Reducing Risk among Highly Vulnerable Youth

DESCRIPTION (provided by applicant): Minority group inner-city adolescents are at particular risk for acquiring HIV/STDs. Interventions based on Social Cognitive theories have been successful in reducing risk, but the magnitude of effects has been small. We propose to evaluate the efficacy of "It Takes Two" (IT2) for highly vulnerable inner-city minority-group sexually experienced adolescents 14-17 years of age, in reducing risk for HIV/STDs. IT2 is based on modified versions of theories of Social Competency and Social Learning, and incorporates six innovations; it: (1) targets sexually experienced youth; (2) uses structural rebound as a delivery system; (3) is more intensive than most risk reduction programs at 50 contact hours; (4) teaches how gender norms increase sexual risk; (5) addresses how relationship beliefs interfere with condom use; (6) addresses the distinction between a general intention to use condoms and "partner-specific intention". IT2 has two parts: (1) a paid 13-session training program that provides and knowledge/skills about sexual risk reduction, and sessions on gender norms, relationships and risk; and (2) a paid internship for 7 weeks working 4-6 hours per week as "experts" on teen sexual behavior. In the internship, teens become part of our program effort; they design and produce their own video messages to help other teens recognize gender and relationship as risks for unsafe sexual behavior. We propose a two-group intent-to-treat randomized controlled trial involving 400 minority group inner-city adolescents recruited from Montefiore Medical Center (200 per group). IT2 will be compared to an attention control, TEEN, our award-winning peer counseling program that has been shown to increase self-esteem and reduce psychological distress in adolescents. This "attention" control is as intensive as IT2 but does not include any discussion of substance use or sexual risk. Teenagers will be interviewed four times: baseline; T2 (6 months post-baseline, when the IT2 and TEEN programs are completed); T3 (one year after baseline) and T4 (18 months post baseline) to assess longer-term program effects.