students in grades 7-12 access to condoms on request without a procedure for parents to refuse participation on behalf of their children (Mahler, 1996).

Mass Media Interventions

An important community-based approach to reducing STDs is to use mass media to disseminate information and promote specific behavior changes. There is compelling evidence that properly designed mass media campaigns can have beneficial effects on health behaviors. Flay (1987) reviewed 40 mass media programs focused on smoking and concluded that information and motivation programs generally produced positive changes in awareness, knowledge, and attitudes. Extensive national campaigns also produced meaningful behavior change. In many ways, changing knowledge and attitudes regarding smoking is less difficult than for STDs. Yet, because there is widespread lack of awareness and information regarding STDs, it is possible that national campaigns would have a greater impact on STDs compared to well-recognized issues such as smoking.

A recent review of HIV prevention mass media campaigns (Flora et al., 1995) concluded that, with the exception of campaigns in Australia and Britain, most of the campaigns that were intended to increase knowledge were successful (Appendix E). The results were mixed with respect to attitude change. Programs designed to change behaviors were largely successful. One prominent example is a Swiss multimedia campaign to promote condom use among adolescents and young adults that has significantly increased condom use among these groups (Wasserfallen et al., 1993). In addition, this campaign, which incorporated explicit messages regarding sexuality, did not result in increased sexual activity among young people. Authors of studies in Italy and Zaire have attributed reductions in HIV infection rates to mass media campaigns (Flora et al., 1995). As mentioned previously, perceived risk is an essential element in almost all models of behavioral risk reduction. The only studies to examine the impact of media campaigns on perceived risk were done in Brazil, France, and the Philippines, and the campaigns were deemed successful (Flora et al., 1995).

Other Methods

Effective interventions are available to prevent exposure to and reduce transmission of STDs. Biomedical methods, such as vaccines and antibiotic therapy, require education of, access to, and compliance among individuals. Similarly, condom use requires behavioral modification to utilize the intervention appropriately. Partner notification and treatment clearly has both behavioral and technical components. Thus, the technical expertise provides methods for intervening in the transmission of STDs, but utilizing the technology requires applying clinical and behavioral interventions concurrently.

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