REAL men: a group-randomized trial of an HIV prevention intervention for adolescent boys.

OBJECTIVES: We tested the efficacy of an intervention among 11- to 14-year-old adolescent boys to promote delay of sexual intercourse, condom use among those who were sexually active, and communication on sexuality between fathers (or father figures) and sons. METHODS: Sites were randomly assigned to the intervention and control groups. Assessments were conducted prior to the intervention and at 3-, 6-, and 12-month follow-up interviews. RESULTS: A total of 277 fathers and their sons completed baseline assessments. Most participants were African American, and most fathers lived with their sons. Significantly higher rates of sexual abstinence and condom use and of intent to delay initiation of sexual intercourse were observed among adolescent boys whose fathers participated in the intervention. Fathers in the intervention group reported significantly more discussions about sexuality and greater intentions to discuss sexuality than did control-group fathers. CONCLUSIONS: The study demonstrates that fathers can serve as an important educator on HIV prevention and sexuality for their sons.

The moderating influence of mother-adolescent discussion on early and middle African-American adolescent sexual behavior.

We examined how African-American mothers' discussions with their adolescents about sex moderated the relationship between adolescents' sex-based discussions with their friends and adolescents' involvement in sexual behaviors. The 425 African-American adolescents were 12 through 15 years of age and had participated in an HIV prevention research project with their mothers. Linear and logistic regression analyses showed that, for girls, age, discussions with friends, and the interaction between mother and friend's sex-based discussions were statistically significant predictors of sexual behaviors. These findings suggest that the level of discussion with mothers had a moderating effect on the relationship between friends' discussions about sex and a girl's involvement in sexual behaviors. Although these results were not apparent for boys, there was a strong relationship between discussions with friends about sex and sexual behaviors among boys.

An exploration of social cognitive theory mediators of father-son communication about sex.

OBJECTIVES: R.E.A.L. MEN (responsible, empowered, aware, living) is an HIV prevention project developed for fathers and their sons. The primary aim of R.E.A.L. MEN was to test the efficacy of an intervention to promote delay of sexual intercourse among 11- to 14-year-old adolescents and to enhance the father's role as a sexuality educator. In this article, we report the outcomes related to father-son communication about sex and the results of an exploratory analysis to test the hypothesis that the intervention effect on father-son communication about sex-related topics is mediated by the social cognitive variables of self-efficacy and outcome expectations. METHODS: Two hundred seventy-seven fathers and their sons enrolled in the study. Fathers randomized to the intervention group attended seven group sessions, and their sons attended the final session with them. Fathers and sons completed baseline and 3-, 6-, and 12-month follow-up assessments. The fathers who completed the 3-month follow-up assessment were included in the mediation analyses described in this article. RESULTS: All the participants were male, most were African American (97%), and most fathers and sons reported residing in the same household. The mean age of father participants was 40.5 years; most had graduated from high school, and about 60% reported a yearly income over 30,000 dollars. Based on the results of mediation analyses, the data supported a mediation model that suggests that the effect of the intervention on father-son communication was mediated by differences in self-efficacy. A mediation effect for outcome expectations was weak and could not be validated using additional tests. CONCLUSIONS: The mediation analysis provides some understanding of the role of self-efficacy and outcome expectations in promoting behavioral change. Understanding the active components of interventions can help refine the interventions to eliminate nonfunctioning components and enhance the active components leading to more streamlined programs.

Keepin' it R.E.A.L.!: results of a mother-adolescent HIV prevention program.

BACKGROUND: The concern that adolescents may be placing themselves at risk for contracting HIV has led to widespread public and parental support for HIV prevention programs. Several programs on increasing communication between parents and teenagers have been tested, but the study of the impact of these programs on resulting sexual behavior is lacking. OBJECTIVE: To test the efficacy of two interventions for mothers and their adolescents in delaying initiation of sexual intercourse for youth who are not sexually active and encouraging the use of condoms among sexually active youth. METHODS: Employed were a control group and two treatment groups: one based on social cognitive theory (SCT) and the other a life skills program (LSK) based on problem behavior theory. Assessments were conducted before the intervention (baseline) and at 4, 12, and 24 months after the baseline assessment. RESULTS: Adolescents and their mothers (total N = 582) enrolled in the trial. At baseline, the adolescents ranged in age 11-14 years and were mostly male and African American. The mean age of the mothers was 37.9 years, and most were African American and single. The primary analyses showed no difference among groups in abstinence rates for adolescents. However, adolescents in the LSK group demonstrated an increase in the condom use rate, and those in the SCT and control groups scored higher on human immunodeficiency virus (HIV) knowledge than those in the LSK group. Mothers showed substantial increases over time in comfort talking about sex and self-efficacy. For HIV knowledge, mothers in the SCT group scored significantly higher than those in the LSK and control groups. CONCLUSION: The results of this study are comparable to previous studies that have included mothers in the HIV education of their adolescents. Although the program did not demonstrate a substantial effect on abstinence rates, increases were observed in condom use among adolescents and in mother's sex-based discussions and comfort in talking about sexual issues.