A Randomized Controlled Trial to Compare Computer-Assisted Motivational Intervention with Didactic Educational Counseling to Reduce Unprotected Sex in Female Adolescents

To examine a computer-assisted, counselor-guided motivational intervention (CAMI) aimed at reducing the risk of unprotected sexual intercourse.

We conducted a 9-month, longitudinal randomized controlled trial with a multisite recruitment strategy including clinic, university, and social referrals, and compared the CAMI with didactic educational counseling in 572 female adolescents with a mean age of 17 years (SD = 2.2 years; range = 13-21 years; 59% African American) who were at risk for pregnancy and sexually transmitted diseases. The primary outcome was the acceptability of the CAMI according to self-reported rating scales. The secondary outcome was the reduction of pregnancy and sexually transmitted disease risk using a 9-month, self-report timeline follow-back calendar of unprotected sex.

The CAMI was rated easy to use. Compared with the didactic educational counseling, there was a significant effect of the intervention which suggested that the CAMI helped reduce unprotected sex among participants who completed the study. However, because of the high attrition rate, the intent to treat analysis did not demonstrate a significant effect of the CAMI on reducing the rate of unprotected sex.

Among those who completed the intervention, the CAMI reduced unprotected sex among an at-risk, predominantly minority sample of female adolescents. Modification of the CAMI to address methodological issues that contributed to a high drop-out rate are needed to make the intervention more acceptable and feasible for use among sexually active predominantly minority, at-risk, female adolescents.

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By: Gold MA1, Tzilos GK2, Stein LA3, Anderson BJ4, Stein MD5, Ryan CM6, Zuckoff A7, DiClemente C8.

• 1Columbia University Medical Center, Department of Pediatrics, Division of Child and Adolescent Health, Mailman School of Public Health, Department of Population and Family Health, and New York-Presbyterian Hospital, New York, New York.
• 2Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island. Electronic address: Golfo_Tzilos@brown.edu.
• 3Department of Psychology, University of Rhode Island, Kingston, Rhode Island.
• 4Butler Hospital, Providence, Rhode Island.
• 5Department of Medicine, Public Health and Public Policy, Brown University, Providence, Rhode Island.
• 6Department of Psychiatry, Psychology, Health and Community Systems, University of Pittsburgh, Pittsburgh, Pennsylvania.
• 7Departments of Psychology and Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
• 8Department of Psychology, University of Maryland, Baltimore County, Maryland.  

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