Melissa Peskin, Ph.D. - US grants

DESCRIPTION (provided by applicant): Web-Based Middle School HIV Prevention Curricula: Aspiring for Reach &Impact Early adolescent sexual behavior is a significant public health problem in the U.S. Few programs, however, have proven effective in delaying sexual behavior among middle school students, and many have limited potential for wide-scale dissemination. This investigative team has developed and evaluated a new HIV, STI and pregnancy prevention classroom and computer-based program, entitled It's Your Game...Keep it Real (IYG). We found IYG to be effective in delaying sexual initiation among youth after long term follow-up. This evaluation was based on student's participation in both the classroom and computer-based components. To increase its dissemination potential, determining the relative long-term effectiveness of the computer-based component as a standalone curriculum has become an important next step in the field, as this examines additional avenues for prevention. We recently converted all of the IYG computer activities to an Internet-based platform. An Internet version of the IYG computer-based component incorporates technological advances and the appeal of the Internet for youth, which may have the potential to bolster effects, improve lesson fidelity, and facilitate dissemination in a cost-effective manner. In a small pilot study of this Internet program, students exposed to the program were more likely to report positive effects on psychosocial factors related to risky sexual behavior. These findings need to be replicated in a larger trial;thus, this 3-year study proposes to evaluate this Internet-based HIV, sexually transmitted infection (STI), and pregnancy prevention curriculum as a standalone intervention for middle school students in a large urban school district. A randomized two-arm nested design will be conducted with 1,600 middle school students where schools receiving the Internet-based curriculum (n=7 schools) will be compared with comparison schools receiving usual care (n=7). This study builds on extensive prior research in this domain and will contribute to our understanding of using the Internet to deliver an HIV, STI, and pregnancy prevention program to middle school students. PUBLIC HEALTH RELEVANCE: Narrative Description The use of computers, games, and the Internet to address adolescent sex education is a burgeoning research area. An Internet-based HIV, STI, and pregnancy prevention program for middle school students has the potential for low-cost, high fidelity dissemination, if it is proven to be effective at delaying sexual initiation.

DESCRIPTION (provided by applicant): The prevalence and consequences of dating violence among young adolescents is alarming. In this study, we propose to evaluate a web-based teen dating violence (TDV) prevention program for ethnic minority middle school students, It's Your Game-Dating Violence (IYG-DV). Although initially developed as It's Your Game...Keep it Real (IYG) to impact adolescent sexual health, it has also shown positive impact on reducing emotional and physical TDV victimization and emotional TDV perpetration. There were no effects, however, for physical TDV perpetration and effects on sexual TDV are unknown. The benefits of IYG for reducing TDV, therefore, can be enhanced by expanding the IYG program to a) more directly address physical and sexual TDV perpetration and b) encompass multiple levels of the social-ecological model (e.g., youth, family, school staff) for TDV prevention. IYG-DV will include interactive, web-based activities (including activities tailored by gender, relationship status, and experience of dating abuse) to enhance psychosocial factors (e.g., knowledge, skills, self-efficacy, attitudes and norms, gender role beliefs, perceived parental and school factors) related to preventing TDV. It will also incorporate web-based school staff and parent materials to assist with identification, skills training, referral, and resource support. Th evaluation design will comprise a randomized controlled trial (n=1000 7th-grade youth) in 10 urban middle schools. Baseline, immediate post- intervention and 12-month follow-up student surveys will be administered via ACASI to assess the program's short- and long-term impact on psychosocial and behavioral outcomes. Cost-effectiveness analyses will be included to examine the program's economic impact. IYG-DV will have significant advantages over existing TDV prevention programs, most of which are costly and/or taxing on schools' limited resources and targeted to older predominantly white youth. IYG-DV will (1) be designed for younger, ethnic minority youth, who are at increased risk for TDV; (2) be easily delivered and tailored to individual student needs; (3) incorporate technological advances and the Internet's appeal to youth; (4) reduce implementation costs by removing the need for teacher training; and (5) include parent and school staff components. If it is found to be effective, IYG-DV could be disseminated to schools across the United States, dramatically reducing TDV and subsequent adult domestic violence on a national level. PUBLIC HEALTH RELEVANCE: Teen dating violence presents a serious public health problem for adolescents, especially young ethnic minorities. This study will determine the short- and long-term impact and cost-effectiveness of a web-based teen dating violence prevention program for ethnic minority middle school youth that incorporates activities at multiple levels of the social-ecological model. It will provide a significant contribution in examining additional avenues for prevention and dissemination to target a major public health challenge.

Native iCHAMPS: An Innovative Online Decision Support System for Increasing Implementation of Effective Sexual Health Education in Tribal Communities ABSTRACT American Indian and Alaska Native (AIAN) youth experience serious disparities in sexual and reproductive health. These disparities may be ameliorated by the implementation of effective sexual health education. Yet, multiple factors, such as lack of access to culturally-relevant evidence-based interventions (EBIs), limited trained personnel, cultural barriers, and geographic isolation, hinder the adoption and implementation of effective sexual health EBIs in tribal communities. The goal of this R21 study is to adapt and assess the feasibility of an innovative online decision support system (DSS), Native iCHAMPS, as an effective implementation strategy to facilitate the adoption and implementation of sexual health EBIs in AIAN communities. We propose to adapt iCHAMPSS (CHoosing And Maintaining Effective Programs for Sex Education in Schools), a theory-based, online DSS developed by our research team to increase uptake and implementation of sexual health EBIs in Texas schools. Grounded in dissemination and implementation (D&I) theories, iCHAMPSS comprises 60+ tools to provide step-by-step guidance to overcome D&I barriers for sexual health education. Shown to impact critical determinants of EBI adoption and implementation and to mobilize school personnel to obtain board approval and implement a sexual health EBI, iCHAMPSS serves as an excellent implementation strategy to adapt for AIAN communities. AIAN stakeholders (n=35) rated iCHAMPSS as acceptable, easy to use, credible, appealing, and more helpful than current resources for EBI adoption and implementation in AIAN communities. Yet, because iCHAMPSS was designed specifically for Texas schools, the underlying DI& processes may not adequately reflect D&I processes in AIAN communities. Indeed, AIAN stakeholders recommended adaptations to iCHAMPSS to better reflect the needs and values of tribal communities. Our long-term goal is to reduce teen pregnancy, STI/HIV among AIAN youth by increasing the adoption, implementation, and maintenance of culturally-relevant sexual health EBIs in AIAN communities. In this R21 study, we propose to adapt the existing iCHAMPSS conceptual model and DSS to address barriers and facilitators to the adoption, implementation, and maintenance of sexual health education EBIs in AIAN communities (Native iCHAMPS), identify strategies to optimize its adoption and implementation, and assess the feasibility and impact of adopting and implementing Native iCHAMPS among a sample of heterogeneous and geographically disparate AIAN stakeholders (n=45) across the U.S. The study is innovative as it informs a culturally relevant, conceptual D&I model for sexual health EBIs in AIAN communities, and translates that model as a practical cross-platform digital DSS (Native iCHAMPS) to increase D&I capacity in geographically isolated, low-resource AIAN communities. It is significant because it advances use of culturally-relevant sexual health EBIs, thus impacting population health for underserved, high-risk AIAN youth. Findings will inform a randomized multisite R01 trial to assess the effectiveness of Native iCHAMPS in AIAN communities.