Safer Sex Intervention (SSI)

Investigators: Lydia A. Shrier, MD, MPH, Rose Ancheta, MPH, Elizabeth Goodman, MD, Victoria Chiou, BA, Michelle R. Lyden, RN, PNP, & S. Jean Emans, MD

Data from the Centers for Disease Control and Prevention suggest that over 50% (and in some years, as high as two thirds) of the population who contract an STI are under the age of 25, and disproportionately, are adolescent girls. Adolescent girls with an STI infection are at risk for recurrence and more long-term reproductive health issues such as pelvic inflammatory disease (PID) and infertility. Safer Sex Intervention (SSI) is an individualized STI intervention program aimed at sexually active young women, ages 13-23, who have been diagnosed with an STI. The overall goals are to reduce high-risk sexual behaviors, increase condom use and prevent the recurrence of an STI among sexually active young women. The program is appropriate for use in clinics or community based organizations led by a female health educator. This individualized intervention was designed to be delivered at the time of STI diagnosis/treatment, when the participant was most likely to be contemplating her diagnosis relative to her sexual risk behaviors. The intervention is administered 1-on-1 and face-to-face using one of two discrete 30- to 50-minute sessions. Safer Sex Intervention (SSI) was evaluated with an opportunistic study design (at time of STI treatment) that included baseline, 1, 3, 6 and 12 month follow up. Subjects were female, under 24 years of age, with a diagnosis and treatment plan for either cervicitis or PID. At 1 month, the intervention condition subjects had increased sexual risk knowledge (P=.02), more positive attitudes towards condom use (P=.007). At 6 months, intervention subjects report fewer instances of sexual intercourse with non-main partners than the standard-of-care condition. In other words, they were more likely to report lower sexual risk (sex with a non-main partner) as compared to the standard-of-care (control) condition (P=.01). Consistent with findings at 1 month, the intervention condition had a continued increase in positive attitudes regarding condoms (P=.007). One year after SSI, the girls who received the program were more likely to have a main sexual partner and thus, decreased their risk (P=.07) and were also less likely to have recurrence of an STI than the control group (but this was not significant; P=.17). SSI is supported by the Office of Adolescent Health (OAH)'s Teen Pregnancy Prevention (TPP) program as an EBI that is medically accurate, age appropriate, and has proven through rigorous evaluation to prevent teen pregnancy and/or associated sexual risk behaviors. Click here to view more detailed information on this program.

FOCUS: Preventing Sexually Transmitted Infections and Unwanted Pregnancies among Young Women

Investigators: Cherrie Boyer, Mary-Ann Shafer, Lance Pollack, Kelli Betsinger, Y. Jason Yang, Julius Schachter, Richard Shaffer, Stephanie Brodine, Heidi Kraft

The FOCUS program, a four-session cognitive-behavioral group intervention addressing prevention of sexually transmitted infections (STIs) and unintended pregnancies, was originally delivered to young women US Marine Corps recruits. Following a baseline survey, 2,157 women were randomized into either the experimental group (n=1,062) or the control group (n=1,095). Both groups received interventions of four two-hour sessions. Follow-up surveys were conducted with both groups at approximately four months post-baseline and approximately 14 months post-baseline. The evaluation results revealed that a higher proportion of the control group had a post-intervention STI or unintended pregnancy than the intervention group (Odds Ratio = 1.41, 95% Confidence Interval = 1.01-1.98). Among study participants who had no pre-intervention history of STIs or pregnancy, but who engaged in risky sexual behaviors just before recruit training, the control group was significantly more likely to acquire a post-intervention STI than the intervention group (OR = 2.05, CI = 1.74-4.08). Among study participants who reported not being sexually experienced at baseline, control group participants were significantly more likely to have had multiple sexual partners post-intervention than intervention group participants (OR = 1.87, CI = 1.01-3.47). FOCUS is supported by the Office of Adolescent Health (OAH)'s Teen Pregnancy Prevention (TPP) program as an EBI that is medically accurate, age appropriate, and has been proven through rigorous evaluation to prevent teen pregnancy and/or associated sexual risk behaviors. Click here to view more detailed information on this program.

Computer-Assisted Motivational Interviewing (CAMI): Preventing Repeat Births Among Adolescent Mothers

Investigators: Beth Barnet, Jiexin Liu, Margo DeVoe, Anne K. Duggan, Melanie A. Gold, & Edward Pecukonis

According to the Centers for Disease Control and Prevention, in 2010, more than 360,000 infants were born to women aged 15 to 19 years in the United States. Nearly one-quarter of adolescent mothers give birth to another child within two years, despite national efforts to increase timing between births. Adolescent mothers who give birth to more than one child may be at high risk for experiencing poorer medical, educational, economic, and developmental outcomes. The purpose of the Computer-Assisted Motivational Interviewing (CAMI) is to increase motivation among adolescent mothers to consistently use condoms and contraception with the long-term goal of reducing rapid repeat births. CAMI consists of at least two 60-minute sessions conducted in two-parts by trained counselors who meet one-on-one with pregnant and/or parenting adolescent mothers, ages 12 through 18 years old. During the first part of each session, participants use the computer-based CAMI Program to answer questions about current sexual relationships and contraceptive use intentions and behaviors. Based on the responses generated, CAMI counselors conduct a stage-matched motivational interviewing session to enhance participants' motivation to consistently use condoms and contraception in order to reduce the risk for a repeat pregnancy. An evaluation of CAMI has demonstrated that receiving two or more CAMI sessions, either alone or within a multi-component home-based intervention, reduced the risk of repeat births among adolescent mothers aged 18 years and younger. Click here to view more detailed information on this program.

ABAN AYA Youth Project: 5th Grade

Investigators: Brian Flay, DPhil, Sally Graumlich, EdD, CHES, & the ABAN AYA Team

ABAN AYA is an Afrocentric social development curriculum instructed over a four-year period, beginning in the fifth grade. The ABAN AYA 5th Grade product contains all of the materials needed to implement the ABAN AYA 5th grade curriculum. The ABAN AYA name is drawn from two Ghanaian words: ABAN (fence) signifies double/social protection; AYA (the unfurling fern) signifies self-determination. The purpose of ABAN AYA is to promote abstinence from sex, and to teach students how to avoid drugs and alcohol, and how to resolve conflicts non-violently. ABAN AYA was developed to address multiple problem behaviors such as violence, substance abuse, delinquency and sexual activity, simultaneously in a long-term intervention specifically for African American youths in grades five through eight. The longitudinal evaluation of the program involved 12 schools in the metropolitan Chicago area between 1994 and 1998. At baseline, 1153 fifth graders participated in the pencil-and-paper assessment. All participants were African American. Follow-up assessments were conducted at the conclusion of grades five through eight. At study conclusion, there were no significant intervention effects for girls. For boys, however, ABAN AYA significantly reduced the rate of increase in violent behavior (by 35% compared with controls), provoking behavior (41%) school delinquency (31%) drug use (32%), and recent sexual intercourse (44%). ABAN AYA also improved the rate of increase in condom use (95%) as compared to the health education control condition. Aban Aya is supported by the Office of Adolescent Health's Teen Pregnancy Prevention (TPP) program as an EBI that is medically accurate, age appropriate, and has proven through rigorous evaluation to prevent teen pregnancy and/or associated sexual risk behaviors. Click here to view more detailed information on this program.

ABAN AYA Youth Project: 7th Grade

Investigators: Brian Flay, DPhil, Sally Graumlich, EdD, CHES, & the ABAN AYA Team

ABAN AYA is an Afrocentric social development curriculum instructed over a four-year period, beginning in the fifth grade. The ABAN AYA 7th Grade product contains all of the materials needed to implement the ABAN AYA 7th grade curriculum. The ABAN AYA name is drawn from two Ghanaian words: ABAN (fence) signifies double/social protection; AYA (the unfurling fern) signifies self-determination. The purpose of ABAN AYA is to promote abstinence from sex, and to teach students how to avoid drugs and alcohol, and how to resolve conflicts non-violently. ABAN AYA was developed to address multiple problem behaviors such as violence, substance abuse, delinquency and sexual activity, simultaneously in a long-term intervention specifically for African American youths in grades five through eight. The longitudinal evaluation of the program involved 12 schools in the metropolitan Chicago area between 1994 and 1998. At baseline, 1153 fifth graders participated in the pencil-and-paper assessment. All participants were African American. Follow-up assessments were conducted at the conclusion of grades five through eight. At study conclusion, there were no significant intervention effects for girls. For boys, however, ABAN AYA significantly reduced the rate of increase in violent behavior (by 35% compared with controls), provoking behavior (41%) school delinquency (31%) drug use (32%), and recent sexual intercourse (44%). ABAN AYA also improved the rate of increase in condom use (95%) as compared to the health education control condition. Aban Aya is supported by the Office of Adolescent Health's Teen Pregnancy Prevention (TPP) program as an EBI that is medically accurate, age appropriate, and has proven through rigorous evaluation to prevent teen pregnancy and/or associated sexual risk behaviors. Click here to view more detailed information on this program.

ABAN AYA Youth Project: 6th Grade

Investigators: Brian Flay, DPhil, Sally Graumlich, EdD, CHES, & the ABAN AYA Team

ABAN AYA is an Afrocentric social development curriculum instructed over a four-year period, beginning in the fifth grade. The ABAN AYA 6th Grade product contains all of the materials needed to implement the ABAN AYA 6th grade curriculum. The ABAN AYA name is drawn from two Ghanaian words: ABAN (fence) signifies double/social protection; AYA (the unfurling fern) signifies self-determination. The purpose of ABAN AYA is to promote abstinence from sex, and to teach students how to avoid drugs and alcohol, and how to resolve conflicts non-violently. ABAN AYA was developed to address multiple problem behaviors such as violence, substance abuse, delinquency and sexual activity, simultaneously in a long-term intervention specifically for African American youths in grades five through eight. The longitudinal evaluation of the program involved 12 schools in the metropolitan Chicago area between 1994 and 1998. At baseline, 1153 fifth graders participated in the pencil-and-paper assessment. All participants were African American. Follow-up assessments were conducted at the conclusion of grades five through eight. At study conclusion, there were no significant intervention effects for girls. For boys, however, ABAN AYA significantly reduced the rate of increase in violent behavior (by 35% compared with controls), provoking behavior (41%) school delinquency (31%) drug use (32%), and recent sexual intercourse (44%). ABAN AYA also improved the rate of increase in condom use (95%) as compared to the health education control condition. Aban Aya is supported by the Office of Adolescent Health's Teen Pregnancy Prevention (TPP) program as an EBI that is medically accurate, age appropriate, and has proven through rigorous evaluation to prevent teen pregnancy and/or associated sexual risk behaviors. Click here to view more detailed information on this program.

ABAN AYA Youth Project: 8th Grade

Investigators: Brian Flay, DPhil, Sally Graumlich, EdD, CHES, & the ABAN AYA Team

ABAN AYA is an Afrocentric social development curriculum instructed over a four-year period, beginning in the fifth grade. The ABAN AYA 8th Grade product contains all of the materials needed to implement the ABAN AYA 8th grade curriculum. The ABAN AYA name is drawn from two Ghanaian words: ABAN (fence) signifies double/social protection; AYA (the unfurling fern) signifies self-determination. The purpose of ABAN AYA is to promote abstinence from sex, and to teach students how to avoid drugs and alcohol, and how to resolve conflicts non-violently. ABAN AYA was developed to address multiple problem behaviors such as violence, substance abuse, delinquency and sexual activity, simultaneously in a long-term intervention specifically for African American youths in grades five through eight. The longitudinal evaluation of the program involved 12 schools in the metropolitan Chicago area between 1994 and 1998. At baseline, 1153 fifth graders participated in the pencil-and-paper assessment. All participants were African American. Follow-up assessments were conducted at the conclusion of grades five through eight. At study conclusion, there were no significant intervention effects for girls. For boys, however, ABAN AYA significantly reduced the rate of increase in violent behavior (by 35% compared with controls), provoking behavior (41%) school delinquency (31%) drug use (32%), and recent sexual intercourse (44%). ABAN AYA also improved the rate of increase in condom use (95%) as compared to the health education control condition. Aban Aya is supported by the Office of Adolescent Health's Teen Pregnancy Prevention (TPP) program as an EBI that is medically accurate, age appropriate, and has proven through rigorous evaluation to prevent teen pregnancy and/or associated sexual risk behaviors. Click here to view more detailed information on this program.

Reach for Health: A School-Sponsored Community Youth Service Intervention for Middle School Students

Investigators: Lydia O'Donnell, Alexi San Doval, Richard Duran, Deborah Haber, Rebecca Atnafou, Patricia Piessens, & Renee F. Wilson-Simmons, Ann Stueve, Joseph H. Pleck, Norma Johnson, Uda Grant, Helen Murray

The REACH FOR HEALTH COMMUNITY YOUTH SERVICES PROGRAM (RFH-CYS) targets African-American and Hispanic youth living in urban areas. REACH FOR HEALTH combines a classroom teaching component with community service work. The intervention, as implemented, provides opportunities for middle school students to participate in service activities within their communities while simultaneously reducing early and unprotected sexual activity. The intervention was initially delivered in 1994 to two large middle schools in Brooklyn, NY; one school was designated as the intervention school, the other as the control. A total of 68 classrooms participated in the initial implementation. In the control school, 33 classrooms (584 students) received the standard New York City health education program, which includes some mandated lessons on drugs and AIDS. Within the intervention school, 22 classrooms (222 students) were randomly assigned to receive core RFH curriculum (classroom component only). The remaining 13 intervention classrooms (255 students) received the enhanced RFH plus Community Youth Services program (RFH-CYS). Bi-lingual and special education classes were included from both school sites. At follow-up six months later, reports of sexual activity were higher across the sample. However, students in the control condition showed greater increases in risk behavior (ever had sex, recent sex, recent sex without condom, recent sex without birth control) than did their peers in the treatment conditions. In contrast, students in both intervention conditions showed increases in their use of STD protection and birth control. Also noteworthy are the findings that eighth graders and special education students showed the greatest improvement. Click here to view more detailed information on this program.

National Health and Social Life Survey, 1992

Investigators: Edward O. Laumann, Robert T. Michaels, John H. Gagnon, & Stuart Michaels

The 1992 National Health and Social Life Survey (NHSLS) is the most comprehensive representative survey to date of sexual behavior in the United States general population. Conducted by a research team centered at the University of Chicago, the NHSLS was designed not only to determine the prevalence of various sexual practices, but also to examine the social and psychological contexts in which those practices occur. The NHSLS dataset contains information on 1,604 variables gathered from interviews with a national probability sample of 3,432 American men and women between the ages of 18 and 59. The study explores the extent to which sexual conduct and general attitudes toward sexuality are influenced by gender, age, marital status, and other demographic characteristics. Among the numerous topics covered by the NHSLS are early sexual experiences, masturbation, contraception and fertility, sexual abuse, coercion, sexual health, satisfaction, sexual fantasy, sexual dysfunction and homosexuality. Demographic information was collected on race, religious affiliation, education, and income.

National Survey of Adolescent Males-1988 and 1990-91

Investigators: Freya L. Sonenstein, Joseph H. Pleck, & Leighton Ku

The National Survey of Adolescent Males 1988 and 1990-91 (NSAM) is a two-wave, longitudinal study conducted between 1988 and 1991. The survey followed young men from adolescence, the period of initiation of sexual activity and other risk behaviors, into the beginning of young adulthood, a time when sexual activity is often at its highest. This dataset includes data from both Wave 1 (1988) and Wave 2 (1990-91) of the survey. In 1988, a nationally representative sample of 1,880 never-married, non-institutionalized males ages 15 to 19 living in the contiguous United States was surveyed. The original sample of 1,880 males was drawn as a multistage area probability sample that oversampled for Blacks and Hispanics. The study's primary objective was to determine adolescent males' behaviors, education and knowledge concerning human sexuality, contraception, and sexually transmitted diseases. Wave 1 data were collected between April and December 1988. The primary mode of data collection was face-to-face interviews. The most sensitive topics (e.g., substance use, risky sexual behaviors) were assessed with confidential, written self-administered questionnaires. Extensive personal histories of sexual activity and contraception use were gathered, as well as respondents' personal perceptions of the various costs and benefits of contraceptive use and fathering children. Information on school attendance and recent employment history were also included. Wave 2 of NSAM, which is also referred to as the Follow-up Survey of Young Men (FSAM), was conducted between November 1990 and March 1991, when respondents were generally between the ages of 17 and 22. Of those respondents that participated in Wave 1, the follow-up rate was 89 percent (N=1,676). Data collection procedures were similar to that of Wave 1, with the use of face-to-face interviews and self-administered questionnaires.