Adolescent Sexual Risk Reduction in Low-Income Housing Developments: A Pilot Study of the Effectiveness of an Intensive Summer Youth Development Program

Introduction: This study is a pilot test of the effectiveness of a youth development program, the Adolescent Family Life Comprehensive Abstinence Program (AFL-CAP), that adheres to the principles of effective prevention programs (Nation et al., 2003) and to a youth asset development model which the CDC refers to as a “promising approach to HIV prevention” (CDC, 2010). AFL-CAP is delivered in the context of a summer camp within low-income housing developments and administered by paraprofessionals employed by a non-profit community agency. The program is based upon the social-ecological model of sexual risk (DiClimente et al. 2005) and youth development principles, which highlight the importance of promoting youth strengths (Catalano et al. 2002). Recognizing the multiple risks associated with growing up in urban poverty, the AFL-CAP educates adolescents about social, psychological, and health gains resulting from abstaining from sexual activity, violence, and substance use, and aims to increase participants’ practice of healthy behaviors. Of note, AFL-CAP incorporates abstinence-based education which, unlike abstinence-only education, does not prohibit discussion of contraceptive health.

Methods: Participants (N = 142; M (SD) age = 14.3(1.7); 44.4% male; 90.1% African American) were recruited from households in and around low-income public housing developments located in a metropolitan area. At baseline, nearly 50% of participants reported that they had had sexual intercourse and almost 70% of those who were sexually active reported that they did not use a condom the last time they had sex. In addition, 86% of the adolescents reported that they had smoked cigarettes and used marijuana. Measures included behavioral outcomes (e.g., abstinence, number of sexual partners, and contraceptive use during sexual intercourse) and psychosocial outcomes (e.g., communication with parents about sex, general self-efficacy, and self-efficacy related to abstinence). All measures showed acceptable to strong reliability.  Baseline data were collected prior to the start of the intensive 6-week summer program, at posttest immediately following the program, and at 12-month follow-up.

Results: A single-group pretest-posttest follow-up design was used. A paired sample t-test of pretest and posttest summary scores from a sample of youth for whom 12-month follow-up data were not available showed a significant difference in the expected direction for communication with parents [t(258) = -4.483, p =0.00] and self-efficacy [t(259) = -1.967, p= .05], with an alpha of p < .05. Further analyses with the follow-up sample will explore whether changes in psychosocial variables, such as communication and self-efficacy, at posttest predict changes in behavioral outcomes at 12-month follow-up. In addition, changes in posttest and follow-up outcomes will be examined as a function of gender, age, and baseline risk behavior.

Conclusions: Results will be discussed in light of the study limitations, findings from existing community-based sexual risk reduction programs, and the need to target high-risk youth for whom co-occurring problems are prevalent.