The Onset of STI Diagnosis Through Age 30: Results from the Seattle Social Development Project Intervention

Abstract

Objectives To examine (1) whether onset of sexually transmitted infections (STI) through age 30 differed for youths who received a social developmental intervention during elementary grades compared to those in the control condition; (2) potential social-developmental mediators of this intervention; and (3) the extent to which these results differed by ethnicity. Design A nonrandomized controlled trial followed participants to age 30, 18 years after the intervention ended. Three intervention conditions were compared: a full intervention group, assigned to intervention in grades 1 through 6; a late intervention group, assigned to intervention in grades 5 and 6 only; and a no-treatment control group. Setting Eighteen public elementary schools serving diverse neighborhoods including high-crime neighborhoods of Seattle. Analysis Sample 608 participants in three intervention conditions interviewed from age 10 through 30. Interventions Teacher training in classroom instruction and management, child social and emotional skill development, and parent workshops. Outcome Cumulative onset of participant report of STI diagnosis. Intervention Mechanisms Adolescent family environment, bonding to school, antisocial peer affiliation, early sex initiation, alcohol use, cigarette use, and marijuana use were tested. Analysis and Results Complementary log-log survival analysis found significantly lower odds of STI onset for the full intervention compared to the control condition. The lowering of STI onset risk was significantly greater for African Americans and Asian Americans compared to European Americans. Family environment, school bonding and delayed initiation of sexual behavior mediated the relationship between treatment and STI hazard. Conclusions A universal intervention for urban elementary school children, focused on classroom management and instruction, children’s social competence, and parenting practices may reduce the onset of STI through age 30, especially for African Americans.

Unleashing the Power of Prevention

“…For example, the Seattle Social Development Project used a school-and family-focused universal preventive intervention called Raising Healthy Children in elementary schools serving high-crime Seattle neighborhoods. When compared with controls, children in intervention classrooms delayed sexual initiation and had fewer sexual partners during adolescence (Hawkins et al, 1999), experienced significantly lower rates of teen pregnancy and childbirth among young women under 21 , and reported significantly lower rates of STIs through age 30 (Hill et al, 2014), eliminating STI disparities between African Americans and European Americans.…”

“…They found that 44 universal and selective prevention programs were effective in reducing several problems at once and that effect sizes were comparable to those produced by interventions targeting only a single behavioral health problem. It is important to note that young people exposed to the highest levels of risk-children and adolescents who are often disproportionately low-income and/or youth of color-often benefit most from preventive interventions (Campbell et al, 2002;Clark et al, 2005;Dodge et al, 2015;Hill et al, 2014).…”

Toward the Development of Preventive Interventions to Reduce HRSB, HIV/AIDS, and Multiple Problem Behaviors

“…Despite these notable differences and without any direct focus on sexual behavior, four of these long-term studies found significant (direct or indirect) reductions in HRSB for some or all of participants (Caruthers et al 2014;Hill et al 2014;Kellam et al 2014;Spoth et al 2014). Although the remaining two studies did not find intervention effects, they did provide etiologic data supporting the general thesis of this Supplemental Issue (Conduct Problems Prevention Research Group 2014; Skinner et al 2014).…”

“…One paper focuses on a school-based intervention targeting early aggressive behavior in children (Kellam et al 2014). Two papers focus on universal interventions targeting drug use and associated risk factors using either a combined school-and family-based intervention implemented during childhood (Hill et al 2014) or a familybased intervention implemented during early adolescence (Spoth et al 2014). One paper focuses on universal and targeted interventions implemented during childhood to address conduct problems using both school-and family-based approaches (Conduct Problems Prevention Research Group 2014).…”

The dynamic epigenome and its implications for behavioral interventions: a role for epigenetics to inform disorder prevention and health promotion

“…How do we use epigenetic concepts to design interventions? Prevention research has shown that early life preventive interventions can have long-lasting effects on the children into adulthood [37][38][39][40]. Could epigenetic markers be used to follow up these interventions?…”