Emotional regulation intervention linked to decreased high risk sexual behavior
1. Adolescents with no baseline sexual activity who underwent an emotional regulation (ER) sexual health intervention were less likely to report first-time vaginal or anal sex over a follow-up period of 30 months compared to adolescents who underwent a traditional health promotion (HP) sexual health intervention without emotional regulation teaching.
2. Adolescents in the ER group, when compared to the HP group, were less likely to have sexual intercourse without condoms, to use substances before sex and to have multiple sexual partners.
Evidence Rating Level: 2 (Good)
Study Rundown: Early initiation of sexual intercourse has been associated with a higher risk of sexually transmitted infections (STI) and pregnancy. Difficulties with ER, a skillset that draws on identifying the relationship between behaviors and emotions and then creating strategies for regulating such emotions, may be present in adolescents who engage in high risk behaviors. The purpose of this prospective cohort study was to evaluate the efficacy of an ER-based sexual health intervention compared to a standard, HP sexual health intervention in reducing high risk sexual behaviors in seventh grade adolescents with suspected mental health symptoms. Of adolescents with no prior history of vaginal or anal sex, those in the ER group had a significant delay in initiation of vaginal sex during the study period compared to the HP group. Additionally, the ER group had significantly fewer episodes of condomless sex, multiple partners and substance use before sex. For adolescents who entered the study with vaginal or anal sex history at baseline, those in the ER group engaged in vaginal sex and substance use before sex less often than their HP counterparts. Limitations of this study include potential bias secondary to use of self-reported interviews, lack of randomization to eliminate for treatment confounders and participants limited to one geographic area. Data from this study suggest that emotional regulation may serve as an effective healthcare intervention in adolescents to reduce high risk sexual behaviors.
In-Depth [prospective cohort]: This study was conducted across 5 Rhode Island public schools between September 2009 and February 2012. Included participants had to be in the seventh grade, between 12-14 years of age, English-speaking, and have at least 1 symptom of emotional/behavioral problems or suspected sexual activity or substance use as identified by a school professional. Follow-up surveys were administered at 6-month intervals up until 30-months. Participants were excluded if they had a history of sexual aggression, HIV infection, current pregnancy, developmental delay, or a participating sibling. The ER intervention (n = 222) consisted of 12, 1-hour, twice-weekly small group sessions (4-8 adolescents per group) that focused on emotional regulation in the setting of decision making about sexual behaviors lead by a male-female mental health clinician pair. The HP intervention (n = 198) similarly focused on sexual health and high-risk behaviors, but without the focus on explicit ER skills. During the 3-year study period, 27% of students were referred, and 40% were consented/assented (n=420). A total of 72% of participants completed all follow-up evaluations. The average participant age was 12.94 ± 0.53 years of age.
The primary outcome was delay in sexual initiation and secondary outcomes included individual sexual risk behaviors as well as a sexual risk composite. For participants who did not have sex at baseline, 68 (39%) and 63 (31%) in the HP and ER group, respectively, reported having vaginal sex for the first time during the study period (AHR = 0.61; 95%CI 0.42-0.89). In the full sample analysis, participants in the ER group, when compared to the HP group, were less likely to report multiple partners during any 6-month period (aOR = 0.54; 95% CI=0.30-0.99), substance abuse before sex (aOR = 0.42; 95%CI 0.23-0.75), vaginal or anal sex without condoms (ARR = 0.36; 95%CI 0.14-0.90), and any behavior falling into the sexual risk composite during the entire study period (aOR = 0.52, 95%CI 0.32-0.84). For adolescents who reported any sex at baseline or at any follow-up, there was no significant difference between the ER and HP groups with regards to multiple sexual partners during any 6-month period, and vaginal or anal sex without condoms. However, those in the ER group with baseline sexual activity were less likely to report using substances before sex compared to their HP counterparts (aOR = 0.52; 95%CI 0.29-0.95) and had a lower frequency of vaginal or anal sex acts after sexual debut (ARR = 0.53; 95%CI 0.25-1.17).
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