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ƏT7 kwIx1/0_"'G+WH,PlD~FÛhsJ"&tq)*~|u)11ܹL;ɘc~̓9P.%&#\yc9:i5T}ty} 1oT}q&??yMM/!OroM'j{:pm=m{G}r'u&YH7keBYڀ(c~G9s2=~'YȄ\A]eli _嗐ip_chQ,Pa?oͥI@ďO4U7ʭI~żOjx- 5^S1+sDhy.%{3 N 1'XT1ߣD/q3qm{9?e/[nkg%Og%*>TŜ>DSk_§h*~Pt:[utGMF?@A/$"$LQ;Y_Y% <2R$wpznC [2R$(,޿[t*F*gk$$$$"$! v?Vd§BwL:"$@O| 9, "$/!(UnL5  "0e0e    A A 8c8c     ?1 d0u@T NP'p<'pA)BCD|E|| "0e@     @ABC DEEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abN E5%  N E5%  N F   5%    !"?N@ABC DEFFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `ab (Lj333}&> 33@8  F FlO ʚ;Sk8ʚ;g4ldldŒx: 0ppp@ <4dddd@ 0tt<4!d!d@ 0tt<4dddd@ 0tt.9___PPT10 6z___PPT9\T   0  F`@0 0&_VD ? ,Op= \Douglas Kirby, Wayne State University, Sept 29PbSex & HIV Education Programs for Youth: Their Impact and Characteristics of Effective Programs &ca$3$8Douglas Kirby, Ph.D., ETR Associates September 29, 2006 &9833Based on The Report(xSex and HIV Education Programs: Their Impact and Important Characteristics By Douglas Kirby, B.A Laris, & Lori Rolleri 6Li-L-:L   UAvailable on the ETR website: http://www.etr.org/recapp/programs/ SexHIVedProgs.pdf f"7((5,&/Sex and HIV/AIDS programs have multiple goals:00(aDecrease unintended pregnancy Decrease STD including HIV/AIDS Improve sexual health in other ways b P2bStudy Criteria(Programs: Targeted young people up to age 25 Were curriculum-based with structured activities involving groups of youth (not one-on-one interaction) Were implemented in schools or community settings Were implemented anywhere in the worldJ pi#0i  Studies: Employed experimental or quasi-experimental design Had a sample size of 100 or larger Measured impact on initiation of sex for at least 6 months and other behaviors for at least 3 months Were published in 1990 or later8 ss Potential BiasesMany tests of significance Multiple groups Multiple measures Multiple time periods Solutions Counteracting bias Insufficient power L88PThe Number of Programs with Indicated Effects on Sexual Behaviors (N=84 Studies)"QB$AThe Number of Programs with Indicated Effects on Sexual BehaviorsBB$BThe Number of Programs with Indicated Effects on Sexual Behaviors "CA$ IThe Number and Percent of Programs with Indicated Effects on Any Behavior.J=$$ $ DConclusions about the Impact of Sex/HIV Education Programs continued.E:$ :Sex/HIV education programs Do not increase sexual activity Some sex/HIV education programs: Delay initiation of intercourse Reduce number of sexual partners or Increase use of condoms/contraception Some do all three Emphases upon abstinence, fewer partners and condoms/contraception are compatible, not conflictingi KP!ijKP0ic0d !ju DConclusions about the Impact of Sex/HIV Education Programs continued.E:$ [Programs are quite robust; they are effective with multiple groups: Males and females All major ethnic groups in U.S. Sexually experienced and inexperienced Youth in advantaged and disadvantaged communities Programs may be especially effective: With higher risk youth in disadvantaged communities In communities where they address a salient issueDiPPP&ifKPD3&f DConclusions about the Impact of Sex/HIV Education Programs continued.E:$ ySex/HIV education programs: Are not a complete solution Can be an effective component in a more comprehensive initiative HP^\     ! -Replications of Studies: Reducing the Risk".  California schools: 16 sessions Delayed sex; increased contraceptive use Arkansas schools: 16 sessions Delayed sex; increased condom use Kentucky schools: 16 sessions Delayed sex; no impact on condom use Kentucky schools: 12 sessions Delayed sex; no impact on condom use!)P"P%P%P!)"%  %"4Replications of Studies: Be Proud, Be Responsible"5   Philadelphia: 5 hours on Saturdays Reduced sex & # partners; increased condom use Philadelphia: 8 hours on Saturdays Reduced freq of sex; increased condom use 86 CBO in northeast: 8 hours on Saturdays Increased condom use Philadelphia: 8 hours on Saturdays Reduced sex & # partners; increased condom use Cleveland: 8 sessions in school Deleted one condom activity No significant effects on any behavior'i/PP'i*PP.iPP'i/PP$iCPP3$/'*.'  /  C#7Replications of Studies: Becoming a Responsible Teen"8    Jackson, Miss health center: 12 90-minute sessions Delayed sex; reduced frequency; increased condom use Residential drug treatment: 12 90-minute sessions Reduced sex & # partners; increased condom use Juvenile reformatory: 6 1-hour sessions No effects85P7/P, P3557/  $)Replications of Studies: Focus on Kids"*   Baltimore recreation center: 8 sessions Increased condom use West Virginia rural areas: 8 90-minute sessions Deleted some condom activities No effects,P5*P3)5*%2Replications of Studies: Preliminary Conclusions33 GCurricula can remain effective when implemented with fidelity by others! Fidelity: All activities; similar structure Substantially shortening programs may reduce behavioral impact Deleting condom activities may reduce impact on condom use Moving from voluntary after-school format to school classroom may reduce effectiveness pIi-KP0i(ZI-&1st Policy Implication(Your most promising strategy: Implement programs with strong evidence that they were effective with populations similar to your ownFfh' What are they? 6663(Criteria for Strongest Evidence (A single study with a very rigorous experimental design demonstrating positive impact for at least one year OR Multiple studies with strong quasi-experimental designs demonstrating positive impact for at least one year lmsslsskpIU.S. Abstinence Only Curricula with Strong Evidence for Behavior ChangeJJ$  Making a Difference: Abstinence Only Not school-based Targeted African-American youth Delayed and reduced sex over two years *s0s(H0Z(PZ#3Y)>U.S. Sex Ed Curricula with Strong Evidence for Behavior Change??$5 Safer Choices: Preventing HIV, Other STD and Pregnancy School-based Delayed sex for Hispanics; increased condom & contraceptive use Reduced unprotected sex for 31 months or more Reducing the Risk: Building Skills to Prevent Pregnancy, STD & HIV School-based Delayed sex and increased contraceptive use :s{PZF0s(:PZPZ#3 ({30:*>U.S. Sex Ed Curricula with Strong Evidence for Behavior Change??$ Making Proud Choices: A Safer Sex Approach to STD, Teen Pregnancy and HIV/AIDS Prevention Not school-based Targeted African-American youth Increased condom use for one year \S P(@#3DS+@U.S. HIV/AIDS Curricula with Strong Evidence for Behavior ChangeAA$  Becoming a Responsible Teen: An HIV Risk Reduction Program for Adolescents Not school-based Targeted African-American youth Focused primarily on HIV/AIDS Increased abstinence, reduced the number of sexual partners, increased condom use and reduced unprotected sex MP (3.@U.S. HIV/AIDS Curricula with Strong Evidence for Behavior ChangeAA$ SIHLE: Sistas, Informing, Healing, Living, Empowering Not school-based Targeted African-American youth Focused primarily on HIV/AIDS Increased condom use for one year, decreased pregnancy rate for 6 months and decreased STD rates for one year:0K( P($3$$.$ -2nd Policy Implication0( ((Your second most promising strategy: Implement sex/HIV education programs with the common characteristics of those programs that were effective at changing behaviorH%~_!Uncovering the 17 Characteristics""(Identified 28 programs that had strongest evidence for positive behavior change Obtained 19 curricula for effective programs Conducted in-depth content analyses of these curricula XnQ - 7kV&Characteristics of Effective Curricula''(Three broad categories: Process of development Curriculum characteristics Overall design Activities and instructional methods Implementation 2n4n24   "Category 1: Process of Development##$Assessed relevant needs and assets of target group Used logic model approach Involved multiple people with different backgrounds to design curriculum$p" 3d<"Category 1: Process of Development##$Designed activities consistent with community values and resources available (staff time, staff skills, facility space, and supplies) Pilot-tested the program6p" 3d<M9Category 2: Curriculum Content(Focused on clear health goals - the prevention of STD/HIV and/or pregnancy Focused narrowly on specific behaviors leading to these health goals Addressed multiple sexual psychosocial risk and protective factors affecting sexual behaviors$p" 3Z<B Ms   Category 2: Curriculum Content(Created a safe social environment for youth to participate Included multiple activities to change each of the targeted risk and protective factors 6. Employed effective teaching methods bp" 3d<'p" 3d<s$f3  P   .Why are these important?(They can help people: Develop programs Assess and select programs Adapt and improve programs Implement programs successfully and with reasonable fidelity HeKOther Kinds of Programs<One-On-One Sex Education or Counseling in the Clinic Setting==(Clinics changed their protocols for working with adolescent clients Provided more than routine information Asked questions about adolescents sexual behavior and barriers to abstaining from sex or using protection Did role plays refusing sex or using condoms Gave a clear message about avoiding unprotected sex Multiple studies found a significant increase in condom or other contraceptive useBDPPSPDSImplications for Policy  Clinics should implement clinician-patient protocols found to be effective Youth-serving agencies should refer youth to health services with effective protocolsnYouth Development ProgramsSome youth development programs without a good sexuality education program did not reduce teen sexual risk-taking or pregnancy But some did9Youth Development Programs that May Reduce Teen Pregnancy::(Service Learning (Teen Outreach Program) Included: Volunteer service in community Small group discussions Reduced teen pregnancy during academic year students involvedT) 9>)$ 9>3Youth Development Programs that Reduced Sexual Risk 43( 0Aban Aya Intervention Grades 5-8 Focused on social competence skills to manage potential high risk situations Methods Randomized trial Effects Girls: No significant effects Boys: Reduced violent behavior, provoking behavior, school delinquency, drug use, recent sexual behavior and improved condom use Z ZXZZZZZ  X  $)Implications for Policy  Should recognize that some programs can reduce teen sexual risk-taking even though they do not focus upon sexual behavior Should not avoid programs that address sexual risk and protective factorsn RIntegrated Sex Education and Youth Development Programs that Reduce Teen PregnancySSRChildren s Aid Society Carrera Program Included many components (e.g., help with school, job club, sex education, health and mental health services, art and sports) Delayed initiation of sex and increased contraceptive use among females Reduced pregnancy by half for 3 years as reported by females$'ZZ* Implications for Policy  Should recognize that intensive, comprehensive, long-term programs that address both sexual and non-sexual risk and protective factors may have the largest long term impactn  Conclusions oSome sex and STD/HIV education programs and some clinic programs address sexual risk and protective factors and can delay sex or increase condom or contraceptive use Some youth development programs (e.g., service learning) address non-sexual risk and protective factors and can reduce adolescent pregnancy Some intensive and comprehensive programs (e.g.,the CAS-Carrera program) address both groups of factors and may have the greatest impact on teen pregnancy, STD and HIV/AIDS Most effective programs give a clear message about avoiding unprotected sex and involve youth interactively so that they personalize the messagepPZ(pjhN/4   P   0` ` ̙33` 333MMM` ff3333f` f` f` 3>?" dd@,?" d}@ 3"d (Lj" ___@"`" ___ n?" dd@   @@``PT $   @ ` `pH @`H @`L0 E(  c  0I "   Click to edit Master text styles Second level bullet text Third level bullet text Fourth level bullet text Fifth level bullet text *!   6I "  I T Click to edit Master title style! !  0 I "P I \*   0I "P  I ^*   0I "P I ^* ~  fA$޽h ?cloud_skipper_sld ̙33___PPT10i.Vk+D=' I= @B + :Training seminar presentationd  0L0 c[0(    6x "  T Click to edit Master title style! !  0x "P0   W#Click to edit Master subtitle style$ $  0Ȓ "P  \*   0_ "P   ^*   0f "P  ^* |  dA"޽h ?cloud_skipper_qx ̙33___PPT10i.Vk+D=' I= @B +@ 0 DP(  DB D 3 rlyǼyǼ1 ?"/   z*  a00aaD D 3 ryǼyǼ1 ?"3 /  |*  a00aar D c $ ?"  f D 3 r̿yǼyǼ1 ?"9 g  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     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