Keeping middle school students abstinent: outcomes of a primary prevention intervention

(a) To test the longer-term (6-12 month) effect of a school-based intervention designed to delay the onset of sexual intercourse on continuation of abstinence, (b) to compare the effect of the intervention when delivered by different providers, and (c) to describe the factors that influence students' transition from abstinence to sexual activity.

This study was a nonrandomized control trial with one control and three intervention groups. The setting was health education classes in urban, predominantly ethnic minority schools. The participants were middle school students (N = 1352; mean age, 13.1 years) in five schools. Of participants, 50% were African American, 20% white, 16% Hispanic, and 14% other. Youth were assigned to one of four groups. The control group consisted of the regular school health curriculum and teacher. All three intervention groups received the Rochester AIDS Prevention Project curriculum, but implemented by different types of instructors, including ethnically diverse male-female pairs of adult professional educators; male-female pairs of extensively trained high school peer educators; and school district health teachers. A confidential questionnaire administered preintervention and at long-term follow-up (mean, 44 weeks) measured demographics, risk behaviors, and sexual intercourse history.

At preintervention, 27% of girls and 62% of boys reported sexual intercourse experience. At follow-up, 19% and 32%, respectively, of the previously abstinent girls and boys had "transitioned" to sexual activity. Increasing age (p <.01, females; p <.001, males), lower socioeconomic status (p <.0001), and higher general risk behaviors (p <.0001) best predicted the transition. Logistic regression indicated that the intervention was effective for peer-taught males (p =.02) and regular teacher-taught males (p =.001) and females (p =.05).

Successful abstinence maintenance was only possible among those subjects who were not already sexually experienced at study enrollment. Baseline scores regarding intercourse and general life risks already evident by seventh grade suggest that urban, school-based primary prevention interventions must occur before adolescence. Early adolescence interventions need to include both abstinence and safer sex messages.