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Promoting Health Among Teens! (Comprehensive)

A 12-hour pregnancy prevention program to reduce risky sexual behavior for African American teens through various types of sex education, including HIV/sexually transmitted infections (STI) and pregnancy prevention, safer sex, and abstinence education.

Program Outcomes

  • HIV/AIDS
  • Sexual Risk Behaviors
  • STIs

Program Type

  • Cognitive-Behavioral Training
  • Skills Training

Program Setting

  • School
  • Community

Continuum of Intervention

  • Universal Prevention

Age

  • Early Adolescence (12-14) - Middle School

Gender

  • Both

Race/Ethnicity

  • African American

Endorsements

Blueprints: Promising

Program Information Contact

ETR
100 Enterprise Way. Suite G300
Scotts Valley, CA 95066
Tel: (800) 620-8884
Fax: (831) 438-4284
Main Website: etr.org
Program Website: pub.etr.org/ProductDetails.aspx

Program Developer/Owner

John B. Jemmott III
University of Pennsylvania, School of Medicine


Brief Description of the Program

The program is a 12-hour HIV/sexually transmitted infections (STI) and pregnancy-prevention intervention for African American teens that offers optional booster sessions and one-on-one meetings for up to two years following program completion. It aims to increase knowledge of HIV and STIs, strengthen behavioral beliefs supporting abstinence, strengthen behavioral beliefs supporting condom use, increase skills to negotiate abstinence, and increase skills to use condoms and negotiate condom use among 6th and 7th grade students.

Outcomes

Across the study period (Jemmott et al., 2010), compared to the control group, participants in the 12-hour comprehensive treatment group were significantly less likely to:

  • report having multiple sexual partners in the last three months

Brief Evaluation Methodology

The study (Jemmott et al., 2010) randomly assigned 662 African American 6th and 7th grade students recruited from 4 public middle schools in a northeastern US city. Participants randomly assigned to the 12-hour version of a comprehensive intervention including abstinence and safer sex (treatment group) were compared to participants randomly assigned to 8-hour abstinence only, 8-hour safer sex only (focusing on condom use), 8-hour version of the comprehensive intervention, and an 8-hour health promotion control group focusing on health behaviors unrelated to sexual contact. In addition, students in each intervention were randomly assigned to a maintenance program. The primary measure was a self-report of sexual contact, and secondary measures addressed other sexual behaviors such as multiple partners, unprotected intercourse, and consistent condom use. Participants completed pretest, posttest, and 3-, 6-, 12-, 18-, and 24-month follow-up questionnaires.

Study 1

Jemmott, J. B., Jemmott, L. S., & Fong, G. T. (2010). Efficacy of a theory-based abstinence-only intervention over 24 months: A randomized controlled trial with young adolescents. Archives of Pediatric and Adolescent Medicine, 164, 152-159.


Protective Factors

Individual: Problem solving skills, Refusal skills


* Risk/Protective Factor was significantly impacted by the program

See also: Promoting Health Among Teens! (Comprehensive) Logic Model (PDF)

Race/Ethnicity Specific Findings
  • African American
Race/Ethnicity/Gender Details
Jemmott et al. (2010) included only African American students and did not disaggregate results by gender.

For information about ETR's distributive learning process please see: http://www.etr.org/ebi/training-ta/professional-learning-services/

Training is two days. Participants are required to have the basic set materials for the program. The PHAT-COMP cost per participant is $1,654 ($975 for training + $679 for facilitator guide and initial set of student workbooks). These costs do not include participant travel or lodging (if they come to a scheduled regional training). If an ETR trainer comes to the site for the training, the agency will need to pay trainer travel and lodging expenses.

All ETR trainings include the research based elements of pre-assessment, pre-work, skills development (including practice in facilitating specific curriculum elements), and follow-up support.

More information can also be found at: http://www.etr.org/solutions/professional-development/

Training Certification Process

ETR offers Training of Trainers sessions for seasoned program facilitators that will qualify them to train other educators in delivery of the program. Regional TOT sessions, in which participants provide their own transportation costs, average $2500 per participant.

Source: Washington State Institute for Public Policy
All benefit-cost ratios are the most recent estimates published by The Washington State Institute for Public Policy for Blueprint programs implemented in Washington State. These ratios are based on a) meta-analysis estimates of effect size and b) monetized benefits and calculated costs for programs as delivered in the State of Washington. Caution is recommended in applying these estimates of the benefit-cost ratio to any other state or local area. They are provided as an illustration of the benefit-cost ratio found in one specific state. When feasible, local costs and monetized benefits should be used to calculate expected local benefit-cost ratios. The formula for this calculation can be found on the WSIPP website.

Start-Up Costs

Initial Training and Technical Assistance

ETR recommends that facilitators receive research-based professional development to prepare them to effectively implement and replicate the curriculum with fidelity for the intended target group. Regional Training of Educators 2-day sessions, in which participants provide their own transportation costs, are $1654 per participant. The fee includes training ($975) and required materials for facilitation, the facilitator guide and student workbooks ($679). ETR also provides onsite training. Implementing agencies are encouraged to submit a Training & TA Request Form for information on pricing: http://www.etr.org/solutions/professional-development/training-ta-request-form/

Curriculum and Materials

ETR provides a budget calculator on its Program Success Center website page for each program: http://www.etr.org/ebi/programs/promoting-health-among-teens-abstinence-only/

A curriculum set for a single classroom (1 facilitator guide and 30 student workbooks) costs $679 and is included in the initial training expense. Additional student workbooks average $3 each.

Licensing

None.

Other Start-Up Costs

It is important to plan for a sufficient number of facilitators to keep the youth groups small and interactive. One facilitator for every 12 youth is the recommended maximum.

Space for program delivery must also be considered. If an agency cannot provide space in its own facility or use other donated space, rental fees may be necessary.

Intervention Implementation Costs

Ongoing Curriculum and Materials

Once all facilitators have their manuals, the only ongoing curriculum costs are the student workbooks. These can be purchased in sets of 5 ($15) or 30 ($90). Bulk discounts can be negotiated with the publisher.

Staffing

Qualifications: There are no specific qualifications required for facilitators. Facilitators are typically youth development workers, school counselors or health educators with a minimum four-year college degree.

Ratios: One facilitator delivers the program to 12 youth.

Time to Deliver Intervention: The program includes twelve one-hour modules which are typically delivered in three sessions.

Other Implementation Costs

No information is available

Implementation Support and Fidelity Monitoring Costs

Ongoing Training and Technical Assistance

ETR offers Training of Trainers sessions for seasoned program facilitators that will qualify them to train other educators in delivery of the program. Regional TOT sessions, in which participants provide their own transportation costs, average $2500 per participant.

ETR can provide technical assistance in various formats. Implementing agencies are encouraged to submit a Training & TA Request Form for information on pricing: http://www.etr.org/solutions/professional-development/training-ta-request-form/

Fidelity Monitoring and Evaluation

These will vary greatly by site, based on what kind of evaluation is desired/required.

Ongoing License Fees

None.

Other Implementation Support and Fidelity Monitoring Costs

No information is available

Other Cost Considerations

None.

Year One Cost Example

In this example, an agency sends one staff person to a Regional Training of Educators to be trained as a facilitator of the Promoting Health Among Teens-Comprehensive program. The facilitator delivers six rounds of the program during the first year to groups of 12 youth each.

Training + Facilitator Guide and Initial Set of Student Workbooks $1,654.00
Training Travel Expenses $1,000.00
Additional Student Workbooks (45) $135.00
Total One Year Cost $2,789.00

With one facilitator delivering 6 sessions to 12 youth each, the program would serve 72 youth in Year One and the cost per youth would be $39.

If an agency chooses to hire outside facilitators, additional expenses for salaries would need to be considered.

Funding Overview

PHAT-Comprehensive, as a health education program aimed at preventing HIV and other STDs and unwanted pregnancy, can be funded with prevention and health promotion dollars focused on high-risk adolescents.

Funding Strategies

Improving the Use of Existing Public Funds

To the extent that existing health education and pregnancy prevention programs are not evidence-based, a locality can consider re-directing funds targeted for health education and pregnancy prevention into PHAT-Comprehensive to get better outcomes.

Allocating State or Local General Funds

State and local health departments as well as city youth development and recreation offices may offer grants supporting pregnancy prevention and the reduction of sexually-transmitted disease.

Maximizing Federal Funds

Formula Funds:

  • The Personal Responsibility Education Program (PREP), administered by the Administration on Children, Youth, and Families (ACYF), provides $55 million annually by formula to states and territories for evidence-based programs that educate adolescents on both abstinence and contraception to prevent pregnancy and sexually transmitted infections.
  • Temporary Assistance to Needy Families (TANF) is a formula grant that states use to provide cash assistance and work supports to needy families. One of the four stated purposes of TANF funding is to prevent and reduce out-of-wedlock pregnancies and many states have used TANF to support pregnancy prevention programs.
  • The Social Services Block Grant Program (SSBG) provides states very flexible dollars to fund a variety of social service programs. State social service agencies may allocate some portion of these funds toward pregnancy programs.
  • The Community Development Block Grant (CDBG) program is administered from the federal Department of Housing and Urban Development to localities to support community economic development. Fifteen percent of these funds can be used to support a wide range of public services. Cities may choose to direct some portion of these funds to pregnancy prevention programs.

Discretionary Grants: Discretionary grants opportunities may be found under the CDC Office of Adolescent Health (OAH) grants, as well as the Administration for Children and Families, Family Youth Services Bureau (FYSB). OAH administers the Teen Pregnancy Prevention Program which supports replication of evidence-based TTP programs, of which PHAT-Comprehensive is one. The Prevention and Public Health Fund, created by the Affordable Care Act and administered by the Department of Health and Human Services (HHS) is also funding some community-based prevention programs. The Fund was originally funded with $15 billion over 10 years, but has undergone $5 billion in cuts since it was passed. HHS is continuing to administer remaining dollars in the fund to a wide variety of public health and prevention purposes.

Foundation Grants and Public-Private Partnerships

Foundations, particularly those interested in adolescent health and pregnancy prevention and evidence-based practices, can be considered for training and curriculum purchase dollars.

Debt Financing

No information is available

Generating New Revenue

No information is available

Data Sources

No information is available

Program Developer/Owner

John B. Jemmott IIIProfessorUniversity of Pennsylvania, School of MedicineDepartment of PsychiatryCenter for Health Behavior and Communication ResearchPhiladelphia, PA 19104-3309215-573-9366jjemmott@asc.upenn.edu

Program Outcomes

  • HIV/AIDS
  • Sexual Risk Behaviors
  • STIs

Program Specifics

Program Type

  • Cognitive-Behavioral Training
  • Skills Training

Program Setting

  • School
  • Community

Continuum of Intervention

  • Universal Prevention

Program Goals

A 12-hour pregnancy prevention program to reduce risky sexual behavior for African American teens through various types of sex education, including HIV/sexually transmitted infections (STI) and pregnancy prevention, safer sex, and abstinence education.

Population Demographics

The program targets African American 6th and 7th grade students living in urban settings.

Target Population

Age

  • Early Adolescence (12-14) - Middle School

Gender

  • Both

Race/Ethnicity

  • African American

Race/Ethnicity Specific Findings

  • African American

Race/Ethnicity/Gender Details

Jemmott et al. (2010) included only African American students and did not disaggregate results by gender.

Other Risk and Protective Factors

Goal-oriented behavior, problem-solving and negotiation skills, and resistance to peer pressure reduce risky sexual behaviors.

Risk/Protective Factor Domain

  • Individual

Risk/Protective Factors

Risk Factors

Protective Factors

Individual: Problem solving skills, Refusal skills


*Risk/Protective Factor was significantly impacted by the program

See also: Promoting Health Among Teens! (Comprehensive) Logic Model (PDF)

Brief Description of the Program

The program is a 12-hour HIV/sexually transmitted infections (STI) and pregnancy-prevention intervention for African American teens that offers optional booster sessions and one-on-one meetings for up to two years following program completion. It aims to increase knowledge of HIV and STIs, strengthen behavioral beliefs supporting abstinence, strengthen behavioral beliefs supporting condom use, increase skills to negotiate abstinence, and increase skills to use condoms and negotiate condom use among 6th and 7th grade students.

Description of the Program

The program is a 12-hour HIV/sexually transmitted infections (STI) and pregnancy-prevention intervention for African American teens that is delivered over 12 one-hour modules. In addition, there are optional booster sessions and one-on-one meetings for up to two years following program completion. It aims to increase knowledge of HIV and STIs, strengthen behavioral beliefs supporting abstinence, strengthen behavioral beliefs supporting condom use, increase skills to negotiate abstinence, and increase skills to use condoms and negotiate condom use among 6th and 7th grade students. Four hours of the curriculum are focused on the safer-sex content, four hours are focused on the abstinence content, and another four hours are devoted to general content applicable to both single-component interventions. Modules are delivered by trained facilitators and include brief group discussions, videos, games, brainstorming, experiential exercises, and skill-building activities.

Theoretical Rationale

The program draws upon: 1) social cognitive theory, 2) the theory of reasoned action, and 3) the theory of planned behavior. All three theories emphasize the importance of beliefs and considering whether a given behavior will have negative or positive consequences.

Theoretical Orientation

  • Cognitive Behavioral

Brief Evaluation Methodology

The study (Jemmott et al., 2010) randomly assigned 662 African American 6th and 7th grade students recruited from 4 public middle schools in a northeastern US city. Participants randomly assigned to the 12-hour version of a comprehensive intervention including abstinence and safer sex (treatment group) were compared to participants randomly assigned to 8-hour abstinence only, 8-hour safer sex only (focusing on condom use), 8-hour version of the comprehensive intervention, and an 8-hour health promotion control group focusing on health behaviors unrelated to sexual contact. In addition, students in each intervention were randomly assigned to a maintenance program. The primary measure was a self-report of sexual contact, and secondary measures addressed other sexual behaviors such as multiple partners, unprotected intercourse, and consistent condom use. Participants completed pretest, posttest, and 3-, 6-, 12-, 18-, and 24-month follow-up questionnaires.

Outcomes (Brief, over all studies)

Across the study period (Jemmott et al. 2010), participants in the 12-hour comprehensive treatment group were significantly less likely to report multiple recent sexual partners as compared to participants in the control group.

Outcomes

Across the study period (Jemmott et al., 2010), compared to the control group, participants in the 12-hour comprehensive treatment group were significantly less likely to:

  • report having multiple sexual partners in the last three months

Mediating Effects

Jemmott et al. (2010) did not conduct a formal mediator analysis.

Effect Size

Jemmott et al. (2010) reported a small effect size (risk ratio of .95).

Generalizability

The study (Jemmott et al., 2010) was conducted at 4 public middle schools in one city with mostly African-American students.

Potential Limitations

Jemmott et al. (2010)

  • Long-term effects were hard to determine because of the maintenence sessions provided to roughly half the sample

Notes

Promoting Health Among Teens! - Abstinence-Only (PHAT - Abstinence), an 8-hour abstinence-based intervention that was also reported by Jemmott et al. (2010), is included as a separate write-up.

Endorsements

Blueprints: Promising

Program Information Contact

ETR
100 Enterprise Way. Suite G300
Scotts Valley, CA 95066
Tel: (800) 620-8884
Fax: (831) 438-4284
Main Website: etr.org
Program Website: pub.etr.org/ProductDetails.aspx

References

Study 1

Certified Jemmott, J. B., Jemmott, L. S., & Fong, G. T. (2010). Efficacy of a theory-based abstinence-only intervention over 24 months: A randomized controlled trial with young adolescents. Archives of Pediatric and Adolescent Medicine, 164, 152-159.

Study 1

Evaluation Methodology

Design:

Recruitment: The study made announcements in assemblies, classrooms, and lunchrooms and sent letters to parents or guardians in 4 middle schools in a northeastern city in the U.S. African American students in the 6th and 7th grades who volunteered and had written parent or guardian consent were included in the study (which resulted in 86.9% of those eligible).

Assignment: A total of 662 students were randomly assigned to one of the 5 conditions: 12-hour version of a comprehensive intervention including abstinence and safer sex (n = 131), 8-hour version of the comprehensive program (n = 134), 8-hour abstinence only (n = 134), 8-hour safer sex only (focusing on condom use; n = 129), and an 8-hour health promotion control group focusing on health behaviors unrelated to sexual contact (n = 134). In addition, 315 students (48% of the baseline sample) were randomly assigned to an intervention maintenance group for up to 21 months following program completion.

Attrition: Participants completed pretest, posttest, and 3-, 6-, 12-, 18-, and 24-month follow-up questionnaires from 2001-2004. There were 559 students (84% of the baseline sample) that completed the 24-month follow-up . According to follow-up with the authors, there were no differences by condition in the attrition rates.

Sample: About 53.5% of participants were female; ages ranged from 10-15 years with a mean of 12.2 years. Approximately 23.4% of the sample reported sexual initiation before the baseline measure.

Measures: For the primary outcome of sexual initiation, the study included a self-report of ever having had sex. In addition, the study used self-reports of sex behaviors in the past 3 months, including sexual intercourse, multiple partners, unprotected intercourse, and consistent condom use. Trained data collectors were blind to participant assignment, and special efforts were made to obtain honest answers from students (including adding a social desirability scale that was found to have no association with the outcomes).

Analysis: The study tested the report of ever having sexual intercourse using generalized linear regression with a log link. The study used either the Bernoulli or Poisson error distribution depending on whether predicted probabilities violated the 0,1 range of probability. The other measures were analyzed using Poisson generalized estimating equations with a log link. Analyses on ever having sexual intercourse excluded participants who reported having sexual intercourse at baseline. Analyses controlled for baseline outcome measures, time, condition, gender, and age where possible. The study conducted a 24-month follow-up, but did not report significance of results at each assessment point. Instead, the data were averaged over the entire period of the study, including the long-term follow-up.

Intent-to-Treat: The study used an intent-to-treat approach in which participants' data were analyzed regardless of the number of intervention or data collection sessions they attended. About 98% of those randomized were included in the analysis.

Outcomes

Implementation Fidelity: The study stated that the modules were highly structured and facilitators used an intervention manual, however no quantitative measures of fidelity were reported. Attendance was high for the 3 sessions comprising the 12-hour program (at least 95%).

Baseline Equivalence: The study did not report significance tests of differences between conditions at baseline. However, this information was requested and obtained from the program developers, and their table showed only 1 of 9 significant differences between the conditions at baseline (condom use in the past 3 months).

Differential Attrition: The study reported that there was no significant difference in attrition between conditions and that attending a follow-up session was "unrelated to gender, age, living with both parents, and sexual behavior outcomes." Other tests of differential attrition were not reported.

Posttest: Across the study period, the 12-hour comprehensive intervention had a significant effect on reducing multiple partners within the last three months but no effect on sexual initiation, recent sexual intercourse (i.e., sex within the last 3 months), consistent condom use, or unprotected intercourse.

Maintenance/booster sessions were provided to roughly half the sample within the 21 months following completion of the 12-hour curriculum. Being assigned to the maintenance sessions did not moderate the efficacy of the intervention in reducing most outcomes, but the 12-hour comprehensive initiative did more to reduce multiple partners when the maintenance component was added.

Long-Term: No long-term follow-up was reported.

Contact

Blueprints for Healthy Youth Development
University of Colorado Boulder
Institute of Behavioral Science
UCB 483, Boulder, CO 80309

Email: blueprints@colorado.edu

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Blueprints for Healthy Youth Development is
currently funded by Arnold Ventures (formerly the Laura and John Arnold Foundation) and historically has received funding from the Annie E. Casey Foundation and the Office of Juvenile Justice and Delinquency Prevention.