EARLY EFFECTS OF A SCHOOL-BASED HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION AND SEXUAL RISK PREVENTION INTERVENTION

Objective: To determine the short-term effect of a middle and high sch ool-based human immunodeficiency virus and sexuality intervention (Roc hester AIDS Prevention Project for Youth [RAPP]) on knowledge, self-ef ficacy, and behavior intention. Design: Nonrandomized intervention stu dy with 2 intervention groups and 1 control group. Setting: Middle and high school health classes in an urban, predominantly minority school district. Participants: Middle and high school students (N = 3635) en rolled in health classes in 9 schools; 50% African American, 16% Hispa nic, 20% white, and 14% other. Less than 10% of students refused parti cipation. Intervention: There were 3 study conditions: (1) Control, us ual health education curriculum taught by classroom teacher; (2) RAPP adult health educator, intervention curriculum implemented by ethnical ly diverse male-female pairs of highly trained health educators; and ( 3) RAPP peer educator, intervention implemented by male-female pairs o f extensively trained high school students. Health classes within scho ols were assigned to 1 of the 3 conditions each semester, and simultan eous implementation of the control program with health educators or pe er educators in the same school and during the same semester was not p ermitted. Main Outcome Measure: A confidential questionnaire administe red to all study subjects before and immediately after the interventio n, containing scales to measure knowledge, sexual self-efficacy, and s afe behavior intention. Results: Preintervention data indicated that t he study population was involved in sexual activity and other risk beh aviors at rates comparable to those of other urban adolescent populati ons. Examination of 3 outcome constructs as dependent variables (knowl edge, sexual self-efficacy, and safe behavior intention) revealed that the health educators and peer educators increased students' knowledge significantly more than did the control condition for both middle (fe males, P<.01; males, P<.01) and high (females, P<.001; males, P<.001) school. Comparisons of self-efficacy changes across intervention group s did not reach statistical significance, and safe behavior intention changes differed significantly by intervention group for high school b ut not for middle school students. For all analyses, the preinterventi on scores for each outcome variable were the most powerful predictors of postintervention scores, and analysis of variance models predicted substantial overall variance. Conclusions: At short-term follow-up, th e RAPP intervention had a powerful effect on knowledge for all student s and a moderate effect on sexual self-efficacy and safe behavior inte ntion, particularly for high school students. The peer educators were found to be equally and, for some variables, more effective than the h ighly trained adult educators. The substantial effect of the baseline scores and the high prevalence of risk behavior already evident by sev enth grade indicate the importance of early implementation of school-b ased sexuality programs.