Using Intervention Mapping to develop, implement, and evaluate comparable abstinence education and comprehensive sexuality curricula

Background: Legislative initiatives have funded both abstinence education and comprehensive sexuality programs to prevent adolescent pregnancy. The efficacy of both approaches has been debated. Further studies are necessary to identify common elements of effective programs and to examine how each approach impacts sexual behavior. Methods: All About Youth is a randomized controlled trial to develop and evaluate two middle school curricula – one risk avoidance (RA), one risk reduction (RR) - that are comparable in duration, delivery, and theoretical base. Intervention Mapping, a methodology combining theoretical and empirical evidence with community (youth, parents, school personnel) and expert input, was used to identify: (1) critical learning objectives for each curriculum; (2) methods and strategies for effective intervention; (3) critical implementation issues. Results: Key curriculum elements were identified by reviewing evaluated abstinence and comprehensive sexual health curricula (n=31), and obtaining input from an Expert Advisory Group. The RA curriculum complies with Title V A-H criteria, is directive, emphasizes character development, and benefits of abstinence-until-marriage. The RR curriculum is non-directive, emphasizes respect for self and others, and includes condom/contraceptive skills-training. Both curricula address peer norms, attitudes, refusal and communication skills related to healthy relationships, dating, and sex. Common methods including modeling, skills-training, and individualization delivered via classroom and computer-based activities, including activities tailored by gender and sexual experience. Community input provided positive support for implementation issues including recruitment, randomization, and cultural and developmental sensitivity. Conclusions: Using a systematic approach to develop and implement comparable curricula will assist in the identification of common effective elements.