Teens Benefited from Internet-Delivered Program to Prevent STIs and Pregnancy
Comprehensive sex ed needed, but lacking
June 1, 2023 4 minutes read
Researchers designed an intervention to help prevent sexually transmitted infections (STIs) and unintended pregnancy among Black teenagers in Louisiana. They found the internet-based program was well-received by the young women, and increased STI prevention behaviors.1
“We focused on older teens because most of the pregnancies happen there,” says Patricia Kissinger, PhD, BSN, MPH, lead study author and professor of epidemiology in the department of epidemiology at Tulane University School of Public Health and Tropical Medicine in New Orleans. “It’s devastating when a 14-year-old gets pregnant, but equally devastating for a 17- to 18-year-old because it can derail their career path and college.”
The study’s participants were older teens who had sex with men and could potentially become pregnant. Some had children, but none were actively trying to become pregnant.
Investigators recruited the teens from historically Black universities and colleges, beauty shops, and through websites. Once recruited, they were asked to undergo STI testing. Some of the young women asked that the kits be mailed to them, so researchers created home testing kits, Kissinger says. Future studies and interventions like this also could include LGBTQ and male participants.
The program was designed to fill in a large gap in sexual education for this target population, including providing medically accurate information about preventing STIs. The target teen audience also reports a high rate of STIs. “Sex ed in the Delta South is not very good,” Kissinger laments. “It’s not comprehensively provided.”
For instance, sex education for teens cannot include abortion or show images of same-sex couples. Louisiana is one of 19 states that does not mandate HIV prevention education or sex education in schools. The state also does not allow for distribution of condoms or contraception in schools, even though Louisiana ranks second nationally for chlamydia and gonorrhea infections, and has the third highest teen pregnancy rate.1-3
The lack of evidence-based education can negatively affect young women’s reproductive health. For example, women with chlamydia or gonorrhea infections are more likely to develop pelvic inflammatory disease, experience ectopic pregnancy, become infertile, and acquire HIV.1,4-5
The intervention can increase teens’ knowledge through eight different online modules. “It’s all online, and we recruited girls, primarily African Americans because they have the highest rates of teen pregnancy and STIs,” Kissinger explains. “We focused on chlamydia and gonorrhea in this study.”
The modules included information on consent-to-condom skills, negotiation skills, and communication skills — the kinds of things for which older teens need more information. (For more information, see the story on the sex education modules in this issue.)
Study participants received $5 for each module they viewed, for a total of $40. Investigators followed the teens and checked on them at three months, six months, and 12 months. The teens were tested for pregnancy and STIs.
“We found a modest difference in teen pregnancy,” Kissinger says. “This was largely because by the time we got into the field, so many young women were on long-acting reversible contraceptives [LARC].”
While that was a positive trend, it did not mean they were invulnerable to STIs. “At six months, we did see a diminution of sexually transmitted infections,” Kissinger says. “The lower rates waned at 12 months, so either we need a booster, or something happens a year later that we need to look into further.”
Engagement with the modules was high at 80%. “In hindsight, I’d have a booster module,” Kissinger says. “It’d be an additional module to allow them to have ongoing access to the intervention.”
The study’s control arm included participants who could know the intervention participants, so the modules were closed after the intervention group completed them to prevent people from sharing the website information and causing study contamination.
“I just wrote a grant to see if we could do this intervention again in a larger capacity and to do it for all sexes,” Kissinger says.
The research showed that teens need comprehensive sexual education that includes evidence-based information about STI prevention and contraception. “Sex ed should be all along the life cycle, starting very early,” Kissinger notes.
A reproductive health organization could initiate a similar online program for teens, but it would require some ongoing time and attention. For example, the modules encouraged engagement through blogs that teens could write about what they were learning.
“You have to monitor the blogs,” Kissinger says. “It’s expensive to disseminate the information, and you need resources. Some of the blogs were amazing, some were great, and some were more curt and shorter answers. To finish the module, they were supposed to blog, and some just said it was good, while others wrote long dialogues on whatever went on in their life.”
Teens also discussed their role models. “It was surprising to hear how many of them had role models who were not [female celebrities] like Maya Angelou or Oprah Winfrey,” Kissinger says. “It often was their aunt or mom or a teacher.”
REFERENCES
- Kissinger PJ, Green J, Latimer J, et al. Internet delivered sexually transmitted infection and teen pregnancy prevention program: A randomized trial. Sex Transm Dis 2023;Feb 20. doi: 10.1097/OLQ.0000000000001784. [Online ahead of print].
- Gottlieb SL, Xu F, Brunham RC. Screening and treating Chlamydia trachomatis genital infection to prevent pelvic inflammatory disease: Interpretation of findings from randomized controlled trials. Sex Transm Dis 2013;40:97-102.
- Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2021. Last reviewed April 11, 2023.
- Hamilton BE. State teen birth rates by race and hispanic origin: United States, 2017-2018. Natl Vital Stat Rep 2020;69:1-12.
- Leftwich HK, Alves MVO. Adolescent pregnancy. Pediatr Clin North Am 2017;64:381-388.
Researchers designed an intervention to help prevent STIs and unintended pregnancy among Black teenagers in Louisiana. They found the internet-based program was well-received by the young women, and increased STI prevention behaviors.
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