It's Your Game: Keep it Real

Guide to Effective Programs
for Children and Youth

It’s Your Game: Keep it Real

OVERVIEW

It’s Your Game: Keep it Real (IYG) is a school-based HIV, STI, and pregnancy prevention program that targets middle school students. Through grade-specific curricula that utilize both group and individual components, the program encourages students to set limits on their personal risk behaviors and to use refusal skills, while also providing information on puberty, safe sex, dating, and STIs, HIV, and pregnancy. A parent-child homework component is also used at both grade levels to help encourage dialogue on relevant topics. An experimental evaluation of IYG found that the program was successful in significantly reducing the proportion of those in the program group who had initiated sex from 7^th to 9^th grade. The program also had significant impacts on initiation of oral and anal sex, as well as on certain psychosocial outcome measures (e.g., general beliefs about waiting to have sex, self-efficacy to use condoms).

DESCRIPTION OF PROGRAM

Target Population: Middle school students

The intervention consists of twelve, 45-minute school-based sessions, conducted in the 7^th grade and then in the 8^th grade. For both grade levels, lessons utilize both group-based and individual activities, the latter of which includes keeping a personal journal (to express opinions and feelings) and working through program material on laptop computers (educational activities on determinants of sexual risk-taking that specifically adapt to gender and sexual experience differences). Classroom sessions are based around teaching students decision-making life skills that revolve around selecting personal limits for engaging in risky behaviors, detecting warning signs of situations that could challenge those limits, and protecting limits by utilizing refusal skills and other strategies (Select, Detect, Protect paradigm). For the 7^th grade curriculum, topics are covered that include setting personal limits and practicing refusal skills for sexual behavior and in a general context (e.g., skipping school, cheating, drug and alcohol use), characteristics of healthy relationships, and information on puberty, sex, and STIs. The 8^th grade curriculum includes these same topics, as well as the importance of STI, HIV, and pregnancy tests for sexually active individuals, training for contraceptive/condom use, and healthy dating relationships. All lessons are conducted by trained facilitators.

A separate parent-child homework component is also built into both the 7^th and 8^th grade versions of the program. Activities are designed to initiate and encourage dialogue between parents and their children on topics that include sexual behavior, dating, and friendship qualities.

EVALUATION(S) OF PROGRAM

Evaluated population: Participants consisted of 907 7^th grade students (average age = 13 years) from ten urban, low-income, middle schools in Texas. Fifty-nine percent of the total sample was female; 42 percent of the sample was African American, and 44 percent was Hispanic. The authors made an a priori decision to define the analysis sample as comprised of all students who took the 8^th grade survey. These students were followed into more than 50 high schools to collect follow-up data.

Approach: Each of the ten schools selected for the study were randomized into either the intervention (N=349 students) or control (N=558 students) conditions, at which point students were recruited. Significant differences did exist between groups at baseline in terms of race/ethnicity and age. Students assigned to the control condition continued to receive their regular health classes, which were school-specific.

To evaluate the program’s effectiveness, student self-report data were collected using audio-computer assisted interviews on participation and initiation of sexual activity (oral, vaginal, anal), as well as for the following psychosocial outcomes: general beliefs about waiting to have sex; beliefs about abstinence until marriage; perceived friends’ beliefs about waiting to have sex; perceived friends’ sexual behavior; self-efficacy to refuse sex; condom knowledge; perceived friends’ beliefs about condoms; self-efficacy to use condoms; exposure to risky situations; STI signs/sex knowledge; HIV/STI knowledge; reasons to have sex; reasons not to have sex; intention to have oral sex in next year; intention to have vaginal sex in next year; intention to be abstinent through high school; and intention to remain abstinent until marriage. Data were collected at baseline and at the 9^th grade follow-up (approximately 24 months later). Multi-level models were estimated, and controls were included, for baseline measures of outcomes as well as for confounding variables specific to each dependent variable.

Results: At the 9^th grade follow up, sexual initiation was assessed among the participants who had reported having no sexual experience at the 7^th grade baseline; a significantly lower proportion of the intervention group reported initiating sex than in the control group (30% vs. 23%). In looking at specific types of sex, the intervention group had significantly lower proportions initiating oral and anal sex. There were no significant differences between conditions for initiation of vaginal sex.

Significant differences were also found in the subgroup analyses. On overall reports of initiating sex, significant positive impacts were found for Hispanics and females, but not for males and African Americans. For initiation of oral sex, significant positive impacts were found for African Americans and females, and for initiation of anal sex, these impacts were found for African Americans, males, and females. Hispanics were the only subgroup to have significant positive differences for initiation of vaginal sex.

Psychosocial outcomes for the intervention and control conditions were compared for both the 8^th and 9^th grade levels. For the 8^th grade level, significant positive impacts were found for beliefs about abstinence until marriage, perceived friends’ beliefs about waiting to have sex, self-efficacy to refuse sex, condom knowledge, self-efficacy to refuse condoms, exposure to risky situations, STI signs/sex knowledge, HIV/STI knowledge, reasons not to have sex, and intention to have oral sex within the next year. For the 9^th grade level, significant positive differences were found for beliefs about abstinence until marriage, perceived friends’ sexual behavior, condom knowledge, perceived friends’ beliefs about condoms, exposure to risky situations, STI signs/sex knowledge, and HIV/STI knowledge. No significant differences were found at either grade level for general beliefs about waiting to have sex, reasons to have sex, intention to have vaginal sex in the next year, and intention to remain abstinent until marriage.

SOURCES FOR MORE INFORMATION

References

Tortolero, S.R., Markham, C.M., Peskin, M.F., Shegog, R., Addy, R.C., Escobar-Chaves, S.L., & Baumler, E.R. (2010). It’s your game. Keep it real: Delaying sexual behavior with an effective middle school program. Journal of Adolescent Health, 46(2), 1-19

KEYWORDS: Adolescents, Middle School, Males and Females (Co-ed), Black/African American, Hispanic/Latino, Urban, School-Based, Parent or Family Component, Computer-Based, Skills Training, Abstinence Education, Social Skills/Life Skills, Teen Pregnancy, STD/HIV/AIDS, Sexual Activity, Condom Use and Contraception

Program information last updated 10/3/11