Context matters: Setting-level influences on active program participation and HIV risk reduction among urban youth

Background: The organizational culture of agencies that deliver adolescent sexual health programs affects the quality of both program delivery and youth participation. The Complementary Strengths Research Partnership explores how active youth program participation in an urban setting may contribute to HIV risk reduction practices. Methods: Using community-based participatory research, three waves of data were collected from youth aged 13-17 who were enrolled in New York City after-school programs. 329 youth participated in the study (62% female; 74% heterosexual; 3% white). 93% completed follow-up surveys. We later conducted in-depth follow-up interviews with youth (n=44) and staff (n=18) in the same programs. Interview data were used to create 8 dichotomous program-level variables that described characteristics that may contribute to high-quality youth program participation (e.g., active welcome, staff stability). Data were analyzed using multilevel models. Results: Findings from this study suggest that high quality youth program participation may contribute to sustained HIV risk reduction and that setting-level factors may influence quality of participation. For example, participants in programs with lower levels (-1 SD) of program-level participation reported greater declines in risk reduction practices than participants attending programs with higher levels (+1 SD) of participation (b=-0.32, p=.005). Specific empirical findings will be presented, as well as lessons learned and recommendations for setting-level practices in adolescent HIV prevention programs. Conclusions: Measurable features of organizational culture contribute to active youth participation. Active participation is associated with more sustained adolescent HIV risk reduction practices. Setting-level intervention that foster high-quality program participation may enhance sexual health promotion efforts.