Be Proud! Be Responsible! is an HIV prevention program originally developed for black urban male adolescents, and was replicated with a diverse population in schools in a suburban setting. Five pairs of schools matched on location, community socioeconomic status, and racial composition were used, and within each pair, one school was randomly assigned to use the intervention curriculum and the other school to use a control curriculum in their health education classes for 9th and 10th grade students. The outcomes assessed included knowledge, efficacy, beliefs, perceived peer beliefs, intentions, and sexual behavior. Significant impacts were found in the areas of knowledge, efficacy, and intentions, but there was little change in sexual behavior. Additional analyses examining subgroup differences found a more consistent impact on students in suburban schools.
DESCRIPTION OF PROGRAM
Target population: Black urban male adolescents
Be Proud! Be Responsible! program consists of six 50 minutes modules, including group discussions, videos of role model stories, interactive exercises, and role playing. It takes an abstinence-first approach, meaning that although it focuses on safe-sex decision making, it also supports abstinence as the most effective way to prevent pregnancy and protect against STDs. The program is designed to shape principles related to health behavior and emphasizes the themes of sexual responsibility and accountability, sense of community, and pride, and how these themes affect sexual choices. The curriculum was taught by health education teachers and school nurses in health education classes to 9th and 10th grade students at urban and suburban high schools.
EVALUATION OF PROGRAM
Evaluated population: 1357 9th and 10th grade students enrolled in mandatory health education classes from 2000 to 2002 at ten high schools in a midsize metropolitan area in the Midwest. Of the students, 49.7% were white, 35.8% black, 11.9% Hispanic, and 2.6% other. 51.8% of the students were female.
Approach: Five pairs of high schools were recruited. Each pair was matched on characteristics such as location (urban, inner ring suburb, or outer ring suburb), community socioeconomic status, and racial composition of the student body. In each pair, one school was randomly assigned to teach the Be Proud! Be Responsible! curriculum, including a booster session four to twelve months after the program ended, while the other school was assigned to teach a control health education curriculum, along with a control booster session.
Data were collected at pre-test, immediately after the intervention, and at four and twelve month follow-ups, examining the outcomes of knowledge of condoms, HIV and other STDs, and general health, efficacy in terms of impulse control, condom negotiation skills, and condom technical skills, beliefs regarding the importance of condom use, how much condoms interfere, the protective quality of condoms, and the value of abstinence, perceived peer beliefs regarding the acceptability of sexual activity and the importance of condom use, and intentions to have sex and use condoms, and sexual behavior.
Results: The intervention had no impact on sexual initiation, frequency, or condom use. However, positive impacts were found on knowledge of STDs and condom use. Improvements were also found on impulse control, condom negotiation skills, condom technical skills, condom use beliefs, perceived peer beliefs, and intentions to have sex and use a condom at post-test. However, these impacts dissipated. Improvements in condom negotiation skills, condom technical skills, and condom use beliefs were significant at four month follow-up, but not at twelve month follow-up. Among students who were sexually inexperienced at baseline, those assigned to the program were more likely than the control group to have talked to a health professional about a sex-related matter at the four month follow-up.
Analysis by subgroup revealed that males in the intervention schools had higher impulse control, condom negotiation skills, and condom technical skills at post-test compared with those in the control schools, and the difference in condom negotiation skills remained through the twelve month follow-up. In contrast, there were no differences for females in terms of impulse control and condom negotiation skills, and the difference in condom technical skills were only maintained through the four month follow-up. Females in the intervention schools had lower intentions to have sex compared with those in the control schools, which was not true for males.
Subgroup analyses also demonstrated more consistent and sustained results among students at suburban intervention schools, with an increase in knowledge of STDs and condoms through twelve month follow-up and an increase in condom negotiation and condom technical skills through four month follow-up, while improvements found at post-test for students at urban schools, were not maintained at follow-up. Interestingly, students at urban intervention schools were more likely than students at urban control schools to believe that condoms interfere at four and twelve month follow ups, although not at post-test, and were significantly less likely to think that using condoms is important at twelve month follow-up. Impacts on rural schools were not reported.
Analysis by race revealed an increase in knowledge of condoms and STDs for both white and black students. However, the increase in knowledge of STDs was maintained through twelve month follow-up only for black students, while the increase in knowledge of condoms was maintained through four month follow-up for black students and through twelve month follow-up for white students. White students had improvements in condom negotiation and condom technical skills through four month follow-up and an increase in the belief that condoms protect against STDs at post-test, while black students had an increase in impulse control at post-test.
SOURCES FOR MORE INFORMATION
Borawski, E.A., Trapl, E.S., Adams-Tufts, K., Kayman, L.L., Goodwin, M.A., & Lovegreen, L.D. (2009). Taking Be Proud! Be Responsible! to the suburbs: A replication study. Perspectives on Sexual and Reproductive Health, 41, 12-22.
Link to program curriculum: http://www.selectmedia.org/programs/protective.html
KEYWORDS: Adolescents (12-17), High School, Males and Females (Co-ed), White/Caucasian, Black/African American, Urban, Suburban, School-based, Manual is Available, STD/HIV/AIDS, Sexual Activity, Condom Use and Contraception, Other Reproductive Health.
Program information last updated 10/19/10