ASSESS (AWARENESS, SKILLS, SELF-EFFICACY/SELF-ESTEEM, AND SOCIAL SUPPORT)

OVERVIEW

ASSESS is a risk assessment and safe-sex education program designed to reduce sexual intercourse and increase condom use in teens. Physicians provided information on STDs, abstinence and condom use, and taught skills to help teens avoid risky situations. Participants had short-term increases in positive attitudes toward and use of condoms, and longer-term decreases in STD transmission.

DESCRIPTION OF PROGRAM

Target population: Middle school and high school age teens

The ASSESS (Awareness, Skills, Self-efficacy/Self-esteem, and Social Support) program is designed to give comprehensive sexual health information to adolescents through their primary care physician.  The emphasis of the program is to increase adolescent awareness of sexual risks, skills to avoid risky sexual situations, self-efficacy, and social support.  Physicians tailor their instruction around condom use or abstinence depending on the adolescent's sexual experience.  Teens complete an audiotaped risk assessment before visiting their physician to assess perceived susceptibility to STDs.  Teens also receive materials such as a pyramid of risk behaviors, two brochures about skills and self-efficacy, a community resources brochure, and two brochures for their parents about how to discuss sex and drug risks.

Prior to meeting with the teens, physicians are given a manuscript about the program and complete a 45-minute, in-office training session with a health educator.  The training included a videotape modeling the tools to use and how to problem-solve with the tools.  Physicians review the adolescent's risk assessment, provide the parent with the brochures on discussing alcohol and sex, and ask the parent to leave the room at the appropriate time.  After the parent leaves, the physician uses the risk behavior pyramid as an ice breaker to discuss the adolescent's concerns regarding risky sexual behaviors and review the brochure on abstinence and/or condom use.

EVALUATION(S) OF PROGRAM

Boekeloo, B. O., Schamus, L. A., Simmens, S. J., Cheng, T. L., O'Connor, K., & D'Angelo, L. J. (1999). A STD/HIV prevention trial among adolescents in managed care. Pediatrics, 103(1), 107-115.

 

Evaluated population: 215 adolescents aged 12-15 who visited a one of five primary care physician's office for a general health exam in the Washington, D.C. metropolitan area.  Of the adolescents, approximately 64% were African-American, 19% white, 4% Hispanic, and 13% other.

Approach: The adolescents were randomly assigned to intervention and control groups.  The intervention adolescents participated in the ASSESS program, while control adolescents continued their normal physician visits with no educational tools. 

At post-test and 3- and 9-month follow-ups, adolescents were measured on discussion of sexual risk topics, lifetime sexual activity, condom use, HIV knowledge, perceived susceptibility to HIV and STD infection, self efficacy regarding condom use and resisting sexual intercourse, perceived opinion of the physician regarding condom use and intercourse, perceived timing of intercourse, condom use attitudes, intention to have intercourse, and intention to use condoms.

Results:  At post-test and both follow-ups there were no significant differences between the groups regarding frequency of sexual intercourse or number of partners.  At 3 months, sexually active intervention adolescents had a significantly greater rate of condom use when compared with the control group.

At 3 months, there were no significant differences between the groups regarding STD diagnoses, genital signs of STDs, STD treatments, or pregnancies.  At 9 months, significantly more control group adolescents reported signs of STDs than intervention adolescents.

At post-test, intervention adolescents reported significantly more discussion of sexual risk topics with their physician when compared with control adolescents.  At the 3-month follow-up, there was no significant difference between the groups regarding their discussion with parents about sexual risk topics. 

At post-test, intervention adolescents were significantly more likely to know that HIV is transmitted through oral and anal intercourse, believe the physician thought they should use condoms, believe that they should use condoms, and believe they could refuse sex with a partner who refused condom use.  There were no significant differences between the groups regarding perceived HIV susceptibility, condom use self efficacy, and abstinence beliefs. 

SOURCES FOR MORE INFORMATION

References:

Boekeloo, B. O., Schamus, L. A., Simmens, S. J., Cheng, T. L., O'Connor, K., & D'Angelo, L. J. (1999). A STD/HIV prevention trial among adolescents in managed care. Pediatrics, 103(1), 107-115.

Program also discussed in the following Child Trends publication(s):

Manlove, J., Terry-Humen, E., Romano Papillo, A., Franzetta, K., Williams, S., & Ryan, S. (2002). Preventing teenage pregnancy, childbearing, and sexually transmitted diseases: What the research shows (Research brief). Washington , DC : Child Trends.

Manlove, J., Terry-Humen, E., Romano Papillo, A., Franzetta, K., Williams, S., & Ryan, S. (2001). Background for community-level work on positive reproductive health in adolescence: Reviewing the literature on contributing factors. Washington, DC: Child Trends.

SUMMARY & CATEGORIZATION

Program categorized in this guide according to the following:

Evaluated participant ages: 12-15 / Program age ranges in the Guide: 12-14, 15-21

Program components: Clinic/provider-based

Measured outcomes: Reproductive health

KEYWORDS: Adolescence (12-17), Youth, Urban, Suburban, African-American or Black, Clinic-based, Education, Reproductive Health, Risky Sex, STD/HIV/AIDS

Program information last updated 4/1/09.