Preventing sexually transmitted infections among adolescents: An assessment of ecological approaches and study methods

Most primary prevention research has attempted to explain sexual health outcomes, such as sexually transmitted infections, by focusing on individual characteristics (e.g. age), qualities (e.g. knowledge levels), and risk behaviour (e.g. unprotected intercourse). Emerging evidence indicates that population-level health outcomes are unlikely to be explained adequately as an aggregate of such individual-level factors. Rather, approaches that move beyond individualistic frameworks and adopt more ecological approaches may hold promise for promoting sexual health at the population level. This paper assessed the degree to which ecological approaches were integrated into empirical research regarding interventions to prevent sexually transmitted infections among adolescents. The paper also assessed the scientific rigour of the 35 intervention reports included in this review. Most (n = 31) reports focused exclusively on the micro-level (e.g. individual knowledge and attitudes) issues. No studies accounted for macro-level concerns (e.g. socio-cultural influences). Three reports were rated as methodologically 'strong,' 11 were of moderate quality and 21 reports were rated as 'weak.' Most sexual health interventions targeting adolescents have focused nearly exclusively on individual risk, but have failed to yield encouraging results in terms of behaviour change or reducing disease burden in this population. More attention should be paid to ecological approaches and new study methods should be explored.