Skills-Based Approaches Affect STI Risk Behavior More Than Information
Hollander, D., International Family Planning Perspectives
Interventions that emphasize STI risk reduction skills may be more effective at lowering the prevalence of risky behaviors and preventing infection among teenage women than programs that simply provide information about how to reduce risk. (1) In a randomized controlled trial conducted in Philadelphia, a city in the northeastern United States, participants in a skills-based STI prevention intervention reported less unprotected sex one year later than did a control group, who received a general health promotion intervention. They also had a lower STI incidence and reported less involvement with multiple partners and less unprotected sex while drunk or high than controls. Outcomes among young women who received an information-based STI prevention intervention did not differ from those among controls.
The interventions were part of a project designed to lower the risk of health problems among inner-city black and Hispanic teenage women. Using group discussions, videotapes, games and exercises in a single 250-minute session, the STI prevention programs addressed the high rates of HIV and other STIs among black and Hispanic young women, personal vulnerability, substance use, and condom use and negotiation skills. They differed only in that the skills-based intervention had participants practice putting condoms on anatomical models and engage in role-playing exercises to increase condom negotiation skills. The trial was open to sexually experienced, nonpregnant 12-19-year-olds obtaining family planning care at a hospital adolescent medicine clinic.
In all, 682 young women (463 blacks and 219 Hispanics) enrolled. Participants completed a self-administered questionnaire before the intervention, immediately afterward, and at three-, six- and 12-month follow-up visits; they also provided biological specimens for STI testing at enrollment and at the six- and 12-month visits. According to data from the baseline surveys, in the three months before entering the study, 87% of the teenagers had had intercourse, 52% had had unprotected sex and 16% had had multiple partners; two in 10 tested positive for gonorrhea, chlamydia or trichomoniasis at baseline. Women in the three study groups did not differ on these characteristics or on any of a range of variables that might mediate the effects of the interventions.
For the primary outcome measure, the reported number of days on which respondents had had unprotected sex in the previous three months, no differences were observed between groups at the three- and six-month follow-up visits. …