The Influence of Program Settings on Sexual Risk Reduction and Health Promotion Among Adolescents

Introduction: Agencies that deliver adolescent sexual health programs have diverse policies and practices that influence the quality of both program delivery and youth participation. Our research with urban out-of-school time (OST) programs suggests that the quality of youth program participation fostered within these settings may contribute to HIV risk reduction practices among the youth they serve. Methods: A community-based participatory research team generated three waves of data from youth aged 13-17 who were enrolled in New York City OST programs. 329 youth participated in the study (62% female; 74% heterosexual; 80% African American and/or Hispanic, 3% non-Hispanic white). 93% completed follow-up surveys. Follow-up interview data with 44 youth and 18 program staff members generated 8 dichotomous program-level variables that described characteristics that may contribute to high-quality youth program participation (e.g., active welcome, staff stability). Data were analyzed using multilevel models. Results: We found that setting-level factors influence the quality of youth participation, and that high quality youth program participation as measured by a scale validated by the research team may contribute to sustained HIV risk reduction. In this study, participants in OST programs with lower levels (-1 SD) of program-level participation reported greater declines in risk reduction practices than participants attending programs with higher levels (+1 SD) of participation (b=-0.32, p=.005). An interaction between participation and duration of involvement indicated that individuals needed to be involved for a longer length of time to reap participation-related benefits. A high staff-to-youth ratio was also associated with increased HIV risk reduction practices among youth (b=0.31; 95% CI, 0.07, 0.57).  Conclusions:  A growing body of literature identifies OST programs as contexts for delivery of adolescent sexual health promotion and risk reduction interventions. Our findings suggest that it is important to consider both setting- and individual-level influences when designing interventions to promote adolescent sexual health because contextual factors contribute to active youth participation and active participation is associated with more sustained adolescent HIV risk reduction practices. Setting-level interventions that foster high-quality program participation may enhance the impact of sexual health promotion programs.