A randomized controlled trial of a behavioral intervention to reduce high-risk sexual behavior among adolescents in STD clinics

doi:10.1016/S0005-7894(00)80003-9

Behavior Therapy

Volume 31, Issue 1, Winter 2000, Pages 27-54

https://doi.org/10.1016/S0005-7894(00)80003-9 Get rights and content

A five-session behavioral intervention to reduce risky sexual behavior was evaluated in a randomized controlled trial, in which 339 adolescents, ages 15 to 19 years, were recruited in public sexually transmitted disease clinics and randomly assigned to receive the intervention or usual care. The intervention targeted (a) decision-making about safer sex goals, (b) social skills for achieving safer sex, and (c) acceptance of negative thoughts and feelings. Compared to the control group at 6-months follow-up, treatment participants reported fewer sexual partners, fewer nonmonogamous partners, and fewer sexual contacts with strangers in the past 3 months, and less use of marijuana before or during sex. Treated adolescents also performed better on a taped situations test of skill in handling difficult sexual situations. Strongest intervention effects were for male and nonminority youth. Further research is needed to develop interventions with strong, durable effects across gender and ethnic groups that can be delivered cost-effectively within existing service systems.

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As parents learned new skills, the number and intensity of child behavior problems decreased, and most improvements were maintained at six months. A recent systematic review of the literature (Swain, Hancock, Hainsworth, & Bowman, 2013) found 21 studies in which ACT was employed with children displaying a variety of presenting problems such as impulsivity (Luciano, Herruzo, & Barnes-Holmes, 2001), sexualized behavior (Metzler, Biglan, Noell, Ary, & Ochs, 2000), and trichotillomania (Fine, Walther, Joseph, Robinson, & Ricketts, 2012). Of these, only Fine and colleagues used a time series design and reported on individual participant behavior.
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This was a randomized controlled trial conducted at the only national sexually transmitted infection clinic in Singapore. The intervention focused on information giving, motivation, and skills building to abstain or practice safer sex. The outcome measures were self-reported secondary abstinence, consistent condom use, and keeping to one partner in the past 6 months over a 12-month period. We recruited 688 adolescents, with 337 participants receiving intervention and 351 receiving standard care (control).
At the 12-month follow-up, 187 (56%) intervention participants and 189 (54%) control participants were retained. Over the 12-month period, the intervention had a significant effect on secondary abstinence in adolescent boys (42% vs. 27%, adjusted risk ratio [aRR] 1.80, 95% confidence interval [CI] 1.29–2.34) but not in adolescent girls (21% vs. 24%, aRR 1.10, 95% CI .68–1.66). Consistent condom use was higher among intervention adolescent girls than control adolescent girls (40% vs. 20%, aRR 2.01, 95% CI 1.32–2.82), but this effect was not evident in adolescent boys (51% vs. 43%, aRR 1.27, 95% CI .78–1.88). Intervention effect on keeping to one partner was evident in both adolescent boys (76% vs. 45%, aRR 1.35, 95% CI 1.06–1.50) and adolescent girls (79% vs. 65%, aRR 1.20, 95% CI 1.02–1.23).
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A small number of interventions which could be used, or adapted for use, in sexual health clinics were found to be effective in reducing STIs among young people and in promoting self-reported STI-risk behavior change in MSM.
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To date, most early intervention programs have been based on emotion regulation strategies that address dysfunctional cognitive appraisals, problem-solving skills, and rumination. Another emotion regulation strategy, ‘acceptance’ training, has largely been overlooked. To examine the efficacy of this strategy, a school-based mental health program combining positive psychology with acceptance and commitment therapy (Strong Minds) was evaluated in a randomized controlled trial with a sample of 267 Year 10 and 11 high-school students in Sydney, Australia. Mixed models for repeated measures examined whether the program led to reductions in symptoms amongst students who commenced the program with high depression, anxiety, and stress scores, and increased wellbeing scores amongst all students. Results demonstrated that compared to controls, participants in the Strong Minds condition with elevated symptom scores (n = 63) reported significant reductions in depression (p = .047), stress (p = .01), and composite depression/anxiety symptoms (p = .02) with medium to strong effect sizes (Cohen's d = 0.53, 0.74, and 0.57, respectively). Increased wellbeing (p = .03) in the total sample and decreased anxiety scores (p = .048) for students with elevated symptoms were significant for Year 10 students with medium effect sizes (Cohen's d = 0.43 and 0.54, respectively). This study tentatively suggests that including the emotion regulation strategy of acceptance in early intervention programs may be effective in reducing symptoms and improving wellbeing in high school students. Further research to investigate the generalizability of these findings is warranted.
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These included two RCTs (Hayes, Boyd, & Sewell, 2011; Metzler, Biglan, Noell, Ary, & Ochs, 2000) and one between-group study (Franklin, Best, Wilson, Loew, & Compton, 2011). The utility of a behaviour therapy programme (including ACT approaches) vs TAU (psychoeducation) for 339 adolescents with high risk sexualised behaviour was examined in one study (Metzler et al., 2000). At 3-month follow-up, in contrast to predictions, ACT participants engaged in greater frequency of sex than TAU participants.
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^*: This research was supported by grant R01-MH45651 from the National Institute of Mental Health and the National Institute of Allergy and Infectious Diseases, with partial support provided by grant R01-DA09306 from the National Institute on Drug Abuse.

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Original ResearchA randomized controlled trial of a behavioral intervention to reduce high-risk sexual behavior among adolescents in STD clinics*

American Journal of Preventive Medicine

Journal of Adolescent Health

Consistency of adolescents' self-report of sexual behavior in a longitudinal study

Journal of Youth and Adolescence

Fertility and fertility-related behavior among Mexican-American and non-Hispanic white female adolescents

Journal of Health and Social Behavior

The behavioral assessment of social competence in males

Behavior Therapy

Changing AIDS- and fertility-related behavior: The effectiveness of sexual education

Journal of Sex Research

Social cognitive theory and exercise of control over HIV infection

Preventing adolescent pregnancy with social cognitive skills

Journal of Adolescent Research

Age-specific risks of syphilis, gonorrhea, and hospitalized pelvic inflammatory disease in sexually experienced U.S. women

Sexually Transmitted Diseases

An integration of theory: Adolescent sexual contacts

Journal of Youth and Adolescence

Does sexual coercion play a role in the high-risk sexual behavior of adolescent and young adult women?

Journal of Behavioral Medicine

Patterns of adolescent friendship and effects on sexual behavior

Social Psychology Quarterly

The influence of male and female best friends on adolescent sexual behavior

Adolescence

IV. Multiple sexual partners among young adults in high-risk cities

Family Planning Perspectives

Pregnancy-prevention groups for adolescents

Social Work

Development of a scale to measure attitude toward the condom as a method of birth control

Journal of Sex Research

Predicting the timing of first sexual intercourse for at-risk adolescent males

Child Development

Methodological problems in AIDS behavioral research: Influences on measurement error and participation bias in studies of sexual behavior

Psychological Bulletin

Epidemiology and control of sexually transmitted diseases in adolescents

Annual Report, 1992.

Sexually transmitted disease surveillance 1994

Statistical power analysis for the behavioral sciences

Minorities and AIDS: Knowledge, attitudes, and misconceptions among black and Latin adolescents

American Journal of Public Health

A randomized controlled trial of an HIV sexual risk-reduction intervention for young African-American women

Journal of the American Medical Association

Syndrome of problem behavior in adolescence: A replication

Journal of Consulting and Clinical Psychology

Multimethod assessment of socially anxious and socially nonanxious women

Behavioral Assessment

Adolescents at risk: Prevalence and prevention

Evaluating the impact of a theory-based sexuality and contraceptive education program

Family Planning Perspectives

Interpersonal context as an influence on sexual timetables of youths: Gender and ethnic effects

Journal of Research on Adolescence

Changing AIDS-risk behavior

Psychological Bulletin

Statistical methods for rates and proportions

Black women and AIDS prevention: A view towards understanding the gender rules

Journal of Sex Research

Sexually transmitted disease prevention: Adolescents' perceptions of possible side effects

Adolescence

Race differences in the timing of adolescent intercourse

American Sociological Review

A contextual approach to therapeutic change

Content, context, and the types of psychological acceptance

Acceptance and commitment therapy: Altering the verbal support for experiential avoidance. Special section: Clinical behavior analysis

Behavior Analyst

Original Research
A randomized controlled trial of a behavioral intervention to reduce high-risk sexual behavior among adolescents in STD clinics*