title: A Randomized Controlled Trial to Compare Computer-assisted Motivational Intervention with Didactic Educational Counseling to Reduce Unprotected Sex in Female Adolescents.
abstract: OBJECTIVE
  To examine a computer-assisted, counselor-guided motivational intervention (CAMI) aimed at reducing the risk of unprotected sexual intercourse. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted a 9-month, longitudinal randomized controlled trial with a multisite recruitment strategy including clinic, university, and social referrals, and compared the CAMI with didactic educational counseling in 572 female adolescents with a mean age of 17 years (SD = 2.2 years; range = 13-21 years; 59% African American) who were at risk for pregnancy and sexually transmitted diseases. The primary outcome was the acceptability of the CAMI according to self-reported rating scales. The secondary outcome was the reduction of pregnancy and sexually transmitted disease risk using a 9-month, self-report timeline follow-back calendar of unprotected sex.
  
  
  RESULTS
  The CAMI was rated easy to use. Compared with the didactic educational counseling, there was a significant effect of the intervention which suggested that the CAMI helped reduce unprotected sex among participants who completed the study. However, because of the high attrition rate, the intent to treat analysis did not demonstrate a significant effect of the CAMI on reducing the rate of unprotected sex.
  
  
  CONCLUSIONS
  Among those who completed the intervention, the CAMI reduced unprotected sex among an at-risk, predominantly minority sample of female adolescents. Modification of the CAMI to address methodological issues that contributed to a high drop-out rate are needed to make the intervention more acceptable and feasible for use among sexually active predominantly minority, at-risk, female adolescents.
authors.affiliation: Columbia University Medical Center, Department of Pediatrics, Division of Child and Adolescent Health, Mailman School of Public Health, Department of Population and Family Health, and New York-Presbyterian Hospital, New York, New York.
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Gold
authors.affiliation: Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island. Electronic address: Golfo_Tzilos@brown.edu.
authors.forename: Golfo K
authors.initials: GK
authors.lastname: Tzilos
authors.affiliation: Department of Psychology, University of Rhode Island, Kingston, Rhode Island.
authors.forename: L A R
authors.initials: LA
authors.lastname: Stein
authors.affiliation: Butler Hospital, Providence, Rhode Island.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Anderson
authors.affiliation: Department of Medicine, Public Health and Public Policy, Brown University, Providence, Rhode Island.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stein
authors.affiliation: Department of Psychiatry, Psychology, Health and Community Systems, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Ryan
authors.affiliation: Departments of Psychology and Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Allan
authors.initials: A
authors.lastname: Zuckoff
authors.affiliation: Department of Psychology, University of Maryland, Baltimore County, Maryland.
authors.forename: Carlo
authors.initials: C
authors.lastname: DiClemente
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D003376:Counseling / Q000379:methods*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D009042:Motivation; D011247:Pregnancy; D015397:Program Evaluation / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D012984:Software; D047568:Unsafe Sex / Q000517:prevention & control*; D055815:Young Adult
keywords: Adolescents; Computer intervention; Condom; Contraception; HIV; Motivational interviewing (MI); Pregnancy prevention; Sexually transmitted diseases (STDs); Transtheoretical model (TTM)