Be Proud! Be Responsible!

Featured Grant OpportunitySchool Emergency Response to Violence (Project SERV) (Funding Opportunity) 

Featured Grant OpportunityShare with Youth: NOAA Student Opportunities Database

Developers

Loretta Sweet Jemmott, Ph.D., RN, F.A.A.N.; John B. Jemmott III, Ph.D.; and Konstance A. McCaffree, Ph.D.

Program Summary

Be Proud! Be Responsible! is a five hour intervention (delivered in six fifty-minute modules), designed to modify behaviors and build knowledge, understanding, and a sense of responsibility regarding STD/HIV risk in vulnerable youth. The intervention aims to affect knowledge, beliefs, and intentions related to condom use and sexual behaviors such as initiation and frequency of intercourse.

Intended Population

Be Proud! Be Responsible! was designed for diverse populations of youth, ranging in age from 13 to 18 years. The program was evaluated with mostly African American adolescents, ages 11-14.

Program Setting

The program is designed to be implemented in a variety of settings, including schools or youth-serving community-based organizations. It was evaluated in a community-based setting.

Contact and Availability Information

Nancy Gonzalez-Caro, MPH
Evidence-Based Product Specialist
ETR
100 Enterprise Way, Suite G300
Scotts Valley, CA 95066
Phone: 1-800-321-4407
Website: http://www.etr.org/ebi/programs/be-proud-be-responsible/
Cody Sigel, MPH, CHES
Health Education Training Coordinator
ETR
1333 Broadway, Suite P110
Oakland, CA 94612
Phone: 510-858-0995
Website: http://www.etr.org/ebi/programs/be-proud-be-responsible/

Sample of curriculum available for review prior to purchase

Yes

Adaptation guidelines or kit available

Yes

Languages available

English

Program Core Components

Category	Component	Core Component	Component present	Notes	Lesson number(s) / activities where present
Content	School engagement	No	No
Content	Anatomy/physiology	No	No
Content	Other
Content	Volunteering/civic engagement	No	No
Content	Spirituality	No	No
Content	Morals/values	No	Yes (both versions)		Module 1, Activity E (43)
Content	Identity development	No	No
Content	Social support/capital	No	No
Content	Social influence/actual vs. perceived social norms	Yes	Yes (both versions)		Module 1, Activity E (43)
Content	Social competence	No	No
Content	Parenting skills	No	No
Content	Normative beliefs	Yes	Yes (both versions)		Module 1, Activity A (29), Activity E (43)
Content	Leadership	No	No
Content	Gender roles	No	No
Content	Gender identity	No	No
Content	Cultural values	Yes	Yes (both versions)		Module 1, Activity E (43)
Content	Connections with trusted adults	No	No
Content	Conflict resolution/social problem solving	Yes	Yes (both versions)		Module 8, All Activities (116)
Content	Communication skills	Yes	Yes (both versions)		Module 8, All Activities (116)
Content	Child development	No	No
Content	Boundary setting/refusal skills	Yes	Yes (both versions)		Module 8, All Activities (116)
Content	Substance use cessation	No	No
Content	Substance use - Other drugs	No	No
Content	Substance use - Alcohol	No	No
Content	Substance use - Abstinence	No	No
Content	Brain development and substance use	No	No
Content	Vocational/skills training	No	No
Content	Supplemental academic services	No	No
Content	Graduating from high school	No	No
Content	College preparation	No	No
Content	Alternative schooling	No	No
Content	Self-regulation	No	No
Content	Self-esteem	No	No
Content	Self-efficacy/empowerment	Yes	Yes (both versions)		Module 8, All Activities (116)
Content	Resilience	No	No
Content	Risk of STIs and Pregnancy	Yes	Yes (both versions)		Module 1, Activity D (37), Activity E (43); Module 3, All Activities (61), Module 4, All Activities (77)
Content	STIs - Screening	Yes	Yes (both versions)	Only HIV	Module 1, Activity D (37)
Content	STIs - Prevention	Yes	Yes (both versions)		Module 3, Activity C (66); Module 5, All Activities (92)
Content	STIs - Information	No	No	Only HIV
Content	Sexual risk reduction	Yes	Yes (both versions)		Module 1, Activity D (37), Activity E (43); Module 2, Activity C (52); Module 3, All Activities (61); Module 5, All Activities (92)
Content	Sexual risk discontinuation	Yes	Yes (both versions)		Module 1, Activity D (37), Activity E (43); Module 2, Activity C (52); Module 3, All Activities (61)
Content	Sexual risk avoidance	Yes	Yes (current version)		Module 1, Activity D (37), Activity E (43); Module 2, Activity C (52); Module 3, All Activities (61)
Content	Sexual orientation	No	No
Content	Personal vulnerability	Yes	Yes (both versions)		Module 8, All Activities (116)
Content	Contraception - Pills, patches, rings, and shots	No	Optional		Appendix A (209)
Content	Contraception - Condoms	Yes	Yes (both versions)		Module 5, All Activities (92)
Content	Motivational interviewing	No	No
Content	Contraception - Long-acting reversible contraceptives	No	Optional		Appendix A (209)
Content	Contraception - Other	No	Optional		Appendix A (209)
Content	Puberty/development	No	Optional		Appendix A (180)

Program Objectives

Be Proud! Be Responsible! aims to help participants change behaviors that place them at risk for HIV and other STDs, delay the initiation of sex among sexually inexperienced youth, reduce unprotected sex among sexually active youth, and help youth make proud and responsible decisions about their sexual behaviors.

The program seeks to achieve these objectives by:

Increasing participant knowledge about HIV, AIDS and other STDs
Affecting participant beliefs in value of safer sex and abstinence
Increasing confidence in ability to negotiate safer sex and to use condoms correctly, improve condom use and negotiation skills
Improving intentions to practice safer sex

Program Content

Be Proud! Be Responsible! consists of six modules, on the following topics:

Module 1: Introduction to HIV and AIDS
Module 2: Building Knowledge about HIV
Module 3: Understanding Vulnerability to HIV Infection
Module 4: Attitudes and Beliefs about HIV, AIDS, and Safer Sex
Module 5: Building Condom Use Skills
Module 6: Building Negotiation and Refusal Skills

The curriculum's core content consists of:

HIV, etiology, transmission, and prevention
Prevention strategies – negotiation, condom use, problem solving

The six session curriculum addresses the following types of core behavioral beliefs and outcome expectancies:

Goals and Dreams Beliefs: The belief that unprotected sex can interfere with one's goals and dreams for an education and career. In Session 1, participants engage in a goals and dreams activity and discuss obstacles to their goals and dreams. Having unprotected sex is listed and discussed as an obstacle. This belief is also incorporated throughout the curriculum.
Prevention Beliefs: The belief that condoms can reduce the risk of sexually transmitted diseases, including HIV/AIDS. This belief is incorporated throughout the curriculum.
Partner Reaction Beliefs: The belief that one's boyfriend/girlfriend will not approve of condom use and will react negatively to it. This belief may prevent a person from negotiating condom use. In Sessions 5 and 6, participants learn and practice how to use negotiation and refusal skills to communicate with their partners about safer sex.
Hedonistic Beliefs: The belief that condom use interferes with sexual pleasure. For example, many people believe that condoms reduce physical sensations during sexual activity and ruin the mood. Therefore, they are less likely to use condoms during sexual intercourse. In Sessions 5 and 6, youth learn that sex is still fun and pleasurable when a condom is used, and are taught how to incorporate this belief into role-play scenarios.

Program Methods

The program is delivered through small group discussions and culturally appropriate exercises, brainstorming, videos, games, and role play. Activities incorporate social cognitive-behavioral skill-building strategies (such as presentation, modeling, and the practice of abstinence negotiation skills). Each activity lasts a brief time, and most activities are active exercises in which adolescents get out of their seats and interact with each other.

Program Structure and Timeline

Be Proud! Be Responsible! is designed to be implemented in six 50-minute modules, but can be implemented in a variety of formats. For example, in community settings, it can be implemented in a 2-day format (2.5 hours each day), a 6-day format (50 minutes each day) or on a single day (Saturday). The program is designed to be delivered to a group of 6 to 8 adolescents.

Staffing

Facilitators must be trained adults and be well-versed in highly participatory and interactive skills and in working with youth. Facilitators should be able relate to participants and their life circumstances.

Program Materials and Resources

Intervention materials consist of the intervention curriculum manual, posters and activity materials. The program also includes video clips specifically selected for intervention.

The distributor provides access to a table of contents and sample lesson on their website: http://www.etr.org/ebi/programs/be-proud-be-responsible/

Additional Needs for Implementation

The program requires the use of a TV monitor and DVD player.

Fidelity

Fidelity benchmarks, a logic model, and monitoring and evaluation tools are available for providers to implement the program with fidelity.

Additional adaptation guidance for Be Proud, Be Responsible! can be found on ETR’s Program Success Center website: http://www.etr.org/ebi/programs/be-proud-be-responsible/

Staff Training

It is highly recommended that educators who plan to teach Be Proud, Be Responsible! receive research-based professional development to prepare them to effectively implement and replicate the curriculum with fidelity for the intended target group.

Training on Be Proud, Be Responsible! is available through ETR's Professional Learning Services. Training options include a 2-day Training of Educators with follow-up support. Visit http://www.etr.org/ebi/training-ta/types-of-services/training-of-educators/ for more information or submit a Training & TA Request Form (http://www.etr.org/solutions/professional-development/training-ta-request-form/).

Technical Assistance and Ongoing Support

ETR provides in-person and web- or phone-based technical assistance before, during and/or after program implementation. TA is tailored to the needs of the site and is designed to support quality assurance, trouble-shoot adaptation issues, and boost implementation. Contact ETR’s Professional Learning Services through the Program Support Help Desk (https://programsupport.etr.org/) or visit http://www.etr.org/ebi/training-ta/.

Allowable Adaptations

Specific characteristics of this program may be altered without changing the effectiveness of the program. Adaptations are allowed in consultation with the developer, if they do not alter the core components of the program.

Number of days to deliver the modules and order in which modules are delivered (the program should be completed within a 2 week time frame)
Deletion or replacement of modules or activities
Age of participants (in classes with diverse age groups, group students into similar age ranges);
Group size (ideally 6-12 youth per group). Larger groups will require additional facilitators.
Interactive activities

Reviewed Studies

Citation	High-Quality Randomized Trial	Moderate-Quality Randomized Trial	Moderate-Quality Quasi-experiment	Low Study Rating	Did Not Meet Eligibility Criteria
Borawski et al. 2009 Borawski et al. 2015	✓
Jemmott et al. 1992	✓
Jemmott et al. 1999	✓
Jemmott et al. 2010	✓

Study Characteristics

Citation	Setting	Majority Age Group	Majority Racial/Ethnic Group	Gender	Sample Size
Borawski et al. 2009 Borawski et al. 2015	In school: High school	14 to 17	White	Youth of any gender	1357
Jemmott et al. 1992	After school	14 to 17	African American or Black	Young men	157
Jemmott et al. 1999	After school	13 or younger	African American or Black	Youth of any gender	496
Jemmott et al. 2010	After school	14 to 17	African American or Black	Youth of any gender	1707

Study Findings

Evidence by Outcome Domain and Study

Citation	Number of Sexual Partners	Contraceptive Use	STIs or HIV	Pregnancy
Borawski et al. 2009 Borawski et al. 2015	n.a.	n.a.	n.a.	n.a.
Jemmott et al. 1992			n.a.	n.a.
Jemmott et al. 1999			n.a.	n.a.
Jemmott et al. 2010	n.a.		n.a.	n.a.

Detailed Findings

Citation	Details
Borawski et al. 2009 Borawski et al. 2015	A more recent study by a separate group of researchers evaluated the program when implemented in suburban high schools during the regular school day. The study used a cluster randomized controlled trial involving ninth and tenth grade students from a Midwestern metropolitan area. Participating schools were randomly assigned in matched pairs to either a treatment group that implemented the program or to a control group that implemented a general health promotion curriculum. Surveys were administered before the program (baseline), immediately after the program, and again four and 12 months after the program ended. The study found no statistically significant program impact on sexual initiation rates for the subgroup of students who were sexually inexperienced at baseline. The study also examined program impacts on the frequency of intercourse and four measures of unprotected intercourse. Findings for these outcomes were not considered for the review because they did not meet the review evidence standards. Specifically, the outcomes were measured for subgroups of youth defined by sexual activity at follow up. The study also examined program impacts on measures of condom and STDs knowledge, self-efficacy, condom use and abstinence beliefs, sexual activity and condom use perceived peer beliefs, and intentions to have sex and to use a condom. Findings for these outcomes were not considered for the review because the outcomes fell outside the scope of the review.
Jemmott et al. 1992	The program's evidence of effectiveness was first established in a randomized controlled trial involving African American male adolescents recruited from school- and community-based locations in Philadelphia, PA. Study participants were randomly assigned to either a treatment group that received the program during a single 5-hour session delivered on a Saturday morning, or to a control group that received a career opportunities development program during the same 5-hour session. Surveys were administered immediately before the program session (baseline), immediately after the session ended, and three months after the session. The study found that three months after the program session, adolescents in the treatment group reported having significantly fewer female sexual partners (difference in means = -0.93, confidence interval = -1.53 to -0.33), fewer days of vaginal intercourse (difference in means = -3.32, confidence interval = -5.78 to -0.89), and fewer days of vaginal intercourse without a condom (difference in means = -1.73, confidence interval = -2.86 to -0.60). In addition, adolescents in the treatment group were significantly less likely to report having had heterosexual anal sex in the last three months (difference in means = -0.19, confidence interval = -0.32 to -0.06). The study found no statistically significant program impacts on reports of ever having had sex, the number of female anal sex partners, or the frequency of heterosexual anal sex in the last three months. The study also examined program impacts on measures of attitudes, intentions, and knowledge regarding sexual risk behaviors. Findings for these outcomes were not considered for the review because the outcomes fell outside the scope of the review.
Jemmott et al. 1999	A subsequent study by the same group of researchers evaluated the program among a younger, co-ed sample of adolescents. The study used a randomized controlled trial involving African American seventh and eighth grade students in Trenton, NJ. Study participants were randomly assigned to either a treatment group that received the program during a single 5-hour session delivered on a Saturday, or to a control group that received a general health promotion program during the same session. Surveys were administered immediately before the 5-hour session (baseline), immediately after the session ended, and three and six months after the session. The study successfully replicated one of the favorable impacts from the original study of the program by Jemmott (1992). Specifically, for the 6-month follow-up survey, the study found that adolescents in the treatment group were less likely than those in the control group to report having had heterosexual anal sex in the last three months. For the 6-month follow-up survey, the study also reported statistically significant program impacts on measures of the frequency of anal intercourse and number of anal sex partners, and on the frequency unprotected sex. The study also examined program impacts on measures of attitudes toward condoms, self-efficacy, and condom-use intentions. Findings for these outcomes were not considered for the review because the outcomes fell outside the scope of the review.
Jemmott et al. 2010	A separate study by the original group of researchers evaluated the program when implemented outside of school on a broad scale by local community-based organizations. The study used a cluster randomized controlled trial involving 86 community-based organizations in New Jersey and Philadelphia, PA. The study randomly assigned half the organizations to a treatment group that implemented the program and half to a control group that implemented a general health promotion curriculum. Surveys were administered immediately before the program started (baseline); immediately after the program ended, and three, six, and twelve months after the program ended. The study findings failed to replicate the favorable impact on frequency of sexual intercourse found in the original study of the program by Jemmott (1992). However, the study also examined program impacts on four outcomes not measured in prior studies of the program: (1) consistency of condom use in the prior 90 days, (2) proportion of condom-protected sexual intercourse acts in the prior 90 days, (3) frequency of condom use in the prior 90 days, and (4) use of condoms at last intercourse. When averaging data across the three follow-up surveys, the study found statistically significant program impacts for the first three of these outcomes.

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