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Mbengo F, Adama E, Towell-Barnard A, Bhana A, Zgambo M. Barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth worldwide: a systematic review. BMC Infect Dis 2022; 22:679. [PMID: 35941562 PMCID: PMC9361597 DOI: 10.1186/s12879-022-07649-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interventions aimed at reducing risky sexual behavior are considered an important strategy for averting Human Immunodeficiency Virus (HIV) infection among youth (15-24 years) who continue to be at risk of the disease. Enhancing intervention success requires a comprehensive understanding of the barriers and facilitators to interventions targeting youth. However, there is lack of a systematic review of both quantitative and qualitative studies to comprehensively identify and synthesize barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth worldwide. This review aimed to identify and synthesize barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth globally based on original peer-reviewed studies published in the last decade. METHODS The Joanna Briggs Institute approach for mixed methods systematic reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to guide this review. Nine electronic databases, Joint United Nations Programme on HIV/AIDS and World Health Organization websites, and reference lists of included studies and systematic reviews on barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth were searched for eligible articles. Studies that met the inclusion criteria underwent quality appraisal and data extraction. Findings were analyzed using thematic synthesis and underpinned by Nilsen, 2015's Determinant Framework. RESULTS Overall 13 studies comprising of eight qualitative studies, four quantitative studies and one mixed methods study were included in the review. Several barriers and facilitators across the five Determinant Framework domains were identified. Most of the barriers fell under the characteristics of the context domain (e.g., gender-biased norms). The next important group of barriers emerged within the characteristics of the end users domain (e.g., fear of relationship breakdown). In terms of facilitators, the majority fell under the characteristics of the strategy of facilitating implementation domain (e.g., implementation of intervention with fidelity) and characteristics of the end users domain (e.g., fear of pregnancy or sexually transmitted infections). The next common set of facilitators appeared within the characteristics of the context domain (e.g., family support). CONCLUSION This review identified several multi-level barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth. Multi-level and combination approaches are needed to address these factors and enhance intervention success.
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Affiliation(s)
- Fungai Mbengo
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, 6027, Australia.
| | - Esther Adama
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, 6027, Australia
| | - Amanda Towell-Barnard
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, 6027, Australia
| | - Arvin Bhana
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, 7505, South Africa.,Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Maggie Zgambo
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, 6027, Australia
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Gómez-Lugo M, Morales A, Saavedra-Roa A, Niebles-Charris J, Abello-Luque D, Marchal-Bertrand L, García-Roncallo P, García-Montaño E, Pérez-Pedraza D, Espada JP, Vallejo-Medina P. Effects of a Sexual Risk-Reduction Intervention for Teenagers: A Cluster-Randomized Control Trial. AIDS Behav 2022; 26:2446-2458. [PMID: 35084613 PMCID: PMC9162964 DOI: 10.1007/s10461-022-03574-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 12/03/2022]
Abstract
This study evaluated the efficacy of the COMPAS program in the short term and 6 months after its application. For the initial sample, 2047 teenagers aged 14–19 years from 14 schools in 11 Colombian cities participated; eight schools were randomly assigned to the experimental condition and six to the control group. The participants completed self-report assessments that evaluated several variables theoretically associated with protective sexual behaviors. In the short term, the experimental group showed increased knowledge about HIV and other STIs, sexual assertiveness, self-efficacy, greater behavioral intention toward condom use, and more favorable attitudes toward HIV and condom use than the control group. After 6 months, most psychological and health variables also showed a significant positive change. In conclusion, the COMPAS program is the first school-based sexuality education program that has been shown to be effective in reducing mediating and behavioral variables associated with sexual risk reduction in Colombia.
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Affiliation(s)
| | - Alexandra Morales
- AITANA Research Group, Department of Health Psychology, Universidad Miguel Hernández, Avda. de la Universidad, s/n., 03202, Elche, Alicante, Spain.
| | | | | | | | | | | | | | | | - Jose P Espada
- AITANA Research Group, Department of Health Psychology, Universidad Miguel Hernández, Avda. de la Universidad, s/n., 03202, Elche, Alicante, Spain
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Ilskens K, Wrona KJ, Dockweiler C, Fischer F. Evidence map on serious games in preventing sexually transmitted infections among adolescents: Systematic review about outcome categories investigated in primary studies (Preprint). JMIR Serious Games 2021; 10:e30526. [PMID: 35107438 PMCID: PMC8851332 DOI: 10.2196/30526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/01/2021] [Accepted: 10/23/2021] [Indexed: 11/26/2022] Open
Abstract
Background Sexually transmitted infections (STIs) represent a global health risk. Adolescents are at increased risk of infection for several reasons such as lack of knowledge, risky sexual behaviors, and lack of behavioral sills (eg, to negotiate safer sex). Given the fact that adolescents often use digital media and that serious games are considered to have the potential to change knowledge, attitudes and behavior, serious games represent an opportunity for the prevention of STIs. Objective The aim of this systematic review was to identify and systematically summarize the dimensions that have been investigated in primary studies on serious games targeting STI prevention among adolescents. Methods A systematic review was conducted in PubMed and Web of Science. Studies published from 2009 to 2021 were included that assessed the effectiveness of serious games on adolescent sexual health. A total of 18 studies met the inclusion criteria and were categorized according to dimensions of effectiveness and user experience. Results Various dimensions of effectiveness and aspects of user experience were investigated in the primary studies. In total, 9 dimensions of effectiveness were observed: sexual behavior, behavioral intentions, knowledge, attitudes and beliefs, self-efficacy and personal limitations, character traits and future orientation, environmental and individual risk factors, risk perception and risk assessment, as well as normative beliefs and (social) norms. Furthermore, several dimensions related to user experience were investigated in primary studies, that is, motivation, acceptability, trustworthiness, comprehensibility, handling and control, perceived effectiveness, as well as satisfaction. Conclusions This review provides an overview of serious games interventions that are vastly different in approach, content, and even platform. In previous studies, knowledge has already been comprehensively assessed, and a positive influence of serious games on knowledge about sexual topics is evident. The results clearly show that adolescents’ sexual knowledge has been increased by the serious games interventions. However, methodological and content differences in the surveys make it difficult to draw conclusions about the effectiveness related to changes in attitudes and behavior.
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Affiliation(s)
- Karina Ilskens
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Kamil J Wrona
- School of Public Health, Bielefeld University, Bielefeld, Germany
- Faculty of Health, University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - Christoph Dockweiler
- Department of Digital Public Health and Biomedicine, School of Life Sciences, University of Siegen, Siegen, Germany
| | - Florian Fischer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany
- Bavarian Research Center for Digital Health and Social Care, Kempten University of Applied Sciences, Kempten, Germany
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Alfaiate D, Giaché S, Pradat P, Cotte L, Chidiac C. Sexually transmitted infections knowledge in different populations attending a French University Hospital - A prospective observational study. Epidemiol Infect 2021; 149:1-18. [PMID: 33880990 PMCID: PMC8193766 DOI: 10.1017/s0950268821000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 12/03/2022] Open
Abstract
We conducted a prospective study about sexually transmitted infections (STIs) knowledge in different populations attending Lyon's University Hospitals in order to estimate awareness on STIs. Pre-exposure prophylaxis (PrEP)-users (PrEP group), persons living with HIV (PLWH group) and persons undergoing free STI screening (screening group) filled an anonymous questionnaire evaluating STI knowledge. A composite STI knowledge score was calculated and was correlated with patients’ characteristics. A total of 756 patients were enrolled in three groups: screening (n = 509), PrEP (n = 103) and PLWH (n = 144). STI transmission knowledge was better for HIV than for other STIs. The median STI knowledge score was significantly higher in PrEP-users than in the screening and PLWH groups. PrEP use and a previous STI diagnosis were independently associated with a higher score. PrEP-users have better STI knowledge than PLWH and persons undergoing free STI screening. Sexual health promotion interventions routinely reserved to PrEP-users in France seem to be effective in raising the awareness of this group for STIs. Continuous efforts are justified for PLWH and the younger layers of the population.
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Affiliation(s)
- Dulce Alfaiate
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Susanna Giaché
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Orléans La Source, Orléans, France
| | - Pierre Pradat
- Centre de Recherche Clinique, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Laurent Cotte
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Christian Chidiac
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
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Effectiveness of School-Based Teen Pregnancy Prevention Programs in the USA: a Systematic Review and Meta-Analysis. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 19:468-489. [PMID: 29374797 DOI: 10.1007/s11121-017-0861-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
School-based programs have been a mainstay of youth pregnancy prevention efforts in the USA. We conducted a systematic review and meta-analysis to assess their effectiveness. Eligible studies evaluated the effect on pregnancy rates of programs delivered in elementary, middle, or high schools in the USA and Canada, published between January 1985 and September 2016. The primary outcome was pregnancy; secondary outcomes were delay in sexual initiation, condom use, and oral contraception use. Randomized controlled trials (RCTs) and non-RCTs with comparator groups were eligible. We developed a comprehensive search strategy, applied to major bibliographic databases, article bibliographies, gray literature, and contact with authors. We calculated risk ratios (RR) with 95% confidence intervals (CI) for each outcome and pooled data in random effects meta-analysis. We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess evidence quality. Ten RCTs and 11 non-RCTs conducted from 1984 to 2016 yielded 30 unique pooled comparisons for pregnancy, of which 24 were not statistically significant. Six showed statistically significant changes in pregnancy rates: two with increased risk (RR 1.30, 95% CI 1.02-1.65; and RR 1.39, 95% CI 1.10-1.75) and four with decreased risk ranging from RR 0.56, 95% CI 0.41-0.77, to RR 0.75, 95% CI 0.58-0.96. All studies were at high risk of bias, and the quality of evidence was low or very low. Identified evidence indicated no consistent difference in rates of pregnancies between intervention recipients and controls.
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Mirzazadeh A, Biggs MA, Viitanen A, Horvath H, Wang LY, Dunville R, Barrios LC, Kahn JG, Marseille E. Do School-Based Programs Prevent HIV and Other Sexually Transmitted Infections in Adolescents? A Systematic Review and Meta-analysis. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 19:490-506. [PMID: 28786046 DOI: 10.1007/s11121-017-0830-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We systematically reviewed the literature to assess the effectiveness of school-based programs to prevent HIV and other sexually transmitted infections (STI) among adolescents in the USA. We searched six databases including PubMed for studies published through May 2017. Eligible studies included youth ages 10-19 years and assessed any school-based programs in the USA that reported changes in HIV/STI incidence or testing. We used Cochrane tool to assess the risk of bias and GRADE to determine the evidence quality for each outcome. Three RCTs and six non-RCTs, describing seven interventions, met study inclusion criteria. No study reported changes in HIV incidence or prevalence. One comprehensive intervention, assessed in a non-RCT and delivered to pre-teens, reduced STI incidence into adulthood (RR 0.36, 95% CI 0.23-0.56). A non-RCT examining chlamydia and gonorrhea incidence before and after a condom availability program found a significant effect at the city level among young men 3 years later (RR 0.43, 95% CI 0.23-0.80). The remaining four interventions found no effect. The effect on STI prevalence was also not significant (pooled RR 0.83 from two non-RCTs, RR 0.70 from one RCT). Only one non-RCT showed an increase in HIV testing (RR 3.19, 95% CI 1.24-8.24). The quality of evidence for all outcomes was very low. Studies, including the RCTs, were of low methodological quality and had mixed findings, thus offering no persuasive evidence for the effectiveness of school-based programs. The most effective intervention spanned 6 years, was a social development-based intervention with multiple components, rather than a sex education program, and started in first grade.
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Affiliation(s)
- Ali Mirzazadeh
- School of Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA. .,Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
| | - M Antonia Biggs
- Department of Obstetrics, Gynecology and Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA
| | - Amanda Viitanen
- Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Hacsi Horvath
- School of Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.,Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Li Yan Wang
- Division of Adolescent and School Health, U.S. Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, 30329, USA
| | - Richard Dunville
- Division of Adolescent and School Health, U.S. Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, 30329, USA
| | - Lisa C Barrios
- Division of Adolescent and School Health, U.S. Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, 30329, USA
| | - James G Kahn
- Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.,Global Health Economics Consortium, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
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Raya-Tena A, García-Hernández D, Blázquez-Gómez C. Knowledge of adolescents about sexually transmitted infections: The need for effective interventions. ENFERMERIA CLINICA 2019; 29:257-258. [PMID: 30718207 DOI: 10.1016/j.enfcli.2018.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 12/07/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Antonia Raya-Tena
- Equipo de Atención Primaria Dr. Lluís Sayé, Instituto Catalán de la Salud, Gerencia Territorial de Barcelona, Barcelona, España.
| | - David García-Hernández
- Equipo de Atención Primaria Dr. Lluís Sayé, Instituto Catalán de la Salud, Gerencia Territorial de Barcelona, Barcelona, España
| | - Celia Blázquez-Gómez
- Equipo de Atención Primaria Dr. Lluís Sayé, Instituto Catalán de la Salud, Gerencia Territorial de Barcelona, Barcelona, España
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Forsyth R, Purcell C, Barry S, Simpson S, Hunter R, McDaid L, Elliot L, Bailey J, Wetherall K, McCann M, Broccatelli C, Moore L, Mitchell K. Peer-led intervention to prevent and reduce STI transmission and improve sexual health in secondary schools (STASH): protocol for a feasibility study. Pilot Feasibility Stud 2018; 4:180. [PMID: 30519482 PMCID: PMC6264037 DOI: 10.1186/s40814-018-0354-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Young people in the UK are at highest risk of sexually transmitted infections and report higher levels of unsafe sex than any other age group. Involving peer supporters in intervention delivery is acceptable to students and effective in reducing risk behaviours via ‘diffusion of innovation’, particularly where peer supporters are influential in their networks. Informal peer-led interventions offer a useful alternative to peer-led didactic teaching, which has shown limited effects. Building on the successful ASSIST anti-smoking intervention, the ‘STis And Sexual Health’ (STASH) intervention involves identification and recruitment of the most influential students as peer supporters, training and support to these students by specialist trainers, positive sex and relationships messages, spread by peer supporters to their friendship groups in person and via social media. Methods/design This protocol describes a feasibility trial of the STASH intervention in six schools. It builds on an earlier study phase of intervention co-development using patient and public involvement (PPI) activities, followed by a pilot of intervention components and evaluation tools in one school. Participants are fourth year (S4) students (aged 14–16) in state-funded Scottish secondary schools who have received some level of teacher-led sex education. The previous cohort of S4 students (those completing S4 in the year prior to the intervention) will serve as controls. Data will be collected from controls (month 16), baseline (month 20–21) and follow-up (month 27–30) via a web-based questionnaire, which will measure (and test the reliability of) primary outcome measures for a phase III trial (delayed initiation of/abstinence from sex and consistent condom use), secondary outcomes and mediators of sexual behaviour (including school climate and social networks). The main feasibility outcome is whether the study meets pre-set progression criteria regarding feasibility and acceptability, measured largely via a process evaluation (basic measures in all 6 schools and in-depth in 2-4 schools). An economic evaluation reporting costs alongside consequences will be conducted. Discussion This study will inform decisions on the feasibility, design and sample size for a phase III effectiveness trial to assess whether the STASH intervention is effective in reducing the risk of sexually transmitted infections in young people. Trial registration ISRCTN97369178
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Affiliation(s)
- Ross Forsyth
- 1MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield St, Glasgow, G2 3AX UK
| | - Carrie Purcell
- 1MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield St, Glasgow, G2 3AX UK
| | - Sarah Barry
- 3Department of Mathematics and Statistics, Strathclyde University, Glasgow, UK
| | - Sharon Simpson
- 1MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield St, Glasgow, G2 3AX UK
| | - Rachael Hunter
- 2Research Department of Primary Care and Population Health, University College London, London, UK
| | - Lisa McDaid
- 1MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield St, Glasgow, G2 3AX UK
| | - Lawrie Elliot
- 4Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Julia Bailey
- 2Research Department of Primary Care and Population Health, University College London, London, UK
| | - Kirsty Wetherall
- 5Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mark McCann
- 1MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield St, Glasgow, G2 3AX UK
| | - Chiara Broccatelli
- 1MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield St, Glasgow, G2 3AX UK
| | - Laurence Moore
- 1MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield St, Glasgow, G2 3AX UK
| | - Kirstin Mitchell
- 1MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield St, Glasgow, G2 3AX UK
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Narasimhan M, Pedersen H, Ogilvie G, Vermund SH. The case for integrated human papillomavirus vaccine and HIV prevention with broader sexual and reproductive health and rights services for adolescent girls and young women. Trans R Soc Trop Med Hyg 2018; 111:141-143. [PMID: 28673020 PMCID: PMC6257065 DOI: 10.1093/trstmh/trx032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 01/29/2023] Open
Affiliation(s)
- Manjulaa Narasimhan
- Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme, World Health Organization, Geneva, 1211, Switzerland
| | - Heather Pedersen
- University of British Columbia Faculty of Medicine and British Columbia Centre for Disease Control, Vancouver, BC, V6H 3N1, Canada
| | - Gina Ogilvie
- University of British Columbia Faculty of Medicine and British Columbia Centre for Disease Control, Vancouver, BC, V6H 3N1, Canada
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Guerra C, Del Río FJ, Cabello F, Morales IM. Creation and validation of a scale of sexuality for adolescents: Scale of Myths about Sexuality. Rev Int Androl 2018; 17:123-129. [PMID: 30219644 DOI: 10.1016/j.androl.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/03/2018] [Accepted: 06/12/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In recent decades western countries have become more open about sexuality and sexual relations, and adolescents get information about these issues mainly through the internet, TV and social networks. Often such information is incomplete, wrong or even contradicts itself. What favors them to develop myths, false beliefs and/or negative attitudes about sexuality, love, equality in relationships, or Sexually Transmitted Infections. At the same time, the presence of myths favors double standards, sexism, and a negative attitude toward toward personal, partner and/or social sexuality. OBJECTIVES To create a scale for evaluating the permanence of myths about sexuality in adolescents, and to analyze the structural reliability and validity of this scale. METHOD The sample was formed by a pilot group (n=216) and a final group (n=661), both with adolescents from high schools in the province of Malaga, obtained by non-probability cluster sampling. The first 69 initial items were given to the pilot sample to determine the final questions making up the "Escala de Mitos sobre la Sexualidad". RESULT All final items have an item-total correlation over 0.29. A final questionnaire was obtained of 27 items, grouped into 6 components. The Cronbach's alpha coefficient indicated a high internal consistency of the test (0.881). Moreover, it confirms a significant difference between the sexes and between grades (cohorts). CONCLUSION The Scale has appropriate parameters for use in sex education and research. The use of this scale would help to discover adherence to the myths of adolescents, in order to eliminate them and build a solid, free and personal concept of sexuality.
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Affiliation(s)
| | - Francisco Javier Del Río
- Departamento de Investigación, Instituto Andaluz de Sexología y Psicología, Málaga, Spain; Área de Metodología, Departamento de Psicología, Universidad de Cádiz, Cádiz, Spain
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11
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Morales A, Espada JP, Orgilés M, Escribano S, Johnson BT, Lightfoot M. Interventions to reduce risk for sexually transmitted infections in adolescents: A meta-analysis of trials, 2008-2016. PLoS One 2018; 13:e0199421. [PMID: 29953546 PMCID: PMC6023153 DOI: 10.1371/journal.pone.0199421] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/07/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Numerous studies have evaluated the efficacy of interventions to reduce risk for sexually transmitted infections in adolescents in recent years, but their global effects remain unknown since 2008, the last date of a comprehensive review of prior studies. AIMS This study aims at evaluating the efficacy of interventions to promote sexual health, reduce STIs and unplanned pregnancies targeted to adolescents available after 2008; and analyzing the moderators of their global efficacy. METHODS We searched electronic databases and manual searches of some journals focused on STIs in May 2016. The studies evaluated the efficacy of interventions to reduce sexual risk in adolescents (age range: 11-19) anywhere in the world. Effect size of the relevant outcomes for sexual risk was calculated for every study. Analyses incorporated random-effect assumptions for each outcome. The homogeneity in the results was examined with the I2 statistic and its associated 95% confident interval. RESULTS Data from 63 studies (59,795 participants) were analyzed for behavioral and non-behavioral outcomes. In the short term, interventions had a positive impact in sexual health-related knowledge (Hedges'g = 1.01), attitudes (g = 0.29), self-efficacy toward condom use (g = 0.22), intention to refuse sex (g = 0.56), condom use intention (g = 0.46), and condom use (g = 0.38). In the medium term, positive effects observed at the short-term were maintained, although effect size significantly decreased in all variables. In the long term, interventions improved condom use (g = 0.47). Moderators of the efficacy are discussed. CONCLUSIONS Sexual health promotion interventions are effective to promote sexual health through increasing condom use. Effects on non-behavioral variables tend to decrease over time, while condom use increased in the long-term. Interventions should focus on the long-term efficacy, especially in behavioral and biological measures.
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Affiliation(s)
- Alexandra Morales
- Department of Health Psychology, Miguel Hernández University, Elche, Spain
| | - José P. Espada
- Department of Health Psychology, Miguel Hernández University, Elche, Spain
| | - Mireia Orgilés
- Department of Health Psychology, Miguel Hernández University, Elche, Spain
| | - Silvia Escribano
- Department of Health Psychology, Miguel Hernández University, Elche, Spain
| | - Blair T. Johnson
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, Connecticut, United States of America
| | - Marguerita Lightfoot
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
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Nartey Y, Hill P, Amo-Antwi K, Asmah R, Nyarko K, Yarney J, Damale N, Cox B. Recommendations for cervical cancer prevention and control in Ghana: public education and human papillomavirus vaccination. Ghana Med J 2018; 52:94-102. [PMID: 30662082 PMCID: PMC6326540 DOI: 10.4314/gmj.v52i2.6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Globally, cervical cancer is a major public health issue causing increasing morbidity and mortality especially in low- and middle-income countries where preventive and control measures are lacking. In Ghana, it is the most common cancer among women. Approaches to reduce the incidence and mortality of the disease in Ghana have had little success due to lack of accurate data on the disease among other factors, to inform policies on prevention, early detection, diagnosis and treatment. Additionally, the lack of clear commitment, policy direction and resources has hindered the scale-up of some of the initiatives implemented to curb the cervical cancer situation in Ghana. In this paper, we make recommendations on cervical cancer education and human papillomavirus vaccination. A collaborative approach is needed involving both private and government organizations, health professionals and the general public. Public education on cervical cancer and HPV vaccination needs to be delivered through a mixture of systems including both healthcare facilities and outreach programs, involving teachers, youth groups, community members and professional bodies. The vaccination of adolescents aged 10-14 years using the nonavalent HPV vaccine will be important in reducing the incidence and mortality of cervical cancer in Ghana. The integration of public education on cervical cancer prevention, HPV vaccination and screening programs into both medical and public health services is critical in achieving high coverage of these programs. FUNDING None.
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Affiliation(s)
- Yvonne Nartey
- Hugh Adam Cancer Epidemiology Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Philip Hill
- Hugh Adam Cancer Epidemiology Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Kwabena Amo-Antwi
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Richard Asmah
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Legon, Greater Accra, Ghana
| | - Kofi Nyarko
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Greater Accra, Ghana
| | - Joel Yarney
- National Centre for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - Nelson Damale
- Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital Accra, Greater Accra, Ghana
| | - Brian Cox
- Hugh Adam Cancer Epidemiology Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, Otago, New Zealand
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Powwattana A, Thammaraksa P, Manora S. Culturally-grounded mother-daughter communication-focused intervention for Thai female adolescents. Nurs Health Sci 2018; 20:214-223. [DOI: 10.1111/nhs.12404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 10/31/2017] [Accepted: 11/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Arpaporn Powwattana
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University; Bangkok Thailand
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Bowring AL, Wright CJC, Douglass C, Gold J, Lim MSC. Features of successful sexual health promotion programs for young people: findings from a review of systematic reviews. Health Promot J Austr 2018; 29:46-57. [PMID: 29700941 DOI: 10.1002/hpja.3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 06/22/2017] [Indexed: 11/11/2022] Open
Abstract
ISSUE ADDRESSED Young people have a high burden of sexual and reproductive health (SRH) problems, and it is important to reach this group through health promotion initiatives. We conducted a systematic review of reviews to identify successful elements of health promotion programs for improving SRH of young people. METHODS We identified and collated systematic reviews published in 2005-2015 which focused on young people (10-24 years), reported on SRH outcomes (pregnancy, sexually transmissible infections, condoms/contraceptive use, risky sexual behaviour, sexual healthcare access or intimate partner violence), and included primary studies predominantly conducted in high-income countries. This report focuses on features of successful SRH programs identified in the interpretation and discussion of included systematic reviews. RESULTS We identified 66 systematic reviews, of which 37 reported on program features which were anecdotally or statistically associated with improved program effectiveness and success. Common features of effective interventions were: longer term or repeated implementation; multi-setting and multi-component; parental involvement; culturally/gender/age appropriate; and inclusion of skills-building. SO WHAT?: There is marked consistency of features improving SRH program effectiveness for young people despite the wide variation in interventions reviewed. There is a need to better implement this knowledge in future programs, and our findings provide useful guidance for optimising the design of SRH interventions for young people.
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Affiliation(s)
| | - Cassandra J C Wright
- Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Caitlin Douglass
- Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Judy Gold
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Megan S C Lim
- Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Krishnaratne S, Hensen B, Cordes J, Enstone J, Hargreaves JR. Interventions to strengthen the HIV prevention cascade: a systematic review of reviews. Lancet HIV 2017; 3:e307-17. [PMID: 27365205 DOI: 10.1016/s2352-3018(16)30038-8] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/22/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Much progress has been made in interventions to prevent HIV infection. However, development of evidence-informed prevention programmes that translate the efficacy of these strategies into population effect remain a challenge. In this systematic review, we map current evidence for HIV prevention against a new classification system, the HIV prevention cascade. METHODS We searched for systematic reviews on the effectiveness of HIV prevention interventions published in English from Jan 1, 1995, to July, 2015. From eligible reviews, we identified primary studies that assessed at least one of: HIV incidence, HIV prevalence, condom use, and uptake of HIV testing. We categorised interventions as those seeking to increase demand for HIV prevention, improve supply of HIV prevention methods, support adherence to prevention behaviours, or directly prevent HIV. For each specific intervention, we assigned a rating based on the number of randomised trials and the strength of evidence. FINDINGS From 88 eligible reviews, we identified 1964 primary studies, of which 292 were eligible for inclusion. Primary studies of direct prevention mechanisms showed strong evidence for the efficacy of pre-exposure prophylaxis (PrEP) and voluntary medical male circumcision. Evidence suggests that interventions to increase supply of prevention methods such as condoms or clean needles can be effective. Evidence arising from demand-side interventions and interventions to promote use of or adherence to prevention tools was less clear, with some strategies likely to be effective and others showing no effect. The quality of the evidence varied across categories. INTERPRETATION There is growing evidence to support a number of efficacious HIV prevention behaviours, products, and procedures. Translating this evidence into population impact will require interventions that strengthen demand for HIV prevention, supply of HIV prevention technologies, and use of and adherence to HIV prevention methods. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Shari Krishnaratne
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK; Centre for Evaluation, London School of Hygiene & Tropical Medicine, London, UK.
| | - Bernadette Hensen
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Jillian Cordes
- Department of Global Health, Emory University, Atlanta, GA, USA
| | - Joanne Enstone
- Public Health and Epidemiology, School of Medicine, Nottingham University, Nottingham, UK
| | - James R Hargreaves
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
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Mason‐Jones AJ, Sinclair D, Mathews C, Kagee A, Hillman A, Lombard C. School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents. Cochrane Database Syst Rev 2016; 11:CD006417. [PMID: 27824221 PMCID: PMC5461872 DOI: 10.1002/14651858.cd006417.pub3] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND School-based sexual and reproductive health programmes are widely accepted as an approach to reducing high-risk sexual behaviour among adolescents. Many studies and systematic reviews have concentrated on measuring effects on knowledge or self-reported behaviour rather than biological outcomes, such as pregnancy or prevalence of sexually transmitted infections (STIs). OBJECTIVES To evaluate the effects of school-based sexual and reproductive health programmes on sexually transmitted infections (such as HIV, herpes simplex virus, and syphilis), and pregnancy among adolescents. SEARCH METHODS We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for published peer-reviewed journal articles; and ClinicalTrials.gov and the World Health Organization's (WHO) International Clinical Trials Registry Platform for prospective trials; AIDS Educaton and Global Information System (AEGIS) and National Library of Medicine (NLM) gateway for conference presentations; and the Centers for Disease Control and Prevention (CDC), UNAIDS, the WHO and the National Health Service (NHS) centre for Reviews and Dissemination (CRD) websites from 1990 to 7 April 2016. We handsearched the reference lists of all relevant papers. SELECTION CRITERIA We included randomized controlled trials (RCTs), both individually randomized and cluster-randomized, that evaluated school-based programmes aimed at improving the sexual and reproductive health of adolescents. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, evaluated risk of bias, and extracted data. When appropriate, we obtained summary measures of treatment effect through a random-effects meta-analysis and we reported them using risk ratios (RR) with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included eight cluster-RCTs that enrolled 55,157 participants. Five trials were conducted in sub-Saharan Africa (Malawi, South Africa, Tanzania, Zimbabwe, and Kenya), one in Latin America (Chile), and two in Europe (England and Scotland). Sexual and reproductive health educational programmesSix trials evaluated school-based educational interventions.In these trials, the educational programmes evaluated had no demonstrable effect on the prevalence of HIV (RR 1.03, 95% CI 0.80 to 1.32, three trials; 14,163 participants; low certainty evidence), or other STIs (herpes simplex virus prevalence: RR 1.04, 95% CI 0.94 to 1.15; three trials, 17,445 participants; moderate certainty evidence; syphilis prevalence: RR 0.81, 95% CI 0.47 to 1.39; one trial, 6977 participants; low certainty evidence). There was also no apparent effect on the number of young women who were pregnant at the end of the trial (RR 0.99, 95% CI 0.84 to 1.16; three trials, 8280 participants; moderate certainty evidence). Material or monetary incentive-based programmes to promote school attendanceTwo trials evaluated incentive-based programmes to promote school attendance.In these two trials, the incentives used had no demonstrable effect on HIV prevalence (RR 1.23, 95% CI 0.51 to 2.96; two trials, 3805 participants; low certainty evidence). Compared to controls, the prevalence of herpes simplex virus infection was lower in young women receiving a monthly cash incentive to stay in school (RR 0.30, 95% CI 0.11 to 0.85), but not in young people given free school uniforms (Data not pooled, two trials, 7229 participants; very low certainty evidence). One trial evaluated the effects on syphilis and the prevalence was too low to detect or exclude effects confidently (RR 0.41, 95% CI 0.05 to 3.27; one trial, 1291 participants; very low certainty evidence). However, the number of young women who were pregnant at the end of the trial was lower among those who received incentives (RR 0.76, 95% CI 0.58 to 0.99; two trials, 4200 participants; low certainty evidence). Combined educational and incentive-based programmesThe single trial that evaluated free school uniforms also included a trial arm in which participants received both uniforms and a programme of sexual and reproductive education. In this trial arm herpes simplex virus infection was reduced (RR 0.82, 95% CI 0.68 to 0.99; one trial, 5899 participants; low certainty evidence), predominantly in young women, but no effect was detected for HIV or pregnancy (low certainty evidence). AUTHORS' CONCLUSIONS There is a continued need to provide health services to adolescents that include contraceptive choices and condoms and that involve them in the design of services. Schools may be a good place in which to provide these services. There is little evidence that educational curriculum-based programmes alone are effective in improving sexual and reproductive health outcomes for adolescents. Incentive-based interventions that focus on keeping young people in secondary school may reduce adolescent pregnancy but further trials are needed to confirm this.
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Affiliation(s)
- Amanda J Mason‐Jones
- University of YorkDepartment of Health SciencesSeebohm Rowntree Building, HeslingtonYorkUKYO10 5DD
- University of Cape TownDepartment of Psychiatry and Mental HealthCape TownSouth Africa
- University of StellenboschInterdisciplinary Health SciencesCape TownSouth Africa
| | - David Sinclair
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolUKL3 5QA
| | - Catherine Mathews
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergCape TownSouth Africa7505
- University of Cape TownSchool of Public Health and Family MedicineRondeboschCape TownSouth Africa7700
| | - Ashraf Kagee
- Stellenbosch UniversityDepartment of PsychologyPrivate Bag X1MatielandWestern CapeSouth Africa7602
| | - Alex Hillman
- University of YorkDepartment of Health SciencesSeebohm Rowntree Building, HeslingtonYorkUKYO10 5DD
| | - Carl Lombard
- South African Medical Research CouncilBiostatistics UnitCape TownSouth Africa
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Hill LM, Maman S, Kilonzo MN, Kajula LJ. Anxiety and depression strongly associated with sexual risk behaviors among networks of young men in Dar es Salaam, Tanzania. AIDS Care 2016; 29:252-258. [PMID: 27469516 DOI: 10.1080/09540121.2016.1210075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study tested the association between mental health scores and sexual risk behaviors among male members of social groups known as "camps" in Dar es Salaam, Tanzania. Anxiety and depression were measured using the HSCL-25 and condom use and sexual partner concurrency were assessed through self-report. A total of 1113 sexually active men with an average age of 27 years were included in the analyses. Higher anxiety and depression scores were significantly associated with both condom use (Anxiety AOR = 0.58, 95% CI: 0.44, 0.77; Depression AOR = 0.60, 95% CI: 0.47, 0.77) and concurrency (Anxiety AOR = 2.32, 95% CI: 1.73, 3.12; Depression AOR = 2.08, 95% CI: 1.60, 2.70). The results of this study provide information salient to the development of effective HIV prevention interventions targeting populations with high burdens of anxiety and depression. The feasibility and effect of integrating mental health promotion activities into HIV prevention interventions should be explored.
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Affiliation(s)
- Lauren M Hill
- a Department of Health Behavior , University of North Carolina, Chapel Hill , Chapel Hill , NC , USA
| | - Suzanne Maman
- a Department of Health Behavior , University of North Carolina, Chapel Hill , Chapel Hill , NC , USA
| | - Mrema Noel Kilonzo
- b Department of Psychiatry and Mental Health , Muhimbili University of Health and Allied Sciences , Dar es Salaam , United Republic of Tanzania
| | - Lusajo Joel Kajula
- b Department of Psychiatry and Mental Health , Muhimbili University of Health and Allied Sciences , Dar es Salaam , United Republic of Tanzania
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18
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Houck CD, Barker DH, Hadley W, Brown LK, Lansing A, Almy B, Hancock E. The 1-year impact of an emotion regulation intervention on early adolescent health risk behaviors. Health Psychol 2016; 35:1036-45. [PMID: 27175579 DOI: 10.1037/hea0000360] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Sexual activity often begins in early adolescence, and adolescents with mental health symptoms are at greater risk for sexual activity and other health risks. This study aimed to evaluate a developmentally targeted intervention designed to enhance early adolescents' emotion regulation competencies as a strategy for reducing health risk behaviors, including sexual initiation. METHOD Adolescents 12 to 14 years old (N = 420; 53% male) with mental health symptoms participated in either an emotion regulation (ER) or health promotion (HP) intervention consisting of 12 after-school sessions. Participants completed questionnaires on laptop computers at baseline, 2-, 6-, and 12-month follow-ups. RESULTS Time to event analyses were used to compare intervention conditions on rate of initiation to vaginal sex. Results showed that participants in the ER condition were less likely to transition into vaginal sexual activity by 1-year follow-up than were those in the HP condition (adjusted hazard ratio = 0.58, 95% confidence interval [0.36, 0.94], p = .01). However, those who were sexually active did not report differences in sexual risk behaviors (e.g., condomless sex). Participants in the ER condition were significantly less likely to report violence behaviors and showed improvement on a behavioral measure of emotion identification; however, they did not differ from HP participants on self-reports of emotional competence. CONCLUSIONS Emotion regulation strategies can be used to delay sexual initiation among early adolescents with mental health symptoms and may have an important role in health education. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | - Amy Lansing
- Department of Psychiatry, Geisel School of Medicine
| | - Brandon Almy
- Institute of Child Development, University of Minnesota
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Macaya Pascual A, Ferreres Riera J, Campoy Sánchez A. Behavioral Interventions for Preventing Sexually Transmitted Infections and Unintended Pregnancies: An Overview of Systematic Reviews. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.adengl.2016.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Macaya Pascual A, Ferreres Riera JR, Campoy Sánchez A. Behavioral Interventions for Preventing Sexually Transmitted Infections and Unintended Pregnancies: An Overview of Systematic Reviews. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:301-17. [PMID: 26801866 DOI: 10.1016/j.ad.2015.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 10/08/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022] Open
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.
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Affiliation(s)
- A Macaya Pascual
- Universitat Internacional de Catalunya, Barcelona, España; Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, España.
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Khurana A, Romer D, Betancourt LM, Brodsky NL, Giannetta JM, Hurt H. Stronger Working Memory Reduces Sexual Risk Taking in Adolescents, Even After Controlling for Parental Influences. Child Dev 2015; 86:1125-1141. [PMID: 26081926 DOI: 10.1111/cdev.12383] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study examined the prospective influence of adolescent working memory (WM) on changes in impulsivity and sexual risk taking and assessed whether this relation could be explained by confounding effects of parental influences. Data from 360 community adolescents (Mage = 13.5 ± 0.95 years; 52% female; 56% non-Hispanic White; low-mid socioeconomic status (SES); recruited from Philadelphia area in 2004-2005) were analyzed using structural equation modeling to predict changes in impulsivity and sexual risk taking over a 2-year follow-up, using baseline assessments of WM, parental monitoring, parental involvement, and SES. Stronger WM predicted reduced involvement in sexual risk taking at follow-up, effects channeled through changes in impulsivity dimensions of "acting without thinking" and "inability to delay gratification." Parental variables had a protective influence on adolescent impulsivity and risk involvement, but the effects of WM operated independently of parental influences.
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DeSmet A, Shegog R, Van Ryckeghem D, Crombez G, De Bourdeaudhuij I. A Systematic Review and Meta-analysis of Interventions for Sexual Health Promotion Involving Serious Digital Games. Games Health J 2014; 4:78-90. [PMID: 26181801 DOI: 10.1089/g4h.2014.0110] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Serious games may be effective in promoting sexual health behavior. Their confidential nature may encourage users to discuss sensitive sexuality topics. Furthermore, they can tailor messages to the individual's needs and may be intrinsically motivating. This meta-analysis investigates the effectiveness of interventions for sexual health promotion that use serious games. MATERIALS AND METHODS A database search was conducted in PubMed, Web of Science, CINAHL, and PsycINFO for publications before the end of July 2013. Serious digital games studies measuring effects on behavior or its determinants, using a control condition, allowing the calculation of an effect size (Hedges' g, random-effects model) were included. RESULTS Seven game studies for sexual health promotion were included. These showed positive effects on determinants (g=0.242; 95 percent confidence interval, 0.129, 0.356), albeit of small effect size. The effects on behavior, measured in only two studies, were not significant (g=0.456; 95 percent confidence interval, -0.649, 1.561). Most games did not use many game features that are considered to be immersive or enhancing flow. Instead, there was a strong reliance on pure gamification features, such as rewards and feedback. CONCLUSIONS The effectiveness of the next generation of games may be enhanced by building on the behavioral change and educational gaming literatures (e.g., using role-play and simulation game formats, individual tailoring, offering adaptation in the difficulty of the challenge, and amount and timing of the feedback). There is a need for studies with rigorous evaluations of game effectiveness, longer-term follow-up, and using measures of behavior rather than merely their determinants.
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Affiliation(s)
- Ann DeSmet
- 1 Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University , Ghent, Belgium
| | - Ross Shegog
- 2 Center for Health Promotion & Prevention Research, School of Public Health, University of Texas , Houston, Texas
| | - Dimitri Van Ryckeghem
- 3 Department of Experimental-Clinical and Health Psychology, Ghent University , Ghent, Belgium
| | - Geert Crombez
- 3 Department of Experimental-Clinical and Health Psychology, Ghent University , Ghent, Belgium
| | - Ilse De Bourdeaudhuij
- 1 Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University , Ghent, Belgium
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Protogerou C, Johnson BT. Factors underlying the success of behavioral HIV-prevention interventions for adolescents: a meta-review. AIDS Behav 2014; 18:1847-63. [PMID: 24903669 DOI: 10.1007/s10461-014-0807-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this meta-review was to identify characteristics of successful HIV prevention interventions for adolescents based on quantitative (i.e., meta-analyses) and qualitative reviews published to date, and to inform intervention utilization and future development. To that end, we were guided by principles of triangulation. Searches of seven electronic bibliographic databases yielded five meta-analyses and six qualitative reviews that satisfied the selection criteria. Reviews were subjected to careful content analysis. All reviews reported that behavioral interventions had positive outcomes on at least one of the following outcomes: HIV-related knowledge, subjective cognitions and beliefs enabling safer sex, abstinence, delaying next sexual intercourse, decreasing number of sexual partners, and actual condom use. Four categories, suggesting factors more prominently linked to intervention success, emerged: behavior change techniques (e.g., cognitive-behavior and motivation enhancement skills training); recipient characteristics (e.g., age, vulnerability to contracting STIs/HIV); prominent design features (e.g., use of theory, formative research); and socio-ecological features (e.g., supportive school environment). Future interventions would benefit from conducting preliminary formative research in order to enable optimal implementation of all these factors.
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Affiliation(s)
- Cleo Protogerou
- Center for Health, Intervention and Prevention, University of Connecticut, Storrs, CT, USA,
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Shepherd J, Harden A, Barnett-Page E, Kavanagh J, Picot J, Frampton GK, Cooper K, Hartwell D, Clegg A. Using process data to understand outcomes in sexual health promotion: an example from a review of school-based programmes to prevent sexually transmitted infections. HEALTH EDUCATION RESEARCH 2014; 29:566-582. [PMID: 24488650 DOI: 10.1093/her/cyt155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article discusses how process indicators can complement outcomes as part of a comprehensive explanatory evaluation framework, using the example of skills-based behavioural interventions to prevent sexually transmitted infections and promote sexual health among young people in schools. A systematic review was conducted, yielding 12 eligible outcome evaluations, 9 of which included a process evaluation. There were few statistically significant effects in terms of changes in sexual behaviour outcomes, but statistically significant effects were more common for knowledge and self-efficacy. Synthesis of the findings of the process evaluations identified a range of factors that might explain outcomes, and these were organized into two overarching categories: the implementation of interventions, and student engagement and intervention acceptability. Factors which supported implementation and engagement and acceptability included good quality teacher training, involvement and motivation of key school stakeholders and relevance and appeal to young people. Factors which had a negative impact included teachers' failure to comprehend the theoretical basis for behaviour change, school logistical problems and omission of topics that young people considered important. It is recommended that process indicators such as these be assessed in future evaluations of school-based sexual health behavioural interventions, as part of a logic model.
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Affiliation(s)
- J Shepherd
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton SO16 7NS, UK, Institute for Health and Human Development, University of East London, London E15 4LZ, UK and Social Science Research Unit, University of London, London WC1H 0AL, UK
| | - A Harden
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton SO16 7NS, UK, Institute for Health and Human Development, University of East London, London E15 4LZ, UK and Social Science Research Unit, University of London, London WC1H 0AL, UK
| | - E Barnett-Page
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton SO16 7NS, UK, Institute for Health and Human Development, University of East London, London E15 4LZ, UK and Social Science Research Unit, University of London, London WC1H 0AL, UK
| | - J Kavanagh
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton SO16 7NS, UK, Institute for Health and Human Development, University of East London, London E15 4LZ, UK and Social Science Research Unit, University of London, London WC1H 0AL, UK
| | - J Picot
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton SO16 7NS, UK, Institute for Health and Human Development, University of East London, London E15 4LZ, UK and Social Science Research Unit, University of London, London WC1H 0AL, UK
| | - G K Frampton
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton SO16 7NS, UK, Institute for Health and Human Development, University of East London, London E15 4LZ, UK and Social Science Research Unit, University of London, London WC1H 0AL, UK
| | - K Cooper
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton SO16 7NS, UK, Institute for Health and Human Development, University of East London, London E15 4LZ, UK and Social Science Research Unit, University of London, London WC1H 0AL, UK
| | - D Hartwell
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton SO16 7NS, UK, Institute for Health and Human Development, University of East London, London E15 4LZ, UK and Social Science Research Unit, University of London, London WC1H 0AL, UK
| | - A Clegg
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton SO16 7NS, UK, Institute for Health and Human Development, University of East London, London E15 4LZ, UK and Social Science Research Unit, University of London, London WC1H 0AL, UK
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Carmona J, Slesnick N, Guo X, Letcher A. Reducing High Risk Behaviors among Street Living Youth: Outcomes of an Integrated Prevention Intervention. CHILDREN AND YOUTH SERVICES REVIEW 2014; 43:118-123. [PMID: 25104870 PMCID: PMC4120522 DOI: 10.1016/j.childyouth.2014.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Research efforts to reduce Human Immunodeficiency Virus (HIV) risk behavior among street living youth have shown disappointing outcomes, with few studies reporting reduced risk behaviors. The current study tested the impact of an integrated HIV prevention intervention, and predictors of change, for youth (N=270) between the ages of 14 to 20 years receiving substance use treatment through a drop-in center. Condom use, HIV knowledge, number of sexual partners and behaviors associated with an overall HIV risk index were assessed at baseline, 3, 6 and 12 months post-baseline. Findings suggest that HIV prevention integrated with substance use treatment is associated with increased condom use and reduced sex partners. However, the effects on condom use were short lived and dissipated by 12 months post-baseline. Higher treatment attendance and baseline substance use predicted increased condom use. Although no significant change was observed in the overall HIV risk index, increases in depressive symptoms were associated with increases in the index score, as well as more sexual partners. Future research should determine whether successful intervention requires reinforcement of risk reduction behaviors while youth remain homeless.
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Affiliation(s)
- Jasmin Carmona
- Department of Human Sciences, The Ohio State University,135 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43220, USA
| | - Natasha Slesnick
- Department of Human Sciences, The Ohio State University,135 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43220, USA
| | - Xiamei Guo
- Department of Human Sciences, The Ohio State University,135 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43220, USA
| | - Amber Letcher
- Department of Counseling and Human Development, South Dakota State University, Box 2275A Brookings, SD 57007, USA
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Adolescent age at time of receipt of one or more sexual risk reduction interventions. J Adolesc Health 2014; 55:228-34. [PMID: 24656447 PMCID: PMC4108619 DOI: 10.1016/j.jadohealth.2014.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 12/09/2013] [Accepted: 01/28/2014] [Indexed: 11/22/2022]
Abstract
PURPOSE Age of the target audience at time of intervention is thought to be a critical variable influencing the effectiveness of adolescent sexual risk reduction interventions. Despite this postulated importance, to date, studies have not been designed to enable a direct comparison of outcomes according to age at the time of intervention delivery. METHODS We examined outcomes of 598 youth who were sequentially involved in two randomized controlled trials of sexual risk prevention interventions, the first one delivered in grade 6 (Focus on Youth in the Caribbean [FOYC]) and the second one in grade 10 (Bahamian Focus on Older Youth [BFOOY]). Four groups were examined, including those who received (1) both treatment conditions, FOYC and BFOOY; (2) FOYC in grade 6 and the control condition in grade 10; (3) the control condition in grade 6 and BFOOY in grade 10; and (4) both control conditions. Intentions, perceptions, condom-use skills, and HIV-related knowledge were assessed over 60 months. RESULTS Data showed that those who received both interventions had the greatest increase in condom-use skills. Youth who received FOYC in grade 6 had greater scores in knowledge and intention. CONCLUSION These results suggest that youth receive the most protection with early and repeated exposure to interventions. These findings suggest that educators should consider implementing HIV prevention and risk reduction programs as a fixed component of education curriculum beginning in the preadolescent years and if possible also during the adolescent years.
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Thammaraksa P, Powwattana A, Lagampan S, Thaingtham W. Helping teachers conduct sex education in secondary schools in Thailand: overcoming culturally sensitive barriers to sex education. Asian Nurs Res (Korean Soc Nurs Sci) 2014; 8:99-104. [PMID: 25030641 DOI: 10.1016/j.anr.2014.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 11/08/2013] [Accepted: 02/01/2014] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of this quasi experimental study was to evaluate the effects of Culturally Sensitive Sex Education Skill Development, a teacher-led sex education program in secondary schools in Thailand. METHODS Two public secondary schools in the suburban areas of Bangkok were randomly selected. One was designated as the experimental school and the other as the comparison school. Ninety grade seven and eight teachers, 45 from each school, were selected to participate in the study. Self efficacy theory and culturally appropriate basis were applied to develop the program which included 4 weeks of intervention and 2 weeks of follow up. Primary outcomes were attitudes toward sex education, perceived self efficacy, and sex education skills. Statistical analysis included independent and paired t test, and repeated one-way analysis of variance. RESULTS At the end of the intervention and during the follow-up period, the intervention group had significantly higher mean scores of attitudes toward sex education, perceived self efficacy, and sex education skills than their scores before (p < .001), and than those of the comparison group (p < .001). CONCLUSION The results showed that Culturally Sensitive Sex Education Skill Development could enhance attitudes and sex education self efficacy to promote the implementation of sex education among teachers.
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Affiliation(s)
| | | | - Sunee Lagampan
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
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Lopez LM, Stockton LL, Chen M, Steiner MJ, Gallo MF. Behavioral interventions for improving dual-method contraceptive use. Cochrane Database Syst Rev 2014; 2014:CD010915. [PMID: 24683022 PMCID: PMC10590623 DOI: 10.1002/14651858.cd010915.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dual-method contraception refers to using condoms as well as another modern method of contraception. The latter (usually non-barrier) method is commonly hormonal (e.g., oral contraceptives) or a non-hormonal intrauterine device. Use of two methods can better prevent pregnancy and the transmission of HIV and other sexually transmitted infections (STIs) compared to single-method use. Unprotected sex increases risk for disease, disability, and mortality in many areas due to the prevalence and incidence of HIV/STI. Millions of women, especially in lower-resource areas, also have an unmet need for protection against unintended pregnancy. OBJECTIVES We examined comparative studies of behavioral interventions for improving use of dual methods of contraception. Dual-method use refers to using condoms as well as another modern contraceptive method. Our intent was to identify effective interventions for preventing pregnancy as well as HIV/STI transmission. SEARCH METHODS Through January 2014, we searched MEDLINE, CENTRAL, POPLINE, EMBASE, COPAC, and Open Grey. In addition, we searched ClinicalTrials.gov and ICTRP for current trials and trials with relevant data or reports. We examined reference lists of pertinent papers, including review articles, for additional reports. SELECTION CRITERIA Studies could be either randomized or non-randomized. They examined a behavioral intervention with an educational or counseling component to encourage or improve the use of dual methods, i.e., condoms and another modern contraceptive. The intervention had to address preventing pregnancy as well as the transmission of HIV/STI. The program or service could be targeted to individuals, couples, or communities. The comparison condition could be another behavioral intervention to improve contraceptive use, usual care, other health education, or no intervention.Studies had to report use of dual methods, i.e., condoms plus another modern contraceptive method. We focused on the investigator's assessment of consistent dual-method use or use at last sex. Outcomes had to be measured at least three months after the behavioral intervention began. DATA COLLECTION AND ANALYSIS Two authors evaluated abstracts for eligibility and extracted data from included studies. For the dichotomous outcomes, the Mantel-Haenszel odds ratio (OR) with 95% CI was calculated using a fixed-effect model. Where studies used adjusted analysis, we presented the results as reported by the investigators. No meta-analysis was conducted due to differences in interventions and outcome measures. MAIN RESULTS We identified four studies that met the inclusion criteria: three randomized controlled trials and a pilot study for one of the included trials. The interventions differed markedly: computer-delivered, individually tailored sessions; phone counseling added to clinic counseling; and case management plus a peer-leadership program. The latter study, which addressed multiple risks, showed an effect on contraceptive use. Compared to the control group, the intervention group was more likely to report consistent dual-method use, i.e., oral contraceptives and condoms. The reported relative risk was 1.58 at 12 months (95% CI 1.03 to 2.43) and 1.36 at 24 months (95% CI 1.01 to 1.85). The related pilot study showed more reporting of consistent dual-method use for the intervention group compared to the control group (reported P value = 0.06); the investigators used a higher alpha (P < 0.10) for this pilot study. The other two trials did not show any significant difference between the study groups in reported dual-method use or in test results for pregnancy or STIs at 12 or 24 months. AUTHORS' CONCLUSIONS We found few behavioral interventions for improving dual-method contraceptive use and little evidence of effectiveness. A multifaceted program showed some effect but only had self-reported outcomes. Two trials were more applicable to clinical settings and had objective outcomes measures, but neither showed any effect. The included studies had adequate information on intervention fidelity and sufficient follow-up periods for change to occur. However, the overall quality of evidence was considered low. Two trials had design limitations and two had high losses to follow up, as often occurs in contraceptive trials. Good quality studies are still needed of carefully designed and implemented programs or services.
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Affiliation(s)
- Laureen M Lopez
- FHI 360Clinical Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Laurie L Stockton
- FHI 360Health Services Research359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Mario Chen
- FHI 360Division of Biostatistics359 Blackwell St, Suite 200Durham, NCNorth CarolinaUSA27709
| | - Markus J Steiner
- FHI 360Contraceptive Innovation Initiative Dept359 Blackwell StreetDurhamNorth CarolinaUSA27701
| | - Maria F Gallo
- The Ohio State UniversityDivision of EpidemiologyRoom 324 Cunz Hall1841 Neil AvenueColumbusOhioUSA43210‐1351
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Jemmott LS, Jemmott JB, Ngwane Z, Icard L, O’Leary A, Gueits L, Brawner B. 'Let Us Protect Our Future' a culturally congruent evidenced-based HIV/STD risk-reduction intervention for young South African adolescents. HEALTH EDUCATION RESEARCH 2014; 29:166-81. [PMID: 23962491 PMCID: PMC3894663 DOI: 10.1093/her/cyt072] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 06/10/2013] [Indexed: 05/31/2023]
Abstract
One of the worst HIV/AIDS epidemics in the world is occurring in South Africa, where heterosexual exposure is the main mode of HIV transmission. Young people 15-24 years of age, particularly women, account for a large share of new infections. Accordingly, there is an urgent need for behavior-change interventions to reduce the incidence of HIV among adolescents in South Africa. However, there are few such interventions with proven efficacy for South African adolescents, especially young adolescents. A recent cluster-randomized controlled trial of the 'Let Us Protect Our Future!' HIV/STD risk-reduction intervention for Grade 6 South African adolescents (mean age = 12.4 years) found significant decreases in self-reported sexual risk behaviors compared with a control intervention. This article describes the intervention, the use of the social cognitive theory and the reasoned action approach to develop the intervention, how formative research informed its development and the acceptability of the intervention. Challenges in designing and implementing HIV/STD risk-reduction interventions for young adolescents in sub-Saharan Africa are discussed.
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Affiliation(s)
- L. S. Jemmott
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - J. B. Jemmott
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Z. Ngwane
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - L. Icard
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - A. O’Leary
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - L. Gueits
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - B. Brawner
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Lopez LM, Chen M, Steiner MJ, Gallo MF. Behavioral interventions for improving dual-method contraceptive use. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd010915] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Lopez LM, Otterness C, Chen M, Steiner M, Gallo MF. Behavioral interventions for improving condom use for dual protection. Cochrane Database Syst Rev 2013:CD010662. [PMID: 24163112 DOI: 10.1002/14651858.cd010662.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Unprotected sex is a major risk factor for disease, disability, and mortality in many areas of the world due to the prevalence and incidence of sexually transmitted infections (STI) including HIV. The male condom is one of the oldest contraceptive methods and the earliest method for preventing the spread of HIV. When used correctly and consistently, condoms can provide dual protection, i.e., against both pregnancy and HIV/STI. OBJECTIVES We examined comparative studies of behavioral interventions for improving condom use. We were interested in identifying interventions associated with effective condom use as measured with biological assessments, which can provide objective evidence of protection. SEARCH METHODS Through September 2013, we searched computerized databases for comparative studies of behavioral interventions for improving condom use: MEDLINE, POPLINE, CENTRAL, EMBASE, LILACS, OpenGrey, COPAC, ClinicalTrials.gov, and ICTRP. We wrote to investigators for missing data. SELECTION CRITERIA Studies could be either randomized or nonrandomized. They examined a behavioral intervention for improving condom use. The comparison could be another behavioral intervention, usual care, or no intervention. The experimental intervention had an educational or counseling component to encourage or improve condom use. It addressed preventing pregnancy as well as the transmission of HIV/STI. The focus could be on male or female condoms and targeted to individuals, couples, or communities. Potential participants included heterosexual women and heterosexual men.Studies had to provide data from test results or records on a biological outcome: pregnancy, HIV/STI, or presence of semen as assessed with a biological marker, e.g., prostate-specific antigen. We did not include self-reported data on protected or unprotected sex, due to the limitations of recall and social desirability bias. Outcomes were measured at least three months after the behavioral intervention started. DATA COLLECTION AND ANALYSIS Two authors evaluated abstracts for eligibility and extracted data from included studies. For the dichotomous outcomes, the Mantel-Haenszel odds ratio (OR) with 95% CI was calculated using a fixed-effect model. Cluster randomized trials used various methods of accounting for the clustering, such as multilevel modeling. Most reports did not provide information to calculate the effective sample size. Therefore, we presented the results as reported by the investigators. No meta-analysis was conducted due to differences in interventions and outcome measures. MAIN RESULTS Seven studies met our eligibility criteria. All were randomized controlled trials; six assigned clusters and one randomized individuals. Sample sizes for the cluster-randomized trials ranged from 2157 to 15,614; the number of clusters ranged from 18 to 70. Four trials took place in African countries, two in the USA, and one in England. Three were based mainly in schools, two were in community settings, one took place during military training, and one was clinic-based.Five studies provided data on pregnancy, either from pregnancy tests or national records of abortions and live births. Four trials assessed the incidence or prevalence of HIV and HSV-2. Three trials examined other STI. The trials showed or reported no significant difference between study groups for pregnancy or HIV, but favorable effects were evident for some STI. Two showed a lower incidence of HSV-2 for the behavioral-intervention group compared to the usual-care group, with reported adjusted rate ratios (ARR) of 0.65 (95% CI 0.43 to 0.97) and 0.67 (95% CI 0.47 to 0.97), while HIV did not differ significantly. One also reported lower syphilis incidence and gonorrhea prevalence for the behavioral intervention plus STI management compared to the usual-care group. The reported ARR were 0.58 (95% CI 0.35 to 0.96) and 0.28 (95% CI 0.11 to 0.70), respectively. Another study reported a negative effect on gonorrhea for young women in the intervention group versus the control group (ARR 1.93; 95% CI 1.01 to 3.71). The difference occurred among those with only one year of the intervention. AUTHORS' CONCLUSIONS We found few studies and little clinical evidence of effectiveness for interventions promoting condom use for dual protection. We did not find favorable results for pregnancy or HIV, and only found some for other STI. The overall quality of evidence was moderate to low; losses to follow up were high. Effective interventions for improving condom use are needed to prevent pregnancy and HIV/STI transmission. Interventions should be feasible for resource-limited settings and tested using valid and reliable outcome measures.
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Affiliation(s)
- Laureen M Lopez
- Clinical Sciences, FHI 360, P.O. Box 13950, Research Triangle Park, North Carolina, USA, 27709
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Ronis ST, LeBouthillier DM. University students' attitudes toward purchasing condoms. CANADIAN JOURNAL OF HUMAN SEXUALITY 2013. [DOI: 10.3138/cjhs.2013.2201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study assessed participants' attitudes regarding purchasing condoms as well as factors associated with emotional comfort in purchasing them. Participants were 244 university students who were asked about their educational, cultural, and family backgrounds; previous experiences and attitudes in purchasing (or otherwise obtaining) condoms; experience and knowledge about topics directly relevant to sexuality; personality traits; and parent-child sexual communication. Zero-order correlation and multiple regression analyses were used to identify predictors of emotional comfort in purchasing condoms. Regression results demonstrated that lower religiosity, more favourable attitudes toward birth control, lower neuroticism, and greater parent-child sexual communication predicted comfort in purchasing condoms. Qualitative analyses revealed that individuals who purchased condoms typically reported either feeling embarrassed and concerned about being exposed or that they had acted appropriately and responsibly. Findings from this study provide key information about emerging adults' comfort in purchasing condoms and have important implications for enhancing sexual education programs.
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Affiliation(s)
- Scott T. Ronis
- Department of Psychology, University of New Brunswick, Fredericton, NB
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Garcia-Retamero R, Cokely ET. Simple but powerful health messages for increasing condom use in young adults. JOURNAL OF SEX RESEARCH 2013; 52:30-42. [PMID: 24007406 DOI: 10.1080/00224499.2013.806647] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In a large longitudinal study involving young adults, we conducted an eight-hour STD educational intervention and examined the impact of the intervention on the efficacy of a message for promoting condom use. The message was framed in positive or negative terms and was presented visually or in numbers (percentages or frequencies). Results indicated that the numerical positive-framed message increased condom use among young adults who did not receive the intervention, whereas the numerical negative-framed message did not. Attitudes toward condom use along with changes in intentions to use condoms mediated this framing effect. In contrast, the positive-framed and negative-framed messages were equally and highly effective for promoting condom use when the messages were presented visually or when young adults received the STD educational intervention before reading the message, suggesting that the simple brochures featuring visual aids were as effective in changing attitudes and behavioral intentions as the extensive intervention. These findings add to a growing body of evidence detailing the mechanisms that allow well-constructed visual aids to be among the most effective, transparent, memorable, and ethically desirable means of risk communication. Clinical and public health implications are discussed.
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Bridging the Gap: Malaysian Youths and the Pedagogy of School-based Sexual Health Education. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.sbspro.2013.08.355] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Garcia-Retamero R, Cokely ET. The Influence of Skills, Message Frame, and Visual Aids on Prevention of Sexually Transmitted Diseases. JOURNAL OF BEHAVIORAL DECISION MAKING 2013. [DOI: 10.1002/bdm.1797] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Rocio Garcia-Retamero
- Department of Experimental Psychology; University of Granada; Granada Spain
- Center for Adaptive Behavior and Cognition; Max Planck Institute for Human Development; Berlin Germany
| | - Edward T. Cokely
- Department of Cognitive and Learning Sciences; Michigan Technological University; Houghton MI USA
- Center for Adaptive Behavior and Cognition; Max Planck Institute for Human Development; Berlin Germany
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Behavioral interventions for improving condom use for dual protection. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010662] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Farris C, Akers AY, Downs JS, Forbes EE. Translational research applications for the study of adolescent sexual decision making. Clin Transl Sci 2013; 6:78-81. [PMID: 23399094 DOI: 10.1111/cts.12038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Although the initiation of sexual behaviors in adolescence is normative, adverse sexual health outcomes disproportionately affect adolescents relative to adults. Efforts to improve sexual health and increase health promotion behaviors in adolescent populations have not been fully successful. In this paper, we propose that translational research that integrates insights from neuroscience, ecological systems theory, and decision science with adolescent sexual behavior research can lead to advances in our understanding of the etiology and prevention of sexual risk behaviors among adolescents. Moreover, these insights can be further translated to the design and implementation of clinical interventions that improve sexual health.
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