title: Behavioral Interventions for Preventing Sexually Transmitted Infections and Unintended Pregnancies: An Overview of Systematic Reviews.
abstract: BACKGROUND
  Countless sex education programs have been implemented worldwide in recent decades, but epidemiological data show no improvement in rates of sexually transmitted infections or unintended pregnancies.
  
  
  OBJECTIVE
  To summarize the evidence from higher-quality systematic reviews on the efficacy of behavioral interventions for the prevention of sexually transmitted infections and unintended pregnancies.
  
  
  METHODS
  We conducted an overview of reviews by selecting systematic reviews that met minimum quality criteria in terms of the design of the studies reviewed. We compared the results obtained when the effects of interventions were assessed on the basis of objective criteria (biological data) to those obtained when outcomes were assessed on the basis of subjective criteria (self-reports). The results of Cochrane and non-Cochrane reviews were also compared.
  
  
  RESULTS
  We identified 55 systematic reviews. No overall effect on the sexual behavior of program participants was observed in 72.5% of the reviews that used objective criteria and in 48.1% of the reviews based on subjective criteria. In the Cochrane reviews, no evidence of an overall effect was observed in 86% of reviews based on objective variables and in 70.5% of those based on subjective variables.
  
  
  CONCLUSIONS
  There is no evidence that behavioral interventions modify rates of sexually transmitted infections (including human immunodeficiency virus infections) or unintended pregnancies, particularly when effects are assessed using objective, biological data. Primary prevention strategies for sexually transmitted infections and unintended pregnancies need to be re-evaluated.
authors.affiliation: Universitat Internacional de Catalunya, Barcelona, España; Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, España. Electronic address: tonimacaya@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Macaya Pascual
authors.affiliation: Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, España.
authors.forename: J R
authors.initials: JR
authors.lastname: Ferreres Riera
authors.affiliation: Universitat Internacional de Catalunya, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Campoy Sánchez
mesh_terms: D005260:Female; D015438:Health Behavior; D006801:Humans; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D012196:Review Literature as Topic; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*
keywords: Behavior; Conducta; Embarazo no deseado; Human immunodeficiency virus; Infección de transmisión sexual; Sexually transmitted infection; Unintended pregnancy; Virus de la inmunodeficiencia humana