Behavioral interventions to reduce incidence of HIV, STD, and pregnancy among adolescents: a decade in review.
OBJECTIVE
To review adolescent sexual risk-reduction programs that were evaluated using quasi-experimental or experimental methods and published in the 1990s. We describe evaluated programs and identify program and evaluation issues for health educators and researchers.


METHODS
We systematically searched seven electronic databases and hand-searched journals to identify evaluations of behavioral interventions to reduce sexual risk behaviors among adolescents. Articles were included if they were published in the 1990s, provided a theoretical basis for the program, information about the interventions, clear aims, and quasi-experimental or experimental evaluation methods. We identified 101 articles, and 24 met our criteria for inclusion.


RESULTS
We reviewed these evaluations to assess their research and program characteristics. The majority of studies included randomized controlled designs and employed delayed follow-up measures. The most commonly measured outcomes were delay of initiation of sexual intercourse, condom use, contraceptive use, and frequency of sexual intercourse. Programs ranged from 1 to 80 sessions, most had adult facilitators, and commonly included skills-building activities about sexual communication, decision-making, and problem solving. The programs included a wide range of strategies for content delivery such as arts and crafts, school councils, and community service learning.


CONCLUSIONS
Analysis of these programs suggest four overall factors that may impact program effectiveness including the extent to which programs focus on specific skills for reducing sexual risk behaviors; program duration and intensity; what constitutes the content of a total evaluated program including researchers' assumptions of participants' exposure to prior and concurrent programs; and what kind of training is available for facilitators.
Robin
Leah
L
Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS K-33, Atlanta, GA 30341, USA. lrobin@cdc.gov
Dittus
Patricia
P
Whitaker
Daniel
D
Crosby
Richard
R
Ethier
Kathleen
K
Mezoff
Jane
J
Miller
Kim
K
Pappas-Deluca
Katina
K
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control*; D012309:Risk-Taking; D012736:Sex Education / Q000379:methods*; D012725:Sexual Behavior / Q000523:psychology; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*