Prevention Science

, Volume 9, Issue 4, pp 311–321 | Cite as

Substance Use and Sexual Risk Prevention in Cape Town, South Africa: An Evaluation of the HealthWise Program

  • Edward A. SmithEmail author
  • Lori-Ann Palen
  • Linda L. Caldwell
  • Alan J. Flisher
  • John W. Graham
  • Catherine Mathews
  • Lisa Wegner
  • Tania Vergnani


Sexual behavior and substance use represent major threats to the health and well-being of South African adolescents, especially in light of the high prevalence of HIV infection in this population. However, there is currently a lack of evidence-based school programs designed to address health risk behaviors. The current study details the evaluation of HealthWise South Africa, a leisure, life skills, and sexuality education intervention for eighth and ninth grade students. We hypothesized that, compared to controls, HealthWise participants would have delayed sexual initiation, reduced rates of current sexual activity, increased use of and perceived access to condoms, and lower rates of lifetime and past use of multiple substances. Longitudinal data were analyzed using logistic regression of multiply imputed data. Results indicate that HealthWise was effective in increasing the perception of condom availability for both genders (OR = 1.6). As compared to HealthWise participants, control participants also had steeper increases in recent and heavy use of alcohol (OR = 1.4 [95% C.I. = 1.1–1.8], 1.6 [1.2–2.2], respectively) and recent and heavy cigarette use (OR = 1.4 [1.1–1.7], 1.4 [1.1–1.8], respectively). There were also several significant gender by treatment interactions, which are discussed. These results suggest that HealthWise is a promising approach to reducing multiple health risk behaviors among the population of school-going South African adolescents.


Adolescence Intervention Sexual behavior South Africa Substance use Adolescent substance use Adolescent sexual behavior HIV prevention 



This research was funded by NIH Grants R01 DA01749 and T32 DA017629-01A1.


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Copyright information

© Society for Prevention Research 2008

Authors and Affiliations

  • Edward A. Smith
    • 1
    • 5
    Email author
  • Lori-Ann Palen
    • 1
  • Linda L. Caldwell
    • 1
  • Alan J. Flisher
    • 2
    • 3
  • John W. Graham
    • 1
  • Catherine Mathews
    • 2
  • Lisa Wegner
    • 4
  • Tania Vergnani
    • 4
  1. 1.The Pennsylvania State UniversityState CollegeUSA
  2. 2.University of Cape TownCape TownSouth Africa
  3. 3.University of BergenBergenNorway
  4. 4.University of the Western CapeCape TownSouth Africa
  5. 5.University ParkUSA

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