Adolescent Risk Reduction Interventions Research Articles

Effects of Teacher Training and Continued Support on the Delivery of an Evidence-Based HIV Prevention Program: Findings From a National Implementation Study in the Bahamas.

Few studies have investigated the effects of teacher training and continued support on teachers' delivery of evidence-based HIV prevention programs. We examined these factors in a national implementation study of an evidence-based HIV risk reduction intervention for adolescents in the sixth grade in the Bahamas. Data were collected from 126 grade 6 teachers and 3,118 students in 58 government elementary schools in the Bahamas in 2019-2021. This is a Hybrid Type III implementation study guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) model. Teachers attended 2-day training workshops. Trained school coordinators and peer mentors provided biweekly monitoring and mentorship. We used mixed-effects models to assess the effects of teacher training and continued support on implementation fidelity. Teachers who received training in-person or both in-person and online taught the most core activities (27.0 and 27.2 of 35), versus only online training (21.9) and no training (14.9) (F = 15.27, p < .001). Teachers with an "excellent" or "very good" school coordinator taught more core activities than those with a "satisfactory" coordinator or no coordinator (29.2 vs. 27.8 vs. 19.3 vs. 14.8, F = 29.20, p < .001). Teachers with a "very good" mentor taught more core activities and sessions than those with a "satisfactory" mentor or no mentor (30.4 vs. 25.0 vs. 23.1; F = 7.20; p < .01). Teacher training, implementation monitoring, peer mentoring, teachers' self-efficacy, and school-level support were associated with implementation fidelity, which in turn was associated with improved student outcomes (HIV/AIDS knowledge, preventive reproductive health skills, self-efficacy, and intention to use protection). Teachers receiving in-person training and those having higher-rated school coordinator and mentor support taught a larger number of HIV prevention core activities. Effective teacher training, implementation monitoring, and peer mentoring are critical for improving implementation fidelity and student outcomes.

Attention Deficit Hyperactivity Disorder (ADHD) Subtypes, Co-Occurring Psychiatric Symptoms and Sexual Risk Behaviors among Adolescents Receiving Substance Abuse Treatment

Background: Adolescents entering substance abuse treatment report clustered psychiatric symptoms and sexual risk behaviors representing differential levels of impairment and risk for maladaptive health outcomes. Objectives: To examine the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) subtypes among adolescents receiving outpatient substance abuse treatment; To document group differences in (a) past-year psychiatric symptom scores and (b) sexual risk behaviors by ADHD subtype and gender. Methods: Self-report data were collected via structured interviews from 394 adolescents (280 males, M = 16.33 years, SD = 1.15 years), enrolled in an HIV/STI risk reduction intervention for adolescents receiving outpatient substance abuse treatment. ADHD diagnostic subtypes and other past-year psychiatric symptoms were assessed using the Brief Michigan Version of the Composite Internal Diagnostic Interview (UM-CIDI). Adolescents provided self-report data on sexual risk behaviors. Results: Multivariate analyses of variance (MANOVAs) documented that Inattentive and Hyperactive-Impulsive ADHD subtypes were significantly associated with higher scores for all past-year psychiatric symptoms. The combined ADHD subtype was significantly associated with higher scores for all psychiatric symptoms except affective disorder. Girls reported significantly higher mean symptoms than boys for alcohol abuse and dependence, anxiety, and affective disorder symptoms. Sexual risk behavior scores were not associated with ADHD status, but girls reported consistently higher scores for multiple risk behavior outcomes. Several psychiatric disorder symptoms were significant covariates of multiple sexual risk behaviors. Conclusion/Importance: Brief screenings for ADHD, other psychiatric disorders and sexual risk behaviors can provide data for tailoring substance abuse services to improve adolescent health outcomes for high-risk subgroups.

Outcomes of a Culturally-Based Sexually Risk Reduction Intervention for Adolescents in Puerto Rico: A Cohort Evaluation Report

Objective: Teen pregnancy and sexually risky behaviors among adolescents represent a major public health concern. Despite reduction of teen birth rates, Hispanic adolescents still report higher rates in comparison to other racial and ethnic groups. Under uncontrolled community and school settings, ¡Cuídate! was implemented for assisting Puerto Rican youth reduce sexual risk behaviors in high risk communities. Methods: A prospective assessment was conducted among adolescents that participated in the intervention. A stratified probabilistic sample of 185 adolescents was re-contacted and comparisons were made between participants that completed and not completed the intervention in terms of intent to have sex, sexual encounters, contraceptive methods, teen pregnancy, and improvement in life coping skills. Results: After intervention’s completion participation, adolescents were more likely to ask sexual partner to use any birth control or condom that non-completers. Completers reported 75% less probability of reporting sex ever than those non-completers after controlling for age and gender. They also were more likely to indicate higher intentions to have sex. Among those adolescents that indicated not having sex before starting the intervention, 12.0% had sex and from those that had sex after the intervention, 1.2% reported being pregnant or gotten someone pregnant. Conclusions: The investigation found that an impact in knowledge and attitudes were experienced. Despite teen pregnancy prevention did not reach statistical significance, it resulted in lower incidence than the general population of adolescents.¡Cuídate! resulted effective in changing the perception towards abstinence, condom utilization, and in delaying age of first sexual encounter.

Mediation of an efficacious HIV risk reduction intervention for adolescents: A cluster-randomised controlled trial.

The 'Cuidate' programme for adolescents in Spain has proven to be effective for promoting healthy sexuality (N = 626), but the mechanisms underlying its effects are unknown. This study aimed to identify mediators of the intervention's effects compared to a control group. Participants were students from five areas of Spain, who completed baseline, immediate-posttest, 12-month and 24-month follow-up assessments. Mediation analyses revealed that 'Cuidate' positively affected consistent condom use indirectly through knowledge in serial with the intention to use condoms. The findings underscore the importance of targeting knowledge on HIV and sexually transmitted infections to promote condom use intention and consistent condom use.

The impact of parent involvement in an effective adolescent risk reduction intervention on sexual risk communication and adolescent outcomes.

Parent involvement in prevention efforts targeting adolescents increases the impact of such programs. However, the majority of risk-reduction intervention programs that are implemented through schools do not include parents, in part because most existing parental interventions require significant time commitment by parents. We designed a brief parent-adolescent sexual risk communication intervention to be delivered with an effective HIV prevention intervention as part of a randomized, controlled trial among 2,564 grade 10 students and their parents in the Bahamas. Mixed effects modeling analysis was conducted to evaluate the effect of the brief parent-adolescent communication intervention using four waves of longitudinal data. Results indicate that a brief parent-adolescent communication intervention is effective in improving parent-adolescent communication on sex-related issues and perceived parental monitoring as well as the youth's condom use skills and self-efficacy. There is a marginal effect on consistent condom use. In addition, there is an apparent dose effect of the brief parent intervention on perceived parent-adolescent sexual risk communication and adolescent outcomes. These findings suggest that adolescent risk reduction interventions should include a brief parent-adolescent communication intervention that should be reinforced by periodic boosters in order to enhance the impact of adolescent HIV prevention programs.

Association of “Macho Man” Sexual Attitudes and Behavioral Risks in Urban Adolescents

We examined whether sexual attitudes of adolescents were related to their self-reported sexual risk behavior by analyzing survey data from 1,052 boys and girls aged 14 to 17 years from a low income, urban community. Sexual behavior norms that may increase sexually transmitted infection/HIV risks in youth were sanctioned more by males and by sexually experienced youth, but their attitudes were unassociated with either their age or race/ethnicity. Endorsement was correlated with greater intention to have sexual intercourse among all youth. Among sexually experienced participants, it was associated with earlier sexual debut, more partners, and less intention to use condoms but not with the number of unprotected sexual episodes in the prior six months. Sexual attitudes of youth may conflict with initiation and maintenance of safer sex practices, making them vulnerable to HIV and other sexually transmitted infections. Risk reduction interventions for adolescents should address this.

Prevalence and predictors of injection drug use and risky sexual behaviors among adolescents in substance treatment

The longitudinal risk for human immunodeficiency virus (HIV) infection following adolescent substance treatment is not known. Therefore, it is not known if adolescent substance treatment should include HIV prevention interventions. To address this important research gap, this study evaluates the longitudinal prevalence and predictors of injection drug use (IDU) and sex risk behaviors among adolescents in substance treatment. Participants were 260 adolescents (13-18 years) in substance treatment and 201 community control adolescents (11-19 years). Participants were assessed at baseline and follow-up (mean time between assessments = 6.9 years for the clinical sample and 5.6 years for the community control sample). Outcomes included self-report lifetime history of IDU, number of lifetime sex partners and frequency of unprotected sexual intercourse. At baseline, 7.5% of the clinical sample, compared to 1.0% of the community control sample had a lifetime history of IDU (χ12=10.53, p = .001). At follow-up, 17.4% of the clinical sample compared to 0% of the community control sample had a lifetime history of IDU (χ12=26.61, p = .0005). The number of baseline substance use disorders and onset age of marijuana use significantly predicted the presence of lifetime IDU at follow-up, after adjusting for baseline age, race, and sex. The clinical sample reported more lifetime sex partners and more frequent unprotected sex than the community control sample at baseline and follow-up. Many adolescents in substance treatment develop IDU and report persistent risky sex. Effective risk reduction interventions for adolescents in substance treatment are needed that address both IDU and risky sex.

Relationships between Adolescent Sexual Risk Behaviors and Emotional Self-Efficacy

Relationships between sexual risk behaviors and emotional self-efficacy among high school adolescents (N = 2,566), with the exclusion of some respondents, were explored via cross-sectional study in South Carolina. The CDC Youth Risk Behavior Survey sexual risk-taking items and an adolescent emotional self-efficacy scale were utilized. Adjusted logistic regression analyses revealed significant race/gender differences. Findings suggest that ever having sexual intercourse, early age of first sex, number of recent and lifetime sexual partners, non-condom use/non-contraceptive use, alcohol use before intercourse and being forced to have sex were associated (α ≤ .05) with reduced emotional self-efficacy for specific race/gender groups. Results have implications for sexual risk reduction interventions for adolescents.

Effectiveness of an HIV/STD risk-reduction intervention for adolescents when implemented by community-based organizations: a cluster-randomized controlled trial.

We evaluated the effectiveness of an HIV/STD risk-reduction intervention when implemented by community-based organizations (CBOs). In a cluster-randomized controlled trial, 86 CBOs that served African American adolescents aged 13 to 18 years were randomized to implement either an HIV/STD risk-reduction intervention whose efficacy has been demonstrated or a health-promotion control intervention. CBOs agreed to implement 6 intervention groups, a random half of which completed 3-, 6-, and 12-month follow-up assessments. The primary outcome was consistent condom use in the 3 months prior to each follow-up assessment, averaged over the follow-up assessments. Participants were 1707 adolescents, 863 in HIV/STD-intervention CBOs and 844 in control-intervention CBOs. HIV/STD-intervention participants were more likely to report consistent condom use (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.06, 1.84) than were control-intervention participants. HIV/STD-intervention participants also reported a greater proportion of condom-protected intercourse (beta = 0.06; 95% CI = 0.00, 0.12) than did the control group. This is the first large, randomized intervention trial to demonstrate that CBOs can successfully implement an HIV/STD risk-reduction intervention whose efficacy has been established.

Creating Project Talanoa: A Culturally Based Community Health Program for U.S. Pacific Islander Adolescents

This is an evaluation of the process and outcome of a research study to determine a culturally targeted health promotion program for U.S. Pacific Islander youth who are at risk for co-occurring problem behaviors, including risky sexual behavior, substance abuse, and interpersonal violence. An exploratory design was used and included qualitative interviews (N=54), focus groups (N=16), participant observation (over 3 years), and surveys (N=24) with Pacific Islander adults and youth. After identifying key cultural values and reviewing existing evidence-based prevention interventions, "Project Talanoa" was developed around 4 constructs: (1) cultural identity and pride, (2) teen health, (3) peer relations, and (4) family ties. The program was pilot tested and evaluated by 24 Pacific Islander adolescents (ages 12-15 years). Results indicate it was culturally appropriate, well liked by the participants, supported by parents and others in the community, and found to be feasible. Additional research is needed to test it for effectiveness. Project Talanoa provides a model for applying cultural concepts in the development of a risk reduction intervention for adolescents.

LATENT CLASS ANALYSIS OF RISK BEHAVIORS AMONG BAHAMIAN YOUNG ADOLESCENTS: RELATIONSHIP BETWEEN VALUES PRIORITIZATION AND LATENT CLASS

To explore an association between values and risk behaviors among early adolescents, baseline data from 689 Bahamian youth (median age = 10) were collected from the Portrait Values Questionnaire (Schwartz et al., 2001) and The Bahamian Youth Health Risk Behavioral Inventory. Latent class analysis identified three classes of youth in differing patterns of risk behavior: (7.8%) high levels of drug and delinquency risk behaviors; (2.8%) high levels of sexual risk behavior; (89.4%) low risk takers. Results showed low risk takers included more females, while at least twice as many males comprised the two risk behavior classes. ANOVA found Benevolence, Conformity, Security, Tradition and Universalism values were associated with low risk takers, and logistic regressions for ordered categorical (ordinal) dependent variables showed both values and latent class predicted intentions for future risk behavior. Latent class analysis and values assessment are discussed as tools to guide adolescent riskreduction interventions.

Developmentally appropriate sexual risk reduction interventions for adolescents: rationale, review of interventions, and recommendations for research and practice.

Despite awareness of the need to design developmentally appropriate sexual risk reduction interventions for adolescents, limited information exists to identify the aspects of intervention design or content that make an intervention developmentally appropriate. (a) To clarify the rationale for designing developmentally appropriate interventions, (b) to review randomized controlled trials (RCTs) of adolescent sexual risk reduction interventions, (c) to identify developmentally appropriate strategies, (d) to examine the relationship between developmental appropriateness and sexual risk outcomes, and (e) to provide recommendations for research. The authors examined studies (n = 24) published before 2003 that evaluated a risk reduction intervention, sampled adolescents, used an RCT study design, and evaluated sexual behavior outcomes. Content analysis indicated that the interventions tested were often tailored to the cognitive level of adolescents, as indicated by the use of exercises on decision making, goal setting and planning, and concrete explanation of abstract concepts. Interventions also addressed the social influences of risky sex such as peer norms and provided communication skills training. Overall, the interventions tested in RCTs were more effective in delaying the onset of sexual activity than in promoting abstinence among sexually active youth. Interventions with booster sessions were effective in reducing sexual risk behavior. The use of process measures, linked with developmental constructs, was rare. However, improvements in sexual communication skills and perceived norms for safer sex were associated with reductions in sexual risk outcomes. Developmental transitions during adolescence influence sexual behavior and should be considered when developing and evaluating risk reduction interventions for youth. Future research should assess process measures of key developmental constructs as well as risk behavior and biological outcomes.

Challenges and New Directions in the Rural Setting

ABSTRACT Although frequently not perceived as a rural problem, the prevalence of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) has been increasing in rural settings. Since the emergence of the AIDS epidemic in the United States, researchers and clinicians have been concerned about behaviors placing adolescent populations at risk for acquiring HIV and have sought to develop effective intervention programs. To date, most of these programs have targeted urban or suburban settings. Assessing the applicability of current adolescent risk reduction interventions in new settings is essential to the successful deployment of intervention programs on a wide scale basis. Previous rural research has identified factors suggesting that programs originally developed for urban areas may need to be altered to be applicable to rural settings. As part of our effort to adopt an urban adolescent HIV prevention program entitled “Focus on Kids” to a low-income rural setting, we explored the interplay of rural factors within adolescent risk and protective behaviors and prevention programs according to the perception of community residents. Qualitative research methods were used, including ethnographic approaches previously employed in the urban setting to design the original “Focus on Kids Program.” The findings from the present study identified several factors that might influence the adaptation of urban adolescent risk reduction interventions in low-income rural areas. The present findings suggest that a poor, rural setting provides contextual differences that may influence adolescents' involvement in unprotected sexual behaviors and other risk behaviors.

Longitudinal influence of perceptions of peer and parental factors on African American adolescent risk involvement.

To explore the long-term contributions of perceived peer and parental influences on adolescent risk and protective behaviors (sexual involvement, condom use, and drug use), we assessed self-reported behaviors and perceptions of peer risk involvement and parental supervision and communication among 383 low-income, urban African Americans aged 9 to 15 years at baseline over a 4-year period. Baseline perceptions of peer sexual involvement were significantly associated with youth sexual behavior at baseline and were predictive of sexual involvement through all 4 years of follow-up. Perceived parental monitoring was inversely correlated with sexual involvement through 3 years of follow-up. Perceptions of peer condom use were associated with increased levels of condom use at baseline and through 6 months of follow-up. Positive parental communication was correlated with increased condom use. Drug use was higher among youths who perceived peers or family members to be using drugs and was inversely correlated with increased parental monitoring and supervision. Stepwise regression revealed peer and parental influences for all three behaviors. Perceptions of both peer and parental behaviors influence long-term risk and protective behaviors of adolescents. Therefore, parents should be included in adolescent risk-reduction intervention efforts. Inclusion of friends and/or changing youth perceptions of peer involvement may also be effective intervention strategies.