The Effect of Sex Education on Adolescents' Use of Condoms: Applying the Solomon Four-Group Design

Institute of Psychology, University of Oslo, Norway.
Health education quarterly 03/1996; 23(1):34-47. DOI: 10.1177/109019819602300103
Source: PubMed


A school-based sex education program was developed in order to prevent sexually transmitted diseases and unwanted pregnancies. A Solomon four-group design, with random assignment to the different conditions, was used to evaluate an intervention based on cognitive social learning theory and social influence theory. The main goal of the intervention was to increase use of condoms. A stratified sample of 124 classes (2,411 students) was drawn at random from all the upper secondary schools (high schools/colleges) in one county in Norway. The results indicate a consistent interaction between pretest and intervention, which seems to have an effect on condom use. Pretest or intervention alone did not contribute to this effect. The interaction effect appeared among the students with few sexual partners. Several possible explanations to the observed interaction effect and the implication for future interventions are discussed.

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Available from: Ingela Lundin Kvalem, Jun 16, 2014
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    • "Ten studies were eligible for inclusion in this review [22], [23], [24], [25], [26], [27], [28], [29], [30], [31] – see Figure for a summary of the study selection process and Table 1 for details of included studies. The majority (n = 6) of these studies took place in schools and were concerned with the prevention of health compromising behaviours among children. "
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    ABSTRACT: The possible effects of research assessments on participant behaviour have attracted research interest, especially in studies with behavioural interventions and/or outcomes. Assessments may introduce bias in randomised controlled trials by altering receptivity to intervention in experimental groups and differentially impacting on the behaviour of control groups. In a Solomon 4-group design, participants are randomly allocated to one of four arms: (1) assessed experimental group; (2) unassessed experimental group (3) assessed control group; or (4) unassessed control group. This design provides a test of the internal validity of effect sizes obtained in conventional two-group trials by controlling for the effects of baseline assessment, and assessing interactions between the intervention and baseline assessment. The aim of this systematic review is to evaluate evidence from Solomon 4-group studies with behavioural outcomes that baseline research assessments themselves can introduce bias into trials. Electronic databases were searched, supplemented by citation searching. Studies were eligible if they reported appropriately analysed results in peer-reviewed journals and used Solomon 4-group designs in non-laboratory settings with behavioural outcome measures and sample sizes of 20 per group or greater. Ten studies from a range of applied areas were included. There was inconsistent evidence of main effects of assessment, sparse evidence of interactions with behavioural interventions, and a lack of convincing data in relation to the research question for this review. There were too few high quality completed studies to infer conclusively that biases stemming from baseline research assessments do or do not exist. There is, therefore a need for new rigorous Solomon 4-group studies that are purposively designed to evaluate the potential for research assessments to cause bias in behaviour change trials.
    Preview · Article · Oct 2011 · PLoS ONE
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    • "2 , 7 9 . 0 ( 2 6 . 1 x e s ) d e i f i c e p s n u r o ( l a n i g a v g n i r u d e s u m o d n o c % 0 0 1 ) I C % 5 9 ( R O D I y d u t S Fitzgerald et al 1999 49 Kirby et al 1997 50 Kvalem et al 1996 51 Philliber et al 2002 32 Shrier et al 2001 52 Stanton et al 2006 53 Stanton et al 1998 54 Stanton et al 1998 55 Weeks et al1997 56 2. 1 2 1 ( . 0 5 , 3. ) 6 2 ) 1 9 . "
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    ABSTRACT: Effective condom use can prevent sexually transmitted infections (STIs) and unwanted pregnancy. We conducted a systematic review and methodological appraisal of randomised controlled trials (RCTs) of interventions to promote effective condom use. We searched for all RCTs of interventions to promote effective condom use using the Cochrane Infectious Diseases Group's trials register (Oct 2006), CENTRAL (Issue 4, 2006), MEDLINE (1966 to Oct 2006), EMBASE (1974 to Oct 2006), LILACS (1982 to Oct 2006), IBSS (1951 to Oct 2006) and Psychinfo (1996 to Oct 2006). We extracted data on allocation sequence, allocation concealment, blinding, loss to follow-up and measures of effect. Effect estimates were calculated. We identified 139 trials. Seven out of ten trials reported reductions in 'any STI' with five statistically significant results. Three out of four trials reported reductions in pregnancy, although none was statistically significant. Only four trials met all the quality criteria. Trials reported a median of 11 (IQR 7-17) outcome measures. Few trials used the same outcome measure. Altogether, 10 trials (7%) used the outcome 'any STI', 4 (3%) self-reported pregnancy and 22 (16%) used 'condom use at last sex'. The results are generally consistent with modest benefits but there is considerable potential for bias due to poor trial quality. Because of the low proportion of trials using the same outcome the potential for bias from selective reporting of outcomes is considerable. Despite the public health importance of increasing condom use there is little reliable evidence on the effectiveness of condom promotion interventions.
    Full-text · Article · Oct 2009 · Journal of epidemiology and community health
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    • "Contraceptive use has similarly been found to be inconsistently related to school-based sex education, with some studies flnding a positive influence (e.g. Kvalem et al., 1996) and others flnding no influence at all (e.g. Taylor et al., 1989). "
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    ABSTRACT: The purpose of this study was to explore the comparative contribution that (a) multiple sources of education about sexual topics (peers, media, school and other adults), and (b) the timing of this sex education, make on American adolescent sexual attitudes and behavior. Participants were 672 ethnically and economically diverse male and female, high‐school adolescents. Regression analyses revealed that earlier learning from most sources and more learning from schools about various sexual topics, including the importance of using birth control and consequences of teen pregnancy, were generally significantly predictive of less frequent oral sex and sexual intercourse. Other sources of sex education (peers, media, other adults) seemed to be less important in influencing outcomes. Ethnic/racial and gender variations also resulted.
    Full-text · Article · Feb 2005 · Educational Review
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