Reducing Substance Use and Sexual Risk Inequality Among a Diverse Sample of Youth: A Randomized Clinical Trial

Background: Substance use and sexual risk behaviors remain significant public health concerns in the United States, and racial and ethnic minority youth are disproportionately affected. Technology-based interventions may reduce substance use and sexual risk inequalities, yet efficacious preventive interventions are limited. Storytelling 4 Empowerment (S4E), is a theory-driven, culturally congruent, web-based substance use and sexual risk behaviors preventive application (app) for use in clinic settings. S4E has been shown to be feasible and acceptable among youth and clinicians. The purpose of this research was to examine the preliminary efficacy of S4E, relative to a control group, in reducing substance use and sexual risk behaviors among a diverse sample of youth.

Methods: Data are from an ongoing randomized clinical trial (RCT). We recruited a diverse sample of 100 youth (M_age =19.4 years-old, Range: 14-21) from an urban youth-centered community clinic. Participants were randomized to either S4E or control group, and assessed at baseline and 90-day follow-up. Participants completed measures to assess demographics, substance use and sexual risk behaviors. Approximately 50% of youth identified as female, 55% identified as racial or ethnic minority, and 45% non-Hispanic white. Youth participants in the experimental group were provided the S4E web-based intervention, an interactive, targeted and tailored app that consists of a risk assessment, followed by psychoeducational prevention content and risk reduction encounter with a clinician. Clinician participants were provided the youth risk behavior scores via the S4E app, aimed at facilitating youth-clinician risk communication, and link youth to care and prevention services. Data were analyzed by computing change in mean scores and proportion differences by group across time. Given the preliminary efficacy design, statistical significance is deemphasized, Rather, our goal was to determine the parameters and shifts in our outcomes to use in a future larger RCT.

Results: Preliminary findings indicate that, relative to participants in the control group, the participants in the S4E group showed reductions in substance use and sexual risk behaviors, including cigarette use (Δ -12.50% vs. 0%), binge drinking (Δ-25% vs. 0%), and in engagement of condomless oral, anal and vaginal sex (ΔM = -1.71 vs. ΔM =1.81; Cohen’s D = 0.93) at 90-days follow-up.

 Implications: These findings demonstrate the preliminary efficacy of S4E on substance use and sexual risk behaviors among a diverse sample of youth. The development and testing of evidence-informed practices is essential to reducing substance use and sexual risk inequality among vulnerable youth. Findings suggest that a future larger RCT may be warranted.