¡Cuídate! is a 6-module culturally based curriculum designed to reduce HIV sexual risk among Latino youth. It helps Latino youth develop the knowledge, attitudes and skills to reduce their risk for HIV. Activities are designed to help teens build the skills they need to negotiate and practice abstinence and condom use. The curriculum is available in an English and a Spanish version.
This 6-module culturally based curriculum is designed to reduce HIV sexual risk among Latino youth. It helps Latino youth develop the knowledge, attitudes and skills to reduce their risk for HIV. Activities are designed to help teens build the skills they need to negotiate and practice abstinence and condom use.
The word "cuídate" means “take care of yourself,” which is the theme of this culturally based program designed to reduce HIV sexual risk among Latino youth. ¡Cuídate! is an adaptation of the Be Proud! Be Responsible! program. Today all teens, including Latinos, face many health risks related to sexual behavior, such as pregnancy and sexually transmitted diseases (STDs), including HIV. ¡Cuídate! helps Latino youth develop the knowledge, attitudes and skills to reduce their risk for HIV. The program, recommended for use with grades 8-11, emphasizes risk reduction strategies such as sexual abstinence and condom use through activities that allow youth to:
Using the ¡Cuídate! program, educators can help teens act in ways that will support good health and protect them from serious risks related to sexual behavior. ¡Cuídate! is unique because it addresses cultural beliefs related to sexual risk behaviors that are common among many Latino subgroups. Specifically, ¡Cuídate! includes cultural beliefs related to abstinence and condom use. Program activities show these attitudes and beliefs in a positive way. Aspects of Latino culture, such as familialism and gender-role expectations, including machismo, are also built into the program. These values are used to show abstinence and condom use as culturally acceptable and effective ways to avoid unplanned pregnancy or STDs, including HIV.
The goals of the curriculm are to:
The program aims to increase each participant’s skill level and self-efficacy in communicating and negotiating with sexual partners about abstinence and condom use; help teens develop the technical skills they need for correct condom use; and provide important information about the causes, diagnosis, transmission and prevention of HIV and STDs, as well as the risk of HIV infection for Latino youth.
Learning activities such as small-group discussions, videos, games, demonstrations, and role-plays are designed to help teens build the skills they need to negotiate and practice abstinence and condom use. These activities make teens aware of how choices about their sexual behavior can affect their health. The activities show how safer sexual behavior can help avoid pregnancy and STDs, like HIV and AIDS.
The curriculum modules include:
¡Cuídate! was designed for middle and high school Latino youth and addresses cultural beliefs related to sexual risk behaviors common among many Latino subgroups. Aspects of Latino culture are built into the program to show abstinence and condom use as culturally acceptable and effective ways to avoid unplanned pregnancy or STDs, including HIV.
Antonia M. Villarruel, PhD, RN, FAAN, is a professor and the Margaret Bond Simon Dean of Nursing at the University of Pennsylvania School of Nursing. Internationally renowned for her leadership in policy, practice and research, she is a former board member of the American Academy of Nursing and was elected to the Institute of Medicine (IOM) in 2007. Prior to becoming dean, Dr. Villarruel was a professor, the Nola J. Pender Collegiate Chair and the associate dean for research and global affairs at the University of Michigan School of Nursing. She also held a joint faculty appointment in the School of Public Health and was director of the school’s World Health Organization Collaborating Center for Research and Clinical Training in Health Promotion Nursing.
Dr. Villarruel’s research focus has been on health promotion and health disparities underpinned by a community participatory approach. She has been principal or co-principal investigator for research funded by the National Institutes of Health, the National Institute of Nursing Research, and the Centers for Disease Control and Prevention (CDC), among others. Her current research projects include sexual risk reduction interventions for Latino and Mexican youth; parent-adolescent communication interventions to prevent teen pregnancy and sexually transmitted disease; the use of virtual environments to train community participants to implement evidence-based interventions; and language learning to promote global health competency in undergraduate nurses. Among her national leadership roles, she is a former board member of the American Academy of Nursing, a board member of the Institute of Medicine Board on Population Health, and co-chair of the Institute of Medicine Roundtable on the Elimination of Health Disparities and the Promotion of Health Equity.
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.
The program is divided into six 1-hour modules.
Core intervention materials include:
The ¡Cuídate! implementation set includes the facilitator's guide, activity set, 3 DVDs and 1 music CD. The curriculum requires the use of a monitor with DVD capabilities.
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 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 ¡Cuídate! 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.
The study was a randomized controlled trial with data collection at preintervention; immediately after completion of the 2-day intervention; and at 3, 6 and 12 months after intervention. Latino students were recruited from 3 northeast Philadelphia high schools and community-based organizations within these neighborhoods. The study was implemented with a pilot group, and 5 subsequent groups enrolled sequentially across 5 months. Youth were eligible to participate if they self-reported as being Latino, were age 13 through 18, and provided assent and parental consent. Non-Latino students (n=103) were not excluded from participation in the intervention but were excluded from the analysis.
Using a stratified permuted block randomization, adolescents were stratified according to gender, primary language, ethnicity (Latino and non-Latino) and age. On the basis of computer-generated random number sequences, adolescents were randomly assigned to the HIV risk-reduction intervention (¡Cuídate!) or the health-promotion intervention. The interventions were similar in organization, format, length and delivery mode. Both interventions involved small-group discussions, videos, interactive exercises and skill-building activities. Functionally equivalent versions of the HIV risk-reduction and health-promotion curriculum in English and Spanish were developed and pilot tested.
The HIV risk-reduction curriculum tested in this study was an adaptation of Be Proud! Be Responsible! and was based on social cognitive theory and the theories of reasoned action and planned behavior. ¡Cuídate! also incorporated salient aspects of Latino culture, specifically familialism, or the importance of family, and gender-role expectations. Abstinence and condom use were presented as culturally accepted and effective ways to prevent sexually transmitted diseases, including HIV. The health-promotion intervention focused on behaviors related to significant health issues affecting Latinos. These behaviors included diet; exercise and physical activity; and cigarette, alcohol and drug use. Latino cultural values were presented as an important context that supported positive health behaviors.
A total of 684 adolescents were eligible to participate; data analyzed for this study included 553 self-identified Latino adolescents (249 males and 304 females). Most participants were Puerto Rican (472 [85.4%]) with nearly half (249 [45.0%]) born outside the mainland United States. Participants had a mean (SD) age of 14.9 (1.49) years and a median of ninth grade in school, with 86.9% of the students in grades 8 through 11. About 235 (42.5%) reported ever having sexual intercourse, and the mean (SD) age of first intercourse was 13.5 (1.81) years.
Students were asked their language preference and subsequently received the English or Spanish version of the questionnaires. The English versions were received by 412 adolescents and the Spanish versions by 141 adolescents. Several self-report measures of sexual activity and condom use were used. Participants were asked if they ever had sexual intercourse (“your penis in a girl’s vagina” or “boy’s penis in your vagina”) and whether they had done so in the past 3 months (yes or no). Given the past 3 months as a reference point, adolescents also were asked the number of days in which they had intercourse, the number of times they had sex, the number of days of sex without using a condom, and the number of sexual partners. For condom use, adolescents indicated on a 5-point Likert scale how often they used a condom (1=never to 5=always). Binary variables were created for consistent condom use (always used a condom; 0=no; 1=yes), and number of partners (0=1 or no partner; 1=2 or more partners). The proportion of days of protected sex was also calculated (number of days of sex without a condom/number of days of sex).
There were no significant differences between adolescent intervention groups at baseline in gender, language use or age. The intervention had significant effects on sexual intercourse and multiple partners in the past 3 months. Results of generalized estimation equation analyses indicate that adolescents in the HIV risk-reduction group were less likely to report having had sexual intercourse in the past 3 months during follow-up (OR, 0.66; 95% CI, 0.46-0.96) than were those in the health-promotion intervention. Similarly, adolescents in the HIV risk-reduction intervention were less likely to report having multiple partners across follow-up compared with adolescents in the health-promotion intervention (OR, 0.53; 95% CI, 0.31-0.90).
The intervention also had significant effects related to consistent condom use and frequency of unprotected sex. Adolescents in the HIV risk-reduction group were more likely to report using condoms consistently (OR, 1.91; 95% CI, 1.24-2.93) and less likely to report days of unprotected sex (relative risk, 0.47; 95% CI, 0.26-0.84) than were adolescents in the health-promotion intervention. There were no significant effects for the outcomes of condom use at last sex (OR, 1.45; 95% CI, 0.97-2.15) and proportion of days of protected sex (B, 0.02; 95% CI, ?0.07 to 0.12).
Villarruel, A. M., Jemmott, J. B. & Jemmott, L. S. (2006). A randomized controlled trial testing an HIV prevention intervention for Latino youth. Archives of Pediatrics and Adolescent Medicine, 160 (11): 1187.
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Educators interested in implementing ¡Cuídate! should be skilled in using interactive teaching methods and guiding group discussions. It is highly recommended that educators who plan to teach ¡Cuídate! receive research-based professional development to prepare them to effectively implement and replicate the curriculum with fidelity for the intended target group.
Training on ¡Cuídate! 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.
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