mental health AIDS

Summer 2005 Newsletter

HIV Prevention News

About Adolescents

Rock, Ireland, Resnick, and McNeely (2005) analyzed longitudinal interview data from a nationally representative sample of 404 male adolescents who were between the ages of 15 and 17 years and sexually inexperienced when data were first collected and who reported that they had become sexually experienced when data were next collected 1 year later. At baseline, objective knowledge regarding proper condom use was measured through a five-item quiz and perceived knowledge was measured on a five-item scale through which the teens rated their confidence in their answers on the objective measure. Rock and colleagues found that male teens with low objective knowledge but high perceived knowledge (i.e., those who believed they knew how to use condoms correctly but, in fact, did not) were nearly 3 times less likely to report condom use at first intercourse than those with high objective knowledge or those with low objective knowledge who perceived this to be the case.

[F]indings suggest that ... providers who work with male adolescents should assess both objective and perceived knowledge ... one-on-one ..., not unlike screening assessments for depression, alcohol addiction, or other conditions. ... Once assessed, level of objective knowledge must be interpreted in the context of perceived knowledge when predicting the likelihood of ... using a condom at first intercourse. It should not be assumed that those with high objective knowledge automatically have high confidence about their knowledge or that those with low objective knowledge … have low perceived knowledge. The male adolescents who are most at risk seem to be those with high perceived but low objective knowledge. By considering both facets of knowledge, providers may be able to predict … which male adolescents are at risk and thus tailor health intervention strategies to those who need it most. (p. 671)

Continuing with the subject of condom use, Bryan, Rocheleau, Robbins, and Hutchinson (2005) assessed 267 criminally involved adolescents at baseline and again 6 months later and found that intentions and attitudes toward condom use measured at baseline could predict later condom use behavior. Importantly, "alcohol use ... [did] not influence the relationships among self-esteem, positive orientation to the future, attitudes, norms, self-efficacy, and intentions to use condoms. Further, alcohol use [did] not seem to moderate the relationship of intentions to use condoms and condom use behavior" (p. 140). These results suggest that "intervention content based on the assumption that self-esteem, positive orientation toward the future, attitudes, norms, and self-efficacy are related to condom use intentions need not be altered whether the participants in the intervention are drinkers or not. [The authors] do not mean to imply that intervention content should ignore alcohol use generally or the drinking status of participants specifically ... but that the more general condom promotion content of the intervention can remain consistent" (p. 139).

Interesting intervention news comes from Jemmott, Jemmott, Braverman, and Fong (2005), who conducted a randomized controlled trial involving 682 sexually experienced, inner-city African American and Puerto Rican adolescent girls recruited from an adolescent medicine clinic. Participants were randomized to one of three single-session "250-minute interventions based on cognitive-behavioral theories and elicitation research: an information-based HIV/STD intervention [that] provided information necessary to practice safer sex; a skill-based HIV/STD intervention [that] provided information and taught skills necessary to practice safer sex; or a health-promotion control intervention [that was] concerned with health issues unrelated to sexual behavior" (p. 440).

Although there were no statistically significant differences in outcomes among the three interventions with respect to frequency of unprotected intercourse, number of partners, or the STD rate at the 3- or 6-month follow-ups, skills-based intervention participants reported less unprotected sexual intercourse at the 12-month follow-up than did participants in the other two interventions. At that time, skills-based intervention participants also reported fewer sexual partners and were less likely to test positive for an STD in comparison with the health-promotion control intervention participants. Outcomes for the information-based and health promotion control interventions did not differ significantly at any of the follow-up intervals.

Jemmott and colleagues conclude that "[s]kill-based HIV/STD interventions can reduce sexual risk behaviors and STD rate among African American and Latino adolescent girls in clinic settings" (p. 440). They also note that their findings "were produced by a single-session intervention of only 250 minutes. This suggests that it is possible to effect significant long-term changes in sexual behavior among adolescent girls – over 12 months in the present study – without great expenditure of time and effort" (p. 448). Moreover,

the present study provides some of the strongest evidence that enhancing skills should be a critical goal for interventions designed to reduce risk[y] sexual behavior. ... Methods for enhancing condom use skills include handling condoms, practicing putting condoms on anatomical models, and role-playing realistic situations that involve pressure to have unprotected intercourse. The implementation of such activities with adolescents may be controversial in certain settings, yet, the present results suggest that they hold the promise of reductions in sexual risk behavior. (p. 447)

Wu et al. (2005) recruited 817 African American youth between the ages of 13 and 16 living in and around Baltimore public housing to participate in an eight-session HIV risk-reduction intervention that targeted multiple risk behaviors. "An instrument designed to measure three levels of sexual risk ('abstinent,' 'protected sex' [having sex with a condom], and 'unprotected sex' [having sex without a condom]) was administered at baseline, 6 months and 12 months postintervention" (p. 56). They found that "youth who engaged in unprotected sexual behavior were significantly more likely to be involved simultaneously in multiple problem behaviors when compared with youth engaged in protected sex or with abstinent youth. The degree of sexual risk increase[d] as the number of other risks increase[d]" (p. 61). Furthermore, "[y]outh who were the highest at baseline remained the highest in risk-taking over time but demonstrated a significant decreasing trend, whereas abstinent youth remained the lowest in risk-taking over time but demonstrated a significant increasing trend" (p. 61). "These findings imply that broad-based interventions targeting multiple behaviors are effective for adolescents who exhibit multiple high-risk behaviors ... . Additionally, interventions preventing onset of problem behaviors among abstinent adolescents may need to be structured differently from interventions for higher risk youth because there was a significant progression of risk behaviors in this group in contrast to the higher risk groups" (p. 61).

Finally, O'Sullivan, Dolezal, Brackis-Cott, Traeger, and Mellins (2005) studied 220 low-income urban mothers and their early adolescent children (ages 10 to 14) and found that mothers who were living with HIV were more likely to report that they talked about HIV and had discussions on related topics more frequently than did uninfected mothers. Additionally, the children of mothers who were living with HIV, compared with those whose mothers were not, reported greater comfort discussing sex- and drug-related topics. Nonetheless, the authors are quick to note that "promoting parent-child communication about HIV and risk behaviors is unlikely to directly affect adolescents' chances of HIV infection" (p. 163). Rather, "[c]ommunication should be perceived as one mechanism by which a better parent-child relationship influences adolescents' future choices about participation in risk activities" (pp. 163-164).

It is the promotion of stronger family relations that is likely to help in ... efforts to prevent infection among adolescents. Teaching parents how to initiate and engage their children in discussion, anticipate reactions, and tailor the content to the child's developmental stage may be useful strategies that support efforts to reduce the risk of infection among young people. Moreover, providing information to parents about overcoming their own inhibitions to communicate with their children, particularly those related to distressing their children, may promote more positive family communication. (p. 164)

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