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August 11, 1993, Vol 270, No. 6 >
ARTICLE | August 11, 1993

AIDS Risk Reduction Among A Multiethnic Sample of Urban High School Students FREE

Heather J. Walter, MD, MPH; Roger D. Vaughan, MS
[+] Author Affiliations

Reprint requests to the Center for Population and Family Health, Columbia University School of Public Health, 60 Haven Ave, New York, NY 10032 (Dr Walter).


JAMA. 1993;270(6):725-730. doi:10.1001/jama.1993.03510060071035
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Published online
Article
References

Objective.  —To evaluate the effectiveness of a teacher-delivered curriculum in favorably modifying acquired immunodeficiency syndrome (AIDS)—related knowledge and beliefs, self-efficacy related to AIDS-preventive actions, and involvement in AIDS risk behaviors among an eligible population of 1316 New York City high school students.

Design.  —Students in two pairs of demographically similar high schools were assigned to receive either a special six-lesson AIDS-preventive curriculum (intervention group) or no formal AIDS-preventive curriculum (comparison group).

Participants.  —Study participants were ninth- and 11th-grade students, 12 to 20 years of age (mean, 15.7 years), 41.5% male, and 72.1% black or Hispanic.

Intervention.  —The special curriculum focused on conveying facts about AIDS, fostering theoretically derived beliefs favorable to AIDS prevention, and teaching skills necessary for the successful performance of AIDS-preventive behaviors.

Main Outcome Measures.  —AIDS-related knowledge, beliefs, self-efficacy, and behaviors were assessed among students in intervention and comparison groups at study baseline and at 3 months' follow-up.

Results.  —Significant (albeit modest) effects favoring intervention were observed for knowledge, beliefs, self-efficacy, and risk behavior scores.

Conclusions.  —School-based AIDS-preventive curricula may play a role in curtailing transmission of the human immunodeficiency virus among multiethnic groups of urban adolescents; however, such curricula may need supplementation by a broader-based prevention effort to achieve substantial risk behavior change.(JAMA. 1993;270:725-730.

REFERENCES

1 +
Centers for Disease Control and Prevention. HIV/ AIDS Surveillance Report . Atlanta, Ga: Division of HIV/AIDS; January 1992;; Center for Infectious Diseases. Centers for Disease Control and Prevention; January 1992.
2 +
Selik RM, Castro KG, Pappaioanou M.  Racial/ ethnic differences in the risk of AIDS in the United States . Am J Public Health . 1988;;78:1539-1545.
3 +
Burke DS, Brundage JF, Goldenbaum M, et al.  Human immunodeficiency virus infections in teenagers: seroprevalence among applicants for US military service. JAMA . 1990;;263:2074-2077.
4 +
St Louis ME, Conway GA, Hayman CR, Miller C, Petersen LR, Dondero TJ.  Human immunodeficiency virus infection in disadvantaged adolescents: findings from the US Job Corps. JAMA . 1991;;266:2387-2391.
5 +
DiClemente RJ, Houston-Hamilton A.  Strategies for prevention of human immunodeficiency virus infection among minority adolescents. Health Educ . 1989;;2:39-43.
6 +
Friedland GH, Klein RS.  Transmission of the human immunodeficiency virus. N Engl J Med . 1987;;317:1125-1135.
7 +
Quinn TC, Glasser D, Cannon RO, et al.  Human immunodeficiency virus infection among patients attending clinics for sexually transmitted diseases. N Engl J Med . 1988;;318:197-203.
8 +
Goodman E, Cohall AT.  Acquired immunodeficiency syndrome and adolescents: knowledge, attitudes, beliefs and behaviors in a New York City adolescent minority population. Pediatrics . 1989;; 84:36-42.
9 +
Keller SE, Bartlett JA, Schleifer SJ, Johnson RL, Pinner E, Delaney B.  HIV-relevant sexual behavior among a healthy inner-city heterosexual adolescent population in an endemic area of HIV. J Adolesc Health . 1991;;12:44-48.
10 +
Shafer MA, Boyer CB.  Psychosocial and behavioral factors associated with risk of sexually transmitted diseases, including human immunodeficiency virus infection, among urban high school students. J Pediatr . 1991;;119:826-833.
11 +
Walter HJ, Vaughan RD, Gladis MM, Ragin DF, Kasen S, Cohall AT.  Factors associated with AIDS risk behaviors among high school students in an AIDS epicenter. Am J Public Health . 1992;;82: 528-532.
12 +
Walter HJ, Vaughan RD, Ragin DF, Cohall AT, Kasen S, Fullilove RE.  Prevalence and correlates of AIDS-risk behaviors among urban minority high school students. Prev Med . In press.
13 +
Walter HJ, Hofman A, Vaughan RD, Wynder EL.  Modification of risk factors for coronary heart disease: five-year results of a school-based intervention trial. N Engl J Med . 1988;;318:1093-1100.
14 +
Walter HJ, Vaughan RD, Wynder EL.  Primary prevention of cancer among children: changes in cigarette smoking and diet after six years of intervention. J Natl Cancer Inst . 1989;;81:995-999.
15 +
Killen JD, Telch MJ, Robinson TN, Maccoby N, Taylor CV, Farquhar JW.  Cardiovascular disease risk reduction for tenth graders: a multiple-factor school-basedAMA. oach. JAMA . 1988;;260: l728-1733.
16 +
PentzDal.Kinnon  A multicommunity trial for primary prevention of adolescent drug abuse: effect on drug use prevalence. JAMA . 1989;;261:3259-3266.
17 +
Ellickson PL, Bell RM.  Drug prevention in junior high: a multi-site longitudinal test. Science . 1990;; 16:1299-1305.
18 +
Walter HJ, Vaughan RD, Cohall AT.  Risk factors for substance use among high school students: implications for prevention. J Am Acad Child Adolesc Psychiatry . 1991;;30:556-562.
19 +
Walter HJ, Vaughan RD, Cohall AT.  Psycho-social influences on AIDS risk behaviors among high school students. Pediatrics . 1991;;88:846-852.
20 +
Vaughan RD, Walter HJ, Gladis MM.  Steroid use among adolescents: another look. AIDS . 1991;; 5:112-113.
21 +
Kasen S, Vaughan RD, Walter HJ.  Self efficacy for AIDS preventive behaviors among tenth grade students. Health Educ Q . 1992;;19:187-202.
22 +
Gladis MM, Michela JL, Walter HJ, Vaughan RD.  High school students' perceptions of AIDS risk: realistic appraisal or motivated denial? Health Psychol . 1992;;11:307-316.
23 +
Walter HJ, Vaughan RD, Gladis MM, Ragin DF, Kasen S, Cohall AT.  Factors associated with AIDS-related behavioral intentions among high school students in an AIDS epicenter. Health Educ Q . In press.
24 +
Walter HJ, Vaughan RD, Cohall AT.  A comparison of three theoretical models of substance use among urban minority high school students. J Am Acad Child Adolesc Psychiatry . In press.
25 +
Walter HJ, Vaughan RD, Gladis MM.  False consensus and problem behaviors among inner city adolescents. J Appl Soc Psychol . In press.
26 +
Walter HJ, Vaughan RD, Ragin DF, Cohall AT, Kasen S.  Prevalence and correlates of AIDS-related behavioral intentions among urban minority high school students. AIDS Educ Prev . In press.
27 +
Cohen J. Statistical Power Analysis for the Behavioral Sciences . 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988;.
28 +
Chancellor's Expanded HIV/AIDS Education Program Including Condom Availability . New York, NY: New York City Board of Education; 1991;.
29 +
Becker M.  The health belief model and personal health behavior. Health Educ Monogr . 1974;;2(special issue).
30 +
Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory . Englewood Cliffs, NJ: Prentice-Hall International Inc; 1986;.
31 +
Fisher JD.  Possible effects of reference group-based social influence on AIDS-risk behavior and AIDS prevention. Am Psychol . 1988;;43:914-920.
32 +
Green LW, Kreuter MW, Deeds SG, Partridge KB. Health Education Planning: A Diagnostic Approach . Palo Alto, Calif: Mayfield Publishing Co; 1980;.
33 +
US Dept of Health and Human Services, Public Health Service, Centers for Disease Control. Understanding AIDS: A Message From the Surgeon General . Atlanta, Ga: Public Health Service, Centers for Disease Control and Prevention; 1988;. Publication CDC HHS-88-8404.
34 +
Hearst N, Hulley SB.  Preventing the heterosexual spread of AIDS: are we giving our patients the best advice? JAMA . 1988;;259:2428-2432.
35 +
Cohen J, Cohen P. Applied Multiple Regression/ Correlation Analysis for the Behavioral Sciences . 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1983;.
36 +
Flay BR.  Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs. Prev Med . 1986;;15:451-474.
37 +
Hosmer DW Jr, Lemeshow S. Applied Logistic Regression . New York, NY: John Wiley & Sons Inc; 1981;.
38 +
Upchurch DM, Weisman CS, Shepherd M, et al.  Interpartner reliability of reporting of recent sexual behaviors. Am J Epidemiol . 1991;;134:1159-1165.
39 +
Hansen WB, Collins LM, Malotte CK, Johnson CA, Fielding JE.  Attrition in prevention research. J Behav Med . 1985;;8:261-275.
40 +
Johnson JA, Sellew JF, Campbell AE, Haskell EG, Gay AA, Bell BJ.  A program using medical students to teach high school students about AIDS. J Med Educ . 1988;;63:522-530.
41 +
Brown LK, Fritz GK, Barone VJ.  The impact of AIDS education on junior and senior high school students. J Adolesc Health Care . 1989;;10:286-389.
42 +
DiClemente RJ, Pies C, Stoller E, et al.  Evaluation of school-based AIDS curricula in San Francisco. J Sex Research . 1989;;26:188-198.
43 +
Huszti HC, Clopton JR, Mason PJ.  Acquired immunodeficiency syndrome educational program: effects on adolescents' knowledge and attitudes. Pediatrics . 1989;;84:986-994.
44 +
Ruder AM, Flam R, Flatto D, Curran AS.  AIDS education: evaluation of school and worksite based presentations. N Y State Med J . 1990;;90:129-133.
45 +
Jemmott JB, Jemmott LS, Fong GT.  Reductions in HIV risk-associated sexual behaviors among black male adolescents: effects of an AIDS prevention intervention. Am J Public Health . 1992;;82: 372-377.
46 +
Kirby D, Barth RP, Leland N, Fetro JV.  Reducing the risk: impact of a new curriculum on sexual risk-taking. Fam Plann Perspect . 1991;;23: 253-263.
47 +
Kirby D.  School-based prevention programs: design, evaluation, and effectiveness.  In: DiClemente RJ, ed. Adolescents and AIDS: A Generation in Jeopardy . Beverly Hills, Calif: Sage Publications Inc; 1992;.
48 +
Rotheram-Borus MJ, Koopman C, Haignere C, Davies M.  Reducing HIV sexual risk behaviors among runaway adolescents. JAMA . 1991;;266:1237-1241.
49 +
Basen-Engquist K, Parcel GS.  Attitudes, norms, and self-efficacy: a model of adolescents' HIV-related sexual risk behavior. Health Educ Q . 1992;; 19:263-277.
50 +
Hingson RW, Strunin L, Berlin BM, Heeren T.  Beliefs about AIDS, use of alcohol and drugs, and unprotected sex among Massachusetts adolescents. Am J Public Health . 1990;;80:295-299.
51 +
Biglan A, Metzler CW, Wirt R, et al.  Social and behavioral factors associated with high-risk sexual behavior among adolescents. J Behav Med . 1990;; 13:245-261.

Figures

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Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Centers for Disease Control and Prevention. HIV/ AIDS Surveillance Report . Atlanta, Ga: Division of HIV/AIDS; January 1992;; Center for Infectious Diseases. Centers for Disease Control and Prevention; January 1992.
2 +
Selik RM, Castro KG, Pappaioanou M.  Racial/ ethnic differences in the risk of AIDS in the United States . Am J Public Health . 1988;;78:1539-1545.
3 +
Burke DS, Brundage JF, Goldenbaum M, et al.  Human immunodeficiency virus infections in teenagers: seroprevalence among applicants for US military service. JAMA . 1990;;263:2074-2077.
4 +
St Louis ME, Conway GA, Hayman CR, Miller C, Petersen LR, Dondero TJ.  Human immunodeficiency virus infection in disadvantaged adolescents: findings from the US Job Corps. JAMA . 1991;;266:2387-2391.
5 +
DiClemente RJ, Houston-Hamilton A.  Strategies for prevention of human immunodeficiency virus infection among minority adolescents. Health Educ . 1989;;2:39-43.
6 +
Friedland GH, Klein RS.  Transmission of the human immunodeficiency virus. N Engl J Med . 1987;;317:1125-1135.
7 +
Quinn TC, Glasser D, Cannon RO, et al.  Human immunodeficiency virus infection among patients attending clinics for sexually transmitted diseases. N Engl J Med . 1988;;318:197-203.
8 +
Goodman E, Cohall AT.  Acquired immunodeficiency syndrome and adolescents: knowledge, attitudes, beliefs and behaviors in a New York City adolescent minority population. Pediatrics . 1989;; 84:36-42.
9 +
Keller SE, Bartlett JA, Schleifer SJ, Johnson RL, Pinner E, Delaney B.  HIV-relevant sexual behavior among a healthy inner-city heterosexual adolescent population in an endemic area of HIV. J Adolesc Health . 1991;;12:44-48.
10 +
Shafer MA, Boyer CB.  Psychosocial and behavioral factors associated with risk of sexually transmitted diseases, including human immunodeficiency virus infection, among urban high school students. J Pediatr . 1991;;119:826-833.
11 +
Walter HJ, Vaughan RD, Gladis MM, Ragin DF, Kasen S, Cohall AT.  Factors associated with AIDS risk behaviors among high school students in an AIDS epicenter. Am J Public Health . 1992;;82: 528-532.
12 +
Walter HJ, Vaughan RD, Ragin DF, Cohall AT, Kasen S, Fullilove RE.  Prevalence and correlates of AIDS-risk behaviors among urban minority high school students. Prev Med . In press.
13 +
Walter HJ, Hofman A, Vaughan RD, Wynder EL.  Modification of risk factors for coronary heart disease: five-year results of a school-based intervention trial. N Engl J Med . 1988;;318:1093-1100.
14 +
Walter HJ, Vaughan RD, Wynder EL.  Primary prevention of cancer among children: changes in cigarette smoking and diet after six years of intervention. J Natl Cancer Inst . 1989;;81:995-999.
15 +
Killen JD, Telch MJ, Robinson TN, Maccoby N, Taylor CV, Farquhar JW.  Cardiovascular disease risk reduction for tenth graders: a multiple-factor school-basedAMA. oach. JAMA . 1988;;260: l728-1733.
16 +
PentzDal.Kinnon  A multicommunity trial for primary prevention of adolescent drug abuse: effect on drug use prevalence. JAMA . 1989;;261:3259-3266.
17 +
Ellickson PL, Bell RM.  Drug prevention in junior high: a multi-site longitudinal test. Science . 1990;; 16:1299-1305.
18 +
Walter HJ, Vaughan RD, Cohall AT.  Risk factors for substance use among high school students: implications for prevention. J Am Acad Child Adolesc Psychiatry . 1991;;30:556-562.
19 +
Walter HJ, Vaughan RD, Cohall AT.  Psycho-social influences on AIDS risk behaviors among high school students. Pediatrics . 1991;;88:846-852.
20 +
Vaughan RD, Walter HJ, Gladis MM.  Steroid use among adolescents: another look. AIDS . 1991;; 5:112-113.
21 +
Kasen S, Vaughan RD, Walter HJ.  Self efficacy for AIDS preventive behaviors among tenth grade students. Health Educ Q . 1992;;19:187-202.
22 +
Gladis MM, Michela JL, Walter HJ, Vaughan RD.  High school students' perceptions of AIDS risk: realistic appraisal or motivated denial? Health Psychol . 1992;;11:307-316.
23 +
Walter HJ, Vaughan RD, Gladis MM, Ragin DF, Kasen S, Cohall AT.  Factors associated with AIDS-related behavioral intentions among high school students in an AIDS epicenter. Health Educ Q . In press.
24 +
Walter HJ, Vaughan RD, Cohall AT.  A comparison of three theoretical models of substance use among urban minority high school students. J Am Acad Child Adolesc Psychiatry . In press.
25 +
Walter HJ, Vaughan RD, Gladis MM.  False consensus and problem behaviors among inner city adolescents. J Appl Soc Psychol . In press.
26 +
Walter HJ, Vaughan RD, Ragin DF, Cohall AT, Kasen S.  Prevalence and correlates of AIDS-related behavioral intentions among urban minority high school students. AIDS Educ Prev . In press.
27 +
Cohen J. Statistical Power Analysis for the Behavioral Sciences . 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988;.
28 +
Chancellor's Expanded HIV/AIDS Education Program Including Condom Availability . New York, NY: New York City Board of Education; 1991;.
29 +
Becker M.  The health belief model and personal health behavior. Health Educ Monogr . 1974;;2(special issue).
30 +
Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory . Englewood Cliffs, NJ: Prentice-Hall International Inc; 1986;.
31 +
Fisher JD.  Possible effects of reference group-based social influence on AIDS-risk behavior and AIDS prevention. Am Psychol . 1988;;43:914-920.
32 +
Green LW, Kreuter MW, Deeds SG, Partridge KB. Health Education Planning: A Diagnostic Approach . Palo Alto, Calif: Mayfield Publishing Co; 1980;.
33 +
US Dept of Health and Human Services, Public Health Service, Centers for Disease Control. Understanding AIDS: A Message From the Surgeon General . Atlanta, Ga: Public Health Service, Centers for Disease Control and Prevention; 1988;. Publication CDC HHS-88-8404.
34 +
Hearst N, Hulley SB.  Preventing the heterosexual spread of AIDS: are we giving our patients the best advice? JAMA . 1988;;259:2428-2432.
35 +
Cohen J, Cohen P. Applied Multiple Regression/ Correlation Analysis for the Behavioral Sciences . 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1983;.
36 +
Flay BR.  Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs. Prev Med . 1986;;15:451-474.
37 +
Hosmer DW Jr, Lemeshow S. Applied Logistic Regression . New York, NY: John Wiley & Sons Inc; 1981;.
38 +
Upchurch DM, Weisman CS, Shepherd M, et al.  Interpartner reliability of reporting of recent sexual behaviors. Am J Epidemiol . 1991;;134:1159-1165.
39 +
Hansen WB, Collins LM, Malotte CK, Johnson CA, Fielding JE.  Attrition in prevention research. J Behav Med . 1985;;8:261-275.
40 +
Johnson JA, Sellew JF, Campbell AE, Haskell EG, Gay AA, Bell BJ.  A program using medical students to teach high school students about AIDS. J Med Educ . 1988;;63:522-530.
41 +
Brown LK, Fritz GK, Barone VJ.  The impact of AIDS education on junior and senior high school students. J Adolesc Health Care . 1989;;10:286-389.
42 +
DiClemente RJ, Pies C, Stoller E, et al.  Evaluation of school-based AIDS curricula in San Francisco. J Sex Research . 1989;;26:188-198.
43 +
Huszti HC, Clopton JR, Mason PJ.  Acquired immunodeficiency syndrome educational program: effects on adolescents' knowledge and attitudes. Pediatrics . 1989;;84:986-994.
44 +
Ruder AM, Flam R, Flatto D, Curran AS.  AIDS education: evaluation of school and worksite based presentations. N Y State Med J . 1990;;90:129-133.
45 +
Jemmott JB, Jemmott LS, Fong GT.  Reductions in HIV risk-associated sexual behaviors among black male adolescents: effects of an AIDS prevention intervention. Am J Public Health . 1992;;82: 372-377.
46 +
Kirby D, Barth RP, Leland N, Fetro JV.  Reducing the risk: impact of a new curriculum on sexual risk-taking. Fam Plann Perspect . 1991;;23: 253-263.
47 +
Kirby D.  School-based prevention programs: design, evaluation, and effectiveness.  In: DiClemente RJ, ed. Adolescents and AIDS: A Generation in Jeopardy . Beverly Hills, Calif: Sage Publications Inc; 1992;.
48 +
Rotheram-Borus MJ, Koopman C, Haignere C, Davies M.  Reducing HIV sexual risk behaviors among runaway adolescents. JAMA . 1991;;266:1237-1241.
49 +
Basen-Engquist K, Parcel GS.  Attitudes, norms, and self-efficacy: a model of adolescents' HIV-related sexual risk behavior. Health Educ Q . 1992;; 19:263-277.
50 +
Hingson RW, Strunin L, Berlin BM, Heeren T.  Beliefs about AIDS, use of alcohol and drugs, and unprotected sex among Massachusetts adolescents. Am J Public Health . 1990;;80:295-299.
51 +
Biglan A, Metzler CW, Wirt R, et al.  Social and behavioral factors associated with high-risk sexual behavior among adolescents. J Behav Med . 1990;; 13:245-261.

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