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Promising Program Seal

HIPTeens

Blueprints Program Rating: Promising

A sexual risk reduction intervention for high school girls that enhances knowledge, increases motivation, and teaches behavioral skills needed to reduce pregnancy, HIV and STI risk.

  • Sexual Risk Behaviors
  • Teen Pregnancy

    Program Type

    • Skills Training

    Program Setting

    • Community (e.g., religious, recreation)
    • School

    Continuum of Intervention

    • Selective Prevention (Elevated Risk)

    A sexual risk reduction intervention for high school girls that enhances knowledge, increases motivation, and teaches behavioral skills needed to reduce pregnancy, HIV and STI risk.

      Population Demographics

      The program targets non-pregnant, sexually active teenage girls, ages 15-19. The sample for the evaluated study came from a low-income, urban area.

      Age

      • Late Adolescence (15-18) - High School

      Gender

      • Female only

      Race/Ethnicity

      • All Race/Ethnicity, African American

      Race/Ethnicity/Gender Details

      The sample was predominantly African American (69%).

      • Individual
      Protective Factors
      • Individual: Refusal skills

      See also: HIPTeens Logic Model (PDF)

      HIPTeens is a sexual-risk reduction program that targets nonpregnant, sexually active teenage girls. The program includes four weekly, 120-minute sessions. At 3 and 6 months after the initial intervention, two 90-minute booster sessions are offered. The intervention is delivered in small groups (6-10 girls) by trained program facilitators. The intervention (a) provides HIV and sexual health information, (b) strives to increase motivation to reduce sexual risk behaviors and (c) allows time to practice interpersonal and self-management skills that facilitate sexual risk reduction. The intervention uses developmentally appropriate strategies such as games, group activities and role plays to deliver program content.

      HIPTeens is a sexual-risk reduction program that targets nonpregnant, sexually active teenage girls. It is delivered to small groups of 6-10 girls by trained program facilitators. The program includes four weekly, 120-minute sessions. Two 90-minute booster sessions are offered at 3 and 6 months after the initial intervention. The intervention (a) provides HIV and sexual health information, (b) strives to increase motivation to reduce sexual risk behaviors, and (c) allows time to practice interpersonal and self-management skills that facilitate sexual risk reduction. Facilitators use developmentally appropriate strategies such as games, group activities and role plays to deliver program content.

      Session content includes:

      • Session 1: Value setting and future goals, sexual health knowledge, and empowerment to practice safer sexual behaviors
      • Session 2: Triggers to risk situations, safer behaviors, and identifying strategies to reduce risk
      • Session 3: Condom use and negotiation skills, role of future goals in changing risky behavioral choices
      • Session 4: Self-empowerment, communication, negotiation skills, developing an individualized menu of risk reduction strategies, and personal motivation for achieving healthy behaviors

      The program is guided by the Information, Motivation, Behavioral (IMB) Skills model, which uses information and motivational strategies to change specific behaviors.

      The evaluation used a randomized controlled trial in which sexually active teenage girls (n = 639) were randomized to the sexual-risk reduction program or a health promotion control group. All subjects were between the ages of 15 and 19 years, and were recruited from youth development and adolescent health centers in upstate New York. Block randomization was used to assign participants to the intervention (n = 329) or control (n = 310) condition. Data were collected at baseline, and at 3-, 6-, and 12-months post-intervention. Outcome measures included frequency and type of sex, use of protection, and number of sexual partners.

      There were several intervention effects that favored the experimental condition. Intervention participants had significantly reduced frequency (total episodes) of vaginal sex at 3, 6, and 12 months post-intervention, when compared to the control condition. There was also a significant decrease in the number of unprotected vaginal sex acts at 3 and 12 months.

      The intervention group had a significant reduction in the total number of sexual partners at 6 months (but not at 3 and 12 months), and a reduced amount of unprotected sex with a steady partner at 3 months (but not at 6 and 12 months), compared to the control condition. There were no significant differences in frequency of unprotected sex with nonsteady partners. The intervention group had greater abstinence from vaginal sex (total, unprotected, with steady partner, without steady partner) than the control group at 6 months.

      The results using medical records presented raw percentages without formal models. They showed significantly fewer pregnancies in the intervention group than the control group.

      Compared to the control group, intervention participants experienced:

      • reduced frequency of vaginal sex and unprotected vaginal sex
      • reduced number of sexual partners and amount of unprotected sex with a steady partner
      • greater abstinence from vaginal sex at 6 months
      • fewer pregnancies

      There was no analysis of mediating effects.

      Most tables did not include effect sizes, but odds ratios for number of sex partners ranged from .368 to .536 (small-medium to medium effects).

      Given that the program targets nonpregnant, sexually active teen girls and the evaluated sample came from an urban, low-income area, program effects may only be generalizable to similar populations.

      • Significant baseline differences existed for two outcomes (Table 2); however, these indicated the treatment group was more at risk
      • Although similar across conditions, attrition differed by age

      • Blueprints: Promising

      Morrison-Beedy, D., Jones, S., Xia, Y., Tu, X., Crean, H., & Carey, M. (2013). Reducing sexual risk behavior in adolescent girls: Results from a randomized controlled trial. Journal of Adolescent Health, 52(3), 314-321.

      Dianne Morrison-Beedy
      Phone: (813) 230-3335
      Email: hip4change@gmail.com
      Web: www.hip4change.com

      Morrison-Beedy, D., Jones, S., Xia, Y., Tu, X., Crean, H., & Carey, M. (2013). Reducing sexual risk behavior in adolescent girls: Results from a randomized controlled trial. Journal of Adolescent Health, 52(3), 314-321.

      Evaluation Methodology

      Design: The evaluation used a randomized controlled trial in which sexually active teenage girls (n = 639) were randomized to the sexual-risk reduction program or a health promotion control group. All subjects were between the ages of 15 and 19 years, and were recruited from youth development and adolescent health centers in upstate New York. Block randomization was used to assign participants to the intervention (n = 329) or control (n = 310) condition. Data were collected at baseline, and at 3-, 6-, and 12-months post-intervention, but relative to the 6-month program of group meetings and booster sessions, the assessments occurred at baseline, mid-program, posttest and 6-month follow-up.

      Eligibility requirements included: English-speaking, unmarried, not currently pregnant, not given birth within the past 3 months, and sexually active within the past 3 months. The control condition included information on general health topics (i.e., nutrition, breast health and anger management). The control condition was designed to be structurally equivalent to the intervention, and had the same number of sessions and same program facilitators as the intervention.

      Attrition: Of the 1,778 girls who were screened, 765 (43%) did not meet eligibility criteria. Among eligible participants, 738 consented, and 639 ultimately participated. Across both groups, completion was 85% at 3 months, 84% at 6 months and 76% at 12 months.

      Sample: Participants were predominantly African American (69%), but also included Caucasian (9%), multiracial (11%) and other (11%). The sample was mostly low-income (69%, as measured by 'free lunch' status). All subjects were girls, with a mean age of 16.5 years.

      Measures: Measures were collected using an audio computer-assisted self-interview at all intervals. In the self-interview, participants reported demographic and health behaviors. These items included age at first vaginal, oral and anal sex; age of sexual partner; number of concurrent male sexual partners; and episodes of protected and unprotected vaginal and anal sex with steady and nonsteady partners (past 3 months). Participants also provided urine samples at baseline, 6 and 12 months that were tested for Chlamydia and Gonorrhea.

      Additionally, data from some participants' medical charts (n = 322) were abstracted from participating health clinics. Researchers used the data to identify additional infections and positive pregnancy tests outside of those documented by the testing protocol.

      Analysis: Analyses followed the intent-to-treat principal and included all girls randomized to groups. Analyses controlled for race, age, and poverty, as well as baseline status of the dependent measure. The models did not adjust for clustering within the intervention groups.

      Zero-inflated Poisson (ZIP) regression analyses were used for count behavior (frequency of sexual behavior) with substantial numbers of zeros. For the ZIP models, two regression equations were estimated simultaneously: (a) a logistic regression model to predict whether specific types of sexual behavior occurred (e.g., reported protected vaginal sex), and (b) a Poisson regression model to predict the values of the episodes of sexual activity. The ZIP models allowed for the possibility that different variables may predict whether a subject had participated in a sexual behavior, as well as the frequency.

      The impact of the intervention was also analyzed on the number of sex partners. Number of partners was classified into three categories (zero partners, one partner, and two or more partners). These categorical data were then modeled using generalized logit regression, assessing the differences between those subjects with (a) zero partners and one partner, (b) zero partners and two or more partners. Cases with missing data were evaluated to assess potential biases on the outcomes. The ZIP model was evaluated with 3, 6, and 12-month post-intervention data for each outcome, controlling for the baseline value of the variable and six covariates: age, white race, multiracial, other ethnicity, Hispanic, free lunch, and treatment condition. Each follow-up visit was modeled separately.

      Outcomes:

      Implementation fidelity: Program sessions were audiotaped and randomly selected for review. Independent raters scored facilitators at 97% fidelity to content and process. There was no information on program attendance.

      Baseline equivalence: There were no differences between intervention and control groups in race, ethnicity or poverty (as measured by 'free lunch' status). However, Table 2 showed some significant baseline differences on the number of times having had vaginal sex and unprotected vaginal sex, indicating greater risk for the treatment group.

      Differential attrition: Group assignment was not associated with attrition, but older girls were significantly more likely to be lost to follow-up. Figure 1 shows that 24 control subjects (7.7%) and 0 intervention subjects were "lost to follow-up" rather than to attrition, but the study made no note of the different form of drop out or the possible influence on results.

      Posttest:

      There were several intervention effects that favored the experimental condition. Intervention participants had significantly reduced frequency of vaginal sex at 3, 6, and 12 months post-intervention, when compared to the control condition. There was also a significant decrease in the number of unprotected vaginal sex acts at 3 and 12 months.

      The intervention group had a significant reduction in the total number of sexual partners at 6 months (but not at 3 and 12 months), and a reduced amount of unprotected sex with a steady partner at 3 months (but not at 6 and 12 months), compared to the control condition. There were no significant differences between conditions in frequency of unprotected sex with nonsteady partners. The intervention group had greater abstinence from vaginal sex (total, unprotected, with steady partner, without steady partner) than the control group at 6 months.

      The results using medical records and urine tests presented raw percentages without formal models. They showed significantly fewer pregnancies in the intervention group than the control group but no significant differences in sexually transmitted infections.