Students together against negative decisions (STAND): Evaluation of a school-based sexual risk reduction intervention in the rural South

Twenty-one 10th graders selected as opinion leaders by their peers in a rur al county in a southern state participated in a 36-hour peer-educator train ing program Students Together Against Negative Decisions (STAND) based on d iffusion of innovations theory and the transtheoretical model. Comparison s ubjects received either a 22-hour leadership training course (n = 20) or no intervention (n = 45). STAND and comparison subjects completed a 154-item written knowledge, attitude, and behavior survey at the beginning of the tr aining (Time 1), at the end of the training (Time 2), and again 8 months la ter (Time 3). One hundred and sixty-seven other 9th and 10th graders in the intervention county and 74 in the comparison county completed an abbreviat ed telephone interview at Time 1 and Time 3. At Time 3 STAND-trained peer e ducators reported significantly greater increases in AIDS Risk Behavior Kno wledge (more than 4 times comparison groups), frequency of conversations wi th peers about birth control/condoms (+180% vs. +12%) and sexually transmit ted diseases (STDs; +282% vs. -33%), condom use self efficacy (+16% vs. -1% ), and consistent condom use (+28% vs. +15%). STAND teens also reported sub stantial favorable trends at Time 3, including increased condom use (+213% vs. +31%) and decreased unprotected intercourse (-30% vs. +29%). At Time 3 teens in the intervention county reported significantly greater increases i n the number of people who talked with friends in the preceding 3 months ab out STDs (+39% vs. -19%) or with a parent/adult about sex (+6% vs. -37%). I ntervention county teens also reported a substantial but nonsignificant 2.6 -fold greater increase in condom use at last intercourse (+64% vs. +25%) bu t unfavorable changes in other risk behaviors. The STAND peer-educator trai ning program appears to be an effective method for improving selected sexua l knowledge, attitudes, and behaviors among participant teenagers in the ru ral South.