The Healthy for Life project: sexual risk behavior outcomes.

Sexual risk behavior outcome data from the Healthy for Life (HFL) project is presented. Using a social influences model, the intervention was designed to positively affect the health behaviors of middle school students in five related areas: alcohol use, tobacco use, marijuana use, nutrition, and sexuality. The in-school program was supplemented by parent, community and peer components. The research used self-report data on an initial sample of 2,483 middle school students followed from Grade 6 to Grade 10. Twenty-one schools were assigned to three conditions--age appropriate (program taught in Grades 6, 7, and 8), intensive (program taught in Grade 7) and control--using blocked randomization. Attrition was 20% (by Year 4) and 33% (by Year 5). By ninth grade the lifetime intercourse rate among both groups of HFL subjects was significantly higher than for controls (controlling for baseline substance use risk and involvement with the opposite sex), but reported past month intercourse rates and condom use did not differ. At the tenth grade follow-up, the age appropriate subjects reported higher adjusted rates of lifetime and past month intercourse than did the controls. Intensive subjects perceived significantly lower normative rates of intercourse than controls at ninth grade follow-up, but age appropriate subjects perceived significantly higher norms at tenth grade. Our expectation that this approach would be effective in reducing adolescent sexual risk behavior has not been supported. The influence of social and community norms and contextual factors has a far greater influence on the behavior of students (even 6 years later) than this school-based social influences program targeting only one grade cohort.

An outcome evaluation of project model health: a middle school health promotion program.

This article reports findings from the outcome evaluation of Project Model Health (PMH), an intensive in-school health promotion program for middle school students. Promising prevention strategies identified in past research based on social influences theory were combined in PMH, targeting multiple health behaviors in the areas of nutrition, marijuana use, tobacco use, drinking and driving, and sexuality. Results reported in this paper are based on an experimental group of 115 eight graders who were exposed to the 32 hour program, taught by college-age "role models." The evaluation included both an extensive qualitative process evaluation and a quasi-experimental outcome evaluation. The outcome evaluation used both a prior year's cohort and students from a similar untreated school for comparison purposes. While an immediate post-test showed only inconsistent results, a 20-month follow-up resulted in clear positive outcomes for experimental students on measures of cigarette smoking and improved food choices, and ambiguous but positive results on rates of intercourse. Limitations of the methodology (nonexperimental assignment to conditions, reliance only on self-report data) are such that further more rigorous testing of this program model is called for. However, PMH shows significant promise as an effective adolescent health promotion approach.