Program

Aug 08, 2016

OVERVIEW

Focus on Youth (FoY) was developed as an HIV-risk reduction program for low-income, urban African-American children and adolescents, ages 9 to 15.  Originally, the intervention was called Focus on Kids (FoK).  The goal is to increase abstinence and promote condom use when engaging in sexual activity.  The eight-session intervention is intended for small groups of friends or peers, and includes interactive discussions, games, multimedia activities, and presentations of program projects.  It focuses on decision-making, communication, and negotiation skills.  Two evaluations have examined FoY and found positive impacts on perceptions and beliefs related to sexual health.  However, findings related to sexual health behaviors have been mixed, with one evaluation finding only short-term improvements in condom and contraception use, and another evaluation finding no impacts on behaviors. An evaluation of Teens Take Charge, which replicated the FoK approach with 12- to 15-year-olds in Seattle, found no differences on key outcomes variables (sexual behaviors, intentions, norms, and attitudes) at either the 6- or 12-month post-intervention follow-ups.

DESCRIPTION OF PROGRAM

Target population: Groups of high-risk, low-income, urban African-American friends or peers, ages nine to 15.

Focus on Kids is based on Protection Motivation Theory, and was originally designed to be delivered to small groups of same-gender friends.  Topics under discussion include decision-making, goal-setting, communication, negotiation, and consensual relationships.  Communication and negotiation skills are emphasized, as are facts about AIDS, sexually transmitted diseases, contraception, and human development.  Multiple content delivery formats are employed, including small group discussions, lectures, videos, games, role-playing, acting, storytelling, and crafts projects.  The program concludes with children developing and presenting community projects. The program is provided in eight weekly meetings, each lasting 1.5 hours.

The program was previously called Focus on Kids (FoK).  When authors refer to the program as FoK in their evaluation article, that is the program name that is used in that evaluation overview.

EVALUATION(S) OF PROGRAM

Stanton, B. F., Li, X., Galbraith, J., Feigelman, S., & Kaljee, L.  (1996). Sexually transmitted diseases, human immunodeficiency virus, and pregnancy prevention: Combined contraceptive practices among urban African-American early adolescents.  Archives of Pediatric and Adolescent Medicine, 150, 17-24.

Stanton, B. F., Li, X., Ricardo, I., Galbraith, J., Feigelman, S., & Kaljee, L.  (1996). A randomized, controlled effectiveness trial of an AIDS prevention program for low-income African-American youths.  Archives of Pediatric and Adolescent Medicine, 150, 363-372.

Evaluated population: A total of 383 African-American children and adolescents between the ages of 9 and 15 served as the study sample for this investigation. Youths were recruited from nine recreation centers associated with three public housing developments in Baltimore, Maryland. Participants were recruited in small friend-groups, and groups included between three and ten participants.  More than half (213 participants) were male, and nearly two-thirds were pre-teens (ages 9 to12).  Prior to entry into the study, 36 percent of youths were sexually active.

Approach: Research staff conducted three introductory sessions at each recreation center, in order to create interest in the study.  Participants were informed that they would have to enroll in the study as part of a “friendship group.”  That is to say, children and adolescents had to sign up with three to ten same-gender friends in order to participate in the study.  The 383 participants (organized into 76 friendship groups) received parental consent to participate in the study.  Friendship groups were matched on the basis of gender, age, and sexual experience of group members.  Friendship groups were then randomly assigned to receive either the treatment program (n=38 groups, 206 participants) or the control program (n=38 groups, 177 participants).

Participants in the FoK group met at local community centers for 1.5 hours each week for seven weeks, and then took part in a day-long session at a rural campsite for the final session and graduation ceremony. FoK sessions were delivered to friendship groups by pairs of interventionists, who were primarily African American and from the Baltimore community.  At least one interventionist from each pair was gender-matched to the friendship group.

Participants in the control group were invited to attend weekly AIDS information sessions offered at six sites in the community.  No attempt was made to deliver these sessions to natural friendship groups; individuals could attend any session with or without their friends.  Each session featured a video on AIDS and discussion of the video’s content.  Both the FoK program and the control program provided attendees with condoms.

Participants completed baseline questionnaires assessing sociodemographics, sexual activity, knowledge about HIV/AIDS and contraceptives, self-efficacy with regard to abstaining from sex or using condoms, intentions to use condoms, condom and other contraceptive use at last intercourse, and perceptions of risk and protective factors related to condom use.  Follow-up questionnaires were distributed at three, six, 12, and 18 months.

Results: At the six-month follow-up, participants in the FoK group were significantly more likely than participants in the control group to report having used a condom during their last sexual intercourse. Subpopulation analyses found that program impact was significant among participants in their early teens (ages 13-15), and among males.  The impact was also marginally significant among teens who were sexually active at baseline, and became significant after controlling for baseline condom use, gender, and age.  Further, those in the FoK group were also more likely than those in the control group to report intentions to use condoms at the six-month follow-up (and subpopulation analyses revealed that this program impact was significant among females, preteens, and those who were sexually active at baseline). Additionally, intervention participants were significantly more likely to report using some form of contraception (condoms, or condoms plus another method) than control group youth.  Finally, intervention participants were significantly more likely than control participants to perceive their peers as being condom-users, and to perceive themselves as being vulnerable to HIV.

By the 12-month follow-up, however, no intervention impacts on condom use and condom use intentions were found.  There remained a marginally significant program impact on condom use among the young teens only.  Also at 12-months, participants in the FoK group were more likely than those in the control group to report that sexually transmitted diseases were “serious.”

At the 18-month follow-up, FoK participants were once again more likely than were control group participants to report using condoms, or condoms plus another method of contraception (versus nothing).

At no time did participants from friendship groups assigned to take part in the Focus on Kids intervention differ significantly from control participants on a measure of AIDS knowledge.

Stanton, B. Harris, C. Cottrell, L., Li, X., Gibson, C., Guo, J., Pack, R., Galbraith, J., Pendleton, S., Wu, Y., Burns, J., Cole, M., & Marshall, S. (2006). Trial of an urban adolescent sexual risk-reduction intervention for rural youth: A promising but imperfect fit. Journal of Adolescent Health, 38, 55.e25-55.e36.

Evaluated population: Participants were 1,131 predominantly white adolescents between the ages of 12 and 16 years, from a dozen rural counties in West Virginia that had low rates of sexually transmitted diseases. Of the total sample, 422 were recruited from community settings, and 709 were recruited from schools. At baseline, 21 percent of participants had engaged in sex during the last six months.

Approach: One hundred and ten groups were randomly assigned either to the FoK group (n=870 adolescents), or to the control condition (n=261 adolescents). The control condition involved an environmental health intervention. The program was implemented in both school and community settings.  For the community settings, FoK was delivered in one day-long session or two half-day sessions. For the school settings, FoK was delivered in the original eight-session format. Although FoK was designed to be implemented in small group settings (12 or fewer people per group), some groups in this evaluation exceeded this size. Participants were assessed at baseline, and three, six, and nine months post-intervention, on sexual initiation and participation, condom use at last intercourse, frequency of condom use, dual birth control and condom use at last intercourse, HIV/AIDS knowledge, knowledge of partner’s sexual activity and condom use, and perceptions of abstinence and condom use.

Results: At the three-, six-, or nine-month follow-ups, the evaluation found that there were no program impacts on sexual activity in the past six months, frequency of condom use during the past six months, condom use at most recent sex, dual contraceptive method use at most recent sex, knowledge of partner’s sexual activity or condom use, or HIV/AIDs knowledge.

At the three-month follow-up, FoK showed positive impacts on participants’ perceptions that they will face risks or negative reactions if they use condoms.  Subgroup analyses revealed that this impact was significant for those who were already sexually active at baseline.

At the six-month follow-up, FoK showed positive program impacts on self-efficacy for abstaining from sex, on perceptions that it is okay to abstain from sex, and on perceptions that there will be not be any risks or negative reactions if they abstain from sex.  Subgroup analyses revealed that the latter impact was significant among participants who were sexually experienced at baseline, and that all three were significant or marginally significant among those who were not sexually experienced.  Further, among those who were not sexually experienced, FoK participants also perceived greater vulnerability to the risks of not abstaining (such as sexually transmitted diseases and unintended pregnancies) than did control group members.  Those in the FoK group also demonstrated increased self-efficacy for using condoms, and fewer perceptions that peers would reward them for having sex.

Among the whole group, no FoK program impacts were seen at the nine-month follow-up.  However, among those who had not had sex at baseline, FoK had positive program impacts on their perceived vulnerability to the risks of not abstaining, and on their perceptions of peer norms related to abstinence.

Morrison, D. M., Hoppe, M. J., Wells, E. A., Beadnell, B. A., Wildson, A., Higa, D., Gillmore, M. R., Casey, E. A. (2007). Replicating a teen HIV/STD preventive intervention in a multicultural city. AIDS Education and Prevention, 19(3), 258-273.

Evaluated Population: A total of 454 12- to15-year-olds were recruited, of which 402 completed the baseline questionnaire and participated in the study.  The youths were recruited from 20 community centers, youth programs, and after-school programs in Seattle.  At recruitment, participants were, on average, 12.7 years old; 63 percent were female, 82 percent were born in the Untied States, 37 percent were African American, 14 percent were Asian or Pacific Islander American, 16 percent were of mixed race, 9 percent were white, two percent were Latino, and three percent were of other races/ethnicities.  At baseline, about 6.5 percent of the participants had engaged in sex during the last six months.

Approach: This intervention, called Teens Take Charge (TTC), was one of six funded by The National institute of Child Health and Human Development to replicate what had been demonstrated to be successful in controlled clinical trials. The TTC intervention consisted of eight weekly sessions of about two hours in length, followed by a two-hour booster session at nine months post-intervention.  Two trained adult facilitators recruited from the community led the sessions, which were conducted in same-sex groups and followed a detailed manual. Data collection was through computer-administered questionnaire with audio assistance.  Youths were assessed at baseline, immediately after the eight-week intervention, and six and 12 months later. Participants received $5 each for completing the baseline survey, $10 for the post-test, and $15 for each of the follow-up surveys.  The control curriculum focused on career exploration, matched in length, style, intensity, and exercises and activities to the experimental intervention.  Youth received reminder telephone calls every week, transportation to and from the sessions if needed, food at each session, and $2 for each session attended.  The 454 participants were divided into 54 groups, with an average of eight participants per group.  The groups were randomly assigned to receive the experimental intervention or the control curriculum.

Results: The evaluation found no differences between the intervention and control groups on key outcome variables (sexual behaviors, intentions, norms, and attitudes) at either the 6- or 12-month post-intervention follow-ups.

SOURCES FOR MORE INFORMATION

Curriculum materials available at:

http://www.etr.org/foy/index.htm

http://www.effectiveinterventions.org/en/HighImpactPrevention/Interventions/FOY.aspx

References:

Galbraith J, Ricardo I, Stanton B, Black M, Feigelman S, Kaljee L. (1996). Challenges and

rewards of involving community in research: An overview of the “Focus on Kids” AIDS prevention program. Health Education Quarterly, 23, 383–394.

Morrison, D. M., Hoppe, M.J., Wells, E. A., Beadnell, B.A., Wildson, A., Higa, D., Gillmore, M. R., Casey, E. A. (2007). Replicating a teen HIV/STD preventive intervention in a multicultural city. AIDS Education and Prevention, 19(3), 258-273.

Stanton, B. Harris, C. Cottrell, L., Li, X., Gibson, C., Guo, J., Pack, R., Galbraith, J., Pendleton, S., Wu, Y., Burns, J., Cole, M., & Marshall, S. (2006). Trial of an urban adolescent sexual risk-reduction intervention for rural youth: A promising but imperfect fit. Journal of Adolescent Health, 38, 55.e25-55.e36.

Stanton, B. F., Li, X., Galbraith, J., Feigelman, S., & Kaljee, L.  (1996). Sexually transmitted diseases, human immunodeficiency virus, and pregnancy prevention: Combined contraceptive practices among urban African-American early adolescents.  Archives of Pediatric and Adolescent Medicine, 150, 17-24.

Stanton, B. F., Li, X., Ricardo, I., Galbraith, J., Feigelman, S., & Kaljee, L.  (1996). A randomized, controlled effectiveness trial of an AIDS prevention program for low-income African-American youths.  Archives of Pediatric and Adolescent Medicine, 150, 363-372.

KEYWORDS: Children, Adolescents, Males and Females (Co-ed), High-Risk, Black or African American, Urban, Rural, School-based, Community-based, Cost Information is Available, Manual is Available, Skills Training, STD/HIV/AIDS, Sexual Activity, Condom Use and Contraception, Reproductive Health – Other.

Program information last updated on 8/8/16.