Sexual Health Programs for Latinx Adolescents: A Meta-analysis

Abstract

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.

Preliminary Evaluation of a Prescription Opioid Misuse Prevention Program Among Rural Middle School Students

“…Although TINAD was a brief intervention that could be delivered in just a single classroom session, preliminary results from this study are in line with others that suggest even brief programming can impact adolescent health cognitions and behavior [30], and some meta-analyses that show Table 3 Changes from pretest to posttest in prescription opioid misuse knowledge, attitudes, self-efficacy, and intentions The same pattern of results emerged when analyses were run separately among adolescents who reported previous opioid misuse and among adolescents who did not report previous misuse. Knowledge: n = 484; Attitudes: n = 537; Self-efficacy: n = 519; Intentions: n = 555 that health interventions for youth can be effective regardless of their duration [31][32][33]. Since TINAD is wide reaching, acceptable, and shows preliminary efficacy at promoting healthier cognitions regarding opioid misuse, as demonstrated by this study with middle school students and one other study with high school students [12], it seems fruitful to build on and improve the TINAD program so that in the future, we can expect adapted iterations to change adolescent opioid misuse intentions and behavior.…”

Consideration of Heterogeneity in a Meta-analysis of Latino Sexual Health Interventions

“…This variability, defined as methodologic heterogeneity, can result in differing degrees of validity across included studies and affect the strength of meta-analytical findings. 11 To assess the impact of methodologic heterogeneity on their findings, Evans et al 5 conducted sensitivity analyses with attention to several potential sources of bias, including random sequence generation, overall attrition, and selective reporting. However, other domains of potential methodologic heterogeneity, such as refusal bias, differential attrition, or information bias, remained unaccounted for.…”

“…9 In interpreting meta-analyses' results, consideration of clinical heterogeneity is important because variability in individual effects due to differences in clinical characteristics is not reflected in pooled effect sizes. The search strategy and inclusion criteria defined by Evans et al 5 sought to minimize clinical heterogeneity, but residual clinical heterogeneity is inevitable in meta-analyses and often cannot be adjusted for. 9 To illustrate, Evans et al 5 highlighted that reporting on the foreign-born participant proportions was incomplete across studies, thereby excluding this clinical heterogeneity domain from formal moderation analyses.…”

“…The search strategy and inclusion criteria defined by Evans et al 5 sought to minimize clinical heterogeneity, but residual clinical heterogeneity is inevitable in meta-analyses and often cannot be adjusted for. 9 To illustrate, Evans et al 5 highlighted that reporting on the foreign-born participant proportions was incomplete across studies, thereby excluding this clinical heterogeneity domain from formal moderation analyses. Therefore, developers of Latino SRH interventions should interpret meta-analysis findings with attention to clinical heterogeneity in domains that may moderate intervention effectiveness.…”

“…In this issue of Pediatrics, Evans et al 5 systematically reviewed and metaanalyzed the empirical evidence regarding the effectiveness of SRH interventions for Latino adolescents. Their findings suggested small to moderate but significant mean pooled intervention effects across all examined behavioral outcomes (abstinence, condom use, and number of sex partners).…”