School-Linked Reproductive Health Services (The Self Center)

Investigators: Laurie Schwab-Zabin, Janet B. Hardy, & Rosalie Streett

Originally launched as a partnership between junior and senior high schools and a neighborhood clinic, this program combines education, counseling, and reproductive services into a comprehensive intervention for youth. Services are provided by a team of nurses and social workers who divide their time between the schools and clinic. School-based components include: (1) at least one presentation to each homeroom class per semester to introduce the program and begin discussing values clarification, decision making, and reproductive health; ( 2) informal discussion groups that arise as students seek advice and information from staff on such themes as pubertal development, drug use, and parenting; and (3) individual counseling sessions, available as needed, with a social worker. At the clinic, reproductive and extended counseling services are provided, and referrals are given for teens requiring medical care. Staff encourage students waiting for appointments to participate in discussion groups and examine educational videos and pamphlets. A three-year field test of the intervention was conducted in a low-income neighborhood in Baltimore, Maryland, where elevated rates of sexual activity and teen pregnancy had been recorded. Compared to their peers attending comparable schools, students in the target schools showed reduced levels of sexual activity and (among the sexually active) more effective use of contraception. These effects were greatest among the younger, sexually active girls and boys whose use of contraception was minimal at the start of the program. A delay in the onset of sexual activity was also recorded among abstinent youth. Click here to view more detailed information on this program.

Tailoring Family Planning Services to the Special Needs of Adolescents: New Adolescent Approach Protocols

Investigators: Lynn Cooper Breckenmaker & Laraine Winter

This family planning clinic-based intervention was originally developed for teens less than 18 years of age. It is based on the premise that regular contraceptive use by teens can be increased by offering information, social support, and counseling, in addition to health and medical services. Accordingly, the program aims to provide family planning services in a manner that will increase teens' sense of comfort, increase their self-confidence, and reduce any fears that may discourage regular and effective contraception. A key component of the intervention is the Personal Information Form, a one-page questionnaire designed to aid staff in understanding teens' concerns, providing counsel and identifying patients who may be at greatest risk for early pregnancy. To ease teens' anxiety, the first appointment is divided into two visits, with education and counseling provided in the first session and the medical examination (and contraceptive prescription) deferred until the second. The intervention also includes: (1) education in a one-on-one rather than a group setting; (2) use of visual aids; (3) a follow-up visit scheduled six weeks after the initial appointment; and (4) encouragement of participation by family members, partners, and friends, while respecting the patient's right to confidential services. A field study was conducted with 1,261 teens attending six family planning clinics. Compared to their peers receiving standard services, program participants showed significantly greater gains in knowledge, contraceptive usage and significantly fewer pregnancies at the 6- and 12-month follow-up assessments. Click here to view more detailed information on this program.

Teen Talk

Investigators: Marvin Eisen, Alfred L. McAlister, & Gail L. Zellman

This is a collaborative school- and community health centers-based sex and contraception education intervention for teens between the ages of 13 and 19 years. The 12- to 15-hour pregnancy prevention program begins with two large-group, lecture format presentations covering reproductive physiology, contraception methods, and contraceptive effectiveness. During the remaining four sessions, students participate in small group discussions that are designed to help teens: (1) understand and personalize the risks and consequences of teenage pregnancy; (2) develop and practice the skills that will make abstinence an easier decision to implement; and (3) become more knowledgeable regarding contraception. The sessions include games, role plays, and trigger films that encourage group discussion. A field study of the intervention was conducted in both rural and urban communities in Texas and California. Teens of diverse ethnicities recruited from different agencies and schools participated. Participation in the program was especially beneficial to males, leading to a delay in the onset of sexual activity among male virgins, and to the use of more effective contraception among male non-virgins. Click here to view more detailed information on this program.

Youth and AIDS Project's HIV Prevention Program

Investigators: Gary Remafedi, Susan Reynolds, John Yoakam, & Kevin Cwayna

A community and university partnership launched this program to provide education, peer support, counseling, and case management to gay and bisexual male adolescents between 13 and 21 years of age, who are at high risk for HIV/AIDS. The program begins with an initial two-hour interview for individualized HIV/AIDS risk assessment and risk reduction counseling. Youth then participate in a 90-minute interactive peer education program designed to provide clear, factual information in an atmosphere of mutual support. The program's lessons are reinforced in an educational video. Optional peer support groups meet weekly, if youth wish to attend. Finally, there is a one-hour follow-up visit for reassessment and referrals, as needed, to medical and social services. A field study of the program was conducted with a predominantly white sample of males, ages 13-21, who identified themselves as gay or bisexual. Following the intervention, the 139 participants reported less frequent unprotected anal intercourse and more frequent use of condoms. A reduction in substance abuse, particularly amphetamines and amyl nitrate, was also recorded. Click here to view more detailed information on this program.

ABAN AYA Youth Project: 6th Grade

Investigators: Brian Flay, DPhil, Sally Graumlich, EdD, CHES, & the ABAN AYA Team

ABAN AYA is an Afrocentric social development curriculum instructed over a four-year period, beginning in the fifth grade. The ABAN AYA 6th Grade product contains all of the materials needed to implement the ABAN AYA 6th grade curriculum. The ABAN AYA name is drawn from two Ghanaian words: ABAN (fence) signifies double/social protection; AYA (the unfurling fern) signifies self-determination. The purpose of ABAN AYA is to promote abstinence from sex, and to teach students how to avoid drugs and alcohol, and how to resolve conflicts non-violently. ABAN AYA was developed to address multiple problem behaviors such as violence, substance abuse, delinquency and sexual activity, simultaneously in a long-term intervention specifically for African American youths in grades five through eight. The longitudinal evaluation of the program involved 12 schools in the metropolitan Chicago area between 1994 and 1998. At baseline, 1153 fifth graders participated in the pencil-and-paper assessment. All participants were African American. Follow-up assessments were conducted at the conclusion of grades five through eight. At study conclusion, there were no significant intervention effects for girls. For boys, however, ABAN AYA significantly reduced the rate of increase in violent behavior (by 35% compared with controls), provoking behavior (41%) school delinquency (31%) drug use (32%), and recent sexual intercourse (44%). ABAN AYA also improved the rate of increase in condom use (95%) as compared to the health education control condition. Aban Aya is supported by the Office of Adolescent Health's Teen Pregnancy Prevention (TPP) program as an EBI that is medically accurate, age appropriate, and has proven through rigorous evaluation to prevent teen pregnancy and/or associated sexual risk behaviors. Click here to view more detailed information on this program.

ABAN AYA Youth Project: 7th Grade

Investigators: Brian Flay, DPhil, Sally Graumlich, EdD, CHES, & the ABAN AYA Team

ABAN AYA is an Afrocentric social development curriculum instructed over a four-year period, beginning in the fifth grade. The ABAN AYA 7th Grade product contains all of the materials needed to implement the ABAN AYA 7th grade curriculum. The ABAN AYA name is drawn from two Ghanaian words: ABAN (fence) signifies double/social protection; AYA (the unfurling fern) signifies self-determination. The purpose of ABAN AYA is to promote abstinence from sex, and to teach students how to avoid drugs and alcohol, and how to resolve conflicts non-violently. ABAN AYA was developed to address multiple problem behaviors such as violence, substance abuse, delinquency and sexual activity, simultaneously in a long-term intervention specifically for African American youths in grades five through eight. The longitudinal evaluation of the program involved 12 schools in the metropolitan Chicago area between 1994 and 1998. At baseline, 1153 fifth graders participated in the pencil-and-paper assessment. All participants were African American. Follow-up assessments were conducted at the conclusion of grades five through eight. At study conclusion, there were no significant intervention effects for girls. For boys, however, ABAN AYA significantly reduced the rate of increase in violent behavior (by 35% compared with controls), provoking behavior (41%) school delinquency (31%) drug use (32%), and recent sexual intercourse (44%). ABAN AYA also improved the rate of increase in condom use (95%) as compared to the health education control condition. Aban Aya is supported by the Office of Adolescent Health's Teen Pregnancy Prevention (TPP) program as an EBI that is medically accurate, age appropriate, and has proven through rigorous evaluation to prevent teen pregnancy and/or associated sexual risk behaviors. Click here to view more detailed information on this program.

ABAN AYA Youth Project: 8th Grade

Investigators: Brian Flay, DPhil, Sally Graumlich, EdD, CHES, & the ABAN AYA Team

ABAN AYA is an Afrocentric social development curriculum instructed over a four-year period, beginning in the fifth grade. The ABAN AYA 8th Grade product contains all of the materials needed to implement the ABAN AYA 8th grade curriculum. The ABAN AYA name is drawn from two Ghanaian words: ABAN (fence) signifies double/social protection; AYA (the unfurling fern) signifies self-determination. The purpose of ABAN AYA is to promote abstinence from sex, and to teach students how to avoid drugs and alcohol, and how to resolve conflicts non-violently. ABAN AYA was developed to address multiple problem behaviors such as violence, substance abuse, delinquency and sexual activity, simultaneously in a long-term intervention specifically for African American youths in grades five through eight. The longitudinal evaluation of the program involved 12 schools in the metropolitan Chicago area between 1994 and 1998. At baseline, 1153 fifth graders participated in the pencil-and-paper assessment. All participants were African American. Follow-up assessments were conducted at the conclusion of grades five through eight. At study conclusion, there were no significant intervention effects for girls. For boys, however, ABAN AYA significantly reduced the rate of increase in violent behavior (by 35% compared with controls), provoking behavior (41%) school delinquency (31%) drug use (32%), and recent sexual intercourse (44%). ABAN AYA also improved the rate of increase in condom use (95%) as compared to the health education control condition. Aban Aya is supported by the Office of Adolescent Health's Teen Pregnancy Prevention (TPP) program as an EBI that is medically accurate, age appropriate, and has proven through rigorous evaluation to prevent teen pregnancy and/or associated sexual risk behaviors. Click here to view more detailed information on this program.

Sexual Health and Adolescent Risk Prevention (SHARP)

Investigators: Angela D. Bryan, PhD, Sarah J. Schmiege, PhD, & Michelle R. Broaddus, PhD

Adolescents in general are at high risk for sexually transmitted infections (STIs), including HIV. Even higher rates of STIs have been observed among youth involved with the criminal justice system. Typically, these adolescents are younger at first intercourse, have a higher number of sexual partners, and report lower rates of condom use than their peers. Despite the fact that these adolescents are at greater risk for HIV/STIs, few prevention interventions have been developed for them. In addition, few interventions for adolescents target both substance use and sexual risk reduction. SEXUAL HEALTH AND ADOLESCENT RISK PREVENTION (SHARP) aims to fill these gaps. SHARP is an intensive, interactive single-session (divided into five sections) intervention lasting 3-4 hours that incorporates videos, lecture, group discussion and activities. The groups are organized by gender, either all male or all female, with no more than 10 per session (but on average, the ideal number per session is between 3-5 participants per session). Overall SHARP program goals are to deepen STI/HIV knowledge, improve correct condom use, reduce sexual risks and alcohol use and set long-term goals to utilize knowledge and skills learned during the session. SHARP was evaluated using a randomized controlled trial with three group-based conditions. These three conditions were HIV information only (control group); SHARP program (intervention group) and SHARP + motivational enhancement therapy (enhanced intervention group). The study was conducted over a 12 month period, with data collected in 5 waves (baseline, 3, 6, 9 and 12 months). The enhanced intervention condition (SHARP + Motivational Enhancement Therapy) was statistically different and more significant than the control condition (HIV Information only). Any decrease in alcohol problems over time was statistically significant in the SHARP condition and the SHARP + Motivational Enhancement Therapy, when compared to HIV Information only. SHARP is supported by the Office of Adolescent Health (OAH)'s Teen Pregnancy Prevention (TPP) program as an EBI that is medically accurate, age appropriate, and has proven through rigorous evaluation to prevent teen pregnancy and/or associated sexual risk behaviors. Click here to view more detailed information on this program.

Adolescents Living Safely: AIDS Awareness, Attitudes and Actions

Investigators: Mary Jane Rotheram-Borus, Ph.D., Sutherland Miller, Ph.D., Cheryl Koopman, Ph.D., Clara Haignere, Ph.D. & Calvin Selfridge

To meet the comprehensive needs of runaway youths between 11 and 18 years of age, this program combines 20 small group discussion sessions with case management and private counseling. The group sessions provide general instruction about HIV/AIDS through video and art workshops in which youth create their own educational materials and review commercially available videos. Participants also receive behavioral and cognitive skills training for coping with high-risk situations. The case management and counseling components are designed to identify individual needs and provide youth with appropriate services (e.g., legal, medical, vocational). A field study of the program was conducted at two urban shelters serving predominantly African-American runaways. The sessions were held over a three week period, but youth joined the program at various points, and their levels of participation varied. For runaways who attended at least fifteen sessions, the high-risk pattern of sexual behavior dropped in frequency from 20% to zero over a six-month period. At the two-year follow-up assessment, program effects remained strongest for male and African-American participants. Click here to view more detailed information on this program.

Adolescents Living Safely: AIDS Awareness, Attitudes and Actions for Gay, Lesbian and Bisexual Teens

Investigators: Sutherland Miller, Joyce Hunter, M.S.W., & Mary Jane Rotheram-Borus, Ph.D.

Designed to provide education, social and medical services, and peer support to gay,lesbian and bisexual youths between 14 and 19 years of age, this program combines case management, comprehensive health care, and risk assessment counseling with small group discussion sessions. During the group sessions, transmission and prevention of HIV/AIDS are investigated through workshops in which youth create their own educational materials. Participants also receive behavioral and cognitive skills training for coping with high-risk situations. The case management and counseling components are designed to identify individual needs and provide youth with appropriate services (e.g., legal, medical, vocational). A field study of the intervention was initiated with 138 males at a community-based agency serving gay youth in New York City. The impact of the program was found to vary over time and across racial/ethnic groups. African-American and white teens showed a significant decrease in unprotected anal intercourse at the three-month follow-up assessment; at six months the decrease was recorded only among whites. On measures of unprotected oral intercourse, white and Hispanic youths engaged in fewer risk acts through the twelve-month assessment; for African-Americans, the decrease was maintained only until six months following the intervention. Click here to view more detailed information on this program.