Sexual Risk Prevention Programs Research Articles

A randomized controlled trial of an online alcohol and sexual risk prevention program for college students studying abroad

IntroductionAmerican college students who study abroad experience increases in their drinking behavior, concerning risky sexual behaviors, and high rates of sexual violence while abroad. Despite these concerns, institutions offer limited programming to students prior to departure to address these risks and no empirically supported interventions currently exist that are targeted toward preventing increased drinking, risky sexual behavior, and sexual violence abroad. To help address alcohol and sexual risk abroad, we designed a brief, single-session online predeparture intervention focused on risk and protective factors known to associate with alcohol and sexual risk abroad. MethodsUsing a sample of 650 college students from 40 home institutions, we conducted a randomized controlled trial of the intervention and tested its effects on drinking (drinks per week, binge drinking frequency, alcohol related-consequences), risky sexual behaviors, and sexual violence victimization during the trip abroad (first month, last month abroad) and one-month and three-months after return home. ResultsWe observed small, but nonsignificant, intervention effects on drinks per week and binge drinking days during the first month abroad and three months after they had returned home to the United States, and small, significant effects on risky sexual behaviors during the first month abroad. The study found no observable effects at any time point for alcohol-related consequences or for sexual violence victimization abroad. ConclusionsThough mostly nonsignificant, small initial intervention effects were promising in this first empirical test of an alcohol and sexual risk prevention program for study abroad students. However, students may need more intensive programming with booster sessions to experience lasting intervention effects during this particularly high-risk period. ClinicalTrials.gov identifierNCT03928067

Risky sexual behavior and associated factors among sexually-experienced adolescents in Bangkok, Thailand: findings from a school web-based survey

BackgroundThe risk of sexually transmitted infections (STI) arises when there is unsafe sexual activity. Unsafe sex often begins in the teenage years, and it will persist as long as there is the opportunity for risky sexual activity. The purpose of this study was to assess the sexual risk behaviors and related factors of sexually-active adolescents in educational institutions in Thailand.MethodsThis was cross-sectional survey using an Internet-based application in schools in Bangkok from November 2020 to February 2021 with a total of 6,167 high school and vocational students. The schools were selected by simple random sampling among institutions, and the students were systematically randomly selected, with an equal number of males and females. We used multivariable logistic regression to analyze associations and control confounding variables. Indicators of risky sex include: (1) Not using a condom; (2) Having more than one sex partner; (3) Having sex in exchange for cash or in-kind compensation; and (4) Having sex without consent.ResultsOf a total of 872 sexually-active participants, the mean age was 15.6 years, 66.9% were vocational students, 42.1% were male, 57.9% were female, and 69.5% had sex risk behavior. The multivariate logistic regression analysis identified the following statistically-significant factors related to risky sex: smokes cigarettes (AOR = 1.79; 95% CI 1.12–2.88); uses cannabis (AOR = 2.84; 95% CI 1.23–6.56); gambles (AOR = 1.81; 95% CI 1.28–2.55); has sex without contraception (AOR = 2.74; 95% CI 2.91–3.93); has a history of childhood sex abuse (AOR = 1.60; 95% CI 1.03–2.56).ConclusionsOur findings suggest that, in designing and implementing sexual risk prevention programs for adolescents in educational settings, there is a need to highlight the role of substance abuse in relation to sexual risk behaviors. Programs should target both male and female students. Teenagers who use marijuana are more likely to be sexually active than those who have never used marijuana. These potential risks should be taken into account with respect to legalization of marijuana and recreational use of this drug.

Meeting Kids Where They Are At-A Substance Use and Sexual Risk Prevention Program via Telemedicine for African American Girls: Usability and Acceptability Study.

BackgroundRural African American youth lack access to drug and sexual risk–taking prevention programs available in more urban areas. Recent data indicate that rural youth now use substances at higher rates and at younger ages than their urban peers.ObjectiveThis study aims to evaluate the initial usability and acceptability of a low-cost, technology-based approach to delivering effective, culturally tailored, integrated substance use disorder (SUD) and HIV risk behavior prevention programs to African American female youth to inform the use of this intervention via telemedicine for rural youth.MethodsEffective SUD prevention strategies and emotion regulation skills were integrated into an existing evidence-based HIV risk reduction program culturally tailored for African American female adolescents—Sisters Informing, Healing, Living, and Empowering (SIHLE)—and delivered to 39 African American female youth via group telehealth. The evaluation of the resulting program, 12-session SIHLEplus, was completed by 27 girls who also completed self-report measures that assessed sexual risk behaviors (eg, number of partners and age of sex initiation), substance use, exposure to traumatic events, and emotion regulation.ResultsThe descriptive and qualitative results of the pilot study demonstrate the initial usability and acceptability of delivering evidence-based prevention successfully via telehealth to help address health disparities in this vulnerable population.ConclusionsAlthough more research is needed, the findings from this study suggest that SIHLEplus has demonstrated initial usability and acceptability.

Infecciones de transmisión sexual en población joven ¿qué mantiene su exposición al riesgo?

Las infecciones de transmisión sexual, suponen uno de los riesgos más prevalentes entre lapoblación joven. En España, su incidencia se ha incrementado en los últimos años, siendo uno los países más afectados de Europa. Si bien se han llevado a cabo distintos esfuerzos preventivos para revertir la situación, no han mostrado la eficacia esperada. Por eso, resulta necesario profundizar en el análisis de aquellos factores que podrían mantener las conductas de riesgo. Así pues, el objetivo del presente estudio es evaluar el papel de factores psicológicos en la prevención de infecciones de transmisión sexual entre población joven. Para ello, 984 jóvenes de entre 18 y 24 años (32,7% hombres y 67,3% mujeres), sexualmente activos, cumplimentaron un cuestionario online sobre estilos de vida con una sección específica sobre salud sexual. Tras los análisis se observa cómo, solamente,un 37,2%, usa el preservativo en el coito vaginal de modo sistemático y un 12,1% en el coito anal. Asimismo, se observa cómo un mayor uso del preservativo se relaciona con tener miedo a las infecciones de transmisión sexual (rho = ,098; p = ,002), pero también con una mayor edad de inicio en las prácticas sexuales (rho = ,075; p = ,021), menor frecuencia en el consumo de alcohol (rho = -,069; p = ,037), menores niveles de ansiedad (rho = -,094; p = ,003), una mayor satisfacción con la imagen corporal (rho = ,066; p = ,033) y un menor uso de pornografía (rho = -,107; p = ,001). En concreto, además del temor a las infecciones de transmisión sexual, el menor uso de pornografía y una menor ansiedad, también contribuirían a una mayor probabilidad de uso del preservativo (Chi2 = 29,18; p = ,001). Así pues, parece evidente la necesidad de incluir también estos otros elementos en los programas de prevención de riesgos sexuales, para mejorar su eficacia entre la población joven.

Depressive Symptoms Moderate Dating Violence Prevention Outcomes Among Adolescent Girls.

Purpose: Few dating violence prevention programs assess how variations in initial violence risk affects responsiveness. This study examines the efficacy of Date SMART, a dating violence and sexual risk prevention program designed to target high-risk adolescent girls, in preventing dating violence in the context of varying initial levels of depressive symptoms. Method: A diverse sample of N = 109 female adolescents with a history of physical dating violence participated in a randomized controlled trial of the Date SMART program and a knowledge only (KO) comparison. Results: Using baseline depression level as a primary risk factor, a series of multilevel models revealed significant main effects of baseline depression such that higher baseline depression was associated with greater physical dating violence perpetration and victimization. Results also showed a three-way interaction for assessment point, depressive symptoms, and condition for physical dating violence perpetration. Specifically, those with higher baseline depression in Date SMART showed significantly less physical dating violence perpetration at follow-ups compared with those with higher baseline depression in the KO group. This difference in violence reduction between conditions was not observed for those with lower baseline depression. Discussion: Date SMART appears to effectively reduce physical dating violence perpetration in those with higher levels of initial risk. Current findings support that adolescents with different risk profiles respond differently to violence prevention programs.

Project Date SMART: a Dating Violence (DV) and Sexual Risk Prevention Program for Adolescent Girls with Prior DV Exposure.

Clinical Trials, NCT01326195, and http://www.clinicaltrials.gov.

The Effects of Men's Hostility Toward Women, Acute Alcohol Intoxication, and Women's Condom Request Style on Men's Condom Use Resistance Tactics.

To extend previous research demonstrating that intoxicated men high in hostility toward women report stronger intentions to use coercive condom use resistance (CUR) tactics to have unprotected sex by examining the role of women's condom request style. Community, non-problem drinking men, ages 21-30 (N = 296) completed standard alcohol administration procedures and read an eroticized story of a casual sexual interaction. Following the woman's request to use a condom, intentions to engage in coercive CUR tactics were assessed. Generalized linear models with gamma distributions assessed the 3-way interaction of men's hostility toward women, beverage condition (alcohol or sober), and the woman's condom request style (indirect, direct, or insistent). The 3-way interaction between hostility toward women, beverage condition, and indirect condom request (vs. direct) significantly predicted men's coercive CUR intentions. Men high in hostility toward women reported stronger CUR intentions after experiencing an indirect condom request, when sober or intoxicated, and after a direct condom request when intoxicated. Men high in hostility toward women reported the weakest CUR intentions when sober following an insistent or direct condom request. Men high in hostility toward women pose a threat to women's sexual safety, particularly when intoxicated or following an indirect condom request. Hostility toward women and alcohol consumption should be addressed in sexual risk prevention programs. Pending further replication, women should be informed of the relative effectiveness of using insistent condom requests.

A Review of the Effectiveness of HIV Sexual Risk Prevention Interventions in Adult Prison Inmates.

This article reviews the effectiveness of HIV sexual risk prevention programs among adult prison inmates. A database search was performed to identify studies that used HIV sexual risk prevention programs with incarcerated adults. Of the 234 articles identified, 9 met the inclusion criteria. In addition, 5 articles were found containing supporting information for the 9 studies reviewed, increasing the number of articles reviewed to 14. All studies reported a significant increase in knowledge or a decrease in high-risk behaviors among the inmates at the conclusion of the interventions. Common limitations included a lack of a theoretical framework used in developing the interventions, a lack of process evaluations to measure program fidelity, and a lack of validity and reliability reporting for the study surveys. However, programs and interventions targeting HIV and sexual risk reduction appear to improve the knowledge of HIV prevention and reduce risk in the adult prison inmate population.

Translational Research in South Africa: Evaluating Implementation Quality Using a Factorial Design

BACKGROUND: HealthWise South Africa: Life Skills for Adolescents (HW) is an evidence-based substance use and sexual risk prevention program that emphasizes the positive use of leisure time. Since 2000, this program has evolved from pilot testing through an efficacy trial involving over 7,000 youth in the Cape Town area. Beginning in 2011, through 2015, we are undertaking a new study that expands HW to all schools in the Metro South Education District. OBJECTIVE: This paper describes a research study designed in partnership with our South African collaborators that examines three factors hypothesized to affect the quality and fidelity of HW implementation: enhanced teacher training; teacher support, structure and supervision; and enhanced school environment. METHODS: Teachers and students from 56 schools in the Cape Town area will participate in this study. Teacher observations are the primary means of collecting data on factors affecting implementation quality. These factors address the practical concerns of teachers and schools related to likelihood of use and cost-effectiveness, and are hypothesized to be "active ingredients" related to high-quality program implementation in real-world settings. An innovative factorial experimental design was chosen to enable estimation of the individual effect of each of the three factors. RESULTS: Because this paper describes the conceptualization of our study, results are not yet available. CONCLUSIONS: The results of this study may have both substantive and methodological implications for advancing Type 2 translational research.

Hooking Up and Sexual Risk Taking Among College Students: A Health Belief Model Perspective

"Hooking up" with friends, strangers, and acquaintances is a popular way for college students to experience sexual intimacy without investing in relationships. Because hooking up often occurs in situations in which prophylactics against sexually transmitted infections (STIs) are not available or in which students' judgment is impaired, it can involve risky behaviors that compromise student health. As such, in-depth studies of the factors related to sexual risk taking during hookups are needed, to advance preventive research and programming. Based on semistructured interviews with 71 college students about their hooking-up experiences, the findings of this study demonstrate that the Health Belief Model can serve as a useful framework for understanding sexual risk taking during hooking up, and offers suggestions for sexual risk-prevention programs on college campuses. The results demonstrate why students' assessments of their own and their peers' susceptibility to STIs are often misinformed. The findings also show how situational characteristics, such as spontaneity, undermine students' sexual self-efficacy.

Challenges of Evaluating Multilevel Interventions

This article uses the Comprehensive Mixed-Methods Participatory Evaluation (CMMPE; Nastasi and Hitchcock Transforming school mental health services: Population-based approaches to promoting the competency and wellness of children, Thousand Oaks, CA: Corwin Press with National Association of School Psychologists 2008; Nastasi et al. School-based mental health services: creating comprehensive and culturally specific programs. Washington, DC: American Psychological Association 2004) model as a framework for addressing the multiplicity of evaluation decisions and complex nature of questions related to program success in multilevel interventions. CMMPE defines program success in terms of acceptability, integrity, social or cultural validity, outcomes (impact), sustainability and institutionalization, thus broadening the traditional notions of program outcomes. The authors use CMMPE and an example of a community-based multilevel sexual risk prevention program with multiple outcomes to discuss challenges of evaluating multilevel interventions. The sexual risk program exemplifies what Schensul and Trickett (this issue) characterize as multilevel intervention-multilevel evaluation (M-M), with both intervention and evaluation at community, health practitioner, and patient levels. The illustration provides the context for considering several challenges related to M-M designs: feasibility of randomized controlled trials within community-based multilevel intervention; acceptability and social or cultural validity of evaluation procedures; implementer, recipient, and contextual variations in program success; interactions among levels of the intervention; unanticipated changes or conditions; multiple indicators of program success; engaging multiple stakeholders in a participatory process; and evaluating sustainability and institutionalization. The complexity of multilevel intervention and evaluation designs challenges traditional notions of evaluation research and experimental designs. Overcoming these challenges is critical to effective translation of research to practice in psychology and related disciplines.

Efficacy of a Parent-Based Sexual-Risk Prevention Program for African American Preadolescents

To evaluate the efficacy of a parent-based sexual-risk prevention program for African American preadolescents. Randomized controlled trial. Community-based study conducted in Athens, Georgia; Atlanta, Georgia; and Little Rock, Arkansas from 2001 to 2004. From 1545 inquiries, 1115 African American parent-preadolescent dyads (child, aged 9-12 years) formed the analytic sample. Participants were randomized into 1 of 3 study arms: enhanced communication intervention (five 2 1/2-hour sessions), single-session communication intervention (one 2 1/2-hour session), and general health intervention (control, one 2 1/2-hour session). Continuous measures of parent-preadolescent sexual communication and parental responsiveness to sex-related questions at preintervention, postintervention, and at 6- and 12-month follow-ups; and dichotomous measure of preadolescent sexual risk (having engaged in or intending to engage in sexual intercourse at 12-month follow-up). Using intent-to-treat participants, differences of mean change from baseline for continuous measures and relative risk for the dichotomous measure of sexual risk were calculated. Participants in the enhanced intervention had higher mean changes from baseline scores, indicating more sexual communication and responsiveness to sexual communication at each assessment after intervention for all continuous measures than those in the control intervention and single-session intervention. Preadolescents whose parents attended all 5 sessions of the enhanced intervention had a likelihood of sexual risk at the 12-month follow-up of less than 1.00 relative to those whose parents attended the control (relative risk, 0.65; 95% confidence interval, 0.41-1.03) and single-session (relative risk, 0.62; 95% confidence interval, 0.40-0.97) interventions. These results provide preliminary evidence for the efficacy of a parenting program designed to teach sexual communication skills to prevent sexual risk in preadolescents. TRIAL REGISTRATION; clinicaltrials.gov Identifier: NCT00137943.

Community-Based Sexual Risk Prevention Program for SRI Lankan Youth: Influencing Sexual-Risk Decision Making

This article describes the design, implementation, and evaluation of a sexual-risk prevention program focused on the development of individual competencies and cultural norms promoting healthy sexual decision making. The community-based peer-facilitated intervention targeted adolescents and young adult men and women in Sri Lanka, who participated in small-group activities targeting sexual knowledge, attitudes, and practices; risk perception; and sexual-risk decision making. The intervention and evaluation tools were based on formative research data collected from members of the target population. Researchers from Sri Lanka and North America collaborated with local community health workers and community members in formative data collection and program development. The pilot intervention project was successful in improving sexual-risk perception and decision making, and (for women) knowledge of condoms and sexual terminology. The use of group process showed promise as a tool for fostering negotiation of perspectives and consensus building regarding sexuality and sexual risks. The lessons learned from this project can inform the development of culture-specific sexual-risk prevention programs worldwide.