Program

Dec 02, 2015

OVERVIEW

Making a Difference! is an abstinence-based approach to HIV/AIDS and teen pregnancy prevention.  The program is directed toward empowering inner-city, African American and Latino adolescents to refrain from engaging in sex.

In an experimental evaluation comparing the Making a Difference! the program showed positive impacts on abstinence during the three months at the 3-month follow-up.  This impact was no longer observable at the 6- and 12-month follow-ups.  Making a Difference! also had positive impacts on knowledge of HIV and on beliefs and intentions related to abstinence, as well as on condom use at the 12-month follow-up.

Another evaluation compared the Making a Difference! program with the Making Proud Choices! program, two combined Making a Difference! and Making Proud Choices! programs, and a control group.  Those in the Making a Difference! group were less likely than those in the control group to initiate sex and those who had already initiated sex were less likely to have had sex in the previous three months.  Those in the combined groups were less likely to have multiple sex partners.

A third evaluation compared Making a Difference! with a parent-based intervention, Families Talking Together , and a combined Making a Difference! and Families Talking Together intervention.  There were no differences between groups in sexual initiation at the 12-month follow-up or, among those who had initiated sex, in frequency of sex.

DESCRIPTION OF PROGRAM

Target population: African American adolescents from low-income families

The Making a Difference! curriculum consists of eight culturally-appropriate, hour-long modules (which can also be administered as four two-hour modules or two four-hour modules).  These modules address facts, attitudes, and beliefs about abstinence, HIV/AIDS, and teen pregnancy.  They also teach negotiation-refusal techniques.  Program activities include role-playing and video-watching.

Making a Difference! is an abstinence-based adaptation and extension of the Be Proud!  Be Responsible! curriculum.  This particular intervention differs from Be Proud!  Be Responsible! in that it deals not only with HIV/AIDS prevention, but also pregnancy prevention.  Making a Difference! acknowledges that condoms reduce the risks associated with sex, but promotes abstinence as a way to eradicate those risks.  The program places specific emphasis upon adolescents’ goals and dreams and on how sexual behavior has the potential to thwart those dreams.

In that Making a Difference! is an abstinence-based program, it promotes abstinence from sex as the only way to eliminate the risk for pregnancy and STDs.  This intervention does not teach condom use skills.  However, Making a Difference! does not present sex in a negative light and is not moralistic.  A safer-sex version of the Making a Difference! curriculum is marketed under the name Making Proud Choices!

EVALUATION(S) OF PROGRAM

Jemmott, J.B., Jemmott, L.S., & Fong, G.T.  (1998).  Abstinence and Safer Sex HIV Risk-Reduction Interventions for African American Adolescents.  Journal of the American Medical Association, 279(19), 1529-1536.

Evaluated population: In the late 1990s, 659 black adolescents (mean age = 11.8) were recruited from 6th and 7th grade classes in three middles schools serving low-income communities in Philadelphia, PA.  Just over one-quarter of these students lived with both of their parents.

Approach: Participants completed baseline surveys on their recent sexual behavior.  They also responded to questions about their attitudes and intentions regarding risky sexual behavior and their knowledge of AIDS and STDs.  While they completed these measures, participants were stratified by age and gender, and then randomly assigned within age and gender to one of three interventions: Making a Difference!, an abstinence-based HIV-prevention intervention (n=220), Making Proud Choices!, a safer-sex-based HIV-prevention intervention (n=221), or a health promotion intervention (n=218).  Participants were further assigned to a small group that was either led by one adult facilitator or two peer co-facilitators.  Peer facilitators were high school students who were trained and monitored for implementation fidelity.

Each intervention consisted of eight hour-long modules.  These modules were presented over the course of two consecutive Saturdays.  Students assigned to the abstinence-based HIV-prevention intervention received the Making a Difference! curriculum and students assigned to the safer-sex-based HIV-prevention intervention received the Making Proud Choices! curriculum.  The health promotion intervention dealt with non-sexual health concerns.

Immediately after the intervention, participants were again surveyed on their attitudes and intentions regarding risky sexual behavior and on their knowledge of AIDS and STDs.  Participants completed follow-up surveys three months, six months, and 12 months after the intervention.  At 12 months, 93 percent of participants remained in the study.

Results: The Making a Difference! abstinence-based curriculum had an immediate positive impact on participants’ knowledge of HIV and on their beliefs and intentions relating to abstinence.  Students assigned to the Making a Difference! intervention expressed more favorable attitudes towards abstinence and weaker intentions to engage in sexual intercourse during the next three months than did the students assigned to the health promotion control group.

At the 3-month follow-up, students assigned to the Making a Difference! intervention were significantly less likely to have had sex during the previous three months than were students assigned to the health promotion control group (and this was true for both the full group, and among those who were already sexually active at baseline).

By the 6-month follow-up, however, students assigned to the Making a Difference! abstinence-based intervention were no more likely to be abstaining from sex than were students assigned to the health promotion control group.  This lack of impact persisted at the 12-month follow-up.

Participants assigned to the Making a Difference! intervention did not report significantly more frequent condom use than participants assigned to the health promotion control group at the 3-month or 6-month follow-up, but did at the 12-month follow-up.

The program was found to have comparable impact regardless of whether it was led by an adult facilitator or two peer facilitators.

 

Guilamo-Ramos, V., Jaccard, J., Bouris, A., Gonzalez, B., Casillas, E., & Banspach, S. (2011). A comparative study of interventions for delaying the initiation of sexual intercourse among Latino and black youth. Perspectives on Sexual and Reproductive Health, 43(4), 247-254.

Evaluated Population: The evaluated population consisted of 2,016 Latino and black mother-adolescent dyads from five middle schools in the New York neighborhoods of Harlem and the Bronx.  Dyads included a Latino or black adolescent enrolled in 6th or 7th grade at the time of enrollment and a mother (defined as an adult female who lived in the household with and who was a primary caregiver of the adolescent). Of the dyads, 75 percent were Latino, and 25 percent were black.  Of the adolescents, 77 percent were native-born, and 32 percent reported speaking Spanish as a primary language at home.  Half of the adolescents were male. The mothers had a mean age of 40.1 and the adolescents had a mean age of 12.2.

Approach: The dyads were randomly assigned via a computer program to one of three intervention groups: an adolescent-only Making a Difference! group, a parent-adolescent Families Talking Together group (more information about this program can be found here), and a combined parent-adolescent Making a Difference! + Families Talking Together (MAD+FTT) group. Of the evaluated sample, 679 mother-adolescent dyads were assigned to the Making a Difference! intervention, 666 to the Families Talking Together intervention, and 671 to the MAD+FTT intervention. At baseline, five percent of those in the Making a Difference! group had had sex, and eight percent of both the Families Talking Together and MAD+FTT group had had sex.  Among those who had had sex, the mean frequency of sex in the past month was just over two times for each of the three groups.

The Making a Difference! curriculum implemented in this evaluation was a slightly modified version of the original Making a Difference! curriculum.  Specifically, this modified curriculum consisted of two 2.5-hour sessions that included a pre-intervention survey, focus groups with mothers and adolescents regarding the intervention content and delivery, as well as in-depth interviews with the mothers and adolescents regarding adolescent sexual behavior.  This curriculum also omitted the Making a Difference! videos, which were only available in English.  All program content was delivered by bilingual facilitators, and was supplemented by English- and Spanish-language workbooks.

On the first day of the school-based intervention, the first five modules of Making a Difference! were implemented: getting to know your dreams and steps to making your dreams come true; understanding adolescent sexuality and abstinence; HIV infection; attitudes, beliefs and giving advice about HIV, STDs and abstinence; and STDs. During the same time, the Families Talking Together manual was distributed to the mothers in that intervention group, and the corresponding modules were discussed.  On the second day, the remaining modules were implemented: pregnancy; responding to peer and partner pressure; and role-plays on refusal and negotiation skills.  For the Families Talking Together group, the second day included a review of content and a focus on the homework assignments associated with the Families Talking Together curriculum.  Those in the Families Talking Together group also received one- and six-month “booster” calls. Mother-adolescent dyads who could not attend the school-based sessions were provided with a home visit to complete the interventions.

Self-administered questionnaires were completed at baseline and at a 12-month follow-up to assess sexual initiation, frequency of sex in the past 30 days, and four measures of mother-adolescent relationship: maternal monitoring or supervision, maternal expertise, maternal trustworthiness, and satisfaction with mother-adolescent relationship.

Results: At 12-month post-intervention, there were no differences in sexual initiation, comparing those in the Making a Difference! group, the Families Talking Together group, and the MAD+FTT group.  There were also no differences in frequency of sex, among those who had already initiated sex at baseline.

However, there were differences between groups in terms of mother-adolescent communication about sex: the adolescents in the adolescent-only Making a Difference! group were less likely than those in either of the other parent-adolescent intervention groups to have ever talked with their mother about sex.  Those in the Making a Difference! group also rated their mothers lower on maternal monitoring or supervision, maternal expertise, maternal trustworthiness, and satisfaction with their mother-adolescent relationship.

SOURCES FOR MORE INFORMATION

References:

Guilamo-Ramos, V., Jaccard, J., Bouris, A., Gonzalez, B., Casillas, E., & Banspach, S. (2011). A comparative study of interventions for delaying the initiation of sexual intercourse among Latino and black youth. Perspectives on Sexual and Reproductive Health, 43(4), 247-254.

Jemmott, J.B., Jemmott, L.S., & Fong, G.T.  (1998). Abstinence and Safer Sex HIV Risk-Reduction Interventions for African American Adolescents. Journal of the American Medical Association, 279(19), 1529-1536.

Website:

http://www.selectmedia.org/programs/difference.html

KEYWORDS: Middle Childhood (6-11), Adolescence (12-17), Middle School, School-based, Urban, Black/African American, Hispanic/Latino, Abstinence, Sexual Activity, Condom Use and Contraception, Parent-Child Relationship, Manual is Available

Program information last updated 12/2/2015