Implement SMART in your community
As we continue to collect data from teens, we’re starting to look to the future! We are re-packaging SMART into an implementable format usable by community organizations, schools, programs, and individuals. If you or your organization, school, or program would like to experience SMART and learn more information about providing SMART to your teens, please contact us. Our team will reach out to discuss the SMART suite of programs and how we can help you get the SMART curriculum to those who need it most.
A recent study found that only 23% of AMSM aged 13 to 18 years reported testing at least once for HIV in their lifetime (Li, Moskowitz, Macapagal, Saber, Mustanski, 2020).
Adolescent men who have sex with men (AMSM) in the United States account for 83% of all new HIV occurrences among those aged 13 to 19 years (CDC, 2018).
None of the current programs identified by the CDC as effective HIV risk reduction interventions are designated for AMSM (CDC, 2022)
SMART is the eHealth intervention program that addresses a critical need among AMSM
SMART is the first web-based program for AMSM to take a stepped-care approach to sexual education and HIV prevention. This design indicates that SMART delivers resources to all adolescents, but more costly treatments (e.g., video chat counseling in SMART Sessions) are conserved for individuals who need them the most. SMART has the potential to reach AMSM to provide them with a sex-positive curriculum that empowers them with the information, motivation, and skills to make better health choices.
The SMART Curriculum
Participants receive one section of SMART every three months, starting with SMART Squad and ending with virtual health coaching in SMART Sessions.
SMART Sex Ed
Part One
“SMART Sex Ed,” is a comprehensive LGBTQ-inclusive sex education program developmentally adapted from the Queer Sex Ed intervention (Mustanski, Greene, Ryan, & Whitton, 2015). It accesses the motivations behind risk-taking behaviors by displaying relevant AMSM situations and contexts.
Structure: Four modules
Estimated completion time: ~2.5 hours
Measured Effects
There was a significant increase in receipt of HIV and STI testing and HIV knowledge from baseline to three-month follow-up (Mustanski et al., 2022).
Participants’ prevention self-efficacy (e.g., ability to ask providers for key screening and prevention tools, such as PrEP) improved from baseline to three month follow (Mustanski et al., 2022).
SMART Squad
Part Two
SMART Squad is a developmental adaptation of the Keep it Up! intervention (Mustanski, Garofalo, Monahan, Gratzer, & Andrews, 2013; Mustanski et al., 2018) that was classified by the Centers for Disease Control and Prevention (CDC) as a “best evidence” intervention for HIV risk reduction (CDC, 2019).
Structure: 6 episodes + 2 bonus episodes/boosters
Estimated completion time: ~2.5 hours
Measured Effects
STI incidence was 40% lower among young men who have sex with men (YMSM) who received KIU! (which SMART Squad is adapted from) at baseline (Mustanski et al., 2018)
The efficacy of KIU! compares favorably to a recently published intervention for YMSM, which demonstrated a 24% reduction in CAS (Mustanski et al., 2018).
SMART Sessions
Part Three
The last intervention in the stepped care package is “SMART Sessions,” a motivational interviewing protocol based on the CDC-best evidence Young Men’s Health Project that aims to reduce substance use and sexual risk behaviors (Parsons, Lelutiu-Weinberger, Botsko, & Golub, 2014).
Designed to provide information about high-risk sex, enhance motivation and personal responsibility, and assess participant stages of change.
Structure: 3-4 one hour sessions
Measured Effects
Participants who received motivational interviewing (MI) reduced their cross-time averaged odds of ever using any drug by 67% over the one-year follow-up (Parsons, Lelutiu-Weinberger, Botsko, & Golub, 2014).
SMART Sex Ed Topics
Section 1
Sexual Orientation & Gender Identity
1.0 - Introduction
1.1 - How do you know your sexual orientation?
1.2 - Gender identity and expression
1.3 – Coming Out to Parents
1.4 – Sexual Orientation Labels, Coming Out, & Support
Section 2
Sexual Pleasure & Sexual Rights
2.0 - Introduction
2.1 – Sexual activity and pleasure
2.2 - Consent
2.3 – Sexting
2.4 – Adolescent sexual health rights
2.5 – State laws
Section 3
STIs, HIV, & Prevention
3.0 – Introduction
3.1 – Viral STIs
3.2 – Bacterial STIs
3.3 – Barrier methods
3.4 – Substance use and sex
3.5 – HIV risk calculator
3.6 – Getting an HIV test
Section 4
Healthy Relationships
4.0 - Introduction
4.1 – Dating and being single
4.2 – Communication skills
4.3 – Relationship expectations
4.4 – Relationship agreements
publications cited
Mustanski B, Saber R, Macapagal K, Matson M, Laber E, Rodriguez-Diaz C, Moran KO, Carrion A, Moskowitz DA, Newcomb ME. Effectiveness of the SMART Sex Ed program among 13-18 year old English and Spanish speaking adolescent men who have sex with men. AIDS Behav. 2022 Aug 11. doi: 10.1007/s10461-022-03806-2. Epub ahead of print. PMID: 35951143.
Li DH, Moskowitz DA, Macapagal K, Saber R, Mustanski B. Using Intervention Mapping to Developmentally Adapt an Online HIV Risk Reduction Program for Adolescent Men Who Have Sex with Men. Prev Sci. 2020 Oct;21(7):885-897. doi: 10.1007/s11121-020-01148-w. PMID: 32761287; PMCID: PMC7470630.
Mustanski, B., Garofalo, R., Monahan, C., Gratzer, B., & Andrews, R. (2013). Feasibility, acceptability, and preliminary efficacy of an online HIV prevention program for diverse young men who have sex with men: The Keep It Up! intervention. AIDS Behav, 17(9), 2999-3012. doi:10.1007/s10461-013-0507-z
Mustanski, B., Greene, G. J., Ryan, D., & Whitton, S. W. (2015). Feasibility, acceptability, and initial efficacy of an online sexual health promotion program for LGBT youth: the Queer Sex Ed intervention. J Sex Res, 52(2), 220-230. doi:10.1080/00224499.2013.867924
Mustanski, B., Parsons, J. T., Sullivan, P. S., Madkins, K., Rosenberg, E., & Swann, G. (2018). Biomedical and behavioral outcomes of Keep It Up!: An eHealth HIV prevention program RCT. Am J Prev Med, 55(2), 151-158. doi:10.1016/j.amepre.2018.04.026
Parsons, J. T., Lelutiu-Weinberger, C., Botsko, M., & Golub, S. A. (2014). A randomized controlled trial utilizing motivational interviewing to reduce HIV risk and drug use in young gay and bisexual men. J Consult Clin Psychol, 82(1), 9-18. doi:10.1037/a0035311
Centers for Disease Control and Prevention. (2022). Compendium of evidence-based interventions and best practices for HIV prevention. Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. Retrieved October 11, 2022 from Compendium | Intervention Research | Research | HIV | CDC