Behavioral interventions to reduce incidence of HIV, STD, and pregnancy among adolescents: A decade in review

Purpose: To review adolescent sexual risk-reduction programs that were evaluated using quasi-experimental or experimental methods and published in the 1990s. We describe evaluated programs and identify program and evaluation issues for health educators and researchers. Methods: We systematically searched seven electronic databases and hand-searched journals to identify evaluations of behavioral interventions to reduce sexual risk behaviors among adolescents. Articles were included if they were published in the 1990s, provided a theoretical basis for the program, information about the interventions, clear aims, and quasi-experimental or experimental evaluation methods. We identified 101 articles, and 24 met our criteria for inclusion. Results: We reviewed these evaluations to assess their research and program characteristics. The majority of studies included randomized controlled designs and employed delayed follow-up measures. The most commonly measured outcomes were delay of initiation of sexual intercourse, condom use, contraceptive use, and frequency of sexual intercourse. Programs ranged from 1 to 80 sessions, most had adult facilitators, and commonly included skills-building activities about sexual communication, decision-making, and problem solving. The programs included a wide range of strategies for content delivery such as arts and crafts, school councils, and community service learning. Conclusions: Analysis of these programs suggest four overall factors that may impact program effectiveness including the extent to which programs focus on specific skills for reducing sexual risk behaviors; program duration and intensity; what constitutes the content of a total evaluated program including researchers' assumptions of participants' exposure to prior and concurrent programs; and what kind of training is available for facilitators.