This multisite project provides a unique test of a multilevel HIV/STD prevention strategy for high-risk youth. A total of 1600 African American adolescents, ages 12-16, will be recruited through CBOs in 4 cities, two in the Northeast (Providence and Syracuse) and two in the Southeast (Columbia and Macon), to participate in this HIV/STD prevention trial. Adolescents will complete a baseline ACASI administered survey to assess their attitudes, beliefs and sexual behaviors, and provide a urine specimen for detection of three prevalent STDs. Following baseline assessment, all adolescents will be randomly assigned to receive either the Focus on Kids HIV-prevention intervention or a General Health Promotion control. Subsequently, adolescents will be followed longitudinally and complete similar assessments at 6-, 12- and 18-months follow-up. The second level of intervention involves tailored HIV/STD prevention messages through local mass media. One city in each regional city-pair will be randomly assigned to receive the HIV prevention media campaign while the other city will serve as a control city (no media campaign). Thus, the media messages will be directed to African American youth in only one of the two cities in each geographic region. The media program will deliver HIV-prevention messages that are culturally sensitive and age appropriate;these programs will promote both abstinence and risk reduction practices. Cross-sectional surveys of 1200 African American youth using random-digit-dialing telephone interviews in the two cities that receive the media campaign and the two media control cities will be conducted over a 30-month period to determine the community-wide effects of the HIV media campaign. This design will enable a test of the joint and separate effects of the two interventions over an 18-month follow-up for the youth participating in the small-group interventions. In addition, the media campaign is predicted to independently enhance adolescents'adoption of HIV-preventive attitudes, beliefs and behaviors on a community-wide basis compared to youth in the non-media control cities. Causal modeling methodology will be employed to assess the effects of the two levels of intervention and to identify the role of supportive messages received through the media and from peers that are predicted to maintain safer sexual behavior as adolescents mature.
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