Making a Difference! An Evidence-Based, Abstinence Approach to Teen Pregnancy and HIV/STD Prevention is an 8-module curriculum that provides young adolescents with the knowledge, confidence and skills necessary to reduce their risk of sexually transmitted diseases, HIV and pregnancy by abstaining from sex. The program is also available in a 13-module School Edition, with shorter sessions to accommodate school scheduling.
Note: Ideally, young people will receive sexual health education that targets knowledge, attitudes and skills related to both abstinence and safer sex practices such as condom use and contraception. However, for settings in which this approach is not permissible, an evidence-based abstinence-focused program can provide adolescents with support and strategies for choosing abstinence and resisting sexual pressures. Making a Difference! lessons do not include information on condoms or other forms of birth control.
For a prevention program that also addresses knowledge, attitudes and behaviors related to condoms and contraception, please see Making Proud Choices!
To reduce STD/HIV and pregnancy risk-related behaviors, young adolescents not only need knowledge and perception of personal vulnerability, but also positive attitudes and beliefs regarding abstinence, abstinence negotiation skills, and confidence in their ability to abstain from sex. The Making a Difference! curriculum is designed to meet those needs.
The program’s goal is to empower young adolescents to change their behavior in ways that will reduce their risk of pregnancy and HIV or other STD infection. Specifically, this curriculum emphasizes that young adolescents should postpone sexual activity and that practicing abstinence is the only way to eliminate the risk for pregnancy and STDs, including HIV.
The goals of the Making a Difference! program are to:
The Making a Difference! curriculum includes a series of fun and interactive learning experiences designed to increase participation and help young adolescents understand the faulty reasoning and decision making that puts them at risk for HIV/STDs and pregnancy. Activities are designed to increase comfort with practicing abstinence, address concerns about practicing abstinence, and provide strategies for overcoming concerns and obstacles to practicing abstinence.
The activities incorporate social cognitive-behavioral skill-building strategies (i.e., presentation, modeling, and the practice of abstinence 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 a brief time, and most are active exercises in which the adolescents get out of their seats and interact with each other. In this way, it is possible to maintain interest and attention that might fade during a lecture or lengthy group discussion.
Below are some example activities used in Making a Difference!:
The curriculum was designed to be used with small groups ranging from 6–12 participants, but can be implemented with larger groups as well. The curriculum can be implemented in various community settings, including schools and youth-serving agencies.
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.
The standard curriculum has 8 hours of content divided into eight 60-minute modules. It can be implemented in 8 classroom sessions of 60 minutes each or in four 2-hour sessions. In community settings, it can be implemented in a 2-day format (four modules each day), 4-day format (two modules each day) or 8-day format (one module each day).
The School Edition of the curriculum has 8 hours and 40 minutes worth of content divided into thirteen 40-minute modules. It can be implemented in thirteen sessions of 40 minutes each, as laid out in the facilitator curriculum, or in whatever format is conducive for the needs of the site. The modules must be implemented consecutively.
Core intervention materials include:
The Making a Difference! implementation set for both editions includes the facilitator's guide, activity set, a classroom set of 30 student workbooks and 3 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.
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 a Difference! 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 a Difference! 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 a Difference! 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.
Research shows that curricula are most effective if they are based on a sound theoretical framework. The Making A Difference! curriculum draws upon three theories: 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 included in these theories:
Beliefs are critically important to behavior change. The Making A Difference! curriculum addresses each of the principles, usually in more than one activity.
The program logic model can be found here:
Logic Model (pdf)
In a 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, and 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 Social Cognitive Theory, including knowledge, beliefs, norms, intentions and self-efficacy regarding abstinence and condom use.
The participants who received the Making a Difference! abstinence curriculum were less likely to report having sexual intercourse in the 3 months after the intervention than were control-group participants.
The curriculum delayed sexual experience among virgins. Among the participants who reported no previous sexual experience at the baseline, the students who received Making a Difference! were less likely to report having sexual intercourse at the 3-month follow-up than those in the control group.
The study found that the adult and peer facilitators were equally effective. There were no differences in the intervention’s effects on behavior when adult facilitators were compared to peer co-facilitators.
The adolescents who received Making a Difference! believed more strongly that practicing abstinence would prevent pregnancy and HIV, expressed less favorable attitudes toward sexual intercourse, and reported weaker intentions of having sexual intercourse over the next 3 months than did those in the control group or the safer sex group. Adolescents who received Making A Difference! also believed more strongly that practicing abstinence would help them achieve their career goals than did those in the control group.
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.
For answers to Frequently Asked Questions about program adaptations, please visit our Program Support Help Desk.
Read ETR's Adaptations Policy.
Click the link below for the logs for Making a Difference! 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.
Note: The pre/post test for Making a Difference was used in the study in which the comprehensive Making Proud Choices program was also studied. Therefore, the survey includes questions about condoms and condom use. Abstinence-only sites may want to edit this survey before using it for their programs.
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.
All trainings align with ETR’s distributive learning process, an interactive experience that takes place over time. Core to this research-based approach is the acquisition of knowledge and development of skills, followed by the implementation of the program and educator self-reflection. During this process, ETR trainers engage learners through teaching strategies, interactive activities, modeling and follow-up support.
All of the following components are critical for skill development and implementation success. Make sure you can commit about 10 hours of total time to the training experience for program excellence!
Educators will have the knowledge, skills and confidence to effectively implement the program with youth.