Program Components

• Abstinence education curriculum
• Eight modules, each lasting one hour and implemented across two sessions
• Culturally appropriate, theory-based curriculum tailored to the target population
• Interactive sessions, including group discussions, games, brainstorming, experiential exercises, and skills-building activities
• Activities that address the context of and beliefs about sexual activity
• Educator training

For Use With

• African American students in 6th and 7th grades
• Urban, low-income African American early adolescents

Evaluation Methodology

• Quasi-experimental, randomized controlled trial with five conditions: 1) 12-hour comprehensive program combining abstinence and safer sex interventions (n=131) ; 2) 8-hour hour comprehensive program combining abstinence and safer sex interventions (n=134); 3) 8-hour contraception-only intervention (n=129); 4) abstinence-only intervention (n=134); and 5) health promotion comparison (n=134)
• African American students in grades 6 and 7 (n=662), recruited from 4 public middle schools in the Northeastern United States randomly assigned to one of five conditions
• Baseline assessment and follow-up at 3-, 6-, 12-, 18-, and 24-months post intervention
• Primary outcome analysis of n=649: n=128 in condition #1 (12-hour comprehensive); n=131 in condition #2 (8-hour comprehensive); n=129 in condition #3 (safer sex only); n=132 in condition #4 (abstinence-only); and n=129 in condition #5 (health comparison)

Evaluation Findings

• Students in the abstinence-only group delayed initiation of sex compared to those in the health education group
• Students in the abstinence-only group reported reduced frequency of sex compared to the health education group

Evaluators' Comments: The results of this trial should not be taken to mean that all abstinence-only interventions are efficacious. This trial tested a theory-based abstinence-only intervention that would not meet federal criteria for abstinence programs. It was not vulnerable to many criticisms that have been leveled against interventions that meet federal criteria. It was not moralistic and did not criticize the use of condoms. Moreover, it had several characteristics associated with effective sexual risk reduction interventions. It was theory-based and tailored to the target population based on qualitative data and included skill-building activities. It addressed the context of sexual activity and beliefs about the consequences of sexual involvement derived from the target population.
Source: Jemmott, Jemmott, Fong, 2010

Program Description

This evaluation set out to test the impact of an intervention for 6th and 7th graders that provided information only about abstinence but did not moralize about sex or demonize condoms. Comparison groups included a health-education-only intervention, 2 comprehensive interventions and an intervention that presented information on contraception but not abstinence. The evaluation results published focused mostly on the abstinence-only intervention as compared to the health education intervention. The abstinence-only program is based on social cognitive theory, the theory of reasoned action, and the theory of planned behavior. It includes eight modules, each lasting one hour. The curriculum is interactive and includes group discussions, videos, games, brainstorming, experiential activities, and exercises to build skills. The curriculum encourages abstinence to eliminate the risk of pregnancy and STIs, including HIV. It is designed to increase HIV/STI knowledge and to strengthen behavioral beliefs, including that abstinence can prevent pregnancy, HIV and STIs and that abstinence can foster the attainment of future goals. It builds skills in negotiation and resisting pressure. It is not designed to meet federal abstinence-only criteria, and it does not meet them. For example, the curriculum encourages abstinence from vaginal, anal and oral sex until such time as the adolescent is more prepared to handle the potential consequences of sex. The program is not moralistic; it does not preach abstinence-until-marriage; and it does not denigrate condoms.

Evaluation Methodology

The curriculum was evaluated in a randomized, quasi-experimental controlled trial, conducted among 662 African American middle school students, recruited from four public middle schools serving low-income African American communities in a large, northeastern U.S. city. Students were recruited via announcements in assemblies, classrooms, lunchrooms, and letters to parents or guardians. Eligible participants (n=762) were African American, in grades six or seven, and had written consent to participate from parents or guardians. The study was conducted in four cycles, one at each of the four schools.

Students were stratified by age and sex and randomly allocated to the 8-hour abstinence-only, 8-hour contraception-only, 8-hour comprehensive, 12-hour comprehensive, or 8-hour health comparison condition. They were also randomly assigned to intervention maintenance or no maintenance and to a group of six to eight participants. Of the 662 students randomized to one of the five conditions, 131 were randomly assigned to receive the 12-hour comprehensive program; 134, the 8-hour comprehensive program; 129, the 8-hour contraception-only program; 134, the abstinence-only program; and 134, the health education comparison condition.

Participants were also randomly assigned to receive or not receive an intervention maintenance program tailored to their intervention. It consisted of two 3-hour booster sessions, six issues of a newsletter, and six 20-minute one-on-one counseling sessions during follow-up. Evaluation found no benefit for the maintenance programs.

At baseline, 54 percent of the participants were female. Participants' ages ranged from 10 to 15 years, with a mean of 12.2 years; 45 percent were in grade six; 55 percent, in grade seven. About one-third (34 percent) lived with both parents. About 23 percent reported having experienced coitus at least once; 12 percent reported coitus in the previous three months; six percent reported multiple partners in the previous three months; and three percent reported unprotected intercourse in the previous three months. Among those who reported intercourse in the previous three months, 67 percent reported consistent condom use.

All participants attended session one and 97 percent attended session two. Only the 12-hour comprehensive intervention had a session three and all participants assigned to that intervention attended session three. Of the trial participants, 649 (98 percent) attended at least one of the follow-up assessments and 559 (84 percent) attended the 24-month follow-up assessment. The interventions did not vary significantly in retention at intervention sessions or at follow-up assessments. Attending a follow-up assessment was unrelated to sex, age, sexual behaviors, or living with both parents. Note: evaluators had no information on the 100 students who were eligible to participate but did not. The evaluation did not present information on changes in attitudes or knowledge.

Outcomes of abstinence-only intervention vs. health education group

• Behaviors—
  • Delayed initiation of sex—At 24-month follow-up, abstinence-only intervention participants reported significantly less sexual initiation than did health comparisons (34 versus 49 percent; P=.03).
  • Reduced frequency of sex—Averaged over the 3-, 6-, 12-, 18-, and 24-month follow-ups, sexually active participants in the abstinence-only intervention reported significantly reduced incidence of sex in the previous three months than did their sexually active health comparisions (21 versus 29 percent; P=.02).

Notes:

1) The contraception-only and comprehensive programs did not differ from the comparison group in sexual initiation.
2) Versus comparisons, sexually active participants in the 8-hour comprehensive group and 12-hour comprehensive group were significantly less likely to report having multiple partners (P=.03 and .02, respectively). Sexually active participants in the abstinence-only group did not differ from the control group in reports of multiple partners.
3) Sexually active participants in the abstinence-only group did not differ from comparisons in condom use.

For More Information, Contact

• Loretta Sweet Jemmott, PhD, RN, FAAN, School of Nursing, University of Pennsylvania, 420 Guardian Drive, Philadelphia PA 19104; phone 215.898.6373; email This e-mail address is being protected from spambots. You need JavaScript enabled to view it