PEDIATRICS Vol. 103 No. 1 January 1999, pp. 107-115
A STD/HIV Prevention Trial Among Adolescents in Managed Care
Received Mar 12, 1998; accepted Jul 27, 1998.
,
From the * George Washington University Medical Center,
Department of Health Care Sciences, Washington, DC (during the study);
and the Children's National Medical Center, Department of General
Pediatric and Adolescent Medicine, Washington, DC.
Objective. To determine if sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection, risk assessment, and education tools provided as part of office-based primary care reduce adolescent risky sexual behaviors.
Design. A randomized intervention trial with 3- and 9-month follow-up.
Setting. Five staff-model managed care sites in Washington, DC (n = 19 pediatricians).
Patients. Consecutive 12- to 15-year-olds receiving a general health examination; 81% minority. Participation rate = 215/432 (50%). Nine-month follow-up rate = 197/215 (92%).
Intervention. Audiotaped STD risk assessment and education about staying safe (safer = condoms, safest = abstinence).
Main Outcome Measures. Adolescent-reported sexual intercourse and condom use.
Results. More intervention adolescents reported pediatrician discussion on 11/13 sexual topics. Although more vaginal intercourse (odds ratio [OR] = 2.46, 95% confidence interval [CI] = 1.04-5.84) was reported in the intervention group at 3 months, this was not true of overall sexual intercourse (OR = 1.55, 95% CI = .73-3.32). More sexually active adolescents reported condom use in the intervention group at 3 months (OR = 18.05, 95% CI = 1.27-256.03). At 9 months, there were no group differences in sexual behaviors; however, more signs of STD were reported by the control (7/103) than the intervention group (0/94).
Conclusions. STD risk assessment and education tools administered in a single office visit facilitated STD/HIV prevention education. Any impact on sexual activity and condom use was short-lived. Further research is needed to develop brief, office-based sexual risk reduction for young adolescents. Key words: STD, HIV, prevention, adolescents, physicians.
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