Effectiveness of an Adapted HIV/STD Prevention Curriculum: Addressing Risky Sexual Behavior in Academically at-Risk Older Adolescents

Background and Purpose:

While adolescent pregnancy rates have been on the decline in recent years, the U.S. Department of Health and Human Services continues to place an emphasis on reducing unwanted teen pregnancies. Previous studies of the Be Proud! Be Responsible! curriculum demonstrated a reduction in unprotected sex and increased condom use among youth in the program. This study aimed to determine if these program effects could be replicated when modified into a 3-day field trip infused with the curriculum along with components targeted at developing interpersonal skills, connecting with community resources, and educational goal setting. The program targeted older, academically at-risk adolescents in a large suburban school district, a population underrepresented in the literature. The study assessed the impact of participation in the adapted program on participants’ condom use at three, six, and twelve months post-intervention.

Methods:

The research design utilized a longitudinal cohort-based randomized control trial. Participants were age 17 to 19, identified as high risk for dropping out of school, and were participating in academic support services within the local school district. A total of 21 cohorts of youth were included resulting in 1,174 randomized participants (Treatment = 596 and Comparison = 578). Data were collected via online surveys administered in person or through text or e-mail, at four time points (Baseline, 3-months, 6-months, and 12-months post-intervention). Youth received a $20 Walmart gift card for completion of each survey.

An intent-to-treat framework was used to assess program impacts. Impact estimates are the regression-adjusted difference between the average outcomes of youth who were assigned to the intervention program and youth who were assigned to the comparison group. Only impact estimates with p-values less than 0.05 were considered statistically significant and provided support that behavioral changes were attributed to the program.

Results:

The results of the impact analysis indicate that participation in the program did not produce significant differences in vaginal intercourse without a condom between treatment and comparison groups at 3 and 12 months post-intervention. In contrast, at the six-month follow-up, 40.4% of the comparison group responded that they did not use a condom during vaginal intercourse, compared to 31.7% of the treatment group. The linear probability model was demonstrated significant differences between groups (p < .05), indicating that youth in the treatment group were less likely to have intercourse without a condom than participants in the comparison group.

Conclusions and Implications:

The results of this study indicate that the adapted version of the Be Proud! Be Responsible! curriculum was not effective at reducing risky sexual behavior initially; however, measureable impacts did occur over time. Findings support the notion that older adolescents likely have established sexual norms, making it more difficult to change overall behaviors suggesting the curriculum may be more effective for a younger population who has not already engaged in sexual activity. Interviews with youth indicate relationship developed with program staff over time were impactful suggesting changes in sexual behaviors may be a result of the combination of curriculum and the person communicating the messages.