Programs that Work
Be Proud! Be Responsible!
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
Community-Based Service Provider
Health Care Provider
Type of Service
Type of Outcome Addressed
Teen Sex / Pregnancy
Evidence Level (What does this mean?)
Be Proud! Be Responsible! (BPBR, alternatively called Be Proud!) is a five-hour sex-decisionmaking intervention, made up of six 50-minute modules, typically delivered over the course of one day. The goal of the curriculum is to help adolescents change behaviors that put them at risk of transmitting HIV and other sexually transmitted diseases (STDs). To accomplish this, the curriculum is intended to delay the initiation of sex, reduce the frequency of unprotected sex, and support young people in their making responsible decisions about their own sexual behaviors.
The intervention covers the ways in which STDs, including HIV/AIDS, are spread. It also covers condom use and the risks posed by unprotected sexual intercourse, multiple partners, vaginal intercourse, and anal intercourse (regardless of gender). The curriculum aims to increase participants' knowledge about the risks of various behaviors and educate participants on how condoms can effectively be used to lower those risks. The BPBR curriculum also targets beliefs about the negative consequences of condom use on sexual enjoyment and works to build decisionmaking and interpersonal negotiation skills to increase the frequency of condom use. The curriculum also attempts to improve self-efficacy regarding condom use—that is, increasing adolescents' belief in the effectiveness of condom use, their ability to use a condom correctly, and their ability to convince a sexual partner to agree to use a condom when he or she originally does not want to use one.
Each module incorporates a 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. 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 and are led by a trained facilitator.
Be Proud! Be Responsible! is also an umbrella term for a collection of three curricula: the original BPBR curriculum described above, Making Proud Choices! (an eight-hour, multi-module, safer-sex intervention), and Making a Difference! (an eight-hour, multi-module, abstinence-based intervention). Each curriculum is a distinct, stand-alone unit; they need not be implemented in succession. In this summary, we use the term Be Proud! Be Responsible! to refer to the six-module safer-sex intervention only, and not the other curricula. Please see the PPN summary of Making Proud Choices! for more information on that curriculum.
Adolescents in a school setting.
Four evaluations of the BPBR curriculum meet the PPN evidence criteria.
The first study (Jemmott, Jemmott, and Fong, 1992) looked at the impact of the one-day, five-hour BPBR 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 any type of sexual intercourse within the previous three months reported that they never used a condom during that period. These data were 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 BPBR intervention. The control group received a presentation that focused on career opportunities and 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 BPBR intervention and 13 small groups in the control condition), each led by a trained facilitator. Eighty-five teens were assigned to the BPBR 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 BPBR curriculum in Trenton, New Jersey. In this evaluation, 496 African American males and females were randomly assigned to receive the BPBR 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- 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 vaginal intercourse at least once; 30.2 percent of the participants reported having had vaginal 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 BPBR 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.
The third study (Borawski et al., 2009) examined the effects of the BPBR curriculum implemented in five Midwestern schools compared with five matched schools. Schools were matched on location (inner suburb, outer suburb, inner city), percentage of families below the Federal Poverty Line, and the racial composition of student body. Matched pairs of schools were then assigned to the Be Proud! or control conditions based on a coin flip. The intervention participants were 631 9th- and 10th-grade students from five schools, and the control participants included 726 9th- and 10th-grade students from five schools. There were significant differences in demographic features between the intervention and control groups at baseline, which were controlled for in analyses. These differences included the following:
- Treatment group was more likely to be female (55 versus 48 percent).
- Treatment group was more likely to be Hispanic (17 versus 7 percent).
- Treatment group had more neighborhood households in poverty (16 versus 14 percent).
There were no differences in history of sexual intercourse or condom use at baseline. Participants in both groups completed baseline (pre-intervention) questionnaires, questionnaires immediately following completion of the program, and questionnaires at 4- and 12-month follow-ups. Questionnaires assessed the following: (1) knowledge of proper condom use and HIV and other STDs, (2) efficacy, including impulse control, condom negotiation skills, and condom technical skills, (3) beliefs about condom use, including utility, pleasure when using a condom, and the fact that condoms prevent STDs, (4) perceived peer beliefs about the acceptability of sexual activity and condom use, (5) intentions of having sex in the next three or 12 months, and (6) ever had vaginal intercourse and frequency of vaginal intercourse. Clustering of outcomes at the school level was accounted for in analysis.
A final study (Jemmott et al., 2010) examined the implementation of BPBRs among community-based organizations (CBOs) in New Jersey and Philadelphia. Eighty-six CBOs were eligible and agreed to participate in the trial. Selected CBOs served predominately African-American adolescents ages 13-18. Half of participating CBOs were assigned to implement six intervention groups in which they were to deliver the BPBR curriculum. The other half implemented at least six intervention groups involving general health promotion. A total of 1,707 youth were involved across all CBOs, 90 percent of whom were African-American, with a mean age of 14.8 years. Surveys were administered at baseline; immediately after the intervention; and three, six, and 12 months after the intervention. The study assessed self-reported condom use (consistent use, frequency, at last sexual encounter) and frequency of intercourse. Study authors controlled for clustering within CBOs in their analyses for the 12-month follow-up.
Key Evaluation Findings
Jemmott, Jemmott, and Fong (1992) found the following at the three-month follow-up (adjusting for differences in the groups at baseline):
- Total days of sexual intercourse in past three months was significantly lower in the treatment group than the control group (2.15 versus 5.48 days), as was the percentage of treatment group participants having any sexual intercourse in the past three months (48 versus 60 percent).
- Total number of sexual partners in the past three months was significantly lower in the treatment group than the control group (0.85 versus 1.79 partners).
- Frequency of condom use was higher in the treatment group than the control group (4.35 versus 3.50, on a five-point scale).
Jemmott et al. (1999) found the following:
- At the three-month follow-up:
- Participants who received the intervention scored higher on HIV risk-reduction knowledge, expressed more favorable prevention beliefs and hedonistic beliefs, and expressed greater self-efficacy and stronger condom use intentions than the participants in the control group.
- There was no significant difference across groups on subjective norms regarding condoms.
- There were no significant differences on any of the risky sexual behaviors measured.
- At the six-month follow-up:
- BPBR participants scored lower on HIV risk-associated sexual behaviors, higher on HIV risk-reduction knowledge, and expressed more favorable hedonistic beliefs, greater self-efficacy, and greater intentions to use condoms than participants in the control group.
- Treatment participants reported a lower frequency of unprotected sexual intercourse than those in the control group (47 versus 70 percent of sexual acts unprotected).
- The percentage of adolescents who reported engaging in any anal intercourse in the previous three months was significantly lower in the BPBR group than in the control group (3 versus 10 percent).
- There were no significant differences between treatment and control groups in prevention beliefs.
- There was no significant difference across groups on subjective norms regarding condoms.
- There were no significant differences between groups regarding their beliefs that condoms can prevent pregnancy and STDs, including HIV/AIDS.
Borawski et al. (2009) found the following:
- Immediately following the intervention:
- Knowledge of proper condom use was significantly higher in the treatment group than in the control group (4.06 versus 2.83 on a seven-point scale).
- Knowledge of HIV and other STDs was significantly higher in the treatment group than in the control group (5.24 versus 4.81 on seven-point scale).
- Impulse control was significantly higher in the treatment group (3.95 versus 3.84 on a five-point scale).
- Condom negotiation skills were significantly higher in the treatment group (4.13 versus 3.98 on a five-point scale).
- Condom technical skills were significantly higher in the treatment group (4.30 versus 3.99 on a five-point scale).
- Beliefs in condom use were significantly higher in the treatment group (3.42 versus 3.16 on a five-point scale).
- Intentions to use a condom were significantly higher in the treatment group (3.42 versus 3.16 on a five-point scale).
- At the four-month follow-up:
- Knowledge of proper condom use was significantly higher in the treatment group than in the control group (4.14 versus 3.44 on a seven-point scale).
- Knowledge of HIV and other STDs was significantly higher in the treatment group than in the control group (5.07 versus 4.88 on a seven-point scale).
- Condom negotiation skills were significantly higher in the treatment group (4.05 versus 3.93 on a five-point scale).
- Condom technical skills were significantly higher in the treatment group (4.23 versus 4.06 on a five-point scale).
- Beliefs in condom use were significantly higher in the treatment group (4.68 versus 4.59 on a five-point scale).
- Intentions to have sex were significantly lower in the treatment group (3.08 versus 3.20 on a five-point scale).
- At the 12-month follow-up:
- Knowledge of proper condom use was significantly higher in the treatment group (4.18 versus 3.64 on a seven-point scale).
- Knowledge of HIV and other STDs was significantly higher in the treatment group (5.13 versus 4.96 on a seven-point scale).
- Impulse control was significantly higher in the treatment group (3.99 versus 3.87)
- Perceptions of peer acceptance of sexual activity was lower in the treatment group (2.97 versus 3.11 on a five-point scale).
- Sexual behaviors (sexual initiation, frequency of intercourse, and condom use) were not significantly different between treatment and control groups at any of the follow-ups.
Jemmott et al. (2010) found that, at the 12-month follow-up:
- The treatment group reported significantly higher consistent condom use (use of a condom during every sexual act) than the control group (56 versus 50 percent).
- The percentage of sexual acts that were condom-protected was significantly higher in the treatment group than in the control group (73 versus 69 percent).
- Condom use at last sexual encounter was significantly higher in the treatment group than in the control group (70.9 versus 71.8 percent).
- There were no significant differences in frequency of sexual intercourse or self-rated frequency of condom use on a five-point scale.
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.
BPBR (also called Be Proud!) is a five-hour, six-module program intended to increase teens' level of knowledge regarding HIV/AIDS and other STDS, to have a positive impact on 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 impart negotiation and refusal skills to help teens decrease risky sexual behaviors and situations.
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. Evaluations indicate that the program produced some positive results; however, the results are somewhat inconsistent. In the 1992, 1999, and 2009 evaluations of Be Proud!, 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 2010 evaluation did show sustained effects at 12-month follow-up; however, the effects were not large enough to receive a "proven" rating.
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.
Borawski, Elaine A., Erika S. Trapl, Kimberly Adams-Tufts, Laura L. Kayman, Meredith A. Goodwin, and Loren D. Lovegreen, "Taking Be Proud! Be Responsible! to the Suburbs: A Replication Study,"
Perspectives on Sexual and Reproductive Health,
Vol. 41, No. 1, 2009, pp. 12-22.
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 Knashawn H Morales, "Effectiveness of an HIV/STD Risk-Reduction Intervention for Adolescents When Implemented by Community-Based Organizations: A Cluster-Randomized Controlled Trial," American Journal of Public Health, Vol. 100, No. 4, 2010, pp. 720-726.
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.