Reach for Health: A School-Sponsored Community Youth Service Intervention for Middle School Students

Investigators: Lydia O'Donnell, Alexi San Doval, Richard Duran, Deborah Haber, Rebecca Atnafou, Patricia Piessens, & Renee F. Wilson-Simmons, Ann Stueve, Joseph H. Pleck, Norma Johnson, Uda Grant, Helen Murray

The REACH FOR HEALTH COMMUNITY YOUTH SERVICES PROGRAM (RFH-CYS) targets African-American and Hispanic youth living in urban areas. REACH FOR HEALTH combines a classroom teaching component with community service work. The intervention, as implemented, provides opportunities for middle school students to participate in service activities within their communities while simultaneously reducing early and unprotected sexual activity. The intervention was initially delivered in 1994 to two large middle schools in Brooklyn, NY; one school was designated as the intervention school, the other as the control. A total of 68 classrooms participated in the initial implementation. In the control school, 33 classrooms (584 students) received the standard New York City health education program, which includes some mandated lessons on drugs and AIDS. Within the intervention school, 22 classrooms (222 students) were randomly assigned to receive core RFH curriculum (classroom component only). The remaining 13 intervention classrooms (255 students) received the enhanced RFH plus Community Youth Services program (RFH-CYS). Bi-lingual and special education classes were included from both school sites. At follow-up six months later, reports of sexual activity were higher across the sample. However, students in the control condition showed greater increases in risk behavior (ever had sex, recent sex, recent sex without condom, recent sex without birth control) than did their peers in the treatment conditions. In contrast, students in both intervention conditions showed increases in their use of STD protection and birth control. Also noteworthy are the findings that eighth graders and special education students showed the greatest improvement. Click here to view more detailed information on this program.

Real Men Are Safe (REMAS)

Investigators: Donald A. Calsyn, PhD, Mary Hatch-Maillette, PhD, Susan Tross, PhD, Suzanne R. Doyle, PhD, Yong S. Song, PhD, Judy M. Harrer, PhD, Genise Lalos, MA, Sara B. Berns, PhD

REMAS is a group-level, clinic-based behavioral intervention designed to reduce HIV/STI risk among male substance abuse treatment center attendees. More specifically, the program aims to reduce the number of times that men engage in unprotected vaginal and anal sexual intercourse, or have sex while under the influence of drugs or alcohol. Two trained male health counselors teach participants information, help participants develop risk-reduction skills, and motivate behavior change through group discussion, role-play, and condom use skill training. REMAS is comprised of five 90-minute sessions where participants learn about HIV risky-behaviors, HIV prevention planning, and methods for communicating about safer sex and discussing sex without drugs. Click here to view more detailed information on this program.

CyberSenga

Investigators: Michelle Ybarra, Tonya Prescott, Josephine Korchmaros, Julius Kiwanuka, Sheana Bull, David Bangsberg, Norma Ware, & Ruth Birungi

CyberSenga is part of an effort to increase technology-based HIV prevention research in resource-limited settings such as Uganda. The purpose of CyberSenga is to prevent more people from getting HIV and to help those who have HIV live healthy lives by taking advantage of Internet technology to give young people both honest and truthful information, and the tools they need to make good decisions. CyberSenga consists of five one-hour modules conducted through the online CyberSenga software, along with a four-month post-intervention booster session. At the beginning of the program, participants answer two questions to sort them into four groups: abstinent boys, abstinent girls, sexually active boys, and sexually active girls. Based on their responses, participants are directed to intervention content tailored for saliency based upon their biological sex and sexual experience, although all versions include the same concepts. Content discusses relevant topics to provide youth with the information and skills they need to make healthy decisions in the future. An evaluation of CyberSenga has demonstrated that receiving the five CyberSenga sessions improves youths’ HIV preventive information as well as motivation to use condoms, and the booster session delivered four months after the initial intervention enhances the learning effect. Click here to view more detailed information on this program.

Prime Time: A Positive Youth Development Program

Investigators: Renee Sieving, Jenny Oliphant, Kayci Rush, Bethany Divakaran, Jill Farris, and Glynis Shea

Prime Time is an 18-month multicomponent program that seeks to reduce sexual risk behaviors, violence involvement, and school disconnection among sexually active female adolescents at increased risk for early pregnancy and sexually transmitted diseases. The program is grounded in a Positive Youth Development framework that views young people as resources to be developed, not problems to be fixed. Prime Time aims to build adolescents’ skills and competencies, confidence, character, connections, and contributions through program activites. Prime Time consists of two core components. The first is one-on-one case management, which addresses social and emotional skills, responsible behaviors, healthy relationships, and positive involvement with family, school and the community. The second core component is a 16-session peer educator program called Just In Time, which addresses communication, stress management and conflict resolution skills, responsible sexual behaviors, sexual decision-making, and contraceptive use. Through a combination of case management and the peer educator program, Prime Time targets outcomes including fewer sexual partners; consistent condom and hormonal contraceptive use; reduced interpersonal aggression and violence; and reduced school misbehavior and dropout. An evaluation of Prime Time showed that receiving the intervention increased abstinence, as well as more consistent use of condoms, hormonal contraception, and dual-method contraception. Intervention participants also reported improvements in family connectedness and self-efficacy to refuse unwanted sex, and reductions in the perceived importance of having sex. Click here to view more detailed information on this program.

Wise Guys: A Male-Oriented Teen Pregnancy Prevention Program

Investigators: Children's Home Society of NC

The Wise Guys program is designed to prevent adolescent pregnancy by teaching adolescent males self-responsibility in the areas of sexual development, decision-making, and relationships. The Wise Guys program is a weekly, 10-session group intervention for adolescent males that is delivered by a staff educator. Each session is approximately 45 to 60 minutes long. The program may be offered in a variety of settings including, but not limited to, school athletic programs, faith-based institutions, juvenile detention center, and other community sites. The program is available only as a shipped hard copy package. The Wise Guys program covers a broad range of topics including: masculinity, communication, relationships, dating violence, fatherhood, values, goal setting, decision making, sexuality, sexually transmitted infections, contraception, and abstinence. Participatory lessons and activities focus on assisting youth to identify their long-range personal and career goals so that they can use those goals to direct the decisions they make throughout adolescence. Wise Guys has been demonstrated to effectively improve adolescent males' knowledge of sexual behavior and reproductive behavior, and their knowledge of STI transmission, and to instill desirable attitudes toward sex and appropriate behavior in sexual relationships. The Wise Guys evaluation found: - Participants had significantly higher scores than controls at both posttest and follow-up (p = .007) on general knowledge of sexual behavior and reproductive biology. - Participants had significantly higher scores than controls at both posttest and follow-up (p = .000) on knowledge of STI transmission. - Scores for participants were higher than those of controls at all 3 data points, but were significantly higher at posttest and follow-up (p = .013) on attitudes toward sex and appropriate behavior in sexual relationships. - Regression analyses confirmed that participation in Wise Guys was significantly associated with higher posttest and follow-up general knowledge, STI knowledge, and desirable attitude scores, independent of age, grade, race, or pretest scores. - To assess the relative importance of participation in the Wise Guys program for predicting every time contraception at 6-month follow-up, regression analyses were done using age, grade, race, and participation in Wise Guys as the independent variables. The strongest and only statistically significant predictor of contraception use "every time" was participation in the Wise Guys curriculum. Click here to view more detailed information on this program.

Go Grrrls

Investigators: Craig W. LeCroy, MSW, PhD, & Janice Daley, MSW

Go Grrrls is a program designed to promote healthy psychosocial development in female adolescents. Building a foundation of information and skills that related to middle school females is a core feature of the program. The program is not just a pregnancy prevention program but a program about empowering adolescent females with pregnancy prevention as one core part. All of the units in the program work together to create the context and motivation for taking actions that can prevent teen pregnancy. The program has been delivered to girls in grades six through nine and is expected to occur as a series of 8 units held outside of traditional school hours. The 8-unit curriculum covers six topics related to female adolescent development: being a girl in today's society (gender role identity), establishing a positive self-image, establishing independence, making and keeping friends, when it all seems like too much (learning to obtain help and find access to resources), and planning for the future. Sessions are expected to last 90-120 minutes and occur once per week. They are made up of groups of 6-11 female adolescents, led by two group facilitators with appropriate interest, background knowledge (e.g., social work or psychology), and past experience working with young people. The sessions include didactic instruction, class discussion, group exercises, completion of worksheets, role-playing, and weekly journal assignments. The Go Grrrls program materials include a Go Grrrls curriculum guide for group leaders and a Go Grrrls workbook for use by group attendees. In addition, the program developers offer one-day trainings for group leaders on topics such as an introduction to Go Grrrls and female adolescent development, being a group leader, and advanced topics related to leading a Go Grrrls group. Click here to view more detailed information on this program.

SiHLE: Health Workshops for Young Black Women

Investigators: Ralph DiClemente, Gina Wingood, Kathy Harrington, Delia Lang, Susan Davies, Edward Hook III, M. Kim Oh, Richard Crosby, Vicki Stover Hertzberg, Angelita Gordon, James Hardin, Shan Parker, & Alyssa Robillard

SiHLE (Sistas, Informing, Healing, Living, Empowering) was developed to address the STI/HIV/AIDS prevention needs of African-American adolescent girls. Research has shown that this subgroup of the general population is at higher risk than their White or Hispanic peers. SiHLE was originally implemented in the South, where adolescent HIV prevalence was higher than any other geographic region in the U.S. Participants were girls seeking health services at community health agencies. Eliglible participants were African American between the ages of 14 and 18 who had engaged in vaginal intercourse within the previous six months. At baseline, 522 girls, aged 14-18, completed the baseline survey and were randomized into either the HIV-prevention intervention (n=251) or the general health control group (n=271). The HIV-prevention intervention was grounded in social cognitive theory and the theory of gender and power. Participants explored issues related to ethnic and gender pride, risk reduction strategies (including correct and consistent condom use), negotiating safer sex, and healthy relationships as they relate to practicing safer sex. At the six-month follow-up, intervention girls reported using condoms more consistently in the previous 30 days than did their control group counterparts (intervention, 75.3% vs. control, 58.2%). At the 12-month follow-up, intervention girls reported more consistent condom use both in the previous 30 days (intervention, 73.3% vs. control, 56.5%) and during the entire 12-month review period (adjusted odds ratio, 2.30; 95% CI, 1.51-3.5; Phere to view more detailed information on this program.

Rikers Health Advocacy Program (RHAP)

Investigators: Stephen Magura, Janet Shapiro, & Sung-Yeon Kang

This program, originally developed for use with incarcerated male adolescent drug users between 16 and 18 years of age, consists of four one hour small group sessions focusing on health education issues, particularly HIV/AIDS. Adapting techniques of Problem Solving Therapy, the facilitator guides eight-person groups in discussing the following topics: general health, HIV and AIDS, drug abuse and its consequences, sexual behavior, health and AIDS-risk behaviors, and strategies for seeking health and social services. Active learning is emphasized, with opportunities for youths to define high-risk attitudes and behaviors, suggest alternative actions, and engage in role play and rehearsal activities. A field study of the curriculum compared the attitudes and behaviors of RHAP participants with those of a control group of teens, selected from a waiting list for the program. Both samples were predominantly African-American and Hispanic. Following the intervention, program participants were more likely to use condoms during intercourse, compared to the comparison group of teens. RHAP 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.

Safer Sex Intervention (SSI)

Investigators: Lydia A. Shrier, MD, MPH, Rose Ancheta, MPH, Elizabeth Goodman, MD, Victoria Chiou, BA, Michelle R. Lyden, RN, PNP, & S. Jean Emans, MD

Data from the Centers for Disease Control and Prevention suggest that over 50% (and in some years, as high as two thirds) of the population who contract an STI are under the age of 25, and disproportionately, are adolescent girls. Adolescent girls with an STI infection are at risk for recurrence and more long-term reproductive health issues such as pelvic inflammatory disease (PID) and infertility. Safer Sex Intervention (SSI) is an individualized STI intervention program aimed at sexually active young women, ages 13-23, who have been diagnosed with an STI. The overall goals are to reduce high-risk sexual behaviors, increase condom use and prevent the recurrence of an STI among sexually active young women. The program is appropriate for use in clinics or community based organizations led by a female health educator. This individualized intervention was designed to be delivered at the time of STI diagnosis/treatment, when the participant was most likely to be contemplating her diagnosis relative to her sexual risk behaviors. The intervention is administered 1-on-1 and face-to-face using one of two discrete 30- to 50-minute sessions. Safer Sex Intervention (SSI) was evaluated with an opportunistic study design (at time of STI treatment) that included baseline, 1, 3, 6 and 12 month follow up. Subjects were female, under 24 years of age, with a diagnosis and treatment plan for either cervicitis or PID. At 1 month, the intervention condition subjects had increased sexual risk knowledge (P=.02), more positive attitudes towards condom use (P=.007). At 6 months, intervention subjects report fewer instances of sexual intercourse with non-main partners than the standard-of-care condition. In other words, they were more likely to report lower sexual risk (sex with a non-main partner) as compared to the standard-of-care (control) condition (P=.01). Consistent with findings at 1 month, the intervention condition had a continued increase in positive attitudes regarding condoms (P=.007). One year after SSI, the girls who received the program were more likely to have a main sexual partner and thus, decreased their risk (P=.07) and were also less likely to have recurrence of an STI than the control group (but this was not significant; P=.17). SSI 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.

SMART Couples

Investigators: Robert Remien, PhD, Michael Stirratt, PhD, Joanna Dognin, PsyD, Emily May, MA, Curtis Dolezal, PhD, Alex Carballo-Dieguez, PhD, Nabila El Bassel, DSW, Tiffany Jung, NP, Patricia Warne, PhD, & Glenn Wagner, PhD

SMART COUPLES is a four-session intervention delivered by a nurse practitioner to serodiscordant (mixed HIV status) couples. The program aims to increase antiretroviral therapy (ART) adherence in the partner living with HIV/AIDS by increasing knowledge about the importance of medical care adherence, increasing adherence motivation and self-monitoring, increasing problem solving skills to overcome adherence issues, increasing self-efficacy, and optimizing partner support. In addition, the program was designed to foster active support between partners and help couples address issues of sex, intimacy, and transmission risk behaviors. During four 45- to 60-minute sessions, the couples engage in structured discussion and instruction, as well as specific problem-solving and couple-communication exercises. The nurse practitioner helps participants learn the different components of medical care adherence, and how a partner can help prompt adherence. Participants are also given an opportunity to discuss barriers to adherence, and how to communicate with their partners about different health care concerns including sexual risk taking. Finally, couples determine what their .triggers. are for poor medication adherence, and how to avoid these triggers in the future. Click here to view more detailed information on this program.