A theory-based, abstinence-only intervention appears to be associated with a lower rate of sexual involvement among African American sixth- and seventh-graders, according to a report in the February issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
"Adolescents risk the deleterious consequences of early sexual involvement including human immunodeficiency virus (HIV), other sexually transmitted infections (STIs) and unintended pregnancies. In the United States, these risks are especially great among African American adolescents," the authors write as background information in the article. "Although considerable research suggests that behavioral interventions can reduce sexual behaviors related to risk of STI among adolescents, including younger adolescents aged 11 to 15 years, a public policy debate has revolved around the appropriateness and efficacy of different sexual risk-reduction interventions." Some have advocated abstinence-only interventions, whereas others favor comprehensive interventions that also discuss safer sex.
John B. Jemmott III, Ph.D, of the University of Pennsylvania, Philadelphia, and colleagues conducted a randomized controlled trial to evaluate one intervention, an eight-hour abstinence-only program targeting reduced sexual intercourse. A total of 662 African American students (average age 12.2, 53.5 percent girls) were randomly assigned to participate either in the abstinence-only intervention, an eight-hour safer sex-only intervention targeting increased condom use; eight-hour and 12-hour comprehensive interventions targeting both sexual intercourse and condom use; or an eight-hour health-promotion control intervention focusing on issues not related to sexual behavior. Some participants were then randomly selected to receive an intervention maintenance program designed to extend the efficacy of each program.
After 24 months, 84.4 percent of the students were still enrolled in the program. The probability of ever having sexual intercourse by the 24-month follow-up was 33.5 percent in the abstinence-only program and 48.5 percent in the control group attending health promotion courses. Rates in the safer sex and comprehensive programs did not differ significantly from the control group.
In addition, fewer students in the abstinence-only group (20.6 percent) vs. those in the control group (29 percent) reported having sex in the previous three months during the follow-up period. The abstinence-only intervention did not appear to change rates of condom use. The eight-hour and 12-hour comprehensive programs appeared to be associated with reduced reports of having multiple partners when compared with the control group.
The findings do not indicate that this intervention is the best approach or that other programs should be abandoned, the authors note. "Tackling the problem of STIs among young people requires an array of approaches implemented in a variety of venues," they conclude. "What the present results suggest is that theory-based abstinence-only interventions can be part of this mix. Using theory-based abstinence-only interventions selectively might contribute to the overall goal of curbing the spread of STIs in both the United States and other countries."
(Arch Pediatr Adolesc Med. 2010;164:152-159. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was supported by a grant from the National Institute of Mental Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Study Helps Inform Public Policy Debate
"The study by Jemmott and colleagues in this issue of the Archives was designed to test some specific hypotheses within the larger public policy question of how to prevent human immunodeficiency virus/AIDS and other sexually transmitted infections, as well as unwanted pregnancies, among adolescents in this country," write Frederick P. Rivara, M.D., M.P.H., of the University of Washington and Seattle Children's Hospital and editor of the Archives, and Alain Joffe, M.D., M.P.H., of Johns Hopkins University, Baltimore, and associate editor of the Archives, in an accompanying editorial.
"This is an immensely important issue, and one that clearly will not be solved through any single intervention," they write. "The results of this study now must be combined with those from other studies on prevention of sexually transmitted infections and unintended pregnancy and become part of the knowledge base for the formation of public policy on sexuality education in our schools and for our children."
"No public policy should be based on the results of one study, nor should policy makers selectively use scientific literature to formulate a policy that meets preconceived ideologies. Well-done studies, especially randomized controlled trials, are an important element of the data on which informed policy rests. They should be reviewed carefully to develop policies that promote the health of our nation."
(Arch Pediatr Adolesc Med. 2010;164:200. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.