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/STI prevention curriculum
• Six sessions, each lasting one hour, delivered on consecutive days
• Experiential activities included to build skills in refusal as well as in risk assessment and risk reduction
• Educator training recommended

For Use With

• High school students
• Urban youth
• Multiethnic populations – black and Hispanic youth and also white and Asian youth

Evaluation Methodology

• A quasi-experimental design, including treatment and comparison conditions, in four high schools in New York, New York
• Urban youth (n=1,201 at baseline; n=867 at follow-up); mean age 15.7
• Pretest and follow-up survey at three months post-intervention

Evaluation Findings

• Increased monogamy
• Reduced number of high risk sexual partners
• Increased condom use
• Long-term: Reduced incidence of STIs

Evaluators' comments: [This] special, theoretically and empirically based HIV/AIDS preventive curriculum was feasible to implement on a large scale in an inner-city school system, was acceptable to key constituent groups, and was associated with favorable changes in students' involvement in sexual…risk behaviors.
Source: Walter and Vaughan, 1993

Program Description

This school-based, teacher-delivered curriculum for urban high school students seeks to increase knowledge about HIV and AIDS, build skills to recognize and prevent behaviors that put youth at risk of HIV infection, and encourage youth to make healthy decisions. Based on three theories of health behavior change (the health belief model, social cognitive theory, and a model of social influence), the curriculum emphasizes delaying the initiation of sex and, among youth who choose to have sex, consistently using condoms. The program uses role-playing and other experiential activities to enhance students' confidence and their ability to avoid risky situations. The overall goal of the program is to prevent unprotected sexual intercourse.[3]

The curriculum comprises six hour-long lessons, implemented on consecutive days.

The first two lessons focus on conveying correct information about HIV transmission and prevention, including:

• Teaching students to accurately appraise their risk of HIV infection;
• Fostering appropriate concern about HIV infection, based on youth's individual risk behaviors; and
• Directing students to HIV prevention resources within the school and community.

The next two lessons focus on:

• Correcting students' misperceptions regarding their peers' HIV risk behaviors;
• Helping students clarify their individual values; and
• Empowering students, via role-playing, with negotiation skills to delay the initiation of sexual intercourse.
  The final two lessons focus on:
• Empowering students with skills to negotiate condom use; and
• Giving youth the skills to obtain and use condoms correctly when they become sexually active.

Teachers receive an eight-hour in-service training prior to implementing this curriculum, which is also suitable for use in community-based organizations.[3]

Evaluation Methodology

The study population consisted of ninth and 11th grade students (n=1,201) enrolled in required general education courses in four academic high schools in New York City. The four schools were selected on the basis of their combined demographic representation of the total population of schools in the borough and were grouped into two pairs of schools. Thirty percent of ninth grade classrooms in the first two schools were randomly selected to receive the HIV prevention curriculum. Twenty percent of ninth grade classes in the second pair of schools were randomly selected as comparison classes and received no formal HIV prevention education. At the same time, 30 percent of 11th grade classrooms in the second pair of schools received the intervention, while 20 percent of 11th grade classes in the first pair of schools acted as comparisons.[3]

In evaluation, participating (n=667) and comparison (n=534) students were mostly female (59 percent). Youth were mostly black (37 percent) or Hispanic (35 percent); the remaining 28 percent of youth were mostly non-Hispanic white or Asian. The mean age of students was 15.7. Forty-eight percent were in ninth grade and 52 percent, in 11th grade. At baseline, one-third of students reported having had sex in the past three months. Among these sexually experienced students: over half reported inconsistently or never using condoms; one-fifth reported two or more sexual partners; and one in 20 reported having a high risk[*] sexual partner.[3]

At baseline, 11th graders reported more risk factors (i.e., inconsistent or no use of condoms, multiple sexual partners, sex with high-risk partners, or diagnosis with an STI) than did ninth graders; males reported more risk factors than females; and blacks reported more risk factors than whites, Asians, or Hispanics. When assessed against the comparison group at baseline, a higher percentage of students in the intervention group were older, male, black or Hispanic, and held more unfavorable beliefs about the benefits of preventive action. The program's effectiveness was assessed at three-months post-intervention, when 71 percent of intervention youth and 73 percent of comparison youth completed the follow-up assessment.[3]

Outcomes

• Knowledge—Evaluation showed that participants' net change in knowledge regarding HIV transmission was significantly greater than that of comparison students.[3]
• Attitudes and perceptions—Participants' net change in attitudes related to risk reduction and self-efficacy[**] was significantly greater than comparisons' net change in attitudes. Significant, favorable net change was observed in the participants' beliefs about their susceptibility to HIV, attitudes about the benefits of using condoms, and self-efficacy related to condom use.[3]
• Behaviors[***]—
  • Increased monogamy—A significantly greater percentage of intervention than comparison youth reported behaviors baseline to follow-up that included initiating or continuing monogamy (approximately 23 and 16 percent, respectively).[3]
  • Reduced number of high risk sexual partners—A significantly smaller percentage of intervention participants than comparison youth reported having high-risk sexual partners between baseline and follow-up (approximately two and eight percent, respectively).[3]
  • Increased condom use—A significantly greater percentage of intervention participants than comparison youth reported consistent condom use from baseline to follow-up (approximately six and three percent, respectively).[3]
  • Timing of sexual initiation unaffected—The program had no significant impact on delaying the initiation of sex.[3]

Long-Term Impact

• Reduced incidence of STIs—The intervention appeared to be associated with a favorable trend in incidence of STIs.[3]

For More Information or to Order, Contact

• Sociometrics, Program Archive on Sexuality, Health & Adolescence: Phone, 1.800.846.3475; Fax, 1.650.949.3299; E-mail, This e-mail address is being protected from spambots. You need JavaScript enabled to view it ; Web, http://www.socio.com

* A high risk sexual partner was one who injected, inhaled, or smoked drugs.
** Self-efficacy means a belief in one’s own ability to perform a task or get a desired result.
*** Effects did not vary significantly by students’ age, race /ethnicity, or gender.