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Abstract

Background: Racial/ethnic-minority 9th graders are at increased risk for teen pregnancy, HIV, and STIs compared to their White peers. Yet, few effective sexual health education programs exist for this population. Purpose: To apply IM Adapt—a systematic theory- and evidence-based approach to program adaptation—to modify an effective middle school sexual health education curriculum, It’s Your Game…Keep It Real! (IYG), for racial/ethnic-minority 9th graders. Methods: Following the six steps of IM Adapt, we conducted a needs assessment to describe the health problems and risk behaviors of the new population; reviewed existing evidence-based programs; assessed the fit of IYG for the new population regarding behavioral outcomes, determinants, change methods, delivery, and implementation; modified materials and activities; planned for implementation and evaluation. Results: Needs assessment findings indicated that IYG targeted relevant health and risk behaviors for racial/ethnic-minority 9th graders but required additional focus on contraceptive use, dating violence prevention, active consent, and access to healthcare services. Behavioral outcomes and matrices of change objectives for IYG were modified accordingly. Theoretical methods and practical applications were identified to address these behavioral outcomes, and new activities developed. Youth provided input on activity modifications. School personnel guided modifications to IYG’s scope and sequence, and delivery. The adapted program, Your Game, Your Life, comprised fifteen 30-minute lessons targeting determinants of sexual behavior and healthy dating relationships. Pilot-test data from 9th graders in two urban high schools indicate promising results. Conclusion: IM Adapt provides a systematic theory- and evidence-based approach for adapting existing evidence-based sexual health education curricula for a new population whilst retaining essential elements that made the original program effective. Youth and school personnel input ensured that the adapted program was age-appropriate, culturally sensitive, and responsive to the needs of the new population. IM Adapt contributes to the limited literature on systematic approaches to program adaptation.

Key Take Away Points

  • Racial/ethnic minority 9th grade students are at high risk for HIV infection, other sexually transmitted infections, and teen pregnancy.
  • Few evidence-based sexual health education programs exist for racial/ethnic minority 9th grade students.
  • Intervention Mapping provides a useful framework to guide the adaptation of an evidence-based program for a new population and/or setting, retaining essential elements that made the original program effective.
  • Wide scale implementation of age-appropriate, culturally sensitive, school-based comprehensive sexual health education curricula, such as Your Game, Your Life, may help to reduce racial/ethnic disparities in adolescent sexual health.

Author Biography

Christine Markham, PhD, Associate Professor and Associate Department Chair of Health Promotion and Behavioral Sciences at the University of Texas Health Science Center at Houston School of Public Health and Associate Director at the Center for Health Promotion and Prevention Research, has over 25 years’ experience in adolescent sexual health research including family- and school-based programs. Melissa Peskin, PhD, Associate Professor of Health Promotion and Behavioral Sciences at the University of Texas Health Science Center at Houston School of Public Health, is an expert in the development, implementation, evaluation, and dissemination of adolescent sexual health programs. Ross Shegog, PhD, Associate Professor of Health Promotion and Behavioral Sciences at the University of Texas Health Science Center at Houston School of Public Health, is an expert in the application of instructional technology in health promotion and disease prevention to optimally impact adolescent health behavior. Paula Cuccaro, PhD, Assistant Professor of Health Promotion and Behavioral Sciences at the University of Texas Health Science Center at Houston School of Public Health, is an expert in adolescent protective and risk factors, mental health, the needs of homeless and foster care youth. Efrat Gabay, MPH, Research Coordinator at the Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, has research experience in the development, implementation, and dissemination of technology-based sexual health education programs. Kimberly Johnson-Baker, DrPH, MPH, Faculty Associate in Health Promotion and Behavioral Sciences at the University of Texas Health Science Center at Houston School of Public Health, has research expertise in sexual health disparities, dating violence prevention, and community-based participatory research involving youth as investigators. Honora Swain-Ogbonno, PhD, Faculty Associate in Health Promotion and Behavioral Sciences at the University of Texas Health Science Center at Houston School of Public Health, has research expertise in risk and protective factors for adolescent sexual health, and development of technology-based sexual health education programs. Sharon Edwards, President of The Cornerstone Consulting Group Inc., is an expert in adolescent health, strategic planning, and organizational development. She has partnered with national organizations to implement collaborative local, statewide, and national initiatives. Susan Tortolero Emery, PhD, Professor of Health Promotion and Behavioral Sciences, and Epidemiology, and Senior Associate Dean for Academic and Research Affairs at the University of Texas Health Science Center at Houston School of Public Health, has over 25 years’ experience developing, evaluating, and disseminating effective adolescent sexual health interventions.

Acknowledgements

This study was funded by Houston Endowment, Houston, TX. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Houston Endowment.

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