Engineering an Online STI Prevention Program

The overall objective of the proposed research is to reduce the incidence of sexually
transmitted infections (STIs) among college students. The investigators propose to accomplish
this by using the innovative, engineering-inspired multiphase optimization strategy (MOST) to
develop a highly effective, appealing, economical, and readily scalable internet-delivered
behavioral intervention targeting the intersection of alcohol use and sexual risk behavior.
The rate of STIs on college campuses is alarming: one in four college students is diagnosed
with an STI at least once during their college experience. Sexual activity when drinking
alcohol is highly prevalent among college students. Alcohol use is known to contribute to the
sexual risk behaviors that are most responsible for the transmission of STIs, namely
unprotected sex, contact with numerous partners, and "hook-ups" (casual sexual encounters).
Few interventions have been developed that explicitly target the intersection of alcohol use
and sexual risk behaviors, and none have been optimized. In order to reduce the incidence of
STI transmission among this and other high-risk groups, a new approach is needed. MOST is a
comprehensive methodological framework that brings the power of engineering principles to
bear on optimization of behavioral interventions. MOST enables researchers to experimentally
test the individual components in an intervention to determine their effectiveness,
indicating which components need to be revised and re-tested. Given the high rates of alcohol
use and sex among college students, the college setting provides an ideal opportunity for
intervening on alcohol use and sexual risk behaviors. The proposed study will include a
diverse population of college students on 4 campuses which will increase the generalizability
of the findings. The specific aims are to (1) develop and pilot test an initial set of online
intervention components targeting the link between alcohol use and sexual risk behaviors, (2)
use the MOST approach to build an optimized preventive intervention, and (3) evaluate the
effectiveness of the newly optimized preventive intervention using a fully powered randomized
controlled trial (RCT). This work will result in a new, more potent behavioral intervention
that will reduce the incidence of STIs among college students in the US, and will lay the
groundwork for a new generation of highly effective STI prevention interventions aimed at
other subpopulations at risk.