It’s Your Game…Keep It Real is a classroom and digital HIV, STI and pregnancy prevention program for middle school students. This abstinence-plus program has been proven to delay sexual behaviors among adolescents, and is a fun and effective way to teach teens about their bodies, personal relationships, personal rules and sex, while giving them the skills to grow into safe, responsible young adults. It integrates group-based classroom activities, such as roleplays, discussions and small-group work, with personalized journaling and individually tailored computer-based activities to help young people delay sex, develop positive attitudes toward abstinence, gain greater self-efficacy for refusing sex, and increase their knowledge about condom and contraceptive use.
It’s Your Game…Keep It Real (IYG) is a classroom- and computer-based HIV, STI and pregnancy prevention program for middle school students. This abstinence-plus program has been proven to delay sexual behaviors among adolescents, and is a fun and effective way to teach teens about their bodies, personal relationships, personal rules and sex, while giving them the skills to grow into safe, responsible young adults. It integrates group-based classroom activities, such as roleplays, discussions and small-group work, with personalized journaling and individually tailored computer-based activities to help young people delay sex, develop positive attitudes toward abstinence, gain greater self-efficacy for refusing sex, and increase their knowledge about condom and contraceptive use.
It’s Your Game... Keep It Real consists of twelve 50-minute lessons (eight delivered in class and four delivered via computer) at seventh grade, and twelve 50-minute lessons (seven delivered in class and five delivered via computer) at eighth grade. The intervention is designed to be provided to the same seventh and eighth graders over a 2-year period (i.e., the same students receive up to 24 lessons over 2 years).
In each grade, the curriculum integrates group-based classroom activities with personalized journaling and individually tailored computer-based activities. A life-skills decision-making paradigm (Select, Detect, Protect) underlies the activities, teaching students to select personal rules regarding risk behaviors, detect signs or situations that might challenge these rules, and use refusal skills and other tactics to protect these rules. Abstinence is the primary focus and is encouraged over any other behavior.
The classroom curriculum also includes three parent-child homework activities at each grade level designed to facilitate dialogue on topics such as friendships, dating, and sexual behavior. The curriculum is grounded in social cognitive theory, the theory of triadic influence, and social influence models.
The computer-based activities included in the curriculum cover the following topics:
The curriculum was designed to be implemented in a school classroom with seventh and eighth graders in an urban setting.
Program developers include Drs. Susan Tortolero Emery, Christine Markham, Ross Shegog and Melissa Peskin. All are faculty in the Center for Health Promotion and Prevention Research (CHPPR) in the Department of Health Promotion and Behavioral Science at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health. UT Health School of Public Health is located in the Texas Medical Center in Houston, and includes other campuses in Dallas, Brownsville, El Paso, Austin and San Antonio. The mission of the CHPPR is to conduct research to develop, evaluate and disseminate health promotion and disease prevention programs in diverse settings and populations. The developers have extensive expertise in the development, implementation, evaluation and dissemination of theory- and evidence-based adolescent health promotion interventions.
The curriculum has 10 hours of content at each level, divided into twelve 50-minute sessions, for a total of 24 sessions to be delivered over 4 months.
Core intervention materials include:
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 a skilled facilitator. 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 It’s Your Game receive research-based professional development to prepare them to effectively implement and replicate the curriculum with fidelity for the intended target group. Training is available through ETR's Professional Learning Services.
It’s Your Game was developed using intervention mapping, a framework for developing health education interventions based on both theoretical (Social Cognitive Theory, Theory of Triadic Influence, Social Influence Models) and empirical evidence.
The program logic model can be found here:
Logic Model (pdf)
It’s Your Game has been tested in several separate studies in urban settings. The first study (Tortolero et al., 2010) used a cluster randomized controlled trial design with ten Texas urban middle schools with low-income populations; half received the 2-year intervention (twelve lessons in seventh grade and twelve lessons in eighth grade). Investigators defined and tracked a cohort of 981 seventh grade youth through the end of ninth grade, with 92% completing the final follow up survey.
The second study (Markham et al., 2012) used a cluster randomized controlled trial design with 15 urban middle schools; schools were assigned to one of three intervention conditions: IYG (referenced as a risk-reduction program in the article), a risk-avoidance program or control. A cohort of 1,742 seventh grade students was tracked into ninth grade, with 76.5% completing the final follow-up survey; the final analysis sample included 1,258 youth. The primary outcome variable, sexual initiation was defined as initiation of vaginal, oral or anal intercourse, consistent with the first study.
The third study (Peskin, Coyle et al., under review) was a real-world replication study: a cluster randomized controlled trial design with 20 Texas middle schools with low-income populations; half received the 2-year intervention (twelve lessons in seventh grade and twelve lessons in eighth grade). Investigators defined and tracked a cohort of 2,377 seventh grade youth through the end of ninth grade, with 75% completing the final follow-up survey. The primary outcome variable, sexual initiation was defined as initiation of vaginal or oral intercourse [anal intercourse not asked].
The primary outcome variable, sexual initiation, was defined as initiation of vaginal, oral or anal intercourse. Results of the first study showed that:
Results of the second study showed that:
Results of the third study showed that:
Tortolero, S. R., Markham, C. M., Peskin, M. F., Shegog, R., Addy, R. C., Escobar-Chaves, S. L., & Baumler, E. R. (2010). It’s Your Game: Keep It Real: Delaying Sexual Behavior with an Effective Middle School Program. Journal of Adolescent Health, 46: 169–179.
Markham, C. M., Tortolero, S. R., Peskin, M. F., Shegog, R., Thiel, M., Baumler, E. R., Addy, R. C., Escobar-Chaves, S. L., Reininger, B., & Robin, L. (2012). Sexual Risk Avoidance and Sexual Risk Reduction Intervention for Middle School Youth: A Randomized Controlled Trial. Journal of Adolescent Health, (50)3: 279–288.
Peskin, M. F., Coyle, K. K., Anderson, P. M., Laris, B. A., Glassman, J. R., Franks, H. M., Thiel, M. A., Potter, S. C., Unti, T., Edwards, S., Johnson-Baker, K., Cuccaro, P. M., Diamond, P., Markham, C. M., Shegog, R., Baumler, E. R., Gabay, E. K., Tortolero Emery, S. (2019). It’s Your Game...Keep it Real!: Replication of an Evidence-Based Program. The Journal of Primary Prevention, (40): 297–323.
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.
For answers to Frequently Asked Questions about program adaptations, please visit our Program Support Help Desk.
Read ETR's Adaptations Policy.
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.
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.) 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.
It’s Your Game Pretest (pdf)
It’s Your Game Posttest (pdf)
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 It’s Your Game should be skilled in using interactive teaching methods and guiding group discussions. It is highly recommended that educators who plan to teach It’s Your Game receive research-based professional development to prepare them to effectively implement and replicate the curriculum with fidelity for the intended target group.
Training on It’s Your Game is available through ETR's Professional Learning Services. Training options include a 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.