Educational Program Shows Promise as an STI Intervention for At-Risk Adolescent Girls

Angels in Action, an engaging 9-week program that incorporates games and scripted role-plays to teach teen girls how to prevent sexually transmitted infections (STIs) shows promise as an STI intervention for at-risk teens, according to a recent pilot study published by Stephanie Staras, Ph.D., M.S.P.H.

The study, “Increasing adolescent girls’ ability to identify STI-risk characteristics of sexual partners: a pilot study within an alternative disciplinary school,” was published in Sexually Transmitted Infections ahead of print on Feb. 7. The research was funded by the National Institute for Alcohol Abuse and Alcoholism.

Staras, a faculty member of the Department of Health Outcomes and Biomedical Informatics (HOBI) and interim director of the department’s Division of Health Outcomes and Implementation Science, co-authored the study with Eric Richardson, a Ph.D. student at University of Florida’s School of Human Development and Organizational Studies; Kelli Komro, Ph.D., a professor at Emory University’s Department of Behavioral Sciences and Health Education; and Esaa Samarah, a HOBI research coordinator.

The STI prevention program was implemented in an alternative disciplinary school, with 17 girls ages 16 to 18.

According to a 2017 ProPublica analysis, roughly half a million of the nation’s most vulnerable students are enrolled in alternative schools. The schools are designed for students with academic or disciplinary issues, which are often compounded by other problems, such as substance abuse, mental health issues, homelessness and abuse.

According to Staras, research shows that teen girls at alternative schools are twice as likely as mainstream students to report being sexually active. They are also at high risk of acquiring STIs.  However, STI prevention interventions in alternative schools are scarce.

The researchers designed Angels in Action with a simple goal: teach adolescent girls how to reduce their risk of acquiring STIs with an effective intervention program that teens find enjoyable.

The researchers communicated feasible STI prevention methods, such as abstinence and making safe partner choices, through hour-long interactive in-class activities and brief out-of-class activities that encouraged girls to seek emotional support from close friends.

The girls received incentives such as nail polish and lotion when they completed out-of-class activities. Class attendance was high, and 80 percent of the girls reported enjoying the intervention, according to the study.

The program increased the percentage of girls who could correctly recognize partner risk factors, which includes age, recent sexual activity, history of STIs and history of jail.

According prior research, a teen girl’s chances of acquiring an STI are more influenced by choosing a risky partner than by her own history of sexual behavior.

A follow-up survey showed that participants’ condom use increased and partner risk scores decreased.

“Programs like Angels in Action can help teen girls gain essential skills that help them make more informed sexual decisions and live healthier lives,” Staras said.

Along with STI prevention, Staras’ areas of expertise include HPV vaccine implementation and racial and ethnic disparities. Her research focuses on using implementation science to prevent disease and decrease health disparities.