Be Proud! Be Responsible!
Overview of the Curriculum
Be Proud! Be Responsible! is a six-part evidence-based curriculum that provides adolescents with the knowledge, motivation, and skills necessary to change their behaviors in ways that will reduce their risk of pregnancy or contracting HIV and other sexually transmitted diseases. To change behavior, adolescents need not only information and a perception of personal vulnerability, but also the skills and the confidence in their ability to act safely. The curriculum consists of six 50-minute sessions, which can be presented over one to six days.
The Be Proud! Be Responsible! curriculum was designed to be used with small groups ranging from 6 to 12 participants, but it has been implemented in recent years in settings with larger numbers of youth. The curriculum can be implemented in various community settings, including schools or youth-serving agencies.
At the completion of this program, youth will:
- Increase their knowledge about HIV, AIDS, and other STDs.
- Believe in the value of safer sex, including abstinence.
- Have confidence in their ability to negotiate safer sex and to use condoms correctly.
- Be able to use condoms and negotiate sexual situations.
- Intend to practice safer sex.
- Reduce sexual risk behaviors.
- Take pride in and responsibility for choosing responsible sexual behaviors.
Be Proud! Be Responsible! includes the following six modules:
Module I: Introduction to HIV and AIDS
Module II: Building Knowledge About HIV and AIDS
Module III: Understanding Vulnerability to HIV Infection
Module IV: Attitudes and Beliefs about HIV, AIDS, and Safer Sex
Module V: Condom Use Skill Building
Module VI: Building Negotiation and Refusal Skills
Unique Features of the Curriculum
Although it was developed primarily as an HIV prevention curriculum, Be Proud! Be Responsible! addresses sexual risk-taking behaviors that are pertinent to pregnancy prevention as well. Three overriding themes provide the Be Proud! Be Responsible! curriculum with a unique approach that has proved to be successful in urban environments.
The Inner-City and Sense-of-Community Approach
A unique feature of this curriculum is its strong inner-city and sense-of-community approach. It emphasizes how HIV infection and AIDS have affected inner-city communities and discusses the importance of protecting the community as a motive to change individual risky behaviors. This theme is different from traditional prevention curricula that focus on individuals' knowledge, attitudes, and risk behaviors. Be Proud! Be Responsible! focuses on participants' needs to adopt responsible and safer sexual behaviors to prevent the sexual transmission of HIV, not only for the sake of themselves, but for the sake of their families, sexual partners, children, and community.
The Role of Sexual Responsibility and Accountability
Adolescents need to learn how to be sexually responsible and accountable. Thus, participants will learn that becoming sexually active is a choice nearly every person makes at some point in his or her life. That choice should be based upon how individuals feel about themselves, their partners, and the consequences of active sexual relations, such as STDs, including HIV infection, or pregnancy. Participants will investigate what constitutes sexual responsibility, such as abstinence or condom use during sexual intercourse, and will learn to make responsible decisions regarding their sexual behavior.
The Role of Pride in Making Safer Sexual Choices
Adolescence is a time of confusion, mixed emotions, and uncertainty. During this time, adolescents struggle with issues around self-esteem, self-respect, and self-pride; therefore, they need to feel good about themselves, their decisions, and their behaviors. Be Proud! Be Responsible! addresses these feelings by emphasizing that it can feel good to make proud and responsible safer sexual choices. As adolescents complete the curriculum, their sense of pride, self-confidence, self-satisfaction, and self-respect is encouraged and reinforced during the role plays and other skill-building activities.
Be Proud! Be Responsible! draws upon three theories: Social Cognitive Theory, the Theory of Reasoned Action, and its extension, the Theory of Planned Behavior. These theories have been shown to be of great value to understanding a wide range of health-related behaviors. Three types of outcome expectancies or behavioral beliefs are emphasized in Be Proud! Be Responsible!
- Prevention Belief — The belief that behaving in a specific manner will prevent a negative outcome. An example of such an outcome expectancy is the belief that the effective use of condoms can reduce the risk of pregnancy and sexually transmitted HIV infection. For example, the curriculum devotes all of Session V to building condom use skills.
- Hedonistic Belief — Such beliefs are influenced by personal satisfaction and gratification. People engage in sexual activities for a variety of reasons, including sexual enjoyment. Hedonistic considerations may influence key outcome expectancies during sexual experiences. For example, many people believe that condoms reduce physical sensations during sexual activity or ruin the mood and, therefore, are less likely to use condoms during sexual intercourse. For example, the curriculum has youth identify ways to make condoms fun and pleasurable in Session V.
- Partner-Reaction Belief — The third type of belief influencing outcome expectancies is an individual's perception of his or her partner's attitudes about engaging in particular safer sex practices. For example, the belief that one's sexual partner will react negatively to the use of condoms may prevent a person from suggesting condom use during sexual intercourse. For example, in Session VI, youth learn how to use negotiation and refusal skills to communicate with their partners about abstinence or condom use.
Also emphasized in the Social Cognitive Theory and the Theory of Planned Behavior is the importance of skills and self-efficacy to perform a behavior. Perceived self-efficacy, defined as confidence in one's ability to perform a given behavior required to produce desired outcomes, has been shown to affect: 1) whether people consider changing their behavior; 2) the degree of effort they invest in changing; and 3) the long-term maintenance of behavioral change (Bandura 1982,1986,1989; O'Leary 1985). In addition, recent studies suggest that perceived self-efficacy is also important to HIV risk behavior change (e.g., Jemmott & Jemmott 1992; Jemmott et al. 1992; O'Leary et al. 1991; Valdiserri et al. 1989; Brafford & Beck 1991).
Ordering and Training Information
Be Proud! Be Responsible! is distributed by ETR, www.etr.org/ebi/programs/be-proud-be-responsible. The evidence-based implementation kit includes: facilitator curriculum, an activity set with role-play, implementation DVD (Wrap it Up, The Subject is: HIV and The Hard Way), and one student workbook.
Basic educator trainings for Be Proud! Be Responsible! are available on a fee-for-service basis from ETR. Fee-for service trainings are provided by request from a state or local education or health agency for groups of approximately 20-50 people. Costs vary depending on the size of the group trained. For more information, contact ETR's Training Department at firstname.lastname@example.org.
Evaluation Fact Sheet
In the research study, the 5-hour curriculum was implemented with an all male population in a single-day format on a Saturday. The curriculum stressed behavior change for prevention of HIV-AIDS. The behavioral findings (see below) indicate that it also reduced the incidence of risky behaviors leading to pregnancy.
Three months following the intervention, the students in Be Proud! Be Responsible! reported less risky sexual behavior than did students in the control condition and reported having sexual intercourse on fewer occasions and with fewer women. Those who had sexual intercourse used condoms more consistently, and a smaller percentage of them reported engaging in anal intercourse.
Other Significant Findings
The students who participated in Be Proud! Be Responsible! scored higher on a test of AIDS and STD knowledge, expressed less favorable attitudes toward risky sexual behavior, and reported weaker intentions to engage in risky sexual behavior than did the students who had participated in the control condition.
The participants were 157 inner-city African-American male adolescents. Their ages ranged from 12 to 19, with a mean of 14.6 years. The students were stratified by age and assigned randomly within age to Be Proud! Be Responsible! or to a control condition which received instruction on career opportunities. The students received the curriculum in small groups of 6 to 8 students led by a trained adult facilitator. Because the students were stratified by age, each group had a range of ages and the average age in each of the groups was about the same.
The participants completed questionnaires before, immediately after, and 3 months after the intervention. Of the original 157 students, 150 or 96% returned to complete the 3-month follow-up questionnaire. The measures included HIV risk-associated sexual behavior, intentions to engage in risky sexual behaviors, attitudes toward risky sexual behaviors, and AIDS and STD knowledge.
For more in-depth information:
Jemmott JB, Jemmott LS, and Fong GT (1992). Reductions in HIV risk-associated sexual behaviors among black male adolescents: Effects of an AIDS Prevention Intervention. American Journal of Public Health 82(3): 372-377.
Bandura, A. (1986). Social Foundations of Thought and Action: A Social Cognitive Theory, Englewood Cliffs, NJ: Prentice-Hall.
Bandura, A. (1989) Perceived Self-efficacy. In V.M. Mays, G.W. Albee, & S.F. Schenider (Eds.), Primary Prevention of AIDS: Psychological Approaches. Newbury Park, CA: Sage.
Bradford, L.J., & Beck, K.H. (1991). Development and Validation of a Condom Self-efficacy Scale for College Students. Journal of American College Health 39, 219-225.
Jemmott, L.S., & Jemmott, J.B. III (1992). Increasing Condom-Use Intentions Among Sexually Active Inner-City Adolescent Women: Effects of an AIDS Prevention Program. Nursing Research, 41, 273-278.
Jemmott, J.B., Jemmott, L.S., & Fong, G.T. (1992). Reductions in HIV Risk-Associated Sexual Behaviors Among Black Adolescents: Effects of an AIDS Prevention." American Journal of Public Health, 82, 372-377.
Jemmott, J.B., Jemmott, L.S., Spears, H., Hewitt, N., & Cruz-Collins, M. (1992). AIDS Information, Self-Efficacy, Hedonistic Expectancies, and Condom-Use Intentions: Testing the Information alone Hypothesis. Journal of Adolescent Health, 13, 512-519.
O'Leary, A., Goodhart, F.F., Jemmott, L.S., & Boccher-Lattimore, D. (1992). Predictors of Safer Sex on the College Campus: A Social Cognitive Theory Analysis. Journal of American College Health, 40, 254-263.
Valdiserri, R.O., Lyter, D.W., Leviton, L.C., Callahan, C.M., Kingsley, L.A., & Rinaldo, C.R. (1989). AIDS Prevention in Homosexual and Bisexual Men: Results of a Randomized Trial Evaluating Two Risk-reduction Interventions. AIDS, 3, 21-26.