The Centers for Disease Control estimates that approximately 12 million cases of sexually transmitted diseases (STDs) occur annually in the United States. Of these cases, two-thirds are estimated to occur in individuals under the age of 25 (Centers for Disease Control, 1991). Moreover, based on the number of gonorrhea infections in this age group, when compared to all other age groups, it is estimated that one in four sexually active teenagers will contract an STD before graduating from high school (Centers for Disease Control, 1991). Although less than one percent of all AIDS cases reported to date are among adolescents (Centers for Disease Control, 1994), these statistics do not reflect the potentially large pool of undetected HIV infection, as suggested by the epidemic rates of chlamydia, gonorrhea, and syphilis in this group (Centers for Disease Control, 1993).
Preventing STDs, including HIV infection, is a complex process requiring innovative strategies to effect change in knowledge, attitudes, cognitive decision-making skills, and to prevent or reduce risky sexual behaviors associated with disease transmission (Bandura, 1992; Boyer & Kegeles, 1991). To achieve these goals it is imperative that adolescents not only have information about the risk and prevention of STDs, they also must have the skills to resist peer pressure, negotiate the use of condoms, and project the future consequences of their behavior (Boyer & Kegeles, 1991). Moreover, to prevent STDs adolescents must have the means, resources, and social support to develop self-regulative skills (self-motivation and self-guidance) and a strong belief in oneself (self-efficacy) to engage in risk-reduction and health-promoting behaviors (Bandura, 1992). Skills-building programs have been shown to be effective in changing adolescents' risk behaviors associated with smoking (Schinke, Gilchrist, Schilling, & Senechal, 1987; Schinke et al., 1987), sexual activity, STDs, and HIV (Howard, 1985; Hynes & Bruch, 1985; Jemmott, Jemmott, & Fong, 1992; Kipke, Boyer, & Hein, 1993; Rotheram-Borus, Koopman, Haignere, & Davies, 1990).
Although STD/HIV prevention programs should be implemented in a variety of places where adolescents can be reached, school-based programs represent a practical and cost-effective approach. However, many school-based AIDS education programs have utilized only didactic instruction and have focused on knowledge and attitudes about HIV and AIDS (Brown, Fritz, & Barone, 1989; DiClemente et al., 1989; Petosa & Wessinger, 1999; Schinke, Gordon, & Weston, 1990; Ruder, Flam, Flatto, & Curran, 1990). Therefore, in order to extend current school-based education strategies and to draw upon existing skills-building strategies, the present study was undertaken to develop, implement, and evaluate a knowledge- and cognitive-behavioral skills-building intervention to prevent the acquisition and transmission of STDs, including HIV infection in adolescents in an urban public high school setting (see Molbert, Boyer, & Shafer, 1993 for a detailed description of the appropriate steps and mechanisms by which this intervention was implemented in the participating school district). The specific objectives of the intervention were to: (a) increase accurate knowledge regarding STD/HIV transmission, prevention, and personal risk; (b) build decision-making, communication, and problem-solving skills with regard to STD/HIV prevention; and (3) prevent or reduce behaviors associated with STD/HIV transmission.
High school students, primarily ninth graders, were recruited to participate in the intervention study for a number of reasons. The transition from middle school to high school (early and middle adolescence) is marked by the initiation of many risk behaviors, including the onset of sexual activity (Boyer, 1990; Dryfoos, 1990), suggesting that some of these youth may be at risk for STDs/HIV infection. …