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.

A Clinic-Based AIDS Education Program for Female Adolescents

Investigators: Vaughn Rickert, Anita Gottlieb, & Susan Jay

This is a single-session group intervention originally targeted toward sexually active girls between 13 and 21 years of age. The session includes a brief lecture on the transmission and prevention of HIV/AIDS (based on CDC guidelines), followed by a video explaining the purpose and use of condoms. As the session ends, participants receive an educational booklet reinforcing the program's lessons and coupons that may be redeemed anonymously for an unmarked box of condoms at a local pharmacy. The redemption rate of the coupons provides a measure of the program's impact. A field study of the intervention was conducted with 75 White and African-American females, all of whom were sexually active. Among prior purchasers of condoms, girls who took part in the intervention were significantly more likely to redeem the coupons than were control groups of their peers. Overall, 60% of program participants obtained condoms, a rate 2 1/2 times greater than that recorded in comparable programs without a confidential redemption procedure. Click here to view more detailed information on this program.

ASSESS for Adolescent Risk Reduction

Investigators: Bradley O. Boekeloo

The ASSESS program provides tools to enhance risk-reduction communication between health care providers and teens while in a physician's office or clinic setting. A randomized controlled behavioral intervention trial of the program was conducted in the metropolitan Washington, DC area between 1995 and 1997. The trial involved 19 physicians at five primary care pediatric practices, and 215 teens who were randomly assigned to intervention (n=205) or control group (n=114) conditions. Control group teens received their usual health care examination. Intervention group teens listened to an audiotape and answered 11 risk-related questions. The physician used answer sheets, pamphlets, an icebreaker activity and role-playing strategies to encourage risk behavior discussion and practice risk refusal strategies. Participants were interviewed post-checkup to determine how many sexual health topics they had discussed with their provider. Telephone follow-up interviews were conducted at three months and nine months. Study findings showed that more intervention teens reported discussing sexual topics with their physicians than did control group teens. At three-month follow-up, more sexually active intervention group teens reported condom use than control group teens. While more vaginal intercourse was also reported in the intervention group than the control group, this was not true of overall sexual intercourse. At nine months, there were no group differences in sexual behavior; however, more signs of STDs were reported by the control than the intervention group. Click here to view more detailed information on this program.

Queens Hospital Center's Teenage Program

Investigators: Jill M. Rabin & Vicki Seltzer

Based upon the premise that a teen's first pregnancy may stem from underlying, unmet needs, this clinic-based program provides medical care, psychosocial support, and education to the adolescent, her partner, and her family. The comprehensive approach to service emphasizes early intervention, beginning during pregnancy. For the duration of the intervention, each patient and her infant remain with a team of providers: an obstetrician-gynecologist, pediatrician, social worker, and health educator. The program also includes a physician/ practitioner 24 hour "on call" system and a reproductive health and family life education program, featuring bi-weekly classes for the patient, her partner, and family. In an effort to prevent repeat pregnancy and STDs, the teen's partner is encouraged to participate in education, support, and counseling activities. A field study of the intervention was conducted in Queens, New York, with 498 adolescents and their infants. Compared to a control group of teen mothers, program participants were more likely to attend and graduate from school and (for those who were sexually active) use regular contraception; additionally, both they and their infants experienced significantly better health. Moreover, the repeat pregnancy rate was significantly lower for program participants compared to the control group. Click here to view more detailed information on this program.

HORIZONS: STI/HIV Sexual Risk Reduction Intervention for African American Girls

Investigators: Ralph J. DiClemente, Gina M. Wingood, Eve S. Rose, Jessica M Sales, Delia L. Lang, Angela M. Calienda, James W. Hardin & Richard A. Crosby

HORIZONS, a two-session STI-prevention program developed for small groups of sexually-active African American adolescent girls, was developed to address a broad range of risk factors, including personal, relational, sociocultural, and structural factors. The overall goals of the program are to reduce recurrent STIs and enhance STI/HIV preventive behaviors. The workshops are interactive, involving the participants in games, role playing, poetry readings, condom skills practice, and self-reflection activities. HORIZONS was evaluated with a randomized control trial that included two conditions (control and intervention). Data was collected from the subjects at baseline, 6-months and 12-months post-completion of the program. When the program participants were compared to their control group peers, the program participants had, on average, a 35% lower risk of having Chlamydia than the control participants (RR, 0.65; 95% CI, 0.42 to 0.98; P=.04). Overall, participants in the program condition had higher self-reported condom use during sexual activity in the previous 14 days (P=.004) and 60 days (Phere to view more detailed information on this program.

FOCUS: Preventing Sexually Transmitted Infections and Unwanted Pregnancies among Young Women

Investigators: Cherrie Boyer, Mary-Ann Shafer, Lance Pollack, Kelli Betsinger, Y. Jason Yang, Julius Schachter, Richard Shaffer, Stephanie Brodine, Heidi Kraft

The FOCUS program, a four-session cognitive-behavioral group intervention addressing prevention of sexually transmitted infections (STIs) and unintended pregnancies, was originally delivered to young women US Marine Corps recruits. Following a baseline survey, 2,157 women were randomized into either the experimental group (n=1,062) or the control group (n=1,095). Both groups received interventions of four two-hour sessions. Follow-up surveys were conducted with both groups at approximately four months post-baseline and approximately 14 months post-baseline. The evaluation results revealed that a higher proportion of the control group had a post-intervention STI or unintended pregnancy than the intervention group (Odds Ratio = 1.41, 95% Confidence Interval = 1.01-1.98). Among study participants who had no pre-intervention history of STIs or pregnancy, but who engaged in risky sexual behaviors just before recruit training, the control group was significantly more likely to acquire a post-intervention STI than the intervention group (OR = 2.05, CI = 1.74-4.08). Among study participants who reported not being sexually experienced at baseline, control group participants were significantly more likely to have had multiple sexual partners post-intervention than intervention group participants (OR = 1.87, CI = 1.01-3.47). FOCUS 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 been 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: 5th 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 5th Grade product contains all of the materials needed to implement the ABAN AYA 5th 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.

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.

Computer-Assisted Motivational Interviewing (CAMI): Preventing Repeat Births Among Adolescent Mothers

Investigators: Beth Barnet, Jiexin Liu, Margo DeVoe, Anne K. Duggan, Melanie A. Gold, & Edward Pecukonis

According to the Centers for Disease Control and Prevention, in 2010, more than 360,000 infants were born to women aged 15 to 19 years in the United States. Nearly one-quarter of adolescent mothers give birth to another child within two years, despite national efforts to increase timing between births. Adolescent mothers who give birth to more than one child may be at high risk for experiencing poorer medical, educational, economic, and developmental outcomes. The purpose of the Computer-Assisted Motivational Interviewing (CAMI) is to increase motivation among adolescent mothers to consistently use condoms and contraception with the long-term goal of reducing rapid repeat births. CAMI consists of at least two 60-minute sessions conducted in two-parts by trained counselors who meet one-on-one with pregnant and/or parenting adolescent mothers, ages 12 through 18 years old. During the first part of each session, participants use the computer-based CAMI Program to answer questions about current sexual relationships and contraceptive use intentions and behaviors. Based on the responses generated, CAMI counselors conduct a stage-matched motivational interviewing session to enhance participants' motivation to consistently use condoms and contraception in order to reduce the risk for a repeat pregnancy. An evaluation of CAMI has demonstrated that receiving two or more CAMI sessions, either alone or within a multi-component home-based intervention, reduced the risk of repeat births among adolescent mothers aged 18 years and younger. Click here to view more detailed information on this program.

Youth AIDS Prevention Project (YAPP)

Investigators: Susan Levy, Brian Flay, & Arden Handler

Originally designed for African-American youth, YAPP aims to prevent STDs, HIV/AIDS, and substance abuse among high-risk junior high school students. Guiding the program is the social influence model of behavioral change, which targets teens' knowledge, attitudes, intentions, and behaviors regarding high-risk activities. The intervention includes ten sessions for 7th grade students, delivered in regularly scheduled health or science classes, and a five-part booster session offered one year later, when the teens have entered 8th grade. Classes cover transmission and prevention of STDs and HIV/AIDS, the importance of using condoms for those who choose to have sex, and the development of decision-making and resistance/negotiation skills. In addition to lectures and class discussions, active learning is emphasized, with opportunities for students to participate in small group exercises and role plays. There are also homework activities and opportunities for parental involvement. A field study of the intervention was conducted in fifteen high-risk school districts in Chicago. Research focused on the group of students who first became sexually active during the study period. Following the booster session, these students were more likely than a control group of peers to report using condoms with foam; they also expressed greater intention to use condoms with foam in the future. Click here to view more detailed information on this program.