Schoolwide effects of a multicomponent HIV, STD, and pregnancy prevention program for high school students.

Few studies have tested schoolwide interventions to reduce sexual risk behavior, and none have demonstrated significant schoolwide effects. This study evaluates the schoolwide effects of Safer Choices, a multicomponent, behavioral theory-based HIV, STD, and pregnancy prevention program, on risk behavior, school climate, and psychosocial variables. Twenty urban high schools were randomized, and cross-sectional samples of classes were surveyed at baseline, the end of intervention (19 months after baseline), and 31 months afterbaseline. At 19 months, the program had a positive effect on the frequency of sex without a condom. At 31 months, students in Safer Choices schools reported having sexual intercourse without a condom with fewer partners. The program positively affected psychosocial variables and school climate for HIV/STD and pregnancy prevention. The program did not influence the prevalence of recent sexual intercourse. Schoolwide changes in condomuse demonstrated that aschool-based program can reduce the sexual risk behavior of adolescents.

Health-risk behaviors among middle school students in a large majority-minority school district.

Since 1991, the Centers for Disease Control and Prevention has administered the Youth Risk Behavior Survey (YRBS) biennially to representative samples of high school students. YRBS results indicate that health-risk behaviors often developed during middle school years. To date, few state and local education agencies have administered the YRBS-Middle School. This study measured prevalence of health-risk behaviors among middle school students in a large, majority-minority school district (n = 1,783). Results indicated that young adolescents (ages 11-14) are engaging in multiple health-risk behaviors. For example, 24.4% seriously considered committing suicide in the previous year, 53.3% had been in a physical fight, 50.2% ever drank alcohol, 17.9% ever used marijuana, and 13.4% had already had sex. Such behaviors potentially could lead to serious consequences related to their educational achievement and overall health status. Health-related policy and program applications are discussed.

Older boyfriends and girlfriends increase risk of sexual initiation in young adolescents.

PURPOSE: To explore the prevalence and impact of older boyfriends or girlfriends on sexual behavior in sixth graders (mean age 11.5 years). METHODS: Students in 19 ethnically diverse middle schools in an urban area were surveyed (n = 2829, response rate 68%). Instrument measured demographics, age of oldest boyfriend or girlfriend, unwanted sexual advances, peer norms, and sexual behavior. Students with older, same-age, or no boyfriend or girlfriend were compared on demographic and psychosocial variables using analysis of variance. Separate multivariate logistic regressions for both boys and girls were used to predict sexual behavior from demographics, psychosocial variables, and age categories of boyfriend or girlfriend. RESULTS: One-half of the respondents (56%) had never had a serious boyfriend or girlfriend, 35% reported that their oldest boyfriend or girlfriend was <2 years older than they, and 8.5% reported a partner > or =2 years older. Those reporting an older boyfriend or girlfriend were more likely to be Hispanic, were less acculturated, reported more unwanted sexual advances and more friends who were sexually active, and, among girls, were more likely to have experienced menarche. Overall, 4% of students reported ever having had sex. Students with an older boyfriend or girlfriend were over 30 times more likely than those with no boyfriend or girlfriend ever to have had sex (odds ratio = 33.8 for boys and 44.2 for girls). In the multivariate logistic regressions, peer norms about sexual behavior, having experienced unwanted sexual advances, and having a boyfriend or girlfriend were strongly associated with having had sex. CONCLUSIONS: Having an older boyfriend or girlfriend, although rare, is associated with early sexual onset and unwanted sexual activity in this population of sixth graders.

Psychosocial predictors of delay of first sexual intercourse by adolescents.

This investigation predicted adolescents' delay of intercourse onset from attitudes, social norms, and self-efficacy about refraining from sexual intercourse. Age, gender, ethnicity, and parental education were also examined as predictors and moderators of the relationships among the 3 psychosocial determinants and onset. The participants (N = 827), part of a cohort initially surveyed in the 9th grade, reported at baseline that they had never engaged in intercourse. The multivariable proportional hazards regression model suggested that adolescents with more positive attitudinal and normative beliefs, as well as those with a parent who graduated from college, were less likely to engage in intercourse in the follow-up period (up to approximately 2 years). Interventions that include an objective to delay onset may benefit from addressing psychosocial determinants, especially attitudes and norms about sexual intercourse.

PIP: This study predicted adolescent's delay of intercourse onset from attitudes, social norms, and self-efficacy about refraining from sexual intercourse. Age, gender, ethnicity, and parental education were also examined as predictors and moderators of the relationships among the three psychosocial determinants and onset. The longitudinal data for the study were obtained from 827 participants in the US who were part of a cohort initially surveyed in the 9th grade. These participants reported at baseline that they had never engaged in intercourse. Utilizing the multivariable proportional hazards regression model, findings suggested that adolescents with more positive attitudinal and normative beliefs were less likely to engage in intercourse in the follow-up period (up to approximately 2 years). This was also the case for those students with a parent who graduated from college. Attitudes and norms were the most robust predictors of intercourse. In addition, a relatively modest increase in either scale was predictive of a 30% reduction in the onset of future intercourse in the most conservative analytic model. Interventions that include an objective to delay onset may benefit from addressing psychosocial determinants, especially attitudes and norms about sexual intercourse.

Incentives and motivators in school-based hepatitis B vaccination programs.

During a school-based vaccination program, incentives and education were offered to help motivate students to participate. Each student at all schools in the program received scholastic credit for returning a signed form, material rewards for receiving each vaccine dose, and free attendance at a social event after completing the vaccine series. In two of four schools, classes received a reward if every student in the classroom returned a signed form within five days: in these schools, 91% and 98% of students returned signed forms within five days, compared to 82% and 85%, respectively, in the two schools without this peer incentive. Approximately half the students receiving the peer incentive reported that it played a motivating role, whereas 60% cited wanting to be protected. Few students named individual rewards as motivators. Although peer incentives appeared effective in encouraging some students to return parent consent or refusal forms, the desire to be protected may have been a stronger motivator.