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Population-averaged results are reported. To determine whether intervention group or time was associated with risk reduction outcomes, generalized estimating equations GEE 43 were conducted for count measures specifying a poisson distribution , and linear mixed models were conducted for measures that were normally distributed using SAS. All analyses represented change using a piecewise linear function i.
For the linear mixed models analysis of the normally distributed outcomes, the intercept and both slopes were allowed to vary randomly across participants; if there was no variability across participants in one or more of these parameters, the parameter s was constrained to be equal across participants. Predictors for all analyses were: All participants who provided data on at least one occasion were included in the analyses.
There were no adverse events associated with any of the interventions, or study procedures. As reported previously, 44 logistic regression analyses compared patients who consented to participate with those who declined.
Effects of a Brief, Theory-Based STD-Prevention Program for Female College Students
The pattern of retention 12 month completers vs. Baseline means M s and standard deviations SD s for the baseline variables by condition appear in Table 1. At baseline, of patients Means and standard deviations for the sexual risk behavior outcomes appear in Table 2. Overall, there were no differences among intervention conditions from baseline to 3 months, and no consistent pattern of intervention effects from 3 to 12 months. There were significant changes over time for all of the sexual behavior outcomes. The number of partners decreased from 2. The total number of episodes of unprotected sex decreased from The number of episodes of unprotected sex with a steady partner decreased from The slope from 3 to 12 months did not differ from zero.
The slope from 3 to 12 months did not differ from zero for these variables. Means and standard deviations for the psychological antecedents of risk behavior appear in Table 3. For the motivational and skills outcomes, improvements were generally equivalent across conditions with no consistent pattern of intervention effects. Workshop attendance did not differ as a function of brief intervention: Attendance did not differ as a function of sexual risk characteristics.
This RCT tested whether a unique two-step approach that combined a brief intervention with an intensive group-based intervention would reduce sexual risk behavior and incident STDs among patients seeking care at a STD clinic. Overall, four new findings were obtained. These findings should be interpreted mindful of study strengths and limitations. Strengths include the use of a large and diverse sample; multimodal assessment using ACASI, biologic testing, and chart abstraction; a year-long follow-up; theoretically-guided interventions implemented by well-trained, culturally sensitive facilitators; and careful data analyses using an intent-to-treat approach.
The primary study limitation is the lack of a pure, no treatment control condition. However, ethical obligations require that all patients receive counseling as the standard of care. In addition, the trial was implemented at a progressive clinic where the standard of care was already quite high.
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A second limitation involves the use of self-report to measure risk behavior and its antecedents; self-report is vulnerable to cognitive limitations and social influence. However, use of ACASI minimizes the demands associated with interviews and problems due to low literacy. Fourth, recruitment was limited to persons 18 years of age and older; it is possible that inclusion of adolescents, who are more vulnerable to STDs, may have provided a more sensitive test of intervention effectiveness.
Fifth, biological testing was limited to gonorrhea and chlamydia; testing for a wider range of STDs would have provided for a more sensitive test of intervention effectiveness.
Finally, patients were recruited from a single clinic, so generalization to other clinics and settings cannot be assumed and should be investigated. This research suggests several directions for future investigation. First, research might evaluate the effects of detailed assessments on risk awareness and behavior change.
One interpretation for the equivalent effects observed across conditions is the sensitizing effects of the baseline assessment. Previous research has demonstrated that detailed assessment of health behaviors can lead to increased risk awareness and behavior change. This important question can be addressed with a Solomon four-group design.
Second, brief and intensive interventions can be improved. To optimize their feasibility and effectiveness, such interventions should target the behaviors that drive the epidemic, and be attractive to participants. In this regard, research has identified partner concurrency as an important driver of STD epidemics; 58 59 research also indicates that some men define masculinity, in part, by a man's ability to attract multiple partners.
Research needs to identify the active ingredients of such interventions, and clarify the differential benefits afforded by detailed assessments, STD testing, and brief and intensive interventions. Research also needs to identify ways to further supplement the gains achieved with biomedical and behavioral interventions. Investigation of community-based programs, media campaigns, and other structural interventions is needed. STDs in the U.
National Center for Biotechnology Information , U. Author manuscript; available in PMC Aug Carey , PhD, a, b Theresa E. Senn , PhD, a Peter A. Urban , MD b. See other articles in PMC that cite the published article. Abstract Objective To evaluate the separate and combined effectiveness of brief and intensive interventions for sexual risk reduction among patients at a STD clinic. Results Infection rates declined from Conclusions Implementing behavioral interventions in a STD clinic was associated with significant reduction of sexual risk behavior, and risk antecedents.
Open in a separate window. Procedures This manuscript provide a general overview of the procedures; a more detailed overview of the study procedures is available elsewhere. Baseline Patients completed an audio, computer-assisted, self-interview ACASI , an assessment mode that minimizes socially desirable responding. Randomization Patients were randomly assigned to a brief and an intensive intervention condition using a random number generator. Brief intervention Step 1 While waiting for lab results, patients received one of two brief interventions.
Intensive intervention Step 2 Participants who had been invited to an intensive intervention were called prior to the workshop, and encouraged to attend. Follow-up assessments Participants were contacted by telephone or mail, and encouraged to return for follow-up assessments at 3, 6, and 12 months. Chart abstraction At 12 months, clinic and county databases were reviewed for incident STDs resulting from clinic visits between follow-up assessments, and diagnosis and treatment of a STD elsewhere in the county. Outcome Measures STD infection was assessed through: Statistical Analyses Sample size was determined a priori for primary outcomes i.
STD infection At baseline, of patients Patients in all six conditions appear to have benefited. This pattern of improvement was consistently observed over 12 months and across multiple outcomes; gains were observed on variables that are immune to social demand i. The decrease in STDs from baseline to 3 months should be interpreted cautiously, because baseline data include both new and existing infections i.
However, because the majority of patients presented to the clinic with symptoms, it is likely that many of the STDs diagnosed at baseline were recently acquired. In addition, it is unlikely that risk behavior or knowledge gains can be so explained. Overall, the consistent pattern of results suggests that the use of well-designed, theoretically-informed behavioral interventions will help patients to reduce sexual risk behavior and avoid re-infection with a STD.
Such an interpretation is also consistent with previous results from both primary-level investigations and meta-analytic integrations. The pattern of improvement across the six intervention conditions was relatively equivalent.
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This finding contrasts with the prediction that intensive workshops would facilitate greater risk reduction; however, it is not unprecedented, especially when the comparison conditions are also active risk reduction interventions. Because the standard of care requires that all patients who are tested for HIV receive counseling, it would not have been ethical to withhold a behavioral intervention. This ethical necessity led to the use of a study design that is not optimal for demonstrating intervention effectiveness because the differential effect of a new intervention is often small relative to the absolute amount of change observed.
Little is known about reactivity resulting from detailed sexual health assessments; however, research on other health behaviors indicates that detailed assessments can prompt behavior change. Further research is needed to determine whether detailed sexual assessments result in behavior change. Disentangling such reactivity from true intervention effects is needed to develop realistic expectations of intervention effectiveness when implemented in contexts that do not include detailed, sexual assessments.
Contrary to research in the treatment of substance use, 22 the BMI did not improve attendance at the intensive interventions i. This finding might indicate that the BMI we implemented was not effective; alternatively, it is possible that the practical strategies we used to encourage attendance e. Future research might investigate the effects of a BMI on receipt of further services without the ancillary encouragement we provided. The effects observed at the initial 3-month follow-up did not appear to decay over the ensuing 9 months.
Indeed, patients continued to reduce the number of partners from 3 to 12 months; moreover, we detected no significant decay on the other outcomes. The lack of decay is encouraging, and may reflect the enduring influence of the interventions. However, because patients were reassessed and re-tested for STDs for the entire study, it is also possible that these ongoing assessments prompted continued vigilance regarding risk reduction and, in this sense, served inadvertently as intervention booster sessions.
Previous research 23 has not found this, but our data do not allow us to draw strong inferences regarding this finding. Study Strengths and Limitations These findings should be interpreted mindful of study strengths and limitations. Suggestions for Future Research This research suggests several directions for future investigation. World Health Organization Global prevalence and incidence of selected curable sexually transmitted infections: Centers for Disease Control and Prevention.
Sexually transmitted diseases among American youth: Incidence and prevalence estimates, Perspect Sex Reprod Health. Centers for Disease Control and Prevention Trends in reportable sexually transmitted diseases in the United States, Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med. From epidemiological synergy to public health policy and practice: The contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Do clinic-based STD data reflect community patterns?
STD prevention and the challenge of gender and cultural diversity: Concurrent sexual partnerships among men in the United States. Am J Public Health. Social context of sexual relationships among rural African Americans. HIV seroincidence and risk factors among patients repeatedly tested for HIV attending sexually transmitted disease clinics in the United States, to Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: Theoretical approaches to individual-level change in HIV risk behavior.
Handbook of HIV prevention. Behavioral HIV risk reduction among people who inject drugs: J Subst Abuse Treat. Sexual risk reduction for persons living with HIV: J Acquir Immune Defic Syndr. Sexual risk reduction interventions do not inadvertently increase the overall frequency of sexual behavior: Changing HIV risk behavior: A Sourcebook for Behavioral Interventions. The use of brief interventions adapted from motivational interviewing across behavioral domains: Prevention of sexually transmitted HIV infection: A meta-analytic review of the behavioral outcome literature.
Evaluating a two-step approach to sexual risk reduction in a publicly-funded STI clinic: Methodological challenges in research on sexual risk behavior: In search of how people change: Yet another proof that it is not just numbers, but with whom you have sex that decides what you catch. Brisbane, if you can.
Effects of a Brief, Theory-Based STD-Prevention Program for Female College Students
High school students in Brisbane aged 15—18 have chlamydia prevalence rates of 1. Selection bias aside, these figures are surprisingly low for this age group. But chlamydia isolation rates have also been low in Brisbane university students, gay men, sexual health clinic attendees, and even persons locked up in prison. The journal is currently developing a number of self contained electronic continuing professional development modules.