|
Intervention Description
Intervention Package Information
Evaluation Study and Results
References and Contact Information
Intervention Description
Target Population
Runaway youth
Goals of Intervention
- Eliminate or reduce sex risk
behaviors
- Eliminate or reduce substance use
Brief Description
Street Smart is a 10-session intensive
small-group skills-based intervention
for runaway youth. The intervention
focuses on providing access to health
resources, making condoms available,
training youth on personal skills, and
training staff to help support the youth
in changing their behavior. In small
groups of 5-6, the youth discussed the
following topics: basics about HIV/STD
risk, assessing personal risk and
avoiding sexual risk, the correct use
male and female condoms, how substance
use affects sexual control and judgment,
identifying and managing triggers for
unsafe sex, and problem solving. Each
session, youth use a “Feeling
Thermometer” to help the youth recognize
and discuss their feelings. Youth are
taught to cope with their feelings by
practicing coping skills and relaxation
skills to control feelings of anxiety,
depression, anger, and desire. The
intervention focuses on positive
self-talk to build self esteem, help
with difficult situations, and increase
self-efficacy for safer sex. Tokens of
appreciation and compliments are
exchanged among the youth to provide
positive support for appropriate
behavior and meeting HIV-related goals.
Activities to promote positive
attitudes, increase self-efficacy, and
build effective communication, personal,
and technical skills include games,
exercises, practicing, role-playing. In
addition, youth attended video and art
workshops to develop media messages
through soap opera dramas, public
service announcements commercials, or
raps to reinforce safer sex. An
individual counseling session is
provided to discuss attitudes, identify
triggers and barriers, and develop a
plan for coping and overcoming barriers
to practice safer sex. Finally, youth
visit a local community-based agency
providing health and mental health care
to learn about other available resources
in the community. |
Theoretic Basis
Intervention Duration
10 sessions (9 small-group and 1 individual)
delivered over a 3 week period
Intervention Settings
Four runaway youth shelters
Deliverer
Co-led by a trained researcher and a shelter
staff
Delivery Methods
- Counseling
- Developing video and art
media
- Exercises/Games
- Goal Setting
- Group Discuss
- Homework
- Practice
- Role Play
- Video
Go to top
Intervention Package Information
An intervention package was developed with funding from CDC’s Replicating
Effective Programs (REP) Project. The intervention package and training are
available through CDC’s
Diffusion of
Effective Behavioral Interventions (DEBI) project.
Go to top
Evaluation Study and Results
The original evaluation was conducted in
New York and New Jersey between 1988 and
1991.
Key Intervention Effects
Study Sample
The propensity-matched baseline study sample of 187 runaway youths is
characterized by:
- 53% African American, 29%
Hispanic, 17% White or other
- 51% Male, 49% Female
- Mean age of 16 years, range:
11-18 years
- 45% dropped out of school
Recruitment Settings
Runaway youth shelters
Eligibility Criteria
All runaway youth at the four shelters
Assignment Method
Four shelters were assigned to 1 of 2 groups: Street Smart (n = 2
shelters; 167 participants) or comparison (n
= 2 shelters; 144 participants). Baseline
propensity scoring was used to identify
comparable intervention and control
sub-groups of youth for analyses (n = 187
overall; n = 101 Intervention, n = 88
comparison).
Comparison Group
Participants in the control shelters
received routine shelter services. Staff
received HIV education training and could
have provided individual HIV-related risk
reduction counseling to the youth. They were
given local referrals for health concerns
and condoms were made available at the
shelters.
Relevant Outcomes Measured and Follow-up Time
- Sex behaviors measured in the
previous 3 months were: the number of
sex partners, number of insertive or
receptive vaginal, anal, or oral sex
acts, number of unprotected sex acts of
each type, and abstinent from vaginal or
anal sexual acts.
- Substance use behaviors measured in the
previous 3 months were: prevalence and
frequency of the use of alcohol, marijuana,
crack, cocaine, hallucinogens, barbiturates,
sedative, amphetamines, over the counter
drugs, prescription drugs, and heroin.
- Outcomes were measured at 3, 6, 12, 18,
and 24 months after baseline which
translates to approximately 0, 3, 9, 15, and
21 months after the intervention.
Participant Retention
- Intervention (propensity-matched
sub-sample):
55% retained at immediate
post-intervention
60% retained at 3 months after the
intervention
40% retained at 9 months after the
intervention
41% retained at 15 months after the
intervention
65% retained at 21 months after the
intervention
- Control (propensity-matched
sub-sample):
59% retained at immediate
post-intervention
65% retained at 3 months after the
intervention
63% retained at 9 months after the
intervention
58% retained at 15 months after the
intervention
76% retained at 21 months after the
intervention
Significant Findings
Among female youth, intervention
participants reported significantly
fewer unprotected sex acts than control
participants at 21 months after the
intervention (p = .018).
Considerations
- This intervention fails to meet the best-evidence criteria due to low
retention rates and assigning groups of individuals to study conditions
while analyzing at the individual level.
- The intervention was available at the intervention shelters throughout
the 3 month period after assignment, so it is unclear if youth received more
than the intended 10 sessions. This also means that the follow-up
assessments translate to approximately 0, 3, 9, 15, 21 months after the
intervention.
- Among female youth, intervention participants were more likely to report
abstinence from vaginal and anal sex than control participants at 15 months
after the intervention (p = .088), although this finding was not
statistically significant and was at a follow-up with low retention rates.
- After identifying a propensity-matched sub-sample, baseline differences
still existed. Those in the control group were more likely to report recent
alcohol and marijuana use at baseline than those in the intervention group (p’s
< .05).
- There were no significant intervention effects among male youth for any
of the intended outcomes except for a lower proportion of male youth
reporting marijuana use immediately following the intervention, compared to
control youth (p < .05). This finding does not meet promising-evidence
criteria due to the type of outcome, no follow-up time, and low retention
rates.
- At 9 months after the intervention, female youth in the intervention
were less likely to report using alcohol (p = .053) or marijuana (p = .005)
and reported fewer numbers of drugs used (p = .019) than female youth in the
control group. Similar findings were found for marijuana use and number of
drugs used at 3 months after the intervention. These findings do not meet
promising-evidence criteria due to the type of outcome and low retention
rates at 9 months.
- There were baseline differences in the original study sample. A
propensity score matching that identified similar baseline sub-groups of
intervention and control youth was conducted to protect the findings from
confounding bias.
- This intervention could be considered a community-level intervention as
the intervention was available on an ongoing basis in the shelters for 3
months. Since the evaluation, utilizing a cohort design, can be reviewed
using these criteria, this intervention is included within this review and
will be updated later in the community-level intervention section of the
website.
Go to top
References and Contact Information
- Rotheram-Borus, M., Song, J., Gwadz, M., Lee, M., Van Rossem, R., &
Koopman, C. (2003). Reductions in HIV risk among runaway youth.
Prevention Science, 4, 173-187.
- Rotheram-Borus, M., Koopman, S., Haignere, C., & Davies, M. (1991).
Reducing HIV sexual risk behaviors among runaway adolescents. JAMA,
266, 1237-1241.
Researcher: Dr. Mary Jane Rotheram-Borus,
Department of Psychiatry, University of California Los Angeles, 10920
Wilshire Blvd, Suite 350, Los Angeles, CA 90024. email:
rotheram@ucla.edu
Go to top
|
=
Link to a PDF document
