| It's Your Game: Keep it Real |
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Program Components
For Use With
Evaluation Methodology
Evaluation Findings
Evaluators' Comments: This study is the first trial, to our knowledge, demonstrating that a middle school-based HIV, STI, and pregnancy prevention intervention can delay overall sexual behavior ... and can have an impact on specific sexual behaviors. Subgroup analysis revealed differential effects by gender and race/ethnicity. In particular, the intervention delayed overall sexual behavior as well as oral and anal sex among females... Students who were sexually active at baseline (9 percent), in the fall of seventh grade, represent particularly high risk populations with respect to health outcomes. Program DescriptionThe curriculum is based on social cognitive theory, social influence models, and the theory of triadic influence. It's Your Game: Keep It Real consists of 12 lessons taught during seventh grade and 12 lessons taught during eighth grade. Each lesson is 45 minutes in length and delivered by trained facilitators. The program integrates group-based classroom lessons with personal journaling and individualized activities delivered on a laptop computer. The curriculum also incorporates a life skills decision-making paradigm that assists students to: 1) select personal limits on risk behaviors; 2) detect situations that might challenge these limits; and 3) use refusal skills and other tactics to protect their chosen limits. Topics covered during seventh grade include: 1) characteristics of healthy friendships; 2) setting personal limits and practicing refusal skills in regard to alcohol and drug use, skipping school, and cheating; and 3) setting personal limits and practicing refusal skills in regard to sexual behaviors. The eighth grade curriculum reviews these topics and adds the following topics: 1) the characteristics of healthy dating relationships; 2) the importance of HIV, STI, and pregnancy testing for sexually active people; and 3) skills training in using condoms and contraception. Other components include six parent-child homework activities at each grade level and individualized computer activities. The parent-child homework activities facilitate conversation on such topics as friendship qualities, dating, and sexual behavior. The laptop educational activities target determinants of sexual risk-taking and are individually tailored to the gender and sexual experience of each middle school student. The computer component includes a virtual world, educational activities, and 'real world' teen stories. Online student feedback encourages later group discussion in the classroom. Evaluation MethodologyThe evaluation was carried out using a quasi-experimental, randomized, controlled trial design, conducted in 10 urban, Texas middle schools serving low-income youth. Researchers and school district officials worked together to identify 13 representative middle schools in seven feeder patterns across the school district. Researchers decided to exclude one school that had less than 500 students. The remaining 12 schools were invited to participate; two declined. As a result, 10 schools were randomly assigned to intervention or comparison condition. At baseline, there were no significant differences between intervention and comparison youth. All schools had a high percentage (over 90 percent) of students who received free or reduced-cost lunches, so poverty was not a factor in the randomization process. At baseline, 60 percent of intervention participants and 58 percent of comparisons were female. By race/ethnicity, 48 percent of intervention youth and 39 percent of comparisons were African American; 43 percent of intervention youth and 45 percent of comparisons were Latino; 10 percent of intervention and 16 percent of comparison youth were of other race/ethnicity. The mean age of intervention youth was 13.1; that of comparisons was 13.0. Forty-four percent of intervention youth lived with both biological parents as did 49 percent of comparison youth. Forty-seven percent of intervention youth reported making mostly As and Bs in school as did 54 percent of comparison youth. In analysis, the set of covariates included in each model varied from outcome to outcome. Intervention students received the IYG curriculum in 7th and 8th grade; comparison students received their regular health classes, which varied by school. All students received the assigned curriculum (IYG or health control); but parental consent was necessary for participating in the follow-up surveys and the evaluation. Students received $5.00 for returning a signed parental consent form. Those who returned the form also received $10.00 as an incentive for participating in the survey at the end of 7th grade and again at the end of 8th grade. Because the intervention was multi-year and school-wide, the study cohort included only those students who had completed a baseline survey and were still enrolled at their original, randomized school at the time of the 8th grade survey (n=981; n=382 intervention students; n=599 comparisons). The sample size imbalance between intervention and comparison conditions was not associated with recruitment or consent procedures as these were performed prior to randomization. For ninth grade follow-up, students were tracked and located in more than 50 different high schools across several school districts. Of the 981 students in the 8th grade cohort, 58 were lost to follow-up; and 16 refused to participate. Thus, the 9th grade cohort included 349 intervention participants and 558 comparisons, for a final assessment of 907 students. Outcomes
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