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Am Fam Physician. 2002;65(7):1463

Adolescents continue to have a high incidence of sexually transmitted diseases and unintended pregnancies despite many efforts directed at the prevention of risky sexual behavior. The use of primary prevention is the best strategy to reduce the prevalence of risky behavior in this population. The Rochester AIDS Prevention Project for Youth (RAPP) was developed in an attempt to provide adolescents with knowledge that might reduce these behaviors. A previous short-term study demonstrated that the RAPP program not only improved knowledge but also increased intentions to behave in sexually safer ways. Siegel and colleagues evaluated the longer-term effect of a middle-school and a high-school RAPP intervention on knowledge, self-efficacy (how hard or easy to carry out behaviors in relation to sexuality), behavior intention, and behaviors.

The study consisted of three intervention groups and one control group. The first intervention group received the RAPP curriculum implemented by an adult RAPP educator during the health education curriculum. The second intervention group used RAPP peer educators—high-school students who had received extensive RAPP training. The third intervention group was the RAPP program taught by regular health teachers during middle school. The participants were middle-school and high-school students enrolled in health classes at 10 urban schools. The main outcomes were measured by a confidential questionnaire that measured knowledge, self-efficacy behavior intention, and behaviors, including onset of sexual intercourse experience and engagement in risky sexual behaviors. The questionnaire was administered at baseline and repeated approximately 41 weeks after the start of the study.

Long-term knowledge and self-efficacy scores were significantly higher in the intervention groups than in the control group. The intention to remain safe in sexual behavior was also greater in the intervention groups in the middle-school students, but there was no difference in the high-school students. Students who were already sexually active at the time of the intervention were less likely to show any positive benefit from the RAPP intervention. The group most likely to benefit from the RAPP intervention consisted of female middle-school students.

The authors conclude that the RAPP program had a longer-term positive effect on adolescents' risky sexual behavior, particularly adolescents who were not yet sexually active at the start of the study. The authors also state that it appears that the best time for intervention with the RAPP program is in early adolescence, before the onset of risky sexual behaviors.

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Copyright © 2002 by the American Academy of Family Physicians.

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