Using the PRECEDE Model to Determine Junior High School Students'' Knowledge, Attitudes, and Beliefs about AIDS

The effectiveness of a one-period school-based AIDS education program on an adolescent population of seventh and eighth grade students (N = 585) was determined. An instrument based on the PRECEDE model was used to assess program effectiveness. Three-way analysis of variance indicated significant differences (p v .01) between pretest to posttest scores for knowledge, attitude, and beliefs for those who received the program versus those who did not by grade and gender of students. The intervention group scored significantly higher than the comparison group on knowledge gain for both seventh and eighth grade students and for males and females. On attitude items, a significant increase occurred from pretest to posttest for eighth grade students who received the program, but not for seventh grade students. The experimental group of eighth grade students scored higher on the attitudes component than the comparison of eighth grade students on the posttest. When attitudes were examined by gender for females in the educational intervention, an increase occurred in attitude scores from pretest to posttest. While belief scores increased significantly from pretest to posttest for the experimental seventh and eighth grade students, significant increases occurred only for experimental group females. Findings support the contention that a one-class period AIDS education program can affect more than just knowledge since attitudes and beliefs also were partially affected.     

Long-term reductions in sexual initiation and sexual activity among urban middle schoolers in the reach for health service learning program.

PURPOSE: To evaluate the sustained effectiveness of a middle school service learning intervention on reducing sexual initiation and recent sex among urban African-American and Latino adolescents from 7th grade through the 10th grade. METHODS: During the fall of seventh grade and again in eighth grade, students were randomly assigned by classroom to participate either in community youth service (CYS) or not (controls). Service learning is an educational strategy that couples meaningful service in the community with classroom instruction. Students in both intervention and control conditions received classroom health lessons. Surveys were conducted at seventh grade baseline and at the end of 10th grade, approximately 2 years after intervention. Self-reported sexual behaviors of youths who had participated in CYS were compared with those of controls receiving classroom curriculum alone (n = 195). RESULTS: CYS participants were significantly less likely than controls to report sexual initiation (2 years CYS, odds ratio [OR] = 0.32; 1 year, OR = 0.49) as well as recent sex (2 years CYS, OR = 0.39; 1 year CYS, OR = 0.48). Among those who were virgins at seventh grade, 80% of males in the curriculum-only condition had initiated sex, compared with 61.5% who received 1 year of CYS, and 50% who received 2 years. Among females, the figures were 65.2%, 48.3%, and 39.6%, respectively. CONCLUSION: A service learning intervention that combines community involvement with health instruction can have a long-term benefit by reducing sexual risk taking among urban adolescents.     

Perceptions regarding preventive sexual practices and communication with sexual partners among Chinese college students

PURPOSE: To assess the relation between Chinese college students' perceptions and attitudes regarding preventive sexual behaviors, their sexual knowledge, and their use of protective sexual behaviors. METHODS: A subsample of 133 sexually active college students (18-25 years old) was obtained to identify factors related to protective sexual behaviors (e.g., knowledge of partner's sexual history, condom use). RESULTS: Seventy-five percent of the sexually active students were male. Significantly more females had discussed AIDS and sexually transmitted diseases (STDs) issues with their partners and had asked their partners about their sexual histories than males. Students endorsing the use of preventive behaviors were more likely to have discussed AIDS issues with their partners, used condoms, and known their partner's sexual history. CONCLUSIONS: Student perceptions about preventive behaviors have a significant impact on their knowledge of their sexual partners and their own sexual behaviors. These findings, as well as the presence of significant gender differences in perceptions and communications with their partners, have major implications for risk reduction programs.     

Impact of a school-based AIDS prevention program on young adolescents' self-efficacy skills

This paper examines the impact of a school-based AIDS preventionprogram on enhancing AIDS/STD-related self-efficacy and preventionpractices among young teenage students. The 15 participatingschool districts are located in a large metropolitan area inthe Midwest and were recruited from 45 districts likely to beat greatest risk for high prevalence of the human immunodeficiencyvirus. Districts were randomly assigned to either the treatmentor the delayed treatment/control group. The intervention, whichconsisted of a 15-session curriculum taught in seventh and eighthgrades by trained health educators, was delivered to 2318 students.It was designed to enhance AIDS-related self-efficacy, behavioralintentions and prevention practices through behavioral skillstraining. We measured two types of self-efficacy: (1) use self-efficacy,defined as students' perceived ability to obtain and use protectivecontraceptive products, and (2) refusal self-efficacy, definedas students' perceived ability to refuse to engage in high-riskbehaviors. Results indicate that there were significant changesin some types of self-efficacy and intentions to adopt preventionpractices in the treatment group. Specifically, the interventionhad a significant effect on students' self-efficacy to buy contraceptivefoam from stores, to obtain condoms and foam from clinics, andintentions to use condoms and foam together.     

Postponing sexual intercourse among urban junior high school students-a randomized controlled evaluation.

PURPOSE: To describe a randomized, controlled evaluation of a school-based intervention to delay sexual intercourse among urban junior high school students. METHODS: Six Washington, D.C., junior high schools were randomly assigned to the intervention or nonintervention control condition for an educational program. During the first school year, seventh graders (n = 582) from the six schools obtained written parental consent to participate. Three health professionals (one per intervention school) implemented the program, which consisted of reproductive health classes, the Postponing Sexual Involvement Curriculum, health risk screening, and "booster" educational activities during the following (eighth grade) school year. Cross-sectional surveys were administered at baseline, the end of the seventh grade, and the beginning and end of the eighth grade. Intervention and control group differences in virginity, attitudes toward delayed sex and childbearing, and sexual knowledge and behavior were assessed at all four time points. RESULTS: At baseline, 44% of the seventh grade males and 81% of the seventh grade females reported being virgins. At the end of the seventh grade (first follow-up), after controlling for baseline study group differences, intervention-group females were more likely to report virginity, self-efficacy to refuse sex with a boyfriend, and the intention to avoid sexual involvement during the following 6 months. At the end of the eighth grade, significantly more intervention- than control-group females reported virginity, birth control use at last intercourse (for nonvirgins), and knowledge of adolescent reproductive health and confidentiality rights. No changes in virginity, self-efficacy to refuse sex, or sexual intent for the next 6 months were observed among male participants at any time during the study. However, on all three follow-up surveys, intervention-group males scored significantly higher than their control-group counterparts in knowledge of birth control method efficacy. No change in attitudes toward abstinence was observed for either gender at any follow-up point. CONCLUSIONS: Gender differences in baseline sexual activity rates and in various study outcomes suggest a possible need for separate, gender-specific intervention activities that can adequately address the social and cognitive needs of both sexes.     

Evaluation of a school-based intervention for HIV/AIDS prevention among Belizean adolescents

The purpose of this study was to evaluate the impact of a cognitive-behavioral peer-facilitated school-based HIV/AIDS education program on knowledge, attitudes and behavior among primary and secondary students in Belize. Students (N = 150) were recruited from six schools in Belize City. A quasi-experimental research design was used to assess the impact of a 3-month intervention. Seventy-five students received the intervention and 75 students served as controls. The intervention was guided by constructs from the Theory of Reasoned Action and Social Cognitive Theory. At the follow-up assessment, the intervention group showed higher HIV knowledge, were more likely to report condom use, had more positive attitudes toward condoms and were more likely to report future intentions to use condoms than the students in the control group. Overall, the findings indicate that the intervention had a positive impact on participants. Given the increasing rate of HIV/AIDS in Belize, especially among adolescents, this study has important implications for the country of Belize.     

Impact of the Nutrition for Life Program on Junior High Students in New York State

School-based nutrition education represents an important component in a national strategy for health promotion. This study evaluated the impact of a school-based nutrition teaching program, Nutrition For Life, on the nutrition knowledge, attitudes, and self-reported behavior of seventh and eighth grade students from New York State. Some 1,863 students in 103 randomly selected classes completed a paper and pencil test covering nutrition attitudes, behavior, and knowledge. Modest use of the teaching program (median use = 3 hours) was associated with modest but significant differences in nutrition attitude, behavior, and knowledge scores. Interactions among teacher assignment, nutrition teaching, and Nutrition For Life use explained significant variations in nutrition test scores. Additional exposure to the program was associated with significantly higher nutrition attitude and behavior scores in schools with a higher proportion of low-income students.     

Free Condoms in the Schools of Copenhagen, Denmark

Attitudes of ninth grade students and their classroom teachers toward using condoms as a preventive measure against contracting AIDS were studied. Students (N = 438) and their teachers (N = 28) in the council schools of the Municipality of Copenhagen were surveyed using a structured questionnaire. Overall, results demonstrated that the message regarding "safe sex" had been well understood. However, 42% of pupils reported not using a condom during their last sexual intercourse. Many pupils indicated difficulty in using condoms. A continuing need exists for advice to the young. An information campaign, with distribution of free condoms, was well accepted by pupils and teachers. Almost all (94%) pupils indicated they will use condoms more frequently in the future. This campaign differed from other efforts that focused more on general information. The importance of other strategies designed to alter behavior to reduce the risk of contracting AIDS is discussed.     

AIDS/HIV knowledge level and perceived chance of having HIV among rural adolescents.

Behaviors that increase the risk of acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) among adolescents living in rural areas have been reported to be as frequent as those of lower socioeconomic minority youth living in large urban areas. Little is known, however, about whether rural adolescents possess adequate knowledge upon which to make responsible decisions to avoid exposure to HIV. In order to address this deficit, we administered the Centers for Disease Control (CDC) 1989 Secondary School Health Risk Survey to 294 sixth, seventh, and eighth grade students (30.2% sample) from a rural county with significant social problems including epidemic sexually transmitted diseases STDs, sex-for-drugs, poverty, and drug abuse. The sample was 65% African-American, 50% female, with a mean age of 12.9 +/- 1.3 years. Although 68% reported having received school-based AIDS education, a lower proportion (greater than or equal to 10%) the students were found to correctly answer 8 of 17 AIDS/HIV knowledge questions than those from a national comparison group. The mean was 12.8 +/- 3.1 of 17 items answered correct. Lower AIDS/HIV knowledge was associated with lower school grade (rho = 0.46, p less than or equal to 0.0001); being African-American, Hispanic, or Native American (p less than or equal to 0.043); and never receiving school-based AIDS/HIV education (p less than or equal to 0.0001). Based on multivariate analysis of variance (ANOVA), only school-based AIDS/HIV education was a significant predictor (p less than or equal to 0.0001) of knowledge.(ABSTRACT TRUNCATED AT 250 WORDS)     

Project Towards No Tobacco Use: implementation, process and post-test knowledge evaluation

This paper describes the curricula contents, and presents data to evaluate the implementation, process and immediate post-test knowledge of Project Towards No Tobacco Use (Project TNT). Four different school-based tobacco use prevention curricula were developed to counteract the effects of three types of tobacco use acquisition variables typically addressed within a comprehensive social influences program: (1) peer approval for using tobacco (normative social influence), (2) incorrect social informational provided about tobacco use (information social influence) and (3) lack of knowledge or misperceptions about physical consequences resulting from tobacco use. Three curricula were designed to counteract the effects of single acquisition variables, whereas a fourth curriculum was designed to counteract the effects of combined social and physical consequences-related influences. These curricula were delivered to seventh grade students by trained project health educators to maximize implementation. 'Program' schools, those schools that received one of these curricula, were compared to 'control' schools that provided asystematic health education delivered by school personnel. A total of five conditions were contrasted through use of a randomized experiment involving 48 southern California junior high schools. This paper documents high levels of implementation in all program conditions. Also, favorable process ratings were obtained across the four program conditions, using multiple measures and sources of ratings (students, health educators and classroom teachers who observed curricula delivery). Finally, knowledge item sets completed by the students demonstrated discriminant validity across all five conditions. Because the program conditions were discriminable, yet were quite similar in implementation and process ratings, planned future study of behavioral outcomes can be interpreted as relatively uncontaminated by delivery or credibility confounds.     

The effectiveness of the Reach for Health Community Youth Service learning program in reducing early and unprotected sex among urban middle school students.

OBJECTIVES: This study evaluated the effectiveness of a community youth service (CYS) program in reducing sexual risk behaviors among African American and Latino urban young adolescents. METHODS: A total of 1061 students at 2 urban middle schools were surveyed at baseline and 6-month follow-up. Students at one school were randomly assigned by classroom to receive either the Reach for Health CYS program or the Reach for Health classroom curriculum only. Students at the other school served as controls. RESULTS: At follow-up. CYS participants reported significantly less recent sexual activity (P < .05) and scored lower on a sexual activity index than those in the control condition (P < .03). The greatest effect was among eighth graders, who received the most intensive service program (P < .03). The benefit of the curriculum-only intervention appeared greatest among students in special education classes. CONCLUSIONS: Well-organized CYS that couples community involvement with classroom health instruction can have a positive impact on the sexual behaviors of young adolescents at risk for HIV, sexually transmitted diseases, and unintended pregnancy. This study also suggests the importance of including students in special education classes in health education programs.     

Self-efficacy, hedonistic expectancies, and condom-use intentions among inner-city black adolescent women: a social cognitive approach to AIDS risk behavior.

The effects on condom-use intentions of an acquired immune deficiency syndrome (AIDS) prevention intervention based on social cognitive theory were investigated among 19 sexually active black adolescent women recruited from an inner-city family planning clinic. The women received the social cognitive intervention designed to increase perceived self-efficacy and favorable outcome expectancies about the hedonistic consequences of using condoms or one of two control interventions: An information-alone intervention designed to increase AIDS knowledge or a general health-promotion intervention designed to provide information about important health problems other than AIDS. All interventions lasted 105 min and involved films and small-group exercises. Participants' evaluations did not differ among conditions. As hypothesized, analysis of covariance indicated that participants in the social cognitive condition reported greater intentions to use condoms than did those in the two control conditions. In addition, participants in the social cognitive condition scored higher in perceived self-efficacy and favorable hedonistic expectancies--the two hypothesized mediators of the intervention effect. Although participants who received the information-alone intervention subsequently had greater AIDS knowledge than did those in the health promotion condition, they did not express greater intentions to use condoms. These results highlight the value of a social cognitive approach to AIDS risk behavior: outcome expectancies regarding the effects of precautionary practices on sexual enjoyment and perceived self-efficacy to implement such practices play an important role in decisions about condom use.     

Six school-based clinics: their reproductive health services and impact on sexual behavior

An evaluation of the reproductive health programs of six diverse school-based clinics measured the impact of the clinics on sexual behavior and contraceptive use. All six clinics served low-income populations; at five of them, the great majority of the students served were black. An analysis of student visits by type of care given found that these clinics were not primarily family planning facilities; rather, they provided reproductive health care as one component of a comprehensive health program. Student survey data collected in the clinic schools and nearby comparison schools (four sites) or collected both before the clinic opened and two years later (two sites) indicated that the clinics neither hastened the onset of sexual activity nor increased its frequency. The clinics had varying effects on contraceptive use. Providing contraceptives on site was not enough to significantly increase their use; in only one of the three sites that did so were students in the clinic school significantly more likely than students in the comparison school to have used birth control during last intercourse. However, condom use rose sharply at one clinic school that had a strong AIDS education program and was located in a community where AIDS was a salient issue. At another clinic school, where pregnancy prevention was a high priority and staff issued vouchers for contraceptives, the use of condoms and pills was significantly higher than in the comparison school. A third clinic school--which focused on high-risk youth, emphasized pregnancy prevention and dispensed birth control pills--recorded a significantly higher use of pills than its comparison school. Although the data suggest that the clinics probably prevented small numbers of pregnancies at some schools, none of the clinics had a statistically significant effect on school-wide pregnancy rates.     

Affective and social influences approaches to the prevention of multiple substance abuse among seventh grade students: results from project SMART

Two drug abuse prevention curricula were tested to determine their efficacy in preventing the onset of tobacco, alcohol, and marijuana use among adolescents. The first program focused on prevention through social pressure resistance training. The second featured affective education approaches to prevention. Curricula were tested on seventh grade students. Subjects were pretested just prior to the program and were post-tested at 12 and 24 months. Post-test analyses indicated that the social program delivered to seventh grade subjects was effective in delaying the onset of tobacco, alcohol, and marijuana use. No preventive effect of the affective education program was observed. By the final post-test, classrooms that had received the affective program had significantly more drug use than controls.     

Effects of a School-Based Drug Abuse Prevention Program for Adolescents on HIV Risk Behavior in Young Adulthood

Early onset of substance use among adolescents has been found to be associated with later risky sexual behaviors. This study examined long-term follow-up data from a large randomized school-based drug prevention trial to (1) investigate the long-term impact of the prevention program on drug use and sexual behaviors that put one at elevated risk for HIV infection; and (2) use growth modeling procedures to examine potential mechanisms of intervention effects. Self-report survey data were collected from students in the 7th grade, prior to the intervention in 1985, and in grades 8, 9, 10, and 12. Participants in the intervention condition received a 30-session drug prevention program in 7th through 9th grades. Follow-up surveys were completed by 2042 young adults (mean age = 24) in 1998. As young adults, participants were considered to be engaging in high-risk behavior for HIV infection if they reported having multiple sex partners, having intercourse when drunk or very high, and recent high-risk substance use. The intervention had a direct protective effect on HIV risk behavior in the overall sample in young adulthood. Furthermore, among participants receiving 60% or more of the prevention program, analyses showed that the intervention significantly reduced growth in alcohol and marijuana intoxication over the course of adolescence, which in turn was associated with a reduction in later HIV risk behavior. The behavioral effects of competence-enhancement drug prevention programs can extend to risk behaviors including those that put one at risk for HIV infection.     

Studies find school condom programs don't promote sex

A recent study conducted in Philadelphia high schools found that school-based condom programs do not encourage sexual activity. Philadelphia high schools have made condoms available through a comprehensive school-based health resource center. Sixty-four percent of students questioned at the health centers reported engaging in sex; the same number as students in schools that lack health centers and condom access programs. In Massachusetts, the availability of condoms in schools also did not lead to increased sexual activity. A study comparing condom use before and after the program found a 43 percent increase in condom use in sexually active students. No study has conclusively shown that making contraceptives available to teens leads to increased sexual activity, according to the Alan Guttmacher Institute.     

Impact of HealthWise South Africa on polydrug use and high-risk sexual behavior

This study was designed to evaluate the efficacy of the HealthWise South Africa HIV and substance abuse prevention program at impacting adolescents' polydrug use and sexual risk behaviors. HealthWise is a school-based intervention designed to promote social-emotional skills, increase knowledge and refusal skills relevant to substance use and sexual behaviors, and encourage healthy free time activities. Four intervention schools in one township near Cape Town, South Africa were matched to five comparison schools (N = 4040). The sample included equal numbers of male and female participants (Mean age = 14.0). Multiple regression was used to assess the impact of HealthWise on the outcomes of interest. Findings suggest that among virgins at baseline (beginning of eighth grade) who had sex by Wave 5 (beginning of 10th grade), HealthWise youth were less likely than comparison youth to engage in two or more risk behaviors at last sex. Additionally, HealthWise was effective at slowing the onset of frequent polydrug use among non-users at baseline and slowing the increase in this outcome among all participants. Program effects were not found for lifetime sexual activity, condomless sex refusal and past-month polydrug use. These findings suggest that HealthWise is a promising approach to HIV and substance abuse prevention.     

School-based HIV/AIDS education,risky sexual behaviors,and HIV testing among high school students in the United States

This study assessed the practical value of HIV/AIDS education among at-risk adolescents in the United States. Data were drawn from the 2013 Youth Risk Behavior Surveillance System spanning students in grades 9-12 who have engaged in sexual intercourse. A multivariate hierarchical logistic regression analysis was employed to test: (1) the individual effects of school-based HIV/AIDS education and risky sexual behaviors on the probability of HIV testing and (2) the interaction effects to estimate the degree to which the education effect varied by specific risky sexual behavior. The results indicated that students who engaged in risky sexual activities and received HIV/AIDS education were more likely to test for HIV compared to those who did not receive HIV/AIDS education. The relationship between education and HIV testing also varied according to the number of recent sexual partners. The findings have policy and practice implications. Specifically, HIV/AIDS education that promotes HIV testing should be encouraged particularly with the high-risk student population.     

Sexual Behaviors of Middle School Students: 2009 Youth Risk Behavior Survey Results From 16 Locations

BACKGROUND: The potential negative consequences of engaging in sexual risk behaviors at a young age are well documented. Unfortunately, there is a dearth of information about the prevalence of sexual behaviors among middle school students. This article provides an overview of the sexual risk behaviors of middle school students from 16 districts and states throughout the country, and examines these risks by demographic variables. METHODS: In 2009, 10 states and 6 districts administered the Youth Risk Behavior Survey‐Middle School and included sexual behavior questions. Data were examined using the Centers for Disease Control and Prevention's Youth Online database. Frequencies were run for 4 sexual behaviors and an HIV/AIDS education question for each location. A series of t‐tests were calculated for these 5 items by gender, age, and race for each location. RESULTS: Data show that 5–20% of sixth graders and 14–42% of eighth graders have engaged in sexual intercourse. A concerning percentage of students have also engaged in other sexual risk behaviors and many are not receiving HIV/AIDS education. Additionally, there were significant differences by gender, race, and age. CONCLUSION: Consistent with previous studies, males, minorities, and older students are more likely to engage in sexual risk behaviors. There is also variation in the percentage of students engaging in sexual behaviors across locations. Sexual risk reduction education is important for middle school youth, particularly for minorities, males and those from southern and/or larger, urban cities as those are the populations with generally higher sexual risk behaviors.