School/Community Program for Sexual Risk Reduction among Teens

Investigators: Murray Vincent

This program is a community-wide public outreach campaign. It incorporates multiple forms of outreach and public education to engage the entire community in preventing pregnancy among unmarried adolescents. Public schools, universities, church groups and civic organizations are all targeted as sites for training and workshops concerning human physiology, sexual development, self-concept and sexual awareness, values clarification and communication skills. Abstinence is promoted as the preferred sexual health decision in all activities; contraceptive information is provided for teens who do choose to become sexually active. The intervention was developed and field tested in a rural, low-income and predominantly African-American community. A significant drop in the pregnancy rate was recorded during the full implementation period of the program. 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.

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.

Sniffer

Investigators: Don C. Des Jarlais, Cathy Casriel, Ray Rodriguez, Andrew Rosenblum, Samuel Friedman, Bruce Stepherson & Elizabeth Khuri

Sniffer is designed to prevent intranasal heroin users from making the transition to injection drug use, and to prevent those who have used injection drugs in the past from returning to that mode of use. Participants attend four 90-120 minute sessions in which didactic materials, group discussions, and situational role play scenarios are employed to communicate information about AIDS, drug use, sexual risk behavior, and drug abuse treatment options. The intervention also seeks to reduce non-injection use of illicit drugs, but advocates harm reduction practices and treatment rather than condemning the behavior of group members who use illicit non-injection drugs. The program's effectiveness was evaluated in a study of 104 intranasal drug users in New York City, each of whom had injected heroin less than 60 times in the previous two years and was HIV and/or hepatitis B negative. Participants were recruited and assigned to test and control groups. All subjects received information about AIDS prior to enrollment. Follow-up interviews at roughly nine months after enrollment collected information about drug use and sexual behavior as well as attitudes towards AIDS. Participation in the intervention was associated with a significantly lower probability of self-reported injection drug use and increased condom use during the follow-up period. (Des Jarlais, Casriel, Friedman and Rosenblum, 1995; Casriel et al., 1990). Click here to view more detailed information on this program.

State-Wide Indian Drug Prevention Program

Investigators: Steven P. Schinke

The program is a drug prevention program, designed to combine a social learning based intervention with bicultural competence theory. Bicultural competence encompasses skills that can enable American-Indian people to adapt the roles in which they were raised with the culture in which they are surrounded. The three subgoals of bicultural competence, knowledge and practice in communication, coping, and discrimination skills, provide the theoretical foundation for intervention to prevent substance abuse with American-Indian youth. The original program was designed primarily for fourth and fifth grade Native American/Alaskan Native students in s classroom setting, but it can easily be modified for higher-grade levels and other adolescents. The curriculum can be implemented in a wide variety of settings, including public schools, tribal schools, tribal community centers, and student retreats. The intervention is administered in 15 one-hour sessions. Click here to view more detailed information on this program.

Study to Reduce Intravenous Exposures (STRIVE)

Investigators: Steffanie Strathdee, Ph.D., Sebastian Booner, Ph.D., Elizabeth Golub, Ph.D., Mary Latka, M.P.H., Ph.D., Farzana Kapadia, Ph.D., Holly Hagan, M.P.H., Ph.D., Jennifer Campbell, & Richard Garfein, Ph.D., M.P.H

STRIVE is a group-level, clinic-based, behavioral intervention that aims to reduce risky distributive injection practices (e.g., syringe lending and unsafe drug preparation) among young injection drug users who are HCV positive. During six 2-hour sessions, two trained health advisors promote group cohesion and support peer education within the STRIVE group. The health advisors encourage behavior change by teaching peer-education tactics and risk reduction skills. The STRIVE program increases participants. HCV knowledge and risk awareness, problem-solving and risk-reduction skills, and supports sustained behavior change. The effectiveness of the STRIVE program was evaluated using a randomized trial design with a time-equivalent attention-control group. Participants included 418 HCV-positive injection drug users aged 18 to 35 years in three US cities. Participants reported their injection-related behaviors at baseline, and at three- and six-month follow-ups. Compared with the control group, intervention group participants reported a 26% relative reduction of distributive risk behaviors at three months and six months, but were no more likely to cite their HIV-positive status as a reason for refraining from syringe lending. Effects were strongest among intervention group participants who had known their HCV-positive status for at least six months. Peer mentoring and self-efficacy were significantly increased among intervention group participants, and intervention effects were mediated through self-efficacy. 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 Health Project (THP): Community-Level HIV Prevention Intervention for Adolescents in Low Income Housing Development

Investigators: Kathleen J. Sikkema, Jeffrey A. Kelly & the Teen Health Project Team

TEEN HEALTH PROJECT was developed for adolescents ages 12 to 17 living in low-income housing developments. The purpose of the evaluation study was to determine whether the effects of a community-level HIV risk reduction intervention would be stronger when the intervention targeted change in individual-level risk reduction as well as change in the social and peer normative environment. Participants (n = 1,172) were recruited from 15 housing developments. Developments were randomly assigned to the community-level intervention (5 developments), workshop-only (5 developments), or a control condition (5 developments). Assessments were conducted at baseline, approximately 3 months after completion of the educational sessions, and again approximately 18 months after baseline. At long-term follow-up, adolescents living in the community-level developments were more likely to have remained abstinent than their control group peers (t(1, 10) = 2.22, Phere 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.

The Abecedarian Approach

Investigators: Craig T. Ramey, Joseph J. Sparling, & Sharon L. Ramey

The Abecedarian Approach is a combination of teaching and learning enrichment strategies for use in early childhood education settings that is comprised of four key elements: 1) learning games, 2) conversational reading, 3) language priority, and 4) enriched care giving. These strategies were developed for and validated in a longitudinal research study known as the Abecedarian Project. By using the Abecedarian Approach, early childhood professionals can enhance their abilities to provide stable and stimulating interactions with children by engaging them in many rich and varied adult-child interaction activities on a daily basis. The ultimate goal of this educational approach is to facilitate positive child outcomes in areas such as cognitive, social-emotional, communication, and school readiness skills. The evaluation results of the Abecedarian Project demonstrate that early education for at-risk children within a safe, responsive, and stimulating environment can produce positive and long-lasting effects on the course of development. The Abecedarian Project is the only early childhood education program that has demonstrated statistically significant cognitive benefits into young adulthood. The four key elements of the Abecedarian Approach constitute a powerful tool for early childhood professionals to improve the competence and quality of life, particularly for children from low resource environments.