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Houck et al. (2006) observe that "[p]revention efforts are most successful when they are compatible with their target audiences. ... In the field of HIV prevention, the challenge of addressing adolescents within the context of other risk behaviors and life circumstances provides an opportunity to increase the relevance of intervention approaches to reduce the transmission of HIV" (p. 627). To this end, Houck and colleagues utilized cluster analysis to categorize a community sample of 1,153 adolescents (ages 15 to 21 years) with histories of unprotected sex into five HIV risk domains: unprotected sex, mental health crises, alcohol/marijuana use, other drug use, and arrest/school dropout. "Cluster analysis revealed separate three-cluster solutions for males and females. Among males, clusters were characterized by (a) mental health crises and unprotected sex, (b) alcohol/marijuana use and unprotected sex, and (c) lower risk. Among females, clusters were distinguished by (a) unprotected sex, (b) substance use and mental health crises, and (c) lower risk" (p. 619). The "lower risk" clusters reflect the finding that "most of the sexual risk behavior was accounted for by less than 50% of the participants" (p. 624).
With regard to risk reduction interventions, the investigators stress that "adolescents with a history of mental health crises are likely to be at sexual risk and may benefit from prevention efforts" (p. 626) and that "[c]omprehensive interventions that convey an understanding of adolescents' situations, including acknowledging the complex reasons for engaging in risk, appear to be the next step in adolescent HIV prevention efforts" (p. 627).
[C]omprehensive interventions may provide greater impact by addressing the "bigger picture" of adolescent's lives. For example, adolescents can be encouraged to adhere to prescribed psychiatric medication. Moreover, specific mental health issues may dictate differences in clinical intervention efforts. Programs for adolescents with a history of psychiatric crises may require greater focus on identifying strategies that decrease emotional distress and enhance social support, whereas those targeting teens with arrest or truancy histories might focus on helping young adults identify more options for their futures or strategies for reducing impulsive behavior that may lead to arrest. (p. 627)
Houck and colleagues also stress that "clusters labeled 'lower risk' included large numbers of adolescents. ... [who] still engaged in behaviors that put them at significant risk for HIV and ST[D]s [sexually transmitted diseases]. Unlike with other clusters that exhibited co-occurring risks (e.g., substance use, mental health crises), identifying factors contributing to sexual risk as targets for intervention among this subsample proves more difficult, but nonetheless critical" (p. 627).
Less comprehensive interventions do, of course, continue to have their place in the prevention armamentarium. It stands to reason, for example, that interventions designed to increase condom use may be enhanced if they furnish cues to recall safe-sex messages in the context of sexual activity. In Canada, Dal Cin, MacDonald, Fong, Zanna, and Elton-Marshall (2006)
tested this notion by assigning sexually active introductory psychology students (N = 196) to a standard safe-sex intervention, a safe-sex with reminder intervention, or a control (drinking and driving) intervention. Participants assigned to the reminder intervention were given a "friendship bracelet" to wear and were instructed to have the bracelet remind them of the intervention. In a follow-up session (5-7 weeks later), they were asked questions pertaining to condom use. Of the 125 participants who had engaged in sexual intercourse, condom use at last intercourse was higher in the bracelet condition (55%) than in the standard (27%) or control (36%) conditions. The authors also found that the bracelet remained effective, even when participants were under the influence of alcohol. These findings therefore imply that health intervention programs may be more efficacious if they include … reminder cues to increase the salience of health information in the appropriate contexts. (p. 438)
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Fall 2006 Newsletter / Volume 8, Issue 1
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