title: Students together against negative decisions (STAND): evaluation of a school-based sexual risk reduction intervention in the rural south.
abstract: Twenty-one 10th graders selected as opinion leaders by their peers in a rural county in a southern state participated in a 36-hour peer-educator training program Students Together Against Negative Decisions (STAND) based on diffusion of innovations theory and the transtheoretical model. Comparison subjects received either a 22-hour leadership training course (n = 20) or no intervention (n = 45). STAND and comparison subjects completed a 154-item written knowledge, attitude, and behavior survey at the beginning of the training (Time 1), at the end of the training (Time 2), and again 8 months later (Time 3). One hundred and sixty-seven other 9th and 10th graders in the intervention county and 74 in the comparison county completed an abbreviated telephone interview at Time 1 and Time 3. At Time 3 STAND-trained peer educators reported significantly greater increases in AIDS Risk Behavior Knowledge (more than 4 times comparison groups), frequency of conversations with peers about birth control/condoms (+180% vs. +12%) and sexually transmitted diseases (STDs; +282% vs. -33%), condom use self efficacy (+16% vs. -1%), and consistent condom use (+28% vs. +15%). STAND teens also reported substantial favorable trends at Time 3, including increased condom use (+213% vs. +31%) and decreased unprotected intercourse (-30% vs. +29%). At Time 3 teens in the intervention county reported significantly greater increases in the number of people who talked with friends in the preceding 3 months about STDs (+39% vs. -19%) or with a parent/adult about sex (+6% vs. -37%). Intervention county teens also reported a substantial but nonsignificant 2.6-fold greater increase in condom use at last intercourse (+64% vs. +25%) but unfavorable changes in other risk behaviors. The STAND peer-educator training program appears to be an effective method for improving selected sexual knowledge, attitudes, and behaviors among participant teenagers in the rural South.
authors.affiliation: Department of Internal Medicine, Mercer University School of Medicine, Macon, GA 31201, USA. smith_mu@mercer.edu
authors.forename: M U
authors.initials: MU
authors.lastname: Smith
authors.forename: F C
authors.initials: FC
authors.lastname: Dane
authors.forename: M E
authors.initials: ME
authors.lastname: Archer
authors.forename: R S
authors.initials: RS
authors.lastname: Devereaux
authors.forename: H P
authors.initials: HP
authors.lastname: Katner
mesh_terms: D000293:Adolescent; D003625:Data Collection; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010379:Peer Group; D015397:Program Evaluation; D012309:Risk-Taking; D012424:Rural Population; D012736:Sex Education / Q000592:standards*; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*; D013334:Students