title: A review of STD/HIV preventive interventions for adolescents: sustaining effects using an ecological approach.
abstract: OBJECTIVE
  Behavioral intervention programs to reduce adolescent sexual risk behaviors have shown statistically significant reductions in the short-term; however, longer-term follow-up has demonstrated that effects diminish. One criticism has been the reliance on individual-level models. We review the research that has shaped this narrow perspective and propose that a broader, ecological perspective is needed to amplify and extend the efficacy of sexual risk reduction interventions.
  
  
  METHODS
  We summarize adolescent sexual risk research and outline intervention research that is suggestive of an ecological perspective. Examples from the published literature that have investigated antecedents or conceptualized preventive interventions using a multilevel approach are provided.
  
  
  RESULTS
  Adolescents are exposed to diverse sources of influence transecting different levels of causation. To adequately prevent, reduce, and maintain the likelihood of adolescents' adopting sexual risk behaviors, intervention programs should be designed to address these myriad levels of causation. This approach has been implemented in Brazil and was shown to be effective.
  
  
  CONCLUSIONS
  Research should cross manifold levels of causation so that programs will be more effective at promoting adolescents' adoption and maintenance of STD/HIV preventive behaviors.
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. rdiclem@sph.emory.edu
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: DiClemente
authors.forename: Laura F
authors.initials: LF
authors.lastname: Salazar
authors.forename: Richard A
authors.initials: RA
authors.lastname: Crosby
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008297:Male; D024382:Professional Role; D002666:Psychology, Child / Q000379:methods; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*; D012931:Social Environment