Promoting Health Among Teens! Abstinence-Only Intervention

Program Overview

Developer(s)

Loretta Sweet Jemmott, Ph.D., R.N., F.A.A.N., John B. Jemmott III, Ph.D., and Konstance McCaffree, Ph.D.

Program Summary

Promoting Health Among Teens! Abstinence-Only (PHAT-AO) is an eight hour abstinence-only HIV/STD- and pregnancy-prevention intervention for adolescents. The interactive and student-centric curriculum is designed to teach participants about puberty, HIV/STDs, and pregnancy prevention, and building refusal and negotiation skills, with a focus on abstinence as the best method for avoiding infection and pregnancy.  

Target Population

The program was designed for and evaluated with African American youth ages 11 to 14 in urban school settings. It has been adapted for use with other racial/ethnic populations and older youth up to age 18, and has also been evaluated with 6th and 7th grade Latino youth.

Program Setting

The program was designed for various community settings for small groups of youth in an urban setting (although it can be adapted for larger groups and non-urban settings). It was evaluated in after-school, community-based settings.

Contact and Availability Information

For curriculum, materials, and pricing information, please contact:

Nancy Gonzalez-Caro, MPH
Evidence-Based Product Specialist
ETR
100 Enterprise Way, Suite G300
Scotts Valley, CA 95066
Phone: 1-800-321-4407
Website: http://www.etr.org/ebi/programs/promoting-health-among-teens-abstinence-only/

For training and support, please contact:

Cody Sigel, MPH, CHES
Health Education Training Coordinator
ETR
1333 Broadway, Suite P110
Oakland, CA 94612
Phone: 510-858-0995
Website: http://www.etr.org/ebi/programs/promoting-health-among-teens-abstinence-only/

Sample of curriculum available for review prior to purchase: Yes

Adaptation guidelines or kit available: No

Languages available: English

Program Components

Program Objectives

PHAT-AO seeks to reduce HIV/STD infection and pregnancy risk behaviors among adolescents by teaching participants correct information about puberty, HIV/STDs, and abstinence-only strategies. Participants are taught that abstinence is a positive choice and is the best strategy to avoid pregnancy and HIV/STDs. The program aims to help participants build negotiation, refusal, and problem solving skills for practicing abstinence.

Program Content

PHAT-AO is based on Social-Cognitive Theory, the Theory of Reasoned Action, and the Theory of Planned Behavior. The program's core components consist of eight modules that cover general information about puberty, sex, the consequences of sex, abstinence, the benefits of abstinence, as well as specific negotiation and refusal skill-building strategies to practice abstinence.

  • Module 1: “Getting to Know You and Steps to Making Your Dreams and Goals Come True” provides an introduction to the curriculum, sets up the theme of proud and responsible behavior, and asks participants to identify short-term and long-term goals and dreams.
  • Module 2: “Puberty and Adolescent Sexuality” provides an overview of reproductive anatomy, discusses messages about sex, discusses how people express themselves sexually, and the benefits of abstinence.
  • Module 3: “Making Abstinence Work for Me” includes activities that explore attitudes toward abstinence and problem solving skills to address partner pressure.
  • Module 4: “The Consequences of Sex: HIV/AIDS” consists of information on HIV etiology, transmission and prevention. At the end of this session, participants are given a homework assignment where they are to discuss the first four modules with a trusted adult.
  • Module 5: “The Consequences of Sex: STD Infection” consists of a review of the homework assignment followed by activities that teach information about STD etiology, types, transmission and prevention.
  • Module 6: “The Consequences of Sex: Pregnancy” consists of activities that teach knowledge about pregnancy and prevention, as well as how to respond to peer pressure.
  • Module 7: “Improving Sexual Choices & Negotiation” consists of interactive activities that address participants’ problem-solving and negotiation skills.
  • Module 8: “Role Plays: Refusal and Negotiation Skills” has activities for participants to further practice refusal and address partner and peer pressure.

Program Methods

The program is delivered through group discussion, brainstorming, role play, videos/DVDs, modeling, practice, and homework.

Implementation Requirements and Guidance

Program Structure and Timeline

PHAT-AO consists of eight 1-hour modules delivered to groups of six to ten youth. The program can be delivered to larger groups as long as additional facilitators are used.

Staffing

Facilitators should be well-trained in the model and have experience working with teens and using participatory and interactive methods. The staffing model is flexible, but should consist of one facilitator for 8 to 10 youth and support staff to assist when implementing the program in larger class settings.   

Program Materials and Resources

ETR offers an Implementation Kit that includes the following resources:

  • Facilitator Curriculum 
  • Activity Set (hand-outs, role-plays, posters)
  • Four curriculum DVDs: Tanisha & Shay, The Subject Is: HIV (Abstinence-Only), The Subject Is: STDs (Abstinence-Only), The Subject Is: Puberty (Abstinence-Only)
  • Student workbooks (classroom set of 30)

The distributor also provides access to a table of contents and sample lesson on their website: http://www.etr.org/ebi/programs/promoting-health-among-teens-abstinence-only/   

Additional Needs for Implementation

The program requires the use of audiovisual equipment for viewing DVDs.

Fidelity

All curriculum modules are required and must be completed in order. Monitoring and evaluation tools, such as fidelity checklists to be completed by facilitators and a logic model, and additional adaptation guidance can be found on ETR’s Program Success Center website: http://www.etr.org/ebi/programs/promoting-health-among-teens-abstinence-only/

Training and Staff Support

Staff Training:

It is highly recommended that educators who plan to teach Promoting Health Among Teens! receive research-based professional development to prepare them to effectively implement and replicate the curriculum with fidelity for the intended target group.
Training on Promoting Health Among Teens! is available through ETR's Professional Learning Services. Visit http://www.etr.org/ebi/training-ta/types-of-services/training-of-educators/ for more information or submit a Training & TA Request Form (http://www.etr.org/solutions/professional-development/training-ta-request-form/).

Technical Assistance and Ongoing Support:

ETR provides in-person and web- or phone-based technical assistance before, during and/or after program implementation. TA is tailored to the needs of the site and is designed to support quality assurance, trouble-shoot adaptation issues, and boost implementation. Contact ETR’s Professional Learning Services through the Program Support Help Desk (https://programsupport.etr.org/) or visit http://www.etr.org/ebi/training-ta/.

Allowable Adaptations

The developer has noted several allowable adaptations:

  • The eight modules can be delivered in different ways (e.g. two modules per day for four days, one module per day for eight days). The entire intervention should be completed within two weeks.
  • The program can be used with youth older than 14, as long as the group sessions are separated by age.
  • Groups can be larger than 6 to 10 youth as long as additional facilitators are used.
  • Groups can be single gender or mixed gender.
  • Facilitators of different ethnic and professional backgrounds are appropriate, so long as the facilitators have strong facilitation skills and experience working with teens.
  • Peer educators are allowed, as long as they are paired with an adult.
  • If integrating the curriculum into the school classrooms and not having enough time to implement the program, providers should consider using the Promoting Health Among Teens! In School Curriculum version. It is divided into shorter sessions, but maintains the fidelity of the curriculum.
  • Teens of different racial and ethnic groups may participate.
  • Changing the names and settings of the situations in the role plays to reflect the culture of the participants is appropriate.

Implementation Readiness Assessment

The review team conducted an independent assessment of the program’s readiness for implementation. This assessment is based on the team’s review of available program materials and documents. The team also requested input from program developers and distributors about the availability of implementation materials and resources.

On the basis of this assessment, the team calculated an implementation readiness score comprised of three component scores: (1) curriculum and materials, (2) training and staff support, and (3) fidelity monitoring tools and resources. The component scores are combined into a total score, which ranges from 0 to 8, with higher scores indicating the programs most ready to implement.

Curriculum and Materials

Has defined curriculum with lesson plans and/or activities?Yes
Has defined core or required components?Yes
Has facilitator’s guide or instructions?Yes
Component Score3/3

Training and Staff Support

Formal pre-implementation training (by qualified trainers) available?Yes
Supplemental training or ongoing technical support available?Yes
Component Score2/2

Fidelity Monitoring Tools and Resources

Has defined logic model?Yes
Defines fidelity guidelines and benchmarks?Yes
Offers monitoring and evaluation tools?Yes
Component Score3/3

Total Implementation Readiness Score

8/8

Reviewed Studies

CitationHigh-Quality Randomized TrialModerate-Quality Randomized TrialModerate-Quality Quasi-experimentLow Study RatingDid Not Meet Eligibility Criteria

Jemmott et al. 2010

Yes    

Walker et al. 2016

Yes    

Notes

Some study entries may include more than one citation because each citation examines a different follow-up period from the same study sample, or because each citation examines a different set of outcome measures on the same study sample.

Study Characteristics

CitationSettingMajority Age GroupMajority Racial/Ethnic GroupGenderSample Size

Jemmott et al. 2010

After school/Community based13 or youngerAfrican AmericanBoth268

Walker et al. 2016

After school/Community based13 or youngerLatinoBoth1,319

Notes

Some study entries may include more than one citation because each citation examines a different follow-up period from the same study sample, or because each citation examines a different set of outcome measures on the same study sample.

Information on study characteristics is available only for studies that received a high or moderate rating. Read the description of the review process for more information on how these programs are identified.

Study Findings

Citation Sexual Activity Number of Sexual Partners Contraceptive Use STIs or HIV Pregnancy

Jemmott et al. 2010

Uniformly positive impacts across the outcomes examined in this domain Uniformly null impacts across the outcomes examined in this domain Uniformly null impacts across the outcomes examined in this domain

Walker et al. 2016

Uniformly null impacts across the outcomes examined in this domain
CitationDetails

Jemmott et al. 2010

The study evaluated the program with a randomized controlled trial involving middle school students in a low-income African American community in the northeastern United States. Adolescents participating in the study were randomly assigned to either a control group that received an 8-hour general health-promotion program, or to one of four treatment groups, each receiving one of the following interventions: (1) an 8-hour abstinence-only intervention; (2) an 8-hour safer sex-only intervention; (3) an 8-hour comprehensive abstinence and safer sex intervention; or (4) a 12-hour comprehensive abstinence and safer sex intervention. The study administered surveys immediately before the intervention (baseline) and at follows-ups conducted 3, 6, 12, 18, and 24 months after baseline. The effectiveness of each intervention was assessed relative to the control group.

The study found that averaged across the five follow-up periods, adolescents assigned to the PHAT-AO group were statistically significantly less likely than those in the control group to report having had sexual intercourse in the previous three months. In addition, adolescents assigned to the PHAT-AO group who were sexually inexperienced at baseline were statistically significantly less likely to report having initiated sexual intercourse. The study found no statistically significant program impacts on the likelihood of having multiple sexual partners or unprotected intercourse in the past three months.

The study also examined program impacts on consistency of condom use. Findings for this measure were not considered for the review because they did not meet the review evidence standards. Specifically, findings were reported only for subgroups of youth defined by sexual activity at follow up.

Walker et al. 2016

A more recent study by a separate group of researchers evaluated PHAT-AO using a randomized controlled trial that involved 1,319 adolescents attending 6th and 7th grades in public schools in Yonkers, New York. Adolescents participating in the study were randomly assigned either to a treatment group that received the 8-module PHAT-AO program or a control group that received a general health curriculum, the Promoting Health Among Teens! Health Intervention. Surveys were administered before random assignment (baseline), and again three, six, and 12 months after the end of the program.

At each of the three follow-ups, the study found no evidence of statistically significant program impacts on the likelihood of ever having sex among the subgroup of adolescents who were sexually inexperienced at baseline.

Notes

Some study entries may include more than one citation because each citation examines a different follow-up period from the same study sample, or because each citation examines a different set of outcome measures on the same study sample. A blank cell indicates the study did not examine any outcome measures within the particular outcome domain or the findings for the outcome measures within that domain did not meet the review evidence standards.

Information on evidence of effectiveness is available only for studies that received a high or moderate rating. Read the description of the review process for more information on how these programs are identified.