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Positive Prevention PLUS

Blueprints Program Rating: Promising

A comprehensive school-based sexual health education and teen pregnancy prevention curriculum to improve high school students' communication and negotiation skills that will help them communicate assertively, abstain from sexual intercourse, and use birth control effectively.

  • Dr. Kim Clark and Christine Ridley, RN, MEd
  • California State University
  • Department of Health Sciences
  • positiveprevention.com
  • Sexual Risk Behaviors

    Program Type

    • School - Individual Strategies

    Program Setting

    • School

    Continuum of Intervention

    • Universal Prevention (Entire Population)

    A comprehensive school-based sexual health education and teen pregnancy prevention curriculum to improve high school students' communication and negotiation skills that will help them communicate assertively, abstain from sexual intercourse, and use birth control effectively.

      Population Demographics

      This program targets high school aged students in grades 9 – 12.

      Age

      • Late Adolescence (15-18) - High School

      Gender

      • Male and Female

      Race/Ethnicity

      • All Race/Ethnicity

      Race/Ethnicity/Gender Details

      The study did not provide differential analyses by gender or race/ethnicity; however, the sample contained students from high schools with large minority populations.

      School-based prevention programs that use experiential, interactive activities to emphasize abstinence and risk reduction techniques are more likely to reduce sexual risk-taking behaviors than those that merely increase student knowledge regarding reproductive anatomy or facts about the consequences of teen pregnancy.

      • Individual

      Positive Prevention PLUS is a school-based adolescent pregnancy prevention program that consists of eleven 45-minute lessons aimed at students in grades 9 through 12. It is delivered by trained classroom teachers during the normal school day in science, health, or physical education courses. The 11-unit curriculum includes lessons on the benefits of abstinence, assertive communication, refusal skills, accessing reproductive health services, condom negotiation, and condom use. Students practice communication about abstinence and risk reduction skills through scripted role play and other interactive activities.

      Positive Prevention PLUS is a school-based adolescent pregnancy prevention program that consists of eleven 45-minute lessons aimed at students in grades 9 through 12. It is delivered by trained classroom teachers during the normal school day in science, health, or physical education courses. The 11-unit curriculum includes lessons on the benefits of abstinence, assertive communication, refusal skills, accessing reproductive health services, condom negotiation, and condom use. Students practice communication about abstinence and risk reduction skills through scripted role play and other interactive activities.

      In LaChausse (2016), the treatment was completed over a 3-week period where educators were expected to complete 11 lessons consecutively. Teachers completed a rigorous training schedule with program developers to ensure fidelity of implementation. First, teachers completed a 2-day training that consisted of an overview of the project and opportunities to practice teaching a lesson. Next, teachers completed an online training program to review key components and to observe each lesson being taught by a veteran teacher. About 1 week before implementation, teachers were also given a 1-day refresher to emphasize key lessons and address any concerns about program implementation.

      The current version of the curriculum includes 13 sessions. The two additional lessons cover: STDs and Safe Surrender per California requirements.

      The program draws on social cognitive theory, which posits that behavior change occurs through several constructs, including observational learning, behavioral capability, outcome expectations, and self-efficacy.

      • Behavioral
      • Skill Oriented

      LaChausse (2016) conducted a cluster randomized control trial in which 21 schools (with 4,267 students) were randomly assigned to a treatment group that received the Positive Prevention Plus program (n = 11 schools) or a control group that received no sexuality-related classroom instruction or school-wide activities (n = 10). Student self-report data were collected at baseline and 6-months following program completion. Outcome measures included three behavioral measures related to sexual activity: (1) ever had sexual intercourse; (2) ever been pregnant or gotten someone pregnant; and (3) ever had sexual intercourse without using birth control in the past 3 months.

      At the 6-month follow-up posttest, students in the treatment group were less likely than students in the control group to report ever having had sex. In addition, students in the treatment group (compared to control students) were less likely to report having had sex without birth control in the past 3 months.

      Relative to the control group, students in the treatment group were less likely to report having had:

      • sexual intercourse
      • sexual intercourse without using birth control in the past 3 months.

      Not conducted.

      Not reported.

      Ethnically diverse sample of 9th grade students in six school districts in Southern California.

      LaChausse (2016)

      • Tests for baseline equivalence were done on the analysis sample rather than the randomized sample.
      • It is not clear whether baseline outcomes were included as covariates.
      • While the author states the program was implemented with high quality, it is not clear how program quality was measured.

      • Blueprints: Promising

      LaChausse, R. G. (2016). A clustered randomized controlled trial of the Positive Prevention PLUS Adolescent Pregnancy Prevention Program. American Journal of Public Health, 106(S1); S91-S96.

      For information about curriculum, content, or training:
      www.positivepreventionplus.com/contact/

      Study 1

      LaChausse, R. G. (2016). A clustered randomized controlled trial of the Positive Prevention PLUS Adolescent Pregnancy Prevention Program. American Journal of Public Health, 106(S1); S91-S96.

      LaChausse, R. G. (2016). A clustered randomized controlled trial of the Positive Prevention PLUS Adolescent Pregnancy Prevention Program. American Journal of Public Health, 106, (S1); S91-S96.

      Evaluation Methodology

      Design:
      Recruitment: High schools across six districts in Southern California with data indicating high adolescent birth rates and a lack of comprehensive sexuality education or adolescent pregnancy prevention programming were approached to participate. Criteria for selection into the study included whether schools were able to implement an adolescent pregnancy prevention program, maintain the treatment and control contrast, and provide access to eligible students. Twenty-two schools were assessed for eligibility and one school was dropped for not meeting inclusion criteria. A total of 7,042 students were assessed for eligibility and provided the opportunity to consent to participate. After excluding one school that was not eligible for participation, 4,267 parental consents were obtained and randomization into treatment and control occurred.

      Assignment: A total of 21 schools (with 4,267 students) were randomly assigned to condition, with 11 schools (n= 2,483 students) in the treatment group and 10 (n = 1,784) in the control group. Students in the control group classrooms received the standard health, science or physical education curriculum. Schools and teachers in the control group were asked to refrain from providing any sexuality-related classroom instruction or school-wide adolescent pregnancy or STD prevention-focused activities, though they were allowed to discuss human reproduction if relevant to their curriculum (for example, in a biology course).

      Attrition: No attrition occurred at the school-level. There were 3,554 participants that completed the baseline survey for an overall baseline attrition rate of 17%. At 6-months follow-up, 3,490 students completed a survey (for an overall attrition rate of 18%).

      Sample:
      The overall population of the sample was not reported, though demographics were reported by condition. Of the students in the treatment group, 34% were white, 18% were black, 8% were Asian, and 74% reported Hispanic ethnicity. Meanwhile, 38% of students in the control group were white, 18% were black, 9% were Asian, and 73% reported Hispanic ethnicity. More than half the overall sample was female, while 52% of students in the treatment group and 56% in the control group were female.

      Measures:
      Outcomes were assessed using a student, self-report yes/no question to the following items:

      • Ever had sexual intercourse
      • Ever been pregnant or gotten someone pregnant
      • Ever had sexual intercourse without using birth control in the past 3 months.

      Analysis:
      The analysis used multi-levels models with robust standard errors, random effects at the school level, and baseline covariates for gender and Hispanic or not. While outcomes were assessed at baseline (see Table 1), it is not clear whether these baseline outcomes were included as covariates. The Benjamini-Hochberg adjustment was made for the three outcomes assessed.

      Intent-to-Treat: All available data of students were analyzed based on the condition to which they were initially assigned which is in line with intent-to-treat protocol. Additional analyses used multiple imputation to include all data.

      Outcomes

      Implementation Fidelity: Teachers completed 95% of the lesson activities scheduled to be delivered. Ninety-one percent of the students attended all of the offered lessons. Seventy-three percent of the lessons received a high-quality rating, however no explanation or quantitative data was provided for how this rating was assessed. In terms of diffusion, only 14% of the participants in the control group reported learning about adolescent pregnancy prevention–related topics, whereas treatment group students reported learning 60% of the adolescent pregnancy prevention–related health topics.

      Baseline Equivalence: Tests used the analytic sample, but not the randomized sample. After adjustment for clustering, the tests showed no significant differences on any of the nine baseline measures (Table 1).

      Differential Attrition: The attrition rate differed across conditions by approximately 8% at baseline and 8% at the 6-month follow-up, with a higher attrition rate in the control group. Tests found no significant differences between the intervention and control groups in the proportion of dropouts who were female, were Hispanic, ever had sex, ever had been pregnant, and had not used birth control. In addition, per Table 1, equivalence for the analytic sample was established with no statistically significant differences in demographics or outcomes detected between the control and treatment groups at baseline.

      Posttest: At posttest, the study found significant impacts on the participants’ likelihood to engage in sexual intercourse and to engage in sexual intercourse without birth control. Relative to the control group, participants in the treatment group were approximately 4 percentage points less likely to have had sex at 6-month follow-up. In addition, participants in the treatment group were approximately 2 percentage points less likely than students in the control group to have had sex without birth control at 6-month follow-up. There were no significant differences between groups in getting pregnant/having gotten someone pregnant at 6-month follow-up.

      However, sensitivity tests found that use of multiple imputation reduced all the program effects to non-significance and use of logical imputation (i.e., using answers to some questions to impute answer to others) reduced the program effect on use of birth control to non-significance.

      Long-Term: , Not conducted.

      Registry

      The clinical trial registry for the study can be found at Clinical.Trials.gov (see https://clinicaltrials.gov/ct2/show/NCT02540278?term=LaChausse&rank=1). As the primary outcomes, the registry lists had sex (ever and last 6 months), been pregnant or gotten someone pregnant (ever and last 6 months), and sex without birth control (last 3 months). These outcomes and the other registry details correspond to those used in the study.