Programs that Work
Be Proud! Be Responsible!
Program Info
Healthy and Safe Children
Indicators
Youths abstaining from sexual activity or not engaging in risky sexual behavior
Topic Areas
Age of Child
Middle Childhood
Adolescence
Type of Setting
Middle School
High School
Type of Service
Youth Development
Type of Outcome Improved
Physical Health
Substance Abuse
Teen Sex / Pregnancy
Evidence Level (What does this mean?)
Promising
TopProgram Overview
Be Proud! Be Responsible!, a collection of three curricula, was developed to help reduce HIV-risk-associated sexual behavior among low-income African American adolescents. The curricula -- Be Proud! (a five-hour safer-sex intervention, made up of six 50-minute modules), Making Proud Choices! (an 8-hour, multi-module, safer-sex intervention), and Making a Difference! (an 8-hour, multi-module, abstinence-based intervention) -- were designed to be educational and, at the same time, entertaining and culturally sensitive. The curricula involve 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. Each curriculum incorporates the "Be Proud! Be Responsible!" theme that 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. Each curriculum is a distinct, stand-alone unit; they need not be implemented in succession.
The interventions cover the ways in which sexually transmitted diseases (STDs), including HIV/AIDS, are spread. The various curricula have slightly different emphases, but each one covers abstinence, condom use, and the risks posed by unprotected sexual intercourse, multiple partners, vaginal intercourse, and anal intercourse (regardless of gender). The curricula aim to increase participants’ knowledge about the risks of various behaviors and educate participants on how condoms and/or abstinence can effectively be used to lower those risks. The safer-sex oriented curricula also target beliefs about the negative consequences of condom use on sexual enjoyment and work to build decision-making and interpersonal negotiation skills to increase the frequency of condom use. The curricula also work to improve self-efficacy regarding condom use -- that is, increasing one’s belief in the effectiveness of condom use and his or her ability to use a condom correctly, and the ability to convince a sexual partner to agree to use a condom when he or she originally does not want to use one. The abstinence-based curricula works to improve participants’ self-efficacy related to abstinence, in terms of believing in the effectiveness of abstinence and the ability to practice it.
Program Participants
The program has been implemented and evaluated with inner-city African American youths in their early adolescence. The mean age of program participants in evaluated implementations of the program ranged from 11.8 to 14.6 years. The program is designed to be used with adolescents through age 18.
Evaluation Methods
Three studies have evaluated the various curricula of the Be Proud! Be Responsible! program. The first study (Jemmott, Jemmott, and Fong, 1992) looked at the impact of the five-hour Be Proud! curriculum on a male African American adolescent group immediately following the completion of the intervention and at a three-month follow-up. The intervention was conducted in Philadelphia; 157 participants were recruited from among outpatients at a medical clinic (44 percent), from among students attending 10th-, 11th-, and 12th-grade assemblies at a local high school (32 percent), and from a local YMCA (24 percent). Participation in the program was voluntary. Approximately 97 percent of the participants were currently enrolled in school. The mean age of the participants was 14.6 years. The mean number of years of education of their mothers was 13.8 (as reported by the participants). The chief HIV risk to the population was from heterosexual intercourse; 33.9 percent of the participants reported having multiple partners within the previous three months, and 12.8 percent indicated that they had had heterosexual anal intercourse during that period; 20.9 percent of the respondents who had had sex within the previous three months reported that they never used a condom during that period. This data was collected via a self-reporting pre-intervention questionnaire.
Participants were grouped by age and then randomly assigned within age groups to either an experimental or control group. The experimental group received the Be Proud! intervention. The control group received a presentation that focused on career-opportunities -- the presentation that group received did not include any information on safer-sex practices or HIV prevention. The experimental and control groups were each further subdivided into small groups (14 small groups in the Be Proud! intervention and 13 small groups in the control condition), each led by a trained facilitator. Eighty-five teens were assigned to the Be Proud! intervention, and 72 teens were assigned to the control group. Participants completed post intervention questionnaires immediately following the completion of the intervention. Of the original 157 participants, 96 percent of the total population completed the follow-up. Participants were assessed on their levels of risky sexual behavior during the previous three months, their intentions toward and attitudes regarding risky sexual behavior for the next three months, and their knowledge of HIV/AIDS and STDs. These data were collected via a self-reporting questionnaire.
A second study (Jemmott et al., 1999) evaluated a replication of the five-hour Be Proud! curriculum in Trenton, New Jersey. The study sought to determine whether the intervention reduced HIV-risk-associated behaviors at three- and six- month follow-ups and whether it caused positive changes in behavioral beliefs, levels of self-confidence regarding the knowledge and ability to act to reduce HIV and STD risks, and sexual behavior intentions. In this evaluation, 496 African American males and females were randomly assigned to receive the Be Proud! HIV intervention or a general health promotion presentation that focused on behaviors associated with risk of heart disease, stroke, hypertension, and certain cancers. Participants who received the general health promotion presentation made up the control group. The participants were recruited from public schools via announcement by project staff during 7th-grade and 8th-grade assemblies and lunch periods. Participation in the program was voluntary. The mean age of participants was 13.2 years; 53.8 percent of the population was female and 100 percent of the population was African American. Prior to the intervention, 55.3 percent of the participants reported having had sexual intercourse at least once; 30.2 percent of the participants reported having had sexual intercourse within the previous three months; 17.7 percent of the participants reported ever having had anal intercourse; and 8.3 percent reported having had anal intercourse in the previous three months.
As in the 1992 study, participants in the 1999 study were grouped by age and gender and randomly assigned to treatment conditions and small groups. A total of 269 teens were assigned to the Be Proud! intervention, and 227 teens were assigned to the control group. Measurement procedures were identical to those used in the 1992 study; however, unlike in the 1992 study, the 1999 study included both three- and six-month follow-ups; 96.8 percent of the original sample completed the three-month follow-up and 92.7 percent completed the six-month follow-up. Attrition analysis indicates that there were no significant differences in attrition between the treatment and control groups. It was found, however, that those individuals not participating in the six-month follow-ups were more likely to have reported on the pre-intervention questionnaire that they had sex in the previous three months, were more likely to have reported negative beliefs that condoms interfered with sexual pleasure, and were significantly older than those who remained in the study.
A third study (Jemmott et al., 1998) examined the relative effects of an abstinence-based intervention (Making a Difference!) and a safer-sex intervention (Making Proud Choices!) compared with each other and with a control population (who 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 abstinence-based intervention group, 22 percent of participants in the safer-sex intervention, and 24 percent of participants in the control population reported ever having had sexual intercourse. Just over 15 percent of all the participants reported having had intercourse in the previous three months. As in the other studies cited here, 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. 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
The research by Jemmott, Jemmott, and Fong (1992) and Jemmott et al. (1999) found that:
- At the 3-month follow-up, teens in the experimental group as compared with their control counterparts:
- Reported engaging in less risky sexual behavior, such as unprotected sex, anal sex, or having multiple sex partners, than did their control counterparts (per the 1992 study). The 1999 study yielded no significant differences in risky sexual behaviors at the 3-month follow-up.
- Scored higher on AIDS knowledge.
- Had weaker intentions to engage in risky sexual behaviors.
- Reported greater self-efficacy regarding condom use and had more favorable prevention beliefs. The size of these effects, however, was small.
- At the 6-month follow-up:
- There were no significant differences between groups regarding their beliefs that condoms can prevent pregnancy and STDs, including HIV/AIDS.
- At 3-months post-intervention:
- Of the participants who were sexually active at pre-intervention, those in the safer-sex group were significantly less likely than their control counterparts (12.9 percent versus 42.9 percent) and were significantly less likely their counterparts in the abstinence group (12.9 percent versus 32.0 percent) to report having had unprotected sex in the previous three months.
- Among participants who were sexually inexperienced at pre-intervention, those in the abstinence group were significantly less likely to have initiated sexual activity during the previous three months. Of those who were sexually inexperienced prior to the intervention, 2.9 percent of the abstinence group had intercourse during the previous three months, as compared with 8.6 percent and 10.3 percent of the safer-sex and control groups, respectively.
- As a whole, teens in the safer-sex group were significantly less likely than teens in the control group to report having had unprotected sex during the previous three months, with 4 percent of the safer-sex group, as compared with 11.6 percent of the control group, having had unprotected sex. There was no significant difference between the safer-sex and abstinence groups or between the abstinence and control groups in the rates of unprotected sex.
- At 6-months post-intervention:
- There were no significant differences between the abstinence and control groups on any of the measures.
- Among teens who were sexually experienced at pre-intervention, those in the safer-sex group reported having sexual intercourse on significantly fewer days (0.6 days) in the previous three months than both the abstinence group (2.1 days) and control group (4.5 days).
- The safer-sex group as a whole reported using condoms significantly more frequently than the control group. On a scale of 1 (never) to 5 (always), the safer-sex group’s mean frequency of condom use score was 4.0, compared with a score of 3.3 for the control group.
- Among teens who were sexually experienced at pre-intervention, those in the safer-sex group reported having unprotected sex on significantly fewer days over the previous three months than did their counterparts in the control group, with the safer-sex group reporting a frequency of 0.3 days and the control group a frequency of 0.8 days.
- At 12-months post-intervention:
- There were no significant differences between the abstinence group and the control group on any of the measures.
- Among teens who were sexually experienced at pre-intervention, those in the safer-sex group reported having had sexual intercourse on 1.3 days in the previous three months compared with their counterparts in the abstinence and control groups, who had sex on 3.0 and 3.8 days, respectively. All groups, however, reported an increase in sexual activity from the 6-month follow-up.
- The safer-sex group as a whole reported using condoms more frequently than the control group. On a scale of 1 (never) to 5 (always), the safer-sex group’s average score was a 4.2, and the control group’s average score was 3.2. This is a significant and sizeable difference, and the reason for the difference was due to both an increase in frequency of condom use within the safer-sex group and a decrease in use among the control group.
- Teens in the safer-sex group who were sexually active at pre-intervention were significantly less likely than both the abstinence and control groups to report having unprotected sex in the previous three months (9.7 percent of the safer-sex group as compared with 32.1 percent and 31.6 percent of the abstinence and control groups, respectively). Further, the frequency (number of days) with which they had unprotected sex was significantly lower than for both the abstinence and control groups (the safer-sex group reported a frequency of 0.04, the abstinence group reported a frequency of 1.09, and the control group reported a frequency of 1.85).
Probable Implementers
Middle and high schools, adolescent health clinics, churches, and youth service organizations
Funding
Funding for initial program implementation and research was provided by the American Foundation for AIDS Research and the United States National Institutes of Health.
Implementation Detail
Program Design
- Program materials are culturally and ethnically specific.
- Multiple methods of instruction are used to keep participants engaged in the program.
There are three distinct curricula associated with the Be Proud! Be Responsible! Program. Each curriculum utilizes similar methods and activities to achieve its goals, including educational videos, role-playing, traditional lectures, group activities, and discussion groups. Materials are designed for use with inner-city adolescents and are culturally specific to the African American community. The three curricula are as follows:
- Be Proud! -- This is a five-hour, six-module program intended to increase teens’ level of knowledge regarding HIV/AIDS and other STDS, have a positive impact attitudes and intentions regarding risky sexual behaviors and condom use, to counter negative beliefs regarding condom use and sexual enjoyment, to improve self-efficacy and confidence so that teens can use prevention methods effectively, and to learn negotiation and refusal skills to help teens decrease risky sexual behaviors and situations.
- Making a Difference! -- This is an abstinence-based intervention. The scope and goals of the program are similar to those of the Be Proud! and Making Proud Choices! programs; however, rather than stressing a safer-sex approach, this curriculum advocates abstinence as the means to avoiding risky sexual behavior and focuses on STDs and pregnancy, in addition to HIV/AIDS. It is an 8-hour program designed to be implemented over multiple sessions.
- Making Proud Choices! -- This is a safer-sex intervention. The scope and goals of this program are essentially the same as the original Be Proud! and Making a Difference! curricula. The primary difference is that the Making Proud Choices! curriculum places a heavier emphasis on safer sex than the other curricula, while also promoting abstinence. It is an 8-hour program designed to be implemented over multiple sessions.
Staffing
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. Evaluations indicate that the program produced some positive results; however, the results are somewhat inconsistent. In the 1992 and 1999 evaluations of Be Proud! (which did not look separately at outcomes for individuals who were and were not sexually active at pre-intervention), the program was shown to increase the levels of knowledge regarding HIV-associated risk factors and effective prevention measures, as well as improving attitudes and intentions regarding risky sexual behavior. However, this change in knowledge and attitudes did not translate into a sustained improvement in teens' behaviors.
The 1998 study examined the impact of participation in three different types of curricula and separately examined outcomes for individuals who were and were not sexually active at pre-intervention. The study found that the results differed for these two groups. The three curricula were Be Proud!, Making Proud Choices!, and Making a Difference! Each of the three interventions produced different outcomes for individuals who were and who were not sexually active at pre-intervention. While the safer-sex intervention (Making Proud Choices!) 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. Finally, the positive outcomes from the abstinence-based intervention (Making a Difference!) are minimal and disappear after the initial three-month follow-up.
It is also important to consider that the curricula are designed to be culturally appropriate for African American adolescents and all participants in the evaluation were African American. As such, it is not clear from existing research how well the program would work with other populations and/or with more-diverse populations.
Another issue to consider is that all participants in this program were volunteers. As such, it is possible that a self-selection bias affected the outcomes; that is, the population may have been made up of individuals who were more likely to change their behaviors and/or who were more open to the message of the program. Based on these evaluations, it is not known whether the program would have had the same effects if were implemented in a non-volunteer situation, such as with all students in a school.
Finally, when considering the evaluations and outcomes, it is important to note that the program’s designers have conducted all evaluative efforts. The Be Proud! Be Responsible! curricula have not yet been evaluated by outside researchers.
Example Sites
Philadelphia, Pennsylvania and Trenton, New Jersey
Contact Information
Select Media
www.selectmedia.org
Marketing Department
375 Greenwich St, suite 828
New York, NY 10013
800-707-6334
212-941-3997 (fax)
beth@selectmedia.org or
tyree@selectmedia.org
Ordering Department
Sophie Ampel
845-774-7335
845-774-2945 (fax)
sophie@selectmedia.org
For training information contact Lynette Gueits at 703-867-9691
Available Resources
Curriculum materials are available from Select Media, Inc. Available materials include a 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.
Bibliography
Jemmott, John B. III, Loretta Sweet Jemmott, and Geoffrey T. Fong, “Reductions in HIV Risk-Associated Sexual Behaviors Among Black Male Adolescents: Effects of an AIDS Prevention Intervention,”
American Journal of Public Health,
Vol. 82, No. 3, 1992, pp. 372–377.
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.
Jemmott, John B. III, Loretta Sweet Jemmott, Geoffrey T. Fong, and Konstance McCaffree, “Reducing HIV Risk-Associated Sexual Behavior Among Africa American Adolescents: Testing the Generality of Intervention Effects,”
American Journal of Community Psychology,
Vol. 27, No. 2, 1999, pp. 161–175.
Last Reviewed
September 2003
Back to Top