Reducing Sexual Risk Behaviours in Adolescents

A systematic review 1 including 24 controlled trials (3 RCTs) with a total of 34 281 participants was abstracted in DARE. Statistically significant findings included improvement in condom use (8/20 studies), reduction in the number of sexual partners (4/12 studies), and reduction in the frequency of unprotected sexual intercourse (5/7 studies). STD prevention interventions did not lead to an increase in the number of adolescents who chose to become sexually active, or in the frequency of sexual intercourse. The authors conclude that effective interventions need five features: theory-based design, provision of STD facts, skills-building exercises, the use of trained facilitators, and a duration of at least 8 hours. Interventions should focus on the provision of condoms, information and demonstration of their use.

Another systematic review 2 including 23 studies (6 experimental, 10 quasi-experimental, 7 national surveys) was abstracted in DARE. According to the authors, effective program characteristics were the following:

• A narrow focus on reducing sexual risk-taking behaviours that may lead to HIV-STD infection or unintended pregnancy
• Social learning theories as a foundation for programme development. These programmes went beyond cognitive level: they focused on recognising social influences, changing individual values, changing group norms and building social skills.
• Provision of basic, accurate information about the risks of unprotected intercourse and methods of avoiding unprotected intercourse through experimental activities designed to personalise this information.
• Inclusion of activities that address social or media influences on sexual behaviours
• Reinforcement of clear and appropriate values to strengthen individual values and group norms against unprotected sex
• Provision of modelling and practice in communication and negotiation skills

A third systematic review 3 abstracted in DARE reviewed the effectiveness of prevention interventions for AIDS in adolescents, including 40 studies (32 RCTs) on subjects with a mean age of 14.3 years (range 10-18 years). Positive intervention impacts included changes in knowledge (88% of studies), changes in attitude (58%), changes in intention to use condoms (60%), condom use (73%), and decrease in the number of sexual partners (64%). Interventions that demonstrated an increase in intention to use a condom were significantly more likely to be theory-based than those that did not show any significant changes in intention (100 versus 0%, p=0.048). Interventions that increased condom use and decreased the number of sexual partners were longer in duration than those that did not improve these outcomes. The meta-analysis (n=4) showed a significant reduction in the proportion of participants who indicated using a condom at their last episode of sexual activity for a 6-month (p=0.005) and 12-month (p=0.015) follow-up. No differences were found in the proportion of participants who always used a condom.

Comment: There is insufficient direct evidence to determine whether any of these educational or clinic programmes actually decreased pregnancy rates, birth rates, or incidence of STD or HIV infections.

References

• Yamada J, DiCenso A, Feldman L, Cormillott P, Wade K, Wignall R, Thomas H. A systematic review of the effectiveness of primary prevention programs to prevent sexually transmitted diseases in adolescents. Dundas, ON, Canada: Ontario Ministry of Health, Region of Hamilton-Wentworth, Social and Public Health Services Division. Effective Public Health Practice Project 1999. [DARE]
• Kirby D, Short L, Collins J, Rugg D, Kolbe L, Howard M, Miller B, Sonenstein F, Zabin LS. School-based programs to reduce sexual risk behaviors: a review of effectiveness. Public Health Rep 1994 May-Jun;109(3):339-60. [PubMed][DARE]
• Kim N, Stanton B, Li X, Dickersin K, Galbraith J. Effectiveness of the 40 adolescent AIDS-risk reduction interventions: a quantitative review. J Adolesc Health 1997 Mar;20(3):204-15. [PubMed] [DARE]