Purpose: Sexually transmitted infections (STIs) and unintended pregnancy rates are disproportionately high in adolescent and young adult populations. We need effective, scalable strategies to promote sexual health and prevent STIs and unintended pregnancies that reach young people in real‐world settings. Interactive computer‐based interventions (ICBI) are promising tools to meet these goals. The purpose of this study was to test the feasibility and acceptability of an interactive computer‐based intervention for sexual health; assess the effectiveness of the intervention in reducing unprotected sex; and pilot test biomarker outcomes of STIs and unintended pregnancy. Methods: The study is a pilot randomized controlled trial of males and females (14‐24 years) seeking care in a public health STD Clinic and reporting at least one episode of unprotected vaginal sex in the last 2 months. Randomization was computer generated and stratified by gender, age group, and visit type. Investigators and participants were blinded to allocation to Intervention or Control Group. Participants entered their sexual history via Computer Assisted Self‐Interview and provided urine samples for Chlamydia, gonorrhea and pregnancy (females) testing. The Intervention group completed an interactive‐computer program and received personal feedback from a Physician Avatar about their protective and risky sexual behaviors; were offered video modules targeting sexual health knowledge and skills; and identified a goal behavior to change. At 3‐month follow‐up participants reported their interim sexual history, underwent follow‐up urine testing. The primary outcome was unprotected vaginal sex (without condoms) in the last 2 months. Secondary outcomes included unprotected vaginal sex (without other contraception), number of sexual partners, incident STIs and unintended pregnancy. Poisson and logistic regression were used to assess for differences in treatment arms. Results: Two hundred and forty‐two of 272 participants completed the study yielding a follow‐up rate of 89%. Average age was 21 years; with 65% female; 37% White; 34% Black; 10% Asian; 7% Hispanic; and 2% Native American. At the baseline visit 75% (99/130) reported the computer intervention was Very or Extremely Helpful. Statistical models were adjusted for baseline differences of self‐reported history of STI and ever transactional sex. At 3‐month follow‐up the Intervention group reported 33% lower rate of unprotected vaginal sex (without condoms) [IRR = 0.67, 95% CI: 0.44‐1.01]; 20% fewer partners [IRR = 0.80, 95% CI: 0.61‐1.05]; and 48% fewer STI infections [IRR = 0.52, 95% CI: 0.24‐1.13]. Intervention females reported lower rate of unprotected vaginal sex (without other contraception) [IRR = 0.78, 95% CI: 0.46‐1.32] and half asmany unintended pregnancies (n=5) versus Control females (n = 10) [IRR = 0.51, 95% CI: 0.16‐1.6]. In a subgroup analysis, Intervention females showed a significant reduction in unprotected vaginal sex (without condoms). Conclusions: The interactive computer‐based intervention for sexual health was feasible to execute and was acceptable to the study population. There was a trend in the effectiveness of the intervention in reducing unprotected vaginal sex, number of partners, incident STI and unintended pregnancy at 3‐month follow‐up although results did not reach statistical significance. The intervention may be more effective in females than males.
Shafii, T., Benson, S. K., Morrison, D. M., Hughes, J. P., Golden, M. R., & Holmes, K. K. (2014). Results from eKISS (electronic KIOSK Intervention for Safer-Sex): A Pilot Randomized Controlled Trial to Test an Interactive Computer-Based Intervention for Sexual Health in Adolescents and Young Adults. Journal of Adolescent Health, 54(2), S10. https://doi.org/10.1016/j.jadohealth.2013.10.036