Promoting Health Among Teens! (Abstinence Only)

In the Promoting Health Among Teens! Abstinence Only curriculum, students learn about puberty, sexually transmitted diseases (STDs), including HIV, and pregnancy prevention through a lively, interactive and student-centric curriculum, that includes talking circles, brainstorming, roleplays, DVDs, exercises and games that make learning enjoyable. The School Edition is designed to work with a classroom schedule. The intervention focuses entirely on knowledge, attitudes and skills that encourage and assist young people in implementing abstinence in their relationships.

Category	Program Features	School Edition
Setting	Community based	School based
Program Length	8 hours/year \| 1 year 8 sessions total	9 hours/year \| 1 year 12 sessions total
Age Group	Ages 12–14	Middle School
Look Inside	Table of Contents Sample Lesson BUY NOW	Table of Contents Sample Lesson BUY NOW

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Note: Ideally, young people will receive sexual health education that targets knowledge, attitudes and skills related to abstinence and safer sex practices such as condom use and contraception. However, for settings in which this approach is not permissible, an evidence-based abstinence-focused program can provide adolescents with support and strategies for choosing abstinence and resisting sexual pressures. This version of Promoting Health Among Teens! is an abstinence-only program. The lessons do not include information on condoms or other forms of birth control.

For a program that also addresses knowledge, attitudes and behaviors related to condoms and contraception, please see Promoting Health Among Teens! Comprehensive.

Overview | Description | Population | Authors

Overview

In the Promoting Health Among Teens! Abstinence Only curriculum, students learn about puberty, sexually transmitted diseases (STDs), including HIV, and pregnancy prevention through a lively, interactive and student-centric curriculum, that includes talking circles, brainstorming, roleplays, DVDs, exercises and games that make learning enjoyable. The intervention focuses entirely on knowledge, attitudes and skills that encourage and assist young people in implementing abstinence in their relationships, and does not include condom use instruction.

Description

The Promoting Health Among Teens! Abstinence Only program consists of eight 1-hour modules that give adolescents the tools they need to reduce their risk of sexually transmitted infections, including HIV, and pregnancy, and to allow them to feel comfortable abstaining from sex completely. The fun and interactive learning experiences are designed to increase participation and help young adolescents understand the kind of faulty reasoning and decision making that can lead to HIV, other STDs and pregnancy. Activities are designed to help students feel comfortable practicing abstinence, address their concerns about practicing abstinence, and provide strategies for overcoming obstacles to this practice. The School Edition consists of twelve 45-minute modules.

Learning activities focus entirely on abstinence, and include viewing culturally sensitive DVDs, playing games, brainstorming, role-playing, engaging in skill-building exercises, and small group discussions that are designed to build group cohesion and enhance the learning experience. Each activity is brief, and most are active exercises that require the participants to get up out of their chairs and interact with one another. This maintains their interest and attention in a way that lectures or lengthy group discussions do not.

Three overriding themes provide the Promoting Health Among Teens! Abstinence Only curriculum with a unique approach that has proven to be successful with young adolescents:

There is a strong emphasis on family and community, including how HIV, other STDs and teenage pregnancy affect various communities in which young people live. The importance of protecting one’s family and community is used as a motive to change individual behavior.
The importance of sexual responsibility and accountability is addressed through teaching participants to make responsible decisions regarding their sexual behavior, urging them to respect themselves and others, and stressing the importance of developing a positive self-image. Students learn that by being responsible and abstaining from sex they will be able to reach their goals and dreams.
The role of pride is key. Because adolescence is a difficult period of development, in which young people are often faced with confusion, mixed emotions and uncertainty, it is extremely important that they learn to feel good about themselves and their decision to abstain from sex. Making proud choices about abstaining from sex can actually lead teens to develop a sense of pride, self-confidence, and self-respect. The role-play exercises and other skill-building activities reinforce the many positive benefits, both psychological and physical, of practicing abstinence.

After participating in the curriculum, students will

Recognize abstinence as the best way to avoid Pregnancy and HIV/STDs.
View abstinence as a positive choice.
Recognize teen pregnancy, HIV and other STDs as obstacles to their goals and dreams.
Respond with confidence to pressures to have sex.

The Promoting Health Among Teens! Abstinence Only curriculum has four major components. The first component focuses on goals and dreams and their relationship to adolescent sexual behavior. The second emphasizes knowledge, including the causes, transmission and prevention of HIV, STDs and teen pregnancy. The third focuses on beliefs and attitudes about abstinence, HIV, STDs and pregnancy. The fourth stresses skills and self-efficacy, including negotiation-refusal skills. The curriculum also provides time for practice, reinforcement and support.

The original curriculum modules include:

Module 1: Getting to Know You and Steps to Making Your Dreams Come True
Module 2: Puberty and Adolescent Sexuality
Module 3: Making Abstinence Work for Me
Module 4: The Consequences of Sex: HIV/AIDS
Module 5: The Consequences of Sex: Sexually Transmitted Diseases
Module 6: The Consequences of Sex: Pregnancy
Module 7: Improving Sexual Choices and Negotiation
Module 8: Role-Plays: Refusal and Negotiation Skills

The School Edition curriculum modules include:

Module 1: Getting to Know You and Steps to Making Your Dreams Come True
Module 2: Goals and Dreams
Module 3: Puberty and Adolescent Sexuality: Part 1
Module 4: Puberty and Adolescent Sexuality: Part 2
Module 5: Making Abstinence Work for Me
Module 6: Consequences of Sex: HIV Infection
Module 8: The Consequences of Sex: Sexually Transmitted Diseases
Module 8: The Consequences of Sex: Pregnancy: Part 1
Module 9: The Consequences of Sex: Pregnancy: Part 2
Module 10: Improving Sexual Choices and Negotiation
Module 11: Role-Plays: Refusal and Negotiation Skills
Module 12: Building Negotiation Skills

Population Served & Setting

The target population is African-American, Hispanic and White adolescents, ages 12 to 18. Promoting Health Among Teens! Abstinence Only was designed to be used with small groups of adolescents in an urban area but can be adapted to be used with larger numbers of participants in rural areas as well. The curriculum can be implemented in various community settings, including schools or youth-serving agencies. The School Edition was designed to be used in school settings with small groups, but can be adapted for use in a myriad of settings, including after-school programs, and can be used with larger groups as well.

About the Authors

Loretta Sweet Jemmott, PhD, RN, FAAN, is one of the nation’s foremost researchers in the field of HIV/AIDS, STD and pregnancy prevention, with a consistent track record of developing evidence-based sexual risk-reduction interventions. As an expert in health promotion research, she has led the nation in understanding the psychological determinants for reducing risk-related behaviors and how best to facilitate and promote positive changes in health behaviors. Her research is devoted to designing and evaluating theory-driven, culturally competent sexual risk-reduction behavioral interventions with various populations across the globe.

An outstanding translational researcher, Dr. Jemmott’s work has had global impact and changed public policy. She has partnered with community-based organizations, including churches, clinics, barbershops and schools, and transformed her NIH-funded evidence-based research outcomes for use in real-world settings. She has presented her research to the U.S. Congress and at the NIH Consensus Development Conference on Interventions to Reduce HIV Risk Behaviors. Dr. Jemmott has received numerous awards for her significant contributions to the field of HIV/STD and pregnancy prevention research, including the U.S. Congressional Merit Award, Sigma Theta Tau National Honor Society’s Episteme Award and Hall of Fame Award, and election to membership in the Institute of Medicine, an honor accorded to very few nurses.

John B. Jemmott III, PhD, received his PhD in psychology from the Department of Psychology and Social Relations at Harvard University. He holds joint faculty appointments at the University of Pennsylvania as the Kenneth B. Clark Professor of Communication in the Annenberg School for Communication, and as Professor of Communication in Psychiatry in the Perelman School of Medicine. He is also the director of the Center for Health Behavior and Communication Research at the Annenberg School for Communication.

Dr. Jemmott is a Fellow of the Association of Psychological Science, the American Psychological Association and the Society for Behavioral Medicine. He has published more than 100 articles and book chapters, and has received numerous grants from the National Institutes of Health to conduct research designed to develop and test theory-based, contextually appropriate HIV/STD risk-reduction interventions for a variety of populations in the United States and sub-Saharan Africa.

Konstance A. McCaffree, PhD, CSE is a certified sexuality educator and adjunct professor in the Center for Education Human Sexuality Program at Widener University in Chester, Pennsylvania. As a classroom teacher in the public schools, she has taught human sexuality to both elementary and secondary students for over 35 years. Her professional association work includes serving on the Board of Directors of the Sexuality Information and Education Council of the U.S. (SIECUS), as President of the Society for the Scientific Study of Sexuality (SSSS) and as an officer in the American Association of Sexuality Education, Counselors and Therapists (AASECT). She conducts workshops nationwide to help educators improve their skills in teaching sexuality education. She also conducts programs for parents, churches and community organizations to enhance their knowledge and skills in dealing with the sexuality of children and teenagers.

In recent years, Dr. McCaffree has developed curricula and implemented training programs for educators and other health professionals in South Africa, Zambia, Nigeria and the Philippines. For the past 10 years she has trained teachers and professors to implement a curriculum she developed in coordination with local educators throughout the country of Nigeria. She has used her expertise to develop training for curricula to prevent HIV/AIDS, unplanned pregnancy, and other health and social issues among children, teenagers and adults.

Length | Elements | Staffing | Notification

Length of Program

The curriculum has 8 hours of content divided into eight 1-hour modules. The School Edition has 9 hours of content divided into twelve 45-minute modules.

Program Elements

Core intervention materials include:

Facilitator Curriculum
Activity Set (handouts, cards, posters)
Curriculum DVDs
- Tanisha and Shay
- The Subject Is: HIV (Abstinence Version)
- The Subject Is: STDs (Abstinence Version)
- The Subject Is: Puberty (Abstinence Version)
Classroom set of 30 Student Workbooks

The Promoting Health Among Teens! Abstinence Only implementation set for both editions includes the facilitator's guide, activity set, a classroom set of 30 student workbooks and 4 DVDs. The curriculum requires the use of a monitor with DVD capabilities.

Student workbooks are recommended for every student. Additional workbook sets of 5 and 30 are available.

Staffing Requirements

This curriculum is designed to be taught by classroom teachers or family life educators. Educators interested in implementing this program should be skilled in using interactive teaching methods and guiding group discussions, and should be comfortable with the program content. Educators knowledgeable about HIV/AIDS, STDs and adolescent sexuality and who have experience implementing an STD/HIV prevention curriculum with youth need approximately 6–8 hours of training that should include reviewing the curriculum, discussing various issues in the curriculum, its implementation and what is unique, different and reasons for it. In addition, selected lessons should be modeled and the participants should have an opportunity to practice them and receive feedback.

If the educators are not knowledgeable about HIV/AIDS, STDs and adolescent sexuality, and have no experience implementing an STD/HIV prevention curriculum with youth, then 24 hours of training are needed. During the training, HIV/AIDS, STD and adolescent pregnancy knowledge and prevention skills should be reviewed and reinforced. Implementation strategies, training issues and the trainees’ comfort level with adolescent sexuality should be discussed. The content of the curriculum should be reviewed and the trainer should walk the educators through the curriculum, as through they were students. A question-and-answer period should be held afterwards. Lastly, the trainee should practice the curriculum and receive performance feedback.

Parent/Guardian Notification

It is essential to inform parents and guardians regarding the nature and scheduling of this or any sexual health education program. Prior to implementation of the curriculum, families should receive written notice describing the goals of Promoting Health Among Teens! Abstinence Only and the nature of the content to be covered. Parents also should be given an opportunity to view the curriculum and related materials if they wish. The vast majority of parents want their children to receive appropriate instruction and be given the information and skills they need to protect their sexual health, but parents/guardians also must be allowed the chance to opt out or exclude their children from participating in the program, if they wish.

Theory | Logic Model | Evidence Summary | Reference

Theory

Research shows that curricula are most effective if they are based on a sound theoretical framework. The Promoting Health Among Teens! Abstinence Only curriculum draws upon three theories: The Social Cognitive Theory, The Theory of Reasoned Action, and its extension, The Theory of Planned Behavior. These theories have been shown to be of great value in understanding a wide range of health related behaviors.

There are two major concepts included in these theories: (1) self-efficacy or perceived behavioral control beliefs, which are defined as a person’s confidence in his or her ability to take part in the behavior, i.e. abstain from sex; and (2) outcome expectancies or behavioral beliefs, which are beliefs about the consequences of the behavior. Experience shows that all of the beliefs below are critically important to change behavior. The Promoting Health Among Teens! Abstinence Only School Edition curriculum addresses each of the principles, usually in more than one activity.

Two types of self-efficacy or perceived behavioral control beliefs are emphasized in the curriculum:

Practicing abstinence is easy: “I can do it”
Getting a partner to cooperate in practicing abstinence is easy: “I can do it”

Logic Model

The program logic model can be found here:

Logic Model (pdf)

Evidence Summary

Research Design

In the research study, the 8-hour curriculum was implemented in a small-group setting with African American students in grades 6 and 7 on two Saturdays in four different urban public schools. In this randomized control trial, 662 African American participants between the ages of 10 and 15, mean age 12.2 years, were stratified by gender and age and randomly assigned to receive one of five curricula: an 8-hour abstinence-only intervention, an 8-hour safer-sex-only intervention, an 8- or 12-hour combined abstinence and safer-sex intervention, or an 8-hour health-promotion control group. The adolescents received the curriculum in small groups of six to eight. The programs were facilitated by minority facilitators—one was Puerto Rican and all others were African American.

Data Gathering

The participants completed questionnaires before, immediately after and at 3, 6, 12, 18 and 24 months after the intervention. Of the original 662 participants, 98% attended at least one of the follow-ups; 95.6% attended the 3-month, 96.1% attended the 6-month, 90.3% attended the 12-month, 87.2% attended the 18-month, and 84.4% attended the 24-month follow-up. The primary outcome for the abstinence only intervention was self-report of ever having sexual intercourse by the 24-month follow up. Secondary outcomes were other self-reported sexual behaviors in the previous 3 months such as sexual intercourse, multiple partners, unprotected intercourse and consistent condom use.

Findings

The abstinence only intervention significantly reduced recent sexual intercourse. Participants who received the abstinence-only intervention were less likely to report having sexual intercourse in all follow-up sessions than the control group or the safer sex only participants. The abstinence only curriculum reduced the sexual initiation among participants.

The participants who received the Promoting Health Among Teens! Abstinence Only intervention curriculum also reported:

A reduction in the incidence of recent sexual intercourse over the past 3 months at the 3-, 6-, 12-, 18- and 24-month follow-ups.
A significant reduction in sexual initiation by the 24-month follow-up (33.5% in the abstinence-only intervention as compared to 48.5% in the control group).

The curriculum delayed sexual experience among virgins. Among the participants who reported no previous sexual experience at the baseline, the students who received the Promoting Health Among Teens! Abstinence-Only intervention were less likely to report having sexual intercourse at the 3-month follow up than those in the control group.

In addition, the adolescents who received the Promoting Health Among Teens! Abstinence-Only intervention believed more strongly that practicing abstinence would prevent pregnancy and AIDS, expressed less favorable attitudes toward sexual intercourse, and reported weaker intentions of having sexual intercourse over the next 3 months than did those in the control group. Adolescents who received the intervention also believed more strongly that practicing abstinence would help them achieve their career goals than did those in the control group.

Reference

Jemmott, J. B., Jemmott, L. S., & Fong, G.T. (2009). Efficacy of a theory-based abstinence-only intervention over 24 months: A randomized control trial with young adolescents. Archives of Pediatrics and Adolescent Medicine, 164 (2): 152–159.

General Adaptation Guidance | Fidelity Log | Pre/Post Tests | Policy

Adaptation Guidance

ETR is a leader in developing adaptation guidelines to enable professionals to adapt evidence-based intervention programs for implementation in underserved communities, while maintaining fidelity to the intervention's core components. ETR works with program developers to ensure that these tools are of the highest quality and meet the different needs of the field and end users, e.g., teachers, trainers, program mangers/staff, research teams, and funders.

See ETR’s General Adaptation Guidance

For answers to Frequently Asked Questions about program adaptations, please visit our Program Support Help Desk.

Read ETR's Adaptations Policy.

Fidelity Log

Click the link below for the log for Promoting Health Among Teens! Abstinence Only.

Promoting Health Among Teens! Abstinence Only Facilitator Log Sheets (pdf)

Pre/Post Tests

Classroom teachers can use pre/post tests to examine whether short-term knowledge learning objectives have been met. A simple pretest-posttest assessment design can be used to measure pre-instruction levels and post-instruction changes in student learning. The sample pre-test provided here is from the research study and gathers demographic data on participants in addition to assessing attitudes and sexual health knowledge. (Please note that the questionnaire from the research study includes questions about safer sex practices as well as abstinence.)

Your ability to detect student change using this survey may vary and can be affected by numerous factors (e.g., number and content of lessons students receive, student scores at pretest, student motivation and interest in topic and survey, etc.) Improvement between pretest and posttest can be viewed as supportive, but not definitive, evidence of the curriculum's impact on short-term knowledge learning objectives. A well-designed evaluation study (e.g., using a strong experimental design with a well-matched comparison group and adequate sample size) with more extensive measurement would be needed to provide stronger evidence of curriculum impact.

Note: The pre/post test for Promoting Health Among Teens was used in the study in which both the comprehensive and abstinence-only versions of the program were studied. Therefore, the survey includes questions about condoms and condom use. Abstinence-only sites may want to edit this survey before using it for their programs.

Promoting Health Among Teens (Comprehensive) Pre- and Post-Questionnaire (pdf)

Promoting Health Among Teens (Comprehensive) Pre- and Post-Questionnaire Key (for Section E) (pdf)

Learn more about how ETR can help with your evaluation needs >>

NOTE: Due to Covid-19, ETR is offering our Trainings in a virtual format only at this time. The virutal training addresses both in-person and online implementation of the program and our trainers will model the virtual delivery of activities. See the Training Calendar.

Training of Educators (TOE)

For over 30 years, ETR has been building the capacity of community-based organizations, schools, school districts, and state, county and local agencies in all 50 states and 7 U.S. territories to implement and replicate evidenced-based programs (EBPs) to prevent teen pregnancy, STD/STI and HIV. Our nationally recognized training and research teams work in partnership with clients to customize training and technical assistance (TA) to address the needs of their agencies and funding requirements.

ETR’s Virtual Training of Educators (TOE) for Promoting Health Among Teens! Abstinence Only equips sexual health facilitators with the knowledge and skills necessary to implement the program with youth.

All trainings align with ETR’s distributive learning process, an interactive experience that takes place over time. Core to this research-based approach is the acquisition of knowledge and development of skills, followed by the implementation of the program and educator self-reflection. During this process, ETR trainers engage learners through teaching strategies, interactive activities, modeling and follow-up support.

Training Components

All of the following components are critical for skill development and implementation success. Make sure you can commit about 10 hours of total time to the training experience for program excellence!

Priming Activities: Learn more about the theories that ground the curriculum and the research that highlights the program’s impact on the sexual health behaviors of youth. These activities, completed prior to Live Session 1, will help to get you acquainted with your program.
Live Sessions: Most of the learning happens live. Over the course of three 2.5 hour sessions spread out over three weeks, our experienced trainers will take you through the curriculum and help develop skills necessary to deliver Promoting Health Among Teens! Abstinence Only. The trainer will model best practices for implementation, build comfort with the subject matter, and tackle a variety of implementation challenges and strategies.
Intersession Activities: Between each live session, guided intersession activities will help participants to keep thinking about their evidence-based program and it’s implementation to continue the learning.
Practice Session: After the live sessions are over, it’s time to see what you know! A practice session, or teach-back, will be assigned to each participant and various opportunities for feedback will be provided.
Follow-up Support: The training is only the beginning. We offer follow-up support for the first three months after training, including additional resources and check-ins via email.

Training Goal

Educators will have the knowledge, skills and confidence to effectively implement the program with youth.