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Journal of Pediatric Psychology Advance Access originally published online on August 27, 2007
Journal of Pediatric Psychology 2007 32(8):888-906; doi:10.1093/jpepsy/jsm056
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© The Author 2007. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

A Review of STD/HIV Preventive Interventions for Adolescents: Sustaining Effects Using an Ecological Approach

Ralph J. DiClemente, PhD1,2,3, Laura F. Salazar, PhD1,2 and Richard A. Crosby, PhD4

1Rollins School of Public Health, Emory University, 2Emory Center for AIDS Research, 3Emory School of Medicine, Department of Pediatrics, and 4College of Health, University of Kentucky

All correspondence concerning this article should be addressed to Ralph J. DiClemente, PhD, Rollins School of Public Health at Emory, 1518 Clifton Road, NE, Rm 554, Atlanta, GA 30322, USA. E-mail: rdiclem{at}sph.emory.edu.


  Abstract

Objective Behavioral intervention programs to reduce adolescent sexual risk behaviors have shown statistically significant reductions in the short-term; however, longer-term follow-up has demonstrated that effects diminish. One criticism has been the reliance on individual-level models. We review the research that has shaped this narrow perspective and propose that a broader, ecological perspective is needed to amplify and extend the efficacy of sexual risk reduction interventions. Methods We summarize adolescent sexual risk research and outline intervention research that is suggestive of an ecological perspective. Examples from the published literature that have investigated antecedents or conceptualized preventive interventions using a multilevel approach are provided. Results Adolescents are exposed to diverse sources of influence transecting different levels of causation. To adequately prevent, reduce, and maintain the likelihood of adolescents’ adopting sexual risk behaviors, intervention programs should be designed to address these myriad levels of causation. This approach has been implemented in Brazil and was shown to be effective. Conclusion Research should cross manifold levels of causation so that programs will be more effective at promoting adolescents’ adoption and maintenance of STD/HIV preventive behaviors.

Key words: adolescents; ecological; sexual health; STD/HIV prevention.

Received February 14, 2006; revision received June 10, 2006; revision received December 4, 2006; accepted December 17, 2006


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