title: Safe Thinking and Affect Regulation (STAR): human immunodeficiency virus prevention in alternative/therapeutic schools.
abstract: OBJECTIVE
  To evaluate the effectiveness of Safe Thinking and Affect Regulation (STAR), a 14-session HIV-prevention program for adolescents at alternative/therapeutic schools. Because these youth frequently have difficulties with emotions and cognitions, it was designed to improve sexuality-specific affect management and cognitive monitoring, as well as HIV-related knowledge and attitudes. It was hypothesized that STAR would lead to a decrease in sexual risk and improved HIV knowledge and attitudes.
  
  
  METHODS
  Fourteen schools were randomly assigned by year either to the STAR intervention or a brief educational program. Schools received the alternate intervention the following year. A total of 185 adolescents in 29 cohorts (groups) participated in the interventions. Assessment of sexual behavior, knowledge and attitudes with audio computer-assisted self-interviews occurred at 3, 6, and 9 months post intervention.
  
  
  RESULTS
  Hierarchical linear model (HLM) analyses found that adolescents in the STAR intervention reported a significantly greater decrease (p < .05) in the Sexual Risk Index than youth in the control group over the 6 months post intervention and similar improvements in the HIV Knowledge Scale and the Condom Use Self Efficacy Scale. There were no group differences between 6 and 9 months post intervention.
  
  
  CONCLUSIONS
  This STAR intervention for youth in alternative schools was associated with decreased sexual risk for 6 months after the intervention. These data suggest that intervention strategies that target cognitions and affect within a sexual context might be usefully applied to improving sexual behavior but may need to be reinforced over time. Clinical trial registration information--HIV, Abuse, and Psychiatric Disorders Among Youth; http://clinicaltrials.gov; NCT00603369.
authors.affiliation: Bradley/Hasbro Children's Research Center of Rhode Island Hospital, and the Warren Alpert Medical School of Brown University, Providence, RI 02903, USA. lkbrown@lifespan.org
authors.forename: Larry K
authors.initials: LK
authors.lastname: Brown
authors.forename: Nicole R
authors.initials: NR
authors.lastname: Nugent
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Houck
authors.forename: Celia M
authors.initials: CM
authors.lastname: Lescano
authors.forename: Laura B
authors.initials: LB
authors.lastname: Whiteley
authors.forename: David
authors.initials: D
authors.lastname: Barker
authors.forename: Lisa
authors.initials: L
authors.lastname: Viau
authors.forename: Caron
authors.initials: C
authors.lastname: Zlotnick
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect / Q000502:physiology; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control*; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D011613:Psychotherapy / Q000379:methods*; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology*; D014584:User-Computer Interface; D055815:Young Adult