Compendium of Evidence-Based HIV Behavioral Interventions
Focus on Youth (FOY)
Low-income, urban African American youth
Goals of Intervention
- Increase abstinence
- Increase condom use
Focus on Youth (FOY) is an 8-session intervention delivered to small naturally formed peer friendship groups (3-10 youths) via discussions, games, and multimedia formats. The intervention consists primarily of seven 90-minute sessions focused on decision-making, which include discussions concerning extrinsic (social approval) rewards with exercises related to communication and negotiating skills and information regarding the high prevalence of peer condom use. Other discussions focus on intrinsic (personal pleasure) rewards and emphasize values clarification and goal setting. Facts regarding AIDS, STDs, contraception, and human development are presented and condoms are provided. In the seventh session, youths develop community projects with specific target audiences and intervention messages. The primary intervention series concludes with the eighth session, which is an all-day field trip in which projects are presented and a “graduation” ceremony is conducted. The intervention is followed by monthly and annual booster sessions in which youth are given specific challenges to work through to reinforce the skills (e.g., decision making, communication, and condom use) they acquire in the primary sessions.
- Protection Motivation Theory
Eight weekly meetings: seven 90-minute sessions and one day-long session
Monthly and annual 90-minute booster sessions
Recreation center meeting room; a rural campsite
Two trained adult interventionists, typically African American community members, at least one of whom is gender matched to the group
- Art and crafts
- Group discussion
- Risk reduction supplies (condoms)
- Role play
- Social event
The FOY intervention package is available through ETR Associates, The FOY+IMPACT intervention was packaged with funding from CDC’s Diffusion of Effective Behavioral Interventions (DEBI) project and intervention package and training are available through CDC’s Diffusion of Effective Behavioral Interventions (DEBI) project.
The original evaluation was conducted in Baltimore, Maryland between 1993 and 1996.
Key Intervention Effects
- Reduced unprotected sex
The baseline study sample of 383 African American youths is characterized by the following:
- 100% African American
- 56% Male, 44% Female
- Mean age of 11 years, range: 9-15 years
Recreation centers associated with public housing developments
Youth were eligible if they were part of a naturally formed friendship group consisting of 3-10 friends of the same gender who varied no more than 3 years in age, with no friend being younger than 9 years or older than 15 years of age at the beginning of the study.
Naturally formed groups of friends (N = 76 groups) were randomly assigned to 1 of 2 arms: Focus on Kids (n = 38 groups; 206 youths) or comparison (n = 38 groups; 177 youths).
The comparison group received a group-level HIV/STD prevention program consisting of 8 weekly sessions delivered at six community sites. At each session, a factual movie about AIDS, AIDS risk behaviors, AIDS prevention, contraception, or other risk and protective behaviors was shown and followed by a discussion with a facilitator. Condoms were also provided. There was no focus on decision-making or cultural integration. Individuals could attend any session with or without their friends, and no attempt was made to deliver the comparison program through the natural friendship groups.
Relevant Outcomes Measured and Follow-up Time
Sex behaviors in the past 6 months (including having sex, condom use at last sex, and unprotected sex) were measured at 6-, 12-, 18-, 24-, and 36-month follow-ups.
- FOY Intervention:
82% retained at 6 months
79% retained at 12 months
73% retained at 18 months
69% retained at 24 months
45% retained at 36 months
75% retained at 6 months
64% retained at 12 months
63% retained at 18 months
58% retained at 24 months
48% retained at 36 months
Sexually active FOY intervention participants were significantly less likely to report unprotected sex compared to those in the comparison at the 18-month follow-up (p < .05)
- This intervention fails to meet the best-evidence criteria due to low retention rates and small analytical sample sizes.
- While the intervention meets GOOD-EVIDENCE criteria based on the 18-month findings, findings at the 24- and 36-month follow-ups do not meet the criteria because of low retention rates and small sample sizes.
- Significant intervention effects for unprotected sex were not found at the shorter follow-ups or maintained at the 24- and 36-month follow-ups, probably due to the small sample sizes at those follow-ups.
- Intervention effects were not found to be significant for the other relevant outcomes at any follow-up, probably due to small sample sizes.
- Very few participants attended the booster sessions, which led the researchers to the conclusion that boosters did not affect findings and to the decision not to include booster sessions in the current intervention package.
- Agencies interested in FOY , may also be interested in FOY+ImPACT. The FOK+ImPACT intervention, which includes the 8 FOY sessions plus the single parent-child session from ImPACT focusing on parental communication, has been identified as a best-evidence intervention. The FOK+ImPACT intervention is currently being packaged as Focus on Youth with ImPACT (FOY with ImPACT) with funding from CDC’s Diffusion of Effective Behavioral Interventions (DEBI) project. The FOY with ImPACT package and training will be available through DEBI soon. Contact DEBI Technical Monitor Winifred King, 404-639-0892, email: WKing@cdc.gov, for details on intervention materials.
- Stanton, B. F., Li, X., Ricardo, I., Galbraith, J., Feigelman, S., & Kaljee, L. (1996). A randomized, controlled effectiveness trial of an AIDS prevention program for low-income African-American youths. Archives of Pediatrics & Adolescent Medicine, 150, 363-372.
- Galbraith, J., Ricardo, I., Stanton, B., Black, M., & Feigelman, S. (1996). Challenges and rewards of involving community in research: An overview of the “Focus on Kids” HIV risk reduction program. Health Education Quarterly, 23, 383-394.
- Stanton, B., Fang, X., Li, X., Feigelman, S., Galbraith, J., & Ricardo, I. (1997). Evolution of risk behaviors over 2 years among a cohort of urban African American adolescents. Archives of Pediatrics & Adolescent Medicine, 151, 398-406.
- Li, X., Stanton, B., Feigelman, S., & Galbraith, J. (2002). Unprotected sex among African-American adolescents: A three-year study. Journal of the National Medical Association, 94, 789-796.
Researcher: Dr. Bonita Stanton
Carmen and Ann Adams Department of Pediatrics
Children’s Hospital of Michigan
Wayne State University School of Medicine
3901 Beaubien Blvd, Suite 1K40
Detroit, MI 48201