Building an ecological-developmental model for adolescent HIV prevention: Program participation and family connectedness

Background: Relationships (e.g. parent-child connectedness) and social environments play a central role in promoting adolescent sexual health and HIV/STI risk reduction. Many risk reduction interventions take place in community-based youth programs which serve as support systems for adolescents. Most program impact measures focus on intrapersonal factors (knowledge, attitudes/intentions, beliefs, and behaviors) rather than on potentially protective eco-developmental effects (e.g. increases in family connectedness). Our study examines the effects of program participation on family and school connectedness, sexual health and experience, and HIV/STI risk reduction practices.

Methods: We surveyed 331 ethnically diverse 13-17 year old enrollees in NYC after-school programs at baseline, 6-months, and 12-months .We examined summary scales measuring program participation (Cronbach's alpha 0.886), family and school connectedness (Cronbach's alpha 0.897 and 0.706 respectively) in relation to measures assessing access to services, sexual risk reduction, and non-use of alcohol, drugs and tobacco.

Results: At baseline, program participation was significantly correlated with access to services (0.278 p=.000), family connectedness (0.293 p=.000), and school connectedness (0.177, p<.001). Family connectedness was correlated with sexual risk reduction practices (0.139, p<.011) and substance non-use (0.193, p<.001) but not with access to services. School connectedness was not correlated with access or risk reduction measures. When controlling for age, gender and ethnicity, correlations remained significant except for the correlation between family connectedness and substance non-use.

Conclusions: Program participation may contribute to HIV/STI risk reduction by enhancing family connectedness. Strong program participation appears to boost adolescents' access to services, including testing and treatment.