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 (STIs), 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/STI prevention. 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.
|Original Program Features
Print or Digital
Print or Digital
English or Spanish
English or Spanish
|8 hrs/yr | 1 year
8 sessions total
|12.5 hrs/yr | 1 year
10 sessions total
|10 hrs/yr | 1 year
10 sessions total
Making Proud Choices! provides adolescents with the knowledge, confidence and skills necessary to reduce their risk of sexually transmitted infections (STIs), 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/STI prevention. The curriculum can be adapted to create a school version with 14 shorter modules that will 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 for the state of California that aligns with the requirements of the California Healthy Youth Act. Making Proud Choices! California Edition is on ACLU California's list of CHYA-compliant curricular materials and resources. For additional information and resources to support implementing and meeting the requirements of the California Healthy Youth Act, California's sexual health education law (2016), visit the California Department of Education's website or the ACLU's CHYA Resources page.
To reduce STI 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 STIs. Specifically, this curriculum emphasizes that adolescents can reduce their risk for STIs, 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 STIs 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, STI and teen pregnancy, however, if they choose to have sex, they must use a condom).
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 STIs, 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 STIs. 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 STI 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 original 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).
Adaptations can be made to create a school version with shorter sessions to meet a classroom schedule. 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.
The California Edition has 10 hours of content divided into nine 60-minute modules and a 60-minute pre-module on healthy realtionships and sexual identity to be taught before the evidence-based program modules begin. It also includes additional content on affirmative consent, dating violence and sexual exploitation, and was designed to meet the requirements of the California Healthy Youth Act. It also can be adapted into a school version by agencies and schools that wish to provide additional comprehensive sexual health education content to the youth they serve.
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 or internet access for showing the videos online.
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 original 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:
To provide evidence of the effectiveness of MPC as implemented with youth today, the Office of Population Affairs commissioned a rigorous national evaluation of the program. The report from this study was released in May 2022. The school-based version of the program tested in this evaluation included fourteen 40-minute lessons.
This recent evaluation used a cluster randomized controlled trial design to assess MPC’s effectiveness. High schools within selected cities were randomly assigned to one of two conditions: (1) MPC implemented by trained health educators or (2) business as usual. Before random assignment, each school was able to select the classroom setting for the study (where MPC would be delivered were the schools randomized to receive it, or where business-as-usual programming would occur); schools most often targeted health classes. The study took place in 15 schools across four cities where the teen birth rate and/or STI rate was markedly higher than the national average, and schools were re-randomized to condition up to three times, depending on how many years the school participated. Altogether, the study included 31 randomized clusters and more than 2,800 youth, most of whom were in 9th and 10th grades.
The evaluation relied on self-reported youth survey data and qualitative and quantitative implementation data. Youth in the study completed a baseline survey administered before programming began and a follow-up outcome survey administered approximately 6 months after the end of programming, 9 months after baseline, on average. The surveys included adapted versions of items previously used in the random assignment evaluation of MPC and other survey items adapted from similar federal evaluations or developed for the study. The surveys measured antecedents to sexual behavior (risk and protective factors), sexual behaviors, and MPC’s health goals (prevention of STIs and teen pregnancies). Program implementation data came from fidelity and attendance logs, observations, interviews, study youth focus groups, staff surveys, and technical assistance logs.
The survey and implementation data suggested a strong difference in experiences across the two conditions examined in this study. A combination of qualitative and quantitative implementation data suggest that health educators delivered the program as intended with high quality, and that the majority of youth received a large dose of the program. In addition, youth in the control group reported receiving far less information about teen pregnancy prevention and sexual health during classes and interactions with reproductive health care providers than youth in the MPC group.
The evaluation showed several large, statistically significant, and favorable impacts on nearly all of the risk and protective factors for risky sexual behavior—the outcomes most proximal to the content of MPC. The MPC program significantly improved knowledge of HIV/STIs, pregnancy, condoms, and other contraceptives; attitudes and beliefs about condoms; and self-efficacy in using condoms, negotiating condom use, and refusing sex.
Among the ten outcomes that measured sexual behaviors (for example, sexual initiation, sex without a condom) and MPC health goals (that is, pregnancy and STI prevention), the study observed one statistically significant impact: the MPC group reported significantly fewer episodes of sex in the past 3 months relative to the control group. The magnitude of the impact estimates for other behavioral and MPC health goal outcomes were small and nonsignificant, but the direction of most findings suggested a favorable effect of MPC. This current study provides evidence to suggest that as implemented today, MPC should continue to be considered an evidence-based program that favorably affects behavioral outcomes.
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.
Cole, R., Schulte Neelan, T., Langan, A., Keating, B., Walzer, J., Asheer, S., & Zief, S. (2022). The impact of the Making Proud Choices! teen pregnancy prevention curriculum. Washington, DC: Office of Population Affairs, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services.
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 managers/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.
ETR has developed the following tools to facilitate implementation of the curriculum, particularly in virtual settings:
Click HERE to request access to the online implementation tools.
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.
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.