AMP!: A Cross-site Analysis of the Effects of a Theater-based Intervention on Adolescent Awareness, Attitudes, and Knowledge about HIV
- 516 Downloads
AMP! (Arts-based, Multiple component, Peer-education) is an HIV intervention developed for high school adolescents. AMP! uses interactive theater-based scenarios developed by trained college undergraduates to deliver messages addressing HIV/STI prevention strategies, healthy relationships, and stigma reduction towards people living with HIV/AIDS. We used a pre-test/post-test, control group study design to simultaneously assess intervention effect on ninth grade students in an urban county in California (N = 159) and a suburban county in North Carolina (N = 317). In each location, the control group received standard health education curricula delivered by teachers; the intervention group received AMP! in addition to standard health education curricula. Structural equation modeling was used to determine intervention effects. The post-test sample was 46 % male, 90 % self-identified as heterosexual, 32 % reported receiving free or reduced lunch, and 49 % White. Structural models indicated that participation in AMP! predicted higher scores on HIV knowledge (p = 0.05), HIV awareness (p = 0.01), and HIV attitudes (p = 0.05) at the post-test. Latent means comparison analyses revealed post-test scores were significantly higher than pre-test scores on HIV knowledge (p = 0.001), HIV awareness (p = 0.001), and HIV attitudes (p = 0.001). Further analyses indicated that scores rose for both groups, but the post-test scores of intervention participants were significantly higher than controls (HIV knowledge (p = 0.01), HIV awareness (p = 0.01), and HIV attitudes (p = 0.05)). Thus, AMP!’s theater-based approach shows promise for addressing multiple adolescent risk factors and attitudes concerning HIV in school settings.
KeywordsHIV prevention Adolescents Sexual health Stigma reduction
The authors would like to acknowledge Robert Gordon for his leadership in the intervention delivery at both sites. The authors would also like to thank the youth who participated in this study.
Compliance with Ethical Standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
All data were collected as part of Institutional Review Board (IRB) approved studies directed by the University of California, Los Angeles and the University of North Carolina at Chapel Hill.
Conflict of Interest
The authors declare that they have no conflict of interest.
This work was supported by a developmental grant from the University of North Carolina (UNC) at Chapel Hill Center for AIDS Research (CFAR) NIH funded program P30 AI50410, the AIDS Institute at the University of California, Los Angeles (UCLA), UCLA Center for AIDS Research (AI28697), the UCLA Clinical and Translational Science Institute, NCRR and NCATS (UL1TR000124), and National Center for Advancing Translational Sciences UCLA CTSI Grant UL1TR000124. Additional support was provided by The Ford Foundation (Grant 1120-1496), the David and Linda Shaheen Foundation, the AIDS Healthcare Foundation, and the Ueltschi course development grant from the University of North Carolina’s Center for Public Service’s APPLES Service-Learning Program. The participation of research assistant and doctoral candidate Tamara Taggart was supported by a fellowship from the National Institute of Allergy and Infectious Diseases of the National Institutes of Health (Award Number T32AI007001).
- Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
- Bentler, P. M. (2006). EQS structural equations program manual. Encino, CA: Multivariate Software, Inc.Google Scholar
- Black, D. S., Sun, P., Rohrbach, L. A., & Sussman, S. (2011). Decision-making style and gender moderation of the self-efficacy–condom use link among adolescents and young adults: Informing targeted STI/HIV prevention programs. Archives of Pediatrics & Adolescent Medicine, 165, 320–325. doi: 10.1001/archpediatrics.2011.17.CrossRefGoogle Scholar
- Brener, N. D., Kann, L., Kinchen, S. A., Grunbaum, J. A., Whalen, L., Eaton, D., Hawkins J., & Ross, J. G. (2004). Methodology of the youth risk behavior surveillance system. Recommendations and reports: Morbidity and mortality weekly report (MMWR). Centers for Disease Control & Prevention, 53, no. RR-12: 1–13.Google Scholar
- Centers for Disease Control and Prevention. (2010a). Effective HIV and STD prevention programs for youth: A summary of scientific evidence. Atlanta: US Department of Health and Human Services. Retrieved from http://www.cdc.gov/healthyyouth/sexualbehaviors/pdf/effective_hiv.pdf.Google Scholar
- Centers for Disease Control and Prevention. (2010b). Bringing high-quality HIV and STD prevention to youth in schools: CDC’s division of adolescent and school health. Atlanta: US Department of Health and Human Services. Retrieved from http://www.cdc.gov/healthyyouth/about/pdf/hivstd_prevention.pdf.Google Scholar
- Centers for Disease Control and Prevention (2012a). Trends in HIV-related risk behaviors among high school students—United States, 1991–2011. Morbidity and mortality weekly report (MMWR) 61: 556–560. Atlanta: US Department of Health and Human Services. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6129a4.htm?s_cid=mm6129a4_w.
- Centers for Disease Control and Prevention (2012b). Estimated HIV Incidence in the United States, 2007–2010. HIV Surveillance Supplemental Report, 17. Atlanta: US Department of Health and Human Services. Retrieved from: http://www.cdc.gov/hiv/library/reports/surveillance/index.html
- Centers for Disease Control and Prevention (2014). Youth risk behavior surveillance—United States 63. Atlanta, GA: Office of Surveillance, Epidemiology and Laboratory Services.Google Scholar
- Doan, A. E., & McFarlane, D. R. (2012). Saying no to abstinence-only education: An analysis of state decision-making. Publius: The Journal of Federalism, pjr052. doi: 10.1093/publius/pjr052.
- Douglas, K. (2007). Emerging answers 2007: New research findings on programs to reduce teen pregnancy—full report. Washington, DC: The National Campaign to Prevent Teen and Unplanned Pregnancy. Retrieved from https://thenationalcampaign.org/resource/emerging-answers-full-report.Google Scholar
- Fishbein, M. (1979). A theory of reasoned action. In H. Howe & M. Page (Eds.), Nebraska symposium on motivation (pp. 65–118). Lincoln: University of Nebraska Press.Google Scholar
- Fishbein, M., & Middlestadt, S. E. (1989). Using the theory of reasoned action as a framework for understanding and changing AIDS-related behaviors. In V. M. Mays, G. W. Albee, & S. F. Schneider (Eds.), Primary prevention of AIDS: Psychological approaches (pp. 93–110). California: Sage Publications.Google Scholar
- Foster, D. W., Neighbors, C., & Young, C. M. (2014). Drink refusal self-efficacy and implicit drinking identity: An evaluation of moderators of the relationship between self-awareness and drinking behavior. Addictive Behaviors, 39, 196–204. doi: 10.1016/j.addbeh.2013.09.024.CrossRefPubMedPubMedCentralGoogle Scholar
- Gavin, L. E., Catalano, R. F., David-Ferdon, C., Gloppen, K. M., & Markham, C. M. (2010). A review of positive youth development programs that promote adolescent sexual and reproductive health. Journal of Adolescent Health, 46, S75–S91. doi: 10.1016/j.jadohealth.2009.11.215.CrossRefPubMedGoogle Scholar
- Jackson, A. (Ed.). (1993). Learning through theatre: New perspectives on theatre in education. London, UK: Routledge.Google Scholar
- Jessor, R., & Jessor, S. L. (1977). Problem behavior and psychosocial development: A longitudinal study of youth. New York: Academic.Google Scholar
- Keogh-Brown, M. R., Bachmann, M. O., Shepstone, L., Hewitt, C., Howe, A., Ramsay, C. R., … & Campbell, M. J. (2007). Contamination in trials of educational interventions. Health Technology Assessment, 11. doi: 10.3310/hta11430.
- Lightfoot, A. F., Taboada, A., Taggart, T., Trang, T., & Burtaine, A. (2015). “I learned to be okay with talking about sex and safety”: Assessing the efficacy of a theater-based HIV prevention approach for adolescents in North Carolina. Sex Education. doi: 10.1080/14681811.2015.1025947.Google Scholar
- Moss, H. B., Chen, C. M., & Yi, H. Y. (2014). Early adolescent patterns of alcohol, cigarettes, and marijuana polysubstance use and young adult substance use outcomes in a nationally representative sample. Drug and Alcohol Dependence, 136, 51–62. doi: 10.1016/j.drugalcdep.2013.12.011.CrossRefPubMedGoogle Scholar
- Mustanski, B., Byck, G. R., Dymnicki, A., Sterrett, E., Henry, D., & Bolland, J. (2013). Trajectories of multiple adolescent health risk behaviors in a low-income African American population. Development and Psychopathology, 25, 1155–1169. doi: 10.1017/S0954579413000436.CrossRefPubMedPubMedCentralGoogle Scholar
- Stanton, B. F., Li, X., Kahihuata, J., Fitzgerald, A. M., Neumbo, S., Kanduuombe, G., … & Zimba, R. F. (1998). Increased protected sex and abstinence among Namibian youth following a HIV risk‐reduction intervention: A randomized, longitudinal study. AIDS, 12, 2473–2480. doi: 10.1097/00002030-199818000-00017.
- Taboada, A., Taggart, T., Holloway, I., Houpt, A., Milburn, N. G., Gordon, R., Gere, D. & Lightfoot, A. (2016). A critical review of the characteristics of theater-based HIV prevention interventions for adolescents in school settings. Health Promotion and Practice, in press.Google Scholar
- World Health Organization. (1989). Interview schedule for knowledge, attitudes, beliefs and practices on AIDS of young people. Geneva, Switzerland: World Health Organization.Google Scholar