Department of Psychology, North Carolina State University, Raleigh.
JAMA Pediatr. 2020 Jul 1;174(7):676-689. doi: 10.1001/jamapediatrics.2020.0382.
Black adolescents are at increased risk of contracting HIV and other sexually transmitted infections (STIs) and experiencing unplanned pregnancy. Although sexual health interventions aimed at decreasing these risks exist, evidence of the association between sexual health interventions and the sexual behavior of black adolescents has not been synthesized to our knowledge.
To examine the associations between sexual health interventions and behavioral, biological, and psychological outcomes.
For this systematic review and meta-analysis, a systematic search was conducted of studies published through January 31, 2019, using the PubMed, PsycINFO, and CINAHL databases and relevant review articles. The following key words were used: youth, adolesc* or teen*; sexual health or safe* sex or sexually transmitted disease or sexually transmitted infection or STD or STI or HIV or AIDS or pregnancy or reproductive health or condom* or contracept* or unprotected sex or abstinence; intervention or program or education or prevention or promotion or trial; latino* or latina* or latinx* or minorit* or ethnic* or hispanic or african american* or black* or race or racial or biracial.
Studies were included if they included a US-based sample of black adolescents, evaluated a sexual health intervention using experimental or quasi-experimental designs, included a behavioral outcome, and were published in English.
Standardized mean differences and 95% CIs were extracted and meta-analyzed using random-effects models.
Behavioral outcomes were abstinence, condom use, and number of sex partners. Biological outcomes were pregnancy and STI contraction. Psychological outcomes were sexual health intentions, knowledge, and self-efficacy.
Across 29 studies including 11 918 black adolescents (weighted mean age, 12.43 years), there was a significant weighted mean association of sexual health interventions with improvements in abstinence (Cohen d = 0.14; 95% CI, 0.05-0.24) and condom use (Cohen d = 0.25; 95% CI, 0.11-0.39). No significant mean association of these interventions with number of sex partners, pregnancy, or STI contraction was found. Sexual health interventions were significantly associated with improvements in psychological outcomes: sexual health intentions (Cohen d = 0.17; 95% CI, 0.05-0.30), knowledge (Cohen d = 0.46; 95% CI, 0.30-0.63), and self-efficacy (Cohen d = 0.19; 95% CI, 0.09-0.28). Intervention effect sizes were consistent across factors, such as participant sex and age and intervention dose.
The findings suggest that sexual health interventions are associated with improvements in sexual well-being among black adolescents. There appears to be a need for wide-scale dissemination of these programs to address racial disparities in sexual health across the US.
黑人青少年感染艾滋病毒和其他性传播感染（STI）以及意外怀孕的风险增加。尽管存在旨在降低这些风险的性健康干预措施，但据我们所知，还没有综合评估这些干预措施与黑人青少年性行为之间的关联。
研究性健康干预措施与行为、生物和心理结果之间的关联。
为了进行这项系统评价和荟萃分析，我们系统地检索了截至 2019 年 1 月 31 日发表的研究，使用了 PubMed、PsycINFO 和 CINAHL 数据库以及相关的综述文章。使用了以下关键词：青年、青少年或少年；性健康或安全性行为或性传播疾病或性传播感染或 STD 或 STI 或 HIV 或 AIDS 或怀孕或生殖健康或避孕套或避孕药或无保护性行为或禁欲；干预或方案或教育或预防或促进或试验；拉丁裔或拉丁裔或拉丁裔*或少数族裔或种族或西班牙裔或非裔美国人或黑人或种族或种族或混血儿。
如果研究包括基于美国的黑人青少年样本，使用实验或准实验设计评估性健康干预措施，包括行为结果，并且以英文发表，则将其纳入研究。
使用随机效应模型提取并荟萃分析标准化均数差值和 95%置信区间。
行为结果是禁欲、使用避孕套和性伴侣数量。生物结果是怀孕和 STI 感染。心理结果是性健康意向、知识和自我效能。
在包括 11918 名黑人青少年（加权平均年龄 12.43 岁）的 29 项研究中，性健康干预措施与禁欲（Cohen d=0.14；95%置信区间，0.05-0.24）和使用避孕套（Cohen d=0.25；95%置信区间，0.11-0.39）的改善呈显著加权平均关联。这些干预措施与性伴侣数量、怀孕或 STI 感染的平均关联不显著。性健康干预措施与心理结果的改善显著相关：性健康意向（Cohen d=0.17；95%置信区间，0.05-0.30）、知识（Cohen d=0.46；95%置信区间，0.30-0.63）和自我效能（Cohen d=0.19；95%置信区间，0.09-0.28）。干预效果大小在参与者性别和年龄以及干预剂量等因素之间是一致的。
研究结果表明，性健康干预措施与黑人青少年的性健康改善有关。似乎需要广泛传播这些方案，以解决美国性健康方面的种族差异。
