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Science and Success, Second Edition: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV and Sexually Transmitted Infections
Full Study Report [pdf]
Executive Summary [html] [pdf]
¡Cuidate!
Program Components
- HIV-prevention curriculum tailored for use with Latino adolescents
- Six one-hour modules, delivered over consecutive days
- Interactive format, including small group discussion, videos, interactive exercises, and activities to build skills
- Salient aspects of Latino culture, including the importance of family and gender role expectations
- Spanish and English versions, led by trained, bilingual facilitators
- Facilitator training highly recommended
For Use With
- Latino youth
- Latino youth whose first language is Spanish
- Urban, high school youth
Evaluation Methodology
- Randomized, controlled trial, including treatment and control youth from three high schools and community-based organizations in Philadelphia, Pennsylvania
- Self-identified Latino youth (n=553 at baseline), divided into treatment (n=263) and control conditions (n=287); pre- and post-tests; and follow-up at three, six, and 12 months post-intervention
Evaluation Findings
- Reduced frequency of sexual intercourse
- Reduced number of sexual partners
- Reduced incidence of unprotected sex
- Increased condom use
Evaluators’ comments: The intervention was tailored to Latino culture, and we found that it had greater effects among Spanish-speaking adolescents on several outcomes. Specifically, Spanish speakers who participated in the HIV risk-reduction intervention had a higher proportion of days of protected sex and more frequent condom use at last sexual intercourse. To our knowledge, this is the first randomized controlled trial to demonstrate greater efficacy of a culturally tailored HIV risk-reduction intervention [in the United States] among people who speak the language of the culture for which it was tailored.
Villarruel, Jemmott, Jemmott, 2007
Program Description
The HIV risk reduction curriculum was culturally adapted from Be Proud! Be Responsible! ¡Cuidate! is based on social cognitive theory and the theories of reasoned action and planned behavior. It incorporates salient aspects of Latino culture, especially the importance of family and gender role expectations. It presents both abstinence and condom use as culturally acceptable and effective ways to prevent STIs, including HIV.[36]
The program’s goals are to: 1) influence attitudes, beliefs, and self-efficacy regarding HIV risk reduction, especially abstinence and condom use; 2) highlight cultural values that support safer sex practices; 3) reframe cultural values that might be perceived as barriers to safer sex; and 4) emphasize how cultural values influence attitudes and beliefs in ways that affect sexual risk behaviors.[36,37]
Youth receive the course over six consecutive days. Bilingual facilitators receive a two-and-a-half day training to deliver ¡Cuidate!, which is available in both Spanish and English. Each version is designed to meet the sexual health education needs of Latino adolescents in their own preferred language.[36,37]
Evaluation Methodology
Latino students were recruited from three northeast Philadelphia high schools and nearby community-based organizations. The study was implemented with a pilot group and five subsequent groups enrolled sequentially across five months. Youth were eligible to participate if they self-identified as Latino, were aged 13 through 18, and provided assent and parental consent. Non-Latino students (n=102) were eligible to participate in the intervention, but were excluded from analysis. Students were asked their language preference and subsequently received the English (n=412) or Spanish (n=141) versions.[36]
Data analysis included 553 self-identified Latinos; 249 were male and 304 were female. Most (85 percent) were Puerto Rican; nearly half (n=249; 45 percent) were born outside the mainland United States. Participants’ mean age was 14.9 years; 87 percent of students were in grades eight through 11. At baseline, 235 (43 percent) reported ever having had sex; the mean age for first sexual intercourse among sexually experienced students was 13.5 years.[36]
Adolescents were randomly assigned to the HIV risk-reduction intervention (participants; n=263) or to a health promotion intervention (controls; n=287) that focused on behaviors related to significant health issues for Latinos, such as cigarette, alcohol, and other drug use. Both the HIV-risk reduction and the health promotion intervention presented Latino cultural values as an important context for positive health behaviors.[36]
At baseline, there was no significant difference between participants and controls in gender, primary language, or age; nor were there significant differences between the two groups in sexual behavior. Forty-one percent of participants (n=106) and 45 percent of controls (n=127) had ever had sex at baseline. Twenty-six percent of participants reported sex in the previous three months as did 29 percent of controls. Twenty-one percent of participants reported having had two or more sexual partners, as did 16 percent of control youth. For condom use, 47 percent of sexually experienced participants and 35 percent of sexually experienced controls reported consistent condom use; 58 and 50 percent, respectively, reported condom use at most recent sex.[36]
Evaluators found little attrition and no significant differences in attrition between participating and control youth. The only significant predictor of attrition was primary language. English speakers were 90 percent more likely to attend a follow-up session than were Spanish speakers (OR=1.91).[36]
Outcomes
- Behaviors—
- Reduced frequency of sexual intercourse—Across follow-up, participants were less likely than control youth to report sexual intercourse in the previous three months (OR, 0.66; 95% CI, 0.46-0.96). Specifically, 26 percent, 28 percent, and 36 percent of participants reported sexual intercourse in the previous three months at three-, six-, and 12- month follow-up, respectively. By comparison, control youth’s percentages were 31, 33, and 41 percent at each follow-up, respectively.[36]
- Reduced number of sex partners—Assessed across 12 months, sexually active adolescents in the HIV risk reduction intervention were less likely than sexually active control youth to report having multiple partners (OR,0.53; 95% percent CI, 0.31-0.90). Although participants were more likely than controls to report having had multiple partners in the previous three months at baseline and at three-month follow-up, this pattern reversed at six- and 12-month follow-up. At baseline, 10 percent of sexually experienced participants reported multiple partners, compared to eight percent of sexually experienced control youth. By six-month follow-up, nine percent of sexually experienced participants and 10 percent of sexually experienced control youth reported having had multiple partners in the previous three months. At 12-month follow-up, the percentages were 11 percent and 17 percent, respectively, for sexually experienced participants and control youth.[36]
- Increased use of condoms—Participants were more likely than control youth to report using condoms consistently (OR,1.91; 95% CI, 1.24-2.93). At baseline and at all follow-up points, significantly larger percentages of sexually active participants than sexually active control youth reported consistent condom use. Forty-seven percent of sexually active participants reported consistent condom use at baseline; 43 percent at three months, 45 percent at six months, and 42 percent at 12-month follow-up. By comparison, 35 percent of sexually experienced participants reported consistent use at baseline; 26 percent at three months; 29 percent at six months; and 28 percent at 12 months. In addition, Spanish speaking participants had a higher proportion of protected sex than did Spanish speaking control youth (mean difference, 0.35; p<.01).[36]
- Condom use at most recent sex—Among Spanish speaking adolescents, the odds of having used a condom at most recent sexual intercourse where nearly five times higher for participants than for control youth (OR, 4.73; 95% CI, 1.72-12.97).[36]
- Reduced incidence of unprotected sex—Sexually active participants were less likely than sexually active control youth to report days of unprotected sex (relative risk, 0.47; 95% CI, 0.26-0.84). Among adolescents who were sexually inexperienced at baseline, participants had fewer days than control youth of unprotected sex (relative risk, 0.22; 95% CI, 0.08-0.63).[36]
For More Information, Contact
- Susan S. Witte at Columbia University, Room 813, 1255 Amsterdam Avenue, New York, New York 10027; Phone 202-851-2394; e-mail SSW12@columbia.edu
Source/Citation:
Alford S. Science and Success, Second Edition: Sex Education and Other Programs That Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Washington, DC: Advocates for Youth, 2008.
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