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Jemmott III JB, Sweet Jemmott L, Fong GT. Abstinence and Safer Sex HIV Risk-Reduction Interventions for African American Adolescents: A Randomized Controlled Trial. JAMA. 1998;279(19):1529–1536. doi:10.1001/jama.279.19.1529
From the Department of Psychology, Princeton University, Princeton, NJ (Dr J. B. Jemmott); the School of Nursing, University of Pennsylvania, Philadelphia (Dr L. S. Jemmott); and the Department of Psychology, University of Waterloo, Waterloo, Ontario (Dr Fong).
Context.— African American adolescents are at high risk of contracting sexually
transmitted infection with human immunodeficiency virus (HIV), but which behavioral
interventions to reduce risk are most effective and who should conduct them
is not known.
Objective.— To evaluate the effects of abstinence and safer-sex HIV risk-reduction
interventions on young inner-city African American adolescents' HIV sexual
risk behaviors when implemented by adult facilitators as compared with peer
Design.— Randomized controlled trial with 3-, 6-, and 12-month follow-up.
Setting.— Three middle schools serving low-income African American communities
in Philadelphia, Pa.
Participants.— A total of 659 African American adolescents recruited for a Saturday
Interventions.— Based on cognitive-behavioral theories and elicitation research, interventions
involved 8 1-hour modules implemented by adult facilitators or peer cofacilitators.
Abstinence intervention stressed delaying sexual intercourse or reducing its
frequency; safer-sex intervention stressed condom use; control intervention
concerned health issues unrelated to sexual behavior.
Main Outcome Measures.— Self-reported sexual intercourse, condom use, and unprotected sexual
Results.— Mean age of the enrollees was 11.8 years; 53% were female and 92.6%
were still enrolled at 12 months. Abstinence intervention participants were
less likely to report having sexual intercourse in the 3 months after intervention
than were control group participants (12.5% vs 21.5%, P=.02), but not at 6- or 12-month follow-up (17.2% vs 22.7%, P=.14; 20.0% vs 23.1%, P=.42, respectively).
Safer-sex intervention participants reported significantly more consistent
condom use than did control group participants at 3 months (odds ratio [OR]=3.38;
95% confidence interval [CI], 1.25-9.16) and higher frequency of condom use
at all follow-ups. Among adolescents who reported sexual experience at baseline,
the safer-sex intervention group reported less sexual intercourse in the previous
3 months at 6- and 12-month follow-up than did control and abstinence intervention
(adjusted mean days over prior 3 months, 1.34 vs 3.77 and 3.03, respectively; P≤.01 at 12-month follow-up) and less unprotected intercourse
at all follow-ups than did control group (adjusted mean days, 0.04 vs 1.85,
respectively, P<.001, at 12-month follow-up).
There were no differences in intervention effects with adult facilitators
as compared with peer cofacilitators.
Conclusion.— Both abstinence and safer-sex interventions can reduce HIV sexual risk
behaviors, but safer-sex interventions may be especially effective with sexually
experienced adolescents and may have longer-lasting effects.
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