Program

Oct 22, 2012

OVERVIEW

ASSESS is a risk assessment and safe sex education program designed to reduce sexual intercourse and increase condom use in teens. Physicians provided information on STDs, abstinence, and condom use and taught skills to help teens avoid risky situations. Participants had short-term increases in positive attitudes toward and use of condoms and longer-term decreases in STD transmission. Among sexually active adolescents, there was an increased use of condoms.

DESCRIPTION OF PROGRAM

Target population: Middle school and high school age teens

The ASSESS (Awareness, Skills, Self-efficacy/Self-esteem, and Social Support) program is designed to give comprehensive sexual health information to adolescents through their primary care physician. The emphasis of the program is to increase adolescent awareness of sexual risks, skills to avoid risky sexual situations, self-efficacy, and social support.  Physicians tailor their instruction around condom use or abstinence depending on the adolescent’s sexual experience. Teens complete an audio-taped risk assessment before visiting their physician to assess perceived susceptibility to STDs. Teens also receive materials such as a pyramid of risk behaviors, two brochures about skills and self-efficacy, a community resources brochure, and two brochures for their parents about how to discuss sex and drug risks.

Prior to meeting with the teens, the physician is given a manuscript about the program and complete a 45-minute, in-office training session with a health educator. The training includes a videotape that models how to use the tools and how to problem-solve with the tools. The physician reviews the adolescent’s risk assessment, provides the parent with the brochures on discussing alcohol and sex, and asks the parent to leave the room at the appropriate time. After the parent leaves, the physician uses the risk behavior pyramid as an ice breaker to discuss the adolescent’s concerns regarding risky sexual behaviors and review the brochure on abstinence and/or condom use.

EVALUATION(S) OF PROGRAM

Boekeloo, B. O., Schamus, L. A., Simmens, S. J., Cheng, T. L., O’Connor, K., & D’Angelo, L. J. (1999). A STD/HIV prevention trial among adolescents in managed care. Pediatrics, 103(1), 107-115.

Evaluated population: A total of 219 adolescents aged 12 to 15 who visited one of five primary care physician’s offices for a general health exam in the Washington, D.C. metropolitan area were included in the study. Of the adolescents, approximately 64 percent were African-American, 19 percent white, 4 percent Hispanic, and 13 percent other.

Approach: The adolescents were randomly assigned to either the intervention and control groups. The intervention adolescents participated in the ASSESS program, while control adolescents continued their normal physician visits with no educational tools.

At post-test and 3- and 9-month follow-ups, adolescents were assessed on discussion of sexual risk topics with physician and guardian, sexual knowledge and attitudes (HIV knowledge, condom knowledge, perceived susceptibility, perceived doctor opinion, own opinion about abstinence and condoms, self-efficacy, and sexual behavior intention), lifetime sexual activity, condom use, and sexual outcomes (STD signs, diagnoses, treatments, and pregnancies).

Results:  At post-test and both follow-ups there were no significant differences between the groups regarding frequency of sexual intercourse or number of partners. At 3 months, sexually active intervention adolescents had a significantly greater rate of condom use when compared with the control group.

At 3 months, there were no significant differences between the groups regarding STD diagnoses, genital signs of STDs, STD treatments, or pregnancies. At 9 months, significantly more control group adolescents reported signs of STDs than intervention adolescents.

At post-test, intervention adolescents reported significantly more discussion of 11 of the 13 sexual risk topics with their physician when compared with control adolescents. At the 3-month follow-up, there was no significant difference between the groups regarding their discussion with parents about sexual risk topics.

At post-test, intervention adolescents were significantly more likely to know that HIV is transmitted through oral and anal intercourse, believe the physician thought they should use condoms, believe that they should use condoms, and believe they could refuse sex with a partner who refused condom use. There were no significant differences between the groups regarding perceived HIV and STD susceptibility, condom use self efficacy, intent to have sexual intercourse, and abstinence beliefs.

SOURCES FOR MORE INFORMATION

References:

Boekeloo, B. O., Schamus, L. A., Simmens, S. J., Cheng, T. L., O’Connor, K., & D’Angelo, L. J. (1999). A STD/HIV prevention trial among adolescents in managed care. Pediatrics, 103(1), 107-115.

KEYWORDS: Adolescence (12-17), Urban, Suburban, African-American or Black, Clinic-based, Reproductive Health, STD/HIV/AIDS, Teen Pregnancy, Sexual Activity, Condom Use and Contraception

Program information last updated 10/22/12.

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