Skills training for pregnancy and AIDS prevention in Anglo and Latino youth

Dual use of long-acting reversible contraceptives and condoms among adolescents

Unintended pregnancy and sexually transmitted infections (STI) continue to be significant public health problems, and adolescents are disproportionately affected by both. With national attention and funding directed toward adolescent pregnancy prevention, promotion of long-acting reversible contraceptive (LARC) use among adolescents is both timely and relevant. However, LARCs provide no protection against STIs, requiring dual-method use of both LARC and barrier methods, most commonly the male latex condom, to address these issues simultaneously. Rates of both LARC and dual-method contraception are low in the United States, but have increased in recent years. Dual-method contraception is highest among younger women and adolescents with multiple or new sex partners. Consistent condom use remains a major barrier to dual-method use, as it necessitates admission of STI risk by both partners, and use is dependent upon two decision-makers rather than a single contraceptive user. Promoting the initiation and maintenance of LARC and condom use across multiple partnered sexual encounters requires understanding of individual, dyadic, and social influences. Successful maintenance of contraceptive and STI prevention behaviors requires individualized, longitudinal reinforcement, and social supports, but can ultimately reduce the burden of unintended pregnancy and STI among adolescents.

Forced intercourse, individual and family context, and risky sexual behavior among adolescent girls

PURPOSE

This study tested the hypothesis that individual and family factors associated with adolescent risky sexual behavior (RSB) operate differently in their relationship to RSB among girls who have experienced forced sexual intercourse (FSI), as compared to those girls who have not.

METHODS

Data were collected from 3,863 eighth-grade girls from a larger statewide sample. Different subgroups of participants received different sets of questions, so 655-2,548 students were included in each analysis. Multilevel modeling was used to examine relationships of individual (social negotiation skills, personal safety, depression, and sensation-seeking personality) and family factors (sibling deviance, parental monitoring, and quality of family relationships) to RSB. FSI was examined as a predictor of RSB and as a moderator of the relationship between individual and family variables and sexual risk.

RESULTS

In the case of individual predictors, social negotiation skills were associated with lower RSB for all girls, but these skills had a stronger relationship to RSB among girls who had experienced FSI. Depression and sensation-seeking tendencies had small positive relationships to RSB for all girls. In the case of family predictors, for girls without a history of FSI, parental monitoring was associated with lower RSB. However, among girls who had experienced FSI, parental monitoring was not significantly related to RSB, but sibling deviance was associated with lower RSB.

CONCLUSIONS

Results suggest that social negotiation skills and parental monitoring may warrant further attention in research and intervention.

Adolescent contraception: review and guidance for pediatric clinicians

The objectives of this article are to review current contraceptive methods available to adolescents and to provide information, guidance, and encouragement to pediatric clinicians to enable them to engage in informed up-to-date interactions with their sexually active adolescent patients. Pregnancy prevention is a complex and dynamic process, and young people benefit from having a reliable authoritative source for information, counseling, and support. Clinicians who provide services for adolescents have a responsibility to develop their skills and knowledge base so that they can serve as that source. This review begins with a discussion about adolescent sexuality and pregnancy in the context of the adolescent developmental stages. We discuss approaches to introduce the topic of contraception during the clinic visit and contraceptive counseling techniques to assist with the discussion around this topic. In addition, information is included regarding confidential services, support of parental involvement, and the importance of male involvement in contraception. The specific contraceptive methods are reviewed in detail with the adolescent patient in mind. For each method, we discuss the mechanism of action, efficacy, contraindications, benefits and risks from the medical perspective, advantages and disadvantages from the patient's perspective, side effects, patient adherence, patient counseling, and any medication interactions. Furthermore, we have included a section that focuses on the contraceptive management for the adolescent patient with a disability and/or chronic illness. The article concludes with an approach to frequently asked or difficult questions. This section largely summarizes subsections on specific contraceptive methods and can be used as a quick reference on particularly challenging topics. Finally, a list of useful contraceptive management resources is provided for both clinicians and patients.

Sexual health behavior interventions for U.S. Latino adolescents: a systematic review of the literature

STUDY OBJECTIVE

To identify sexual health behavior interventions targeting U.S. Latino adolescents.

DESIGN

A systematic literature review.

SETTING

Peer-reviewed articles published between 1993 and 2011, conducted in any type of setting.

PARTICIPANTS

Male and female Latino adolescents ages 11-21 years.

INTERVENTIONS

Interventions promoting sexual abstinence, pregnancy prevention, sexually transmitted infection (STI) prevention, and/or HIV/AIDS prevention.

MAIN OUTCOME MEASURES

Changes in knowledge, attitudes, engagement in risky sexual behaviors, rates of STIs, and/or pregnancy.

RESULTS

Sixty-eight articles were identified. Fifteen were included in this review that specifically addressed Latino adolescent sexual health behavior. Among the reviewed interventions, most aimed to prevent or reduce STI and HIV/AIDS incidence by focusing on behavior change at two levels of the social ecological model: individual and interpersonal. Major strengths of the articles included addressing the most critical issues of sexual health; using social ecological approaches; employing different strategies to deliver sexual health messages; and employing different intervention designs in diverse geographical locations with the largest population of Latino communities. Most of the interventions targeted female adolescents, stressing the need for additional interventions that target Latino adolescent males.

CONCLUSIONS

Latino adolescent sexual health is a new research field with gaps that need to be addressed in reducing negative sexual health outcomes among this population. More research is needed to produce new or validate existing, age-specific, and culturally-sensitive sexual health interventions for Latino male and female adolescents. Further, this research should also be conducted in areas of the U.S. with the newest Latino migration (e.g., North Carolina).

Attitudinal correlates of girls' use of violence in teen dating relationships

This article explores the applicability of the Theory of Planned Behavior in understanding female perpetrated adolescent dating violence. The Theory of Planned Behavior is intended to predict behavioral intention by examining the actor's perceptions of consequences and rewards associated with the behavior, social acceptability of the behavior, and behavioral control. Previous research on adult populations has found that the planned behavior model is correlated with violent behavior among males (Tolman, Edleson, & Fendrich, 1996), but not females (Kernsmith, 2005). The current study found that the model partially explained the violent behavior of girls, but only perceptions of social norms were significant.

Interventions to reduce sexual risk for human immunodeficiency virus in adolescents: a meta-analysis of trials, 1985-2008

OBJECTIVE

To provide an updated review of the efficacy of behavioral interventions to reduce sexual risk of human immunodeficiency virus (HIV) among adolescents.

DESIGN

We searched electronic databases, leading public health journals, and the document depository held by the Synthesis of HIV/AIDS Risk Reduction Project. Studies that fulfilled the selection criteria and were available as of December 31, 2008, were included.

SETTING

Studies that investigated any behavioral intervention advocating sexual risk reduction for HIV prevention, sampled adolescents (age range, 11-19 years), measured a behavioral outcome relevant to sexual risk, and provided sufficient information to calculate effect sizes.

PARTICIPANTS

Data from 98 interventions (51,240 participants) were derived from 67 studies, dividing for qualitatively different interventions and gender when reports permitted it.

MAIN OUTCOME MEASURES

Condom use, sexual frequency, condom use skills, interpersonal communication skills, condom acquisition, and incident sexually transmitted infections (STIs).

RESULTS

Relative to controls, interventions succeeded at reducing incident STIs, increasing condom use, reducing or delaying penetrative sex, and increasing skills to negotiate safer sex and to acquire prophylactic protection. Initial risk reduction varied depending on sample and intervention characteristics but did not decay over time.

CONCLUSIONS

Comprehensive behavioral interventions reduce risky sexual behavior and prevent transmission of STIs. Interventions are most successful to the extent that they deliver intensive content.

Efetividade das ações voltadas à diminuição da gravidez não-planejada na adolescência: revisão da literatura

A gravidez na adolescência é um problema de saúde pública devido à alta ocorrência de morbi-mortalidade materna e infantil e por constituir um possível elemento desestruturador da vida das adolescentes. O objetivo desta revisão foi verificar quais estudos demonstram os resultados da diminuição do índice de gravidez na adolescência a partir de ações estratégicas. Foram identificadas 671 citações na pesquisa às bases de dados, das quais apenas nove foram consideradas apropriadas e utilizadas na análise deste artigo. As abordagens com impacto para redução da ocorrência de gestações precoces foram: a) educação sexual compreensiva (100% com resultados positivos), prevenção de reincidência de gravidez (60%) e programas de abstinência (50%). Apesar de os programas apresentados terem sido focalizados unicamente na população americana, pois foram os que se enquadraram nos critérios de inclusão do presente estudo, observou-se que a utilização de metodologias com abordagens sociais que levam em consideração as diferentes particularidades sócio-demográficas e comportamentais dos adolescentes foram pontos relevantes para o sucesso e reconhecimento das intervenções analisadas, pois são estratégias que remetem à reflexão dos adolescentes sobre as escolhas para sua vida futura.

Pilot test of a single-session AIDS workshop for young Hispanic U.S. immigrants

A multiple-session AIDS workshop poses a substantial burden on the provider and on the clients. Therefore, we developed and pilot-tested a single-session AIDS prevention workshop, using a before and after comparison in a one group design. Young Hispanic patients at an HIV testing clinic completed a baseline survey and were invited to attend a single-session 90-min AIDS prevention workshop. The goals of the workshop were to reinforce issues discussed in the individual HIV counseling session, and to encourage and practice condom carrying, negotiation and use. Forty-seven percent of the patients attended the workshop and evaluated it very positively. Sixty-eight percent of all patients completed a telephone interview 4 weeks later. The proportion of subjects who always carried condoms increased from 18% at baseline to 42% at 4-week follow-up (p < 0.0004). Stratified analyses showed that condom carrying increased significantly only in males and only in workshop attenders.

Adolescent pregnancy

Teen birth rates have decreased steadily over the past decade, but the United States still has the highest birth rates among all developed countries. Young women who give birth as adolescents are likely to have poor school performance, and come from families with low socioeconomic status, a history of teen pregnancies, and low maternal education. The fathers of babies who are born to teen mothers are likely to be unsuccessful in school, have limited earnings, have high rates of substance use, and have trouble with the law. Infants who are born to teen mothers are at risk for low birth weight and physical neglect and abuse; at school age, these children are more likely than children born to adult women to have trouble with school achievement, and they are at risk for becoming teen mothers or fathers themselves. Programs that are successful in reducing teen birthrates are usually multifactorial and combine comprehensive sexuality education with youth development activities; reduction in repeat pregnancies is associated with home visits by nurses combined with long-acting contraceptive use.

Condom availability programs in Massachusetts high schools: relationships with condom use and sexual behavior

OBJECTIVES

This study assessed relationships between condom availability programs accompanied by community discussion and involvement and adolescent sexual practices.

METHODS

Sexual practice and condom use differences were assessed in a representative sample of 4166 adolescents enrolled in high schools with and without condom availability programs.

RESULTS

Adolescents in schools where condoms were available were more likely to receive condom use instruction and less likely to report lifetime or recent sexual intercourse. Sexually active adolescents in those schools were twice as likely to use condoms, but less likely to use other contraceptive methods, during their most recent sexual encounter.

CONCLUSIONS

The strategy of making condoms available, an indication of socioenvironmental support for condom use, may improve HIV prevention practices.

Adolescência e aids: avaliação de uma experiência de educação preventiva entre pares

Ações preventivas de HIV/AIDS, orientadas à superação dos limites das intervenções de corte comportamentalista, incorporando preocupações com os determinantes sócio-culturais desses comportamentos, constituem hoje uma necessidade e, ao mesmo tempo, uma lacuna. O presente artigo trata de estudo de prevenção no ambiente escolar baseado em estratégia de redução de vulnerabilidade. Constitui um estudo de caso, de corte quanti-quali, que, no contexto desta estratégia, avalia o trabalho de prevenção de aids desenvolvido por alunos multiplicadores em uma escola estadual de ensino médio na periferia da cidade de São Paulo. Entre os resultados, destacam-se: a efetividade da proposta, com ampla aceitação e favorável aproveitamento pelos alunos da escola; o perfil diversificado do aluno multiplicador voluntário; e a tensão entre modelos cognitivo-comportamentalistas e social-construtivistas nos processos educativos concretamente operados pelos multiplicadores. Conclui-se pela possibilidade e interesse da ação de alunos multiplicadores na perspectiva das estratégias de redução de vulnerabilidade, apontando-se a necessidade de desenvolver mecanismos de captação e capacitação capazes de problematizar e superar a tensão apontada.

A cluster randomized trial of a sex education programme in Belize, Central America

BACKGROUND

Concerns about adverse consequences of early childbearing and risk of sexually transmitted diseases (STD) have renewed interest in the sexual behaviour of adolescents in developing countries, where they represent a large proportion of the population and are at highest risk. To date, little is known about the sexual knowledge of adolescents in developing countries. This study's primary objective was to evaluate the effectiveness of a responsible sexuality education programme (RSP) in changing knowledge associated with sex and sexuality; secondary objectives were to evaluate changes in attitudes and behavioural intent.

METHODS

A cluster randomized design randomizing high school classes in Belize City. Subjects were 13-19 years old.

RESULTS

Seven schools in Belize City were selected; 8 classrooms were randomized to the intervention arm and 11 classrooms to the control arm (N = 399). The intervention was associated with two more correct answers on the post-test (difference score was 2.22 points, 95% CI = 0.53, 3.91) after adjusting for gender and previous sexual experience. After controlling for gender and previous sexual experience, the intervention was associated with no change in the attitudes (0.06, 95% CI: -2.89, 2.82) or behavioural intent domains (0.84, 95% CI: -1.12, 2.46).

CONCLUSIONS

Greater changes in knowledge were observed in the intervention group than in the control group following the intervention. Changes were not observed for the attitude or behavioural intent domains. These results and the results of similar studies may be used to further improve sex education programmes as it is imperative that students have access to the information necessary to make informed decisions regarding their sexual health.

Tapping youth as agents for change: evaluation of a peer leadership HIV/AIDS intervention

PURPOSE

To evaluate the impact of a community-based HIV/AIDS peer leadership prevention program on newly enrolled peer leaders and youth enrolled as peer educators for one or more years (repeat peer leaders).

METHODS

Quasi-experimental nonrandomized design with two intervention groups (newly enrolled and repeat peer leaders) and one comparison group. The sample consisted of 235 adolescents, 164 peer leaders, and 71 comparison youth, drawn from nine communities in Massachusetts. The intervention consisted of a short course and ongoing group work with an adult advisor to plan and implement HIV/AIDS outreach activities for youth. A confidential questionnaire administered at baseline and postintervention measured change in (a) HIV/AIDS knowledge, (b) planning and presenting skills, (c) self-efficacy, (d) perception of one's self as a change agent in the community, and (e) sexual risk-taking behaviors. Information was collected from both groups of peer leaders on specific activities resulting from the program and perceived benefits. Data were analyzed by both descriptive and multivariate statistics.

RESULTS

Over a 9-month period newly enrolled peer leaders had significantly higher mean scores for HIV/AIDS knowledge and perception of one's self as a change agent in the community than comparison youth. On all baseline outcome measures except risk-taking behaviors, repeat peer leaders reported higher scores than newly enrolled peer leaders. Post-intervention, HIV/AIDS knowledge continued to increase significantly more among repeat peer leaders compared with those newly enrolled in the program. Repeat peer leaders also reported more benefits from peer leadership training.

CONCLUSIONS

A peer education program was found to have benefits to adolescent peer leaders. Benefits gained from the program were sustained and enhanced over time as evidenced by repeat peer leaders included in the study.

Cross-cultural surveys of adolescent health and behavior: progress and problems

Adolescent health surveys administered in different countries or regions often are described as cross-cultural. Although most include youth of different ethnic and cultural groups, few attempt to define these constructs or to collect data that allow their characterization. This paper explores four challenges shared by large-scale surveys of adolescent health-related behaviors and beliefs. First, adolescent health investigators have used the terms culture and ethnicity loosely. The growing interest in contextual analysis demands standardization of the definitions as they apply to adolescents, followed by correct usage of the terms. Hypotheses regarding the associations between race, ethnicity, culture, health-related behaviors, and health outcomes should be clearly stated and incorporated into conceptual models. Second, cross-cultural analyses are interpretable only when the study designs and sampling methods provide adequate representation of cultural and ethnic minorities and when the survey items allow differentiation of factors related to race, ethnicity, culture, and socioeconomic factors. Third, cross-cultural research may expose traditions, beliefs, and behaviors that are supported by one population yet criticized by another. Investigators must recognize their own personal biases and must work collaboratively to analyze and interpret their data correctly. Fourth, generalizations about cultural/ethnic comparisons can evoke powerful emotional reactions. Interpretation and dissemination of research findings should be done sensitively and with the help of experts from the cultural/ethnic groups that have been studied.

Preventing HIV transmission: the perspective of inner-city Puerto Rican adolescents

PURPOSE

To examine the development of HIV prevention strategies that address the concerns and needs of urban Puerto Rican adolescents.

METHODS

The study included 542 Puerto-Rican adolescents, divided into age sets of 12 to 14 years and 15 to 19 years. Participants were recruited from community work programs, recreation centers, schools, drug rehabilitation programs, and directly from neighborhood streets in North Philadelphia. A hierarchical series of peer-facilitated group techniques and interviews allowed adolescents to generate, prioritize and explain strategies. The study question was developed in focus groups. Ideas were generated and prioritized in Nominal Technique Groups. The ideas with the highest priority were used to develop a survey that allowed participants to rank those they believed would be most effective. Participants then clarified the top-ranked ideas in open focus groups.

RESULTS

In both age sets, the strategy perceived as the most effective in preventing HIV-risk behaviors was "Have people who are HIV-infected talk to teens." Similar ideas addressing this theme varied in perceived effectiveness. The second and third rated ideas among participants aged 12 to 14 years were "Teach teens how HIV infects them, " and "Show teens how people die from AIDS." The second and third rated ideas among participants aged 15 to 19 years were "Show teens what AIDS does to people " and "Have parents be more supportive of teens, so if they are having sex, they can encourage them to use condoms." Other top-ranked ideas included the development of community programs, increased efficacy and availability of condoms, and assessing partners for the risk of HIV infection. Three items revealed significant gender differences. Males were more likely to rate "Give out more free condoms" and "Educate teens in schools about AIDS." Females aged 15 to 19 years were more likely to rate "Teens should know their partner's background before having sex."

CONCLUSIONS

To develop effective prevention strategies for youth, their views of the problems and interpretations of proposed solutions must be understood.

Perceived consequences of teenage childbearing among adolescent girls in an urban sample

PURPOSE

The purpose of this study was to examine the perceived positive consequences of teenage childbearing among female adolescents, and to determine whether perceived consequences of teenage childbearing are associated with other attitudes and sexual risk behaviors.

METHODS

The sample consisted of 584 female students attending three urban high schools in Los Angeles, California. The respondents' mean age was 15.8 years, and 72% were Hispanic/Latina. Respondents completed a paper-and-pencil survey assessing their attitudes and risk behaviors relevant to teenage pregnancy. Multiple regression and logistic regression analyses were used to examine the associations between perceived consequences of teenage childbearing and demographic variables, educational variables, parental characteristics, psychosocial variables, attitudes, and sexual behavior.

RESULTS

Higher scores on a scale of perceived positive consequences of teenage childbearing were associated with increased risk of sexual intercourse and unprotected sexual intercourse. Higher scores on this scale were found among girls who were Latinas, were non-U.S. natives, had low levels of expected educational attainment, had low parental monitoring, had good communication with parents, and wished to have many children.

CONCLUSION

Potential strategies for preventing adolescent pregnancy include educating girls about the difficulties of teenage childbearing, countering their positive illusions about the expected benefits, and teaching them more adaptive ways to meet their emotional needs.