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Promoting Health Among Teens! (Abstinence Only)

Blueprints Program Rating: Promising

An 8-hour abstinence-based education program to reduce risky sexual behavior for African American youth by providing information on sexual risks and helping teens build negotiation, refusal, and problem solving skills for practicing abstinence.

  • John B. Jemmott III
  • Professor
  • University of Pennsylvania, School of Medicine
  • Department of Psychiatry
  • Center for Health Behavior and Communication Research
  • 3535 Market Street
  • Philadelphia, PA 19104-3309
  • 215-573-9366
  • jjemmott@asc.upenn.edu
  • Sexual Risk Behaviors

    Program Type

    • Cognitive-Behavioral Training
    • Skills Training

    Program Setting

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

    Continuum of Intervention

    • Universal Prevention (Entire Population)

    An 8-hour abstinence-based education program to reduce risky sexual behavior for African American youth by providing information on sexual risks and helping teens build negotiation, refusal, and problem solving skills for practicing abstinence.

      Population Demographics

      The program targets African American 6th and 7th grade students living in urban settings.

      Age

      • Early Adolescence (12-14) - Middle School

      Gender

      • Male and Female

      Race/Ethnicity

      • African American

      Race/Ethnicity/Gender Details

      The study included only African American students and did not disaggregate results by gender.

      Goal-oriented behavior, problem-solving and negotiation skills, and resistance to peer pressure reduce risky sexual behaviors.

      • Individual
      Protective Factors
      • Individual: Problem solving skills, Refusal skills

      See also: Promoting Health Among Teens! (Abstinence Only) Logic Model (PDF)

      The program is an 8-hour abstinence-based education intervention for African American teens that offers optional booster sessions and one-on-one meetings for up to two years following program completion. It aims to give 6th and 7th grade students accurate information on sexual risks and help participants build negotiation, refusal, and problem solving skills for practicing abstinence.

      The program is an abstinence-based education intervention for African American teens that is delivered over 8 one-hour modules. In addition, there are optional booster sessions and one-on-one meetings for up to two years following program completion. It aims to increase knowledge of HIV/sexually transmitted infections (STIs); strengthen behavioral beliefs supporting abstinence including the belief that abstinence can prevent pregnancy, STIs and HIV; promote the belief that abstinence can foster attainment of future goals; and increase skills to negotiate abstinence and resist pressure to have sex. The intervention contains accurate information and does not portray sex in a negative light or use a moralistic tone. Modules are delivered by trained facilitators and include brief group discussions, videos, games, brainstorming, experiential exercises, and skill-building activities.

      The program draws upon: 1) social cognitive theory, 2) the theory of reasoned action, and 3) the theory of planned behavior. All three theories emphasize the importance of beliefs and considering whether a given behavior will have negative or positive consequences.

      • Cognitive Behavioral

      The study randomly assigned 662 African American 6th and 7th grade students recruited from 4 public middle schools in a northeastern US city. Participants randomly assigned to the 8-hour abstinence-only treatment group were compared to participants randomly assigned to 8-hour safer sex only (focusing on condom use), either an 8- or 12-hour version of a comprehensive intervention including abstinence and safer sex, and an 8-hour health promotion control group focusing on health behaviors unrelated to sexual contact. In addition, students in each intervention were randomly assigned to a maintenance program. The primary measure was a self-report of sexual contact, and secondary measures addressed other sexual behaviors such as multiple partners, unprotected intercourse, and consistent condom use. Participants completed pretest, posttest, and 3-, 6-, 12-, 18-, and 24-month follow-up questionnaires.

      Across the study period (Jemmott et al., 2010), fewer participants in the abstinence-only intervention reported sexual initiation and recent sexual intercourse as compared to the control condition.

      Across the study period (Jemmott et al., 2010) found significant improvement among those assigned to the abstinence-only treatment group as compared to the control group in:

      • sexual initiation
      • recent sexual intercourse

      Jemmott et al. (2010) did not conduct a formal mediator analysis.

      Jemmott et al. (2010) reported a small effect size (risk ratio of .67-.94).

      Jemmott et al. (2010) was conducted at 4 public middle schools in one city with mostly African-American students.

      Jemmott et al. (2010):

      • Long-term effects were hard to determine because roughly half of the sample was assigned to a maintenence group for up to 21 months following program completion

      Promoting Health Among Teens! (PHAT) – Comprehensive, a 12-hour HIV/STI, pregnancy prevention and safer-sex intervention also reported by Jemmott et al. (2010), is included as a separate write-up.

      • Blueprints: Promising

      Jemmott, J. B., Jemmott, L. S., & Fong, G. T. (2010). Efficacy of a theory-based abstinence-only intervention over 24 months: A randomized controlled trial with young adolescents. Archive of Pediatric and Adolescent Medicine, 164, 152-159.

      ETR
      100 Enterprise Way. Suite G300
      Scotts Valley, CA 95066
      Tel: (800) 620-8884
      Fax: (831) 438-4284
      Main Website: etr.org
      Program Website: pub.etr.org/ProductDetails.aspx

      Jemmott, J. B., Jemmott, L. S., & Fong, G. T. (2010). Efficacy of a theory-based abstinence-only intervention over 24 months: A randomized controlled trial with young adolescents. Archive of Pediatric and Adolescent Medicine, 164, 152-159.

      Jemmott, Jemmott, & Fong (2010)

      Evaluation Methodology

      Design:

      Recruitment: The study made announcements in assemblies, classrooms, and lunchrooms and sent letters to parents or guardians in 4 middle schools in a northeastern city in the U.S. African American students in the 6th and 7th grades who volunteered and had written parent or guardian consent were included in the study (which resulted in 86.9% of those eligible).

      Assignment: A total of 662 students were randomly assigned to one of the 5 conditions: 8-hour abstinence only (n = 134), 8-hour safer sex only (focusing on condom use; n = 129), either an 8- or 12-hour version of a comprehensive intervention including abstinence and safer sex (n = 134 and 131, respectively), and an 8-hour health promotion control group focusing on health behaviors unrelated to sexual contact (n = 134). In addition, 315 students (48% of the baseline sample) were also randomly assigned to an intervention maintenance group for up to 21 months following program completion.

      Attrition: Participants completed pretest, posttest, and 3-, 6-, 12-, 18-, and 24-month follow-up questionnaires from 2001-2004. There were 559 students (84% of the baseline sample) that completed the 24-month follow-up. According to follow-up with the authors, there were no differences by condition in the attrition rates.

      Sample: About 53.5% of participants were female; ages ranged from 10-15 years with a mean of 12.2 years. Approximately 23.4% of the sample reported sexual initiation before the baseline measure.

      Measures: For the primary outcome of sexual initiation, the study included a self-report of ever having had sex. In addition, the study used self-reports of sex behaviors in the past 3 months, including sexual intercourse, multiple partners, unprotected intercourse, and consistent condom use. Trained data collectors were blind to participant assignment, and special efforts were made to obtain honest answers from students (including adding a social desirability scale that was found to have no association with the outcomes).

      Analysis: The study tested the report of ever having sexual intercourse using generalized linear regression with a log link. The study used either the Bernoulli or Poisson error distribution depending on whether predicted probabilities violated the 0,1 range of probability. The other measures were analyzed using Poisson generalized estimating equations with a log link. Analyses on ever having sexual intercourse excluded participants who reported having sexual intercourse at baseline. Analyses controlled for baseline outcome measures, time, condition, gender, and age where possible. The study conducted a 24-month follow-up, but did not report significance of results at each assessment point. Instead, the data were averaged over the entire period of the study, including the long-term follow-up.

      Intent-to-Treat: The study used an intent-to-treat approach in which participants’ data were analyzed regardless of the number of intervention or data collection sessions they attended. About 98% of those randomized were included in the analysis.

      Outcomes

      Implementation Fidelity: The study stated that the modules were highly structured and facilitators used an intervention manual, however no quantitative measures of fidelity were reported. Attendance was high for the 2 sessions comprising the 8-hour abstinence-based program (at least 95%).

      Baseline Equivalence: The study did not report significance tests of differences between conditions at baseline. However, this information was requested and obtained from the program developers, and their table showed only 1 of 9 significant differences between the conditions at baseline (condom use in the past 3 months).

      Differential Attrition: The study reported that there was no significant difference in attrition between conditions and that attending a follow-up session was “unrelated to gender, age, living with both parents, and sexual behavior outcomes.” Other tests of differential attrition were not reported.

      Posttest: Across the study period, fewer participants in the abstinence-only intervention reported sexual initiation within the last three months as compared to the control condition. In addition, the abstinence-only intervention reduced recent sexual intercourse within the last three months. The abstinence-only intervention showed no effect on reports of multiple partners, consistent condom use or unprotected intercourse.

      Maintenance/booster sessions were provided to roughly half the sample within the 21 months following completion of the 8-hour curriculum. Being assigned to the maintenance sessions did not moderate the efficacy of the intervention in reducing most outcomes, but the abstinence-only initiative did more to reduce multiple partners when the maintenance component was added.

      Long-Term: No long-term follow-up was reported.