IMPORTANCEBlack adolescents are at increased risk of contracting HIV and other sexually transmitted infections (STIs) and experiencing unplanned pregnancy. Although sexual health interventions aimed at decreasing these risks exist, evidence of the association between sexual health interventions and the sexual behavior of black adolescents has not been synthesized to our knowledge. OBJECTIVE To examine the associations between sexual health interventions and behavioral, biological, and psychological outcomes.DATA SOURCES For this systematic review and meta-analysis, a systematic search was conducted of studies published through January 31, 2019, using the PubMed, PsycINFO, and CINAHL databases and relevant review articles.

CONTEXT: Latinx adolescents are at risk for negative sexual health outcomes, and many interventions have been developed to reduce this risk.OBJECTIVE: In this meta-analysis, we synthesized the literature on sexual health interventions for Latinx adolescents and examined intervention effects on 3 behavioral outcomes (abstinence, condom use, number of sex partners) and 3 psychological outcomes (safer sex knowledge, intentions, self-efficacy). Moderators of intervention success were explored.DATA SOURCES: A systematic search of studies published through January 2019 was conducted by using PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature databases.STUDY SELECTION: All studies included a US-based sample of Latinx adolescents, evaluated sexual health intervention by using an experimental or quasiexperimental design, included a behavioral outcome, and were in English.DATA EXTRACTION: Standardized mean difference (d) and 95% confidence intervals (CIs) were meta-analyzed by using random-effects models. RESULTS: Effect sizes from 12 studies, sampling 4673 adolescents, were synthesized. Sexual health interventions improved abstinence (d = 0.15, 95% CI: 0.02 to 0.28), condom use (d = 0.44, 95% CI: 0.18 to 0.70), number of sex partners (d = 20.19, 95% CI: 20.37 to 20.001), and sexual health knowledge (d = 0.40, 95% CI: 0.10 to 0.70), compared with control conditions. Effects were consistent across a number of demographic and clinical characteristics, although culturally tailored interventions produced greater change in condom use than nontailored interventions.LIMITATIONS: There was variation across studies in measures of sexual behavior, and some elements of individual study quality were unclear.CONCLUSIONS: Sexual health interventions have a small but significant impact on improving safer sexual behavior among Latinx adolescents. Health educators should consider the importance of cultural tailoring to program success.

Starting in the late 1980s and throughout the 1990s, reports appeared in the literature describing the poor health status and poor health outcomes experienced by minority populations, especially blacks, in the United States. Additionally, attention was brought to the limited access to health services for minority populations. These reports prompted Congress to request the Institute of Medicine (IOM) to conduct a study to assess differences in the kinds and quality of healthcare received by US racial and ethnic minorities and nonminorities. The study culminated in the report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.1 Among the recommendations included in the report published in 2003 is a need for (1) change in legal, regulatory, and policy interventions and (2) health systems interventions. The committee extended the recommendations to include (3) implementation of programs to enhance individual education and empowerment, (4) a need for research into identifying racial and ethnic disparities and the development of and assessment of intervention strategies, and (5) a need to integrate cross-cultural education into the training of all health professionals.1 Subsequent to this report, there has been an increase in efforts to increase diversity among healthcare providers and research investigators.2 The American Association of Medical Colleges (AAMC) continues to encourage recruitment of minorities to careers in medicine, to stress the importance of a diverse medical school faculty and administration, and to graduate culturally competent healthcare providers who will decrease health disparities and improve health equity. Additionally, as noted by Ginther et al in 2011, there continues to be a need to increase diversity at the National Institutes of Health (NIH) not only among the workforce but also among the recipients of awards.3 To this end, the NIH has established the Working Group on Diversity in the Biomedical Research Workforce to monitor the efforts of the NIH to increase diversity and to suggest remedies.4

Background Sexual communication between partners is associated with safer sex behaviours, including condom use among adolescents. Several studies have found a relationship between negative psychological constructs (e.g. depression, anxiety) and poor sexual communication; however, scant research exists regarding positive psychological constructs and their potential to promote effective sexual communication among adolescents. This study examined the association between a positive construct, social self-efficacy – a person’s belief in their ability to successfully manage social relationships – and three components of sexual communication: sexual assertiveness, self-efficacy for communication, and frequency of sexual communication with dating partners. Methods: Data were collected in a cross-sectional survey from 222 high school girls in a rural school district in the south-eastern United States (Mage = 15.2; 38% White, 29% Latina, 24% Black; 50% were in a dating relationship in the past 3 months). Variables were measured with Likert-type scales. Bivariate correlation and regression analyses were conducted. Results: Social self-efficacy was significantly positively associated with sexual assertiveness and sexual communication self-efficacy for all girls, and there was a positive trend in the relationship between social self-efficacy and communication frequency among the subsample of girls who had a dating partner. The significant relationship with sexual assertiveness (β = 0.22, s.e. = 0.07, P = 0.001) and sexual communication self-efficacy (β = 0.17, s.e. = 0.04, P = 0.013) remained when controlling for sexual activity status. Conclusions: Strengthening social self-efficacy may enhance girls’ sexual communication and assertiveness skills. Future studies are needed to confirm the causal and temporal nature of these associations.

Family communication patterns theory proposes two dimensions of family communication-conversation orientation and conformity orientation-that can impact adolescent decision making. The purpose of this study is to examine how family communication patterns, above and beyond the frequency of parent-child sexual communication, are associated with adolescents' (a) sexual self-efficacy, (b) intentions to communicate about sex with partners, and (c) intentions to use condoms. Participants were 452 U.S. adolescents (M age = 15.06; 59% girls; 35% White, 33% Latinx, 25% Black). Controlling for the frequency of parent-child sexual communication and gender, we found the interaction between conversation and conformity orientation was associated with adolescent sexual self-efficacy and intentions to communicate about sex with partners. When families were high on conversation and low on conformity, adolescents had statistically significantly higher sexual self-efficacy than any other family communication patterns. When families were low on conversation and low on conformity, adolescents had statistically significantly lower intentions to communicate with future sex partners than any other family communication pattern. Findings highlight the importance of understanding general communication processes beyond the frequency of parent-child sexual communication.