Focus on Kids Intervention for Adolescents in High School to Prevent STDs/HIV Charlotte A. Gaydos, Dr.P.H. Johns Hopkins University Baltimore, Maryland

Introduction Sexually active adolescents are at increased risk for STDs and HIV High prevalences of chlamydia, gonorrhea, and trichomonas have been documented Focus on Kids (FOK) Program, reported by the CDC to be “an intervention that works”, can help reduce risk High schools with School Based Health Centers provide excellent sites for implementation of FOK, as well as STD screening

Objectives To determine whether FOK can be given in high schools during non-class time To measure reported changes in risk behavior after the FOK intervention To use urine based nucleic acid amplification tests (NAATs) to follow the success of the FOK program in students who use the SBHCs

Methods Adolescents in 9 th grade were enrolled from high schools with parental consent Wave I 5 schoolsFeb Wave II 6 schoolsSept Wave III 5 schoolsFeb FOK was administered during lunch periods in small groups for 12 weeks Anonymous 4 page survey instrument Follow-up at intervention end, 6 & 12 mo. Booster session/ STD test at 6 & 12 mo.

Methods Survey Instrument Demographics Parental monitoring Parental communication Risk taking information Relationships Sexual behavior STD/HIV knowledge Condom use Encourage sexually active teens attend SBHC Urine testing (LCR & PCR) Chlamydia, gonorrhea, trichomonas

Small group discussions

Graduation

Focus on Kids Program Community-university-linked research & intervention program Goal: to reduce risk of HIV (STD) infection among urban youth Developed by University of Maryland (Dr. Bonita Stanton) Originally conducted in recreation centers/ community

Focus on Kids Program Built on philosophy of education which provides youth Knowledge- games, role playing, communication Skills-negotiation, SODA (Stop, Option, Decide, Action) Needed to protect themselves from becoming infected Based on friendship groups Surveyed knowledge, attitudes, and risk behaviors around HIV

Results Follow-up Rates Wave I: survey 1:216 survey 2: 145(67.1%) survey 3: 75(34.7%) booster: 48(22.2%) Wave II:survey 1:221 survey 2: 146(66.1%) Wave III:survey 1:266 enrollment ongoing

Results Demographics Wave I: 207/216 youth with evaluable records 50.3% age % Female 35.5% age % Male range Wave II: 221/221 youth with evaluable records 61.3% age % Female 20.3% age % Male range 13-17

Baseline Results Sexual activity Wave I: 207/216 youth with evaluable records 43.5% sexually active (90) 59.6% >1 partner 45.7% sex >5 times/6 mo. Wave II: 221/221 youth with evaluable records 34.8% sexually active (77) 44.7% >1 partner 18.9% sex >5 times/6 mo.

Baseline Results At last sex what method used to avoid pregnancy? Wave I: 31.2% (20/64) used OCP 89.2% (74/83) used condom 31.2% (19/61) used withdrawal 18.5% (12/65) used Depo Provero Wave II:23.0% (14/61) used OCP 79.7% (59/74) used condom 25.9% (14/54) used withdrawal 16.7% (10/60) used Depo Provero

Baseline Results In the last 6 months have you been pregnant or gotten a female pregnant? Wave I: 7.0% (6/86) Wave II:6.8% (5/74) In the past 6 months, have you been told that you have a STD? Wave I: 1.3% (1/75) Wave II:6.2% (4/65)

Baseline Results Have you smoked a cigarette? Wave I: ever 40.4% (82/203) currently19.7% (40/203) Wave II:ever 35.4% (76/215) currently13.9% (30/216) Have you drunk beer, wine or any other alcoholic beverage? Wave I: ever 63.9% (129/202) currently44.5% (89/200) Wave II:ever55.4% (119/215) currently34.0% (73/215)

Baseline Results Parental Monitoring (6 questions) (Scale 1=minimum 5=maximum) Wave I: Wave II: Parent-Adolescent Communication (19 questions) (Scale 1=minimum 5=maximum) Wave I: Wave II:

Baseline Results HIV/STD Knowledge (% correct of 16 questions) Wave I: 76.7% Wave II:72.9% Condom Use Knowledge (% correct of 4 questions) Wave I: 73.9% Wave II:71.6%

Results Comparison between survey 1 and 2 Sexual activity Wave 1:119 matched pairs yes/yes49 no/yes11 yes/no12 Wave II:132 matched pairs yes/yes31 no/yes22 yes/no12

Results Comparison between survey 1 and 2 Condom Use Wave I:50 matched pairs, sexually active yes/yes34 no/yes 0 yes/no 0 Wave II:33 matched pairs, sexually active yes/yes23 no/yes 0 yes/no 0

Results STD screening data Wave I and II: Specimens from 13.2% (37/280) of females Total # of specimens: 66 Mean # of specimens: 1.8 (range 1-4) Chlamydia13.5% (5/37) Gonorrhea 8.1% (3/37) Trichomonas33.3% (3/9)

Results 6 month Booster session quiz 23 True/False questions to test STD knowledge Wave I: 48 students Mean correct score77.3% (17.8/23) Range 52.6% % 1 question 89% incorrect: “People who drink alcohol or smoke or use drugs are more likely to get an STD.”

Conclusions FOK was successfully given during lunch periods at city high schools to 9 th graders (~35- 44% sexually active) Knowledge regarding STD’s, HIV, and AIDS was fair at baseline Prevalent STDs were documented among sexually active students in the intervention groups. Very few students reported for screening Follow-up rates were less than hoped for; many students leave school after 9 th grade

Conclusions STD knowledge at the 6 mo. Booster session was encouraging Continuation of the program will increase our knowledge of how to use interventions successfully and how to monitor and prevent STDs

Collaborators Jennifer Galbraith Christine Arcari Larry White Tarik Walker Gerry Waterfield Alain Joffe Carl Latkin Bonita Stanton