Preventing Sexually Transmitted Infections and Unwanted Pregnancies among Young Women

Cherrie Boyer, PhD, Mary-Ann Shafer, MD, Lance Pollack, PhD, Kelli Betsinger, BA, Y. Jason Yang, MS, Julius Schachter, PhD, Richard Shaffer, PhD, Stephanie Brodine, MD, Heidi Kraft, PhD



The FOCUS program was originally delivered to young women US Marine Corps recruits. This four-session cognitive-behavioral group intervention addressed preventing sexually transmitted diseases (STDs) and unintended pregnancies.

Following a baseline survey and self-administered vaginal swab (for STDs), 2,157 women were voluntarily randomized into either the experimental group (n=1,062) or the control group (n=1,095) during their first week of recruit training. Both experimental and control groups received interventions of four two-hour sessions, delivered during the first, second, fourth and twelfth weeks of recruit training.

At first follow-up, approximately one month after completing the intervention, 80.8% (n=1,743) of the original sample participated. At second follow-up, approximately 14 months after the intervention, 64% (n=1,381) of the original sample took part.

The evaluation results revealed that a higher proportion of the control group had a post-intervention STD or unintended pregnancy (Odds Ratio = 1.41, 95% Confidence Interval = 1.01-1.98). Among participants who had no history of STDs or pregnancy, but who engaged in risky sexual behaviors just before recruit training, the control group was more likely to acquire a post-intervention STD (OR = 2.05, CI = 1.74-4.08), and have had multiple sexual partners (OR = 1.87, CI = 1.01-3.47) post-intervention.


FOCUS is suitable for use in group or class settings in clinics, community-based organizations, or schools/colleges . It should be noted, however, that the subject matter is mature and in some cases quite graphic in nature, and may not be appropriate for participants under the age of 16.


Age, Gender
The original intervention sample included 2,157 young women, aged 17 or older; approx. 90% of the sample was 22 or younger.

More than half of the participants (56%) were Caucasian, 19.7% were Latina, 16.1% were African
American, and about 5% were “Other.”


This four-session intervention was implemented in two-hour segments. However, each segment is divided into several discrete modules, allowing implementation in shorter segments if necessary.


In the original implementation of FOCUS, the intervention was facilitated by two research assistants with groups of 20-25 participants. In your milieu, you may wish to consider conducting the intervention with health educators, or other women facilitators who are both familiar and comfortable with the mature subject matter.

   Primary Pregnancy Prevention
   Secondary Pregnancy Prevention
   STD/HIV/AIDS Prevention


   Behavioral Skills Development
   Community Outreach
   Contraceptive Access
   Contraceptive Education
   Life Option Enhancement
   Sexuality/STD/HIV/AIDS Education

   Adult Involvement
   Case Management
   Group Discussion
   Peer Counseling/Instruction
   Public Service Announcements
   Role Play

   Other: PowerPoint slide presentations



The PASHA Program Package for this program includes:

  • FOCUS User's Guide
  • FOCUS Program Manual
  • 1 Flash Drive Containing 11 Power Point Slide Sets
  • 1 copy of each of these 4 DVDs:
    • Birth Control: Understanding the Options
    • My First Pelvic Exam
    • In Our Own Words: Teens and AIDS
    • Good to Go
  • Video list (blue envelope)
  • 50 copies of two brochures (.STD Facts. and .Birth Control Facts.)
  • Photocopy masters of all handouts (please refer to the red packet)
  • FOCUS Original Evaluation Instruments booklet
  • Prevention Minimum Evaluation Data Set (PMEDS)
  • Local Evaluator Consultant Network Directory

  • Note: There are some secondary materials you will need to obtain in order to deliver this intervention. A television and DVD player will be needed to view the DVDs; a computer with PowerPoint capability and a screen will be needed for the slide set presentations; and a photocopier for handout/worksheet copies. In addition, you will need each of the following items in sufficient quantity for each participant to have at least one:
    • Condoms (for practice and the relay exercise)
    • Wrapped hard candies of two distinct types (to symbolize the outcome of a pregnancy test in a visualization exercise)

    This program box contains a copy of the three written evaluation instruments used in the intervention.s original evaluation. (Please refer to the yellow .Original Evaluation Materials. booklet.) Additional resources for evaluation are also included: (1) Prevention Minimum Evaluation Data Set (PMEDS), a generic questionnaire that can be adapted to suit most prevention programs, and (2) Local Evaluator Consultant Network Directory.