Promoting Health Among Teens! (Abstinence Only)
An 8-hour abstinence-based education program to reduce risky sexual behavior for African American youth by providing information on sexual risks and helping teens build negotiation, refusal, and problem solving skills for practicing abstinence.
Program Outcomes
- Sexual Risk Behaviors
Program Type
- Cognitive-Behavioral Training
- Skills Training
Program Setting
- School
- Community
Continuum of Intervention
- Universal Prevention
Age
- Early Adolescence (12-14) - Middle School
Gender
- Both
Race/Ethnicity
- African American
Endorsements
Blueprints: Promising
Program Information Contact
ETR
100 Enterprise Way. Suite G300
Scotts Valley, CA 95066
Tel: (800) 620-8884
Fax: (831) 438-4284
Main Website: etr.org
Program Website: pub.etr.org/ProductDetails.aspx
Program Developer/Owner
John B. Jemmott III
University of Pennsylvania, School of Medicine
Brief Description of the Program
The program is an 8-hour abstinence-based education intervention for African American teens that offers optional booster sessions and one-on-one meetings for up to two years following program completion. It aims to give 6th and 7th grade students accurate information on sexual risks and help participants build negotiation, refusal, and problem solving skills for practicing abstinence.The program is an abstinence-based education intervention for African American teens that is delivered over 8 one-hour modules. In addition, there are optional booster sessions and one-on-one meetings for up to two years following program completion. It aims to increase knowledge of HIV/sexually transmitted infections (STIs); strengthen behavioral beliefs supporting abstinence including the belief that abstinence can prevent pregnancy, STIs and HIV; promote the belief that abstinence can foster attainment of future goals; and increase skills to negotiate abstinence and resist pressure to have sex. The intervention contains accurate information and does not portray sex in a negative light or use a moralistic tone. Modules are delivered by trained facilitators and include brief group discussions, videos, games, brainstorming, experiential exercises, and skill-building activities.
Outcomes
Primary Evidence Base for Certification
Jemmott et al. (2010) found across the study period significant improvement among those assigned to the abstinence-only treatment group as compared to the control group in:
- sexual initiation
- recent sexual intercourse
Brief Evaluation Methodology
Primary Evidence Base for Certification
Blueprints has reviewed one study, and it meets Blueprints evidentiary standards (specificity, evaluation quality, impact, dissemination readiness). The study was conducted by the program developer.
Study 1
Jemmott et al. (2010) conducted a randomized controlled trial with 662 African American 6th and 7th grade students recruited from 4 public middle schools. Participants were randomly assigned to the 8-hour abstinence-only treatment group, an 8-hour safer sex only (focusing on condom use) intervention, either an 8- or 12-hour version of a comprehensive intervention including abstinence and safer sex, or an 8-hour health promotion control group focusing on health behaviors unrelated to sexual contact. In addition, students in each intervention were randomly assigned to a maintenance program. The primary measure was a self-report of sexual contact, and secondary measures addressed other sexual behaviors such as multiple partners, unprotected intercourse, and consistent condom use. Participants completed pretest, posttest, and 3-, 6-, 12-, 18-, and 24-month follow-up questionnaires.
Study 1
Jemmott, J. B., Jemmott, L. S., & Fong, G. T. (2010). Efficacy of a theory-based abstinence-only intervention over 24 months: A randomized controlled trial with young adolescents. Archives of Pediatric and Adolescent Medicine, 164, 152-159.
Protective Factors
Individual: Problem solving skills, Refusal skills
*
Risk/Protective Factor was significantly impacted by the program
See also: Promoting Health Among Teens! (Abstinence Only) Logic Model (PDF)
Race/Ethnicity Specific Findings
- African American
Subgroup Analysis Details
Subgroup differences in program effects by race, ethnicity, or gender (coded in binary terms as male/female) or program effects for a sample of a specific race, ethnic, or gender group.
Study 1 (Jemmott et al., 2010) found subgroup effects by using a homogenous sample of all African American youths.
Sample demographics including race, ethnicity, and gender for Blueprints-certified studies:
- The sample for Study 1 (Jemmott et al., 2010) included only African American youth of whom 53.5% were female.
For information about ETR's distributive learning process please see: http://www.etr.org/ebi/training-ta/professional-learning-services/
Training is two days. Participants are required to have the basic set materials for the program. The PHAT-AO cost per participant is $1,534 ($975 for training + $559 for facilitator guide and initial set of student workbooks). These costs do not include participant travel or lodging (if they come to a scheduled regional training). If an ETR trainer comes to the site for the training, the agency will need to pay trainer travel and lodging expenses.
All ETR trainings include the research based elements of pre-assessment, pre-work, skills development (including practice in facilitating specific curriculum elements), and follow-up support.
More information can also be found at: http://www.etr.org/solutions/professional-development/
Training Certification Process
ETR offers Training of Trainers sessions for seasoned program facilitators that will qualify them to train other educators in delivery of the program. Regional TOT sessions, in which participants provide their own transportation costs, average $2500 per participant.
Source: Washington State Institute for Public Policy
All benefit-cost ratios are the most recent estimates published by The Washington State Institute for Public Policy for Blueprint programs implemented in Washington State. These ratios are based on a) meta-analysis estimates of effect size and b) monetized benefits and calculated costs for programs as delivered in the State of Washington. Caution is recommended in applying these estimates of the benefit-cost ratio to any other state or local area. They are provided as an illustration of the benefit-cost ratio found in one specific state. When feasible, local costs and monetized benefits should be used to calculate expected local benefit-cost ratios. The formula for this calculation can be found on the WSIPP website.
Start-Up Costs
Initial Training and Technical Assistance
ETR recommends that facilitators receive research-based professional development to prepare them to effectively implement and replicate the curriculum with fidelity for the intended target group. Regional Training of Educators 2-day sessions, in which participants provide their own transportation costs, are $1534 per participant. The fee includes training ($975) and required materials for facilitation, the facilitator guide and student workbooks ($559). ETR also provides onsite training. Implementing agencies are encouraged to submit a Training & TA Request Form for information on pricing: http://www.etr.org/solutions/professional-development/training-ta-request-form/
Curriculum and Materials
ETR provides a budget calculator on its Program Success Center website page for each program: http://www.etr.org/ebi/programs/promoting-health-among-teens-abstinence-only/
A curriculum set for a single classroom (1 facilitator guide and 30 student workbooks) costs $559 and is included in the initial training expense. Additional student workbooks average $3 each.
Licensing
None.
Other Start-Up Costs
It is important to plan for a sufficient number of facilitators to keep the youth groups small and interactive. One facilitator for every 12 youth is the recommended maximum.
Space for program delivery must also be considered. If an agency cannot provide space in its own facility or use other donated space, rental fees may be necessary.
Intervention Implementation Costs
Ongoing Curriculum and Materials
Once all facilitators have their manuals, the only ongoing curriculum costs are the student workbooks. These can be purchased in sets of 5 ($15) or 30 ($90). Bulk discounts can be negotiated with the publisher.
Staffing
Qualifications: There are no specific qualifications required for facilitators. Facilitators are typically youth development workers, school counselors or health educators with a minimum four-year college degree.
Ratios: One facilitator delivers the program to 12 youth.
Time to Deliver Intervention: The program includes eight one-hour modules which are typically delivered in two sessions.
Other Implementation Costs
No information is available
Implementation Support and Fidelity Monitoring Costs
Ongoing Training and Technical Assistance
ETR offers Training of Trainers sessions for seasoned program facilitators that will qualify them to train other educators in delivery of the program. Regional TOT sessions, in which participants provide their own transportation costs, average $2500 per participant.
ETR can provide technical assistance in various formats. Implementing agencies are encouraged to submit a Training & TA Request Form for information on pricing: http://www.etr.org/solutions/professional-development/training-ta-request-form/
Fidelity Monitoring and Evaluation
These will vary greatly by site, based on what kind of evaluation is desired/required.
Ongoing License Fees
None.
Other Implementation Support and Fidelity Monitoring Costs
No information is available
Other Cost Considerations
None.
Year One Cost Example
In this example, an agency sends one staff person to a Regional Training of Educators to be trained as a facilitator of the Promoting Health Among Teens-Abstinence Only program. The facilitator delivers six rounds of the program during the first year to groups of 12 youth each.
| Training + Facilitator Guide and Initial Set of Student Workbooks | $1,534.00 |
| Training Travel Expenses | $1,000.00 |
| Additional Student Workbooks (45) | $135.00 |
| Total One Year Cost | $2,669.00 |
With one facilitator delivering 6 sessions to 12 youth each, the program would serve 72 youth in Year One and the cost per youth would be $37.
If an agency chooses to hire outside facilitators, additional expenses for salaries would need to be considered.
Funding Overview
PHAT-Abstinence Only, as a health education program aimed at preventing HIV and other STDs and unwanted pregnancy, can be funded with prevention and health promotion dollars focused on high-risk adolescents.
Funding Strategies
Improving the Use of Existing Public Funds
To the extent that existing health education and pregnancy prevention programs are not evidence-based, a locality can consider re-directing funds targeted for health education and pregnancy prevention into PHAT-Abstinence Only to get better outcomes.
Allocating State or Local General Funds
State and local health departments as well as city youth development and recreation offices may offer grants supporting pregnancy prevention and the reduction of sexually-transmitted disease.
Maximizing Federal Funds
Formula Funds:
- The Personal Responsibility Education Program (PREP), administered by the Administration on Children, Youth, and Families (ACYF), provides $55 million annually by formula to states and territories for evidence-based programs that educate adolescents on both abstinence and contraception to prevent pregnancy and sexually transmitted infections.
- Temporary Assistance to Needy Families (TANF) is a formula grant that states use to provide cash assistance and work supports to needy families. One of the four stated purposes of TANF funding is to prevent and reduce out-of-wedlock pregnancies and many states have used TANF to support pregnancy prevention programs.
- The Social Services Block Grant Program (SSBG) provides states very flexible dollars to fund a variety of social service programs. State social service agencies may allocate some portion of these funds toward pregnancy programs.
- The Community Development Block Grant (CDBG) program is administered from the federal Department of Housing and Urban Development to localities to support community economic development. Fifteen percent of these funds can be used to support a wide range of public services. Cities may choose to direct some portion of these funds to pregnancy prevention programs.
Discretionary Grants: Discretionary grants opportunities may be found under the CDC Office of Adolescent Health (OAH) grants, as well as the Administration for Children and Families, Family Youth Services Bureau (FYSB). OAH administers the Teen Pregnancy Prevention Program which supports replication of evidence-based TTP programs, of which PHAT-Abstinence Only is one. The Prevention and Public Health Fund, created by the Affordable Care Act and administered by the Department of Health and Human Services (HHS) is also funding some community-based prevention programs. The Fund was originally funded with $15 billion over 10 years, but has undergone $5 billion in cuts since it was passed. HHS is continuing to administer remaining dollars in the fund to a wide variety of public health and prevention purposes.
Foundation Grants and Public-Private Partnerships
Foundations, particularly those interested in adolescent health and pregnancy prevention and evidence-based practices, can be considered for training and curriculum purchase dollars.
Program Developer/Owner
John B. Jemmott IIIProfessorUniversity of Pennsylvania, School of MedicineDepartment of PsychiatryCenter for Health Behavior and Communication ResearchPhiladelphia, PA 19104-3309215-573-9366jjemmott@asc.upenn.edu
Program Outcomes
- Sexual Risk Behaviors
Program Specifics
Program Type
- Cognitive-Behavioral Training
- Skills Training
Program Setting
- School
- Community
Continuum of Intervention
- Universal Prevention
Program Goals
An 8-hour abstinence-based education program to reduce risky sexual behavior for African American youth by providing information on sexual risks and helping teens build negotiation, refusal, and problem solving skills for practicing abstinence.
Population Demographics
The program targets African American 6th and 7th grade students living in urban settings.
Target Population
Age
- Early Adolescence (12-14) - Middle School
Gender
- Both
Race/Ethnicity
- African American
Race/Ethnicity Specific Findings
- African American
Subgroup Analysis Details
Subgroup differences in program effects by race, ethnicity, or gender (coded in binary terms as male/female) or program effects for a sample of a specific race, ethnic, or gender group.
Study 1 (Jemmott et al., 2010) found subgroup effects by using a homogenous sample of all African American youths.
Sample demographics including race, ethnicity, and gender for Blueprints-certified studies:
- The sample for Study 1 (Jemmott et al., 2010) included only African American youth of whom 53.5% were female.
Other Risk and Protective Factors
Goal-oriented behavior, problem-solving and negotiation skills, and resistance to peer pressure reduce risky sexual behaviors.
Risk/Protective Factor Domain
- Individual
Risk/Protective Factors
Risk Factors
Protective Factors
Individual: Problem solving skills, Refusal skills
*Risk/Protective Factor was significantly impacted by the program
See also: Promoting Health Among Teens! (Abstinence Only) Logic Model (PDF)
Brief Description of the Program
The program is an 8-hour abstinence-based education intervention for African American teens that offers optional booster sessions and one-on-one meetings for up to two years following program completion. It aims to give 6th and 7th grade students accurate information on sexual risks and help participants build negotiation, refusal, and problem solving skills for practicing abstinence.Description of the Program
The program is an abstinence-based education intervention for African American teens that is delivered over 8 one-hour modules. In addition, there are optional booster sessions and one-on-one meetings for up to two years following program completion. It aims to increase knowledge of HIV/sexually transmitted infections (STIs); strengthen behavioral beliefs supporting abstinence including the belief that abstinence can prevent pregnancy, STIs and HIV; promote the belief that abstinence can foster attainment of future goals; and increase skills to negotiate abstinence and resist pressure to have sex. The intervention contains accurate information and does not portray sex in a negative light or use a moralistic tone. Modules are delivered by trained facilitators and include brief group discussions, videos, games, brainstorming, experiential exercises, and skill-building activities.
Theoretical Rationale
The program draws upon: 1) social cognitive theory, 2) the theory of reasoned action, and 3) the theory of planned behavior. All three theories emphasize the importance of beliefs and considering whether a given behavior will have negative or positive consequences.
Theoretical Orientation
- Cognitive Behavioral
Brief Evaluation Methodology
Primary Evidence Base for Certification
Blueprints has reviewed one study, and it meets Blueprints evidentiary standards (specificity, evaluation quality, impact, dissemination readiness). The study was conducted by the program developer.
Study 1
Jemmott et al. (2010) conducted a randomized controlled trial with 662 African American 6th and 7th grade students recruited from 4 public middle schools. Participants were randomly assigned to the 8-hour abstinence-only treatment group, an 8-hour safer sex only (focusing on condom use) intervention, either an 8- or 12-hour version of a comprehensive intervention including abstinence and safer sex, or an 8-hour health promotion control group focusing on health behaviors unrelated to sexual contact. In addition, students in each intervention were randomly assigned to a maintenance program. The primary measure was a self-report of sexual contact, and secondary measures addressed other sexual behaviors such as multiple partners, unprotected intercourse, and consistent condom use. Participants completed pretest, posttest, and 3-, 6-, 12-, 18-, and 24-month follow-up questionnaires.
Outcomes (Brief, over all studies)
Primary Evidence Base for Certification
Jemmott et al. (2010) found across the study period fewer participants in the abstinence-only intervention reported sexual initiation and recent sexual intercourse as compared to the control condition.
Outcomes
Primary Evidence Base for Certification
Jemmott et al. (2010) found across the study period significant improvement among those assigned to the abstinence-only treatment group as compared to the control group in:
- sexual initiation
- recent sexual intercourse
Effect Size
In Study 1, Jemmott et al. (2010) reported a small effect size (risk ratio of .67-.94).
Generalizability
One study meets Blueprints standards for high quality methods with strong evidence of program impact (i.e., "certified" by Blueprints): Study 1 (Jemmott et al., 2010). The sample included African American students from public middle schools that serve low-income communities in a Northeastern U.S. city. The treatment group was compared with a general health promotion control group.
Notes
Promoting Health Among Teens! (PHAT) - Comprehensive, a 12-hour HIV/STI, pregnancy prevention and safer-sex intervention also reported by Jemmott et al. (2010), is included as a separate write-up.
Endorsements
Blueprints: Promising
Program Information Contact
ETR
100 Enterprise Way. Suite G300
Scotts Valley, CA 95066
Tel: (800) 620-8884
Fax: (831) 438-4284
Main Website: etr.org
Program Website: pub.etr.org/ProductDetails.aspx
References
Study 1
Certified Jemmott, J. B., Jemmott, L. S., & Fong, G. T. (2010). Efficacy of a theory-based abstinence-only intervention over 24 months: A randomized controlled trial with young adolescents. Archives of Pediatric and Adolescent Medicine, 164, 152-159.
Study 1
Evaluation Methodology
Design:
Recruitment: The study made announcements in assemblies, classrooms, and lunchrooms and sent letters to parents or guardians in 4 middle schools in a northeastern city in the U.S. African American students in the 6th and 7th grades who volunteered and had written parent or guardian consent were included in the study (which resulted in 86.9% of those eligible).
Assignment: A total of 662 students were randomly assigned to one of the 5 conditions: 8-hour abstinence only (n = 134), 8-hour safer sex only (focusing on condom use; n = 129), either an 8- or 12-hour version of a comprehensive intervention including abstinence and safer sex (n = 134 and 131, respectively), and an 8-hour health promotion control group focusing on health behaviors unrelated to sexual contact (n = 134). In addition, 315 students (48% of the baseline sample) were also randomly assigned to an intervention maintenance group for up to 21 months following program completion.
Attrition: Participants completed pretest, posttest, and 3-, 6-, 12-, 18-, and 24-month follow-up questionnaires from 2001-2004. There were 559 students (84% of the baseline sample) that completed the 24-month follow-up. According to follow-up with the authors, there were no differences by condition in the attrition rates.
Sample: About 53.5% of participants were female; ages ranged from 10-15 years with a mean of 12.2 years. Approximately 23.4% of the sample reported sexual initiation before the baseline measure.
Measures: For the primary outcome of sexual initiation, the study included a self-report of ever having had sex. In addition, the study used self-reports of sex behaviors in the past 3 months, including sexual intercourse, multiple partners, unprotected intercourse, and consistent condom use. Trained data collectors were blind to participant assignment, and special efforts were made to obtain honest answers from students (including adding a social desirability scale that was found to have no association with the outcomes).
Analysis: The study tested the report of ever having sexual intercourse using generalized linear regression with a log link. The study used either the Bernoulli or Poisson error distribution depending on whether predicted probabilities violated the 0,1 range of probability. The other measures were analyzed using Poisson generalized estimating equations with a log link. Analyses on ever having sexual intercourse excluded participants who reported having sexual intercourse at baseline. Analyses controlled for baseline outcome measures, time, condition, gender, and age where possible. The study conducted a 24-month follow-up, but did not report significance of results at each assessment point. Instead, the data were averaged over the entire period of the study, including the long-term follow-up.
Intent-to-Treat: The study used an intent-to-treat approach in which participants' data were analyzed regardless of the number of intervention or data collection sessions they attended. About 98% of those randomized were included in the analysis.
Outcomes
Implementation Fidelity: The study stated that the modules were highly structured and facilitators used an intervention manual, however no quantitative measures of fidelity were reported. Attendance was high for the 2 sessions comprising the 8-hour abstinence-based program (at least 95%).
Baseline Equivalence: The study did not report significance tests of differences between conditions at baseline. However, this information was requested and obtained from the program developers, and their table showed only 1 of 9 significant differences between the conditions at baseline (condom use in the past 3 months).
Differential Attrition: The study reported that there was no significant difference in attrition between conditions and that attending a follow-up session was "unrelated to gender, age, living with both parents, and sexual behavior outcomes." Other tests of differential attrition were not reported.
Posttest: Across the study period, fewer participants in the abstinence-only intervention reported sexual initiation within the last three months as compared to the control condition. In addition, the abstinence-only intervention reduced recent sexual intercourse within the last three months. The abstinence-only intervention showed no effect on reports of multiple partners, consistent condom use or unprotected intercourse.
Maintenance/booster sessions were provided to roughly half the sample within the 21 months following completion of the 8-hour curriculum. Being assigned to the maintenance sessions did not moderate the efficacy of the intervention in reducing most outcomes, but the abstinence-only initiative did more to reduce multiple partners when the maintenance component was added.
Long-Term: No long-term follow-up was reported.