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

• Clinic-based HIV-risk reduction program
• Culturally specific program
• Gender specific program
• Single 250-minute (four and one-quarter hours) group session
• Interactive exercises, discussions, games, and experiential activities
• 8-hour training for facilitators

For Use With

• Urban African American adolescent females
• Urban adolescent Latinas
• Economically disadvantaged young women

Evaluation Methodology

• Experimental evaluation design with two randomized treatment conditions and one control condition
• Sexually active clients (n=682) at an adolescent medicine clinic randomly assigned to skills-based treatment (n=235), information-based treatment (n=228), and health-promotion control (n=219) conditions
• Baseline data and follow-up at three, six, and 12 months after the intervention
• Participants received reimbursement for participating in baseline and follow-up surveys

Evaluation Findings

• Reduced number of sex partners
• Reduced incidence of unprotected sexual intercourse
• Long-term: Reduced incidence of STIs

Evaluators’ comments: In the present study, the effects of the intervention were significant primarily at 12-month follow-up, not at shorter-term follow-ups. Such a delayed effect has been observed in other prevention trials. One possible explanation for why the magnitude of intervention effects might increase at later follow-ups is that people have difficulty introducing safer-sex practices into existing relationships. As they become involved with new partners over time, they are able to implement those practices. Hence, intervention effects on behavior are larger at longer-term follow-up. … [From the results of this intervention] it cannot be assumed that an intervention developed for one ethnic group will be ineffective with another group.
Jemmott, Jemmott, Braverman et al, 2005

Program Description

The skills-based HIV and STI risk reduction intervention is based in cognitive behavioral theories and formative research. Designed for use in an adolescent medicine clinic that also provides young clients with confidential and free family planning services, the program teaches young women skills necessary to use condoms. In particular, it illustrates correct condom use, and depicts effective condom-use negotiation with a sexual partner. In addition to providing accurate information, it also addresses personal vulnerability and the heightened HIV risk facing young, inner-city Latinas and African American women. It addresses barriers to condom use, including negative beliefs and alcohol and drug use as well as ways to surmount these barriers. Most importantly, the young women practice handling condoms correctly on anatomical models and engage in role plays to increase their partner negotiation skills.[41]

Evaluation Methodology

Evaluators tested the effects of the skills-based intervention in relation to an information-based HIV prevention intervention and to a generalized health promotion intervention. Participants had volunteered for a women’s health project designed to reduce young women’s risk of eventually developing serious health problems like heart disease, cancer, and AIDS. Each was reimbursed up to $120 ($40 for completing the intervention and pre- and post-intervention questionnaires; $25 for the three- and the six-month follow-up; and $30 for the 12-month follow-up). The young women completed a confidential, self-administered questionnaire immediately before and after the intervention and at three, six, and 12 months later. All questionnaires assessed sexual behavior and variables on demographics and conceptual mediators. Biological specimens for STI testing were collected at baseline and at 6- and 12-month follow-up.[41]

Participants were 682 sexually experienced African American (n=463) and Latina (n=219) young women, ages 12 to 19, who were family planning clients at an adolescent medicine clinic within a children’s hospital that served low-income, inner-city youth in Philadelphia PA. Participants were randomly assigned to the skills-based intervention (n=235), to an information-based treatment (n=228), or to a health promotion control condition (n=219). Of all the adolescents (n=1,150) eligible for the study, 59 percent chose to participate, including a greater percentage of eligible African Americans than Latinas (69 versus 46 percent, respectively; P≤.001). Participants were also somewhat younger than non-participants (15.5 versus 16.1 years; P≤.001). Participants and eligible non-participants did not differ in STI prevalence at baseline.[41]

At baseline, 87 percent of respondents reported previous sexual intercourse. About 52 percent reported unprotected sexual intercourse. Sixteen percent reported sexual intercourse with multiple partners in the previous three months. Ten percent of respondents had at least one child. Twenty-two percent tested positive for gonorrhea, chlamydia, or trichomoniasis. Less than one percent reported having same-gender sexual relationships (0.4 percent) or using injection drugs (0.6 percent).[41]

Ninety-eight percent of participants attended at least one follow-up; 94 percent, the 3-month; 93 percent, the six-month; and 89 percent, the 12-month follow-up. There were few significant differences between those who returned for follow-up and those did not. Non-returnees reported more frequent sex at baseline (mean, 3.44 versus 0.40; P≤.001) and more unprotected sex while intoxicated (mean 0.94 versus 0.24; P≤.001); were more likely to be Latina than African American (96 versus 99 percent; P=.04); and were less likely to live with their mother (94 versus 99 percent; P=.001). At follow-up, evaluators found no significant differences between adolescents assigned to the information-based HIV/STI prevention condition and to the health promotion control condition.[41]

Outcomes

• Reduced incidence of unprotected sexual intercourse—By 12-month follow-up, participants in the skills-based intervention reported significantly fewer days in the past three months when they had sex without using a condom, compared to either the information-based or the health promotion condition (2.27 days versus 4.04 [P=.03] and 5.05 [P=.002], respectively). In addition, young women in the skills-based intervention reported significantly fewer days when they had unprotected sex while using drugs or alcohol, compared to those in the health promotion condition (0.1 days versus 0.22 days; P=.02).[41]
• Reduced number of sex partners—By 12-month follow-up, a significantly smaller proportion of participants in the skills-based intervention reported multiple sex partners in the previous three months compared to youth in the health promotion condition (seven percent versus 17 percent, respectively; P=.002).[41]

Long-Term Impact

• Reduced incidence of STIs— By 12-month follow-up, a significantly smaller proportion of participants in the skills-based intervention tested positive for STIs compared to youth in the health promotion condition (mean 11 percent versus 18 percent, respectively; P=.05).41
  
  Note: There were no significant differences in outcomes related to frequency of unprotected sex, number of sex partners, or rates of STIs by intervention at the three- or six-month follow-up.

For More Information, Contact:

• Loretta Sweet Jemmott, PhD, FAAN, RN, School of Nursing, University of Pennsylvania, Room 239 Fagin Hall, 418 Curie Blvd., Philadelphia, Pennsylvania 19104-6096; Phone, 215.898.8287; E-mail, This e-mail address is being protected from spambots. You need JavaScript enabled to view it
  
  There is little replication information available for this program.