Lessons learned from Better Choices for a Better Future (c): A culturally specific substance abuse and HIV prevention curriculum for youth in St.Croix, US Virgin Islands

Issues: USVI HIV/AIDS rates are among the highest in the US. Recent surveys indicate increasing rates of substance abuse and sexual risk behaviors among USVI high school students. Guidance on implementing and evaluating culturally and developmentally appropriate interventions to reduce substance abuse and HIV risks at earlier ages is urgently needed. Description: A community-initiated research partnership utilized community-based participatory research (CBPR) approaches to develop an after-school substance abuse and HIV prevention program based on two model programs--“Project Alert” and “Focus on Kids.” Lessons learned were used to develop a subsequent model curriculum, Better Choices for a Better Future (c)(BCBF), based on Crucian culture, with a modified integration of the model programs, implemented in two schools (N=392 sixth graders) over a 4-year period. Lessons Learned: BCBF was well-received by students, parents, teachers, and school officials. We received numerous requests for similar interventions for younger and older youth, parent training, and implementation in St. Thomas, USVI. Process evaluation and community feedback suggested that we move to an in-school program to reduce attrition. Summative evaluation data provided evidence that the in-school approach improved retention; and significantly facilitated lower alcohol use and increased perception of risk of harm associated with substance use. Findings support targeting 6th-graders or lower given the effectiveness of BCBF. Recommendations: Expand BCBF to cover wider age ranges and schools across USVI. Supplement in-school programs with after-school boosters and cultural activities to better engage parents and enrich children's cultural heritage and positive youth development to promote healthy behaviors.