Abstract
Despite calls for evidence-based HIV/STI prevention programs for youth aged 12 to 14 transitioning to adolescence, few effective programs exist. In a two-group intent-to-treat randomized trial in the Bronx, NY, 397 participants were randomly assigned to Project Prepared or an attention control, TEEN. Participants completed surveys at baseline, 6 months, and 12 months. Prepared had two components, an 11-session program and a 3-week internship. Content covered sexual risk behavior, social cognitions, gender norms, relationships, and resilience. TEEN built communication skills and had the same intensity and structure as Prepared but no sexual content. In both, boys and girls were trained together in mixed groups of ~ 11 teens. Primary outcomes were HIV knowledge, self-efficacy, condom outcome expectancy, and behavioral intentions. Secondary outcomes were relationship expectations and endorsement of risky gender norms. Generalized estimating equation analyses showed youth randomized to Prepared had significant improvements compared to TEEN at T2 in HIV knowledge, sexual self-efficacy, and outcome expectancy for condom use. At T3, there were significant differences favoring Prepared in outcome expectancy for condom use, sexual self-efficacy, and intention for partner communication about HIV/AIDS or STIs. Analyses by gender showed program effects in both boys (intention to talk to a partner about condom use, abstinence self-efficacy, sexual self-efficacy, and condom outcome expectancy) and girls (gender norms, and abstinence outcome expectancy). Prepared effectively reduced risk in young adolescents. ClinicalTrials.gov ID: NCT01880450, Protocol ID: 2008-551
Highlights
Problem of Sexual Risk in Early Adolescents Over half (57%) of US high school students engage in sexual intercourse by the time they graduate (Witwer et al, 2018)
From the literature on adolescent sexual risk behavior and the theories that guide interventions, we identified the content of Project Prepared
The conceptual model guided the main hypotheses, that those randomized to Prepared, compared to the control group, would have improved knowledge and social cognitions; increased recognition of risky gender norms; more resilient attributes; healthier relationship beliefs; and stronger intentions to engage in safer sex behavior
Summary
Problem of Sexual Risk in Early Adolescents Over half (57%) of US high school students engage in sexual intercourse by the time they graduate (Witwer et al, 2018). The intervention provided the tools and resources young people would need to guide choices in their future sexual behavior These were (1) knowledge about sexuality, how STIs are transmitted, and pregnancy prevention; (2) strategies to reduce risk (e.g., condom use and contraception, refusal skills, condom use negotiation); (3) cognitions (e.g., self-efficacy) to assure confidence in using risk reduction strategies; (4) understanding of gender norms and how they influence sexual behavior; (5) understanding of how relationship factors and power differentials influence behavior and skills in partner. The conceptual model guided the main hypotheses, that those randomized to Prepared, compared to the control group, would have improved knowledge and social cognitions; increased recognition of risky gender norms; more resilient attributes; healthier relationship beliefs; and stronger intentions to engage in safer sex behavior (abstinence, talking to partners about HIV/AIDS, condom use)
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