Sexual risk avoidance and sexual risk reduction interventions for middle school youth: a randomized controlled trial.
OBJECTIVE
To evaluate the efficacy of two, theory-based, multimedia, middle school sexual education programs in delaying sexual initiation.


METHODS
Three-armed, randomized controlled trial comprising 15 urban middle schools; 1,258 predominantly African American and Hispanic seventh grade students followed into ninth grade. Both programs included group and individualized, computer-based activities addressing psychosocial variables. The risk avoidance (RA) program met federal abstinence education guidelines; the risk reduction (RR) program emphasized abstinence and included computer-based condom skills-training. The primary outcome assessed program impact on delayed sexual initiation; secondary outcomes assessed other sexual behaviors and psychosocial outcomes.


RESULTS
Participants were 59.8% females (mean age: 12.6 years). Relative to controls, the RR program delayed any type of sexual initiation (oral, vaginal, or anal sex) in the overall sample (adjusted odds ratio [AOR]: .65, 95% CI: .54-.77), among females (AOR: .43, 95% CI: .31-.60), and among African Americans (AOR: .38, 95% CI: .18-.79). RR students also reduced unprotected sex at last intercourse (AOR: .67, 95% CI: .47-.96), frequency of anal sex in the past 3 months (AOR: .53, 95% CI: .33-.84), and unprotected vaginal sex (AOR: .59, 95% CI: .36-.95). The RA program delayed any sexual initiation among Hispanics (AOR: .40, 95% CI: .19-.86), reduced unprotected sex at last intercourse (AOR: .70, 95% CI: .52-.93), but increased the number of recent vaginal sex partners (AOR: 1.69, 95% CI: 1.01-2.82). Both programs positively affected psychosocial outcomes.


CONCLUSIONS
The RR program positively affected sexually inexperienced and experienced youth, whereas the RA program delayed initiation among Hispanics and had mixed effects among sexually experienced youth.
Center for Health Promotion and Prevention Research, University of Texas Health Science Center, 7000 Fannin Street, Houston, TX 77030, USA. Christine.Markham@uth.tmc.edu
Christine M
CM
Markham
Susan R
SR
Tortolero
Melissa Fleschler
MF
Peskin
Ross
R
Shegog
Melanie
M
Thiel
Elizabeth R
ER
Baumler
Robert C
RC
Addy
Soledad Liliana
SL
Escobar-Chaves
Belinda
B
Reininger
Leah
L
Robin
D000293:Adolescent; D002648:Child; D005260:Female; D006266:Health Education; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D040242:Risk Reduction Behavior; D012746:Sexual Abstinence / Q000706:statistics & numerical data; D012725:Sexual Behavior; D014505:Urban Population