who are high sensation seekers and impulsive decision makers. HHS Public Access MASS MEDIA CAMPAIGNSAs noted by Randolph and Viswanath (2004), "Mass media campaigns to promote healthy behaviors and discourage unhealthy behaviors have become a major tool of public health practitioners in their efforts to improve the health of the public" (p. 419). Although the early h...

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Draw the Line/Respect the Line: A Randomized Trial of a Middle School Intervention to Reduce Sexual Risk Behaviors

Abstract: The program was effective for boys, but not for girls.

Cited by 118 publications

References 31 publications

Sexual Risk Avoidance and Sexual Risk Reduction Interventions for Middle School Youth: A Randomized Controlled Trial

Sexual Risk Avoidance and Sexual Risk Reduction Interventions for Middle School Youth: A Randomized Controlled Trial

Virginity Pledges Among the Willing: Delays in First Intercourse and Consistency of Condom Use

Effects of a Televised Two-City Safer Sex Mass Media Campaign Targeting High-Sensation-Seeking and Impulsive-Decision-Making Young Adults

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