Safer Sex Intervention (SSI)

About This Program

Target Population: Sexually active female adolescents and young adults

For children/adolescents ages: 13 – 23

Program Overview

The Safer Sex Intervention (SSI) is designed to reduce sexual risk behaviors among young women at risk for adverse reproductive health outcomes. The sexual risk behaviors addressed include having sex without a condom, having sex with a nonmain partner, and having sex without contraception. SSI is administered one-on-one and face-to-face by a female health educator in a clinical setting. The 30- to 50-minute session follows one of two intervention guides, selected based on the young woman’s stage of behavior change. Booster sessions are offered at 1, 3, and 6 months postintervention.

Program Goals

The goals of the Safer Sex Intervention are:

  • Reduce sexual risk behaviors, including sex without a condom, sex with a nonmain partner, and sex without contraception
  • Improve safer sex attitudes and intentions, including positive attitudes toward condoms, intention to use condoms, and intention to use contraception
  • Reduce adverse reproductive health outcomes, including repeat sexually transmitted infection (STI), any incident STI, and unplanned pregnancy

Essential Components

The essential components of the Safer Sex Intervention (SSI) include:

  • Administers sessions on a one-on-one and face-to-face basis with a female health educator in a clinical setting
  • Uses one 30-50 minute session to evaluate the young woman and administer the main session of SSI
  • Evaluates a young women’s stage of behavior change about sexual risk behaviors (e.g., having sex without a condom, having sex with a nonmain partner, and having sex without contraception) using self-reporting and health evaluator input
  • Uses the evaluation to place the young woman into one of two categories based on their stage of behavior change
  • Uses the SSI guide that is appropriate for the young woman’s stage of behavior change category
  • Draws on behavior change theory and approaches to counseling (Social Cognitive Theory, Transtheoretical Model of Behavior Change, Motivational Interviewing)
  • Includes information and activities in the SSI guides that are related to condom use, contraception, and sexual refusal
  • Provides booster sessions at 1, 3, and 6 months or at similar intervals aligned with other aspects of care

Program Delivery

Child/Adolescent Services

Safer Sex Intervention (SSI) directly provides services to children/adolescents and addresses the following:

  • Sexual risk behaviors

Recommended Intensity:

One 30- to 50-minute session Three 15- to 20-minute booster sessions at 1, 3, and 6 months

Recommended Duration:

6 months (but for individuals not willing or able to follow-up, may be as short as a single session)

Delivery Setting

This program is typically conducted in a(n):

  • Outpatient Clinic

Homework

This program does not include a homework component.

Resources Needed to Run Program

The typical resources for implementing the program are:

Personnel and a private room

Education and Training

Prerequisite/Minimum Provider Qualifications

Bachelor’s degree, trained as a health educator with experience in sexual health/family planning.

Education and Training Resources

There is a manual that describes how to implement this program , and there is training available for this program.

Training Contact:
Training is obtained:

Arrangements for training must be made with Dr. Shrier or her delegate. Training can be provided on-site or in Boston, depending on logistics.

Number of days/hours:

1.5 days for train-the-facilitator training, 2 days for train-the-trainer training, and half a day for the motivational interviewing workshop

Relevant Published, Peer-Reviewed Research

Shrier, L. A., Ancheta, R., Goodman, E., Chiou, V. M., Lyden, M. R., & Emans, S. J. (2001). Randomized controlled trial of a Safer Sex Intervention for high-risk adolescent girls. Archives of Pediatrics & Adolescent Medicine, 155(1), 73-79.

Type of Study: Randomized controlled trial
Number of Participants: 123

Population:

  • Age — Not specified
  • Race/Ethnicity — Not specified
  • Gender — 100% Female
  • Status — Participants were adolescents with cervicitis or pelvic inflammatory disease (PID).

Location/Institution: Urban children’s hospital adolescent clinic and inpatient service

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to determine the effect of an individualized Safer Sex Intervention (SSI) on condom use and recurrent sexually transmitted disease (STD) among female adolescents diagnosed as having an STD. Participants were randomized to receive safer sex education according to either the study intervention (SSI) or standard care, stratified by presenting diagnosis (cervicitis or PID) using 2 separate random numbers lists. Measures utilized include a sociodemographic interview, the Wheel of Change, and the Youth Risk Behavior Survey. Results indicate at 1 month, compared with control participants, intervention participants had increased sexual risk knowledge and more positive attitudes toward condoms and tended to use condoms more with a nonmain partner. At 6 months, fewer intervention participants than controls had sex with a nonmain sexual partner in the previous 6 months. At 12 months from baseline, intervention participants were less likely to have a current main partner and had a lower rate of recurrent STD than controls, but these differences were not significant. Limitations include small sample size and length of follow-up.

Length of postintervention follow-up: 3 months.

Kelsey, M., Walker, J. T., Layzer, J., Price, C., & Juras, R. (2016). Replicating the Safer Sex Intervention: 9-Month Impact Findings of a randomized controlled trial. American Journal of Public Health, 106(S1), S53-S59.

Type of Study: Randomized controlled trial
Number of Participants: 1,809

Population:

  • Age — 13-20 years
  • Race/Ethnicity — 35% Non-Hispanic Black, 32.6% Non-Hispanic White, 18.4% Hispanic, and 13.5% Other
  • Gender — 100% Female
  • Status — Participants were sexually active female adolescents.

Location/Institution: Minnesota, Tennessee, Florida

Summary: (To include comparison groups, outcomes, measures, notable limitations)
To test the effects of the Safer Sex Intervention (SSI) on female adolescents’ sexual behavior and possible antecedents of behavior such as sexual health attitudes, knowledge, motivation, intentions, and skills. Participants were randomized into SSI (n = 1196) or to no intervention (n = 613) among female adolescents. Measures utilized include a sociodemographic interview and the Wheel of Change. Results indicate compared with control participants, SSI participants were less likely to have sexual intercourse without birth control, more likely to report positive attitudes toward protection and intention to use condoms, and more confident of their ability to refuse sex. SSI did not affect sexual risk knowledge or motivation to delay childbearing. Positive impacts on sexual behavior and sexual risk were observed among key subgroups of youths who were aged 18 years or older, Hispanic, not sexually experienced at baseline, and enrolled at the Minnesota site. Limitations include generalizability of study findings to other ethnicities and gender.

Length of postintervention follow-up: 9 months.

Additional References

Kelsey, M., & Layzer, J. (2014). Implementing three evidence-based program models: Early lessons from the Teen Pregnancy Prevention Replication Study. Journal of Adolescent Health, 54(3, Suppl), S45-S52.

Contact Information

Lydia A. Shrier, MD, MPH
Agency/Affiliation: Boston Children’s Hospital
Website: www.childrenshospital.org/centers-and-services/programs/o-_-z/safer-sex-intervention
Email:
Phone: (617) 355-8306

Date Research Evidence Last Reviewed by CEBC: September 2017

Date Program Content Last Reviewed by Program Staff: November 2017

Date Program Originally Loaded onto CEBC: November 2018