Skip to main content

Advertisement

SpringerLink
Log in

Effectiveness of the SMART Sex Ed program among 13–18 year old English and Spanish speaking adolescent men who have sex with men

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Adolescent men who have sex with men (AMSM) have a high HIV incidence and low utilization of testing and prevention services. However, very few HIV prevention programs exist that focus on the unique sexual health needs of AMSM. SMART is a stepped care package of eHealth interventions that comprehensively address the sexual and HIV prevention needs of AMSM. This study examines the impact of the first step of SMART, “SMART Sex Ed,” on 13- to 18-year-old AMSM (n = 983) from baseline to three-month follow-up across 18 separate outcomes measuring HIV prevention attitudes, skills, and behaviors. We observed significant change from baseline to three-month post-intervention in nine HIV-related outcomes (e.g., receipt of HIV and STI test, HIV knowledge), as well as largely consistent effects across demographic subgroups (e.g., race, age, rural, low SES). Analyses observed no effects on condom use behaviors. SMART Sex Ed shows promise as an effective sexual health education program for diverse AMSM.

Resumen

Los adolescentes hombres que tienen sexo con otros hombres (AHSH) experimentan alta incidencia del VIH y baja utilización de servicios de prueba y prevención. Sin embargo, existen muy pocos programas de prevención del VIH enfocados en las necesidades particulares para la salud sexual de AHSH. SMART es un paquete de intervenciones de cuidado escalonado que usa plataformas electrónicas (eHealth) y que atiende de forma integrada las necesidades de salud sexual y prevención del VIH de AHSH. Este estudio examina el impacto de la primera etapa de SMART, llamada “SMART Sex Ed”, entre AHSH (n = 983) entre las edades de 13 a 18 años e integra datos desde el reclutamiento con seguimiento cada 3 meses. Se recopilaron datos de 18 indicadores de actitudes, destrezas y prácticas de prevención del VIH (Ej. Historial de pruebas de VIH o ITS; conocimiento sobre VIH), así como los efectos en diferentes grupos demográficos (Ej. Raza, edad, área rural, y bajo nivel socioeconómico). Los análisis realizados demuestran que las características demográficas no tienen efecto en las prácticas de uso de condón. SMART Sex Ed es una intervención prometedora para educación sexual efectiva para AHSH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Availability of data and material (data transparency)

Data used for these analyses are available upon request and approval by the corresponding author.

Code availability (software application or custom code)

Custom coded web application developed by internal Research Application Design and Development (RADD) team at the Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH).

References

  1. Mustanski B, Ryan DT, Newcomb ME, D’Aquila RT, Matson M. Very High HIV Incidence and Associated Risk Factors in a Longitudinal Cohort Study of Diverse Adolescent and Young Adult Men Who Have Sex with Men and Transgender Women. AIDS Behav. 2019;24(6):1966–75.

    Article  Google Scholar 

  2. Balaji AB, An Q, Smith JC, Newcomb ME, Mustanski B, Prachand NG, et al. High human immunodeficiency virus incidence and prevalence and associated factors among adolescent sexual minority males-3 cities, 2015. Clin Infect Dis. 2018;66(6):936–44.

    Article  Google Scholar 

  3. Mustanski B, Moskowitz DA, Moran KO, Rendina HJ, Newcomb ME, Macapagal K. Factors Associated With HIV Testing in Teenage Men Who Have Sex With Men. Pediatrics. 2020;145(3).

  4. Sharma A, Wang LY, Dunville R, Valencia RK, Rosenberg ES, Sullivan PS. HIV and sexually transmitted disease testing behavior among adolescent sexual minority males: Analysis of pooled Youth Risk Behavior Survey data, 2005–2013. LGBT Health. 2017;4(2):130–40.

    Article  Google Scholar 

  5. Agnew-Brune CB, Balaji AB, Mustanski B, Newcomb ME, Prachand N, Braunstein SL, et al. Mental health, social support, and HIV-related sexual risk behaviors among HIV-negative adolescent sexual minority males: three U.S. cities, 2015. AIDS Behav. 2019;23(12):3419–26.

    Article  Google Scholar 

  6. Boyer CB, Greenberg L, Korelitz J, Harper GW, Stewart-Campbell R, Straub D, et al. Sexual Partner Characteristics, Relationship Type, and HIV Risk Among a Community Venue-based Sample of Urban Adolescent and Young Adult Men Who Have Sex with Men. Youth Soc. 2019;51(2):219–46.

    Article  Google Scholar 

  7. Morris E, Balaji AB, Trujillo L, Rasberry CN, Mustanski B, Newcomb ME, et al. Family Factors and HIV-Related Risk Behaviors Among Adolescent Sexual Minority Males in Three United States Cities, 2015. LGBT Health. 2020;7(7):367–74.

    Article  Google Scholar 

  8. Olakunde BO, Pharr JR, Adeyinka DA, Danquah P. HIV-related risk behaviors and testing among adolescent gay and bisexual boys in the United States. AIDS. 2019;33(13):2107–9.

    Article  Google Scholar 

  9. Garofalo R, Hotton AL, Kuhns LM, Gratzer B, Mustanski B. Incidence of HIV infection and sexually transmitted infections and related risk factors among very young men who have sex with men. J Acquir Immune Defic Syndr. 2016;72(1):79–86.

    Article  Google Scholar 

  10. Newcomb ME, Moran K, Li DH, Mustanski B. Demographic, Regional, and Political Influences on the Sexual Health Care Experiences of Adolescent Sexual Minority Men. LGBT Health. 2020;7(1):28–36.

    Article  Google Scholar 

  11. Hosek S, Pettifor A. HIV Prevention Interventions for Adolescents. Curr HIV/AIDS Rep. 2019;16(1):120–8.

    Article  Google Scholar 

  12. Hidalgo MA, Kuhns LM, Hotton AL, Johnson AK, Mustanski B, Garofalo R. The MyPEEPS randomized controlled trial: a pilot of preliminary efficacy, feasibility, and acceptability of a group-level, HIV risk reduction intervention for young men who have sex with men. Arch Sex Behav. 2015;44(2):475–85.

    Article  Google Scholar 

  13. Ybarra ML, Prescott TL, Phillips GL 2nd, Bull SS, Parsons JT, Mustanski B. Pilot RCT results of an mHealth HIV prevention program for sexual minority male adolescents. Pediatrics. 2017;140(1).

  14. Nelson KM, Perry NS, Stout CD, Dunsiger SI, Carey MP. The Young Men & Media Study: A pilot randomized controlled trial of a community-informed, online HIV prevention intervention for 14-17-year-old sexual minority males. AIDS and Behavior. 2021;In Press.

  15. Centers for Disease Control and Prevention. Compendium of evidence-based interventions and best practices for HIV prevention Atlanta, GA: Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and. Prevention TB, Centers for Disease Control and Prevention; 2021 [Available from: https://www.cdc.gov/hiv/research/interventionresearch/compendium/index.html.

  16. Meadows E. Sexual health equity in schools: Inclusive sexuality and relationship education for gender and sexual minority students. Am J Sexuality Educ. 2018;13(3):297–309.

    Article  Google Scholar 

  17. Hall WJ, Jones BLH, Witkemper KD, Collins TL, Rodgers GK. State Policy on School-based Sex Education: A Content Analysis Focused on Sexual Behaviors, Relationships, and Identities. Am J Health Behav. 2019;43(3):506–19.

    Article  Google Scholar 

  18. Newcomb ME, LaSala MC, Bouris A, Mustanski B, Prado G, Schrager SM, et al. The influence of families on LGBTQ youth health: A call to action for innovation in research and intervention development. LGBT Health. 2019;6(4):139–45.

    Article  Google Scholar 

  19. Mitchell KJ, Ybarra ML, Korchmaros JD, Kosciw JG. Accessing sexual health information online: Use, motivations and consequences for youth with different sexual orientations. Health Educ Res. 2014;29(1):147–57.

    Article  Google Scholar 

  20. Magee JC, Bigelow L, Dehaan S, Mustanski BS. Sexual health information seeking online: A mixed-methods study among lesbian, gay, bisexual, and transgender young people. Health Educ behavior: official publication Soc Public Health Educ. 2012;39:276–89.

    Article  Google Scholar 

  21. Noar SM, Pierce LB, Black HG. Can computer-mediated interventions change theoretical mediators of safer sex? A meta-analysis. Hum Commun Res. 2010;36(3):261–97.

    Article  Google Scholar 

  22. Nelson KM, Perry NS, Horvath KJ, Smith LR. A systematic review of mHealth interventions for HIV prevention and treatment among gay, bisexual, and other men who have sex with men. Transl Behav Med. 2020;10(5):1211–20.

    Article  Google Scholar 

  23. Schnall R, Travers J, Rojas M, Carballo-Diéguez A. eHealth interventions for HIV prevention in high-risk men who have sex with men: a systematic review. 2014;16(5):e134.

  24. Pew Research Center. Teens, social media & technology 2018. Pew Research Center; 2018 2018-03-31. Contract No.: 2019-04-10.

  25. DeHaan S, Kuper LE, Magee JC, Bigelow L, Mustanski BS. The interplay between online and offline explorations of identity, relationships, and sex: a mixed-methods study with LGBT youth. J Sex Res. 2013;50(5):421–34.

    Article  Google Scholar 

  26. Lefebvre C. Integrating cell phones and mobile technologies into public health practice: a social marketing perspective. Health Promot Pract. 2009;10(4):490–4.

    Article  Google Scholar 

  27. Mustanski B, Moskowitz DA, Moran KO, Newcomb ME, Macapagal K, Rodriguez-Diaz C, et al. Evaluation of a Stepped-Care eHealth HIV Prevention Program for Diverse Adolescent Men Who Have Sex With Men: Protocol for a Hybrid Type 1 Effectiveness Implementation Trial of SMART. JMIR Res Protoc. 2020;9(8):e19701.

    Article  Google Scholar 

  28. Murphy SA. An experimental design for the development of adaptive treatment strategies. Stat Med. 2005;24(10):1455–81.

    Article  CAS  Google Scholar 

  29. Mustanski B, Greene GJ, Ryan D, Whitton SW. Feasibility, acceptability, and initial efficacy of an online sexual health promotion program for LGBT youth: The Queer Sex Ed intervention. J Sex Res. 2015;52(2):220–30.

    Article  Google Scholar 

  30. SIECUS. Guidelines for comprehensive sexuality education: Kindergarten-12th grade, third edition. 2004.

  31. Centers for Disease Control and Prevention. Developing a scope and sequence for sexual health education. Atlanta: CDC; 2016.

    Google Scholar 

  32. Mustanski B, Parsons JT, Sullivan PS, Madkins K, Rosenberg E, Swann G. Biomedical and behavioral outcomes of Keep It Up!: An eHealth HIV prevention program RCT. Am J Prev Med. 2018;55(2):151–8.

    Article  Google Scholar 

  33. Mustanski B, Garofalo R, Monahan C, Gratzer B, Andrews R. Feasibility, acceptability, and preliminary efficacy of an online HIV prevention program for diverse young men who have sex with men: The Keep It Up! intervention. AIDS Behav. 2013;17(9):2999–3012.

    Article  Google Scholar 

  34. Parsons JT, Lelutiu-Weinberger C, Botsko M, Golub SA. A randomized controlled trial utilizing motivational interviewing to reduce HIV risk and drug use in young gay and bisexual men. J Consult Clin Psychol. 2014;82(1):9–18.

    Article  Google Scholar 

  35. National Research Council and Institute of Medicine. Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Washington, DC: Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education; 2009.

    Google Scholar 

  36. Fisher JD, Fisher WA. The information-motivation-behavioral skills model. In: DiClemente RJ, Crosby RA, Kegler MC, editors. Emerging theories in health promotion practice and research: Strategies for improving public health. San Francisco: Jossey-Bass; 2002. pp. 40–70.

    Google Scholar 

  37. Fenton KA. Time for change: rethinking and reframing sexual health in the United States. J Sex Med. 2010;7(Suppl 5):250–2.

    Article  Google Scholar 

  38. Harper GW. Sex isn’t that simple: Culture and context in HIV prevention interventions for gay and bisexual male adolescents. Am Psychol. 2007;62(8):803–19.

    Article  Google Scholar 

  39. Wilson BD, Miller RL. Examining strategies for culturally grounded HIV prevention: a review. AIDS Educ Prev. 2003;15(2):184–202.

    Article  Google Scholar 

  40. Resnicow K, DiIorio C, Davis R. Culture and the development of HIV prevention and treatment programs. In: Edgar T, Noar SM, Freimuth VS, editors. Communication perspectives on HIV/AIDS for the 21st century. New York: Lawrence Ealbaum Associates; 2008.

    Google Scholar 

  41. Raj A, Amaro H. Culturally tailoring HIV/AIDS prevention programs: Why, when, and how? In: Kazarian SS, Evans DR, editors. Handbook of cultural health psychology. San Diego: Academic Press; 2001.

    Google Scholar 

  42. Mustanski B. Ethical and regulatory issues with conducting sexuality research with LGBT adolescents: A call to action for a scientifically informed approach. Arch Sex Behav. 2011;40(4):673–86.

    Article  Google Scholar 

  43. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.

    Article  Google Scholar 

  44. Swann G, Newcomb ME, Mustanski B. Validation of the HIV Risk Assessment of Sexual Partnerships (H-RASP): Comparison to a 2-month prospective diary study. Arch Sex Behav. 2018;47(1):121–31.

    Article  Google Scholar 

  45. Kalichman SC, Cherry C, Browne-Sperling F. Effectiveness of a video-based motivational skills-building HIV risk-reduction intervention for inner-city African American men. J Consult Clin Psychol. 1999;67(6):959–66.

    Article  CAS  Google Scholar 

  46. Kalichman SC, Picciano JF, Roffman RA. Motivation to reduce HIV risk behaviors in the context of the Information, Motivation and Behavioral Skills (IMB) model of HIV prevention. J Health Psychol. 2008;13(5):680–9.

    Article  Google Scholar 

  47. Misovich SJ, Fisher WA, Fisher JD. A measure of AIDS prevention information, motivation, behavioral skills, and behavior. In: Davis CYW, Bauserman R et al, editor. Handbook of sexuality-related measures. Thousand Oaks: SAGE; 1998. pp. 328–37.

    Google Scholar 

  48. Janulis P, Newcomb ME, Sullivan P, Mustanski B. Evaluating HIV knowledge questionnaires among men who have sex with men: A multi-study item response theory analysis. Arch Sex Behav. 2018;47(1):107–19.

    Article  Google Scholar 

  49. Catania JA. The health protective communication scale. In: Davis CM, Yarber WL, Bauserman R, Schreer G, Davis SL, editors. Handbook of Sexuality-Related Measures. Thousand Oaks: Sage Publications; 1998. pp. 544–6.

    Google Scholar 

  50. Mustanski B, Ryan DT, Garofalo R. Associations of sexually transmitted infections with condom problems among young men who have sex with men. Sex Transm Dis. 2014;41(7):427–32.

    Article  Google Scholar 

  51. Du Bois SN, Emerson E, Mustanski B. Condom-related problems among a racially diverse sample of young men who have sex with men. AIDS Behav. 2011;15(7):1342–6.

    Article  Google Scholar 

  52. Crosby RA, Sanders SA, Yarber WL, Graham CA, Dodge B. Condom use errors and problems among college men. Sex Transm Dis. 2002;29(9):552–7.

    Article  Google Scholar 

  53. Benjamini Y, Yekutieli D. The control of the false discovery rate in multiple testing under dependency. The Annals of Statistics. 2001;29(4):1165–88.

    Article  Google Scholar 

  54. Van Buuren S, Groothuis-Oudshoorn K. mice: Multivariate imputation by chained equations in R. J Stat Softw. 2011;45:1–67.

    Article  Google Scholar 

  55. Macapagal K, Kraus A, Korpak AK, Jozsa K, Moskowitz DA. PrEP awareness, uptake, barriers, and correlates among adolescents assigned male at birth who have sex with males in the U.S. Arch Sex Behav. 2020;49(1):113–24.

    Article  Google Scholar 

  56. SIECUS. The SIECUS State Profiles: Michigan’s Sex Ed Snapshot 2021 [Available from: https://siecus.org/wp-content/uploads/2020/01/Michigan.pdf.

  57. Hosek S, Henry-Reid L. PrEP and Adolescents: The Role of Providers in Ending the AIDS Epidemic. Pediatrics. 2020;145(1).

  58. Ali F, Kaushik GN, Carr ND, Hayes E, Plax KL. Screening for urethral, rectal and pharyngeal gonorrhea & chlamydia among asymptomatic male adolescents and young men who have sex with men. J Family Med Disease Prev. 2016;2(4):2:046.

    Article  Google Scholar 

  59. Simpson K. Multilevel analysis of associations between socioeconomic status and injury among Canadian adolescents. J Epidemiol Community Health. 2005;59(12) 1072–7. 10.1136/jech.2005.036723

    Google Scholar 

  60. Underwood JM, Brener N, Thornton J, Harris WA, Bryan LN, Shankli SL, Deputy N, Roberts AM, Queen B, Chyen D, Whittle L, Lim C, Yamakawa Y, Leon-Nguyen M, Kilmer G, Smith-Grant J, Demissie Z, Jones SE, Clayton H, Dittus P. Overview and Methods for the Youth Risk Behavior Surveillance System - United States, 2019. MMWR supplements. 2020;69(1), 1–10. https://doi.org/10.15585/mmwr.su6901a1

    Google Scholar 

  61. USDA ERS. Rural-Urban Commuting Area Codes, https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/ (2020).

Download references

Acknowledgements

We would like to thank all of the staff across Northwestern University, University of Puerto Rico, Hunter College of the City University of New York, North Carolina State University and the University of Hawai’i at Hilo for their hard work. We thank Ji-Young Lee for her help with the literature review. Finally, we would like to thank all of the participants in SMART for their time and commitment to the study.

Funding

This research was supported by a grant from the National Institute on Minority Health and Health Disparities to Brian Mustanski (U01 MD011281). The content of this article is solely the responsibility of the authors and does not necessarily reflect the views of the National Institutes of Health or the National Institute on Minority Health and Health Disparities.

Author information

Authors and Affiliations

  1. Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, 60611 |, Chicago, IL, USA

    Brian Mustanski, Rana Saber, Kathryn Macapagal, Maggie Matson, Kevin O. Moran, Andres Carrion & Michael E. Newcomb

  2. Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Brian Mustanski, Rana Saber, Kathryn Macapagal, Maggie Matson, Kevin O. Moran, Andres Carrion & Michael E. Newcomb

  3. Department of Statistics, North Carolina State University, Raleigh, NC, USA

    Eric Laber

  4. Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA

    Carlos Rodrgiuez-Diaz

  5. Department of Public Health Sciences, The University of Chicago, Biological Sciences Division , Chicago, USA

    David A. Moskowitz

Authors
  1. Brian Mustanski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rana Saber
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kathryn Macapagal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maggie Matson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eric Laber
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carlos Rodrgiuez-Diaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kevin O. Moran
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Andres Carrion
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. David A. Moskowitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Michael E. Newcomb
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Experimental design: Brian Mustanski, Michael E. Newcomb, Kathryn Macapagal, Rana Saber, Carlos Rodriguez-Diaz, and David Moskowitz. Writing manuscript: Brian Mustanski, Michael E. Newcomb, Rana Saber, David Moskowitz, Maggie Matson, Carlos Rodriguez-Diaz, and Andres Carrion. Data analysis: Brian Mustanski, Michael E. Newcomb, Kevin Moran, and Eric Labor. Data Interpretation: Brian Mustanski, Michael E. Newcomb, and Eric Laber.

Corresponding author

Correspondence to Brian Mustanski.

Ethics declarations

Conflicts of interest/Competing interests (include appropriate disclosures)

No conflicts of interest to declare.

Ethics approval (include appropriate approvals or waivers)

All participants provided informed consent for their involvement in the project. A waiver of parental permission was awarded by the IRB.

Consent to participate (include appropriate consent statements)

Prospective, eligible participants were routed to an online consent form and capacity-to-consent assessment. In order to complete enrollment, a video chat with staff confirmed eligibility and consent. Waivers of parental permission were approved by the IRB.

Consent for publication

Not applicable.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mustanski, B., Saber, R., Macapagal, K. et al. Effectiveness of the SMART Sex Ed program among 13–18 year old English and Spanish speaking adolescent men who have sex with men. AIDS Behav 27, 733–744 (2023). https://doi.org/10.1007/s10461-022-03806-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-022-03806-2

Keywords

Search

Navigation