Three million new cases of sexually transmitted diseases (STD) are identified in adolescents every year. The proposed research applies recent advances in cognitive-behavioral theory to increase the effectiveness and durability of multicomponent interventions that promote risk reduction and avoidance in adolescents. In Phase I, we investigate adolescents' psychological representations of decision options (i.e. abstinence vs. risk taking), risk estimates of problem behaviors, and relevant beliefs and attitudes. Specifically, 200 adolescents will be surveyed, presented with realistic sexual decision-making scenarios, and questioned in-depth concerning their perceptions of important risks and consequences (e.g., the cumulative risk of contracting a STD). Hispanics will be oversampled to provide sufficient statistical power to evaluate ethnic differences. In Phase II, 800 adolescents will be randomly assigned to one of three groups: a standard multicomponent intervention (Reducing the Risk), a gist-based enhancement of the standard intervention, or a control group receiving an unrelated intervention. The enhanced intervention will be based on cognitive behavioral theory (e.g., Reyna and Ellis, 1994), as well as on differences identified in Phase 1 between adolescents engaging versus not engaging in risky behaviors. Pre- and post-intervention surveys will assess such outcomes as self-reports of risky behaviors and STD treatment, with follow-up surveys at 3, 6, and 12 months. Multivariate analyses of variance (followed by univariate tests) controlling for background and baseline characteristics, will be used to compare differences among standard, enhanced, and control groups. Logistic regression will be used for categorical outcome measures, such as initiation of intercourse. Thus, the proposed research will provide evidence concerning sexual decision processes in Hispanic and non-Hispanic adolescents, and evaluate a theory-based intervention that focuses on specific behaviors and addresses both social (e.g., refusal skills) and cognitive- developmental factors using a randomized assignment design. We will also compare our survey data to results of a statewide evaluation of abstinence-only programs using the same survey instrument. By emphasizing gist representations, which are well preserved over long time periods and are key memories used in decision making, the enhanced intervention should produce larger and more sustained effects on risk reduction and avoidance.
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