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Helen Yoon

HLTH639
Dr. Niya Werts
Fall 2008

Literature Review

According to the Centers for Disease Control and Prevention, about 18.9 million cases of

sexually transmitted diseases/infections occurred in the United States in 2001. Of the sexually

active population, people aged 15-24 years consist of only 25%. However, in 2001, about half of

sexually transmitted diseases/infections cases took place among this young population (2006).

The Centers for Disease Control and Prevention (1990) reported that African American

youth have the highest chance of getting infected with human immunodeficiency virus (HIV). In

a 2005 survey by the Centers for Disease Control and Prevention (2005), 49% of population

infected with HIV, were African Americans. While studies from the National Institutes of Health

(1997) show that interventions can result in a decrease of risky sexual behaviors in adolescents, it

is still uncertain which specific interventions and who the conductors of the intervention need to

be in order for the program to succeed. Since HIV is caused by unprotected sex the interventions

focused on the individual’s behavior and attitudes. The two methods of interventions

implemented in the article included the abstinence approach which focused on reducing the

amount of sexual intercourse and the safe-sex approach which focused on advocating condom

usage. The control group was a health promotion intervention which educated the students on

various health diseases that is prevalent among African Americans such as heart disease, stroke

and different types of cancer.

According to the Archives of Pediatrics and Adolescent Medicine, in 2001, the incidence

rate of acquired immune deficiency syndrome virus (AIDS) in Latino adolescents was 3 times

higher than the non-Hispanic white population. In addition, results from the national Youth Risk
Behavior Surveillance System showed that Latino adolescents started having sexual intercourse

before the age of 13 and have more multiple partners (greater than 4) compared to the non-

Hispanic white population. Also, the reported condom usage among Latino youth was much less

than the non-Hispanic white population (2006). The purpose of this study was to analyze the

efficacy of prevention interventions that focused on reducing sexual risk behaviors among Latino

youth. The study was a randomized controlled trial from April 2000 to March 2003 and took

place in 3 schools of Northeast Philadelphia. The participants were 684 male and female youth

aged 13 to 18 years of which 553 participants were Latino youth. The intervention included two

types of programs which were both 8-hours long and taught over 2 consecutive Saturdays. The

two types of programs in the intervention were the HIV risk-reduction intervention and the

health-promotion intervention program. The HIV risk-reduction program was based on the social

cognitive theory and the theories of reasoned action and planned behavior. The HIV risk-

reduction program focused on topics such as importance of family, gender-role expectations,

abstinence and condom use to prevent sexually transmitted diseases/infections, including HIV

(2006). The health-promotion intervention emphasized the importance of healthy behaviors such

as diet, exercise, physical activity, etc. After the interventions, the participants were required to

complete questionnaires at 3, 6, and 12-month intervals. From the results of this study, it

provided proof of efficacy among the participants in the HIV risk-reduction program by self-

reported numbers of decreased sexual activity and increased condom usage among Latino youth

(2006).

In 2003, another study was conducted to analyze the efficacy of human

immunodeficiency virus (HIV) sexual risk-reduction interventions among youth. This study

summarized the findings of all the educational, psychological, or behavioral interventions that
supported sexual risk reduction for the purpose of preventing HIV (2003). The information was

collected from 44 studies and 56 interventions that were conducted as of January 2, 2001. From

the data obtained by the interventions, the students who participated in behavioral HIV risk-

reduction interventions showed significantly lower HIV risk due to increased information and

knowledge, motivation and skills to avoid risky sexual behaviors (2003).

In the Journal of the American Medical Association, there was a randomized controlled

trial study that tested the efficacy of individual face-to-face counseling to reduce the risk of

human immunodeficiency virus (HIV) and other sexually transmitted diseases (STD’s). The

program was called “Project RESPECT” and each participant was designated to 1 of 3

counseling interventions. The interventions took place at five public STD clinics (Baltimore,

MD; Denver, CO; Long Beach, CA; Newark, NJ; and San Francisco, CA) and the participants

included 5758 heterosexual, HIV-negative patients who came into the clinics for STD exams.

The participants from this intervention completed questionnaire at 3, 6, 9, and 12-month

intervals. The results from this study concluded that individualized face-to-face interventions can

increase condom use and prevent the incidence of new STD’s when incorporating a personalized

risk reduction plan. Also, this study proved that individual-based counseling can be effective and

conducted even at busy clinic settings (1998).

Another sexually transmitted disease that is prevalent among adolescents is Chlamydia

trachomatis. This sexually transmitted disease is the most reported infection in the United States

with 3 to 4 million incidents per year (2002). Among female adolescents, the rate of infection is

6 times higher than the national average for all women. The Health Plan Employer Data and

Information Set (HEDIS) made Chlamydia trachomatis screening a measure of the quality of

services delivered by health maintenance organizations (HMO’s) (2002). The purpose of this
intervention was to increase Chlamydia trachomatis screening among sexually active female

adolescents during their routine check-ups at the clinics. The intervention took place at 10

pediatric Kaiser Permanente clinics located in northern California. The participants were

adolescent females aged 14 to 18 years and the data was collected from April 2000 through

March 2002. Of the 10 clinics, 5 random clinics were chosen to provide usual routine check-up

care and the other 5 clinics provided the intervention of Chlamydia trachomatis screening. From

the results of this intervention, it significantly increased the number of Chlamydia trachomatis

screening among sexually active female adolescents receiving routine check-ups at these clinics.

Of the five articles discussed, only one article specifically identified the type of models

and theories the intervention was based upon. The article, “Abstinence and Safer Sex HIV Risk-

Reduction Interventions for African American Adolescents” was based on social cognitive

theory, theory of reasoned action, and theory of planned behavior. Although the article, “Effect

of a Clinical Practice Improvement Intervention on Chlamydia Screening Among Adolescent

Girls” does not state the foundational theories within the article, it follows the same model and

intervention strategy as the HIV risk-reduction intervention for African American adolescents.

The three other articles, “A Randomized Controlled Trial Testing an HIV Prevention Intervention

for Latino Youth”, “Interventions to Reduce Sexual Risk for the Human Immunodeficiency Virus

in Adolescents” and “Efficacy of Risk-Reduction Counseling to Prevent Human

Immunodeficiency Virus and Sexually Transmitted Diseases” contained interventions that were

based mostly on the theory of efficacy. Since the theory of efficacy is derived from the Social

Cognitive Theory, all five articles share the theoretical foundations and framework of the

interventions. The most effective and ideal intervention would be to incorporate as many

different theories as possible to obtain accurate evidence and to propose the best solutions.
References:

Jemmott, J., Jemmott, L., & Fong, G. (1998). Abstinence and Safer Sex HIV Risk-Reduction
Interventions for African American Adolescents. Journal of American Medical Association, 279
(19), 1529-1536. Retrieved October 1, 2008, from
http://jama.ama-
assn.org/cgi/content/full/279/19/1529?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&
fulltext=health+intervention&searchid=1&FIRSTINDEX=30&resourcetype=HWCIT

Villarruel, A., Jemmott, J., & Jemmott, L. (2006). A Randomized Controlled Intervention for
Latino Youth. Archives of Pediatrics & Adolescent Medicine, 160 (8), 772-777. Retrieved
October 20, 2008 from
http://archpedi.ama-
assn.org/cgi/content/full/160/8/772?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&ful
ltext=adolescent+std+intervention&searchid=1&FIRSTINDEX=10&resourcetype=HWCIT

Johnson, B., Carey, M., & Marsh, K. et al. (2003). Intervention to Reduce Sexual Risk for the
Human Immunodeficiency Virus in Adolescents, 1985-2000. Archives of Pediatrics &
Adolescent Medicine. 157 (4),
381-388. Retrieved October 20, 2008 from
http://archpedi.ama-
assn.org/cgi/content/full/157/4/381?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&ful
ltext=adolescent+std+intervention&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

Kamb, M., Fishbein, M., & Douglas, J. et al. (1998). Efficacy of Risk-Reduction Counseling to
Prevent Human Immunodeficiency Virus and Sexually Transmitted Diseases. Journal of
American Medical Association, 280 (13), 1161-1167. Retrieved October 20, 2008 from
http://jama.ama-
assn.org/cgi/content/full/280/13/1161?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&
fulltext=adolescents+std+interventions&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

Shafer, M., Tebb, K., & Pantell, R. et al (2002). Effect of a Clinical Pratice Improvement
Intervention on Chlmydial Screening Among Adolescent Girls.
Journal of Americal Medical Association. 288 (22), 2846-2852. Retrieved on October 20, 2008
from
http://jama.ama-
assn.org/cgi/content/full/288/22/2846?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&
fulltext=adolescents+std+interventions&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

Centers for Disease Control and Prevention (2006). STD-Prevention Counseling Practices and
Human Papillomavirus Opinions Among Clinicians with Adolescent Patients. 55 (41), 1117-
1120. Retrieved October 20, 2008 from
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5541a1.htm

National Institute of Allergy & Infections Diseases (2006). HIV Infection in Adolescents and
Young Adults in the U.S. Retrieved October 20, 2008 from
http://www.niaid.nih.gov/factsheets/hivadolescent.htm

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