J Adolesc Health

Purpose To evaluate the efficacy of two, theory-based, multi-media, middle school sexual education programs in delaying sexual initiation. Methods Three-armed, randomized controlled trial comprising fifteen urban middle schools; 1,258 predominantly African-American and Hispanic 7th grade students followed into 9th 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% female, 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]: 0.65, 95% CI: 0.54–0.77), among females (AOR: 0.43, 95% CI: 0.31–0.60) and African-Americans (AOR: 0.38, 95% CI: 0.18–0.79). RR students also reduced unprotected sex at last intercourse (AOR: 0.67, 95% CI: 0.47–0.96), past three months’ frequency of anal sex (AOR: 0.53, 95% CI: 0.33–0.84) and unprotected vaginal sex (AOR: 0.59, 95% CI: 0.36–0.95). The RA program delayed any sexual initiation among Hispanics (AOR: 0.40, 95% CI: 0.19–0.86), reduced unprotected sex at last intercourse (AOR: 0.70, 95% CI: 0.52–0.93) but increased the number of recent vaginal sex partners (AOR: 1.69, 95% CI: 1.01–2.82). Both programs positively impacted psychosocial outcomes. Conclusions The RR program positively impacted sexually inexperienced and experienced youth; the RA program delayed initiation among Hispanics and had mixed effects among sexually experienced youth.

22325134

PMC4882098

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