Effects of a Brief, Theory-Based STD-Prevention Program for Female College Students

A recent study published in the Journal of Adolescent Health evaluates a sexually transmitted disease (STD) risk-reduction intervention tailored to college-aged women.

Participants were 78 undergraduate females who reported inconsistent condom use or multiple sexual partners. They received either partial fulfillment of course requirements or extra credit in undergraduate psychology courses.

The study measured information (using the STD Knowledge Questionnaire), motivation, behavioral skills, and risk behavior.

Procedure

Each intervention group had approximately 8 participants. They were randomly assigned to one of three groups: (a) a one-session intervention based on the information-motivation-behavioral skills (IMB) model, (b) a one-session information-only intervention (INFO), or (c) a wait-list control (WLC) group.

The effectiveness of an information-only intervention was compared with a more comprehensive “informational, motivational, and skills-based” intervention. Both groups were compared to a wait-list control group.

In the INFO group, participants had an opportunity to learn about STD transmission, consequences, prevention, and treatment. Facilitators used an interactive format to elicit names and manifestations of STDs, to correct misconceptions, and to provide information. As a strategy, facilitators did not personalize the threat of STDs.

In the IMB group, the facilitators implemented the 5 principles of the motivational-enhancement approach. They: (a) expressed empathy; (b) increased awareness of the discrepancy between stated safety goals and actual risk behavior; (c) avoided argumentation; (d) “rolled” with resistance; and (e) supported self-efficacy. The group was used to create a social context in which risk-reduction was normative and supported.

The WLC group received an intervention identical to the INFO group, but it occurred after the WLC group’s follow-up survey.

Participants were assessed at three stages: pre-intervention; post-test; and follow-up.

Results

Information

• Compared to the WLC group, both the INFO and the IMB groups improved their STD knowledge over time.

Motivation

• The groups did not differ in terms of attitudes toward condoms, behavioral intentions, and decisional balance.

Sexual Behavior

• No differences were found for condom use during vaginal sexual intercourse or oral sex.
• 16% in the INFO group, 22% in the IMB group, and 11% in the WLC group became sexually abstinent between pre-intervention and follow-up.
• 21% in the INFO group, 35% in the IMB group, and 16% in the WLC group reported a decrease in number of sexual partners from pre-intervention to follow-up.

Participants in the IMB-based brief intervention demonstrated improvements in STD-related information and reduced their number of sexual partners. The intervention did not, however, improve participants’ condom attitudes, intentions, skills, or condom use.

The authors note that 53% of participants in this study were in committed relationships at pre-intervention and were not using condoms. Participants in committed relationships who were not currently using condoms appeared to have rejected the relevance of condom use. They believed that initiating condom use in a committed relationship could be interpreted as questioning commitment. Because of this, the authors note, the study may have had difficulty effecting change on condom use.

The authors suggest future STD risk-reduction studies with college students should be randomized, controlled intervention trials. More effort should be invested in teaching participants how to identify the symptoms, transmission modes, and consequences of STD infection.

The authors also believe practitioners should consider the unique challenges of STD risk-reduction with female college students. Many women practice serial monogamy and view it as a safeguard against STDs instead of viewing it as a form of multiple partnering that confers increased risk. Practitioners need to communicate to college women in a non-judgmental way that engaging in unprotected sexual behavior with a monogamous partner encompasses risk from previous partners.

For more information: B.E. Jaworski and M.P. Carey, “Effects of a Brief, Theory-Based STD-Prevention Program for Female College Students,” Journal of Adolescent Health, vol. 29, no. 6, pp. 417-25.