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

• Two-year intervention, beginning in the seventh grade
• Three 45-minute classroom sessions on reproductive health, delivered by health professionals to seventh graders and again the next year to eighth graders
• Five 45-minute sessions of Postponing Sexual Involvement for seventh graders, led by trained peer educators in 10th and 11th grades
• Eight brown bag sessions for small groups of eighth grade program participants
• Eighth grade assembly
• Contest for eighth grade participants
• Full-time health professional from outside the school, working in each school
• Individual health risk screening of students

For Use With

• Seventh and eighth grade students
• Urban youth at high risk[*]
• African American and Hispanic youth
• Economically disadvantaged youth

Evaluation Methodology

• Experimental evaluation design, including treatment and control conditions, in six junior high schools in Washington, DC
• Urban seventh graders (n=522 at baseline; n=503 at first follow-up; n=459 at second follow-up; n=422 at final follow-up at the end of eighth grade)
• Surveys at baseline (winter of seventh grade) with follow-up at the end of seventh and beginning of eighth grades and post-intervention follow-up at the end of eighth grade

Evaluation Findings

• Delayed initiation of sexual intercourse – females only
• Increased use of contraception – females only

Evaluators' comments: The study's positive findings in reproductive health knowledge and contraceptive use suggest that recruiting outside health professionals to provide education and outreach in the school setting may be a useful prevention strategy.
Source: Aarons, Jenkins, Raine et al, 2000

Program Description

This pregnancy and HIV/STI prevention intervention combines elements of two evaluated programs: Postponing Sexual Involvement and Self Center.[**] Here, the Postponing Sexual Involvement peer education curriculum is coupled with individual and small group educational methods, adapted from the Self Center, bringing outside health professionals to provide education and assistance to students in school settings. The goal of the program is to delay students' initiation of sexual intercourse. This intervention is based on social cognitive theory.[9]

A full-time health professional serves as the project facilitator and leads three 45-minute classroom sessions for seventh grade classes on reproductive health, including information about abstinence and contraception. These classes are followed by five 45-minute classroom sessions of Postponing Sexual Involvement, led by trained peer educators. The peer educators are 10th and 11th grade students recruited from nearby high schools. Toward the end of the first year of the program, students complete a health risk assessment questionnaire that addresses self-rated health, risk behavior, school performance, physical fitness, social support, and depression. Using a series of questions adapted from GAPS (Guidelines for Adolescent Preventive Services), health professionals conduct individual interviews with students whose questionnaires indicated substance use, physical abuse, sexual activity, and/or emotional problems.[9]

In the fall of the next year, facilitators present the three reproductive health classes again to all eighth grade students. A series of booster activities reinforces the concepts of abstinence and self-care. Booster activities include: brown bag sessions for small, informal groups of no more than 15 students; an eighth grade assembly; and a contest for eighth grade participants, featuring their poetry, artwork, etc. Eight brown bag sessions are offered—one per week, covering a range of adolescent health issues, such as gang violence, drug use, and teen pregnancy. Facilitators speak privately with each student who attends a brown bag session, asking if the student has any questions about the topic or other health related matters. The assembly is presented by health professionals from affiliated clinics. Eighth grade intervention students may also participate in a contest on a topic related to the intervention. Contestants enter poems, songs, essays, drawings, and T-shirt designs.[9]

Evaluation Methodology

A non-probability sample of six schools was selected from among 18 middle and junior high schools in the District of Columbia. Schools were chosen based on their proximity to one of the three adolescent health clinics affiliated with the study. Two schools were selected because of their high enrollment of Hispanic students. Schools were paired according to seventh grade class size, location, and racial / ethnic distribution. Pairs of schools were then randomly assigned to the intervention or control group.[9]

Of 896 seventh graders enrolled in the six schools at the beginning of the study, 522 received parental consent to participate. Of these, 274 were female (52 percent); 85 percent were African American and about 12 percent were Hispanic. Participants' average age at baseline was 12.8 years. Sixty-three percent of youth participated in the free or reduced price school lunch program. Forty-six percent of students lived with both parents and an equal percentage lived with one parent or with one parent and another adult. The intervention was assessed by comparing the answers of intervention participants and control students at baseline (n=522); at the end of the seventh grade (n=503); at the beginning of eighth grade (n=459); and at the end of eighth grade (n=422).[9]

Outcomes

• Knowledge—Participating males had significantly more knowledge of birth control methods and services than did control males at all follow-up times. Participating females had significantly more knowledge than control females only at the end of eighth grade.[9]
• Attitudes and perceptions—
  • At the end of seventh grade, female program participants were significantly more likely than control females to say that they would not have sex in the next six months (57 and 46 percent, respectively).[9]
  • A significantly higher percentage of participating females than control females reported feeling able to refuse sex.[9]
  • Participating males had significantly more positive beliefs about the benefits of delaying childbearing than did control males.[9]
• Behaviors—
  • Delayed initiation of sexual intercourse—In post-intervention surveys, intervention group females had higher virginity rates than did control females. The odds ratios were statistically significant at the end of seventh grade (2.09) and at the end of eighth grade (1.9).[9]
  • Increased use of contraception—At three measurement intervals, sexually active female participants were 3.5 to five times more likely than control females to report using birth control at most recent sex.[9]
  • Behavioral findings relating to young men—The program had no statistically significant impact on sexual behaviors in participating males. Evaluators noted that knowledge gains made by participating males had no impact on their timing of sexual initiation or on their contraceptive use.[9]

For More Information or to Order, Contact

• Renee R. Jenkins, MD, Dept. of Pediatrics and Child Health, Howard University Hospital: 2041 Georgia Avenue NW, Washington, DC 20060
• For Postponing Sexual Involvement— Marian Apomah, Coordinator, Jane Fonda Center; Emory Unversity School of Medicine: Building A Briarcliff Campus, 1256 Briarcliff Road, Atlanta, GA, 30306; Phone, 404.712.4710; Fax, 404.712.8739
• For the Self Center— 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

* For this evaluation, high risk was defined by responses to the health assessment survey, including reports of substance use, physical abuse, sexual activity, and/or emotional problems.
** For more information on these programs, please visit http://www.advocatesforyouth.org/programsthatwork/toc.htm