Program

Oct 31, 2008

OVERVIEW

The Reach for Health
community service (RFH CYS) program
is an intervention designed help youth develop
the skills and knowledge they need to make positive health choices and avoid
high-risk behaviors, such as early sexual initiation. The program consists of
classroom health lessons and service learning, where students perform weekly
community service and reflect on the experience in the classroom as a group. A
study of RFH CYS participants surveyed in 7th grade and again in 10th
grade found that students who participated in the intervention were less likely
than their peers in the curriculum-only group to have initiated sex by 10th
grade.

DESCRIPTION OF PROGRAM

Target population:
Urban African-American and Latino middle
school students.

The Reach for
Health community service (RFH CYS) aims to help children and adolescents develop
the attitudes, skills, and knowledge necessary to make healthy choices and avoid
risky health behaviors. The program has two core elements: a classroom health
curriculum and a service learning component. At the beginning of the school
year, students participate in an orientation where they learn about their
community service placements and set personal goals for their service. Students
work at their placements three hours a week which results in approximately 90
hours of community service in a year. Each student participates in one or two
different placements which include, for example, nursing homes, child day care
centers and full-service clinics. Students receive instruction and guidance from
field staff and their classroom teachers. Once per week students meet to discuss
and reflect on their experiences, problem-solve, and share knowledge gained from
their service.

The second
component of RFH CYS involves a classroom health curriculum. The purpose of the
school-based curriculum is to help students choose healthy behaviors while
avoiding risks and to communicate their needs. The curriculum is
developmentally-appropriate for middle school students and emphasizes
interactive classroom activities. The 7th grade curriculum consists
of 40 lessons while the 8th grade curriculum has thirty-four. Lesson
content is determined, in part, by focus groups that consist of teachers,
parents and students. Topics are culturally relevant to the population and
include sexual activity, violence, and substance use, as well as general healthy
development and sexuality.

Classroom teachers receive training in the health curriculum as well as training
to help guide reflection on the community service placements. Field placement
staff receive a training in the more technical aspects of each students’
placement and site, and there is ongoing collaboration between these staff
members and the teachers. Finally, field staff researchers conduct monthly site
visits and observations to monitor program implementation and answer questions.

EVALUATION(S) OF PROGRAM

Evaluated population: Seventh-grade students from a New York City public middle school serving
economically disadvantaged adolescents were randomly assigned by classroom
(n=18) to participate in the RFH CYS program
(intervention group) or to a control group.
Although only RFH CYS students participated in the community service component,
students in both groups received the classroom health curriculum.
Both the classroom health instruction and
community service assignments were implemented for 2 years while the students
were in 7th and 8th grade. Seventy-one percent
of the students identified themselves as
African-American and 26 percent as Latino.

Approach:
During the spring of 1998, when the participants were in 10th grade,
follow-up surveys were administered to students who completed a 7th
grade baseline survey, attended 8th grade at the school, and
continued to live in the New York Metropolitan area. Seventy-seven percent of
eligible students completed a 10th grade survey (195/255). Although
the majority of students remained in their assigned condition over the course of
the study, fifty-two students did move between treatment and control groups due
to additional resources and scheduling conflicts. Students who transferred
between conditions are assessed according to their original assignment unless
otherwise stated.

Self-report
questionnaires were administered at baseline (7th grade) and
follow-up (10th grade). The questionnaire items assessed lifetime and
recent sexual behaviors, teen pregnancy and sexual behavior change scores, i.e.,
teen became sexually active.

Results: At
baseline, 62 percent of boys and 90.5 percent of girls reported never having had
sex. At the 10th grade follow-up, 69.2 percent of boys and 50 percent
of girls had become sexually active. Although differences by gender were
significant, results did not vary by ethnicity.

Data reveal that
among virgins at baseline, 27 percent of boys and 47 percent of girls in the
curriculum-only control group remained virgins at follow-up. These numbers
contrast with data from the RFH CYS treatment group, which reveal that as many
as 43.5 percent of boys and 57.1 percent of girls had not initiated sex during
the same time period. Furthermore, 69 percent of boys and 47.2 percent of girls
in the control group reported recent sex at follow up. The treatment group
reported that 44.8 percent and 38.1 percent, respectively, had engaged in recent
sex.

Overall, the study
found that RFH CYS students were less likely than control students to have
initiated sex or to have engaged in recent sex by the 10th grade
follow-up. (Although these findings were significant at the p < .1 level, when
students who had switched conditions were removed from analyses, these findings
became significant at the p < .01 level.)

Further analyses assessed differences among the full 2-year RFH CYS students,
the 1-year RFH CYS crossover students, and the curriculum-only control students.
No differences were found among the three groups at baseline. By the 10th
grade follow-up, 18.5 percent of control females reported having been pregnant,
in comparison to 10.3 percent of 1-year crossovers, and 6.8 percent of 2-year
RFH CYS female students. However, the authors caution that sample sizes are too
small to warrant firm conclusions.

With regard to
initiation of sex, 80 percent of boys and 65.2 percent of girls in the control
group had initiated sex by the 10th grade follow-up. The results for
boys and girls in the 1-year and 2-year RFH CYS condition groups are 61.5/48.3
percent and 50/39.6 percent, respectively. Overall, students in the
curriculum-only control group were more likely to initiate sex and report recent
sex by the 10th grade follow-up than either the 1- or 2- year RFH CYS
groups. Gender remained a significant predictor, with boys more likely than
girls to engage in the sexual behaviors reported.

SOURCES FOR MORE INFORMATION

References

O’Donnell, L.,
Stueve, A., O’Donnell, C., Duran, R., San Doval, A., Wilson, R.F., Haber, D.,
Perry, E., and Pleck, J.H. (2002). Long-Term Reductions in Sexual Initiation and
Sexual Activity Among Urban Middle Schoolers in Reach for Health Service
Learning Program. Journal of Adolescent Health, 31, 93-100.

KEYWORDS: Adolescence (12-17),
Young Adulthood (18-24), Youth (16-24), School-Based, Service Learning, Service
or Vocational Learning, Middle School, High School, Behavioral Problems,
Violence, Substance Use, Sexual Initiation, Teen Pregnancy, Urban, Black or
African American, Hispanic or Latino, Community Service, Positive Citizenship,
Teen pregnancy, Reproductive Health.

Program
information last updated 10/31/2008.

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