Booster sexual risk reduction counseling implemented as a supplement to HORIZONS
Component overview
Booster sexual health risk reduction counseling is an intervention component that reinforces prevention maintenance concepts discussed in the HORIZONS program, an evidence-based teen pregnancy prevention program. HORIZONS supports participants’ use of preventive behaviors to avoid contracting sexually transmitted infections (STIs) and HIV. During four follow-up phone calls, which occur after the in-person clinic-based intervention, health educators deliver scripted, brief, tailored counseling. The counseling is tailored based on participants’ identified personal STI/HIV risk factors to help them prioritize their STI/HIV prevention strategies, with the aim of reducing risk factors they identify during the calls.
Evaluation findings: The component was evaluated by comparing a group assigned to the HORIZONS program plus a maximum of 18 sexual health counseling phone calls with a group assigned to HORIZONS plus a maximum of 18 general health promotion counseling phone calls. The study found that 36 months after the primary HORIZONS program ended (immediately after the phone calls ended), adolescents assigned to receive sexual health counseling phone calls reported a significantly higher proportion of their vaginal sex episodes as condom-protected in the past 90 days (effect size = 2.2) and the prior six months (effect size = 2.2) when compared with adolescents assigned to receive general health promotion counseling phone calls. Adolescents assigned to sexual health counseling phone calls also reported significantly fewer vaginal sex partners in the past six months (effect size = -2.2).
After the study, the booster sexual health risk reduction counseling was incorporated as a component of HORIZONS, a clinic-based STI/HIV intervention for African American adolescent females. HORIZONS teaches assertive communication skills and proper condom use and fosters self-pride. The program is delivered through two four-hour small group sessions, followed by four 15-minute booster sexual health counseling phone calls over the following year.
The dosage of booster sexual health counseling phone calls incorporated into the HORIZONS program differs from the component that was evaluated. In the study showing evidence of effectiveness of the component, booster sexual health counseling was evaluated as a supplement to HORIZONS with a maximum dosage of 18 phone calls over three years, but it is now integrated into the HORIZONS program with a maximum dosage of four phone calls over one year. There is no evidence available regarding the effectiveness of doing only four booster phone calls over one year. The HORIZONS program page offers more information.
Booster sexual health risk reduction counseling reinforces concepts delivered in the clinic-based STI/HIV prevention intervention. Health educators ask participants to prioritize risk factors related to their engagement in sexual behavior. Health educators then provide tailored counseling strategies that address the identified risk factors.
Booster sexual health risk reduction counseling is delivered after the completion of the group-based component of HORIZONS, a clinic-based STI/HIV intervention.
The protocol for booster sexual health risk reduction counseling available as a component of the overall HORIZONS program includes four phone calls, 15 minutes long (one hour total), over a 12-month period.
The booster sexual health risk reduction counseling shown to be effective by the evaluation was the offer of 18, 10-minute phone calls over a three-year period.
A health educator delivers booster sexual health risk reduction counseling.
Individual telephone calls initiated by health educator.
The booster sexual health risk reduction counseling component is phone-based and can be implemented in any environment.
The booster sexual health risk reduction counseling component is designed for African American females, ages 15 to 21, who are sexually active, single, and trying to avoid pregnancy.
Ralph J. DiClemente, Ph.D.; Gina M. Wingood, Sc.D., M.P.H.; Eve S. Rose, M.S.P.H.; Jessica M. Sales, Ph.D.; Delia L. Lang, Ph.D, M.P.H.; Angela M. Caliendo, M.D., Ph.D.; James W. Hardin, Ph.D.; and Richard A. Crosby, Ph.D.
The program is distributed by the Sociometrics Corporation, 1580 W. El Camino Real, Suite 8, Mountain View, CA 94040. Phone: 650-949-3282 | Email: socio@socio.com. | Website: HORIZONS: STI/HIV Sexual Risk Reduction Intervention for African American Girls - Sociometrics.
The protocol for the booster sexual health risk reduction counseling component, which includes four 15-minute phone calls, is available to purchase as part of the overall HORIZONS program. The full program is available for $20 per month (subscription-based).
| Citation | High-Quality Randomized Trial | Moderate-Quality Randomized Trial | Moderate-Quality Quasi-Experiment | Low Study Rating | Did Not Meet Eligibility Criteria |
|---|---|---|---|---|---|
| DiClemente et al. 2014 Steiner et al. 2014 |
| Citation | Setting | Majority Age Group | Majority Racial/Ethnic Group | Gender | Sample Size |
|---|---|---|---|---|---|
DiClemente et al. 2014 Steiner et al. 2014 |
Health clinic or medical facility | 18 or 19 | African American or Black | Young female | 701 |
Evidence by Outcome Domain and Study
| Citation | Sexual Activity | Number of Sexual Partners | Contraceptive Use | STIs or HIV | Pregnancy |
|---|---|---|---|---|---|
DiClemente et al. 2014 Steiner et al. 2014 |
n.a. |
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n.a. | n.a. |
| Citation | Details |
|---|---|
DiClemente et al. 2014 Steiner et al. 2014 |
Booster sexual health counseling, implemented as part of the evidence-based teen pregnancy prevention program HORIZONS, was evaluated using a randomized controlled trial design involving 701 Black young women ages 14 to 20 recruited from three health clinics in Atlanta, Georgia. This booster sexual health risk reduction counseling component is designed as a prevention maintenance intervention to support the use of behaviors that prevent sexually transmitted infections (STIs) and HIV and reduce the incidence of STIs. The component included a total of 18 telephone calls by health educators, each about 10 minutes long, every eight weeks during a three-year period after the conclusion of the in-person clinic-based HORIZONS program. Participants in the evaluation were randomly assigned to either a treatment group that received HORIZONS plus the booster sexual risk reduction counseling component, or a control group that received HORIZONS plus an identical dosage of general health promotion counseling phone calls. Computer-assisted, self-administered interviews and self-collected vaginal swab specimens were collected at baseline and at 6, 12, 18, 24, 30, and 36 months after the primary HORIZONS program ended. At 36 months after the primary HORIZONS program ended (immediately after the phone calls ended), the study found that adolescents assigned to receive sexual health counseling phone calls reported a significantly higher proportion of their vaginal sex episodes as condom-protected in the past 90 days (effect size = 2.2) and in the past six months (effect size = 2.2) relative to adolescents assigned to receive the general health promotion counseling calls. Adolescents assigned to sexual health counseling also reported having significantly fewer vaginal sex partners in the past six months (effect size = -2.2). The study also examined the impacts of the booster sexual health risk reduction counseling on measures of prevalence of STIs (chlamydial and gonococcal) using a pooled sample of participants who completed any of the six follow-ups. Findings for these outcomes did not meet the review standards because the pooled sample had high attrition and did not demonstrate baseline equivalence. In addition, the authors did not report impact estimates for each follow-up separately. Finally, the study examined impacts on measures of sexual activity while high on drugs or alcohol, but findings for those measures fell outside the scope of the review. |