Safer Choices: A Multicomponent School-Based HIV/STD and Pregnancy Prevention Program for Adolescents
Coyle, Karin, Kirby, Douglas, Parcel, Guy, Basen-Engquist, Karen, Banspach, Stephen, Rugg, Deborah, Weil, Marsha, Journal of School Health
The human immunodeficiency virus (HIV) which causes AIDS has led to an epidemic unparalleled in recent history. In the United States, an estimated 630,000 to 900,000 people currently are infected with HIV. As of October 31, 1995, 501,310 cases of AIDS had been reported to the Centers for Disease Control and Prevention (CDC). Other sexually transmitted diseases (STDs) also present an increasing health threat. Some STDs such as chlamydia produce few symptoms yet lead to serious consequences such as infertility. Other STDs increase a person's risk of contracting HIV.
In the battle against the spread of HIV and other STDs, youth represent an important target group. Although relatively few reported AIDS cases have occurred among adolescents, approximately 20% of cases exist among individuals in their twenties, many of whom probably were infected as adolescents. Furthermore, approximately 3 million teens acquire an STD each year, a rate equivalent to roughly one in eight youth ages 13-19 or one in four teens who have had sexual intercourse. Likewise, unintended teen pregnancy represents yet another consequence of unprotected sexual intercourse. In 1990, there were approximately 835,000 pregnancies among teen-agers, ages 1519. Most of the pregnancies produce a negative impact on the mothers' subsequent education and employment.
Not all teens engage in risk behaviors, but a significant proportion practice behaviors that place them at risk for HIV infection, other STDs, and pregnancy. Approximately 56% of females and 73% of males have had intercourse before their 18th birthday. Also, 37.6% of high school youth reported having sexual intercourse in the past three months. Of these, only 52.8% reported using a condom the last time they had sexual intercourse.
Evidence suggests school-based prevention programs can reduce unprotected sexual intercourse among teens.[10,11] Effective school-based prevention programs have been documented in other health areas as well.[12,13] Despite these successes, effect sizes for reducing risk-taking behavior are relatively small, and some evaluations had methodological limitations. Given the consequences of HIV infection, other STDs, and unintended pregnancy, the field must build on what has been learned thus far, and test new programs using rigorous evaluations.
This paper describes the theoretical framework and key intervention components of Safer Choices, an innovative multicomponent program being tested in 20 schools in Texas and California. It also describes a systematic process for intervention development, which can enable practitioners to apply theory more effectively.
OVERVIEW OF SAFER CHOICES
The Safer Choices project seeks to develop and evaluate the effectiveness of a school-based intervention to reduce risk behaviors or increase protective behaviors to prevent HIV infection, other STDs, and pregnancy in students ages 14-18. Safer Choices includes five primary components: school organization, curriculum and staff development, peer resources and school environment, parent education, and school-community linkages.
The primary purpose of Safer Choices is to reduce the number of students engaging in unprotected sexual intercourse by reducing the number of students who begin or have sexual intercourse during their high school years, and by increasing condom use among those students who have sex. Secondary purposes include reducing the number of students who have multiple sexual partners or who use drugs, particularly injectable drugs, and increasing the number of students who seek HIV/STD counseling, testing, and consultation, of those students whose past or current behavior place them at risk for HIV/STD infection.
THE INTERVENTION FRAMEWORK
Theoretical and Conceptual Foundations
Safer Choices uses a multicomponent approach that addresses change at the student, school, and community levels. …