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The Princeton University Board of Trustees has approved the appointment of 24 faculty members, including six full professors and 18 assistant professors. Sylvain Chassangin economics, specializes in economic theory. He res the Princeton faculty this summer from his professorship at New York University, having ly taught at Princeton from to Chassang has published numerous papers and serves as associate editor of four economics journals.
Objective To evaluate the efficacy of an abstinence-only intervention in preventing sexual involvement in young adolescents. Participants A total of African American students in grades 6 and 7.
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Interventions An 8-hour abstinence-only intervention targeted reduced sexual intercourse; an 8-hour safer sex—only intervention targeted increased condom use; 8-hour and hour comprehensive interventions targeted sexual intercourse and condom use; and an 8-hour health-promotion control intervention targeted health issues unrelated to sexual behavior. Participants also were randomized to receive or not receive an intervention maintenance program to extend intervention efficacy.
Outcome Measures The primary outcome was self-report of ever having sexual intercourse by the month follow-up. Secondary outcomes were other sexual behaviors. The participants' mean age was Abstinence-only intervention reduced sexual initiation risk ratio [RR], 0. The model-estimated probability of ever having sexual intercourse by the month follow-up was Fewer abstinence-only intervention participants Abstinence-only intervention did not affect condom use. The 8-hour RR, 0.
No other differences between interventions and controls were ificant. Conclusion Theory-based abstinence-only interventions may have an important role in preventing adolescent sexual involvement.
Trial Registration clinicaltrials. Adolescents risk the deleterious consequences of early sexual involvement including human immunodeficiency virus HIV1 other sexually transmitted infections STIs2 and unintended pregnancies. Although considerable research suggests that behavioral interventions can reduce sexual behaviors related to risk of STI among adolescents, 12 - 14 including younger adolescents aged 11 to 15 years, 15 - 18 a public policy debate has revolved around the appropriateness and efficacy of different sexual risk—reduction interventions.
Some have advocated abstinence interventions; others have advocated comprehensive interventions—abstinence and, for sexually active adolescents, condom use. Abstinence interventions have been criticized for containing inaccurate information, portraying sex in a negative light, using a moralistic tone, 1920 and risking unintended adverse consequences. Despite the widespread implementation of abstinence interventions and the controversy regarding their appropriateness, few randomized controlled trials have tested their efficacy. Here we report the of a trial regarding the efficacy of such a theory-based abstinence-only intervention.
African American students in grades 6 and 7 were randomly ased to an 8-hour abstinence-only intervention, an 8-hour safer sex—only intervention, an 8- or hour combined abstinence and safer-sex intervention, or an 8-hour health-promotion control group.
We hypothesized that fewer participants in the abstinence-only intervention than in the control group would report ever having sexual intercourse by the month follow-up. A common shortcoming of behavior-change interventions is that efficacy is demonstrated in the short term but disappears at longer-term follow-up.
This may particularly be a problem for abstinence interventions. We deed a multifaceted intervention-maintenance program tailored to each intervention to extend the efficacy of the interventions. A secondary hypothesis, then, was that the intervention-maintenance program would enhance intervention efficacy.
The participants were African American students in grades 6 and 7 who were recruited from 4 public middle schools that serve low-income African American communities in a city in the northeastern United States; they were recruited between September and March via announcements by project staff in assemblies, classrooms, and lunchrooms, and letters to parents or guardians for the Promoting Health Among Teens PHAT Project, which was deed to reduce the chances of adolescents developing devastating health problems including cardiovascular diseases, cancers, and STIs, including HIV.
African American students in grades 6 and 7 at the 4 participating schools who had written parent or guardian consent were eligible to participate. In this randomized controlled trial, students were stratified by age and sex and, using a computer-generated random sequence, randomly allocated to an 8-hour abstinence-only intervention, an 8-hour safer sex—only intervention, an 8-hour comprehensive intervention, a hour comprehensive intervention, or an 8-hour health-promotion control intervention. They were also randomly ased to intervention maintenance or no intervention maintenance and to a group of 6 to 8 participants.
One researcher conducted the computer-generated random asments and distributed the information to other researchers who executed the asments. Adolescents were enrolled in the study in 4 cycles or replications, 1 at each of 4 schools. The Figure shows the of adolescents randomized to each condition. The intervention and data collection sessions were implemented on Saturdays in classrooms at the participating schools. Progress of participating African American students in grades 6 and 7 through the trial.
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Students who were not followed up were absent at the time of the follow-up session and failed to attend the make-up sessions for unknown reasons. The interventions were based on social cognitive theory, 2627 the theory of reasoned action, 2829 and its extension, the theory of planned behavior. Each intervention involved a series of brief group discussions, videos, games, brainstorming, experiential exercises, and skill-building activities.
Four of the interventions consisted of 8 1-hour modules implemented during 2 sessions, and 1 consisted of 12 1-hour modules implemented over 3 sessions. All 5 were pilot tested.
The 8-hour abstinence-only intervention encouraged abstinence to eliminate the risk of pregnancy and STIs including HIV. It was not deed to meet federal criteria for abstinence-only programs. For instance, the target behavior was abstaining from vaginal, anal, and oral intercourse until a time later in life when the adolescent is more prepared to handle the consequences of sex.
The intervention did not contain inaccurate information, portray sex in a negative light, or use a moralistic tone. The training and curriculum manual explicitly instructed the facilitators not to disparage the efficacy of condoms or allow the view that condoms are ineffective to go uncorrected. The 8-hour safer sex—only intervention encouraged condom use to reduce the risk of pregnancy and STIs, including HIV, if adolescents had sex.
It was not deed to influence abstinence. Two comprehensive interventions combined the abstinence and safer-sex, HIV risk—reduction interventions.
One was 12 hours, and the other was 8 hours and contained similar content. Both targeted beliefs and skills to encourage abstinence and condom use. The hour version contained the safer-sex content 4 hoursthe abstinence content 4 hoursand the general content common to both single-component interventions 4 hours. If the hour version had a larger effect than the single-component interventions, it would not have been possible to distinguish the beneficial effects of greater intervention length from the benefits of combining the two components. To control for this, the 8-hour version was the same length as the single-component interventions.
The 8-hour health-promotion intervention, which served as the control, focused on behaviors associated with risk of heart disease, hypertension, stroke, diabetes, and certain cancers. It was deed to increase knowledge and motivation regarding healthful dietary practices, aerobic exercise, and breast and testicular self-examination, and to discourage cigarette smoking. It controls for Hawthorne effects to reduce the likelihood that effects of the HIV interventions could be attributed to nonspecific features including group interaction and special attention.
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Participants were also randomly ased to receive or not receive an intervention-maintenance program tailored to their intervention. It consisted of two 3-hour booster intervention sessions 6 weeks and 3 months after initial intervention sessions6 issues of a newsletter, and six minute 1-on-1 counseling sessions during a month period with their original facilitator. The facilitators were 16 men and 51 women mean age, All were African American except for 1 Puerto Rican individual. We hired facilitators with the skills to implement any of the interventions, stratified them for sex and age, and randomly ased them to receive 2.
In this way, we randomized facilitators' characteristics across interventions, reducing the plausibility of attributing intervention effects to the facilitators' preexisting characteristics.
Participants completed preintervention, immediate postintervention, and 3- 6- and month follow-up questionnaires. Follow-up data were collected between January and August All questions had been pilot tested to ensure that they were clear and that the phrasing was appropriate for the population. Preintervention and follow-up questionnaires assessed sexual behavior, demographic variables, and mediator variables.
The postintervention questionnaire assessed mediator variables and evaluative ratings of the interventions. The primary outcome for the abstinence-only intervention was report of ever having sexual intercourse by the month follow-up.
Secondary outcomes were other self-reported sexual behaviors in the 3 months such as sexual intercourse, multiple partners having sexual intercourse with 2 or more partnersunprotected intercourse 1 or more sexual intercourse acts without using a condomand consistent condom use condom use during every sexual intercourse act. Data collectors received 8 hours of training and were blind to the participants' intervention condition.
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We took several steps to increase the validity of self-reported sexual behavior. To facilitate participants' recall, we asked them to report their behaviors during a brief period ie, past 3 months32 wrote the dates comprising the period on a chalkboard, and gave them calendars highlighting the period. To reduce the likelihood that participants would minimize or exaggerate, we stressed the importance of responding honestly, informing them that their responses would be used to create programs for other African American adolescents like themselves and that we could do so only if they answered the questions honestly.
We assured the participants that their responses would be kept confidential and that code s rather than names would be used on the questionnaires.
Participants ed an agreement pledging to answer the questions honestly, a procedure that has been shown to yield more valid self-reports on sensitive issues. The Marlowe-Crowne Social Desirability Scale 34 included in the preintervention questionnaire assessed the tendency of participants to describe themselves in favorable, socially desirable terms.
To test intervention effects, we used an intention-to-treat approach in which participants' data were analyzed regardless of the of intervention or data collection sessions they attended.
Analyses of recent sexual intercourse, multiple partners, and unprotected intercourse controlled for the baseline measures of the criterion, time, intervention-maintenance condition, sex, and age. Analyses of ever having sexual intercourse excluded participants who reported ever having sexual intercourse at baseline and controlled for intervention-maintenance condition, sex, and age.
Analyses of consistent condom use excluded participants who did not report sexual intercourse in the past 3 months and controlled for time, intervention-maintenance condition, sex, and age. The latter did not control for baseline measures because the small of participants reporting recent sexual intercourse at both baseline and follow-up would have severely limited the sample size. Table 1 summarizes select participant characteristics at baseline.
About Age ranged from 10 to 15 years, with a mean SD of Of those who reported intercourse in the 3 months,