Reducing Sexual Risk Behavior in Early Adolescent Females: Results from an RCT

Purpose: While the overall United States’ (U.S.) teen birth rate declined slightly in recent years, it nonetheless still has the highest teen birth rate of all industrialized countries. STDs are serious concerns among adolescents and are linked to health problems such as chronic pelvic pain, ectopic pregnancy, infertility and increased mortality (World Health Organization, 1995). Half of all new HIV infections occur in young people 25 and younger. Additionally, 25% of sexually experienced adolescents become infected with an STD each year. Certain minority groups are at particularly high risk, as the teen birth rate for Hispanics and African Americans are three times higher than the non-Hispanic Caucasian teen birth rates. Few validated gender- specific curriculum are available. The Go Grrrls curriculum was designed specifically for girls based on research suggesting the critical differences between males and females in regard to sexual activity and other high risk behaviors, including differing motivations and consequences. This study presents the results of a randomized controlled trial to evaluate the impact of the Go Grrrls gender-specific prevention program adapted to emphasize sexual risk reduction among a predominately Hispanic early adolescent population.

Method: 801 adolescents enrolled in the study and were randomly assigned to study conditions. Assignment to study conditions used a random allocation sequence that was conducted by the research staff.  Trained facilitators delivered the gender-specific program that focused on the healthy psychosocial development of early adolescent females to the intervention group. This “universal prevention” content was supplemented with material on sexual risk reduction lessons. The program was 16 weeks long. The control condition received a gender-based program on technology, science and leadership. It included similar lesson plans and activities and was a strong dose-equivalent control group. Outcome measures included condom technical skills, condom self-efficacy, and STD knowledge; secondary outcomes included girl efficacy and self assertive behavior. All measures had acceptable reliability. Outcome measures were administered at posttest, 6 month follow-up and 18 month follow-up. 

Results: Baseline equivalence was verified. Repeated measures ANOVA revealed significant time x group interactions on condom technical skills (p <.001), STD knowledge (p <.001), and a significant trend on condom self-efficacy (p <.11). Results for secondary outcomes indicated significant within subject changes for both groups on girl efficacy (p <.001) and self-assertive behavior (p <.001) but not between group differences.

Conclusions and Implications: This study found that Go Grrrls, a gender-specific program, produced several positive outcomes among early adolescent females on indicators of sexual risk reduction. The participants’ improvements in condom technical skills and STD knowledge were maintained over time.  Previous research (Morrison-Beedy, 2013) found reductions in sexual risk behavior but a return to baseline levels for girls suggesting the importance of investigating risk reduction over time especially for females. A study by Cole et al. (2004) found important effects for middle school boys but not for girls. The current study adds to the existing literature of gender-specific randomized clinical trials for middle school females.