Effects of an Internet-Based Intervention for HIV Prevention: The Youthnet Trials
Youth use the Internet and computers in unprecedented numbers. We have yet to identify interventions that can reach and retain large numbers of diverse youth online and demonstrate HIV prevention efficacy. We tested a single session condom promotion Internet intervention for 18–24 year olds in two RCTs: one sample recruited online and one recruited in clinics. All study elements were carried out on the Internet. Using repeated measures structural equation models we analyzed change in proportion of sex acts protected by condoms (PPA) over time. Among sexually active youth in the Internet sample, persons exposed to the intervention had very slight increases in condom norms, and this was the only factor impacting PPA. We saw no intervention effects in the clinic sample. Internet-based interventions need to be more intensive to see greater effects. We need to do more to reach high risk youth online and keep their attention for multiple sessions.
KeywordsInternet and HIV prevention Randomized controlled trial HIV prevention and youth Technology-based HIV prevention
We gratefully acknowledge the partnership of the Denver Public Health Department and Planned Parenthood of the Rocky Mountains for their collaboration in recruitment of the clinic sample. We also acknowledge the National Institute of Mental Health and our Project Officer, Dr. Willo Pequegnat, for their support of this research, NIH/NIMH -RO1MH063690 and R01MH063690-S.
- Babbie, E. (2003). The practice of social research (9th ed.). Belmont, CA: Wadsworth Publishing.Google Scholar
- Bandura, A. (1986). Social foundations of thought and action. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
- Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W.H. Freeman.Google Scholar
- Benotsch, E. G., Kalichman, S. C., & Weinhardt, L. S. (2004). HIV-AIDS patients’ evaluation of health information on the Internet: The digital divide and vulnerability to fraudulent claims. Journal of Consulting and Clinical Psychology, 72, 1004–1011. doi: 10.1037/0022-006X.72.6.1004.PubMedCrossRefGoogle Scholar
- Bowen, A. M., Williams, M. L., Clayton, S., & Daniel, C. M. (2007b, July). Efficacy of Internet delivered HIV risk reduction for rural who have sex with men in the USA. Presented to the AIDS Impact Conference, Marseilles, France.Google Scholar
- Bull, S. S., Pratte, K., & McFarlane, M. (2008b). Measures of condom attitudes, norms and self-efficacy in two computer-based studies. Journal of Nursing Measurement, under review.Google Scholar
- Centers for Disease Control and Prevention. (2008). HIV/AIDS surveillance report (Rep. No. 18). Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.Google Scholar
- Elford, J., Bolding, G., Davis, M., Sherr, L., & Hart, G. (2004). Web-based behavioral surveillance among men who have sex with men: A comparison of online and offline samples in London, UK. Journal of Acquired Immune Deficiency Syndromes, 35, 421–426. doi: 10.1097/00126334-200404010-00012.PubMedCrossRefGoogle Scholar
- Glasgow, R. E., Bull, S. S., Gillette, C., Klesges, L. M., & Dzewaltowski, D. A. (2002). Behavior change intervention research in health care settings: A review of recent reports, with emphasis on external validity. American Journal of Preventive Medicine, 23, 62–68. doi: 10.1016/S0749-3797(02)00437-3.PubMedCrossRefGoogle Scholar
- Glasgow, R. E., Klesges, L. M., Dzewaltowski, D. A., Bull, S. S., & Estabrooks, P. (2004). The future of health behavior change research: What is needed to improve translation of research into health promotion practice? Annals of Behavioral Medicine, 27, 3–12. doi: 10.1207/s15324796abm2701_2.PubMedCrossRefGoogle Scholar
- Glasgow, R. E., McKay, H. G., Piette, J. D., & Reynolds, K. D. (2001). The RE-AIM framework for evaluating interventions: What can it tell us about approaches to chronic illness management? Patient Education and Counseling, 44, 119–127. doi: 10.1016/S0738-3991(00)00186-5.PubMedCrossRefGoogle Scholar
- Glasgow, R. E., Nelson, C. C., Kearney, K. A., Reid, R., Ritzwoller, D. P., Strecher, V. J., et al. (2007). Reach, engagement and retention in an Internet-based weight loss program in a multi-site randomized controlled trial. Journal of Medical Internet Research, 9, e11. doi: 10.2196/jmir.9.2.e11.PubMedCrossRefGoogle Scholar
- Gustafson, D. H., Hawkins, R. P., Boberg, E. W., McTavish, F., Owens, B., Wise, M., et al. (2002). CHESS: 10 years of research and development in consumer health informatics for broad populations, including the underserved. International Journal of Medical Informatics, 65, 169–177. doi: 10.1016/S1386-5056(02)00048-5.PubMedCrossRefGoogle Scholar
- Kreuter, M. W., Farrell, D., Olevitch, L., & Brennan, L. (2000). Tailoring health messages: Customizing communication with computer technology. Mahweh, NJ: Lawrence Erlbaum.Google Scholar
- Lenhart, A., & Horrigan, J. B. (2003). Re-visualizing the digital divide as a digital spectrum. IT and Society, 1, 23–39.Google Scholar
- Linke, S., Murray, E., Butler, C., & Wallace, P. (2007). Internet-based interactive health intervention for the promotion of sensible drinking: Patterns of use and potential impact on members of the general public. Journal of Medical Internet Research, 9, e10. doi: 10.2196/jmir.9.2.e10.PubMedCrossRefGoogle Scholar
- Madden, M. (2006). Young and wired: How today’s young tech elite will influence the libraries of tomorrow. Presented to the 2006 Tampa Bay Library Consortium Meetings, Tampa, FL.Google Scholar
- Norman, G. Z., Zabinski, M. F., Adams, M. A., Rosenberg, D. E., Yaroch, A. L., & Atienza, A. A. (2007). A review of eHealth interventions for physical activity and dietary behavior change. American Journal of Preventive Medicine, 33, 336–345. doi: 10.1016/j.amepre.2007.05.007.PubMedCrossRefGoogle Scholar
- Pequegnat, W., Rosser, B. R., Bowen, A. M., Bull, S. S., Diclemente, R. J., Bockting, W. O., et al. (2007). Conducting Internet-based HIV/STD prevention survey research: Considerations in design and evaluation. AIDS and Behavior, 11, 505–521. doi: 10.1007/s10461-006-9172-9.PubMedCrossRefGoogle Scholar
- Pew Internet and American Life Project (2006). Latest Trends: February 15–April 6, 2006. Retrieved from http://www.pewinternet.org/.
- Pew Internet and American Life Report (2000). The online health care revolution: How the Web helps Americans take better care of themselves. Retrieved from http://www.pewinternet.org/.
- Rakowski, W., Lipkus, I. M., Clark, M. A., Rimer, B. K., Ehrich, B., Lyna, P., et al. (2003). Reminder letter, tailored stepped-care, and self-choice comparison for repeat mammography. American Journal of Preventive Medicine, 25, 308–314. doi: 10.1016/S0749-3797(03)00215-0.PubMedCrossRefGoogle Scholar
- Rhodes, S. D., Diclemente, R. J., Cecil, H., Hergenrather, K. C., & Yee, L. J. (2002). Risk among men who have sex with men in the United States: A comparison of an Internet sample and a conventional outreach sample. AIDS Education and Prevention, 14, 41–50. doi: 10.1521/aeap.126.96.36.19934.PubMedCrossRefGoogle Scholar
- Rideout, V. (2001). Generation Rx.com: How young people use the Internet for health information. Menlo Park, CA: Henry J. Kaiser Family Foundation.Google Scholar
- Roberts, D. F., Foehr, U. G., & Rideout, V. (2005). Generation M: Media in the lives of 8–18 year olds. San Francisco: Kaiser Family Foundation.Google Scholar
- Verheijden, M. J., Jans, M. P., Hildebrandt, V. H., & Hopman-Rock, M. (2007). Rates and determinants of repeated participation in a web-based behavior change program for healthy body weight and healthy lifestyle. Journal of Medical Internet Research, 9, e1. doi: 10.2196/jmir.9.1.e1.PubMedCrossRefGoogle Scholar
- Winzelberg, A. J., Eldredge, K. L., Eppstein, D., Wilfley, D., Dasmahapatra, R., Dev, P., et al. (2000). Effectiveness of an Internet-based program for reducing risk factors for eating disorders. Journal of Consulting and Clinical Psychology, 68, 346–350. doi: 10.1037/0022-006X.68.2.346.PubMedCrossRefGoogle Scholar