|Community-Level HIV Prevention for Adolescents in Low-Income Developments|
Science and Success, Second Edition: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV and Sexually Transmitted Infections
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Evaluators’ comments: This multi-component, community intervention implemented with adolescents living in low-income housing developments shows considerable promise and produced substantial effects, both in relation to age of sexual debut over time and also in condom use for sexually active adolescents… Among sexually active adolescents in the sample, the skills training component presented in both treatment conditions increased use of condoms at last intercourse. The effect of the community-level intervention was apparent in the continued abstinence rates of teens not sexually active at baseline.
This intervention relies on two major components:
The workshop component is modeled on three evaluated and highly effective programs: 1) Be Proud! Be Responsible!; 2) Adolescents Living Safely: AIDS Awareness, Attitudes, and Actions; and 3) Becoming a Responsible Teen (all described elsewhere in this document). The workshop is led by two trained facilitators in two three-hour sessions, held one week apart. Tailored workshops are conducted separately for males and females who are also divided by age: 12 through 14 years and 15 through 17 years. Content of the workshops focuses on HIV and STI education and on interactive work to build skills in avoiding and/or refusing unwanted sex, negotiating and communicating regarding safer sex or abstinence, and using condoms. The activities are integrated with themes of personal pride and self-respect, especially as they relate to risk avoidance.
The community-level intervention follows the workshop. This portion of the program includes four distinct components:
The research was conducted between 1998 and 2000 in 15 low-income housing developments in Milwaukee and Racine, Wisconsin; Roanoke, Virginia; and Seattle and Tacoma, Washington. Sets of three housing developments, generally similar in size and the ethnicity of residents, were identified in each of the five urban areas. Each development had between 56 and 350 adolescents ages 12 through 17. All developments were located in urban areas with high rates of poverty, STIs, and drug use. In each city, chosen developments were at least two miles apart to minimize the possibility of cross-contamination of the sites.
All households containing adolescents of the right age were informed about the study. Researchers contacted parents or guardians and obtained their consent for the teens to participate; adolescents also gave their own assent to participate. Each adolescent received $20 upon completion of the assessment form. A total of 1,172 adolescents (85 percent of all adolescents living in the housing developments) completed surveys at baseline.
Of the 27 percent of adolescents in the study cohort who reported having had sex at baseline (n=316), 76 percent reported using a condom at most recent sex. In the year preceding baseline, sexually active adolescents reported an average of nearly four sex partners. Eleven percent (n=37) reported anal intercourse while nine percent (n=25) reported having had an STI. Less than one percent (0.5; n=5) reported using injection drugs in the three months prior to baseline.
Following baseline data collection, each development was randomly assigned to the community + workshop intervention, the workshop-only intervention, or the education-only control condition. As such, 392 adolescents were assigned to the community + workshop treatment condition; 428 to the workshop-only condition; and 352 to the control education condition. At the final follow-up, participants included: n=237 in the community + workshop condition; n=274 in the workshop-only condition; and n=252 control youth.
Adolescents who reported never having had sex at baseline (n=841; 73 percent) and who completed follow-up surveys constituted the cohort for evaluating intervention effects on continued abstinence. Of these, 644 (77 percent) returned for short-term follow-up; 580 (69 percent) returned for long-term follow-up. Of all adolescents completing the short-term follow-up, 276 (32 percent) were sexually active; of all adolescents completing the long-term follow-up 282 (37 percent) were sexually active. These sexually active youth comprised the study cohort used to analyze intervention effects on condom use.
Among the 1,172 adolescents who completed baseline surveys, 587 were male; 585 were female. Participants averaged 14.5 years and were mostly African American (51 percent), followed by Asian (20 percent), East African (10 percent), white (10 percent), Hispanic (three percent), and Native American (one percent). Five percent of participants indicated ‘other’ race/ethnicity. Compared to adolescents who did not complete short-term follow-up, the study cohort was slightly younger (by about one-half year) and lived longer in the developments. They were also less likely than those that didn’t complete the short-term follow-up to have had sexual intercourse (25 versus 34 percent); to have had an STI (one versus six percent); or to have used tobacco (12 versus 23 percent), alcohol (14 versus 23 percent), or illegal drugs (10 versus 17 percent). These difference were also evident in the long-term follow-up. Attrition did not differ across study condition.
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