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Making A Difference!

Overview of the Curriculum

Making A Difference! An Abstinence Based Approach to Prevention of STDs, HIV and Teen Pregnancy is an eight-module curriculum that provides young adolescents with the knowledge, confidence, and skills necessary to reduce their risk of sexually transmitted diseases (STDs), HIV, and pregnancy by abstaining from sex. It is based on cognitive behavioral theories, focus groups, and the researchers' extensive experience working with youth. Making A Difference! is an adaptation and extension of the original Be Proud! Be Responsible! curriculum in that it integrates STD, HIV and pregnancy prevention.

To reduce STD/HIV and pregnancy risk-related behaviors, young adolescents need not only knowledge and perception of personal vulnerability, but also positive attitudes and beliefs regarding abstinence, abstinence negotiation skills, and confidence in their ability to abstain from sex. The Making A Difference! curriculum is designed to meet those needs.

Goal of the Curriculum

The goal of Making A Difference! is to empower young adolescents to change their behavior in ways that will reduce their risk of becoming infected with HIV and other STDs and their risk for pregnancy. Specifically, this curriculum emphasizes that young adolescents should postpone sexual activity and that practicing abstinence is the only way to eliminate the risk for pregnancy and STDs, including HIV.

Target Audience

African-American, Hispanic and White adolescents, ages 11-13, who attend middle schools and youth-serving community based programs.

Implementation of the Curriculum

The Making A Difference! curriculum was designed to be used with small groups ranging from six to 12 participants, but it can be implemented with larger numbers of youth. The curriculum can be implemented in various community settings, including schools or youth-serving agencies.

Length

The curriculum has eight hours of content divided into eight 60-minute modules. It can be implemented in eight classroom sessions of 60 minutes each or in four two-module sessions. In community settings, it can be implemented in a two-day format (four modules each day), four-day format (two modules each day) or eight-day format (one module each day).

Curriculum Objectives

At the completion of the Making A Difference! curriculum, youth will have:

  • Increased knowledge about prevention of HIV, STDs and pregnancy;
  • More positive attitudes/beliefs about abstinence;
  • Increased confidence in their ability to negotiate abstinence;
  • Increased negotiation skills;
  • Stronger intentions to abstain from sex;
  • A lower incidence of STD/HIV risk-associated sexual behavior; and
  • A stronger sense of pride and responsibility in making a difference.

Content Outline

The Making A Difference! curriculum has three major components. The first component focuses on goals and dreams and adolescent sexuality. The second component focuses on knowledge, including information about the etiology, transmission, and prevention of HIV, STDs, and teenage pregnancy. It also covers beliefs and attitudes about abstinence, HIV, STD, and pregnancy. The third component focuses on skills and self-efficacy. It covers negotiation and refusal skills, and provides time for practice, reinforcement, and support.

Modules

1: Getting to Know You and Making Your Dreams Come True

2: Understanding Adolescent Sexuality and Abstinence

3: The Consequences of Sex: Pregnancy

4: The Consequences of Sex: STDs

5: The Consequences of Sex: HIV Infection

6: Attitudes, Beliefs and Giving Advice About HIVSTDs and Abstinence

7: Responding to Peer and Partner Pressure

8: Role Plays: Refusal and Negotiation Skills

Types of Activities

The Making A Difference! curriculum includes a series of fun and interactive learning experiences designed to increase participation and help young adolescents understand faulty reasoning and decision making about taking risks for STD/HIV and pregnancy. Activities are designed to increase comfort with practicing abstinence, address concerns about practicing abstinence, and provide strategies for overcoming concerns and obstacles to practicing abstinence.

The activities incorporate social cognitive-behavioral skill building strategies (i.e., presentation, modeling, and the practice of abstinence negotiation skills). They involve culturally sensitive video clips, games, brainstorming, role-playing, skill-building activities and small group discussion that build group cohesion and enhance learning. Each activity lasts a brief time, and most are active exercises in which the adolescents get out of their seats and interact with each other. In this way, it is possible to maintain interest and attention that might fade if lecturing and lengthy group discussions were used.

Below is a description of the types of activities used in the Making A Difference! curriculum.

  • The goals and dreams activity focuses on having the adolescents consider their goals for the future and how participating in sexual activity at their current age might thwart the attainment of their goals. It makes clear that their best strategy is abstaining from sex.
  • DVDs are used to depict young adolescents in various situations. These videos evoke feelings, thoughts, attitudes, beliefs, and stereotypes about HIV/STD and pregnancy, and the importance of practicing abstinence.
  • The role-play scenarios are designed to provide participants with the confidence and skills to negotiate abstinence and delay sexual involvement. These realistic role-play scenarios provide young adolescents with a variety of ways in which they could use the negotiation-refusal skills that they learn in this program.
  • The curriculum incorporates the "Make a Difference! Be Proud! Be Responsible!" theme that encourages the participants to make a difference and abstain from sex, to be proud of themselves, their family, and their community, and to behave responsibly for the sake of themselves, their families, and their communities.

Curriculum Components

The curriculum consists of the facilitation guide manual, which provides detailed description of program activities, activities/games packet, and DVDs. The curriculum requires the use of a TV monitor and DVD player.

Theoretical Framework

Research shows that curricula are most effective if they are based on sound theoretical framework. The Making A Difference! curriculum draws upon three theories: the 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 in understanding a wide range of health-related behaviors.

There are two major concepts of these theories:

  1. Self-efficacy or perceived behavioral control beliefs, which is defined as a person's confidence in his or her ability to do the behavior, i.e. abstain from sex; and
  2. Outcome expectancies or behavioral beliefs, which are beliefs about the consequences of the behavior.

Both concepts are included in Making A Difference!

Below is a description of the three types of outcome expectancies or behavioral beliefs emphasized in the Making A Difference! curriculum:

  1. Goals and Dreams Beliefs — the belief that sexual involvement might 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 sex is listed and discussed as an obstacle. This belief is incorporated throughout the curriculum.
  2. Prevention Beliefs — the belief that abstinence can eliminate the risk of pregnancy, STDs and HIV/AIDS. This belief is incorporated throughout the curriculum.
  3. Partner-Reaction Beliefs — the belief that one's boyfriend/girlfriend would not approve of abstinence behaviors and react negatively to it, which may prevent a person from negotiating abstinence. 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 abstinence.

Unique Features of the Curriculum

Three overriding themes provide the Making A Difference! curriculum with a unique approach that has proved to be successful with young adolescents:

  • The community and family approach: An important component is the strong emphasis on family and community. The Making A Difference! curriculum emphasizes how HIV/AIDS, sexually transmitted diseases (STDs), and unintended adolescent pregnancy have affected their community. It addresses the importance of protecting the family and community as a motive to change individual behavior.

    The focus on the implications for the family and community to motivate change is different from the traditional exclusive focus on individualistic HIV/AIDS knowledge and individualistic attitudes toward risky behavior. In this connection, the intervention incorporates the "Make a Difference! Be Proud! Be Responsible!" theme to encourage the adolescent to be proud of themselves and to abstain from sex as a way to prevent the sexual transmission of HIV, not only for their own sake, but for the sake of their families and community.
  • The role of sexual responsibility and accountability: Many young adolescents do not express their sexual feelings in a responsible or accountable way. This is evidenced by the high incidence of STDs and pregnancy among adolescents. It is also evidenced by their self reports of poor condom use and multiple sexual partners. Therefore, young adolescents need to learn ways to be responsible and accountable in preventing the spread of sexually transmitted HIV infection.

    The Making A Difference! curriculum teaches participants to make responsible decisions regarding their sexual behavior, respect themselves and others, and appreciate the importance of developing a positive image. They learn that by being responsible and abstaining from sex, they will be able to reach their goals and dreams. Participants discuss what constitutes sexual responsibility, such as abstinence, and learn to make responsible decisions regarding their sexual behavior.
  • The role of pride and making a difference with abstinence as their choice: Adolescence is a difficult period of development. Adolescents are faced with a time of confusion, mixed emotions, and uncertainty. They are bombarded with sexual messages from various sources, including TV, music, magazines, friends, and their boyfriends/girlfriends. They receive pressure from their peers and boyfriends/girlfriends to have sex. They struggle with issues around self-esteem, self-respect, and self-pride. Therefore, they need to feel good about themselves, their decision to abstain from sex, and their behavior.

    The Making A Difference! curriculum addresses these feelings by emphasizing that adolescents can feel proud and responsible and make a difference with abstinence as their choice. Their sense of pride, self-confidence, and self-respect regarding making abstinence their choice is encouraged and reinforced during the role plays and other skill building activities.

Ordering and Training Information

To place an order or receive more information, call ETR at 800-321-4407 or visit them online at www.etr.org/ebi/programs/making-a-difference.

If the educators are knowledgeable about HIV/AIDS, STDs and adolescent sexuality and have experience implementing a STD/HIV prevention curriculum with youth, then they may need about six to eight hours of training. Their training should include reviewing the curriculum and discussing various issues in the curriculum and its implementation as well as what is unique and different. In addition, selected lessons should be modeled, and the participants should have an opportunity to practice them and receive feedback.

If the educators are not knowledgeable about HIV/AIDS, STDs, and adolescent sexuality and have no experience implementing a STD/HIV prevention curriculum with youth, then 24 hours of training are needed. During the training, HIV/AIDS, STD and adolescent pregnancy knowledge and prevention skills should be reviewed and reinforced. Implementation strategies, training issues, and the trainees' comfort level with adolescent sexuality should be discussed. The content of the curriculum should be reviewed. The trainer should walk the educators through the curriculum as though they were students. A question and answer period should be held afterwards. Then the trainees should practice the curriculum and receive performance feedback.

For information regarding training, contact:

Loretta Jemmott at (215) 898-8287 or ETR's Training Department at: training@etr.org.

Evaluation Fact Sheet

Intervention

In the research study, Making A Difference! was implemented in a small group format with African-American male and female adolescents, ages 11-13, in a two-day format on two consecutive Saturdays in three different middle schools. The Making A Difference! curriculum is based on cognitive behavioral theory and elicitation research and focuses on abstinence. It emphasizes that abstinence is the only effective way to eliminate risk for STDs, HIV, and pregnancy. It addresses youths' attitudes and beliefs about abstinence and sexual intercourse and teaches them skills to practice abstinence.

Research Design

In a randomized control trial, 659 6th and 7th grade African-American male and female adolescents, mean age 11.8, were stratified by gender and age and randomly assigned to receive one of three 8-hour curricula: an abstinence HIV curriculum, a safer sex HIV curriculum, or a health promotion curriculum (which served as the control group). The adolescents received the curriculum in small groups of six to eight students led by either an African-American adult facilitator (mean age 40) or two peer African-American co-facilitators (mean age 16).

The participants completed questionnaires before, immediately after, and three, six, and 12 months after the intervention. Of the original 659 participants, 97% returned to complete the three-month follow-up questionnaire, 94% completed the six-month questionnaire, and 93% completed the 12-month follow-up. The primary measures were HIV risk-associated sexual behaviors. The secondary measures were variables from the Theory of Planned Behavior and the Social Cognitive Theory, including knowledge, beliefs, norms, intentions, and self-efficacy regarding abstinence and condom use.

Behavioral Findings

  • The participants who received the Making A Difference! curriculum were less likely to report having sexual intercourse in the three months after intervention than were control-group participants (P=.02).
  • The curriculum delayed sexual experience among virgins. Among the participants who reported no previous sexual experience at the baseline, the students who received the Making A Difference! curriculum were less likely to report having sexual intercourse at the three-month follow-up than those in the control group (P=.02).

Other Significant Findings

  • The adult and peer facilitators were equally effective. There were no differences in intervention effects on behavior with adult facilitators as compared with peer co-facilitators.
  • The adolescents who received Making A Difference! believed more strongly that practicing abstinence would prevent pregnancy and AIDS (p‹.02), expressed less favorable attitudes toward sexual intercourse (p‹.002), and reported weaker intentions of having sexual intercourse the next three months (P‹.03) than did those in the control group or the safer sex group.
  • Adolescents who received Making A Difference! also believed more strongly that practicing abstinence would help them achieve their career goals than did those in the control group (p‹.04).

For More In-depth Information

Jemmott, J.B., Jemmott III, L.S. & Fong, G. (1998). Abstinence and Safer Sex HIV risk-reduction interventions for African-American adolescents: A randomized control trial. Journal of American Medical Association (JAMA), 279, 1529-1536.


Background Reading

Jemmott, J.B. III & Jemmott, L.S. (2001) HIV risk-reduction behavioral interventions with heterosexual adolescents. AIDS, 14 (suppl 2), S40-S52.

Jemmott, L.S. (2000). Saving our children: Strategies to empower African-American adolescents to reduce their risk for HIV infection. Journal of National Black Nurses Association, 2(1), 4-14.

Jemmott, J.B. III & Jemmott, L.S. (1999). Reducing HIV risk-associated sexual behaviors among African American adolescents: Testing the generalizability of intervention effects. Journal of Community Psychology, 27, 161-187.

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

Jemmott, J.B. III, Jemmott, L.S., & Hacker, C. (1992). Predicting intentions to use condoms among African-American adolescents: The theory of planned behavior as a model of HIV risk associated behavior. Journal of Ethnicity and Disease, 2, 371-380.

Jemmott, J.B. III, Jemmott, L.S., Spears, H., Hewitt, N. & Cruz-Collins, M. (1992). Self-efficacy, hedonistic expectancies, and condom-use intentions among inner-city Black adolescent women: A social cognitive approach to AIDS risk behavior. Journal of Adolescent Health, 13, 512-519.

Jemmott, J. B. III, Jemmott, L.S., & Fong, G. (1992). Reductions in HIV risk-associated sexual behaviors among Black male adolescents: Effects of an AIDS prevention intervention. American Journal of Public Health, 82, 372-377.

Jemmott, J.B. III, Frye, D., & Jemmott, L.S. Abstinence interventions. In A. O'Leary (Ed.) Beyond Condoms. New York: Plenum, in press.

Jemmott, J.B. III & Jemmott, L.S. Helping adolescents reduce their risk of AIDS. In M. Chesney (Ed.). Health Psychology and HIV Disease. New York: Plenum, in press.

Jemmott, J.B. III & Jemmott, L.S. HIV behavioral interventions for adolescents community settings. In J.L. Peterson & R.J. DiClemente (Eds.) Handbook of HIV Prevention. New York: Plenum, in press.

Jemmott, J.B. III & Jemmott, L.S. (1994). Interventions for adolescents in community settings. In R.J. DiClemente & J.L. Peterson (Eds.) Preventing AIDS: Theory and Practice of Behavioral Interventions, New York: Plenum.