Making Proud
Choices!
A Safer
Sex Approach to Prevention of STDs, HIV and Teen Pregnancy
Overview of the
Curriculum
Making
Proud Choices! A Safer Sex Approach to STDs, Teen Pregnancy, and HIV Prevention
is an eight-module curriculum that provides young 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 researchers' extensive experience working with youth.
Making Proud Choices! is an adaptation and extension of the original
Be Proud! Be Responsible! curriculum in that it integrates STD, HIV
and pregnancy prevention.
To reduce
risk for STD/HIV and pregnancy risk-related behaviors, young adolescents
need not only knowledge and perception 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.
Goal
of the Curriculum
The
goal of Making Proud Choices! is to empower young adolescents to
change their behavior in ways that will reduce their risk of becoming
infected with HIV and other STDs, and their risk for pregnancy. Specifically,
this curriculum emphasizes that they can reduce their risk for STDs, HIV,
and pregnancy by using a condom, if they choose to have sex.
Target
Audience
Young
African-American, Hispanic and White adolescents, ages 11-13, who attend
middle schools and youth-serving community based programs.
Implementation
of the Curriculum
Making
Proud Choices! was designed to be used with small groups ranging from
six to 12 participants, but it can be implemented with larger numbers
of youth. The curriculum can be implemented in various community settings,
including schools or youth-serving agencies.
Length
The
curriculum has eight hours of content divided into eight one-hour modules.
It can be implemented in eight sessions of 60 minutes each or in four
two-module sessions. In community settings, it can be implemented in the
two-day format (four modules each day), four-day format (two modules each
day) or eight-day format (one module each day).
Curriculum
Objectives At the completion
of the Making Proud Choices! curriculum, youth will have:
- increased knowledge about prevention of HIV, STDs and pregnancy
- more positive attitudes/beliefs about condom use
- increased confidence in their ability to negotiate safer sex and to
use condoms correctly
- increased negotiation skills
- improved condom use skills
- stronger intentions to use condoms if they have sex
- a lower incidence of STD/HIV risk-associated sexual behavior
- a stronger sense of pride and responsibility in making a difference
Content
Outline
The
Making Proud Choices! curriculum has four major components. One
component focuses on goals and dreams and adolescent sexuality. The second
component is knowledge. It covers information about the etiology, transmission,
and prevention of STDs, HIV, and teenage pregnancy. The third component
focuses on beliefs and attitudes. The fourth component focuses on skills
and self-efficacy. It covers negotiation-refusal skills and condom use
skills, and provides time for practice, reinforcement, and support.
Types of Activities
The Making
Proud Choices! curriculum includes a series of fun and interactive
learning experiences designed to increase participation and to help young
adolescents understand faulty reasoning and decision-making about taking
risks for STD/HIV and pregnancy. 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.
The activities
incorporate social cognitive-behavioral skill-building strategies (i.e.,
presentation, modeling, and the practice of condom use negotiation skills).
They involve culturally sensitive video clips, games, brainstorming, role-playing,
skill-building activities and small group discussion that build group
cohesion and enhance learning. Each activity lasts a brief time, and most
are active exercises in which the adolescents get out of their seats and
interact a lot with each other. In this way, it is possible to maintain
interest and attention that might fade if lecturing and lengthy group
discussions were used.
Below is
a description of the types of activities used in the Making Proud Choices!
curriculum.
- The goals and dreams activity focuses on having the adolescents consider
their goals for the future and how participating in unsafe sex might
thwart the attainment of their goals.
- Videos are used to depict young adolescents in various situations.
These videos evoke feelings, thoughts, attitudes, beliefs, and stereotypes
about HIV/STD, sexual involvement, and HIV/STD prevention skills.
- The role-play scenarios are designed to provide participants with
the confidence and skills to negotiate condom use. These realistic role-play
scenarios provide young adolescents with a variety of ways in which
they could use the prevention skills that they learn in this program.
- The curriculum incorporates the "Make Proud Choices! Be Proud! Be
Responsible!" theme that encourages the participants to be proud of
themselves, their families, and their communities, and to behave responsibly
for the sake of themselves, their families, and their communities.
Curriculum
Components
The curriculum consists of the facilitation guide manual, which provides
detailed description of program activities, activities/games packet, and
video clips. The curriculum requires the use of a TV monitor and VCR.
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Theoretical Framework
Research
shows that curricula are most effective if they are based on sound theoretical
framework. The Making Proud Choices! curriculum draws upon three
theories: the Social Cognitive Theory, the Theory of Reasoned Action, and
its extension, the Theory of Planned Behavior. These theories have been
shown to be of great value in understanding a wide range of health related
behaviors.
There are
two major concepts of these theories:
- self-efficacy or perceived behavioral control beliefs, which is defined
as a person's confidence in his or her ability to do the behavior, i.e.
use a condom, and
- outcome expectancies or behavioral beliefs, which are beliefs about
the consequences of the behavior.
Both concepts
are included in Making Proud Choices!
Below is
a description of the four types of outcome expectancies or behavioral beliefs
emphasized in Making Proud Choices!:
- Goals and Dreams Beliefs — the belief that unprotected
sex can interfere with one's goals and dreams for education and a career.
In Session 1, the participants engage in a goals and dreams activity
and discuss obstacles to goals and dreams. Having unprotected sex is
listed and discussed as an obstacle. This belief is also incorporated
throughout the curriculum.
- Prevention Beliefs — the belief that condoms can reduce
the risk of pregnancy, sexually transmitted diseases and HIV/AIDS. This
belief is incorporated throughout the curriculum.
- Partner-Reaction Beliefs — the belief that one's boyfriend/girlfriend
would not approve of condom use and will react negatively to it. This
belief may prevent a person from negotiating condom use. In Sessions
7 and 8, participants learn how to get out of a risky situation, set
physical limits, and use negotiation and refusal skills to communicate
with their partners about safer sex.
- Hedonistic Beliefs — the belief that condom use interferes
with sexual pleasure. For example, many people believe that condoms
reduce physical sensations during sexual activity or ruin the mood.
Therefore, they are less likely to use condoms during sexual intercourse.
In Sessions 7 and 8, youth learn that sex is still fun and pleasurable
when a condom is used and are taught how to incorporate this belief
into role-play scenarios.
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Unique Features
of the Curriculum
Three
overriding themes provide the Making Proud Choices! curriculum with
a unique approach that has proved to be successful with young adolescents.
- The community and family approach: An important component of
our approach is the strong emphasis on family and community. The Making
Proud Choices! curriculum emphasizes how HIV/AIDS, STDs, and unintended
adolescent pregnancy have affected their community. It addresses the
importance of protecting the family and community as a motive to change
individual behavior.
The focus on the implications for the family and community to motivate
change is different from the traditional exclusive focus on individualistic
HIV/AIDS knowledge and individualistic attitudes toward risky behavior.
In this connection, the intervention incorporates the "Make a Difference!
Be Proud! Be Responsible!" theme to encourage the adolescents to be
proud of themselves and to use condoms as a way to prevent the sexual
transmission of HIV, not only for their own sake, but for the sake of
their families and communities.
- The role of sexual responsibility and accountability: Many
young adolescents do not express their sexual feelings in a responsible
or accountable way. This is evidenced by the high incidence of STDs
and pregnancy among adolescents. It is also evidenced by their self
reports of inconsistent condom use and multiple sexual partners. Young
adolescents need to learn how to become sexually responsible and accountable.
The Making Proud Choices! curriculum teaches participants to
make responsible decisions regarding their sexual behavior, respect
themselves and others, and appreciate 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 role of pride and making a difference in making safer sex their
choice: Adolescence is a difficult period of development. Adolescents
are faced with a time of confusion, mixed emotions and uncertainty.
They are bombarded with sexual messages from various sources, including
TV, music, magazines, friends, and their boyfriends/girlfriends. They
receive pressure from their peers and boyfriends/girlfriends to have
sex. They struggle with issues around self-esteem, self-respect, and
self-pride. Therefore, they need to feel good about themselves, their
decisions to practice safer sex, and their behavior.
The Making Proud Choices! curriculum addresses these feelings
by emphasizing that it can make you feel proud and responsible to make
proud choices about making safer sex your choice. The adolescents' sense
of pride, self-confidence, and self-respect regarding their choice to
practice safer sex is encouraged and reinforced during the role plays
and other skill-building activities.
-
Recommended Training, Cost,
and Ordering Information
Recommended
Training
If the educators are knowledgeable about HIV/AIDS, STDs, and adolescent
sexuality and have experience implementing a STD/HIV prevention curriculum
with youth, then they may need about six to eight hours of training. Their
training should include reviewing the curriculum and discussing various
issues in the curriculum and its implementation and what is unique and different.
In addition, selected lessons should be modeled, and the participants should
have an opportunity to practice them and receive feedback.
If the educators
are not knowledgeable about HIV/AIDS, STDs, and adolescent sexuality and
have no experience implementing a STD/HIV prevention curriculum with youth,
then 24 hours of training are needed. During the training, HIV/AIDS, STD,
and adolescent pregnancy knowledge and prevention skills should be reviewed
and reinforced. Implementation strategies, training issues, and the trainees'
comfort levels with adolescent sexuality should be discussed. The content
of the curriculum should be reviewed. The trainer should walk the educators
through the curriculum as though they were students. A question-and-answer
period should be held afterwards. Then the trainees should practice the
curriculum and receive performance feedback.
For information
regarding training, contact:
Loretta Jemmott at (215) 898-8287, or ETR's Training Department at: training@etr.org.
Cost and Ordering
Information
Making
Proud Choices! can
be ordered from Select Media. The cost of the basic package, which includes
an activity set and video clips, is $99. Optional videos — The
Truth About Sex, $95; The Subject is: HIV,
$118; AIDS Not Us, $80; and Nicole's
Choice, $80 — may be purchased separately or as part
of an entire package for $425.
For more
information or to place an order, call Select Media at 1-800-707-6334
or visit them on-line at www.selectmedia.org.
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Evaluation
Fact Sheet
Intervention
In the research study, the eight-hour curriculum Making Proud Choices!
was implemented in a small group format with African-American male and female
adolescents, ages 11-13, in a two-day format on two consecutive Saturdays
in three different middle schools.
The Making
Proud Choices! curriculum is based on cognitive behavioral theory
and elicitation research and focuses on safer sex. It acknowledges that
abstinence as the most effective way to eliminate their risk for STDs
including HIV. However, it stressed condom use. It explains that if young
people choose to have sex, they must practice safer sex and always use
a condom to reduce their risk for STDs, HIV, and pregnancy. It addresses
attitudes and beliefs about using condoms and builds skills to use condoms
correctly and negotiate condom use.
Research
Design
In
a randomized control trial, 659 6th and 7th 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 eight-hour curricula: an
abstinence HIV curriculum, a safer sex HIV 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 after, and three, six and
12 months after the intervention. Of the original 659 participants, 97%
returned to complete the three-month follow-up questionnaire, 94% completed
the 6-month questionnaire, 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.
Behavioral
Findings
- The students who received the Making Proud Choices! safer sex
curriculum reported:
- more consistent condom use and less unprotected sex in the three
months after the intervention than did those in the control group.
- a higher frequency of condom use at the three-, six-, and 12-month
follow-up sessions than did those in the control group.
- Making Proud Choices! was especially effective with sexually
experienced adolescents. For instance, among students who were sexually
experienced at baseline, those in the safer sex groups reported less
sexual intercourse in the previous three months at the six- (p<.001)
and 12- (p=.002) month follow-up than the control group (p<.03). In
addition, they reported less unprotected sex at all three follow-up
sessions than the control group (p<.03).
Other
Significant Findings
- 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.
- The 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
than did those in the control group.
For
More In-depth Information
Jemmott,
J.B., Jemmott III, L.S., & Fong, G. (1998). Abstinence and Safer Sex HIV
risk-reduction interventions for African-American adolescents: A randomized
control trial. Journal of American Medical Association (JAMA),
279, 1529-1536.
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Background
Reading |
Jemmott,
J.B. III & Jemmott, L.S. (2001) HIV risk-reduction behavioral interventions
with heterosexual adolescents. AIDS, 14 (suppl 2), S40-S52.
 |
Jemmott, L.S. (2000). Saving our children: Strategies to empower African-American
adolescents to reduce their risk for HIV infection. Journal of
National Black Nurses Association, 2(1), 4-14.
|
Jemmott,
J.B. III & Jemmott, L.S. (1999). Reducing HIV risk-associated sexual
behaviors among African American adolescents: Testing the generalizability
of intervention effects. Journal of Community Psychology, 27,
161-187.
|
Jemmott,
J.B. III, Jemmott, L.S., & Fong, G. (1998). Abstinence and safer sex
HIV risk-reduction interventions for African-American adolescents:
A randomized control trial. Journal of American Medical Association
(JAMA), 279, 1529-1536.
|
Jemmott,
J.B. III, Jemmott, L.S., & Hacker, C. (1992). Predicting intentions
to use condoms among African-American adolescents: The theory of planned
behavior as a model of HIV risk associated behavior. Journal of
Ethnicity and Disease, 2, 371-380.
|
Jemmott,
J.B. III, Jemmott, L.S., Spears, H., Hewitt, N. & Cruz-Collins, M.
(1992). Self-efficacy, hedonistic expectancies, and condom-use intentions
among inner-city Black adolescent women: A social cognitive approach
to AIDS risk behavior. Journal of Adolescent Health, 13, 512-519.
|
Jemmott,
J. B. III, Jemmott, L.S., & Fong, G. (1992). Reductions in HIV risk-associated
sexual behaviors among Black male adolescents: Effects of an AIDS
prevention intervention. American Journal of Public Health,
82, 372-377.
|
Jemmott,
J.B. III, Frye, D., & Jemmott, L.S. Abstinence interventions.
In A. O'Leary (Ed.) Beyond Condoms. New York: Plenum, in press.
|
Jemmott,
J.B. III & Jemmott, L.S. Helping adolescents reduce their risk of
AIDS. In M. Chesney (Ed.). Health Psychology and HIV Disease.
New York: Plenum, in press.
|
Jemmott,
J.B. III & Jemmott, L.S. HIV behavioral interventions for adolescents
community settings. In J.L. Peterson & R.J. DiClemente (Eds.) Handbook
of HIV Prevention. New York: Plenum, in press.
|
Jemmott,
J.B. III & Jemmott, L.S. (1994). Interventions for adolescents in
community settings. In R.J. DiClemente & J.L. Peterson (Eds.) Preventing
AIDS: Theory and Practice of Behavioral Interventions, New York:
Plenum.
|
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