The Effectiveness of Group-Based Comprehensive Risk-Reduction and Abstinence Education Interventions to Prevent or Reduce the Risk of Adolescent Pregnancy, Human Immunodeficiency Virus, and Sexually Transmitted Infections Two Systematic Reviews for the Guide to Community Preventive Services

Community Guide Branch, Epidemiology and Analysis Program Office, National Center for Immunization and Respiratory Diseases, CDC, Atlanta GA 30333, USA.
American journal of preventive medicine (Impact Factor: 4.53). 03/2012; 42(3):272-94. DOI: 10.1016/j.amepre.2011.11.006
Source: PubMed


Adolescent pregnancy, HIV, and other sexually transmitted infections (STIs) are major public health problems in the U.S. Implementing group-based interventions that address the sexual behavior of adolescents may reduce the incidence of pregnancy, HIV, and other STIs in this group.
Methods for conducting systematic reviews from the Guide to Community Preventive Services were used to synthesize scientific evidence on the effectiveness of two strategies for group-based behavioral interventions for adolescents: (1) comprehensive risk reduction and (2) abstinence education on preventing pregnancy, HIV, and other STIs. Effectiveness of these interventions was determined by reductions in sexual risk behaviors, pregnancy, HIV, and other STIs and increases in protective sexual behaviors. The literature search identified 6579 citations for comprehensive risk reduction and abstinence education. Of these, 66 studies of comprehensive risk reduction and 23 studies of abstinence education assessed the effects of group-based interventions that address the sexual behavior of adolescents, and were included in the respective reviews.
Meta-analyses were conducted for each strategy on the seven key outcomes identified by the coordination team-current sexual activity; frequency of sexual activity; number of sex partners; frequency of unprotected sexual activity; use of protection (condoms and/or hormonal contraception); pregnancy; and STIs. The results of these meta-analyses for comprehensive risk reduction showed favorable effects for all of the outcomes reviewed. For abstinence education, the meta-analysis showed a small number of studies, with inconsistent findings across studies that varied by study design and follow-up time, leading to considerable uncertainty around effect estimates.
Based on these findings, group-based comprehensive risk reduction was found to be an effective strategy to reduce adolescent pregnancy, HIV, and STIs. No conclusions could be drawn on the effectiveness of group-based abstinence education.

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    • "About 70% of U.S. 19-year-olds are coitally active (Abma, Martinez, & Copen, 2010), and levels of risk behavior vary with age. Those in their teens and twenties practice greater risky sexual behavior than older adults, and also contract a disproportionate percentage of STIs (Chin et al., 2012). In the United States, the potential for risky sexual behavior generally extends over many years as individuals transition from sexual debut, through serial monogamies, to a more permanent relationship. "
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    ABSTRACT: The odds of developing cancer are increased by specific lifestyle behaviors (tobacco use, excess energy and alcohol intakes, low fruit and vegetable intake, physical inactivity, risky sexual behaviors, and inadequate sun protection) that are established risk factors for developing cancer. These behaviors are largely absent in childhood, emerge and tend to cluster over the life span, and show an increased prevalence among those disadvantaged by low education, low income, or minority status. Even though these risk behaviors are modifiable, few are diminishing in the population over time. We review the prevalence and population distribution of these behaviors and apply an ecological model to describe effective or promising healthy lifestyle interventions targeted to the individual, the sociocultural context, or environmental and policy influences. We suggest that implementing multiple health behavior change interventions across these levels could substantially reduce the prevalence of cancer and the burden it places on the public and the health care system. We note important still-unresolved questions about which behaviors can be intervened upon simultaneously in order to maximize positive behavioral synergies, minimize negative ones, and effectively engage underserved populations. We conclude that interprofessional collaboration is needed to appropriately determine and convey the value of primary prevention of cancer and other chronic diseases. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    American Psychologist 02/2015; 70(2):75-90. DOI:10.1037/a0038806 · 6.87 Impact Factor
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    • "In contrast to abstinence approaches, a 2012 CDC meta-analysis of 66 comprehensive risk reduction programs for youth showed favorable effects on current sexual activity, frequency of sexual activity, number of sex partners , frequency of unprotected sexual activity, use of protection (either condoms and/or hormonal contraception), pregnancy, and STIs (Chin et al. 2012). In the same report, the CDC found insufficient scientific evidence for change in behaviors or other outcomes from abstinence education programs (Chin et al. 2012). Since 2010, there has been a shift in federal approaches to sexual health education away from AOUM programs, and towards ''evidence-based interventions'' (EBI), led by the US federal Office of Adolescent Health (OAH) (AOUM programs have still received substantial funding through the Title V State Abstinence Education Grant Program). "
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    ABSTRACT: Scientific research has made major contributions to adolescent health by providing insights into factors that influence it and by defining ways to improve it. However, US adolescent sexual and reproductive health policies-particularly sexuality health education policies and programs-have not benefited from the full scope of scientific understanding. From 1998 to 2009, federal funding for sexuality education focused almost exclusively on ineffective and scientifically inaccurate abstinence-only-until-marriage (AOUM) programs. Since 2010, the largest source of federal funding for sexual health education has been the "tier 1" funding of the Office of Adolescent Health's Teen Pregnancy Prevention Initiative. To be eligible for such funds, public and private entities must choose from a list of 35 programs that have been designated as "evidence-based" interventions (EBIs), determined based on their effectiveness at preventing teen pregnancies, reducing sexually transmitted infections, or reducing rates of sexual risk behaviors (i.e., sexual activity, contraceptive use, or number of partners). Although the transition from primarily AOUM to EBI is important progress, this definition of evidence is narrow and ignores factors known to play key roles in adolescent sexual and reproductive health. Important bodies of evidence are not treated as part of the essential evidence base, including research on lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth; gender; and economic inequalities and health. These bodies of evidence underscore the need for sexual health education to approach adolescent sexuality holistically, to be inclusive of all youth, and to address and mitigate the impact of structural inequities. We provide recommendations to improve US sexual health education and to strengthen the translation of science into programs and policy.
    Journal of Youth and Adolescence 09/2014; 43(10). DOI:10.1007/s10964-014-0178-8 · 2.72 Impact Factor
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    • "For several decades , concerns were raised that risk reduction interventions by describing safer sexual practices could accelerate the initiation of sex and/or increase sexual activity if they were delivered to youth prior to the initiation of sex [4] [5]. This aspect of the variables' " age " and " virginal status " has been exhaustively studied, with an overwhelming preponderance of the literature indicating that sexual risk reduction interventions do not hasten the onset of sex or increase sexual activity [3] [4] [6]. However, the question as to the best timing for delivery of adolescent sexual risk reduction interventions in terms of age (which is confounded with sexual debut status) remains open. "
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    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.
    Journal of Adolescent Health 08/2014; 55(2). DOI:10.1016/j.jadohealth.2014.01.016 · 3.61 Impact Factor
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