A Sex Risk Reduction Text-Message Program for Young Adult Females Discharged From the Emergency Department

doi:10.1016/j.jadohealth.2013.04.006

Journal of Adolescent Health

Volume 53, Issue 3, September 2013, Pages 387-393

Parts of this study were presented as a poster at the 35th Annual Research Society on Alcoholism in San Francisco, June 23, 2012.

https://doi.org/10.1016/j.jadohealth.2013.04.006 Get rights and content

Abstract

Purpose

To pilot test a text message (SMS) sex risk reduction program among at-risk young adult female patients discharged from an emergency department (ED).

Methods

A convenience sample of 52 female patients with hazardous drinking behavior and recent risky sexual encounters were recruited from an urban ED and randomized to the SMS program (n = 23) or a control group (n = 29). All participants completed a web-based questionnaire in the ED and at 3-month follow-up. For 12 weeks, SMS participants were asked to report whether they had a risky sexual encounter in the past week, received theory-based feedback, and were asked if they were willing set a goal to refrain from having another risky encounter.

Results

Thirty-nine percent of SMS participants completed all weeks of SMS reports, and noncompletion increasing from 12% on week 1 to a 33% by week 12. Three-month follow-up was completed in 56% of participants. In the intervention group, there was an increase in the proportion with condom use with last vaginal sex from 20% (95% CI 4%–48%) to 53% (95% CI 27%–79%) and an increase in always condom use over the past 28 days from 0% (95% CI 0%–22%) to 33% (95% CI 12%–62%). These changes were not statistically different from control participants.

Conclusions

SMS programs may be useful to reduce risk for sexually transmitted diseases among at-risk young adults being discharged from the ED. Future trials should examine ways to improve adherence to SMS dialog over time and measure objective outcomes in a larger sample.

Section snippets

Study design

In this pilot study, a randomized control group design was used to assess whether an SMS program would decrease sex risk behaviors at 3-month follow-up relative to a no-intervention control group. Recruitment occurred between September 2011 and April 2012 at a single urban level I trauma and tertiary care hospital ED in western Pennsylvania. The study was approved by the Institutional Review Board at the University of Pittsburgh. The trial was registered with ClinicalTrials.gov (number NCT01548183

Results

A total of 392 young adult female ED patients were approached over a period of 6 months, with patient flow exhibited in Figure 1. Forty-two percent of young adult female ED patients screened positive for both hazardous drinking and risky sex behaviors, among whom 51% were excluded from participation and 15% were not interested in trial participation. Demographic characteristics and sex risk behavior characteristics of the sample are shown in Table 1 for the 52 participants enrolled in the

Discussion

This study demonstrated that an automated, interactive SMS program may be useful to track sex risk behavior over time, deliver sex risk behavioral support messages, and promote goal setting to reduce risk for sexually transmitted diseases among at-risk young adults being discharged from the ED. Although we were not able to show a statistically significant difference in the sex risk outcomes between control and intervention group at 3 months, we were able to show relative positive changes in

Acknowledgments

The authors thank Jack Doman in the Office of Academic Computing at the Western Psychiatric Institute at the University of Pittsburgh for all computer programming support. B.S. is supported by an EMF-Century Council grant, A.A. is supported by the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program, and D.B.C. is supported by R01AA016482 and P50DA05605.

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This prospective cohort study trained advanced practice providers in the EDs of two pediatric urban academic medical centers to deliver brief contraception counseling. A convenience sample of patients enrolled from 2019 to 2021 included females aged 15–18 not pregnant/desiring pregnancy and/or using hormonal contraception/an intrauterine device. Participants completed surveys to assess demographics and intention to initiate contraception (yes/no). Sessions were audiotaped and reviewed for fidelity. We ascertained contraception initiation and follow-up visit completion via medical record review and participant survey at 8 weeks.
Twenty-seven advanced practice providers were trained, and 96 adolescents were counseled/responded to surveys (mean age 16.7 years; 19% non-Hispanic White, 56% non-Hispanic Black; 18% Hispanic). Mean counseling duration was 12 minutes and >90% of reviewed sessions maintained fidelity to content/style. Most participants (61%) reported intention to initiate contraception, and these participants were older and more likely to report prior contraceptive use, compared to those without intention. One-third (33%) initiated contraception in the ED or after the follow-up visit.
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The frequency ranged from one-time to monthly interventions, and weekly intervention was most frequently used. Eleven studies reported outcomes with regard to the use of contraception (Berenson and Rahman, 2012; Castaño et al., 2012; Gilliam et al., 2014; Hebert et al., 2018; Lim et al., 2012; McCarthy et al., 2018; McCarthy et al., 2019; Nielsen et al., 2019; Rokicki et al., 2017; Suffoletto et al., 2013; Trent et al., 2019). Because Berenson and Rahman (2012) used two contraceptive methods as the outcome variable, we included two results of Berenson and Rahman (2012) in this meta-analysis.
Sexual and reproductive health of young people is an international concern with the increasing interest in healthy pregnancy and childbirth. mHealth interventions involve the use of mobile technologies for health support, have wide applications in clinical nursing practice, and play an increasingly important role in disseminating sexual and reproductive health-related information in emerging adulthood. However, there is a lack of evidence on the effects of mHealth intervention programs.
This meta-analysis systematically assessed the effects of mHealth interventions on contraceptive use and pregnancy occurrence in emerging adulthood to identify the characteristics of a successful mHealth intervention program.
We conducted a systematic review and meta-analysis of randomized controlled trials.
Four central electronic databases (PubMed, Embase, CINAHL complete, and the Cochrane Library) were searched for relevant articles published from inception to May 2020.
Data extraction and quality appraisal were performed independently by two reviewers. Eleven papers on the effects of mHealth interventions on sexual and reproductive health in emerging adulthood were selected. The included studies were assessed for the risk of bias with the Risk of Bias 2 (RoB 2) tool. Overall and subgroup meta-analyses were conducted using STATA 16.0. Heterogeneity within studies was calculated using I².
We tested the effect of mHealth interventions on contraceptive use and pregnancy occurrence to identify the impact of sexual and reproductive health. mHealth interventions improved the use of contraception (OR 1.21; 95% CI: 1.02–1.43, I² = 20.7%; p = 0.234) although the effect on pregnancy occurrence was not significant (OR 0.80, 95% CI: 0.61–1.05, I² = 0.0%, p = 0.950). In subgroup analysis, mHealth interventions especially improved oral contraceptive use (OR 1.43, 95% CI: 1.15–1.77, I² = 0.0%, p = 0.784). Regarding the communication type, two-way communication showed statistically significant results with the mHealth intervention in the experimental group (OR 1.28, 95% CI: 1.06–1.54, I² = 0.0%, p = 0.872).
This meta-analysis found a positive effect of mHealth intervention on contraception, whereas the impact on pregnancy occurrences was limited. We also confirmed the factors underlying effective mHealth interventions from the results of our review. Our findings demonstrate that mHealth interventions may be suggested as a useful strategy to promote sexual and reproductive health in emerging adulthood.
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Female sex workers in low-income and middle-income countries face high risks of unintended pregnancy. We developed a 12-month, multifaceted short messaging service intervention (WHISPER) for female sex workers in Kenya who had the potential to become pregnant, to improve their contraceptive knowledge and behaviours. The aim of this study was to assess the effectiveness of the intervention to reduce the incidence of unintended pregnancy among sex workers in Kenya compared with an equal-attention control group receiving nutrition-focused messages (SHOUT).
Our two-arm, cluster-randomised controlled trial was done in sex-work venues in two subcounties of Mombasa, Kenya (Kisauni and Changamwe). Participants, aged 16–34 years, not pregnant or planning pregnancy, able to read text messages in English, residing in the study area, and who had a personal mobile phone with one of two phone networks, were recruited from 93 randomly selected sex-work venues (clusters). Random cluster allocation (1:1) to the intervention or control group was concealed from participants and researchers until the intervention started. Both groups received text messages in English delivered two to three times per week for 12 months (137 messages in total), as well as additional on-demand messages. Message content in the intervention group focused on promotion of contraception, particularly long-acting reversible contraception and dual method contraceptive use; message content in the control group focused on promotion of nutritional knowledge and practices, including food safety, preparation, and purchasing. The primary endpoint, analysed in all participants who were randomly assigned and attended at least one follow-up visit, compared unintended pregnancy incidence between groups using discrete-time survival analysis at 6 and 12 months. This trial is registered with Australian New Zealand Clinical Trials Registry, ACTRN12616000852459, and is closed to new participants.
Between Sept 14, 2016, and May 16, 2017, 1728 individuals were approached to take part in the study. Of these, 1155 were eligible for full screening, 1035 were screened, and 882 were eligible, enrolled, and randomly assigned (451 participants from 47 venues in the intervention group; 431 participants from 46 venues in the control group). 401 participants from the intervention group and 385 participants from the control group were included in the primary analysis. Incidence of unintended pregnancy was 15·5 per 100 person-years in the intervention group and 14·7 per 100 person-years in the control group (hazard ratio 0·98, 95% CI 0·69–1·39).
The intervention had no measurable effect on unintended pregnancy incidence. Mobile health interventions, even when acceptable and rigorously designed, are unlikely to have a sufficient effect on behaviour among female sex workers to change pregnancy incidence when used in isolation.
National Health and Medical Research Council of Australia.
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In this chapter, we follow a young Latina woman named Lourdes as she attempts to balance her own aspirations for a career with her own growth as a young adult in a new sexual relationship. Neither she nor her partner know enough about contraception to take steps they think are important to avoid having children right now. Her solution is one that is growing increasingly common—she combines participation in a face-to-face youth development program with a text-messaging program to carefully consider and choose the contraceptive option that is most appropriate for her.
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To assess the acceptability and feasibility of S2S, a newly adapted behavior intervention to address high-risk sexual behavior.
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View all citing articles on Scopus

: Declaration of conflicts: The authors report no conflicts of interest.

View full text

Original articleA Sex Risk Reduction Text-Message Program for Young Adult Females Discharged From the Emergency Department

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Study design

Results

Discussion

Acknowledgments

J Adolesc Health

J Assoc Nurses AIDS Care

J Adolesc

J Adolesc Health

Behav Ther

Sexually transmitted diseases among American youth: Incidence and prevalence estimates, 2000

Perspect Sex Reprod Health

Sexually transmitted disease surveillance 2010

Ambulatory care among young adults in the United States

Ann Intern Med

Uninsurance and health care access among young adults in the United States

Pediatrics

Dependence on emergency care among young adults in the United States

J Gen Intern Med

Research priorities for human immunodeficiency virus and sexually transmitted infections surveillance, screening, and intervention in emergency departments: Consensus-based recommendations

Acad Emerg Med

Emergency care of urban women with sexually transmitted infections: Time to address deficiencies

Sex Transm Dis

Provider-delivered sexually transmitted infection prevention counseling in the emergency department setting: Another nail in the coffin?

Sex Transm Dis

A randomized controlled trial of Sweet Talk, a text-messaging system to support young people with diabetes

Diabet Med

The use of text messaging to improve asthma control: A pilot study using the mobile phone short messaging service (SMS)

J Telemed Telecare

Do u smoke after txt? Results of a randomised trial of smoking cessation using mobile phone text messaging

Tob Control

Text-message-based drinking assessments and brief interventions for young adults discharged from the emergency department

Alcohol Clin Exp Res

Short message service reminder intervention doubles sexually transmitted infection/HIV re-testing rates among men who have sex with men

Sex Transm Infect

Original article
A Sex Risk Reduction Text-Message Program for Young Adult Females Discharged From the Emergency Department