Many HIV prevention funding agencies require the use of evidence-based behavioral interventions (EBIs) previously shown to be effective through rigorous outcome evaluation. Often, the implementing agency's setting or target population is different than those in the original implementation and evaluation. The Centers for Disease Control and Prevention Division of HIV/AIDS Prevention, in collaboration with internal and external partners, developed draft guidance to adapt an EBI to fit the cultural context, risk determinants, risk behaviors, and unique circumstances of the agency without competing with or contradicting the core elements and internal logic. The guidance described in this article provides a systematic approach to help agencies identify the most appropriate intervention for their target population and agency capacity, monitor the process, and evaluate the outcomes of the adapted intervention. This guidance, currently being piloted with five community-based organizations, will be revised and disseminated at the conclusion of project activities.

OBJECTIVES. Adolescents are increasingly at risk for infection with human immunodeficiency virus (HIV) and other sexually transmitted diseases, especially in poor urban minority communities. To aid the design of interventions in these communities, this study investigated the role of knowledge, attitudes, perceived parental monitoring, and peer behavior in the onset and progression of sexual behavior in children at risk for exposure to HIV. METHODS. A computerized personal interview was administered to 300 African-American 9- to 15-year-old children living in six public housing developments in a large US city. RESULTS. Although children's knowledge about the hazards of sex increased with age, their sexual activity also increased (from 12% sexually experienced at 9 years of age to more than 80% experienced at 15 years of age). Parental monitoring appeared able to influence sexual activity. However, the perceived behavior of friends was associated with the rate at which sexual activity progressed with age and the degree to which condom use was maintained with age. CONCLUSIONS. The early onset and prevalence of sexual behavior and the importance of peer group influence call for early interventions that simultaneously influence the parents and peers in children's social networks.

Based on these findings, group-based comprehensive risk reduction was found to be an effective strategy to reduce adolescent pregnancy, HIV, and STIs. No conclusions could be drawn on the effectiveness of group-based abstinence education.

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ABSTRACT. Objective. To determine whether the addition of a parental monitoring intervention (Informed Parents and Children Together [ImPACT]) alone or with "boosters" could enhance (either broaden or sustain or both) the effect of a small group, face-to-face adolescent risk reduction intervention Focus on Kids (FOK).Methods. A longitudinal, randomized, communitybased cohort study was conducted of 35 low-income, community-based, in-town settings. A total of 817 black youths aged 12 to 16 years at baseline were studied. After completion of baseline measures, youths were randomized to receive a face-to-face intervention alone (FOK only), a face-to-face intervention and a parental monitoring intervention (FOK plus ImPACT), or both of the above plus boosters (FOK plus ImPACT plus boosters). Risk and protective behaviors were assessed at 6 and 12 months after intervention.Results. At 6 months' follow-up, youths in families that were assigned to FOK plus ImPACT reported significantly lower rates of sexual intercourse, sex without a condom, alcohol use, and cigarette use and marginally lower rates of "risky sexual behavior" compared with youths in families that were assigned to FOK only. At 12 months after intervention, rates of alcohol and marijuana use were significantly lower and cigarette use and overall risk intention were marginally lower among FOK plus ImPACT youths compared with FOK only youths. With regard to the boosters delivered at 7 and 10 months, 2 risk behaviors-use of crack/cocaine and drug selling-were significantly lower among the youths who were assigned to receive the additional boosters compared with youths without the boosters. The rates of the other risk behaviors and intentions did not differ significantly.Conclusions. The results of this randomized, controlled trial indicate that the inclusion of a parental monitoring intervention affords additional protection from involvement in adolescent risk behaviors 6 and 12 months later compared with the provision of an intervention that targets adolescents only. At the same time, the results of the present study do not provide sufficient evidence that booster sessions further improve targeted behaviors enough to include them in a combined parent and youth intervention. Pediatrics 2003;111:e32-e38. URL: http://www.pediatrics.org/cgi/content/full/111/1/e32; adolescents, parenting, HIV, risk behavior.

Background: African American adolescents living in high-poverty urban settings are at increased risk for early sexual initiation and sexually transmitted diseases. Objective: To determine whether parental stategies to monitor their children's social behavior and to communicate with them about sexual risks help to reduce the initiation of risky sexual behavior and prevent the resulting adverse health outcomes. Methods: To assess the viability of these strategies, we surveyed a stratified cross-section of African American children aged 9 to 17 years (N = 355) living in urban public housing. Talking computers were used to increase the confidentiality and comparability of the interviews across the wide age range. Results: Children who reported high levels of parental monitoring were less likely to report initiating sex in preadolescence (aged Յ10 years) and reported lower rates of sexual initiation as they aged. Children who reported receiving both greater monitoring and communication concerning sexual risks were also less likely to have engaged in anal sex. Communication was also positively related to the initiation of condom use and consistent condom use. The protective correlates of these parenting strategies were independent of the type of guardian (mother vs other family member). Conclusion: Interventions with parents and other guardians to increase monitoring and communication about sexual risks seem to be promising healthpromotion strategies for adolescents in high-risk settings.