title: Brief Behavioral Intervention to Improve Adolescent Sexual Health: A Feasibility Study in the Emergency Department.
abstract: OBJECTIVE
  Although emergency department (ED) visits offer an opportunity to deliver brief behavioral interventions to improve health, provision of ED-based interventions targeting adolescent sexual health is uncommon. The objectives for this study were to evaluate the feasibility and preliminary effects of a novel sexual health service intervention for adolescents.
  
  
  METHODS
  In this cross-sectional feasibility study, sexually active patients aged 14 to 19 years presenting to a Midwestern pediatric ED were recruited to receive an intervention to improve sexual health. The intervention, based on motivational interviewing (MI), included agenda setting, exploration of behaviors, a decisional balance exercise, tailored feedback, and provision of personalized health services (including condoms, prescription for emergency contraception, urine testing for Chlamydia trachomatis and Neisseria gonorrheae, and referral to the hospital-affiliated adolescent clinic). Data were collected before and after intervention administration and at a 3-month follow-up telephone interview. Surveys assessed sexual risk behaviors, satisfaction with the intervention, health care use, and demographics. Feasibility criteria were (1) subject-rated interventionist fidelity to MI principles (Likert scale 1 [strongly agree] to 4 [strongly disagree]), (2) subject satisfaction (Likert scale 1 [not at all] to 5 [very]), and (3) session duration (minutes, recorded by the interventionist). A secondary outcome was the proportion of subjects who completed at least 1 health service. Services provided at the adolescent clinic were determined by an electronic medical record review. Comparisons of responses between sex subgroups were analyzed using Χ test.
  
  
  RESULTS
  From August to November 2012, 69 adolescents were approached, 66 (96%) completed the screening survey, and 24 (37%) reported previous sexual activity. Of those, 20 (83%) agreed to participate. The mean (SD) age was 16.2 (1.4) years; 60% were female. Most (78%) reported that the interventionist maintained high fidelity to MI principles and most (80%) were very satisfied with the intervention. Mean (SD) intervention length was 15.7 (2.2) minutes. Most subjects (65%) accepted 1 or more health services, including 42% who completed clinic follow-up. In the ED or the referral clinic, the following services were provided to the subjects: condoms (n = 11), emergency contraception prescription (n = 5), C. trachomatis/N. gonorrheae testing (n = 4), hormonal birth control provision (n = 2), and human immunodeficiency virus testing (n = 3). Fifteen subjects (75%) were reached for the 3-month follow-up, and condom use was maintained by 67% of those reporting sexual activity.
  
  
  CONCLUSIONS
  This study demonstrated the feasibility and potential utility of an MI-based service navigation intervention to connect youth with point-of-care services as well as resources for ongoing sexual health needs.
authors.affiliation: From the *Department of Pediatrics, Children's Mercy Hospitals and Clinics; †Department of Psychology and ‡School of Nursing, University of Missouri-Kansas City, Kansas City, MO; §Division of Emergency Medicine, Children's Hospital of Philadelphia; and ∥Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Miller
authors.forename: Sofie
authors.initials: S
authors.lastname: Champassak
authors.forename: Kathy
authors.initials: K
authors.lastname: Goggin
authors.forename: Patricia
authors.initials: P
authors.lastname: Kelly
authors.forename: M Denise
authors.initials: MD
authors.lastname: Dowd
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Mollen
authors.forename: Sharon G
authors.initials: SG
authors.lastname: Humiston
authors.forename: Jennifer
authors.initials: J
authors.lastname: Linebarger
authors.forename: Timothy
authors.initials: T
authors.lastname: Apodaca
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D001521:Behavior Therapy / Q000379:methods*; D017280:Condoms; D044363:Contraception, Postcoital / Q000379:methods; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D006801:Humans; D008297:Male; D062405:Motivational Interviewing / Q000379:methods*; D019095:Point-of-Care Systems; D060728:Reproductive Health / Q000193:education / Q000208:ethnology / Q000592:standards*; D012725:Sexual Behavior / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult