Evaluating the mechanisms and long-term effects of a web-based comprehensive sexual health and media literacy education program for young adults attending community college: study protocol for a three-arm randomized controlled trial.

BACKGROUND: Many community college students experience poor sexual and relationship health outcomes. Young adults consume a plethora of media content, much of which depicts unhealthy sexual and romantic relationships, and research has shown that media exposure can negatively impact health outcomes. Asynchronous, web-based media literacy education (MLE) programs have been shown to improve short-term sexual and relationship health outcomes. However, there is a dearth of research on the mechanisms by which MLE programs impact health outcomes and the long-term effects of MLE programs on sexual and relationship health outcomes among community college students. METHODS: This study will (1) evaluate the unique effects of MLE on primary and secondary sexual and relationship health outcomes; (2) compare the mechanisms underlying the effects of an asynchronous, web-based MLE sexual health program (Media Aware) to the mechanisms underlying the effects of an active control program on health outcomes; and (3) evaluate the long-term efficacy of Media Aware on media literacy skills and sexual and relationship health outcomes compared to active control and delayed intervention control groups. To address these aims, a three-arm randomized controlled trial with young adults attending community college will be conducted. It is expected that around 30 campuses will participate and approximately 67 students from each campus will be enrolled in the study (estimated n = 2010). Campuses will be randomized to either the (1) intervention group (Media Aware); (2) active control group (sexual health education from Media Aware without MLE content or methods); or (3) delayed intervention control group. Students will complete online questionnaires at pretest, posttest, 6-month, and 12-month follow-ups. DISCUSSION: This project has the potential to advance theory about the potential mechanisms through which MLE has an impact on sexual and relationship health outcomes by directly testing the impact of interventions using a randomized design. Additionally, this study is expected to establish strong evidence for the effectiveness of Media Aware for use with young adults and to help identify strategies to optimize the longer-term impact of the program on health. Students' satisfaction with programming will be discussed to inform future implementation efforts.

A Media Literacy Education Approach to High School Sexual Health Education: Immediate Effects of Media Aware on Adolescents' Media, Sexual Health, and Communication Outcomes.

Media may function as sex educators for adolescents; unfortunately, media messages often glamorize risky sexual behaviors and unhealthy relationships and neglect sexual health behaviors and communication. Media Aware is a web-based comprehensive sexual health program for high school students that uses a media literacy education approach. It is designed to improve adolescents' critical thinking about media messages and provide medically-accurate information and skills building related to sexual health and communication. A randomized controlled trial was conducted in 2019-2020 with students (grades 9 and 10; n = 590) from 17 high schools across the United States. The sample was 53% female, 58% white/Caucasian; and 13% Hispanic/Latinx. One high school teacher per school and all of their 9th and 10th grade students were randomly assigned to either the intervention or delayed-intervention (control) condition. The study assessed the immediate (posttest) and short-term (3-month) effects of Media Aware on adolescents' media, sexual health, and communication outcomes. For 9 of the 17 schools, students were home from school due to the beginning of the COVID-19 pandemic during the time of their 3-month data collection, which left the short-term analyses underpowered. However, several impacts of the program were found in the immediate posttest analyses. Media Aware was found to improve sexual health knowledge and redress inaccurate normative beliefs about the frequency of risky teen sex. Media Aware also improved critical thinking about media messages with demonstrated improvements in media message deconstruction skills and decreases in the perceived realism of media messages. Moderator analyses found some differential immediate effects of the program attributable to gender. Media Aware reduced girls' normative beliefs about teen sex, generally, and increased their sexual health communication with parents as well as reduced boys' acceptance of dating violence. Students gave positive feedback about Media Aware, especially related to the online format of the program. The results from this study provide evidence that Media Aware is an effective web-based program for positively enhancing high school students' media, sexual health, and sexual health communication outcomes.

A Six-Month Outcome Evaluation of Media Aware Parent, a Parent-Based Media Mediation and Sexual Health Communication Program to Promote Adolescent Sexual Health.

The purpose of this study was to evaluate the sustained effects of a web-based program for parents of adolescents designed to help them engage in media mediation and high-quality parent-adolescent communication about sex, relationships, and media. A randomized control trial was conducted with parent-adolescent pairs (n=375 pairs). Adolescents were in 7th-9th grade. Pairs were randomly assigned to either the intervention Media Aware Parent or active control (medically accurate adolescent sexual health information). This study analyzed the impact of Media Aware Parent 6 months after pretest. Several outcomes significant at one-month posttest were sustained at 6 months, including enhanced parents' media-related cognitions (e.g. media skepticism) and adolescent awareness of family media rules. Parents' reports of restrictive media mediation and adolescents' reports of their parent engaging in supportive parenting, which were not significant at posttest, emerged as significant at 6 months, signifying that the program resulted in changes in parent behavior and the parent-adolescent relationship over time. The impact of the program on parent-adolescent communication quality and adolescent sexual health and media-related outcomes diminished over time, suggesting the need for program boosters to encourage parents to continue engaging in high-quality conversations with their adolescent children about sex, relationships, and media.

The positive impact of Media Aware Parent on parents' media-related cognitions and adolescents' awareness of family media rules were sustained at 6 months after pretest.Media Aware Parent resulted in parents reporting that they engaged in more restrictive media mediation and adolescents reporting that their parents engaged in more supportive parenting during a six-month follow-up.The short-term impact of Media Aware Parent on adolescent sexual health outcomes, adolescent media cognitions, and parent-adolescent communication quality diminished over time, suggesting the need for program boosters to maintain positive outcomes.