Promoting Health Among Teens! Comprehensive Abstinence and Safer Sex Intervention

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., R.N., F.A.A.N. and John B. Jemmott III, Ph.D., and Konstance McCaffree, Ph.D.

Program Summary

Promoting Health Among Teens! Comprehensive Abstinence and Safer Sex Intervention (PHAT-Comprehensive) is a 12-hour HIV/STD- and pregnancy-prevention intervention for adolescents. The interactive and student-centric curriculum focuses on knowledge of HIV/STDs, abstinence as the best way to avoid infection and pregnancy, encouraging condom use, and building refusal and negotiation skills to practice abstinence and effective condom use.

Intended Population

The program was designed for and evaluated with African American youth ages 11 to 14 in urban school settings. It has been adapted for use with other racial/ethnic populations and for older youth up to age 18. It has also been evaluated with Alaskan Native youth in rural areas.

Program Setting

The program was designed for various community settings for small groups of youth in an urban setting (although can be adapted for larger groups and non-urban settings). It has been evaluated in an after-school (Saturday), community-based setting in a low-income community, and in community-based organizations in rural areas.

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/promoting-health-among-teens-comprehensive/

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/promoting-health-among-teens-comprehensive/

Sample of curriculum available for review prior to purchase

Yes

Adaptation guidelines or kit available

Languages available

English

Program Core Components

Program Objectives

PHAT-Comprehensive seeks to reduce HIV/STD infection and pregnancy risk behaviors among adolescents by improving awareness and knowledge about HIV/STDs and pregnancy, strengthening intentions to abstain from sex or use condoms when having sex, and building skills that support condom use and abstinence. The program aims to help participants build negotiation, refusal, and problem solving skills for practicing abstinence and condom use.

Program Content

PHAT-Comprehensive is based on Social-Cognitive Theory, the Theory of Reasoned Action, and the Theory of Planned Behavior. The program's core content consists of 12 modules that cover general information about puberty, sex, the consequences of sex, abstinence, and condom use, as well as specific negotiation and refusal skill-building strategies to practice abstinence or use condoms.

Module 1: "Getting to Know You" provides an introduction to the curriculum, sets up the theme of proud and responsible behavior, and asks participants to identify short-term and long term goals and dreams.
Module 2: Exploring and Expressing Sexual Feelings
Module 3: "The Consequences of Sex: HIV Infection" increases awareness of participants' vulnerability to HIV infection and help increase knowledge about HIV/AIDS.
Module 4: "A Plan to Reduce the Consequences of Sex" introduces problem-solving technique called STOP, THINK and ACT, and begins to build negotiation and refusal skills for abstinence and condom use.
Module 5: "The Consequences of Sex: STD Infection" focuses on increasing knowledge about STDs and to increase feelings of vulnerability to STDs.
Module 6: "The Consequences of Sex: Pregnancy" has a pregnancy prevention focus, while also addressing knowledge and attitudes about methods of contraception.
Module 7: "STD/HIV Vulnerability" increases feelings of vulnerability to HIV and increasing skills to advocate for abstinence and safer sex.
Module 8: "Risky Sexual Behavior and Content Review" focusing on reinforcing STD and HIV knowledge and attitudes.
Module 9: "Sexual Responsibility: Abstinence Skills" the focus is on abstinence and targeting attitudes and skills to delay sexual activity.
Module 10: "Sexual Responsibility: Condom Use Skills" focuses on how to use a condom and attitudes about condom use.
Module 11: "Enhancing Sexual Responsibility Skills" continues to focus on negotiation skills and attitudes to support abstinence and safer sex.
Module 12: "Role-Plays: Refusal and Negotiation Skills" introduces a negotiation technique called S.T.O.P and provides opportunities for the participants to practice using the negotiation skills they have acquired throughout the program.

Program Methods

The program is delivered through group discussion, games, role play, videos/DVDs, modeling, practice, and homework.

Program Structure and Timeline

PHAT-Comprehensive consists of 12 one-hour modules delivered to groups of six to ten youth. The program can be delivered to larger groups as long as additional facilitators are used.

Staffing

Facilitators should be well-trained in the model and have experience working with teens and using participatory and interactive methods. The staffing model is flexible, but should consist of one facilitator for 8 to 10 youth and support staff to assist when implementing the program in larger class settings.

Program Materials and Resources

ETR offers an Implementation Kit that includes the following resources:

Facilitator Curriculum
Activity Set (handouts, role plays, posters)
Six curriculum DVDs: Tanisha & Shay, The Hard Way, Nicole's Choice, The Subject is: HIV (Safer Sex), The Subject is: Puberty (Compr), The Subject is: STDs (Safer Sex), Wrap it Up & Condom Use Animation
Student workbooks (classroom set of 30)

The distributor also provides access to a table of contents and sample lesson on their website: http://www.etr.org/ebi/programs/promoting-health-among-teens-comprehensive/

Additional Needs for Implementation

The program requires the use of audiovisual equipment for viewing DVDs.

Fidelity

All curriculum modules are required and must be completed in order. Monitoring and evaluation tools, such as fidelity checklists to be completed by facilitators and a logic model, and additional adaptation guidance can be found on ETR’s Program Success Center website: http://www.etr.org/ebi/programs/promoting-health-among-teens-comprehensive/

Staff Training

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

Training on Promoting Health Among Teens! is available through ETR's Professional Learning Services. 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

The developer has noted several allowable adaptations:

The 12 modules can be delivered in different ways (e.g. two modules per day for six days, one module per day for 12 days).
The program can be used with youth older than 14, as long as the group sessions are separated by age.
Groups can be larger than 6 to 10 youth, as long as additional facilitators are used.
Groups can be single gender or mixed gender.
Facilitators of different ethnic and professional backgrounds are appropriate, so long as the facilitators have strong facilitation skills and experience working with teens.
Peer educators are allowed, as long as they are paired with an adult.
If integrating the curriculum into the school classrooms and not having enough time to implement the program, providers should consider using the Promoting Health Among Teens! In School Curriculum version. It is divided into shorter sessions, but maintains the fidelity of the curriculum.
Teens of different racial and ethnic groups may participate.
Changing the names and settings of the situations in the role plays to reflect the culture of the participants is appropriate.

Reviewed Studies

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

Study Characteristics

Citation	Setting	Majority Age Group	Majority Racial/Ethnic Group	Gender	Sample Size
Jemmott et al. 2010	After school	13 or younger	African American or Black	Youth of any gender	409
Martin et al. 2015	After school	14 to 17	American Indian or Alaska Native	Youth of any gender	302

Study Findings

Evidence by Outcome Domain and Study

Citation	Sexual Activity	Number of Sexual Partners	Contraceptive Use	STIs or HIV	Pregnancy
Jemmott et al. 2010				n.a.	n.a.
Martin et al. 2015		n.a.		n.a.	n.a.

Detailed Findings

Citation Details

Citation	Details
Jemmott et al. 2010	The study evaluated the program with a randomized controlled trial involving middle school students in a low-income African American community in the northeastern United States. Adolescents participating in the study were randomly assigned to either a control group that received an 8-hour general health-promotion program, or to one of four treatment groups, each receiving one of the following interventions: (1) an 8-hour abstinence-only intervention; (2) an 8-hour safer sex-only intervention; (3) an 8-hour comprehensive abstinence and safer sex intervention; or (4) a 12-hour comprehensive abstinence and safer sex intervention. The study administered surveys immediately before the intervention (baseline) and at follows-ups conducted 3, 6, 12, 18, and 24 months after baseline. The effectiveness of each intervention was assessed relative to the control group. The study found that averaged across the five follow-up periods, adolescents who were assigned to the PHAT-Comprehensive group were statistically significantly less likely than those in the control group to report having had multiple sexual partners in the previous three months. The study found no statistically significant program impacts on sexual initiation or the likelihood of having intercourse or unprotected intercourse in the past three months. The study also examined program impacts on consistency of condom use. Findings for this measure 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.
Martin et al. 2015	A subsequent study by a separate group of researchers used a randomized controlled trial to evaluate the Alaska Promoting Health Among Teens, Comprehensive Abstinence and Safer Sex (AKPHAT) program, an adaptation of the PHAT-Comprehensive program. The study adapted the PHAT-Comprehensive program to: (1) use peer educators to deliver the program instead of adult facilitators, (2) serve a different target population of older youth in rural areas, (3) use talking circles and talking sticks, and (4) use fingers rather than a penis model in the condom demonstrations module. The study involved 302 Alaskan Native youth recruited from four non-profit organizations serving youth in Alaska. Adolescents participating in the study were randomly assigned to either a treatment group that received the AKPHAT program or a control group that received the standard services available to youth in their schools and communities. The study administered surveys before the program started (baseline), and again immediately, three, six, and 12 months after the end of the program. Six months after the program ended, the study found no evidence of statistically significant program impacts on sexual activity in the last three months or on having sex without using a condom in the last three months.

Jemmott et al. 2010

The study evaluated the program with a randomized controlled trial involving middle school students in a low-income African American community in the northeastern United States. Adolescents participating in the study were randomly assigned to either a control group that received an 8-hour general health-promotion program, or to one of four treatment groups, each receiving one of the following interventions: (1) an 8-hour abstinence-only intervention; (2) an 8-hour safer sex-only intervention; (3) an 8-hour comprehensive abstinence and safer sex intervention; or (4) a 12-hour comprehensive abstinence and safer sex intervention. The study administered surveys immediately before the intervention (baseline) and at follows-ups conducted 3, 6, 12, 18, and 24 months after baseline. The effectiveness of each intervention was assessed relative to the control group.

The study found that averaged across the five follow-up periods, adolescents who were assigned to the PHAT-Comprehensive group were statistically significantly less likely than those in the control group to report having had multiple sexual partners in the previous three months. The study found no statistically significant program impacts on sexual initiation or the likelihood of having intercourse or unprotected intercourse in the past three months.

The study also examined program impacts on consistency of condom use. Findings for this measure 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.

Martin et al. 2015

A subsequent study by a separate group of researchers used a randomized controlled trial to evaluate the Alaska Promoting Health Among Teens, Comprehensive Abstinence and Safer Sex (AKPHAT) program, an adaptation of the PHAT-Comprehensive program. The study adapted the PHAT-Comprehensive program to: (1) use peer educators to deliver the program instead of adult facilitators, (2) serve a different target population of older youth in rural areas, (3) use talking circles and talking sticks, and (4) use fingers rather than a penis model in the condom demonstrations module. The study involved 302 Alaskan Native youth recruited from four non-profit organizations serving youth in Alaska. Adolescents participating in the study were randomly assigned to either a treatment group that received the AKPHAT program or a control group that received the standard services available to youth in their schools and communities. The study administered surveys before the program started (baseline), and again immediately, three, six, and 12 months after the end of the program.

Six months after the program ended, the study found no evidence of statistically significant program impacts on sexual activity in the last three months or on having sex without using a condom in the last three months.

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Promoting Health Among Teens! Comprehensive Abstinence and Safer Sex Intervention

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