It's Your Game: Keep It Real (IYG)

This study did not meet the review's screening criteria

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.

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.

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.

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.

This replication trial of It's Your Game: Keep It Real (IYG), an STI and pregnancy prevention program, was evaluated using a randomized control trial involving students who were not sexually active at baseline in 20 middle schools in urban and rural Southeast Texas. Schools were randomly assigned to the intervention and control group to receive the two-year IYG program. Surveys were administered at baseline in 7th grade and follow-up data for impacts in 9th grade, 24 months after the baseline.

The study found no significant differences between the intervention and control groups on any measure of sexual initiation (vaginal or oral) at the 24-month follow-up.

Other behavioral outcomes such as use of a condom in the past three months, use of other effective birth control in the last three months, use of condom at last sex, use of birth control at last sex, number of times having sex in the past three months, and number of sexual partners in the past three months were not considered for the review because they did not meet the review evidence standards. Specifically, findings were reported only for subgroups defined by sexual activity at follow-up. The study also examined program impacts on gender subgroups. Findings for these gender subgroups were not considered for this review because they did not meet the review evidence standards. Additionally, the study examined a variety of psychosocial outcomes, including attitude, knowledge, and intentions around sex and contraceptives. These outcomes are outside the scope of the review and were not considered for the assessment of evidence of effectiveness.

This study did not meet the review's eligibility criteria