Mobilizing Urban Community Members to Ensure Poverty-Impacted Youth Have Access to Evidence-Based Prevention Programs: The Champions Approach

Purpose and Background: Adolescents of color impacted by poverty are at heightened risk for engaging in high risk sexual and drug taking behavior, which potentially lead to compromised educational attainment, substance abuse, early pregnancy, and exposure to sexually transmitted diseases, including HIV infection.  In response, prevention scientists have developed a number of evidence-based prevention programs targeting poverty-impacted youth.  While such evidence-based intervention materials are available to communities and service delivery systems, funding to deliver evidence-based prevention is extremely scarce, limiting the ability to disseminate these materials.  Consequently, low-cost approaches that tap existing resources, such as community members, to deliver services for young people are critical.  Results from an ongoing NIMH-funded effectiveness/implementation study (R01 MH 069934) will be presented which reports on outcomes associated with an approach to prepare and engage community members to become prevention resources for adolescents in their community, referred to as CHAMPions.  We hypothesized that youth would be more likely to participate and complete the CHAMPions program, as well as evidence improved risk-taking and mental health outcomes, relative to similar services delivered by public health service providers.

Methods:  Outcomes associated with CHAMPions training of urban community parents to deliver an evidence-based prevention program aimed at reducing sexual and drug risk taking behaviors and improving mental health of early adolescents was examined via an experimental study involving 178 community HIV educators and 602 youth (ages 11-14) within urban low-income neighborhoods.  Youth participants were recruited via a community-based participatory sampling strategy with random selections of students drawn from community-identified schools and randomly assigned by classrooms to one of two study conditions:  1) an evidence-based prevention program delivered by trained/supervised CHAMPions community HIV educators or; 2) the same program delivered by public health service providers.  Outcomes related to community penetration, as well as youth risk taking behavior and mental health were captured via standardized assessments at three time points, baseline, post-intervention (8 weeks) and 3 month follow-up (5 months from baseline). Random regression modeling was used to examine multi-level outcomes across time.

Results: Within the CHAMPions experimental condition, community HIV educators were able to recruit the expected sample of 400 youth and had three times as many youth finish the program relative to the comparison condition (227 vs. 61 youth). Compared to youth in the comparison condition, youth participants in CHAMPions also reported a significant increase in knowledge about pregnancy and HIV/AIDS and STDs, knowledge about pregnancy, intention to abstain from sex, and increased youth’s comfort in discussing sexual concerns with a boyfriend or girlfriend from baseline to first follow-up assessment (3 months).  In addition, CHAMPions youth reported an increased tolerance toward peers with AIDS and an increase in self esteem across three month time period, compared to youth in the comparison group.

Implications: With resources supporting youth-focused prevention efforts diminishing within communities where they may be needed the most, there is a need for new, low-cost, public health resources that can penetrate communities and deliver high impact programs.  Community members may be an important and thus far, overlooked resource.