Safer Sex Intervention (SSI)

Sexually active female adolescents and young adults

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 person’s stage of behavior change. Booster sessions are offered at 1, 3, and 6 months postintervention.

Lydia A. Shrier, MD, MPH

• Agency/Affiliation: Boston Children's Hospital
• Website: https://www.childrenshospital.org/programs/safer-sex-intervention-program
• Email: SaferSex@childrens.harvard.edu
• Phone: (617) 355-8306

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

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 person’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 person into one of two categories based on their stage of behavior change
• Uses the SSI guide that is appropriate for the young person’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

Child/Adolescent Services

Safer Sex Intervention (SSI) directly provides services to children 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 Settings

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

Prerequisite/Minimum Provider Qualifications

Bachelor’s degree plus training and experience in sexual health/family planning with adolescents and young adults

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual information:

• Shrier, L. A., Ancheta, R., Goodman, E., Chiou, V., Lyden, M. R., & Emans, J. (2016). Safer Sex Intervention (SSI).

The manual is available for a fee, on request via email to SaferSex@childrens.harvard.edu

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

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

“What is included the Relevant Published, Peer-Reviewed Research section?”

Research on How to Implement the Program

Research has been conducted on how to implement Safer Sex Intervention as listed below:

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), S45-S52. https://doi.org/10.1016/j.jadohealth.2013.12.024

“What is included in the Relevant Published, Peer-Reviewed Research section?”

• 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. https://doi.org/10.1001/archpedi.155.1.73

  Type of Study: Randomized controlled trial

  Participants: 123

  Sample / 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:

  The purpose of the 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 SSI or standard care. Measures utilized include a sociodemographic interview and a self-administered, 62-item questionnaire that used items from previously validated surveys and questions about age of first sexual intercourse, number of sexual partners (lifetime and past 3 months), use of alcohol or other drugs before sexual intercourse (ever and the last time), and condom use with last sexual intercourse were adapted from the Youth Risk Behavior Survey. Results indicate that at 1 month, compared with control participants, SSI participants had increased sexual risk knowledge and more positive attitudes toward condoms. There were no differences between treatment groups in change in any of the study variables at the 3-month visit. At 6 months, fewer SSI participants than controls had sex with a nonmain sexual partner in the previous 6 months. At 12 months from baseline, SSI 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 that the sample was drawn largely from an urban pediatric hospital’s general adolescent clinic and might not be representative of other adolescent populations; concerns about the reliability and validity of the measures; and that the sample size was small.

  Length of controlled postintervention follow-up: 6 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. https://doi.org/10.2105/AJPH.2016.303372

  Type of Study: Randomized controlled trial

  Participants: 1,809

  Sample / Population:

  • Age — 13–20 years
  • Race/Ethnicity — 35% Non Hispanic Black, 33% Non Hispanic White, 18% Hispanic, and 14% Other
  • Gender — 100% Female
  • Status —

    Participants were sexually active female adolescents.

  Location/Institution: Minnesota, Tennessee, and Florida

  Summary:

  The purpose of the study was 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 or to no intervention. Measures utilized include study-developed measures regarding the following: 1) currently sexually active (in the past 90 days); 2) sexual intercourse without birth control in the past 90 days; 3) sexual intercourse in the past 90 days; 4) oral sex in the past 90 days; 5) anal sex in the past 90 days; 6) sexual intercourse without a condom in the past 90 days; 7) oral sex with a condom in the past 90 days; 8) anal sex without a condom in the past 90 days; 9) sexual intercourse with more than one partner (lifetime); and 10) sexual intercourse with more than five partners (lifetime). Results indicate that, compared with control participants, SSI participants were less likely to have sexual intercourse without birth control, but they were no less likely to report being sexually active in the past 90 days than the control group. SSI had no impact on any other measures of sexual behavior. Positive impacts on sexual behavior and sexual risk were observed among several subgroups: youths who were aged 18 years or older, Hispanic youth, and those not sexually experienced at baseline. Limitations include the lack of generalizability of study findings to other ethnicities and genders and the use of study-developed measures.

  Length of controlled postintervention follow-up: None.

• 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. https://doi.org/10.1016/j.jadohealth.2013.12.024

• Kelsey, M., Layzer, J., Price, C., & Francis, K. (2018). Safer Sex Intervention final impact report: Findings from the teen pregnancy prevention replication study. Abt Associates Inc. https://aspe.hhs.gov/teen-pregnancy-prevention-tpp-replication-study

  
  

• Remz, G., & Tilchin, R. (n.d.). Sexual health education: Minneapolis, MN. Results for America. https://catalog.results4america.org/case-studies/sexual-health-minneapolis