Mediation analysis of an adolescent HIV/STI/pregnancy prevention intervention

Most interventions designed to prevent HIV/STI/pregnancy risk behaviors in youth have multiple components based on psychosocial theories (e.g., social cognitive theory) dictating sets of mediating variables to influence to achieve desired changes in behaviors. Mediation analysis is a method for investigating the extent to which a variable X (e.g., intervention indicator) influences an outcome variable Y (e.g., unprotected sex) by first influencing an intermediate variable M (e.g., self-efficacy to use a condom) and provides a way for empirically validating theoretical hypothesized mediation. In this way, mediation analysis is a critical tool for suggesting which components of complex interventions should be the focus of future more efficient and effective interventions. The present study applied multilevel mediation analysis to outcome data from the All4You2! study to begin to examine the relationships between a theory-based HIV/STI/pregnancy prevention curriculum for alternative school youth at risk for education failure, targeted psychosocial mediating variables, and the primary outcome unprotected sex in the past three months. Results suggest helping alternative school youth identify and avoid exposure to risky situations and improving their self-efficacy to refuse sex should be focal points of future interventions with these youth.