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: 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.
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.[36,37]
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]
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.
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.
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.
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.
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).
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