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

Abstract

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...

Promoting Parent–Child Sexual Health Dialogue with an Intergenerational Game: Parent and Youth Perspectives

“…16,27 Computer gamebased sexual health interventions have demonstrated impact on delayed initiation of sex, risk reduction behaviors in sexually active youth, and/or improved knowledge, attitudes, and intentions regarding these behaviors. [28][29][30][31][32][33][34] However, they have primarily targeted youth. An intergenerational game (IGG) is a game that provides an inclusive and shared entertainment experience that is appealing across developmental ages from children to adults, representing a common ''meeting ground'' for families.…”

School-based HIV/AIDS education is associated with reduced risky sexual behaviors and better grades with gender and race/ethnicity differences

“…Studies have shown that school-based HIV/AIDS education programs can effectively reduce youth risky behaviors including delaying initiation of sex, frequency of sex, number of new partners, incidence of unprotected sex, STIs and pregnancy rates; and increase the use of condoms and contraception among sexually active participants [5][6][7][8][9]. However, most of the previous studies were based on a small sample size which did not allow for an assessment of school HIV/AIDS education program effectiveness by race/ethnicity and gender-specific effects.…”

“…However, most of the previous studies were based on a small sample size which did not allow for an assessment of school HIV/AIDS education program effectiveness by race/ethnicity and gender-specific effects. Markham and colleagues [8], and Tortolero and colleagues [9] reported that multi-component, curriculum-based interventions can delay sexual initiation up to 24 months and have positive effects on sexual behaviors and psychosocial outcomes in a large, urban, predominantly African-American and Hispanic school district in Southeast Texas. Due to limited resources, intervention studies such as these, generally target small samples from specific regions, and/ or schools, thus the results may not be generalizable to all American adolescents.…”

Is Participatory Design Associated with the Effectiveness of Serious Digital Games for Healthy Lifestyle Promotion? A Meta-Analysis

“…Out of 22 studies, 4 (18%) involved users via interviews [65-68], 2 (9%) via classroom discussions [58,69], and 1 (5%) via a survey [70]. In 3 studies out of 22 (14%), a user technical advisory board was established [55,57,62], and in 3 studies (14%) reported in 2 papers, target group users were recruited as members of the design team [70,71]. …”