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Making Proud Choices!

A Safer Sex Approach to Prevention of STDs, HIV and Teen Pregnancy


Overview of the Curriculum

Making Proud Choices! A Safer Sex Approach to STDs, Teen Pregnancy, and HIV Prevention 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 or using condoms if they choose to have sex. It is based on cognitive behavioral theories, focus groups, and the researchers' extensive experience working with youth. Making Proud Choices! is an adaptation and extension of the original Be Proud! Be Responsible! curriculum in that it integrates STD, HIV and pregnancy prevention.

To reduce risk for STD/HIV and pregnancy risk-related behaviors, young adolescents need not only knowledge and perception of personal vulnerability, but also positive attitudes towards condom use, skills, and confidence in their ability to use condoms. The Making Proud Choices! curriculum is designed to meet those needs.

Goal of the Curriculum

The goal of Making Proud Choices! 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 they can reduce their risk for STDs, HIV, and pregnancy by using a condom, if they choose to have sex.

Target Audience

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

Implementation of the Curriculum

Making Proud Choices! 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 one-hour modules. It can be implemented in eight sessions of 60 minutes each or in four two-module sessions. In community settings, it can be implemented in the 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 Proud Choices! curriculum, youth will have:

  • increased knowledge about prevention of HIV, STDs and pregnancy
  • more positive attitudes/beliefs about condom use
  • increased confidence in their ability to negotiate safer sex and to use condoms correctly
  • increased negotiation skills
  • improved condom use skills
  • stronger intentions to use condoms if they have sex
  • a lower incidence of STD/HIV risk-associated sexual behavior
  • a stronger sense of pride and responsibility in making a difference

Content Outline

The Making Proud Choices! curriculum has four major components. One component focuses on goals and dreams and adolescent sexuality. The second component is knowledge. It covers information about the etiology, transmission, and prevention of STDs, HIV, and teenage pregnancy. The third component focuses on beliefs and attitudes. The fourth component focuses on skills and self-efficacy. It covers negotiation-refusal skills and condom use skills, and provides time for practice, reinforcement, and support.

Modules

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

2: The Consequences of Sex: Pregnancy

3: The Consequences of Sex: STDs

4: The Consequences of Sex: HIV Infection

5: Attitudes and Beliefs About HIV/AIDS and Condom Use

6: Strategies for Preventing HIV Infection: Stop, Think and Act

7: Developing Condom Use Skills and Negotiation Skills

8: Enhancing Condom Use Negotiation Skills

Types of Activities

The Making Proud Choices! curriculum includes a series of fun and interactive learning experiences designed to increase participation and to 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 condom use, address concerns about negative effects of practicing safer sex, and build skills in condom use and negotiation.

The activities incorporate social cognitive-behavioral skill-building strategies (i.e., presentation, modeling, and the practice of condom use 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 a lot 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 Proud Choices! curriculum.

  • The goals and dreams activity focuses on having the adolescents consider their goals for the future and how participating in unsafe sex might thwart the attainment of their goals.
  • Videos are used to depict young adolescents in various situations. These videos evoke feelings, thoughts, attitudes, beliefs, and stereotypes about HIV/STD, sexual involvement, and HIV/STD prevention skills.
  • The role-play scenarios are designed to provide participants with the confidence and skills to negotiate condom use. These realistic role-play scenarios provide young adolescents with a variety of ways in which they could use the prevention skills that they learn in this program.
  • The curriculum incorporates the "Make Proud Choices! Be Proud! Be Responsible!" theme that encourages the participants to be proud of themselves, their families, and their communities, 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. For additional information, call Select Media at 1-800-707-6334 or visit Select Media's website www.selectmedia.org

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Theoretical Framework

Research shows that curricula are most effective if they are based on sound theoretical framework. The Making Proud Choices! 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:

  • 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. use a condom, and
  • outcome expectancies or behavioral beliefs, which are beliefs about the consequences of the behavior.

Both concepts are included in Making Proud Choices!

Below is a description of the four types of outcome expectancies or behavioral beliefs emphasized in Making Proud Choices!:

  1. 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.
  2. Prevention Beliefs — the belief that condoms can reduce the risk of pregnancy, sexually transmitted diseases 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 condom use and will react negatively to it. This belief may 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.
  4. 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, they 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.

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Unique Features of the Curriculum

Three overriding themes provide the Making Proud Choices! curriculum with a unique approach that has proved to be successful with young adolescents.

  • The community and family approach: An important component of our approach is the strong emphasis on family and community. The Making Proud Choices! curriculum emphasizes how HIV/AIDS, 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 adolescents to be proud of themselves and to use condoms as a way to prevent the sexual transmission of HIV, not only for their own sake, but for the sake of their families and communities.
  • 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 inconsistent condom use and multiple sexual partners. Young adolescents need to learn how to become sexually responsible and accountable. The Making Proud Choices! curriculum teaches participants to make responsible decisions regarding their sexual behavior, respect themselves and others, and appreciate the importance of developing a positive image. Participants discuss what constitutes sexual responsibility, such as condom use, and learn to make responsible decisions regarding their sexual behavior, i.e. that abstinence is the best way to prevent HIV, STD and teen pregnancy. However, if they choose to have sex, they must use a condom.
  • The role of pride and making a difference in making safer sex 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 decisions to practice safer sex, and their behavior.

    The Making Proud Choices! curriculum addresses these feelings by emphasizing that it can make you feel proud and responsible to make proud choices about making safer sex your choice. The adolescents' sense of pride, self-confidence, and self-respect regarding their choice to practice safer sex is encouraged and reinforced during the role plays and other skill-building activities.

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Ordering and Training Information

Ordering

Making Proud Choices! can be purchased as is or in an implementation kit from Select Media. For more information or to place an order, call Select Media at 1-800-707-6334 or visit them on-line at www.selectmedia.org.

Training

If the educators are knowledgeable about HIV/AIDS, STDs, and adolescent sexuality and have experience implementating a STD/HIV prevention curriculum with youth, then they need 16 hours of training. Their training should include reviewing the curriculum and discussing various issues in the curriculum and its implementation and 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 levels with adolescent sexuality should be discussed. The content of the curriculum should be reviewed. The trainer should walk the educators through the curriculum as they 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.

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Evaluation Fact Sheet

Intervention

In the research study, the eight-hour curriculum Making Proud Choices! 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 Proud Choices! curriculum is based on cognitive behavioral theory and elicitation research and focuses on safer sex. It acknowledges that abstinence as the most effective way to eliminate their risk for STDs including HIV. However, it stressed condom use. It explains that if young people choose to have sex, they must practice safer sex and always use a condom to reduce their risk for STDs, HIV, and pregnancy. It addresses attitudes and beliefs about using condoms and builds skills to use condoms correctly and negotiate condom use.

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 eight-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 6-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 students who received the Making Proud Choices! safer sex curriculum reported:
    • more consistent condom use and less unprotected sex in the three months after the intervention than did those in the control group.
    • a higher frequency of condom use at the three-, six-, and 12-month follow-up sessions than did those in the control group.
  • Making Proud Choices! was especially effective with sexually experienced adolescents. For instance, among students who were sexually experienced at baseline, those in the safer sex groups reported less sexual intercourse in the previous three months at the six- (p‹.001) and 12- (p=.002) month follow-up than the control group (p‹.03). In addition, they reported less unprotected sex at all three follow-up sessions than the control group (p‹.03).

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 the Making Proud Choices! curriculum scored higher in condom use knowledge, believed more strongly that condoms can prevent pregnancy, STDs and HIV, believed more strongly that using condoms would not interfere with sexual enjoyment, expressed greater confidence that they could have condoms available when they needed them, and reported greater confidence that they could exercise sufficient impulse control to use condoms and greater self-efficacy for using condoms than did those in the control group.

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.

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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.

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