Sexual risk avoidance and sexual risk reduction interventions for middle school youth: A randomized controlled trial

Christine M. Markham, Susan R. Tortolero, Melissa Fleschler Peskin, Ross Shegog, Melanie Thiel, Elizabeth R. Baumler, Robert C. Addy, Soledad Liliana Escobar-Chaves, Belinda Reininger, Leah Robin

Research output: Contribution to journalArticlepeer-review


Purpose: To evaluate the efficacy of two, theory-based, multimedia, middle school sexual education programs in delaying sexual initiation. Methods: Three-armed, randomized controlled trial comprising 15 urban middle schools; 1,258 predominantly African American and Hispanic seventh grade students followed into ninth grade. Both programs included group and individualized, computer-based activities addressing psychosocial variables. The risk avoidance (RA) program met federal abstinence education guidelines; the risk reduction (RR) program emphasized abstinence and included computer-based condom skills-training. The primary outcome assessed program impact on delayed sexual initiation; secondary outcomes assessed other sexual behaviors and psychosocial outcomes. Results: Participants were 59.8% females (mean age: 12.6 years). Relative to controls, the RR program delayed any type of sexual initiation (oral, vaginal, or anal sex) in the overall sample (adjusted odds ratio [AOR]:.65, 95% CI:.54.77), among females (AOR:.43, 95% CI:.31.60), and among African Americans (AOR:.38, 95% CI:.18.79). RR students also reduced unprotected sex at last intercourse (AOR:.67, 95% CI:.47.96), frequency of anal sex in the past 3 months (AOR:.53, 95% CI:.33.84), and unprotected vaginal sex (AOR:.59, 95% CI:.36.95). The RA program delayed any sexual initiation among Hispanics (AOR:.40, 95% CI:.19.86), reduced unprotected sex at last intercourse (AOR:.70, 95% CI:.52.93), but increased the number of recent vaginal sex partners (AOR: 1.69, 95% CI: 1.012.82). Both programs positively affected psychosocial outcomes. Conclusions: The RR program positively affected sexually inexperienced and experienced youth, whereas the RA program delayed initiation among Hispanics and had mixed effects among sexually experienced youth.

Original languageEnglish (US)
Pages (from-to)279-288
Number of pages10
JournalJournal of Adolescent Health
Issue number3
StatePublished - Mar 2012
Externally publishedYes


  • Adolescents
  • Educational technology
  • Health education
  • Intervention studies
  • Pregnancy
  • Sexual behavior
  • Sexually transmitted infection
  • Urban populations

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health


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