Programs that Work
Making Proud Choices!
Healthy and Safe Children
Youths abstaining from sexual activity or not engaging in risky sexual behavior
Age of Child
Middle Childhood (9-12)
Type of Setting
Out of School Time
Community-Based Service Provider
Health Care Provider
Type of Service
Type of Outcome Addressed
Teen Sex / Pregnancy
Evidence Level (What does this mean?)
Making Proud Choices! (MPC) is an eight-hour, multi-module, sex decisionmaking intervention which was designed to be educational and, at the same time, entertaining and culturally sensitive. It was designed to provide young adolescents with the knowledge, confidence, and skills necessary to reduce their risk of sexually transmitted diseases (STDs), HIV, and pregnancy by abstaining from sex or using condoms if they choose to have sex. It is based on cognitive-behavioral theories, findings from focus groups, and the authors' extensive experience working with youth. It is an adaption and extension of the Be Proud! Be Responsible! (BPBR) curriculum (also listed on PPN), integrating teen pregnancy prevention in addition to the HIV/STD prevention components.
The curriculum involves group discussions, videos, games, brainstorming, experiential exercises, and skill-building activities. Participants in the program work in groups of six to eight teens and are led by a trained facilitator. The curriculum incorporates the BPBR theme, which encourages the participants to be proud of themselves and their community, to behave responsibly for the sake of themselves and their community, and to consider their goals for the future and how unhealthful behavior might impede those goals.
Adolescents in a school or after-school setting.
Jemmott et al. (1998) examined the relative effects of MPC compared with a control population that received a health promotion intervention. The participants were 659 African American adolescents recruited from 6th-grade and 7th-grade classes in three middle schools serving low-income African American communities in Philadelphia. Participation in the program was voluntary. Fifty-three percent of the sample was female, and 26.8 percent of the sample lived with both parents. At baseline, 22 percent of participants in the MPC group and 24 percent of participants in the control group reported ever having had sexual intercourse. Just over 15 percent of all the participants reported having had intercourse in the previous three months. Participants were grouped based on gender and age and randomly assigned to one of the three groups. Participants in all three groups completed pre-intervention questionnaires, questionnaires immediately following completion of the program, and questionnaires at 3-, 6-, and 12-month follow-ups. The questionnaires assessed sexual behaviors and attitudes during the previous three months.
Analyses of baseline data showed that baseline condom-use knowledge was significantly higher in the MPC group than in the control group. No other differences among groups on baseline measures of conceptual variables, sexual behavior, or demographic variables were significant. Baseline condom-use knowledge was associated with three outcome variables: attitude toward sexual intercourse, intention to have sexual intercourse, and HIV risk-reduction knowledge. Researchers used baseline condom-use knowledge as a covariate in analyses of these outcome variables to control for this incomparability across the groups.
Of the original sample, 96.5 percent completed the 3-month follow-up, 94.4 percent completed the 6-month follow-up, and 92.6 percent completed the 12-month follow-up. Attrition analysis indicated that returnees at the 3-month follow-up scored higher in pre-intervention condom beliefs than did non-returnees, indicating that they had stronger beliefs that condoms could prevent the spread of HIV and STDs as well as pregnancy when used correctly. Returnees at the 6-month follow-up scored higher in abstinence prevention beliefs and scored lower in condom-use knowledge than did non-returnees. There were no significant differences in attrition rates between the experimental and control groups.
Key Evaluation Findings
Research by Jemmott et al. (1998) found:
- At 3-months post-intervention:
- Participants in the MPC group were significantly less likely than their control counterparts (4.0 percent versus 11.6 percent) to report having had unprotected sexual intercourse in the previous three months.
- Participants in the MPC group were significantly more likely than controls to report consistent condom use (65.6 percent versus 36.1 percent of sexually active participants) and a higher frequency of condom use (4.22 versus 3.56 on a scale from 1 (never) to 5 (always)) among sexually active participants.
- At 6-months post-intervention:
- Among teens who were sexually experienced at pre-intervention, those in the MPC group reported having sexual intercourse on significantly fewer days (0.6 days) in the previous three months than the control group (4.5 days).
- MPC participants reported a significantly higher mean frequency of condom use than controls (3.99 versus 3.25 on a scale from 1 (never) to 5 (always)).
- At 12-months post-intervention:
- MPC participants reported a significantly higher mean frequency of condom use than controls (4.15 versus 3.16 on a scale from 1 (never) to 5 (always)).
- Among participants who were sexually experienced at baseline, MPC participants were significantly less likely than controls to report unprotected intercourse (9.7 percent versus 31.6 percent).
- Among teens who were sexually experienced at pre-intervention, those in the MPC group reported having sexual intercourse on significantly fewer days (1.3 days) in the previous three months control group (3.8 days).
Middle and high schools, adolescent health clinics, and youth service organizations.
Funding for initial program implementation and research was provided by the American Foundation for AIDS Research and the U.S. National Institutes of Health.
- Program materials are culturally and ethnically specific.
- Multiple methods of instruction are used to keep participants engaged in the program.
Making Proud Choices! is a safer-sex intervention. The scope and goals of this program are essentially the same as the original Be Proud! Be Responsible! curriculum. The primary difference is that the Making Proud Choices! curriculum places a heavier emphasis on safer sex than the other curricula. It is an eight-hour program designed to be implemented over multiple sessions.
All facilitators are trained in the program curriculum prior to implementation. The level of recommended training varies according to the facilitator's background in HIV/AIDS education and knowledge of teenage sexuality. The length of the training programs ranges from 16 to 24 hours. Training includes proper implementation methods, review of HIV/AIDS knowledge, and review of curriculum content. During the training sessions, facilitators participate in the experience of the curriculum as though they were students. In addition, facilitators are given an opportunity to practice their instruction skills and are provided with feedback on their performance.
The program is typically staffed by educators, community mental health workers (for example, social workers), or nurses.
Issues to Consider
This program received a "promising" rating. The 1998 study examined the impact of participation in MPC and found that while MPC does seem to decrease risky behaviors, it appears to have had a consistent and meaningful effect only on teens who were sexually active at the start of the program. Additionally, it is important to note that the MPC program designers conducted the evaluation discussed above.
The Jemmott et al. (1998) study not only compared MPC recipients with a control group but also with recipients of an abstinence-based intervention called Making a Difference!, which is an abstinence-oriented intervention. The positive outcomes from Making a Difference! were minimal and disappeared after the initial 3-month follow-up.
Philadelphia, Pennsylvania, and Trenton, New Jersey
375 Greenwich St, suite 828
New York, NY 10013
For training information, contact Lynette Gueits at 703-867-9691.
Curriculum materials are available from Select Media, Inc. Available materials include program/curriculum manual, activity sets, and program videos. Training for the program is available through the Staff Development Office of the Rocky Mountain Center for Health Promotion and Education at 303-239-6494.
Jemmott, John B. III, Loretta Sweet Jemmott, Geoffrey T. Fong, and Konstance McCaffree, "Abstinence and Safer Sex: HIV Risk-Reduction Interventions for African American Adolescents,"
Journal of the American Medical Association,
Vol. 279, No. 19, 1998, pp. 1529-1536.