Findings from the Mighty Girls Efficacy Trial: Effects on Resistance Self-Efficacy, Intentions, and Heavy Petting

Introduction: Peer resistance skill building programs informed by communication competence, such as the “keepin’ it REAL” program, have been found to be efficacious in substance abuse prevention for early and middle adolescents from various ethnic groups. Given the comorbidity of substance use and risky sexual behavior and the role that peers play in both of these behaviors, it is reasonable to expect that a similar approach might be useful for preventing risky sexual behavior. However, the effects of this type of program on sexual behavior have not been fully explored. This paper presents findings from the efficacy trial of the Mighty Girls program, an early intervention pregnancy prevention program that is an adaptation of keepin’ it REAL. Mighty Girls is a gender specific, and developmentally and culturally tailored program, created for early adolescent (7^th grade), English speaking Latinas. The program combines group classroom sessions with a highly interactive, single player, virtual reality computer game (DRAMA-RAMA) that reinforces classroom content and builds resistance skills by creating a live simulation of everyday early adolescent social encounters involving peer pressure. Program efficacy is tested in the JUEGA! randomized group trial which involves low income, predominately Hispanic schools in Miami-Dade County. The program is delivered in Fall of 7^th grade with follow-up survey and game play booster in Spring of 7^th grade, and additional follow-up surveys in Fall of 8^th and 9^th grade.

Methods: This NINR funded JUEGA! efficacy trial enrolled 330 girls attending one of 13 schools randomly assigned to the Mighty Girls condition and 217 girls attending one of 9 schools randomly assigned to the Game Girls condition. All study activities were completed after school, with survey data collected electronically. Data were analyzed using hierarchical linear modeling for repeated measures data with mixed effects (school effects treated as random effects). Outcome measures include heavy petting behavior -- a risky sexual behavior in this age group that predicts early initiation of intercourse.

Results: Results indicated the Mighty Girls program had a significant effect on resistance self-efficacy, resistance intentions, and heavy petting behavior 2 mos. post intervention relative to baseline levels (Cohen’s d ranged from .20 to .35; p < .001).

Conclusion: Effect sizes for these early results are promising (larger than previously reported for safer sex interventions) and support the efficacy of the Mighty Girls program. Additional analyses needed to evaluate program: 1) effects at 12 mos. (included at presentation); 2) impact on substance use; 3) cost-effectiveness; and 4) implementation quality outcome mediation.