Safer Sex Intervention (SSI)

The program's evidence of effectiveness was first established in a randomized controlled trial involving young women recruitment from the adolescent health clinic of an urban children's hospital. The sample was limited to women younger than 24 who were seeking treatment for cervicitis or pelvic inflammatory disease. Study participants were randomly assigned to either a treatment group that received the intervention or a control group that received the usual clinic services. Surveys were administered immediately before the program started (baseline) and again one, three, six, and 12 months after study enrollment.

The study found that six months after the intervention ended, adolescents in the intervention group were significantly less likely to report having had another sexual partner (in addition to their main partner) in the previous six months. The study found no statistically significant program impacts on having another sexual partner or on condom use at their last sexual encounter at the time of the one-month follow-up survey.

Findings from the 3-month and 12-month follow-ups were not considered for the review because they did not meet the review evidence standards. Specifically, both the 3- and 12-month follow-ups had a high rate of sample attrition, and the study did not establish baseline equivalence for the remaining sample members.

The study also examined program impacts on four measures of condom use (frequency and consistency of use with main partner, and frequency and consistency of use with another partner, in the past six months). Findings for these outcomes were not considered for the review because they did not meet the review evidence standards. Specifically, findings were reported only for subgroups defined by sexual activity at follow-up.

Six months after the program ended, the study found no evidence of statistically significant program impacts on the number of times in the past three months the study participants reported having had sex. The study also found no statistically significant program impacts on the proportion of times in the past three months that the young women in the study's sample had sex without using a condom or without using any type of contraceptives.

A subsequent study conducted by a separate group of researchers evaluated the program when implemented on a broader scale and with a more broadly-defined target population. The study used a randomized controlled trial involving young women recruited from 37 clinics across three states (Florida, Minnesota, and Tennessee). The study focused on young women who were sexually active or about to become sexually active. Participants were randomly assigned to either a treatment group that received the intervention or to a control group that received the standard clinic services. Data were collected immediately before random assignment (baseline) and again nine and 18 months after study enrollment.

The study found that nine months after enrolling in the study, adolescents in the treatment group were significantly less likely to report having had sexual intercourse without birth control in the previous 90 days. The study also found that among the subgroup of adolescents who were sexually inexperienced at baseline, those in the treatment group were significantly less likely to report having had sex or having had more than one lifetime sexual partner. These program effects did not persist 18 months after enrollment in the study. In particular, the study found no evidence of statistically significant program impacts, for the full sample and for any of the subgroups of youth defined by sexual experience at baseline, on rates of sexual activity or sexual activity without birth control in the last 90 days, or on having had more than one lifetime sexual partner.

At the 18-month follow-up, the study also found no evidence of statistically significant program impacts on becoming pregnant or being diagnosed with a STI in the last 12 months for either the full sample or the subsample of youth who were sexually inexperienced at baseline. At both the 9- and 18-month follow-ups, the study found no statistically significant program impacts on the percentage of participants who reported having had sex without a condom in the past 90 days.

The study also examined program impacts on measures of knowledge of pregnancy risk and STI risk, attitudes toward protection, attitudes toward risky sexual behavior, motivation to delay childbearing, condom negotiation and refusal skills, and intentions to engage in sexual risky behavior. Findings for these outcomes were not considered for the review because they fell outside the scope of the review.