Methods: The study featured a longitudinal group-randomized trial involving 9 schools randomized to intervention (5 schools, n=528) or control (4 schools, n=383). The curriculum was taught by outside health educators during 7th grade. The school-wide component started late in 7th grade and continued in 8th grade. Participants completed 3 surveys: a baseline survey in the fall/winter of 7th grade and two follow-up surveys 6- and 18-months after baseline. The sample, 911 7th grade youth (mean age 12.4), represents 76% of the 7th grade students enrolled in the participating schools at the time of the baseline survey. Six- and 18-month follow-up rates were 92% and 80%. Most youth described themselves as black (32%) or Hispanic (33%), and 45% said they speak a language other than English half or more of the time at home. Primary outcomes included intentions to have vaginal sex in next 3 months and by the end of 8thgrade, and initiation of vaginal sex. Multilevel models were used to adjust for the correlation among students within the same school, and the correlation of repeated measurements taken on the same student over time.
Results: There were no statistically significant differences between intervention and control students on intention to have vaginal sex in the next 3 months or by the end of 8thgrade (Cohen’s d = 0.04 and 0.03, respectively). The program reduced sexual initiation at the 6-month and 18-month follow-ups (OR=0.49 and 0.76, respectively), but these reductions did not reach statistical significance (p=.10 and .43 at 6- and 18-month follow-ups). Student and staff reaction data suggest the relationships-based approach was well received. Observations and log data highlight implementation challenges, particularly with the social norms component.
Conclusions: A relationship-based approach has promise for reducing sexual risk behaviors among urban youth as evidenced by the trends in sexual initiation in this small randomized trial. The content is fresh and well received, but an array of issues, such as classroom management, over-extended school staff, and general school dysfunction impacted implementation.