Advertisement

Technology-Based Interventions to Reduce Sexually Transmitted Infections and Unintended Pregnancy Among Youth

      Abstract

      Purpose

      Technology-based interventions to promote sexual health have proliferated in recent years, yet their efficacy among youth has not been meta-analyzed. This study synthesizes the literature on technology-based sexual health interventions among youth.

      Methods

      Studies were included if they (1) sampled youth ages 13–24; (2) utilized technology-based platforms; (3) measured condom use or abstinence as outcomes; (4) evaluated program effects with experimental or quasi-experimental designs; and (5) were published in English.

      Results

      Sixteen studies with 11,525 youth were synthesized. There was a significant weighted mean effect of technology-based interventions on condom use (d = .23, 95% confidence interval [CI] [.12, .34], p < .001) and abstinence (d = .21, 95% CI [.02, .40], p = .027). Effects did not differ by age, gender, country, intervention dose, interactivity, or program tailoring. However, effects were stronger when assessed with short-term (1–5 months) than with longer term (greater than 6 months) follow-ups. Compared with control programs, technology-based interventions were also more effective in increasing sexual health knowledge (d = .40, p < .001) and safer sex norms (d = .15, p = .022) and attitudes (d = .12, p= .016).

      Conclusions

      After 15 years of research on youth-focused technology-based interventions, this meta-analysis demonstrates their promise to improve safer sex behavior and cognitions. Future work should adapt interventions to extend their protective effects over time.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Centers for Disease Control and Prevention
        Sexually transmitted diseases: Adolescents and young adults.
        (Available at)
        • Centers for Disease Control and Prevention
        HIV among youth.
        (Available at)
        https://www.cdc.gov/hiv/group/age/youth/index.html
        Date: 2017
        Date accessed: October 3, 2017
        • UNAIDS
        Global report: UNAIDS report on global AIDS epidemic.
        (Available at)
        • Guttmacher Institute
        ADDING IT UP: Investing in contraception and maternal and newborn health.
        (Available at)
        • World Health Organization
        Adolescent pregnancy.
        (Available at)
        http://www.who.int/mediacentre/factsheets/fs364/en/
        Date: 2014
        Date accessed: October 3, 2017
        • Johnson B.T.
        • Scott-Sheldon L.J.
        • Huedo-Medina T.B.
        • Carey M.P.
        Interventions to reduce sexual risk for human immunodeficiency virus in adolescents: A meta-analysis of trials, 1985–2008.
        Arch Pediatr Adolesc Med. 2011; 165: 77-84
        • Kirby D.B.
        The impact of abstinence and comprehensive sex and STD/HIV education programs on adolescent sexual behavior.
        Sex Res Soc Policy. 2008; 5: 18-27
        • Allison S.
        • Bauermeister J.A.
        • Bull S.
        • et al.
        The intersection of youth, technology, and new media with sexual health: Moving the research agenda forward.
        J Adolesc Health. 2012; 51: 207-212
        • Buhi E.R.
        • Trudnak T.E.
        • Martinasek M.P.
        • et al.
        Mobile phone-based behavioural interventions for health: A systematic review.
        Health Educ J. 2012; 72: 564-583
        • Hightow-Weidman L.B.
        • Muessig K.E.
        • Bauermeister J.
        • et al.
        Youth, technology, and HIV: Recent advances and future directions.
        Curr HIV/AIDS Rep. 2015; 12: 500-515
        • Rapoff M.A.
        E-health interventions in pediatrics.
        Clin Pract Pediatr Psychol. 2013; 1: 309-313
        • Lightfoot M.
        HIV prevention for adolescents: Where do we go from here?.
        Am Psychol. 2012; 67: 661-671
        • Lenhart A.
        • Duggan M.
        • Perrin A.
        • et al.
        Teens, social media & technology overview.
        (Available at)
        • Subrahmanyam K.
        • Šmahel D.
        Digital youth: The role of media in development.
        Springer, New York (NY)2011
        • Chavez N.R.
        • Shearer L.S.
        • Rosenthal S.L.
        Use of digital media technology for primary prevention of STIs/HIV in youth.
        J Pediatr Adolesc Gynecol. 2014; 27: 244-257
        • Guse K.
        • Levine D.
        • Martins S.
        • et al.
        Interventions using new digital media to improve adolescent sexual health: A systematic review.
        J Adolesc Health. 2012; 51: 535-543
        • Bailey J.V.
        • Murray E.
        • Rait G.
        • et al.
        Interactive computer-based interventions for sexual health promotion.
        Cochrane Database Syst Rev. 2010; (CD006483)
        • Noar S.M.
        • Black H.G.
        • Pierce L.B.
        Efficacy of computer technology-based HIV prevention interventions: A meta-analysis.
        AIDS. 2009; 23: 107-115
        • Bailey J.V.
        • Murray E.
        • Rait G.
        • et al.
        Computer-based interventions for sexual health promotion: Systematic review and meta-analyses.
        Int J STD AIDS. 2012; 23: 408-413
        • Swanton R.
        • Allom V.
        • Mullan B.
        A meta-analysis of the effect of new-media interventions on sexual-health behaviours.
        Sex Transm Infect. 2015; 91: 14-20
        • Centers for Disease Control and Prevention
        Sexual risk behaviors: HIV, STD, & teen pregnancy prevention.
        (Available at)
        http://www.cdc.gov/healthyyouth/sexualbehaviors/
        Date: 2017
        Date accessed: October 3, 2017
        • Dehne K.L.
        • Riedner G.
        Sexually transmitted infections among adolescents: The need for adequate health services.
        (Available at)
        • Wike R.
        • Oates R.
        Emerging nations embrace Internet, mobile technology: Cell phones nearly ubiquitous in many countries.
        (Available at)
        • Muessig K.E.
        • Nekkanti M.
        • Bauermeister J.
        • et al.
        A systematic review of recent smartphone, Internet and Web 2.0 interventions to address the HIV continuum of care.
        Curr HIV/AIDS Rep. 2015; 12: 173-190
        • Fishbein M.
        • Ajzen I.
        Predicting and changing behavior: The reasoned action approach.
        Psychology Press, New York (NY)2010
        • Redding C.A.
        • Prochaska J.O.
        • Armstrong K.
        • et al.
        Randomized trial outcomes of a TTM-tailored condom use and smoking intervention in urban adolescent females.
        Health Educ Res. 2015; 30: 162-178
        • Markham C.M.
        • Tortolero S.R.
        • Peskin M.F.
        • et al.
        Sexual risk avoidance and sexual risk reduction interventions for middle school youth: A randomized controlled trial.
        J Adolesc Health. 2012; 50: 279-288
        • Cohen J.
        A power primer.
        Psychol Bull. 1992; 112: 155-159
        • Borenstein M.
        • Hedges L.V.
        • Higgins J.P.T.
        • Rothstein H.R.
        Comprehensive meta-analysis [Computer software].
        2nd ed. Biostat, Englewood (NJ)2005
        • Lipsey M.W.
        • Wilson D.B.
        Practical meta-analysis.
        Sage, Thousand Oaks (CA)2001
        • Antonishak J.
        • Kaye K.
        • Swiader L.
        Impact of an online birth control support network on unintended pregnancy.
        Soc Mar Q. 2015; 21: 23-36
        • Bannink R.
        • Broeren S.
        • Joosten-van Zwanenburg E.
        • et al.
        Effectiveness of a web-based tailored intervention (E-health4Uth) and consultation to promote adolescents' health: Randomized controlled trial.
        J Med Internet Res. 2014; 16: e143
        • Bull S.S.
        • Levine D.K.
        • Black S.R.
        • et al.
        Social media–delivered sexual health intervention: Cluster randomized controlled trial.
        Am J Prev Med. 2012; 43: 467-474
        • Downs J.S.
        • Murray P.J.
        • Bruine de Bruin W.
        • et al.
        Interactive video behavioral intervention to reduce adolescent females' STD risk: A randomized controlled trial.
        Soc Sci Med. 2004; 59: 1561-1572
        • Howard M.N.
        • Davis J.A.
        • Mitchell M.E.
        Improving low-income teen health behaviors with internet-linked clinic interventions.
        Sex Res Soc Policy. 2011; 8: 50-57
        • Kiene S.M.
        • Barta W.D.
        A brief individualized computer-delivered sexual risk reduction intervention increases HIV/AIDS preventive behavior.
        J Adolesc Health. 2006; 39: 404-410
        • Lightfoot M.
        • Comulada W.S.
        • Stover G.
        Computerized HIV preventive intervention for adolescents: Indications of efficacy.
        Am J Public Health. 2007; 97: 1027-1030
        • Lim M.S.
        • Hocking J.S.
        • Aitken C.K.
        • et al.
        Impact of text and email messaging on the sexual health of young people: A randomised controlled trial.
        J Epidemiol Community Health. 2012; 66: 69-74
        • Lou C.H.
        • Zhao Q.
        • Gao E.S.
        • Shah I.H.
        Can the Internet be used effectively to provide sex education to young people in China?.
        J Adolesc Health. 2006; 39: 720-728
        • Mevissen F.E.
        • Ruiter R.A.
        • Meertens R.M.
        • et al.
        Justify your love: Testing an online STI-risk communication intervention designed to promote condom use and STI-testing.
        Psychol Health. 2011; 26: 205
        • Mustanski B.
        • Garofalo R.
        • Monahan C.
        • et al.
        Feasibility, acceptability, and preliminary efficacy of an online HIV prevention program for diverse young men who have sex with men: The Keep it Up! intervention.
        AIDS Behav. 2013; 17: 2999-3012
        • Norton W.E.
        • Fisher J.D.
        • Amico K.R.
        • et al.
        Relative efficacy of a pregnancy, sexually transmitted infection, or human immunodeficiency virus prevention-focused intervention on changing sexual risk behavior among young adults.
        J Am Coll Health. 2012; 60: 574-582
        • Peskin M.F.
        • Shegog R.
        • Markham C.M.
        • et al.
        Efficacy of it's your game-tech: A computer-based sexual health education program for middle school youth.
        J Adolesc Health. 2015; 56: 515-521
        • Roberto A.J.
        • Zimmerman R.S.
        • Carlyle K.E.
        • Abner E.L.
        A computer-based approach to preventing pregnancy, STD, and HIV in rural adolescents.
        J Health Commun. 2007; 12: 53-76
        • Suffoletto B.
        • Akers A.
        • McGinnis K.A.
        • et al.
        A sex risk reduction text-message program for young adult females discharged from the emergency department.
        J Adolesc Health. 2013; 53: 387-393
        • Ybarra M.L.
        • Bull S.S.
        • Prescott T.L.
        • et al.
        Adolescent abstinence and unprotected sex in CyberSenga, an Internet-based HIV prevention program: Randomized clinical trial of efficacy.
        PLoS ONE. 2013; 8
        • Noar S.M.
        • Willoughby J.F.
        eHealth interventions for HIV prevention.
        AIDS Care. 2012; 24: 945-952
        • Morrison L.G.
        • Yardley L.
        • Powell J.
        • Michie S.
        What design features are used in effective e-health interventions? A review using techniques from critical interpretive synthesis.
        Telemed J E Health. 2012; 18: 137-144
        • Steinke J.
        • Root-Bowman M.
        • Estabrook S.
        • et al.
        Meeting the needs of sexual and gender minority youth: Formative research on potential digital health interventions.
        J Adolesc Health. 2017; 60: 541-548
        • Ippoliti N.B.
        • L'Engle K.
        Meet us on the phone: Mobile phone programs for adolescent sexual and reproductive health in low-to-middle income countries.
        Reprod Health. 2017; 14: 11
        • Robin L.
        • Dittus P.
        • Whitaker D.
        • et al.
        Behavioral interventions to reduce incidence of HIV, STD, and pregnancy among adolescents: A decade in review.
        J Adolesc Health. 2004; 34: 3-26
        • DiClemente R.J.
        • Salazar L.F.
        • Crosby R.A.
        A review of STD/HIV preventive interventions for adolescents: Sustaining effects using an ecological approach.
        J Pediatr Psychol. 2007; 32: 888-906
        • Lei H.
        • Nahum-Shani I.
        • Lynch K.
        • et al.
        A “SMART” design for building individualized treatment sequences.
        Annu Rev Clin Psychol. 2012; 8: 21-48
        • Riley W.T.
        • Serrano K.J.
        • Nilsen W.
        • Atienza A.A.
        Mobile and wireless technologies in health behavior and the potential for intensively adaptive interventions.
        Curr Opin Psychol. 2015; 5: 67-71
        • Crepaz N.
        • Lyles C.M.
        • Wolitski R.J.
        • et al.
        Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials.
        AIDS. 2006; 20: 143-157
        • Widman L.
        • Choukas-Bradley S.
        • Noar S.M.
        • et al.
        Parent-adolescent sexual communication and adolescent safer sex behavior: A meta-analysis.
        JAMA Pediatr. 2016; 170: 52-61
        • Widman L.
        • Noar S.M.
        • Choukas-Bradley S.
        • et al.
        Adolescent sexual health communication and condom use: A meta-analysis.
        Health Psychol. 2014; 33: 1113-1124
        • Mirzazadeh A.
        • Biggs M.A.
        • Viitanen A.
        • et al.
        Do school-based programs prevent HIV and other sexually transmitted infections in adolescents? A systematic review and meta-analysis.
        Prev Sci. 2017; 19: 490-506
        • Michie S.
        • Richardson M.
        • Johnston M.
        • et al.
        The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions.
        Ann Behav Med. 2013; 46: 81-95
        • Webb T.L.
        • Joseph J.
        • Yardley L.
        • Michie S.
        Using the internet to promote health behavior change: A systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy.
        J Med Internet Res. 2010; 12: e4
        • Widman L.
        • Golin C.E.
        • Kamke K.
        • et al.
        Sexual assertiveness skills and sexual decision-making in adolescent girls: Randomized controlled trial of an online program.
        Am J Public Health. 2018; 108: 96-102
        • Ybarra M.L.
        • Prescott T.L.
        • Phillips 2nd, G.L.
        • et al.
        Pilot RCT results of an mHealth HIV prevention program for sexual minority male adolescents.
        Pediatrics. 2017; 140
        • Poteat V.P.
        • Russell S.T.
        • Dewaele A.
        Sexual health risk behavior disparities among male and female adolescents using identity and behavior indicators of sexual orientation.
        Arch Sex Behav. 2017;
        • Mustanski B.
        • Birkett M.
        • Greene G.J.
        • et al.
        Envisioning an America without sexual orientation inequities in adolescent health.
        Am J Public Health. 2014; 104: 218-225
        • Mitchell K.J.
        • Ybarra M.L.
        • Korchmaros J.D.
        • et al.
        Accessing sexual health information online: Use, motivations and consequences for youth with different sexual orientations.
        Health Educ Res. 2014; 29: 147-157
        • Centers for Disease Control and Prevention
        STDs in racial and ethnic minorities.
        (Available at)
        https://www.cdc.gov/std/stats16/minorities.htm
        Date: 2017
        Date accessed: February 10, 2018
        • Warschauer M.
        • Matuchniak T.
        New technology and digital worlds: Analyzing evidence of equity in access, use, and outcomes.
        Rev Res Educ. 2010; 34: 179-225
        • Mohr D.C.
        • Cuijpers P.
        • Lehman K.
        Supportive accountability: A model for providing human support to enhance adherence to ehealth interventions.
        J Med Internet Res. 2011; 13: e30
        • Bull S.S.
        Sexual assertiveness skills and decision-making in adolescent girls: Moving to replication, scale, and digital health impact.
        Am J Public Health. 2018; 108: 18-19

      CHORUS Manuscript

      View Open Manuscript