An Interactive Education Program to Reduce High Risk Behavior in Adolescents

Internet-based TRAC (i-TRAC): Interactive Emotion Regulation Skills Training to Improve AdolescentSexual Health Adolescence is a critical developmental period during which behavioral patterns are formed that have powerful influences on current and future health. This is particularly true for sexual behavior, which is affected by the biological changes of puberty as well as normative developmental tasks around sexual exploration. Engaging in sexual behavior in early adolescence (before age 15) is associated with more partners, less condom use, and more frequent sex as teens get older, and these factors increase risk for negative health outcomes (e.g., sexually transmitted infections and unplanned pregnancy) throughout their lives. Many sexual health interven- tions teach prevention skills, such as assertiveness or condom use; the premise of the current application is that these skills are often unused by adolescents because of deficits in emotion regulation (ER), which is un- addressed in most sexual health education. Our research team has developed and tested a novel, engaging, efficacious, and developmentally tailored group intervention (Project TRAC) to teach ER skills to early adoles- cents within the context of sexual health. A study of Project TRAC showed that participants taught ER skills were less likely to start having sex over the 2.5 year follow up. While efficacious, the small group format of the program presents barriers to sustainability and dissemination; significant advantages of web-based delivery exist. To explore whether the ER concepts of TRAC could be taught in a web-based format, we completed a pilot study to translate TRACandapos;s ER content to a web-based intervention (iTRAC), using Designing for Dissemi- nation principles that enhance the likelihood of successful dissemination upon completion. iTRAC demonstrat- ed feasibility and acceptability, and a randomized trial showed that iTRAC participants reported significantly better emotional competence compared to waitlist control participants. The proposed Fast Track project will complete the technology adaptation of the program to include its sexual health content and content linking ER to sexual health. This adaptation (iTRAC for Sexual Risk Prevention; iTRAC-SRP), using well-established the- oretical frameworks, will be approached with advisory boards of school professionals and early adolescents, leading to prototypes of the completed intervention in Phase 1. Phase 2 will include the creation of the remain- ing digital intervention, an acceptability trial, and a randomized controlled trial (RCT) of 120 early adolescents (12-14 years) comparing iTRAC-SRP to a waitlist control. This project represents innovation in adolescent sexual health; its implementation has great potential for sustainability and accessibility.PROJECT NARRATIVE The proposed research will fill a gap by completing the adaptation of iTRAC, a web-based emotion regulation sexual health intervention, and testing its efficacy in promoting safer sexual cognitions and delaying sexual initiation among early adolescents. This application addresses the Office of Disease Prevention and Health Promotionandapos;s Healthy People 2030 indicator FP-08, to increase the proportion of adolescents who get formal sex education before age 18 years (currently less than 53%). It also uses a novel approach, emotion regulation skills training, to address indicator FP-04, to increase the proportion of adolescents who have never had sexual intercourse, and indicator FP-06, to increase the proportion of adolescents who used condoms at last sexual intercourse.