Mediating Pathways in Faith-Based Sexual Risk-Reduction for African American Adolescents: Insights from a Church-Based Randomized Controlled Trial

Abstract

African American youth face disproportionate risks for human immunodeficiency virus (HIV) and other sexually transmitted infections, highlighting the need for culturally tailored, evidence-based interventions. This research reports a secondary, exploratory analysis examining the mediation effects of theoretical constructs on the efficacy of sexual risk-reduction interventions promoting abstinence for African American adolescents in church-based settings. The participants are African American adolescents aged 11-14 from 14 churches in Philadelphia, PA (N = 613) who participated in a randomized controlled trial of parent-child faith-based and non-faith-based sexual risk-reduction interventions. Data were collected at baseline, immediate post-intervention, and 3-, 6-, 12-, and 18-month post-intervention. We examined whether the interventions' effects on the frequency of sexual intercourse in the past 3 months were mediated through theoretical constructs, including outcome expectancies, subjective norms, self-efficacy, and intention, using a product-of-coefficients approach. We also explored potential moderation effects of sexual experience, church membership, child gender, and parent gender. We found that self-efficacy mediated the effect of the faith-based intervention (α × β × γ product = - 0.028, 95% ACI [- 0.064, - 0.002]). However, no significant mediators were identified for the non-faith-based intervention. Neither intervention had significant moderators, indicating no differences in efficacy among adolescents differing in sexual experience, church membership, gender, and parent's gender. These findings suggest that parent-child faith-based sexual risk-reduction interventions among African American adolescents in church-based settings could benefit from focusing on boosting self-efficacy.

Keywords: Adolescents; African American; Church-based intervention; Mediation; Moderation; Sexual risk-reduction.