Preventing Sexually Transmitted Infections and Unwanted Pregnancies Among Young Women

Program Components

• Four, two-hour facilitated sessions
• Interactive activities, including group discussions and exercises and self-risk appraisal
• Three videos

For Use With

• Young sexually active women, ages 17-22
• Female recruits to the military*

Evaluation Methodology

• Quasi-experimental evaluation with treatment and comparison conditions in San Diego, CA, and Beaufort SC, between June 1999 and June 2000
• Female Marine Corps recruits, voluntarily enrolled and randomly assigned by platoon to experimental (n=1,062) and control (n=1,095) conditions
• Sexual history, history of pregnancy, and STI screening for C. trachomatis, N. gonorrhoeae, and T. vaginalis at baseline (n=2,157), one-month (n=1,743), and 14-month (n=1,381) follow-up

Evaluation Findings

• Reduced incidence of STIs
• Reduced incidence of pregnancy

Evaluators' Comments: This experimental intervention had the most salient impact in reducing STIs in women who, before the intervention, had multiple sexual partners or used condoms inconsistently (35% of the study participants). However, our intervention had no significant impact on women who were at no risk (not sexually experienced), at a relatively low risk (engaging in protective sexual behaviors) or were at increased risk (had experienced a pregnancy or STI) before entering recruit training.
Source: Boyer, Shafer, Shaffer et al., 2005

Program Description

The program is based in cognitive behavioral theory, focusing on key elements of the information, motivation, and behavioral (IMB) skills model. The intervention uses a variety of methods to provide participants with opportunities to develop the motivation and skills to avoid HIV risk behaviors. Methods include didactic teaching, interactive group discussions, self-risk appraisal, and videos. The four-session intervention aims to 1) increase knowledge about unintended pregnancy, STIs, and HIV; 2) modify values, beliefs, attitudes around sexual risk behaviors; 3) increase use of contraception and condoms; and 4) build skills in communication, negotiation, and refusal.

*Note: Although the program was originally delivered to female U.S. Marine Corps recruits, Office of Adolescent Health and Sociometrics (PASHA) describe the target audience more broadly as young women, ages 17-22.

Evaluation Methodology

The evaluation used a group-randomized control methodology. During each 13-week recruit training cycle, two platoons (groups of 50 to 75 women) are formed for training purposes. Using the military's already formed platoons, evaluators randomly assigned the platoons to intervention or comparison condition. During the first week of training and outside the presence of military personnel, each female recruit was asked to voluntarily participate. Those agreeing signed informed consent statements. Each session was facilitated by two, trained civilian research assistants with 20 to 25 recruits for the experimental intervention and the entire platoon for the control intervention.

Prior to recruit training, the Marine Corps tested all female recruits for pregnancy, Chlamydia (C. trachomatis), gonorrhea (N. gonorrhoeae), and trichomonas (T. vaginalis). Anyone testing positive was precluded admission to the Marine Corps. The fact that the young women began basic training provided baseline testing status of all study participants. Prior to implementation of the intervention, participant recruits (n=2,157) completed a baseline, self-administered questionnaire. At one month after graduation from recruit training (average 34.5 days) and at 14 months after baseline assessment, participants again filled out the self-assessment questionnaire and were screened for pregnancy, Chlamydia, gonorrhea, and trichomonas. Since about half of all female Marines who finish basic training were assigned to southern California, eastern North Carolina, or southern Japan, the evaluators decided in advance to conduct follow-up STI and pregnancy screening only on participants in these three areas. Marine participants in other areas of the globe received and returned the questionnaires but were not tested for STIs or pregnancy as part of the evaluation.

The experimental condition used a variety of educational strategies, across four two-hour interactive sessions, focused on safer sexual behaviors and skills. The control condition was identical to the experimental condition in regard to time and educational strategies, but was focused instead on: 1) improving participants' nutrition; 2) preventing sports and physical training injuries; and 3) preventing cervical and breast cancer.

Among those randomized to experimental (n=1,062) and comparison (n=1,095) conditions, 89 percent (n=1,916) completed all four sessions; 81 percent (n=1,743) completed the first follow-up; and 64 percent (n=1,381) completed the second and final follow-up. At baseline, differences between intervention and comparison participants were statistically significant in three areas. Intervention participants were more likely to be married (P=.006), to have ever had a casual sex partner (P=.043); and to have had a prior history of gonorrhea (P=.035). Analysis controlled for these differences.

Long-Term Impact

• Reduced incidence of STIs – Among participants who had no pre-intervention history of STIs or pregnancy but who engaged in risky sexual behaviors just prior to recruit training, the comparison group was significantly more likely than their experimental peers to acquire a post-intervention STI (P=.023)
• Reduced incidence of unintended pregnancy and/or STIs – When post-intervention STIs and unintended pregnancies were combined into a single outcome variable, a statistically significant main effect (P=.043) for the intervention group emerged. A significantly higher proportion of the comparison group (24 percent) than of the intervention group (18 percent) tested positive for STIs or pregnancy.

For More Information, Contact:

• Sociometrics, Program Archive on Sexuality, Health & Adolescence: Phone 1.800.846.3475; Fax, 1.650.949.3299; e-mail, This e-mail address is being protected from spambots. You need JavaScript enabled to view it ; Web, http://www.socio.com