Program

Nov 20, 2015

OVERVIEW

The Healthy Teen Girls Project extended an existing sexual health curriculum for juvenile detainees to include specific content on condom skills and communication – including refusal to engage in unsafe sex and negotiation skills.  In an experimental evaluation, the program was found to be successful at teaching girls condom use and communication skills. While knowledge increased, and number of unsafe encounters and frequency of sex under the influence decreased, this was not significantly different from the control group.

DESCRIPTION OF PROGRAM

Target population: Incarcerated adolescent girls

The Healthy Teen Girls Project consists of 18 one-hour sessions on sexual and reproductive health.  The core curriculum addresses reproductive health, the effect of drugs on health (including alcohol, tobacco, and other substances), sexually transmitted infections (STIs), and contraception.  In addition to this core component, the intervention added sessions on correct condom use – focusing on both knowledge and practice – and skills around negotiation and refusal of unwanted behaviors with sexual partners.  These added components were theoretically based in social cognitive theory and in the Information, Motivation, and Behavioral Skills model.  The program was a component of their required health class and they received academic credit for participating.

EVALUATION OF PROGRAM

Robertson, A.R., St. Lawrence, J., Morse, D.T., Baird-Thomas, C., Liew, H., and Gersham, K. (2011). The Healthy Teen Girls Project: Comparison of Health Education and STD Risk Reduction Intervention for Incarcerated Adolescent Females. Health Education and Behavior, 38(3), 241-250.

Evaluated population: All 334 girls who were incarcerated in the facility during the duration of the study were approached and only one girl refused to participate.   Twenty-eight girls did not complete the program: 23 were withdrawn by the administration because they were released early, detained in maximum security, or had health concerns and five girls withdrew voluntarily.  All participants were incarcerated in the facility and consented in writing to participate in the program and study.  Participants ranged in age from 12 to 18 and the mean age was 15 years.  Most were African American with approximately one third who were either Caucasian or other (Latina, Native American or mixed race).  Many came from disadvantaged backgrounds where they had had trouble in school (62 percent), lived with people other than two biological parents (>85 percent), had been assaulted with a weapon (24 percent), reported experiences of forced sex (30 percent), or were a member of a gang (20 percent).  Their interactions with the juvenile justice system ranged from one year to nine years.  Most were sexually experienced with an average age at first sex of 13 and a mean of just under two sexual partners in the three months prior to incarceration.

Approach: Cohorts of girls were assigned to either an intervention curriculum block or a comparable control curriculum block (without the additions to the core program).  The randomization was based on their entry date into the detention facility.  Both curricula consisted of 18 one-hour group sessions and one one-hour individual session.  In order to reduce contamination between these two different curricula programs, there were short breaks in between each intervention block so that contamination from girls who had received one curriculum was reduced.  This was because they would have either been released or have distance from their own health education program and would be less likely to influence the girls in the next block.  Data were collected at baseline, after the intervention, and approximately 9 months after the participant’s release from the detention facility.  At baseline and after the intervention, data were collected with a computer-based survey; after release, female staff members conducted the interview in the girls’ homes.  Outcomes measured included health knowledge, condom application skills (measured by a 10-item checklist scored while watching the girl put a condom on a penile model), the number of occasions of unprotected sexual intercourse, sex under the influence of substances, safer sexual behaviors, incidence of STIs, and assertive communication skills (including acknowledging the other person’s viewpoint, providing a reason for refusal, the use of “I” statements, a statement about safety, providing an alternative action, and refusal for engagement in unsafe activity). Assertive Communication Skills were scored after listening to girls’ role-play responses to vignettes.  Eighty one percent of the girls were contacted for a follow up after their release and this attrition was partially due to the fact that Hurricane Katrina resulted in some mobility of the participants during the follow-up period.  Thus, outcome analyses were conducted for the 246 participants who completed the post-release survey.  The two groups were statistically similar at baseline and there were no differences in rates of attrition between the two groups.

Results: In terms of knowledge and communication skills, there were a number of improvements.  Both the intervention group and the control group were found to have increased knowledge and condom skills; however, the girls in the intervention group were more likely to score higher on condom application skills.  The girls in the intervention group were also significantly more likely to score higher on five of the six assertive communication skills.  Neither group showed improvement over time for the sixth assertive communication skill: refusal for engagement in unsafe activity.  Finally, there was also significant change over time in overall effectiveness of the program for the intervention group (overall effectiveness was calculated as a composite score of all outcomes measured).  Differences in behavioral outcomes across the groups were less common, suggesting both curricula may reduce risky behaviors over time.  There were no differences across groups in the frequency of unprotected sex; however, both groups saw a decline over time.  There also were no differences by group in terms of number of sexual encounters under the influence of substances though there was, again, a decrease over time for both groups.  There were no differences across group or time in perceived barriers to condom use or in terms of which safer sex category girls fell into (abstinence, consistent condom use, or inconsistent/no condom use).  Finally, there was no change in the incidence of STIs over the time period in either group.  Almost 20% of the sample had an STI at both follow-up and baseline.

SOURCES FOR MORE INFORMATION

References

Robertson, A.R., St. Lawrence, J., Morse, D.T., Baird-Thomas, C., Liew, H., and Gersham, K. (2011). The Healthy Teen Girls Project: Comparison of Health Education and STD Risk Reduction Intervention for Incarcerated Adolescent Females. Health Education and Behavior, 38(3), 241-250.

Contact Information

Angela Robertson

Social Science Research Center (SSRC)

Mississippi State University

KEYWORDS: adolescent, juvenile offenders, females, juvenile detention facility, social skills/life skills, teen pregnancy, contraception, STD/HIV/AIDS, sexual activity, other reproductive health

Program information last updated on 11/20/15.

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