Original articles
Influence of prior sexual risk experience on response to intervention targeting multiple risk behaviors among adolescents

https://doi.org/10.1016/j.jadohealth.2003.09.024Get rights and content

Abstract

Purpose

To identify correlates of sexual risk variations among African-American adolescents, and to examine the influence of prior sexual experience on response to a HIV risk-reduction intervention.

Methods

Eight hundred seventeen African-American youth aged 13 to 16 years living in and around urban public housing in Baltimore were recruited to participate in a HIV risk-reduction intervention targeting 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. Multiple regression analyses were conducted to identify predictors of the degree of sexual risk using longitudinal data. Repeated measure analyses were conducted to assess behavioral changes over time among the three groups.

Results

Data confirmed the co-variation of sexual risk behavior and other problem behaviors among adolescents, cross-sectionally and longitudinally. After exposure to an 8-session risk-reduction intervention, youth engaging in the highest degree of sexual risk demonstrated the greatest reduction in both sexual risk and other risks. These improvements were seen at both 6 months and 12 months postintervention. Youth who were abstinent at baseline maintained the lowest levels in risk involvement throughout the study period when compared with sexually active youth. However, abstinent youth risk involvement significantly increased at 6 months and 12 months after baseline. Youth engaging in protected sex at baseline demonstrated a significant increase in non-condom use and a significant decrease in multiple risk involvement over time.

Conclusions

Results support HIV risk-reduction intervention efforts that target multiple risk behaviors. Response of adolescents to the intervention is directly related to the sexual risk behavior at baseline. These data may suggest that the response to risk behavior intervention depends in part on the risk behavior profile of the population to which it is being applied.

Section snippets

Subjects

Eight hundred seventeen African-American youth and their parents from 35 low-income housing developments, community centers, and recreation centers in Baltimore were recruited during 1999–2000. The youth and their parents participated in a randomized longitudinal trial of HIV risk-reduction interventions. The research staff at each site described the purpose, general design, and enrollment criteria to potentially eligible youth who were 13 through 16 years of age. Interested youth were given

Overall

Among the 817 African-American youth who participated in the study, 40 subjects who did not respond to the sexual risk questions were excluded from the present analysis. Among the 783 subjects included in this study, 58% were abstinent, 31% were classified as low-sexual risk, and 11% were high-sexual risk at baseline. The mean age of the sample was 14 years old; 58% were female.

Bivariate associations of sexual risk variations at baseline

Table 1 displays the demographic and behavioral characteristics of youth by their sexual risk index with 0 being

Discussion

Consistent with the literature, data confirm the co-variation of risk behaviors [31] and repeated involvement in multiple problem behaviors in adolescence [32], [33]. As most of the existing research on sexual risk behavior has been conducted using cross-sectional data to assess relationship between high-risk sexual behavior and single-risk behavior such as smoking, alcohol use, and drug use [8], [9], [10], [11], our findings further indicated that youth who engaged in unprotected sexual

Conclusions

Analyses results support intervention efforts targeting multiple risk behaviors, and provide strong evidence that HIV risk-reduction interventions targeting the whole spectrum of risk behaviors is effective in increasing condom use and decreasing problem behavior engagements. Response to the intervention was influenced significantly by the degree of sexual risk involvement at baseline. Youth engaging in the highest degree of sexual risk demonstrated the greatest reduction in both sexual risk

Acknowledgment

This research was supported by the National Institutes of Mental Health (grant RO1 MH 54983). We thank Yvonne Summers and the members of the research team for their assistance in conducting the study and Mary Bane for help in preparing the manuscript.

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