Research and Resources

Annotated Bibliography of HIV/STD Prevention – Family Life Education Research

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Allen, J.P., Philliber, S., Herrling, S., & Kuperminc, G.P. (1997). Preventing teen pregnancy and academic failure: Experimental evaluation of a developmentally based approach. Child Development, 64(4), 729–742.

A true experimental evaluation was conducted of a national volunteer service program, Teen Outreach, that was designed to prevent adolescent problem behaviors by enhancing normative processes of social development in high school students. This evaluation addressed 2 problem behaviors in adolescence–teenage pregnancy and school failure–for which experimental evidence about successful prevention programs has been largely lacking. High School students (N = 695) in 25 sites nationwide were randomly assigned to either a Teen Outreach or Control group and were assessed at both program entry and at program exit 9 months later. Rates of pregnancy, school failure, and academic suspension at exit were substantially lower in the Teen Outreach group, even after accounting for student sociodemographic characteristics and entry differences between groups. Results are interpreted as suggesting the potential value both of the Teen Outreach Program specifically and also more generally of interventions that seek to prevent problem behaviors by addressing broad developmental tasks of adolescence rather than by focusing upon individual problem behaviors or micro-skills.

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Baldwin, J.A., Rolf, J.E., Johnson, J., Bowers, J., Benally, C., & Trotter, R.T. (1996). Developing culturally sensitive HIV/AIDS and substance abuse prevention curricula for Native American youth. Journal of School Health, 66(9), 322–327.

In 1990, researchers and health care professionals joined with members of several southwestern Native American communities to form an HIV/AIDS and substance abuse prevention partnership. Culturally sensitive approaches to theory-based interventions were developed into highly replicable, structured, school-based and community-based intervention programs. Process evaluations indicated high levels of program acceptance and fidelity. Outcome evaluations demonstrated significant positive preventive intervention effects among participants. This article reports how NAPPASA school prevention ;curricula were developed and discusses three critical processes in developing these successful curricula: 1) selection of integrative theory to address the multi-dimensional antecedents of HIV/AIDS and substance abuse among Native Americans, 2) use of ethnographic methodology to obtain intensive input from target groups and community members to ensure cultural and developmental sensitivity in the curriculum and 3) use of process and outcome evaluations of pilot and field trials to develop an optimal curriculum.

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Brock, G., & Beazley, R. (1995) Using the health belief model to explain parents participation in adolescents at-home sexuality education activities. Journal of School Health, 65(4), 124–128.

The Health Belief Model (HBM) was used to study parents involvement in six at-home sexuality education activities for 9th grade students. These activities are part of Skills for Healthy Relationships: A Program about Sexuality, AIDS, and Other STD (SHR). Some 216 parents, 62% of the population, completed and returned a self-administered questionnaire. Perceived barriers correlated most strongly with lack of parents involvement in SHR. Additionally, perceived barriers and perceived self-efficacy were the most significant factors differentiating parents involved in SHR at-home activities from those who were uninvolved. Compared with highly involved parents, noninvolved parents were: 1) less confident their children wanted to do the activities with them, 2) less sure of their children’s desire to talk with them about sex-related issues, and 3) less certain their AIDS-related facts were current. Parents highly involved in SHR reported becoming more comfortable talking with their adolescents about STDs and felt their children talked a little more openly with them about AIDS and STDs. In contrast, uninvolved parents reported no changes relative to communicating with their children about sexuality. For these reasons, SHR‘s inclusion of at-home activities shows promise for increasing parent-adolescent communication about sexuality.

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Cagampang, H.H., Barth, R.P., Korpi, M., & Kirby, D. (1997). Education Now and Babies Later (ENABL): Life history of a campaign to postpone sexual involvement. Family Planning Perspectives, 29(3), 109–114.

Education Now and Babies Later (ENABL), a statewide adolescent pregnancy prevention initiative, was inaugurated in California in June 1992. Developed by the states Office of Family Planning, ENABL utilized a five-session intervention curriculum, Postponing Sexual Involvement (PSI), targeted at delaying the onset of sexual activity among youths aged 12–14. Schoolwide and community-based activities, along with a statewide media and public relations campaign, reinforced the interventions message. Data collected from nearly 9,000 surveys, 75 individual interviews and 50 focus groups indicated that youths, parents and community representatives supported the initiative and endorsed its message, although most recommended changes to the curriculum. However, because no impact on sexual behavior could be demonstrated, the campaign was abruptly terminated in February 1996, despite recommendations that the program be retained and improved.

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Collins, C. (1997). Dangerous inhibitions: How America is letting AIDS become an epidemic of the young. San Francisco: Center for AIDS Prevention Studies (CAPS), University of California, San Francisco.

This monograph summarizes the research on HIV/AIDS prevention efforts targeting youth. The report summarizes recent demographic trends in the epidemic, sexual and risk behaviors of youth, risk factors, cognitive patterns of youth that impact risk behaviors, prevention strategies, limitations and failures of prevention programs, and recommended strategies. Each section is well documented with current research, yet extremely readable. The document ends with a call to action and specific action recommendations for relevant institutions: public and private education, government, the private sector, and the research community.

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Coyle, K., Kirby, D., Parcel, G., Basen-Engquist, K., Banspach, S., Rugg, D., & Weil, M. (1996). Safer Choices: A multicomponent school-based HIV/STD and pregnancy prevention program for adolescents. Journal of School Health, 66(3), 89–94.

Given the serious consequences of HIV infection, other STDs and pregnancy among teens, professionals must develop and evaluate new approaches to reduce risks associated with adolescent sexual behavior. The Safer Choices intervention is a comprehensive, theoretically based program designed to reduce risk behaviors and increase protective behaviors to prevent HIV, other STDs and pregnancy among high school adolescents. The program includes five components: a School Health Promotion Council involving administrators, school staff, students, parents, and community members; curriculum and staff development activities; school environment activities designed and implemented by a team of peer educators; parent education activities; and school-community linkage activities. The School Health Promotion Council is responsible for planning and overseeing program implementation. This article describes the theoretical framework, process for intervention development, and key intervention strategies used in Safer Choices.

Foley, R., & Dudzinski, M. (1995). Human sexuality education: Are special educators prepared to meet the educational needs of disabled youth? Journal of Sex Education and Therapy, 21(3), 182–191.

An apparent critical educational need for students with mild disabilities is comprehensive sex education. However, few data are available to describe the competencies of special educators to deliver sex education to these youth. The purpose of this study was to replicate a previous study examining the extent that preservice and inservice training activities prepared special educators to deliver sex education and their perceived competence levels. The results indicated that special education personnel receive minimal instruction in the delivery of sex education, yet perceive themselves to have average competence for the delivery of the content. Implications for the results are discussed relative to personnel preparation and research issues.

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Frost, J., & Forrest, J. (1995). Understanding the impact of effective teenage pregnancy prevention programs. Family Planning Perspectives, 188–195.

A review of five rigorously evaluated adolescent pregnancy prevention programs shows that all five incorporate an emphasis on abstinence or delay of sexual initiation, training in decision-making and negotiation skills, and education on sexuality and contraception. Four of the five directly or indirectly provide access to contraceptive services. Comparisons between treatment and control groups show that all four programs that measured changes in rates of sexual initiation among adolescents had a significant effect on that outcome, reducing the proportion of adolescents who initiated sexual activity by as much as 15 percentage points; the programs were most successful when they targeted younger adolescents. Three of these four programs also significantly increased rates of contraceptive use among participants relative to controls; the most successful programs, which increased contraceptive use by as much as 22 percentage points, provided access to contraceptive services and targeted adolescents who were younger and those who were not yet sexually experienced. Two programs significantly decreased the proportion of adolescents who became pregnant; these programs were the two that were most active in providing access to contraceptive services.

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Greydanus, D.E., Pratt, H.D., & Dannison, L.L. (1995). Sexuality education programs for youth: Current state of affairs and strategies for the future. Journal of Sex Education and Therapy, 21(4), 238–254.

The topic of sexuality education for youth or what society teaches our youth about their sexuality, is a subject of paramount importance. Most states have some form of comprehensive sexuality education managed at the state level. Most American adolescents, adults, educators, and parents support sexuality education in the public schools. This paper reviews the literature on sexuality education for youth and concludes that carefully structured sexuality education programs can modify adolescents sexual behavior and increase adolescents understanding of moral behavior.

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Kirby, D., Korpi, M., Barth, R.P., & Cagampang, H.H. (1997). The impact of the Postponing Sexual Involvement curriculum among youths in California. Family Planning Perspectives, 29(3), 100–108.

Postponing Sexual Involvement (PSI) is a widely implemented middle school curriculum designed to delay the onset of sexual intercourse. In an evaluation of its effectiveness among 7th and 8th graders in California, 10,600 youths from schools and community-based organizations statewide were recruited and participated in randomly assigned intervention or control groups; the curriculum was implemented by either adult or youth leaders. Survey data were collected before the program was implemented, and at three months and 17 months afterward. At three months, small but statistically significant changes were found in fewer than half of the measured attitudes, behaviors and intentions related to sexual activity; at 17 months, none of these significant positive effects of the PSI program had been sustained. At neither follow-up were there significant positive changes in sexual behavior: Youths in treatment and control groups were equally likely to have become sexually active, and youths in treatment groups were not less likely than youths in control groups to report a pregnancy or a sexually transmitted infection. The evaluation suggests that PSI may be too modest in length and scope to have an impact on youths sexual behavior.

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Levy, S.R., Perhats, C., Weeks, K., Handler, A.S., Chenggang, Z., & Flay, B.R. (1995). Impact of a school-based AIDS prevention program on risk and protective behavior for newly sexually active students. Journal of School Health, 65(4), 145–150.

This project assessed the impact of a school-based AIDS prevention program on student participation in sexual risk and protective behaviors such as use of condoms and use of condoms with foam and intention to participate in such behaviors. The paper focuses on students who became sexually active for the first time between the 7th and 8th grade (“changers,” n — 312). The school-based intervention was developed using social cognitive theory and the social influences model of behavior change. Using an experimental, longitudinal design students in both treatment conditions received a 10-lesson classroom program in the 7th grade with a five-lesson booster in the 8th grade, while control students received a 10-lesson classroom program in the 7th grade with a five-lesson booster in the 8th grade, while control students received basic AIDS education (current practice in their districts) in compliance with state mandates. Results indicated classroom programs had an impact on certain protective behaviors and on frequency of sexual activity in the past month. Post-intervention measures also indicated the program affected students intentions to perform specific protective behaviors.

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OHara, P., Messick, B.J., Fichtner, R.R., & Parris, D. (1996). A peer-led AIDS prevention program for students in an alternative school. Journal of School Health, 66(5), 176–182.

School-based programs designed to measure health risk behavior and reduce the risk of sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) infection have not addressed adequately the needs of adolescents outside of mainstream schools. In Florida, these youth represent a sizable proportion of the population and have been shown to be at increased risk for acquiring sexually transmitted diseases and human immunodeficiency virus. This article describes a peer-led STD/HIV intervention for students in a dropout prevention program in Dade County, Florida. Trained peer counselor/educators (PCEs) led schoolwide activities and classroom sessions covering STD/HIV information, community health resources, communication and negotiation skills, and safer sex strategies. Teachers and students rated the PCEs effective in promoting discussion and serving as sources of information about AIDS and community health resources. Pre/post intervention questionnaire results demonstrated an increase in AIDS awareness and discussion among students as well as an increase in condom use. Based on this social influences approach, peer education appears to be a promising health education strategy for students in dropout prevention programs.

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Ogletree, R.J., Rienzo, B.A., Drolet, J.C., & Fetro, J.V. (1995). An assessment of 23 selected school-based sexuality education curricula. Journal of School Health, 65(5), 186–191.

While quality sexuality education curricula are available, those responsible for selecting a curriculum may not feel confident to choose one to meet the needs of their students and community. This paper presents a method to guide in selecting sexuality education curricula as well as results from an evaluation of 23 school-based sexuality education curricula. School administrators, curriculum specialists, health educators, school nurses, teachers, and parents involved in curriculum adoption or development can use the process described to select or develop a sexuality education curriculum to meet the needs of their school and community.

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Robenstine, C. (1995). Providing HIV/AIDS education for African-American high school students. The University of North Carolina Press, 133–141.

This essay discusses HIV/AIDS education for the general adolescent population and addresses, in particular, the epidemics disproportionate impact on African Americans and the subsequent critical need to provide culturally sensitive high school-based education effective for African American adolescents. Given the demographics of HIV/AIDS entering the second decade, and of teenage sexual activity, attention must be paid to the cultural and socioeconomic aspects of HIV/AIDS.

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Sussman, T., & Duffy, M. (1996). Are we forgetting about gay male adolescents in AIDS-related research and prevention? Youth & Society, 27(3), 379–393.

This article addresses the need for more research-derived data on the sexual practices of gay males, 13 to 19 years old, and subsequent fact-based preventive interventions because the number of AIDS cases among this group is rapidly increasing both in the United States and worldwide. The authors provide a comprehensive overview of unsafe sexual behaviors and review the literature on gay male adolescents perceptions regarding safer sex. They also include suggested questionnaire items and discuss implications for counselors and educators.

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Whatley, M.H., & Trudell, B.K. (1993). Teen-Aid: Another problematic sexuality curriculum. Journal of Sex Education and Therapy, 19(4), 251–271.

In 1991, we critically evaluated Sex Respect: The Option of True Sexual Freedom, a prepackaged and controversial sexuality education curriculum being promoted nationally. Taking the issues that we felt made that curriculum problematic for public schools, this paper examines two curricula produced by Teen-Aid. Both Teen-Aid and Sex Respect promote abstinence as the only possible approach to sexuality for teens and the solution to the problems of unplanned teenage pregnancy and sexually transmitted diseases. Though they share agendas, there are differences between the ways curriculum materials are presented. The comparisons, however, indicate that there are few differences in the issues that make them inappropriate for public schools.

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