The Need for Biological Outcomes to Complement Self-Report in Adolescent Research.

Abstract

* Abbreviations: HIV — : human immunodeficiency virus PSA — : prostate-specific antigen STD — : sexually transmitted disease Yc-PCR — : Y-chromosome polymerase chain reaction Adolescents’ self-reported health behaviors inform medical care and serve as primary intervention outcome measures. Strategies to bolster the validity and reliability of self-report combined with objective biological markers of behavior are urgently needed. We illustrate such strategies within the context of adolescent sexual health research. Research that informs human immunodeficiency virus (HIV) and sexually transmitted disease (STD) prevention efforts and public health policy involves many challenges. One key challenge is the accurate measurement of HIV risk behaviors, particularly sexual behaviors. Adolescent HIV risk reduction intervention trials have relied mainly on outcomes measured via participants’ self-reports of past behavior to evaluate programmatic efficacy. Few trials have complemented participant self-report with biological measures of sexual behaviors (eg, laboratory-confirmed STDs). Indeed, of the 20 US Centers for Disease Control and Prevention evidence-based interventions for adolescents, only 4 have included biological outcomes as trial end points in addition to self-reported measures.1 Although adolescents’ self-reported behaviors have been the most widely measured trial end points, the accuracy of self-report data may be affected by myriad factors, including the cognitive demands of recalling past behaviors and motivational biases that can lead adolescents to misreport behavior.2 Furthermore, inconsistencies between self-reported sexual behaviors and biological end points raise questions about the validity of relying solely on self-report to evaluate the efficacy of HIV risk reduction interventions. Thus, a need exists to both improve the validity of self-report and to integrate biological markers of sexual risk behaviors into future adolescent HIV risk reduction interventions. Motivational biases may result in distortion of self-reported past behaviors to avoid shame or embarrassment or to appear in a more favorable light. … Address correspondence to Jennifer L. Brown, PhD, Department of Psychological Sciences, Texas Tech University, MS 2051, Lubbock, TX 79409-2051. E-mail: jennifer.brown{at}ttu.edu