Evaluation of a cognitive–behavioral, group, randomized controlled intervention trial to prevent sexually transmitted infections and unintended pregnancies in young women

Abstract

Background Few cognitive–behavioral interventions have focused on preventing sexually transmitted infections (STIs) and unintended pregnancies (UPs) in young, sexually active women in a single study. Military recruit training provides a well-defined, national, nonclinic sample in which to evaluate such an intervention. Methods All female Marine recruits ( N = 2,288) in training were approached. Of these, 2,157 (94.3%) voluntarily agreed and were randomly assigned, by platoons, to participate in cognitive–behavioral interventions to prevent STIs or UPs or to prevent physical training injuries and cancer. Participants completed self-administered questionnaires and were screened for pregnancy, Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis at baseline and, on average, 1 and 14 months postintervention. Results A higher proportion of the control group had a postintervention STI or UP [odds ratio (OR) = 1.41, 95% confidence interval (CI) = 1.01–1.98]. Among participants who had no history of STIs or pregnancy, but who engaged in risky sexual behaviors just before recruit training, the control group was more likely to acquire a postintervention STI (OR = 3.24, CI = 1.74–6.03). Among participants who were not sexually experienced at baseline, the control group was more likely to have casual (OR = 2.05, 95% CI = 1.04–4.08) and multiple (OR = 1.87, 95% CI = 1.01–3.47) sexual partners postintervention. Conclusions This randomized controlled trial indicates that cognitive–behavioral interventions are effective for reducing behavioral risk and preventing STIs and UPs in young, sexually active women who are not seeking health care.