Featured Grant OpportunitySchool Emergency Response to Violence (Project SERV) (Funding Opportunity)
Featured Grant OpportunityShare with Youth: NOAA Student Opportunities Database
It's Your Game: Keep It Real (IYG)
Developers
Susan Tortolero, Ph.D., Christine Markham, Ph.D., Ross Shegog, Ph.D., and Melissa Peskin, Ph.D.
Program Summary
It’s Your Game...Keep it Real (IYG) is a classroom and computer-based HIV, STI, and pregnancy prevention program. It consists of twenty-four 50-minute lessons delivered during 7th and 8th grade. In each grade, the program integrates group-based classroom activities (e.g., role plays, group discussion, and small group activities) with personalized journaling and individually tailored activities that are computer-based.
Intended Population
The program was designed for urban middle school youth in grades 7 and 8, ages 12 to 14. It was first tested with youth in grade 7, who were primarily Hispanic and African-American. More recently, it has also been evaluated with White and Hispanic adolescents in 7th and 8th grades.
Program Setting
The program was designed to be implemented in various settings, including in-school or after school and also includes a computer-based component. It has been evaluated in both urban and rural middle schools.
Contact and Availability Information
Efrat Gabay
UT Health – School of Public Health
7000 Fannin, Suite 2656C
Houston, TX 77030
Ph: 713-500-9624
Website: www.itsyourgame.org
UT Health – School of Public Health
7000 Fannin, Suite 2656C
Houston, TX 77030
Ph: 713-500-9624
Website: www.itsyourgame.org
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 | Mindfulness | No | |||
| Content | Spirituality | No | |||
| Content | Morals/values | No | |||
| Content | Identity development | No | |||
| Content | Social support/capital | Yes | Yes (both versions) | Level 1- Lesson 2: Keeping it Real...Among Friends Level 2- Lesson 8&9: Keeping it Real...Healthy Dating Relationships |
|
| Content | Social influence/actual vs. perceived social norms | No | Yes (both versions) | Level 1- Appendix- Dealing with Sensitive Issues Level 1- Lesson 9: Keeping it Real...For Yourself; Lesson 10: Playing By Your Rules...Regarding Sex (Keeping It Real...About Sex! Parent-Student Homework Activity) Level 2- Lesson 2: Keeping it Real...Consequences of Pregnancy |
|
| Content | Social competence | No | Yes (both versions) | Level 1- Lesson 2: Keeping it Real...Among Friends Level 2- Lesson 8&9: Keeping it Real...Healthy Dating Relationships |
|
| Content | Volunteering/civic engagement | No | |||
| Content | Parenting skills | No | Yes (both versions) | Level 1- Lesson 5: It's your game...Playing By Your Rules- (II. Computer Activities- 4. Scoops: Teens Talk) Level 2- Lesson 1: (III. Agreements for Classroom Discussion) |
|
| Content | Normative beliefs | Yes | Yes (both versions) | Level 1- Appendix- Dealing with Sensitive Issues Level 1- Lesson 9: Keeping it Real...For Yourself; Lesson 10: Playing By Your Rules...Regarding Sex (Keeping It Real...About Sex! Parent-Student Homework Activity) Level 2- Lesson 2: Keeping it Real...Consequences of Pregnancy |
|
| Content | Leadership | No | |||
| Content | Gender roles | No | |||
| Content | Gender identity | No | |||
| Content | Cultural values | No | |||
| Content | Connections with trusted adults | Yes | Yes (both versions) | [Throughout] Level 1- Lesson 1/ It's Your Game...Pre-Game Show- Activity 3 (Agreements for Classroom Discussion) Level 2- Lesson 1/ It's Your Game...Pre-Game Show- Activity 3 (Agreements for Classroom Discussion) |
|
| Content | Conflict resolution/social problem solving | Yes | Yes (both versions) | Level 1- Lesson 5: It's Your Game...Playing By Your Rules- (II. Computer Activities) Level 2- Lesson 2: Keeping It Real...Consequences of Pregnancy |
|
| Content | Communication skills | Yes | Yes (both versions) | Level 1- Lesson 6/Protecting Your Rules...A Clear No- Activity 2 (Movie Acting & Discussion) & Activity 3 (Protecting Your Rues...Using a Clear NO!) Level 2 - Lesson 10/Playing By Your Rules...Regarding Sex |
|
| Content | Child development | No | |||
| Content | Boundary setting/refusal skills | Yes | Yes (both versions) | Level 1- Lesson 4/ It's Your Game...Playing By Your Rules (II. SELECT, DETECT, PROTECT) Level 2- Lesson 6: Playing By Your Rules...A Review |
|
| Content | Substance use cessation | No | |||
| Content | Substance use - Other drugs | No | |||
| Content | Substance use - Alcohol | No | |||
| Content | Substance use - Abstinence | No | Yes (both versions) | Level 1- Lesson 4/ It's Your Game...Playing By Your Rules (II. SELECT, DETECT, PROTECT) Level 2- Lesson 6: Playing By Your Rules...A Review |
|
| Content | Brain development and substance use | No | |||
| Content | Vocational/skills training | No | |||
| Content | Supplemental academic services | No | |||
| Content | School engagement | No | |||
| Content | Graduating from high school | No | Yes (both versions) | Level 1- Lesson 12 (II. It's Your Game...Post Game Show- It's Your Game Bingo) Level 2- Lesson 1: It's Your Game...Pre-Game Show- It's Your Game Bingo |
|
| Content | College preparation | No | |||
| Content | Alternative schooling | No | |||
| Content | Self-regulation | Yes | Yes (both versions) | Level 1- Lesson 2: Keeping It Real...Among Friends (Activity III: Characteristics of a Real Friendship) Lesson 2- Lesson 8: Keeping It Real...Healthy Dating Relationships (III. Brainstorming) |
|
| Content | Self-esteem | No | |||
| Content | Self-efficacy/empowerment | Yes | Yes (both versions) | Level 1- Lesson 3/ Keeping It Real...Among Friends- Activity 2 Level 2- Lesson 6: Playing By Your Rules...A Review |
|
| Content | Resilience | ||||
| Content | Personal vulnerability | Yes | Yes (both versions) | Level 1- Lesson 2 & 3: Keeping It Real...Among Friends Lesson 2- Lesson 6: Playing By Your Rules...A Review |
|
| Content | Motivational interviewing | No | |||
| Content | STIs - Screening | No | |||
| Content | Healthy relationships | Yes | Yes (both versions) | Level 1- Lesson 10/ Playing By Your Rules...Regarding Sex; Level 2- Lesson 8/ Keeping It Real...Healthy Dating Relationships |
|
| Content | Values and sexuality | Yes | Yes (both versions) | Level 1- Lesson 4 & 5: It's Your Game...Playing By Your Rules Level 2- Lesson 6 & 7: Playing By Your Rules...A Review |
|
| Content | Sexual health needs and experiences of LGBTQ youth | No | |||
| Content | Cognitive behavioral therapy (CBT) | No | |||
| Content | Consent | Yes | Yes (both versions) | Level 1- Lesson 10/ Playing By Your Rules...Regarding Sex Level 2- Level 2 - Lesson 5: Keeping It Real...Risk Reduction Strategies (Computer) |
|
| Content | Goal setting | Yes | Yes (both versions) | Level 1- Lesson 1: It's Your Game...Pre-Game Show Level 2- Lesson 3: Agreements for Classroom Discussion |
|
| Content | Social media, texting and online interactions | No | |||
| Content | Empathy | Yes | Yes (both versions) | Level 1- Lesson 2 & 3: Keeping it Real...Among Friends Level 2- Lesson 1: It's Your Game...Pre-Game Show (III. Agreements for Classroom Discussion) |
|
| Content | Healthy romantic relationships | Yes | Yes (both versions) | Level 1- Lesson 10: Playing By Your Rules...Regarding Sex; Level 2- Lessons 8 & 9: Keeping It Real...Healthy Dating Relationships |
|
| Content | Meditation | No | |||
| Content | Decision making | Yes | Yes (both versions) | Level 1- Lesson 10/ Playing By Your Rules...Regarding Sex Level 2 -Lesson 8/ Keeping It Real...Healthy Dating Relationships |
|
| Content | Brain development and emotions | No | |||
| Content | Body image | No |
Program Objectives
IYG aims to promote healthy decision making, promote healthy relationships, and increase abstinence among middle school youth as well as reduce risk among sexually active youth.
Program Content
IYG is a two year, 24-lesson curriculum and covers the following topics:
- Knowledge of health risks, healthy relationships, healthy communication, decision-making, goal setting, and condom use.
- Behavioral beliefs regarding goals and dreams, the use of abstinence in preventing risk for HIV, STIs, and pregnancy, and the belief that one’s partner would not approve of abstinence and react negatively to it.
- Attitudes toward abstinence.
- Behavioral intent to remain abstinent.
- Perception of Risk (Personal Vulnerability) to HIV, STIs, and pregnancy.
- Skills and self-efficacy in identifying parts of the male and female reproductive system.
- The physical, emotional, and social consequences of having sex.
- Skills and self-efficacy for refusing sex.
- Skills and self-efficacy for using condoms and other contraceptives.
The IYG curriculum was developed using a systematic instructional design process, Intervention Mapping, to ground its content in social cognitive theory, social influence models, and the theory of triadic influence.
Program Methods
The program is delivered through class discussion, computer-based activities, role play, group discussion, small group work, and personalized journaling.
Program Structure and Timeline
IYG is delivered in twelve 50-minute sessions in 7th grade and another twelve 50-minute sessions in 8th grade. The sessions are divided into 8 classroom-based lessons and 4 computer-based lessons in 7th grade and 7 classroom-based lesson and 5 computer-based lessons in 8th grade.
Staffing
IYG facilitators must be respectful of students, free of religious objections, believe that youth are assets, have a willingness to discuss sex/sexuality with candor and responsibility, respectful and sensitive to differing cultural values, respects that parents/guardians are the primary sexuality educators of their children, and open-minded and non-judgmental with respect to values, attitudes, beliefs, and behaviors that may differ from his/her own.
Program Materials and Resources
Core intervention materials include the IYG curriculum and facilitator manual.
Additional Needs for Implementation
Resources required to use the curriculum include computers, internet access, printing supplies, projector or large notepad, and standard classroom supplies. IYG computer lessons will run on any device that supports Adobe Flash.
Fidelity
Fidelity guidelines are available from the developer. The IYG curriculum should be delivered according to the curriculum manual.
Staff Training
The developer requires a 2-day pre-implementation training, conducted by the University of Texas Prevention Research Center. The training cost is $500 per participant.
Training topics consist of: 1) Overview of the IYG Curriculum; 2) Adolescent sexual health and well being; 3) Life skills, including decision making, communication, and refusal skills; 4) Puberty; 5) Healthy relationships; 6) HIV, STIs, and teen pregnancy.
The training utilizes lesson demonstration and modeling, interactive lesson practice and instant feedback. Trainers also cover strategies for dealing with sensitive issues and handling classroom controversy, guidelines for adapting curriculum to ease implementation, strategies for addressing implementation challenges, and action planning for effective implementation.
Technical Assistance and Ongoing Support
Trained facilitators have access to an online IYG Booster power point presentation that reviews the core components of IYG and offers best practice tips.
Allowable Adaptations
Adaptation guidelines are available from the developer.
Reviewed Studies
| Citation | High-Quality Randomized Trial | Moderate-Quality Randomized Trial | Moderate-Quality Quasi-experiment | Low Study Rating | Did Not Meet Eligibility Criteria |
|---|---|---|---|---|---|
| ✓ | |||||
| Bull et al. 2009 |
✓ | ||||
| Coyle et al. 2015a Potter et al. 2016 |
✓ | ||||
| Coyle et al. 2015b |
✓ | ||||
| Markham et al. 2012 Markham et al. 2014 |
✓ | ||||
| Tortolero et al. 2009 |
✓ |
Study Characteristics
| Citation | Setting | Majority Age Group | Majority Racial/Ethnic Group | Gender | Sample Size |
|---|---|---|---|---|---|
| n.a. | n.a. | n.a. | n.a. | n.a. | |
Bull et al. 2009 |
n.a. | n.a. | n.a. | n.a. | n.a. |
Coyle et al. 2015a Potter et al. 2016 |
In school: Middle school | 13 or younger | White | Youth of any gender | 2487 |
Coyle et al. 2015b |
In school: Middle school | 13 or younger | Hispanic or Latinx of any race | Youth of any gender | 1912 |
Markham et al. 2012 Markham et al. 2014 |
In school: Middle school | 13 or younger | Hispanic or Latinx of any race | Youth of any gender | 1258 |
Tortolero et al. 2009 |
In school: Middle school | 13 or younger | Hispanic or Latinx of any race | Youth of any gender | 3007 |
Study Findings
Evidence by Outcome Domain and Study
| Citation | Sexual Activity | Number of Sexual Partners | Contraceptive Use | STIs or HIV | Pregnancy |
|---|---|---|---|---|---|
| n.a. | n.a. | n.a. | n.a. | n.a. | |
Bull et al. 2009 |
n.a. | n.a. | n.a. | n.a. | n.a. |
Coyle et al. 2015a Potter et al. 2016 |
|
n.a. |
|
n.a. | n.a. |
Coyle et al. 2015b |
|
n.a. | n.a. | n.a. | n.a. |
Markham et al. 2012 Markham et al. 2014 |
|
|
|
n.a. | n.a. |
Tortolero et al. 2009 |
|
n.a. | n.a. | n.a. | n.a. |
Detailed Findings
| Citation | Details |
|---|---|
Bull et al. 2009 |
|
Coyle et al. 2015a Potter et al. 2016 |
In a more recent study conducted by a separate group of researchers, the program was evaluated in a cluster randomized controlled trial involving students from 24 rural middle schools in South Carolina. Twelve schools were randomly selected to deliver the two-year program in 7th and 8th grades. Twelve other schools were randomly selected for a control group that continued implementing their usual health and sex education program.The study findings failed to replicate the favorable program effects found in the earlier studies by Tortolero et al. (2009) and Markham et al. (2012, 2014). For the 9th grade follow-up, students in the treatment schools were more likely than those in the control schools to report having initiated sexual activity, and the reported effect size for this estimate (odds ratio is 1.27) falls outside of the confidence interval of the impact estimate reported in the initial study (0.61 to 0.98). The study also examined program impacts at the time of the 9th grade follow-up on measures of sexual activity in the past three months and sexual activity without use of effective contraception or a condom in the past three months. The study did not find statistically significant program impacts on those outcomes. |
Coyle et al. 2015b |
In a separate recent study, researchers conducted a cluster randomized controlled trial involving students from 20 urban middle schools in Harris County, Texas. Ten schools were randomly selected to deliver the two-year program in 7th and 8th grades. Ten other schools were randomly selected for a control group that continued implementing their usual health curriculum. The study findings for the 9th grade follow-up failed to replicate the favorable program effects found in the earlier studies by Tortolero et al. (2009) and Markham et al. (2012, 2014). In particular, the study found no evidence of a statistically significant program impact on initiation of sexual activity. |
Markham et al. 2012 Markham et al. 2014 |
A subsequent study by the same group of researchers tested two different versions of the program: (1) the standard risk reduction version featured in the initial study and (2) an adapted risk avoidance or abstinence-based version of the program. The study used a cluster randomized trial design involving fifteen schools in a large south-central U.S. school district. Each school was randomly assigned to one of three groups: (1) a treatment group that received the standard risk reduction version of the program, (2) a treatment group that received the adapted risk avoidance version of the program, or (3) a control group in which schools delivered their usual health curriculum. The study findings for the risk reduction program were mixed. Students in treatment schools had several favorable impacts on the recent sex domain at the end of 9th grade, including reduced rates of any sexual initiation for the full sample and for female students, reduced rates of oral and vaginal sex for female students, and reduced frequency of recent vaginal and anal sex. Several of these effects persisted into 10th grade, where there were favorable effects observed for reducing the likelihood of anal sex initiation for the full sample and for female students and reduced frequency of anal sex. In addition, there were favorable effects observed for risky sex: at the end of 9th grade students in the treatment group were less likely to have had unprotected sex in their last vaginal intercourse, and were having less frequent vaginal sex without a condom, and by the end of 10th grade, students were having less frequent anal sex without a condom. However, there was an adverse effect noted on number of sexual partners: by 10th grade, students in the treatment group were more likely to have had a larger number of sex partners in the past 3 months. |
Tortolero et al. 2009 |
The program's evidence of effectiveness was first established in a cluster randomized trial involving ten middle schools in Southeast Texas. Five schools were randomly selected to implement the two-year program in 7th and 8th grades. Five other schools were randomly selected for a control group that continued its regular health classes. The study found that, a year after the program ended, in spring of 9th grade, students in the treatment schools were significantly less likely to report having initiated sexual activity (odds ratio = 0.78, confidence interval = 0.61 to 0.98). The study also examined program impacts on measures of contraceptive use and number of sexual partners. Findings for these outcomes were not considered for the review because they did not meet the review evidence standards. Specifically, findings were reported only for subgroups of youth defined by sexual activity at follow-up. |