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The proposed research is aimed at increasing understanding of the relationships among sensation seeking and decision-making processes, alcohol use, and risky behaviors in adolescents. Drawing upon previous research into these processes, we propose to develop and test more effective mass media and school-based interventions. The proposed research will examine the joint relationship of sensation-seeking (i.e., seeking out situations) and impulsive decision-making (i.e., making quick decisions once in a situation, based on factors that may not be "rational") with risk-taking in association with alcohol and other drug use. Based, on our previous research, we expect that high school-age students who are high on sensation-seeking and impulsive decision-makers (HSS/IDM) will be particularly difficult to reach using conventional skills-based classroom curricula. These curricula are based on models of rational decision-making and do not sufficiently focus on the role of alcohol, or on alternate activities to replace those to be reduced or eliminated. The curricula may also not be sufficiently fast-paced and novel to hold the high sensation seeker's attention. Thus, we propose to develop a radio-based media campaign with messages targeted to HSS/IDM individuals to increase their interest in the school-based program before the beginning of and during the implementation of the curriculum. We also propose to enhance the school-based curriculum to meet the special sensation-seeking and decision-making needs of the HSS/IDM individuals, both in terms of their likely behaviors as HSS/IDM individuals and in the method of presentation itself. The enhanced version will include greater novelty, more involvement, and a faster pace. The intervention will occur within an experimental design over a three-year period in school systems in Louisville, Kentucky and Cleveland, Ohio. It will consist of the main intervention in the first year and booster interventions within the second and third years, to augment the impact of the intervention. Multiple follow-up assessments will occur during the three-year time interval in order to measure the impact of media and classroom-based interventions both independently and jointly. Specific aims of the proposed project are to: delineate more precisely how alcohol use, sensation-seeking, impulsive decision-making, and risky behaviors are related among high school-aged adolescents, and assess the importance of relevant social and psychological mediating variables; develop, via focus and reaction groups, radio public service announcements (PSAs) and an enhanced version of a skills-based classroom intervention that will attract the attention of and increase the salience of HIV for HSS/IDM adolescents; and to assess the joint impact of a radio campaign and an enhanced skill-focused classroom-based HIV intervention on perceived risk of HIV, behavioral intentions, and alcohol use with risk-taking behaviors.
The proposed project will develop, implement, and evaluate an alcohol and HIV prevention curriculum and school-based small media campaign for teens in public schools in South Africa. The curriculum will be based in part on the "Amazing Alternatives" alcohol prevention curriculum, designed as part of Project Northland and evaluated to be successful at delaying the initiation of alcohol use of both in U.S. and in several developing countries, including Swaziland. The curriculum will also be based in part on the "Modified Reducing the Risk" curriculum, a skills-based HIV and pregnancy prevention curriculum, adapted to be more interactive and successful with high sensation seekers and impulsive decision-makers, and evaluated to be successful at delaying the initiation of sexual activity in multiple U.S. samples of students. The small media campaign will be focused in the students' schools and will continue themes developed in the curriculum, using posters, games and contests, comic books and newspapers, videos, and other media determined to be most likely to succeed in the South African setting. The proposed project draws from and extends our current, exploratory HIV and substance abuse prevention study, now underway in several township secondary schools in KwaZulu-Natal Province, Pietermaritzburg area. During Years 2-5 we will recruit two cohorts of 8th or 9th grade students who will be followed for two school years each. Eight schools will be randomized to the intervention or comparison curriculum conditions; each school will be randomized to receive the small media intervention during the first or second cohort. For each cohort, during the first school year (Years 2 & 4), the alcohol and HIV prevention curriculum will be implemented in intervention curriculum schools; during the second school year (Years 3 & 5), the small media campaign will be implemented in small media schools. With this experimental design, we will assess the effectiveness (including simple and joint effects) of both a new alcohol and HIV prevention curriculum and a school-based small media campaign for South African students. We will also further investigate the relationships among social psychological mediating variables, individual difference variables, and alcohol and sexual risk-taking behaviors.
The research proposed here will replicate two established interventions-Reducing the Risk (RTR), a social learning-based, skills-focused school HIV and pregnancy prevention school curriculum which is among a small number supported by the Centers for Disease Control, and a media campaign based on principles from a highly-successful program developed by one of the investigators and associates which were adopted as part of the model for the multi-year national media campaign currently being conducted by the Office of National Drug Control Policy. The interventions, which have been shown in published studies to be effective in urban areas with a general population of adolescents, will be applied to adolescents in rural areas and small towns in an economically-depressed Appalachian region, an area of generally lower incomes, higher unemployment, and poorer health. Particularly targeted will be high sensation-seekers and impulsive decision-makers, groups that the investigators have established in previous research are considerably more likely to engage in HIV-related sexual behaviors. Versions of the interventions, based on our previous work, will be specifically adapted to be successful with these high-risk groups. The project will involve formative research during the first year of the study to adapt and pretest the interventions followed by experimental interventions in which cohorts of ninth graders receive either no skills-based curriculum (the comparison group), the standard RTR curriculum, or an enhanced version of the RTR curriculum featuring more novel presentations and interactive projects. One of the enhanced versions also will include an HIV+ speaker and another will include peer leader participation. Students in half of the communities will receive a media campaign during Years 2 and 3 (first cohort) and half will receive the media campaign during Years 4 and 5 (second cohort). Each cohort will receive a 10-15 class intervention the first year and a 4-5 session booster intervention the second year. All interventions will have as their goals prolonging sexual abstinence, increasing condom use, reducing the number of partners, and reducing substance use with sex. An estimated 6552 ninth grade students in the two cohorts will be measured at baseline and at two follow-up intervals to assess the impact of the interventions on skills, behavioral intentions, and sexual risk-taking behaviors. The proposal involves a randomized design which includes individual, school, and community levels, to be assessed through hierarchical linear modeling, structural equation modeling, and repeated measures MANCOVA.
This proposed study represents an extension of two successful NIH-funded research programs on improving effectiveness of mass media risk reduction campaigns and on developing school- and media-based HIV prevention strategies at that reduce the sexual risk-taking behavior of individuals predisposed to high levels of risk-taking. This study will provide a stringent and externally valid test of highly promising strategies for increasing the persuasive effectiveness of television and radio public service announcements (PSAs) in the arena of HIV and other STI prevention. These strategies revolve around the effective design and targeting of PSAs to reach individuals who are high sensation seekers and/or are impulsive decision-makers. Sensation seeking, a trait characterized by novelty seeking and risk taking, is related to use of a variety of risk-taking behaviors and is related to distinct preferences for novel and arousing messages. Impulsive decision-making, a trait characterized by high levels of disinhibition and affective as opposed to cognitive processing, has also been found to be related to sexual risk-taking in a variety of ways. This study will examine the effectiveness of intensive radio and television campaigns in persuading young adults to increase condom use. It will involve a field experiment in two comparable top 75 Nielsen markets and will employ an innovative and methodologically rigorous controlled time-series design. The study will employ 3 high saturation 3-month TV and radio PSA campaigns(2 in one community and 1 in the other) focusing on condom use, with extensive pre- and post-campaign periods. Over the 33-month assessment period, the study will monitor PSA exposure, condom use, condom use attitudes, self-efficacy, perceived norms, intentions, as well as individual difference variables (particularly sensation seeking and impulsive decision- making), through interviews with monthly random samples from young adult cohorts in the two communities. The principal objectives of the study are: 1) to test the ability of a combined television and radio PSA prevention campaign, employing new and promising strategies for targeting, formative research, message design, and placement, to reach at-risk young adults with HIV and other STI prevention messages (i.e., focusing on safer sex); 2) to provide a controlled longitudinal test of the ability of such a campaign to produce significant changes in attitudes, beliefs, self-efficacy, perceived norms, and behaviors related to sexual risk-taking; 3) to explore the ability of a booster (or follow- up) campaign to enhance or sustain the impact of a previous campaign; and 4) to explore the roles of sensation seeking and impulsive decision-making in mediating the effects of HIV and other STI-related PSAs on condom-related attitudes, beliefs, self-efficacy, perceived norms, and behaviors.
While a number of HIV prevention programs have been evaluated in school settings, much of the focus of this research has been the content of the curriculum; as a result, we still know little about the specific facets of the classroom environment that may yield the strongest effects of an effective school-based FHV, other STD, and pregnancy prevention curriculum. In the proposed research, we plan to bring together expertise from our research in health communications and our research in classroom instruction, combining Donohew's individual differences model of information exposure with Eccles' stage-environment fit theory to assess the impact of curricular, teacher, instructional and student individual difference variables on HIV-related mediating and outcome variables while developing an effective prevention program. Specific aims of the project are, within a randomized control trial in high school health classrooms, to (1) adapt a modified version of a skills-based, MV, other STD, and pregnancy-prevention curriculum to be more appropriate for the needs of impulsive decision makers, in order to bring about desired behavior change in sexual decision-making; (2) assess the impact of characteristics of the instructional environment in health classrooms (i.e., teacher efficacy, teacher immediacy, value orientation, and teacher identity) in order to identify effective instructional methods and teacher characteristics; (3) implement reinforcement and relevance of the curriculum across other classes and content areas in order to foster more effective learning of the material; and 4) Evaluate the interaction among the student, the teacher, and the curriculum to determine optimal learning environments that lead to sustained behavior change. The proposed study, including over 5,000 students and 10-12 schools, will be conducted over a period of five years. During the first three years, six separate intervention implementation studies will occur (two consecutive interventions per year), with the design for five of the six intervention studies as experimental, with randomization occurring by school. In Years 4 and 5, we will also examine the effects of a combined "best practices" classroom based intervention by comparing two groups of students randomized by schools: a comparison condition, with a skills-based HIV/pregnancy prevention curriculum or the optimal version that contains the most successful elements tested in the three preceding years. The analytic design will include individual, classroom, teacher, and school levels, to be assessed through hierarchical linear modeling or other tests of differences. |
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