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April 1996, Vol 150, No. 4 >
Article | April 1996

A Randomized, Controlled Effectiveness Trial of an AIDS Prevention Program for Low-Income African-American Youths FREE

Bonita F. Stanton, MD; Xiaoming Li, PhD; Izabel Ricardo, PhD; Jennifer Galbraith, MA; Susan Feigelman, MD; Linda Kaljee, MA
Arch Pediatr Adolesc Med. 1996;150(4):363-372. doi:10.1001/archpedi.1996.02170290029004.
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Background:  Some interventions to reduce the risk of the acquired immunodeficiency syndrome (AIDS) that target youths have resulted in short-term increases in self-reported condom use. However, long-term intervention effects have not been assessed.

Study Question:  Can a theoretically and culturally based, AIDS-risk reduction intervention delivered to naturally formed peer groups increase self-reported condom use among African-American early adolescents at 6 and 12 months of follow-up?

Methods:  A randomized, controlled trial of a community-based intervention delivered in eight weekly sessions involved 76 naturally formed peer groups consisting of 383 (206 intervention and 177 control) African-American youths 9 to 15 years of age. A theory-based, culturally and developmentally tailored instrument that assessed perceptions, intentions, and self-reported sexual behaviors was administered to all subjects at baseline (preintervention) and 6 and 12 months later.

Results:  At baseline, 36% of youths were sexually experienced, and by 12 months of follow-up, 49% were sexually experienced. Self-reported condom use rates were significantly higher among intervention than control youths (85% vs 61%; P<.05) at the 6-month follow-up. However, by 12 months, rates were no longer significantly higher among intervention youths. The intervention impact at 6 months was especially strong among boys (85% vs 57%; P<.05) and among early teens (13 to 15 years old) (95% vs 60%; P<.01). Self-reported condom use intention was also increased among intervention youths at 6 months but not at 12 months. Some perceptions were positively affected at 6 months, but the change did not persist at 12 months.

Conclusions:  High rates of sexual intercourse underscore the urgent need for effective AIDS-risk reduction interventions that target low-income urban, African-American preteens and early teens. A developmentally and culturally tailored intervention based on social-cognitive theory and delivered to naturally formed peer groups recruited from community settings can increase self-reported condom use. The strong short-term improvements in behaviors and intentions followed by some relapse over longer periods argue for a strengthened program and research focus on sustainability.(Arch Pediatr Adolesc Med. 1996;150:363-372)

REFERENCES

1 +
Centers for Disease Control and Prevention.  HIV/AIDS Surveillance Report Prevention . MMWR Morb Mortal Wkly Rep . 1993;;5:10-11.
2 +
Institute of Medicine and National Academy of Sciences. Confronting AIDS: Directions for Public Health, Health Care, and Research . Washington, DC: National Academy Press; 1986;.
3 +
Johnson JA, Sellew JF, Campbell AE, Haskell EG, Gay AA, Bell BJ.  A program using medical students to teach high school students about AIDS . J Med Educ . 1988;;63:522-530.
4 +
DiClemente RJ, Pies CA, Stoller EJ, et al.  Evaluation of school-based AIDS education curricula in San Francisco . J Sex Res . 1989;;26:188-198.
5 +
Schinke SP, Gordon AN, Weston RE.  Self-instruction to prevent HIV infection among African-American and Hispanic-American adolescents . J Consult Clin Psychol . 1990;;58:432-436.
6 +
Jemmott JB III, Jemmott LS, Fong GT.  Reductions in HIV risk-associated sexual behaviors among black male adolescents: effects of an AIDS prevention intervention . Am J Public Health . 1992;;82:372-377.
7 +
Brown LK, Fritz GK, Barone VJ.  The impact of AIDS education on junior and senior high school students . J Adolesc Health Care . 1989;;10:386-392.
8 +
Rickert VI, Jay MS, Gottlieb A.  Effects of a peer-counseled AIDS education program on knowledge, attitudes, and satisfaction of adolescents . J Adolesc Health . 1991;;12:38-43.
9 +
Damond ME, Breuer NL, Pharr AE.  The evaluation of setting and a culturally specific HIV/AIDS curriculum: HIV/AIDS knowledge and behavioral intent of African American adolescents . J Black Psychol . 1993;;19:169-189.
10 +
Rotheram-Borus MJ, Koopman C, Haignere C, Davies M.  Reducing HIV sexual risk behaviors among runaway adolescents . JAMA . 1991;;266:1237-1241.
11 +
Slap GB, Plotkin SL, Khalid N, Michelman DF, Forke CM.  A human immunodeficiency virus peer education program for adolescent females . J Adolesc Health . 1991;;12:434-442.
12 +
Rickert VI, Gottlieb A, Jay MS.  Is AIDS education related to condom acquisition? Clin Pediatr . (April) 1992;:205-210.
13 +
Ponton LE, DiClemente RJ, McKenna S.  An AIDS education and prevention program for hospitalized adolescents . J Am Acad Child Adolesc Psychiatry . 1991;;30:729-734.
14 +
Newman C, DuRant RH, Ashworth CS, Gaillard G.  An evaluation of a school-based AIDS/HIV education program for young adolescents . AIDS Educ Prev . 1993;;5:327-339.
15 +
Rickert VI, Gottlieb A, Jay MS.  A comparison of three clinic-based AIDS education programs on female adolescents' knowledge, attitudes, and behavior . J Adolesc Health Care . 1990;;11:298-303.
16 +
Kipke MD, Boyer C, Hein K.  An evaluation of an AIDS risk reduction education and skills training (ARREST) program . J Adolesc Health . 1993;;14:533-539.
17 +
Stanton B, Kim N, Galbraith J, Parrott M. Design and implementation issues addressed in published evaluations of adolescent AIDS-risk reduction interventions. J Adolesc Health. In press.
18 +
Stanton B, Romer D, Ricardo I, et al.  Early initiation of sex and its lack of association with risk behaviors among adolescent African-Americans . Pediatrics . 1993;;92:13-19.
19 +
Stanton B, Li X, Black M, et al.  Sexual practices and intentions among preadolescent and early adolescent low-income urban African-Americans . Pediatrics . 1994;;93:966-973.
20 +
Romer D, Black M, Ricardo I, et al.  Social influences on the sexual behavior of youth at risk for HIV exposure . Am J Public Health . 1994;;84:977-985.
21 +
DeWit JBF. vandenHoek JAR, Sandfort TGM, vanGriensven GJP.  Increase in unprotected anogenital intercourse among homosexual men . Am J Public Health . 1993;;83:1451-1453.
22 +
Centers for Disease Control and Prevention.  Health risk behaviors among adolescents who do and do not attend school—United States, 1992 . MMWR Morb Mortal Wkly Rep . 1994;;43:129-132.
23 +
Altschuler DM, Brounstein PJ.  Patterns of drug use, drug trafficking, and other delinquency among inner-city adolescent males in Washington, DC . Criminology . 1991;;29:589-622.
24 +
Walter HJ, Vaughan RD.  AIDS risk reduction among a multiethnic sample of urban high school students . JAMA . 1993;;270:725-730.
25 +
Galbraith J, Ricardo I, Stanton B, et al. Challenges and rewards of involving
26 +
community in research: an overview of the 'Focus on Kids' AIDS-prevention program. Health Educ Q. In press.
27 +
Rogers RW.  Cognitive and physiological processes in fear appeals and attitude change: a revised theory of protection motivation . In: Cacioppi T, Petty RE, eds. Social Psychology . New York, NY: Guilford Press; 1983;:153-176.
28 +
Ford RN, Gregory WH, Mariweather J. The MBF Model, A Metaphor of Identity for 'He' My Baby's Father . Baltimore, Md: FAJR Associates; 1993;.
29 +
Rogers EM. Diffusion of Innovations . New York, NY: Free Press; 1983;.
30 +
Billy JO, Udry JR.  The influence of male and female best friends on adolescent behavior . Adolescence . 1985;;20:21-32.
31 +
Stanton B, Black M, Feigelman S, Ricardo I, Galbraith J, Li X.  Development of a culturally, theoretically and developmentally based survey instrument for assessing AIDS . AIDS Educ Prev . 1995;;7:160-177.
32 +
Crowne D, Marlow D. The Approval Motive . New York, NY: John Wiley & Sons Inc; 1964;.
33 +
SPSS Inc. SPSS Advanced Statistics User's Guide . Chicago, III: SPSS Inc; 1990;.
34 +
Nickerson CA, McClelland GH.  Across-persons versus within-persons tests of expectancy-value models: a methodological note . J Behav Decis Making . 1989;; 2:261-270.
35 +
Stanton BF, Li X, Black MM, Ricardo I, Galbraith J, Feigelman S, Kaljee L. Longitudinal stability and predictiveness of sexual perceptions, intentions, and behaviors among early adolescent African-Americans. J Adolesc Health. In press.
36 +
DeAngelis C. An Introduction to Clinical Research . New York, NY: Oxford University Press; 1990;.
37 +
Ellickson PL, Bell RM, McGuigan K.  Preventing adolescent drug use: long-term results of a junior high program . Am J Public Health . 1993;;83:856-861.
38 +
Klepp KL, Halper A, Perry CL.  The efficacy of peer leaders in drug abuse prevention . J Sch Health . 1986;;56:407-411.
39 +
Kelly JA, St Lawrence JS, Diaz YE, et al.  HIV risk behavior reduction following intervention with key opinion leaders of population: an experimental analysis . Am J Public Health . 1991;;81:168-171.
40 +
Price JH, Desmond S, Kukulka G.  High school students' perceptions and misperceptions of AIDS . J Sch Health . 1985;;55:107-109.
41 +
Helgenson SD, Peterson LR, et al.  Acquired immunodeficiency syndrome and secondary school students: their knowledge is limited and they want to learn more . Pediatrics . 1988;;81:350-355.
42 +
Flora JA, Thoresen CE.  Reducing the risk of AIDS in adolescents . Am Psychol . 1988;;43:965-970.
43 +
Brooks-Gunn J, Boyer CB, Hein K.  Preventing HIV infection and AIDS in children and adolescents: behavioral research and intervention strategies . Am Psychol . 1988;;43:958-964.
44 +
Brooks-Gunn J, Furstenberg FF.  Adolescent sexual behavior . Am Psychol . 1989;; 44:249-257.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Centers for Disease Control and Prevention.  HIV/AIDS Surveillance Report Prevention . MMWR Morb Mortal Wkly Rep . 1993;;5:10-11.
2 +
Institute of Medicine and National Academy of Sciences. Confronting AIDS: Directions for Public Health, Health Care, and Research . Washington, DC: National Academy Press; 1986;.
3 +
Johnson JA, Sellew JF, Campbell AE, Haskell EG, Gay AA, Bell BJ.  A program using medical students to teach high school students about AIDS . J Med Educ . 1988;;63:522-530.
4 +
DiClemente RJ, Pies CA, Stoller EJ, et al.  Evaluation of school-based AIDS education curricula in San Francisco . J Sex Res . 1989;;26:188-198.
5 +
Schinke SP, Gordon AN, Weston RE.  Self-instruction to prevent HIV infection among African-American and Hispanic-American adolescents . J Consult Clin Psychol . 1990;;58:432-436.
6 +
Jemmott JB III, Jemmott LS, Fong GT.  Reductions in HIV risk-associated sexual behaviors among black male adolescents: effects of an AIDS prevention intervention . Am J Public Health . 1992;;82:372-377.
7 +
Brown LK, Fritz GK, Barone VJ.  The impact of AIDS education on junior and senior high school students . J Adolesc Health Care . 1989;;10:386-392.
8 +
Rickert VI, Jay MS, Gottlieb A.  Effects of a peer-counseled AIDS education program on knowledge, attitudes, and satisfaction of adolescents . J Adolesc Health . 1991;;12:38-43.
9 +
Damond ME, Breuer NL, Pharr AE.  The evaluation of setting and a culturally specific HIV/AIDS curriculum: HIV/AIDS knowledge and behavioral intent of African American adolescents . J Black Psychol . 1993;;19:169-189.
10 +
Rotheram-Borus MJ, Koopman C, Haignere C, Davies M.  Reducing HIV sexual risk behaviors among runaway adolescents . JAMA . 1991;;266:1237-1241.
11 +
Slap GB, Plotkin SL, Khalid N, Michelman DF, Forke CM.  A human immunodeficiency virus peer education program for adolescent females . J Adolesc Health . 1991;;12:434-442.
12 +
Rickert VI, Gottlieb A, Jay MS.  Is AIDS education related to condom acquisition? Clin Pediatr . (April) 1992;:205-210.
13 +
Ponton LE, DiClemente RJ, McKenna S.  An AIDS education and prevention program for hospitalized adolescents . J Am Acad Child Adolesc Psychiatry . 1991;;30:729-734.
14 +
Newman C, DuRant RH, Ashworth CS, Gaillard G.  An evaluation of a school-based AIDS/HIV education program for young adolescents . AIDS Educ Prev . 1993;;5:327-339.
15 +
Rickert VI, Gottlieb A, Jay MS.  A comparison of three clinic-based AIDS education programs on female adolescents' knowledge, attitudes, and behavior . J Adolesc Health Care . 1990;;11:298-303.
16 +
Kipke MD, Boyer C, Hein K.  An evaluation of an AIDS risk reduction education and skills training (ARREST) program . J Adolesc Health . 1993;;14:533-539.
17 +
Stanton B, Kim N, Galbraith J, Parrott M. Design and implementation issues addressed in published evaluations of adolescent AIDS-risk reduction interventions. J Adolesc Health. In press.
18 +
Stanton B, Romer D, Ricardo I, et al.  Early initiation of sex and its lack of association with risk behaviors among adolescent African-Americans . Pediatrics . 1993;;92:13-19.
19 +
Stanton B, Li X, Black M, et al.  Sexual practices and intentions among preadolescent and early adolescent low-income urban African-Americans . Pediatrics . 1994;;93:966-973.
20 +
Romer D, Black M, Ricardo I, et al.  Social influences on the sexual behavior of youth at risk for HIV exposure . Am J Public Health . 1994;;84:977-985.
21 +
DeWit JBF. vandenHoek JAR, Sandfort TGM, vanGriensven GJP.  Increase in unprotected anogenital intercourse among homosexual men . Am J Public Health . 1993;;83:1451-1453.
22 +
Centers for Disease Control and Prevention.  Health risk behaviors among adolescents who do and do not attend school—United States, 1992 . MMWR Morb Mortal Wkly Rep . 1994;;43:129-132.
23 +
Altschuler DM, Brounstein PJ.  Patterns of drug use, drug trafficking, and other delinquency among inner-city adolescent males in Washington, DC . Criminology . 1991;;29:589-622.
24 +
Walter HJ, Vaughan RD.  AIDS risk reduction among a multiethnic sample of urban high school students . JAMA . 1993;;270:725-730.
25 +
Galbraith J, Ricardo I, Stanton B, et al. Challenges and rewards of involving
26 +
community in research: an overview of the 'Focus on Kids' AIDS-prevention program. Health Educ Q. In press.
27 +
Rogers RW.  Cognitive and physiological processes in fear appeals and attitude change: a revised theory of protection motivation . In: Cacioppi T, Petty RE, eds. Social Psychology . New York, NY: Guilford Press; 1983;:153-176.
28 +
Ford RN, Gregory WH, Mariweather J. The MBF Model, A Metaphor of Identity for 'He' My Baby's Father . Baltimore, Md: FAJR Associates; 1993;.
29 +
Rogers EM. Diffusion of Innovations . New York, NY: Free Press; 1983;.
30 +
Billy JO, Udry JR.  The influence of male and female best friends on adolescent behavior . Adolescence . 1985;;20:21-32.
31 +
Stanton B, Black M, Feigelman S, Ricardo I, Galbraith J, Li X.  Development of a culturally, theoretically and developmentally based survey instrument for assessing AIDS . AIDS Educ Prev . 1995;;7:160-177.
32 +
Crowne D, Marlow D. The Approval Motive . New York, NY: John Wiley & Sons Inc; 1964;.
33 +
SPSS Inc. SPSS Advanced Statistics User's Guide . Chicago, III: SPSS Inc; 1990;.
34 +
Nickerson CA, McClelland GH.  Across-persons versus within-persons tests of expectancy-value models: a methodological note . J Behav Decis Making . 1989;; 2:261-270.
35 +
Stanton BF, Li X, Black MM, Ricardo I, Galbraith J, Feigelman S, Kaljee L. Longitudinal stability and predictiveness of sexual perceptions, intentions, and behaviors among early adolescent African-Americans. J Adolesc Health. In press.
36 +
DeAngelis C. An Introduction to Clinical Research . New York, NY: Oxford University Press; 1990;.
37 +
Ellickson PL, Bell RM, McGuigan K.  Preventing adolescent drug use: long-term results of a junior high program . Am J Public Health . 1993;;83:856-861.
38 +
Klepp KL, Halper A, Perry CL.  The efficacy of peer leaders in drug abuse prevention . J Sch Health . 1986;;56:407-411.
39 +
Kelly JA, St Lawrence JS, Diaz YE, et al.  HIV risk behavior reduction following intervention with key opinion leaders of population: an experimental analysis . Am J Public Health . 1991;;81:168-171.
40 +
Price JH, Desmond S, Kukulka G.  High school students' perceptions and misperceptions of AIDS . J Sch Health . 1985;;55:107-109.
41 +
Helgenson SD, Peterson LR, et al.  Acquired immunodeficiency syndrome and secondary school students: their knowledge is limited and they want to learn more . Pediatrics . 1988;;81:350-355.
42 +
Flora JA, Thoresen CE.  Reducing the risk of AIDS in adolescents . Am Psychol . 1988;;43:965-970.
43 +
Brooks-Gunn J, Boyer CB, Hein K.  Preventing HIV infection and AIDS in children and adolescents: behavioral research and intervention strategies . Am Psychol . 1988;;43:958-964.
44 +
Brooks-Gunn J, Furstenberg FF.  Adolescent sexual behavior . Am Psychol . 1989;; 44:249-257.

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