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Making Proud Choices! Print

Science and Success, Second Edition: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV and Sexually Transmitted Infections

Full Study Report [HTML] [PDF]
Executive Summary [HTML] [PDF]

Program Components

  • HIV prevention curriculum emphasizing safer sex, including information about both abstinence and condoms
  • Eight culturally appropriate sessions, each lasting 60 minutes
  • Experiential activities included to build skills to delay initiating sex and to communicate with partners and, among sexually active youth, to use condoms
  • Educator training recommended

For Use With

  • African American youth, ages 11 to 13
  • Middle school students / sixth and seventh graders
  • Urban youth

Evaluation Methodology

  • Experimental design, including a randomized, controlled trial in Philadelphia, Pennsylvania
  • Urban, African American youth in sixth and seventh grades (n=659 at baseline; n=610 at 12-month follow-up); mean age 11.8
  • Pretest and follow-up after three, six, and 12 months
  • Participants received monetary incentives for completing surveys

Evaluation Findings

  • Delayed initiation of sexual intercourse
  • Reduced frequency of sex
  • Reduced incidence of unprotected sex
  • Increased condom use

Evaluators' comments: Our findings that the safer sex intervention curbed unprotected sexual intercourse, whereas the abstinence intervention did not, suggests that if the goal is reduction of unprotected sexual intercourse, the safer sex strategy may hold the most promise, particularly with those adolescents who are already sexually experienced. Moreover, safer sex interventions may have longer lasting effects than abstinence interventions.
Source: Jemmott, Jemmott, Fong, 1998

Program Description

This HIV risk reduction curriculum for urban, African American youth, ages 11 to 13, acknowledges that abstinence is the best choice. But it also emphasizes the importance of condoms to reduce the risk of pregnancy and STIs, including HIV, if participants choose to have sex. The intervention is based on social cognitive theory and the theories of reasoned action and of planned behavior.[37]

The intervention consists of eight, one-hour modules. Designed to be educational, entertaining, and culturally sensitive, Making Proud Choices! involves group discussion, videos, games, brainstorming, experiential exercises, and activities to build skills. The curriculum also incorporates themes from Be Proud! Be Responsible!, encouraging participants to take pride in themselves and their community, to behave responsibly for their own sake and for the sake of their community, and to consider their goals for the future and how unhealthy behavior might thwart those goals.[38]

Evaluation Methodology

Making Proud Choices! emphasizes the importance of condoms to reduce the risk of pregnancy and STIs, including HIV. In evaluation, it was tested against two other programs: 1) a similarly structured, abstinence-focused curriculum that emphasized abstinence but also acknowledged that condoms can reduce risk for HIV and other STIs; and 2) another health curriculum unrelated to sexuality.[38]

Participants (n=659) were African American adolescents (mean age 11.8 years), recruited from sixth and seventh grade classes of three middle schools serving low-income, African American communities in Philadelphia, Pennsylvania. About 53 percent were female; 27 percent of the youth lived with both parents. On the pre-intervention questionnaire, 25 percent of respondents reported ever having had sexual intercourse and 15 percent, having had sex in the previous three months. Less than two percent of respondents reported same-gender sexual relationships.[38]

Adolescents were paid up to $100 for participating: $40 at the end of the two-session interview and an additional $20 for each of three follow-up interviews. Adult facilitators were 25 African Americans (mean age 39.5), skilled in working with adolescents and trained for 2.5 days in the intervention to which they had been randomly assigned. Peer facilitators were 45 Philadelphia high school students (mean age 15.6 years) who had a three-day intensive leadership training retreat on basic facilitation skills. The effectiveness of the interventions was measured at three-, six-, and 12-month follow-up.[38]

Outcomes

  • Knowledge—Evaluation showed that participants in both the abstinence-focused and the safer sex curricula increased their HIV prevention knowledge significantly more than did control youth. In addition, youth in the safer sex intervention scored significantly higher in knowledge of HIV prevention than did the youth in the abstinence-focused intervention. Adolescents in the safer sex intervention also scored significantly higher on condom use knowledge compared to youth in the abstinence-focused or health promotion (control) programs.[38]
  • Attitudes
    • Findings showed that both abstinence-focused and safer sex intervention participants increased significantly more than control youth in their belief in their ability to choose abstinence.[38]
    • Adolescents in the abstinence-focused intervention believed more strongly that practicing abstinence would prevent pregnancy and expressed less favorable attitudes toward sexual intercourse, compared to those in the safer sex or control groups.[38]
    • Adolescents in the safer sex intervention scored significantly higher on attitudes about condoms and in confidence that they could acquire and use condoms, compared to abstinence-focused or control groups.[38]
  • Behaviors—
    • Delayed initiation of sexual intercourse—Among youth who had never had sex at the time of the intervention, abstinence-focused intervention participants were significantly less likely than were control youth to report having sex in the three months after the intervention (odds ration = 0.26). They were marginally less likely to report having initiated sex than were safer sex intervention participants (odds ration = 0.32). Safer sex intervention participants were also less likely than control youth to report having initiated sex. But, at six- and 12- month follow-up, abstinence-focused youth were not significantly less likely to report having had sex than were control youth (17.2 versus 22.7 percent at six-month follow-up; 20.0 versus 23.1 percent at 12-month follow-up) and marginally less likely to report having initiated sex than the safer sex intervention participants.[38]
    • Reduced frequency of sex—Among youth who reported sexual experience at baseline, the safer sex intervention group reported less sexual intercourse in the previous three months at both six- and 12-month follow-up than did either control or abstinence-focused intervention participants (adjusted mean days over the prior three months, 1.34 versus 3.77 for control youth and 3.03 for abstinence-focused youth).[38]
    • Reduced incidence of unprotected sex—Among youth who had reported sexual experience at baseline, the safer sex intervention group reported significantly less unprotected intercourse than did controls at six- and 12-month follow-up. (adjusted mean days, 0.04 versus 1.85, respectively). The intervention had no significant effect on unprotected sexual intercourse among participants who had never had sex at baseline.[38]
    • Increased condom use—Among sexually experienced youth, safer sex intervention participants reported significantly more consistent condom use than did control youth at three months follow-up (odds ratio=3.38) or abstinence-focused intervention participants (odds ratio=3.01) and higher frequency of condom use at all follow-up points.[38]

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