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Long-term Effects of a Middle School– and High School–Based Human Immunodeficiency Virus Sexual Risk Prevention Intervention
David M. Siegel, MD, MPH;
Marilyn J. Aten, PhD, RN;
Maisha Enaharo, MPH
Arch Pediatr Adolesc Med. 2001;155:1117-1126.
Objective To determine the longer-term effect (mean ± SD, 41.2 ±
15.3 weeks; range, 14.1-80.5 weeks) of a middle school (MS)– and high
school (HS)–based human immunodeficiency virus and sexuality intervention
(Rochester AIDS Prevention Project for Youth [RAPP]) on knowledge, self-efficacy,
behavior intention, and behaviors.
Design Quasi-experimental design with 3 intervention groups and 1 control group.
Setting Urban, predominantly ethnic, minority MS and HS health classes.
Participants Middle school and HS students (N = 4001) enrolled in health classes
in 10 schools. Fifty percent were African American; 16%, Hispanic; 20%, white;
and 14%, other. Less than 10% of the students refused participation.
Interventions There were 4 study conditions: (1) control, usual health education curriculum
taught by a classroom teacher; (2) RAPP adult health educator, intervention
curriculum implemented by highly trained health educators; (3) RAPP peer educator,
intervention implemented by extensively trained HS students; and (4) a comparison
of the RAPP intervention curriculum taught by regular health teachers, implemented
with MS students only.
Main Outcome Measure A confidential questionnaire was administered to all study subjects
before and at long-term follow-up after the intervention, containing scales
to measure knowledge, self-efficacy, behavior intention, and behaviors, including
onset of sexual intercourse experience and engagement in risky sexual behaviors.
Results Rates of baseline sexual activity in the sample were comparable to those
found in other urban school-based surveys. Long-term knowledge (MS females, P<.001; and MS males, P<.01)
and sexual self-efficacy (MS females, P<.05; and
HS females, P<.01) scores were higher among the
intervention groups (male and female are used in this study to describe those
aged 9 -23 years). Intention to remain safe regarding sexual behavior
was also greater among intervention groups in MS but not HS. However, subjects
who were already sexually active at pretest were less likely to show a positive
intervention effect. An intervention effect for the onset of intercourse and
risky sexual behavior was found most significantly among MS females.
Conclusions A positive long-term effect from the RAPP intervention was observed,
particularly for youth who were involved in less risk (eg, not yet sexually
active) at study enrollment. Thus, we propose that the most appropriate time
for intervention implementation is earlier in adolescence, before the onset
of risky behaviors.
From the Department of Pediatrics (Drs Siegel and Aten) and the School
of Nursing (Dr Aten), University of Rochester, and the Department of Pediatrics,
Rochester General Hospital (Dr Siegel and Ms Enaharo), Rochester, NY.
Corresponding author and reprints: David M. Siegel, MD, MPH, Department
of Pediatrics, Rochester General Hospital, 1425 Portland Ave, Rochester, NY
14621 (e-mail: david_siegel{at}urmc.rochester.edu).
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