Safer choices 2: Rationale, design issues, and baseline results in evaluating school-based health promotion for alternative school students

Abstract

Background-Students attending 'alternative' high schools form relatively small, highly mobile high-risk populations, presenting challenges for the design and implementation of HIV-, other STI-, and pregnancy-prevention interventions. This paper describes the rationale, study design, and baseline results for the Safer Choices 2 program.Study Design-Modified group-randomized intervention trial with crossover of schools but not of students. The study cohort was defined a priori as those who completed the baseline measures and were still enrolled at the time of first follow-up.Design Results-Of 940 students initially enrolled in the study, 711 (76%) formed the study cohort. There were significant demographic differences between those included and those excluded from the study cohort in sex, age, sexual experience, experience with pregnancy, drug use, and some psychosocial measures. There were no significant differences between the intervention and control groups within the study cohort. The only significant difference between those students excluded from the intervention group and those excluded from the control group was reported age at first intercourse.Baseline Data Results-Students (n = 940) enrolled were predominately African-American (29.7%) and Hispanic (61.3%); 57.3% were female; 66% had ever had sex; and reported drug use in the previous 30 days ran from 4.3% (cocaine) to 26.9% (marijuana). Of the 627 sexually experienced, 41.8% reported their age at first intercourse as 13 years or younger; 28.5% reported ever being or having gotten someone pregnant; 74% reported sex in the past 3 months. Of the 464 sexually active in the last 3 months, 55.4% reported unprotected intercourse and 31.3% reported using drugs beforehand. Conclusion-The cross-over design will provide a rigorous test of the intervention; however, loss to follow-up of this population can result in some selection bias. Students attending dropout prevention and recovery schools are at high risk for HIV, STIs, and pregnancy, and are in need of interventions.

Circle of Life: Rationale, Design, and Baseline Results of an HIV Prevention Intervention Among Young American Indian Adolescents of the Northern Plains

“…These parents were likely to be those that worked in places requiring long-distance commutes or long hours, parents living in very remote or rural areas, those who were particularly uninvolved in their child’s school life, or parents who may have feared that abuse, neglect, or their own substance use patterns may come to light in the research process. However, our response rates were similar to those in other comparable studies (Ebreo et al 2002; Kirby et al 2004; O’Donnell et al 2002; Tortolero et al 2008). For example, Coyle and colleagues (2004), in a recent longitudinal study of a school-based sexual risk reduction intervention with ethnically diverse urban middle-school youth, reported 90% parent contact, 77% consent rate, and an overall youth response rate of 68%.…”

The effectiveness and cost-effectiveness of behavioural interventions for the prevention of sexually transmitted infections in young people aged 13–19: a systematic review and economic evaluation

“…As mentioned earlier in Chapter 4, Origin of the interventions, the results of an evaluation of an adaptation of Safer Choices in an 'alternative' school (for students with behavioural and social problems) are awaited (Tortolero and colleagues 86,87 ). It will be interesting to see whether the results are comparable with the original study.…”

“…for students with behavioural problems, truancy, poor educational attainment or pregnancy), has been conducted and results are awaited. 86,87 Another of the six replication projects is the West Virginia Focus on Kids (FoK) intervention by Stanton and colleagues 69 (included in our systematic review). This is an adaptation of the original FoK intervention, which was originally evaluated with urban, low-income, predominantly African-American young people in Baltimore, MD, USA.…”

The individual and contextual impact of a school-based exhibition for AIDS prevention: A mixed methodology approach

“…On the whole, this research reinforces the relevance of prevention efforts directed to adolescents, particularly if we recognize them as they are: a diverse and heterogeneous group, particularly sensitive to group contexts. 1,7,12,34 The way in which the project predisposed the participating schools to the topic, particularly by demonstrating the relevance of new methods -the use of prevention materials designed by adolescents themselves and the implication of participants in their discussion -is particularly revealing of the importance of the school as a health education context, 9,11,13,16,31 open to assume a particular responsibility in the promotion of adolescent health. Data from both the interviews and the focus groups also reveal that short-term interventions, in spite of their discontinuity, can persist beyond their conclusion by inspiring and reinforcing existing school efforts in this domain.…”

“…1 In Portugal, according to the 2010 Joint United Nations Programme on HIV/AIDS (UNAIDS) report, there were 42,000 people living with HIV in 2009 and the estimated rate for both young (15-24 years) men and women (0.3% and 0.2%, respectively) was higher than in most countries from Central and Western Europe. 2 Given its psychosocial characteristics, adolescence is not only a period of particular vulnerability for health risks, but also a time where healthy lifestyles might be promoted.…”