Making Proud Choices!

Developers

Loretta Sweet Jemmott, Ph.D., R.N., F.A.A.N., and John B. Jemmott III, Ph.D.

Program Summary

Making Proud Choices! A Safer Sex Approach to STDs, Teen Pregnancy, and HIV Prevention Program (MPC) aims to provide adolescents with the knowledge, confidence, and skills necessary to reduce their risk of sexually transmitted diseases (STDs), HIV, and pregnancy by abstaining from sex or using condoms if they choose to have sex. The curriculum consists of eight modules delivered by trained facilitators to adolescents.

Intended Population

The curriculum is designed for high-school and middle-school youth. It was originally evaluated with African American 11- to 13-year-olds in urban areas and more recently evaluated with 9th and 10th graders of diverse races/ethnicities in urban and suburban areas.

Program Setting

Making Proud Choices! was designed to be implemented in a variety of community settings, including schools or community-based organizations. The program was evaluated in schools and in an after-school, community-based setting.

Contact and Availability Information

Program Contact Information
Email: sales@etr.org
Phone: (800) 321-4407
Website: https://www.etr.org/store/curricula/making-proud-choices/

Training Contact Information
Kelly Gainor, M.Ed.
ebptraining@etr.org
Website: https://www.etr.org/store/curricula/making-proud-choices/

Sample of Curriculum Available for Review Prior to Purchase

Yes

Languages Available

English, Spanish

Monitoring and Evaluation Tools

Monitoring and evaluation tools available

Yes

Monitoring and evaluation tool usage required

Information about available monitoring and evaluation tools (if applicable)

Guidance on key characteristics, core content, facilitator fidelity logs and evaluation tools, and a logic model are available from ETR. ETR also provides pre- and post-test questionnaires.

Program Core Components

Last updated in 2023

The data presented on this page reflects responses from the program’s developer or distributor to a program component checklist that asked them to report on the individual components within their TPP program. The same program component checklist was sent to the developer or distributor of every active TPP program with evidence of effectiveness. The program component table provides data on seven types of program components including content, delivery mechanism, dosage, staffing, format, environment, and intended population characteristics; whether the component was present or optional in the program; whether the component is considered to be core to the program; and the lesson number or activity where the component can be found in the program. For more details, refer to the FAQ.

Category	Component	Core Component	Component present	Lesson number(s) / activities where present
Content	College preparation	No	No
Content	Anatomy/physiology	No	No
Content	Other
Content	Volunteering/civic engagement	Yes	Yes (both versions)	Module 1 Activity D (41)
Content	Spirituality	No	No
Content	Morals/values	Yes	Yes (both versions)	Module 5 Activity C (126), Module 6 Activity D (157)
Content	Identity development	No	Optional	Appendix A (266)
Content	Social support/capital	No	No
Content	Social influence/actual vs. perceived social norms	Yes	Yes (both versions)	Module 5 Activity C (126), Module 6 Activity D (157)
Content	Social competence	No	No
Content	Parenting skills	No	No
Content	Normative beliefs	Yes	Yes (both versions)	Module 1 Activity C (37), Activity D (41); Module 5 Activity C (126), Module 6 Activity D (157)
Content	Leadership	No	No
Content	Gender roles	No	No
Content	Gender identity
Content	Cultural values	Yes	Yes (both versions)	Module 5 Activity C (126), Module 6 Activity D (157)
Content	Connections with trusted adults	No	No
Content	Conflict resolution/social problem solving	Yes	Yes (both versions)	Module 4 Activity A (93), Activity B (96); Module 7 Activity E (182), Module 8 All Activities (197)
Content	Communication skills	Yes	Yes (both versions)	Module 4 Activity A (93), Activity B (96); Module 7 Activity E (182), Module 8 All Activities (197)
Content	Child development	No	No
Content	Boundary setting/refusal skills	Yes	Yes (both versions)	Module 7 Activity E (182), Module 8 All Activities (197)
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	School engagement	No	No
Content	Graduating from high school	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 1 Activity D (41)
Content	Resilience	No	No
Content	Personal vulnerability	Yes	Yes (both versions)	Module 7 Activity E (182), Module 8 All Activities (197)
Content	Risk of STIs and Pregnancy	Yes	Yes (both versions)	Module 2 All Activities (57), Module 3 All Activities (77), Module 4 Activity C (100), Activity D (102); Module 5 Activity A (112), Activity B (121), Activity C (126); Module 6 Activity A (138), Optional Activity B (143), Activity D (157)
Content	STIs - Screening	Yes	Yes (both versions)	Module 5 Activity A (112)
Content	STIs - Prevention	Yes	Yes (both versions)	Module 5 Activity A (112)
Content	STIs - Information	Yes	Yes (both versions)
Content	Sexual risk reduction	Yes	Yes (both versions)	Module 2 All Activities (57), Module 3 All Activities (77), Module 4 All Activities (93); Module 5 Activity A (112), Activity B (121), Activity C (126); Module 6 Activity A (138), Optional Activity B (143), Activity D (157)
Content	Motivational interviewing	No	No
Content	Sexual risk avoidance	Yes	Yes (both versions)	Module 2 Activity D (70), Module 4 Activity C (100)
Content	Sexual orientation	No	Optional	Appendix A (266)
Content	Sexual health	Yes	Yes (both versions)	Throughout
Content	Contraception - Pills, patches, rings, and shots	Yes	Yes (both versions)	Module 6, Activity C (145)
Content	Contraception - Condoms	Yes	Yes (both versions)	Module 5, Activity D (129); Module 7, Activity A (166), Activity B (170), Activity C (173), Activity D (176)
Content	Contraception - Long-acting reversible contraceptives	Yes	Yes (both versions)	Module 6, Activity C (145)
Content	Contraception - Other	Yes	Yes (both versions)	Module 6, Activity A (138), Activity C (145)
Content	Puberty/development	No	Optional	Appendix A (249)

Program Objectives

The primary goals of Making Proud Choices! are to increase knowledge about prevention of HIV, STDs and pregnancy, reinforce positive attitudes/beliefs about condom use, and increase confidence in participants' ability to negotiate safer sex and use condoms correctly. The program works to lower the incidence of STD/HIV risk-associated sexual behavior among youth, by inculcating a sense of pride and responsibility among its participants, providing them with the knowledge and skills they need, and motivating them to make a difference in their lives.

Program Content

Making Proud Choices! draws on three theories of change: (1) social cognitive theory, (2) the theory of reasoned action, and (3) the theory of planned behavior. This framework relies on the concept of self-efficacy or perceived behavioral control beliefs (beliefs about the ability to conduct the behavior). The framework also relies on the outcome expectancies (beliefs about the consequences of the behaviors). The curriculum uses trauma-informed approaches and is inclusive of LGBTQI+ youth.

The curriculum and core content address four types of behavioral beliefs and outcome expectancies:

Goals and dreams beliefs—the belief that unprotected sex can interfere with one’s goals and dreams for education and a career. In Session 1, the participants engage in a goals and dreams activity and discuss obstacles to 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 pregnancy, STDs, and HIV/AIDS. This belief is incorporated throughout the curriculum.
Partner-reaction beliefs—the belief that one’s boyfriend/girlfriend would not approve of condom use and will react negatively to it. This belief might prevent a person from negotiating condom use. In Sessions 7 and 8, participants learn how to get out of a risky situation, set physical limits, and 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 or ruin the mood. Therefore, people are less likely to use condoms during sexual intercourse. In Sessions 7 and 8, 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.

The curriculum modules cover the following topics:

Module 1. “Getting to Know You and Steps to Making Your Dreams and Goals Come True” introduces the curriculum, sets up the theme of proud and responsible behavior, establishes group rules, and asks participants to identify short-term and long-term goals and dreams.
Module 2. “The Consequences of Sex: HIV Infection” includes information on HIV etiology, transmission, and prevention, as well as myths about HIV.
Module 3. “Attitudes and Beliefs About HIV and Condom Use” includes two videos on HIV transmission risk and interactive discussion about the videos.
Module 4. “Strategies for Preventing HIV Infection: Stop, Think, and Act,” introduces participants to problem-solving skills through role-plays using the “Stop, Think, and Act” framework for decision making.
Module 5. “The Consequences of Sex: STDs and Correct Condom Use” introduces myths and facts about STD transmission. Module 5 includes a condom demonstration by the facilitator and participant practice of condom application with a penis model. The module explores attitudes about condom use. The key theme of the module is that participants can protect themselves against STDs by correctly using condoms every time they have sex.
Module 6. “The Consequences of Sex: Pregnancy” introduces myths and facts about pregnancy, includes a demonstration of birth control methods, and explores attitudes about contraception. The key theme of the module is that participants can protect themselves against pregnancy and STDs by correctly using condoms along with another birth control method every time they have sex.
Module 7. “Developing Condom Use Skills and Negotiation Skills” teaches participants negotiation skills to address partner pressure and discusses ways to make condoms pleasurable.
Module 8. “Enhancing Condom Use Skills and Negotiation Skills” further teaches problem-solving and negotiation skills to participants using the “SWAT” technique (say no effectively, state why, propose an alternative, and talk it out) in role-plays.

Program Methods

Making Proud Choices! aims to create a youth-centered, positive learning environment. It uses role-plays in which all participants practice and receive feedback on their negotiation skills. The program also relies on small group activities, viewing and processing videos, visual presentations, and targeted instruction for multiple learning styles.

Program Structure and Timeline

The curriculum consists of eight modules, each of which is one hour. Instructors should deliver the modules in the order presented and should ideally complete the modules in two weeks. Ideal group size is eight students per facilitator. ETR can provide guidance on adapting the program for a school setting with 14 40-minute sessions. There is also a version of this curriculum that includes additional content to align with the requirements of the California Healthy Youth Act.

Staffing

Providers are expected to use one to three facilitators (depending on number of participants), a program manager, and one or more support staff. Facilitators should be health educators, social workers, nurses, and others who provide social services programs to youth. Facilitators should also have the following qualities:

Be able to use highly participatory and interactive skills.
Be able to work with youth and relate to them and their life circumstances.
Believe in the teens and believe in their resilience.
Have a comprehensive understanding of adolescent development; the developing sexual needs of youth; and the relevance of HIV/AIDS, STDs, and pregnancy for youth.

Staffing should consist of one facilitator for eight to 10 youth, and support staff to assist when implementing the program in larger class size settings.

Staff Training

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

Training on Making Proud Choices! is available through ETR’s Professional Learning Services. Training options include a two-day Training of Educators with follow-up support, as well as interactive virtual training options.

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/).

Program Materials and Resources

The curriculum package consists of:

Facilitator curriculum
Activity set (role-play cards and posters)
Student workbooks (classroom set of 30)
Six curriculum DVDs:
- Tanisha & Shay
- The Hard Way
- Nicole’s Choice
- The Subject Is: HIV
- The Subject Is: STDs
- Wrap it Up and Condom Use Animation
One seat for an interactive virtual curriculum training for the facilitator

The distributor also provides access to a table of contents, an optional LGBTQ supplement, and sample lesson on its website: http://www.etr.org/ebi/programs/making-proud-choices/.

Additional Needs for Implementation

The curriculum requires a TV monitor and DVD player.

Fidelity

Specific recommendations related to implementing the program with fidelity are as follows:

Facilitators should deliver the curriculum modules in the order presented.
Delivery of the intervention must be highly participatory.
Making Proud Choices! was designed to be used with small groups ranging from six to 12 participants (but can be implemented with larger groups with increased staffing, see Allowable adaptations).

Technical Assistance and Ongoing Support

ETR provides in-person and web- or phone-based technical assistance before, during, and/or after program implementation. Technical assistance is tailored to the needs of the site and is designed to support quality assurance, troubleshoot adaptation issues, and boost implementation. Contact ETR’s Professional Learning Services through http://www.etr.org/ebi/training-ta/.

Allowable Adaptations

Adaptation guidance for Making Proud Choices! is available on ETR’s Program Success Center website: http://www.etr.org/ebi/programs/making-proud-choices/.

Adaptation Guidelines or Kit

Yes

Reviewed Studies

Citation	High-Quality Randomized Trial	Moderate-Quality Randomized Trial	Moderate-Quality Quasi-Experiment	Low Study Rating	Did Not Meet Eligibility Criteria
Jemmott, J. B., Jemmott, L. S., Fong, G. T. (1998). Abstinence and safer sex HIV risk-reduction interventions for African American adolescents: A randomized controlled trial. JAMA: Journal of the American Medical Association, 279(19), 1529-1536.	✓
Cole, R., Schulte Neelan, T., Langan, A., Keating, B., Walzer, J., Asheer, S., Zief, S. (2022). The impact of the Making Proud Choices! teen pregnancy prevention curriculum. Office of Population Affairs, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services.	✓

Study Characteristics

Citation	Setting	Majority Age Group	Majority Racial/Ethnic Group	Gender	Sample Size
Jemmott, J. B., Jemmott, L. S., Fong, G. T. (1998). Abstinence and safer sex HIV risk-reduction interventions for African American adolescents: A randomized controlled trial. JAMA: Journal of the American Medical Association, 279(19), 1529-1536.	After school	13 or younger	African American or Black	Youth of any gender	439
Cole, R., Schulte Neelan, T., Langan, A., Keating, B., Walzer, J., Asheer, S., Zief, S. (2022). The impact of the Making Proud Choices! teen pregnancy prevention curriculum. Office of Population Affairs, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services.	In school, classroom based	14 to 17	African American or Black	Youth of any gender	2810

Study Findings

Evidence by Outcome Domain and Study

Citation	Sexual Activity	Number of Sexual Partners	Contraceptive Use	STIs or HIV	Pregnancy
Jemmott, J. B., Jemmott, L. S., Fong, G. T. (1998). Abstinence and safer sex HIV risk-reduction interventions for African American adolescents: A randomized controlled trial. JAMA: Journal of the American Medical Association, 279(19), 1529-1536.		n.a.		n.a.	n.a.
Cole, R., Schulte Neelan, T., Langan, A., Keating, B., Walzer, J., Asheer, S., Zief, S. (2022). The impact of the Making Proud Choices! teen pregnancy prevention curriculum. Office of Population Affairs, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services.

KEY

Evidence Indication

Favorable findings

Potentially favorable findings

Indeterminate findings

Conflicting findings

Potentially unfavorable findings

Unfavorable findings

Note: n.a. indicates the study did not examine any outcome measures within that particular outcome domain, or the study examined outcome measures within that domain but the findings did not meet the review evidence standards.

Detailed Findings

Citation Details

Citation	Details
Jemmott, J. B., Jemmott, L. S., Fong, G. T. (1998). Abstinence and safer sex HIV risk-reduction interventions for African American adolescents: A randomized controlled trial. JAMA: Journal of the American Medical Association, 279(19), 1529-1536.	The program was evaluated in a randomized controlled trial involving middle school students in Philadelphia, PA. Students were randomly assigned to either a treatment group that received the program or to a control group that received a general health-promotion curriculum on diet, exercise, cancer awareness, and smoking. Both the control and intervention programs were delivered outside of regular school hours over two consecutive Saturdays. Surveys were administered immediately before the program (baseline), immediately after the program, and three, six, and 12 months after the program. The study found that three months after the program ended, adolescents participating in the intervention were less likely to report having had unprotected sexual intercourse in the previous 3 months, and reported a lower frequency of unprotected sexual intercourse. The study also examined program impacts on measures of condom use consistency. 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. The study also examined program impacts on attitudes toward abstinence, as well as condom use knowledge, skills, and beliefs. Findings for these outcomes were not considered for the review because they fell outside the scope of the review.
Cole, R., Schulte Neelan, T., Langan, A., Keating, B., Walzer, J., Asheer, S., Zief, S. (2022). The impact of the Making Proud Choices! teen pregnancy prevention curriculum. Office of Population Affairs, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services.	The program was evaluated using a cluster randomized controlled trial involving male and female youth recruited from 15 high schools in Mobile, Alabama; Detroit, Michigan; St. Louis, Missouri; and Cincinnati, Ohio. Schools were randomly assigned in each of three years to a treatment group that received the Making Proud Choices! Program or a control group that received business-as-usual services. Surveys were administered immediately before the program (baseline), and six months after the end of the program. The study found that six months after the end of the program, youth participating in MPC reported having had sex significantly fewer times in the past three months compared with youth in the control group (effect size = -0.10). The study found no statistically significant program impacts on the other eligible outcomes examined: ever had sex, any sex in the past three months, count of vaginal sex partners in past three months, any sex without a condom in past three months, times having any sex without a condom in past three months, sex without birth control in past three months, times having sex without birth control in past three months, ever pregnant, any STI. The study also examined program impacts on measures of knowledge of HIV or STIs, pregnancy, condoms, and other forms of contraception; beliefs about sexual activity as a teen, communication with partners, and condom use; attitudes about condom use; skill and self-efficacy related to condom use, condom use negotiation, and refusal. Findings for these outcomes were not considered for the review because they fell outside the scope of the review.

Jemmott, J. B., Jemmott, L. S., Fong, G. T. (1998). Abstinence and safer sex HIV risk-reduction interventions for African American adolescents: A randomized controlled trial. JAMA: Journal of the American Medical Association, 279(19), 1529-1536.

The program was evaluated in a randomized controlled trial involving middle school students in Philadelphia, PA. Students were randomly assigned to either a treatment group that received the program or to a control group that received a general health-promotion curriculum on diet, exercise, cancer awareness, and smoking. Both the control and intervention programs were delivered outside of regular school hours over two consecutive Saturdays. Surveys were administered immediately before the program (baseline), immediately after the program, and three, six, and 12 months after the program.

The study found that three months after the program ended, adolescents participating in the intervention were less likely to report having had unprotected sexual intercourse in the previous 3 months, and reported a lower frequency of unprotected sexual intercourse.

The study also examined program impacts on measures of condom use consistency. 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. The study also examined program impacts on attitudes toward abstinence, as well as condom use knowledge, skills, and beliefs. Findings for these outcomes were not considered for the review because they fell outside the scope of the review.

Cole, R., Schulte Neelan, T., Langan, A., Keating, B., Walzer, J., Asheer, S., Zief, S. (2022). The impact of the Making Proud Choices! teen pregnancy prevention curriculum. Office of Population Affairs, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services.

The program was evaluated using a cluster randomized controlled trial involving male and female youth recruited from 15 high schools in Mobile, Alabama; Detroit, Michigan; St. Louis, Missouri; and Cincinnati, Ohio. Schools were randomly assigned in each of three years to a treatment group that received the Making Proud Choices! Program or a control group that received business-as-usual services. Surveys were administered immediately before the program (baseline), and six months after the end of the program.

The study found that six months after the end of the program, youth participating in MPC reported having had sex significantly fewer times in the past three months compared with youth in the control group (effect size = -0.10). The study found no statistically significant program impacts on the other eligible outcomes examined: ever had sex, any sex in the past three months, count of vaginal sex partners in past three months, any sex without a condom in past three months, times having any sex without a condom in past three months, sex without birth control in past three months, times having sex without birth control in past three months, ever pregnant, any STI.

The study also examined program impacts on measures of knowledge of HIV or STIs, pregnancy, condoms, and other forms of contraception; beliefs about sexual activity as a teen, communication with partners, and condom use; attitudes about condom use; skill and self-efficacy related to condom use, condom use negotiation, and refusal. Findings for these outcomes were not considered for the review because they fell outside the scope of the review.

Breadcrumb

Making Proud Choices!