Ann Arbor, Mich. -- A culturally tailored HIV-prevention program can help reduce risky sexual behaviors among Latino adolescents, even a year after students attended the training, according to a study led by University of Michigan and University of Pennsylvania researchers.
Education is needed to reverse some disturbing trends among Latino teens, said U-M nursing professor Antonia M. Villarruel, who conducted the study with John B. Jemmott III, a professor at Penn's Annenberg School of Communication and Loretta S. Jemmott, a professor at Penn's School of Nursing.
The incidence of AIDS among adult and adolescent Latinos was more than three times higher than for whites in a 2001 study. Heterosexual contact is the major mode of HIV transmission among Latino adolescents.
Latino youth are more likely than whites to have sexual intercourse before the age of 13 and multiple sexual partners, according to the national Youth Risk Behavior Surveillance System. Other studies have shown that Latino adolescents also are less likely to use condoms than African American or white adolescents.
Villarruel, who is director of the Center for Health Promotion at the U-M School of Nursing, said there is growing evidence that behavioral training, which is culturally tailored and age-appropriate, is more effective with minority adolescents.
"This study is an important contribution in assisting Latino adolescents to decrease HIV sexual risk behavior," Villarruel said. "It also gives practitioners evidence for how to guide and support adolescents in sexual decision-making."
The research involved 553 adolescents (249 males and 304 females) self-identified as Latino who were recruited from three northeast Philadelphia high schools and community-based neighborhood organizations. More than 85 percent of the participants were Puerto Rican, with nearly half born outside the mainland United States. Participants averaged 14.9 years of age and 87 percent were students in grades 8 through 11. More than 40 percent reported having engaged in sexual intercourse at least once, with an average age at first intercourse of 13.5 years.
Students participating in the study called "¡Cuidate! (Take Care of Yourself) The Latino Youth Health Promotion Program," were randomly assigned to one of two interventions. The first, a general health promotion intervention, presented Latino cultural values as an important context that supports positive health behaviors and focused on improving diet, exercise and physical activity, while reducing the use of cigarettes, alcohol and drugs.
The second intervention was the HIV-prevention program. It was adapted for Latino youths from a curriculum developed earlier by Jemmott and her research team at the University of Pennsylvania, entitled "Be Proud! Be Responsible!" This program, based on several behavioral theories, emphasizes abstinence and condom use as culturally accepted and effective methods to prevent sexually transmitted diseases, such as HIV.
Both programs were similar in length and format, consisting of six 50-minute modules delivered on two consecutive Saturdays, and including small-group discussion, videos, interactive exercises and skill-building activities.
In follow-up surveys up to a year after these programs, adolescents in the HIV intervention were less likely to report engaging in sexual intercourse, having multiple partners or having episodes of unprotected intercourse and more likely to report consistent use of condoms than adolescents in the health-promotion class. Also, adolescents in the HIV program who spoke primarily Spanish were more likely to have used a condom at last intercourse and had a greater proportion of protected sex. Students in the HIV program who were sexually inexperienced at the beginning of the study reported fewer days of unprotected sex than similar adolescents in the health-promotion program.
The study also demonstrates that addressing both abstinence and condom use within a curriculum can affect both behaviors.
"The intervention's positive effects on Latino adolescents who were Spanish language dominant or who were sexually inexperienced shows that we should be tailoring our approaches to specific populations," Villarruel said. "Much more research is needed with Latino adolescents to address the health disparity in HIV/AIDS."
The study appears in the August issue of the Archives of Pediatric and Adolescent Medicine and was supported by the National Institute of Nursing Research, a component of the National Institutes of Health.
For more information on Villarruel, visit: www.nursing.umich.edu/faculty/villarruel_antonia.html
U-M Center for Health Promotion, School of Nursing: www.nursing.umich.edu/research/chp/