Interventions Boost Abstinence, Condom Use for Black Teens

Sexual health interventions are effective at increasing both abstinence and condom use in Black adolescents, according to research from North Carolina State University evaluating dozens of studies on interventions and outcomes in Black youth.

The new paper, published in JAMA Pediatrics, draws on data from 29 studies that reported on a total of 11,918 Black adolescents. Sexual health interventions range from school-based health classes to programs offered by community organizations.

“We focused on Black adolescents because they face greater health disparities when it comes to the risk of unplanned pregnancy and contracting sexually-transmitted infections (STIs) compared to other adolescents,” says Reina Evans, first author of the paper and a Ph.D. student at NC State. “This disparity stems, in large part, from the context in which Black teens make decisions about their health. For example, stress from racism and discrimination, as well as unequal access to health care can impact the health of Black teens. We wanted to see whether sexual health interventions can be a valuable tool in addressing this disparity.”

The researchers found that young people were slightly more likely to abstain from sex if they took part in one of these programs – particularly if the intervention occurred at school. The researchers also found a modest increase in condom use for adolescents who took part in an intervention.

“When we considered if youth who completed these programs had lower rates of unintended pregnancy or STIs, we did not see any effect – positive or negative – from the programs,” Evans says. “However, only 4 of the 29 studies investigated these important outcomes, so these findings should be considered preliminary. It is likely that offering a sexual health program to youth could be one component of the puzzle of preventing teen pregnancy and STIs, and other components are also needed – like increasing access to contraception and STI testing and addressing racism in healthcare in the United States.”

The study also showed that interventions made Black adolescents more knowledgeable about sexual health and more confident that they could and would make safe sexual decisions in the future.

In addition, researchers found that the effects were similar regardless of whether interventions were coeducational or aimed at a specific gender, and regardless of the target age range for an intervention.

“These findings highlight that sexual health interventions make a positive difference for many Black adolescents,” Evans says. “Important next steps include finding ways to disseminate interventions more broadly to teens, ensuring the interventions are accessible, and encouraging participation and engagement.

“What’s more, there’s an urgent need to address disparities in access to long-term, high-quality reproductive healthcare, which could have a significant effect on health outcomes for Black teens.”

The paper, “Sexual health interventions for Black adolescents: A meta-analysis,” was co-authored by Laura Widman, an associate professor of psychology at NC State; Elan Hope, an assistant professor of psychology at NC State; and McKenzie Stokes, Hannah Javidi and Julia Brasileiro, Ph.D. students at NC State.

The work was done with support from a Doug Kirby Adolescent Sexual Health Research Grant from the Rural Center for AIDS/STD Prevention at the Indiana University School of Public Health-Bloomington; and from the Center for Family and Community Engagement at NC State.

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Note to Editors: The study abstract follows.

“Sexual health interventions for Black adolescents: A meta-analysis”

Authors: Reina Evans, Laura Widman, McKenzie N. Stokes, Hannah Javidi, Elan C. Hope and Julia Brasileiro, North Carolina State University

Published: April 20, JAMA Pediatrics

Abstract:
Importance: Black adolescents are at increased risk of contracting HIV/STIs and experiencing unplanned pregnancy. Although sexual health interventions aimed at decreasing these risks exist, evidence linking sexual health interventions to Black adolescents’ sexual behavior has not been synthesized.

Objective: This meta-analysis examined the associations between sexual health interventions and three behavioral outcomes: abstinence, condom use, and number of sex partners; as well as two biological outcomes: pregnancy and STI contraction; and three psychological outcomes: sexual health intentions, sexual health knowledge, and sexual health self-efficacy. Potential moderators of intervention success were explored.

Data Sources: A systematic search was conducted of studies published through January 2019 using PubMed, PsycINFO, and CINAHL databases and relevant review articles.

Study Selection: Studies were included if they: included a U.S.-based sample of Black adolescents; evaluated a sexual health intervention using experimental/quasi-experimental designs; included a behavioral outcome; and were published in English.

Data Extraction and Synthesis: Standardized mean difference and 95% confidence intervals were extracted and meta-analyzed using random-effects models.

Main Outcomes and Measures: Behavioral outcomes were abstinence, condom use, and number of sex partners. Biological outcomes were pregnancy and STI contraction. Psychological outcomes were sexual health intentions, knowledge, and self-efficacy.

Results: Across 29 studies reporting on 11,918 Black adolescents, there was a significant weighted mean association of sexual health interventions with improvements in abstinence (d = .14, 95% CI [.05, .24]) and condom use (d = .25, 95% CI [.11, .39]). There was no significant mean association of these interventions on number of sex partners, pregnancy, or STI contraction; however, sexual health interventions were significantly associated with improvements in the psychological outcomes: sexual health intentions (d = .17, 95% CI [.05, .30]), knowledge (d = .46, 95% CI [.30, .63]), and self-efficacy (d = .19, 95% CI [.09, .28]). Intervention effects were consistent across factors such as participant gender and age, as well as intervention dose.

Conclusions and Relevance: Overall, sexual health interventions are associated with improvements in sexual well-being among Black adolescents. There is an urgent need for wide scale dissemination of these programs to address racial disparities in sexual health across the U.S.

This post was originally published in NC State News.