Making Proud Choices! An Evidence-Based, Safer-Sex Approach to Teen Pregnancy and HIV/STD Prevention is an 8-module curriculum that provides adolescents with the knowledge, confidence and skills necessary to reduce their risk of sexually transmitted diseases (STDs), HIV and pregnancy by abstaining from sex or using condoms if they choose to have sex. The intervention is based on cognitive-behavioral theories, focus groups and the authors’ extensive experience working with youth. Making Proud Choices! is an adaptation and extension of the original Be Proud! Be Responsible! curriculum that integrates teen pregnancy prevention along with HIV/STD prevention. The School Edition is a 14-module adaptation designed to fit a school schedule. There is also a 10-module adaptation for youth in out-of-home care, and an adaptation for the state of California that aligns with the requirements of the California Healthy Youth Act.
|Category||Program Features||School Edition||Out-of-Home Youth||California Edition|
|Setting||Community based||School based||Community based||School or Community based|
|8 hrs/yr | 1 year
8 sessions total
|9.5 hrs/yr | 1 year
14 sessions total
|12.5 hrs/yr | 1 year
10 sessions total
|9 hrs/yr | 1 year
9 sessions total
|Age Group||Ages 12–18||Middle/High School||Ages 12–18||Ages 12–18|
Making Proud Choices! provides adolescents with the knowledge, confidence and skills necessary to reduce their risk of sexually transmitted diseases (STDs), HIV and pregnancy by abstaining from sex or using condoms if they choose to have sex. It is based on cognitive-behavioral theories, focus groups and the authors’ extensive experience working with youth. Making Proud Choices! is an adaptation and extension of the original Be Proud! Be Responsible! curriculum that integrates teen pregnancy prevention along with HIV/STD prevention. The School Edition is a 14-module adaptation designed to fit a school schedule. There is also a 10-module adaptation for youth in out-of-home care, with a particular emphasis on trauma-informed language, and an adaptation of both the original and school editions for the state of California that aligns with the requirements of the California Healthy Youth Act.
To reduce STD and pregnancy risk related sexual behaviors, adolescents not only need an awareness of personal vulnerability, but also positive attitudes towards condom-use skills and confidence in their ability to use condoms. The Making Proud Choices! curriculum is designed to meet those needs.
The goal of Making Proud Choices! is to empower adolescents to change their behavior in ways that will reduce their risk of an unplanned pregnancy or becoming infected with HIV and other STDs. Specifically, this curriculum emphasizes that adolescents can reduce their risk for STDs, HIV and pregnancy by using a condom, if they choose to have sex.
The program has four major components. The first component focuses on goals, dreams and adolescent sexuality. The second is knowledge, covering information about the etiology, transmission and prevention of HIV, other STDs and teenage pregnancy. The third focuses on beliefs and attitudes. The fourth focuses on skills and self-efficacy, covering negotiation-refusal skills and condom use skills and providing time for practice, reinforcement and support.
The role of sexual responsibility and accountability is stressed, and the curriculum teaches participants to make responsible decisions regarding their sexual behavior, to respect themselves and others, and the importance of developing a positive image. Participants discuss what constitutes sexual responsibility, such as condom use and learn to make responsible decisions regarding their sexual behavior (i.e. that abstinence is the best way to prevent HIV, STD and teen pregnancy, however, if they choose to have sex, they must use a condom).
The original curriculum modules include:
The School Edition modules include:
The modules in the program for youth in out-of-home care include:
The modules in the community-based California Edition include:
A series of fun and interactive learning experiences increase participation and help adolescents understand the faulty reasoning and decision-making that puts them at risk for STDs, HIV and unplanned pregnancies. Activities are designed to increase comfort with practicing condom use, address concerns about negative effects of practicing safer sex and build skills in condom use and negotiation, and incorporate social cognitive-behavioral skill-building strategies (i.e., presentation, modeling, and the practice of condom use negotiation skills).
The curriculum involves culturally sensitive video clips, games, brainstorming, role-playing, skill-building activities and small group discussions that build group cohesion and enhance learning. Each activity lasts only a brief time and involves adolescents getting out of their seats and interacting with each other. In this way, it is possible to maintain interest and attention that might fade during a lecture or lengthy group discussion.
At the completion of the program, youth will
Making Proud Choices! was designed to be used with small groups ranging from 6 to 12 participants, but it can be implemented with larger groups as well. The curriculum can be implemented in various community settings, including schools and youth-serving agencies. The School Edition was designed to be used in classroom settings, where facilitators may be limited to time constraints.
The adaptation for youth in out-of-home care can be implemented in various community and out-of-care settings, including foster homes, independent and transitional living facilities, and juvenile justice settings. Most young people entering the system bring a host of traumas, including neglect and abuse, that can impact their psychosocial and sexual development and increase the likelihood that they will engage in behaviors that place them at risk of early pregnancy and STDs. The Making Proud Choices! adaptation for youth in out-of-home care is designed to empower in-care adolescents with greater knowledge and self-respect that will encourage them to protect themselves against unintended pregnancies and STD and/or HIV infection.
Loretta Sweet Jemmott, PhD, RN, FAAN, is one of the nation’s foremost researchers in the field of HIV/AIDS, STD and pregnancy prevention, with a consistent track record of developing evidence-based sexual risk-reduction interventions. As an expert in health promotion research, she has led the nation in understanding the psychological determinants for reducing risk-related behaviors and how best to facilitate and promote positive changes in health behaviors. Her research is devoted to designing and evaluating theory-driven, culturally competent sexual risk-reduction behavioral interventions with various populations across the globe.
An outstanding translational researcher, Dr. Jemmott’s work has had global impact and changed public policy. She has partnered with community-based organizations, including churches, clinics, barbershops and schools, and transformed her NIH-funded evidence-based research outcomes for use in real-world settings. She has presented her research to the U.S. Congress and at the NIH Consensus Development Conference on Interventions to Reduce HIV Risk Behaviors. Dr. Jemmott has received numerous awards for her significant contributions to the field of HIV/STD and pregnancy prevention research, including the U.S. Congressional Merit Award, Sigma Theta Tau National Honor Society’s Episteme Award and Hall of Fame Award, and election to membership in the Institute of Medicine, an honor accorded to very few nurses.
John B. Jemmott III, PhD, received his PhD in psychology from the Department of Psychology and Social Relations at Harvard University. He holds joint faculty appointments at the University of Pennsylvania as the Kenneth B. Clark Professor of Communication in the Annenberg School for Communication, and as Professor of Communication in Psychiatry in the Perelman School of Medicine. He is also the director of the Center for Health Behavior and Communication Research at the Annenberg School for Communication.
Dr. Jemmott is a Fellow of the Association of Psychological Science, the American Psychological Association and the Society for Behavioral Medicine. He has published more than 100 articles and book chapters, and has received numerous grants from the National Institutes of Health to conduct research designed to develop and test theory-based, contextually appropriate HIV/STD risk-reduction interventions for a variety of populations in the United States and sub-Saharan Africa.
Konstance A. McCaffree, PhD, CSE is a certified sexuality educator and adjunct professor in the Center for Education Human Sexuality Program at Widener University in Chester, Pennsylvania. As a classroom teacher in the public schools, she has taught human sexuality to both elementary and secondary students for over 35 years. Her professional association work includes serving on the Board of Directors of the Sexuality Information and Education Council of the U.S. (SIECUS), as President of the Society for the Scientific Study of Sexuality (SSSS) and as an officer in the American Association of Sexuality Education, Counselors and Therapists (AASECT). She conducts workshops nationwide to help educators improve their skills in teaching sexuality education. She also conducts programs for parents, churches and community organizations to enhance their knowledge and skills in dealing with the sexuality of children and teenagers.
In recent years, Dr. McCaffree has developed curricula and implemented training programs for educators and other health professionals in South Africa, Zambia, Nigeria and the Philippines. For the past 10 years she has trained teachers and professors to implement a curriculum she developed in coordination with local educators throughout the country of Nigeria. She has used her expertise to develop training for curricula to prevent HIV/AIDS, unplanned pregnancy, and other health and social issues among children, teenagers and adults.
Pamela M. Wilson, MSW, has over 30 years of experience in the fields of sexuality education and reproductive health. Since the late 1980s she has worked as an independent consultant and trainer on many different local, national and international projects. She has taught human sexuality courses at several universities, staffed national sexuality training initiatives, and has written or co-authored over 15 curricula for a variety of audiences including teens, parents, couples, young fathers, and girls ages 9 to 18.
She has worked on multiple evidence-based intervention projects, including providing consultation and training on an evidence-based program designed to help family planning clinics in central Pennsylvania become more youth friendly (Tailoring Family Planning to the Special Needs of Youth). She also worked closely with Dr. Loretta Sweet Jemmott to adapt the evidence-based curriculum Making Proud Choices for youth in out-of-home care, and, as a certified trainer, has trained approximately 100 facilitators in five states to implement the intervention. She has also worked with EngenderHealth to begin the development of an evidence-based HIV prevention curriculum for couples in Tanzania.
The curriculum has 8 hours of content divided into eight 1-hour modules. It can be implemented in eight sessions of 60 minutes each or in four 2-hour modules. In community settings, it can be implemented in a 2-day format (four modules each day), 4-day format (two modules each day) or an 8-day format (one module each day).
The School Edition has about 9-1/2 hours of content divided into fourteen 40-minute modules. It can be implemented in fourteen sessions of 40 minutes each or in any other format that is conducive for the needs of the school or organization in which the curriculum is being implemented (i.e.: seven sessions of 80 minutes); however, the modules should be implemented consecutively.
The adaptation for youth in out-of-home care has 12.5 of content divided into ten 75-minute modules. Ideally, implementation should be as concentrated as possible and completed in no more than 5 weeks total. It can be implemented using a 5-day format (two modules per day) or a 5-week format (2 modules per week). Some agencies have implemented this version of the curriculum in 3 days or over a weekend at a fun retreat setting—a format that will only work with lots of time built in for recreation. When the program for this target population stretches beyond 5 weeks, it’s challenging (but not impossible) to maintain attendance.
Core intervention materials include:
The Making Proud Choices implementation set for both editions includes the facilitator's guide, activity set, a classroom set of 30 student workbooks and 6 DVDs. The curriculum requires the use of a monitor with DVD capabilities.
Student workbooks are recommended for every student. Additional workbook sets of 5 and 30 are available.
An optional LGBTQ Supplement is also available from ETR. It includes a lesson that can be taught before implementing the intervention as well as suggestions for acceptable adaptations to make evidence-based programs more inclusive of LGBTQ youth.
This curriculum is designed to be taught by classroom teachers or family life educators. Educators interested in implementing this program should be skilled in using interactive teaching methods and guiding group discussions, and should be comfortable with the program content.
It is highly recommended that educators who plan to teach Making Proud Choices! receive research-based professional development to prepare them to effectively implement and replicate the curriculum with fidelity for the intended target group. Training on Making Proud Choices! is available through ETR's Professional Learning Services.
It is essential to inform parents and guardians regarding the nature and scheduling of this or any sexual health education program. Prior to implementation of the curriculum, families should receive written notice describing the goals of Making Proud Choices! and the nature of the content to be covered. Parents also should be given an opportunity to view the curriculum and related materials if they wish. The vast majority of parents want their children to receive appropriate instruction and be given the information and skills they need to protect their sexual health, but parents/guardians also must be allowed the chance to opt out or exclude their children from participating in the program, if they wish.
Three overriding themes provide the curriculum with a unique approach that has proven to be successful with young adolescents:
The program logic model can be found here:
Logic Model (pdf)
In the research study, the 8-hour curriculum Making Proud Choices! was implemented in a small-group setting with African-American male and female adolescents, between the ages of 11 and 13, on two consecutive Saturdays in three different middle schools.
In this randomized control trial, 659 sixth- and seventh-grade African-American male and female adolescents, mean age 11.8, were stratified by gender and age and randomly assigned to receive one of three 8-hour curricula: an abstinence curriculum, a safer sex curriculum or a health promotion curriculum (which served as the control group). The adolescents received the curriculum in small groups of six to eight students led by either an African-American adult facilitator (mean age 40) or two peer African-American co-facilitators (mean age 16).
The participants completed questionnaires before, immediately following the curricula, 3, 6 and 12 months after the intervention. Of the original 659 participants, 97% returned to complete the 3-month follow-up questionnaire, 94% completed the 6-month and 93% completed the 12-month follow-up. The primary measures were HIV risk-associated sexual behaviors. The secondary measures were variables from the Theory of Planned Behavior and the Social Cognitive Theory, including knowledge, beliefs, norms, intentions and self-efficacy regarding abstinence and condom use.
The participants who received the Making Proud Choices! safer-sex curriculum reported:
Making Proud Choices! was especially effective with sexually experienced adolescents, For instance, among participants who were sexually experienced at baseline, those in the safer-sex groups reported less sexual intercourse in the previous 3 months at the 6-month (p < .001) and 12-month (p = .002) follow-up than the control group (p < .03). In addition, they reported less unprotected sex at all three follow-up session than the control group (p < .03).
The adult and peer facilitators were equally effective. There were no differences in intervention effects on behavior with adult facilitators as compared with peer-co-facilitators.
Compared to those in the control group, adolescents who received the Making Proud Choices! curriculum scored higher in condom use knowledge; believed more strongly that condoms can prevent pregnancy, STDs and HIV; believed more strongly that using condoms would not interfere with sexual enjoyment; expressed greater confidence that they could have condoms available when they needed them; and reported greater confidence that they could exercise sufficient impulse control to use condoms and greater self-efficacy for using condoms.
As of October 2013, more than 330 youth in care across five states had received the adapted curriculum, Making Proud Choices! for Youth in Out-of-Home Care. Preliminary results from the process evaluation indicate:
Jemmott, J. B. III, Jemmott, L. S., & Fong, G. T. (1998). Abstinence and safer sex HIV risk-reduction interventions for African American adolescents: A randomized controlled trial. Journal of the American Medical Association, 279 (19): 1529-1536.
ETR is a leader in developing adaptation guidelines to enable professionals to adapt evidence-based intervention programs for implementation in underserved communities, while maintaining fidelity to the intervention's core components. ETR works with program developers to ensure that these tools are of the highest quality and meet the different needs of the field and end users, e.g., teachers, trainers, program mangers/staff, research teams, and funders.
Click the links below to view Adaptation Guidelines for Making Proud Choices
Core Components (pdf)
For answers to Frequently Asked Questions about program adaptations, please visit our Program Support Help Desk.
Read ETR's Adaptations Policy.
Click the links below for the logs for Making Proud Choices! Fifth Edition.
Classroom teachers can use pre/post tests to examine whether short-term knowledge learning objectives have been met. A simple pretest-posttest assessment design can be used to measure pre-instruction levels and post-instruction changes in student learning. The sample pre-test provided here is from the research study and gathers demographic data on participants in addition to assessing attitudes and sexual health knowledge.
Your ability to detect student change using this survey may vary and can be affected by numerous factors (e.g., number and content of lessons students receive, student scores at pretest, student motivation and interest in topic and survey, etc.) Improvement between pretest and posttest can be viewed as supportive, but not definitive, evidence of the curriculum's impact on short-term knowledge learning objectives. A well-designed evaluation study (e.g., using a strong experimental design with a well-matched comparison group and adequate sample size) with more extensive measurement would be needed to provide stronger evidence of curriculum impact.
For over 30 years, ETR has been building the capacity of community-based organizations, schools, school districts, and state, county and local agencies in all 50 states and 7 U.S. territories to implement and replicate evidenced-based programs (EBPs) to prevent teen pregnancy, STD/STI and HIV. Our nationally recognized training and research teams work in partnership with clients to customize training and technical assistance (TA) to address the needs of their agencies and funding requirements.
Educators interested in implementing Making Proud Choices! should be skilled in using interactive teaching methods and guiding group discussions. It is highly recommended that educators who plan to teach Making Proud Choices! receive research-based professional development to prepare them to effectively implement and replicate the curriculum with fidelity for the intended target group.
Training on Making Proud Choices! is available through ETR's Professional Learning Services. Training options include a 2-day Training of Educators with follow-up support.
ETR provides in-person and web- or phone-based technical assistance before, during and/or after program implementation. TA is tailored to the needs of the site and is designed to support quality assurance, trouble-shoot adaptation issues, and boost implementation.
To support a holistic approach to teen pregnancy and HIV prevention programs, ETR offers a number of additional training and technical assistance opportunities, including content-specific workshops, skill-based trainings, organizational development consultation and much more. To learn more about these opportunities, visit our Training & TA pages >>
Adaptation support materials, training and/or TA are available to assist educators in meeting the needs of individual communities by implementing EBPs effectively and consistently with core components. All adaptation support is based on ETR's groundbreaking, widely disseminated adaptation guidelines and kits for effective adaptations.
ETR also provides evaluation support for EBP implementation. ETR uses well-established tools for measuring fidelity and outcomes. ETR's evaluation support blends participatory approaches with cutting-edge evaluation science. Services address process and outcome evaluation and include assistance with evaluation planning, instrument design and development, implementation fidelity, data management and analysis, performance measurement, continuous quality improvement (CQI) protocols, and effective tools and strategies for reporting results.
(contains everything needed to teach with fidelity)