Reducing sexual risk among youth in continuation schools: Outcome results from a randomized trial

Background. Adolescents in alternative education settings are an important population for HIV/STI and pregnancy prevention interventions because they are more likely to engage in sexual risk behaviors and experience STI and pregnancy than students in mainstream schools. This paper presents the results of a randomized controlled trial that assessed the short- and longer-term impact of an HIV/STI/pregnancy prevention program, service learning, and the combination of the two intervention approaches. Methods. The interventions were evaluated using a 2 x 2 experimental design involving 47 classrooms (776 youth) from continuation schools. Classrooms were randomly assigned to one of four conditions: (1) theory-based HIV/STI and pregnancy prevention, (2) service learning, (3) HIV/STI and pregnancy prevention plus service learning, or (4) an attention control condition. Students completed 3 surveys (baseline, 6- and 18-month follow-up). Multilevel analytic models were used to adjust for correlation among students (classroom, school, and repeated measures). Results. The HIV/STI/pregnancy prevention curriculum produced several positive changes in behavior and psychosocial factors at the 6-month follow-up that attenuated by 18-months. For example, students were less likely to have intercourse without a condom in the past 3 months (p=.04) than were students in the control condition. The service learning program and combination of HIV/STI/pregnancy prevention plus service learning did not yield these significant changes. Conclusion. This study is one of a few controlled studies of HIV/STI and pregnancy prevention programs in continuation settings, and suggests the curriculum was effective in changing risk behaviors in the short term, but not the long term.