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Replication of It’s Your Game…Keep It Real! in Southeast Texas

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Abstract

Despite the recent efforts of the Office of Adolescent Health to replicate programs with demonstrated efficacy, there are still few evidence-based HIV, sexually transmitted infection (STI), and teen pregnancy prevention programs that have been replicated in “real-world” settings. To test the effectiveness of It’s Your Game…Keep It Real! (IYG), an evidence-based STI and pregnancy prevention program for middle schools, the curriculum was implemented by teachers in urban and suburban middle schools in Southeast Texas from 2012 to 2015. IYG was evaluated using a group-randomized wait-list controlled effectiveness trial design in which 20 middle schools in nine urban and suburban school districts in Southeast Texas were randomized equally, using a multi-attribute randomization protocol, to either the intervention condition (received IYG) (n = 10 schools comprising 1936 eligible seventh graders) or the comparison condition (received usual care) (n = 10 schools comprising 1825 eligible seventh graders). All students were blinded to condition prior to administering the baseline survey. The analytic sample comprised 1543 students (n = 804, intervention; n = 739, comparison) who were followed from baseline (seventh grade) to the 24-month follow-up (ninth grade). Multilevel regression analyses were conducted to assess behavioral and psychosocial outcomes at follow-up. There were no significant differences in initiation of vaginal or oral sex between study conditions at follow-up. However, at 12-month follow-up, compared with students in the comparison condition, students in the intervention condition reported increased knowledge, self-efficacy, and perceived favorable norms related to HIV/STIs, condoms, and/or abstinence; decreased intentions to have sex; and increased intentions to use birth control. Knowledge outcomes were statistically significant at 24-month follow-up. This IYG effectiveness trial did not replicate the behavioral effects of the original IYG efficacy trials. However, it adds to the growing literature on the replication of evidence-based programs, and underscores the need to better understand how variations in implementation, setting, and measurement affect the behavioral impact of such programs.

Clinical trial registration clinicaltrials.gov (NCT03533192).

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Acknowledgements

The authors thank Lionel Santibáñez for his editorial assistance. The authors also thank the participating school districts and students who made this study possible.

Funding

This work was supported by the Office of Adolescent Health (OAH), U.S. Department of Health and Human Services (Grant number FTP1AH000072).

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Authors and Affiliations

  1. Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, 77030, USA

    Melissa F. Peskin, Kimberly Johnson-Baker, Paula M. Cuccaro, Pamela Diamond, Christine M. Markham, Ross Shegog, Elizabeth R. Baumler, Efrat K. Gabay & Susan Tortolero Emery

  2. ETR, Scotts Valley, CA, USA

    Karin K. Coyle, Pamela M. Anderson, B. A. Laris, Jill R. Glassman, Heather M. Franks, Susan C. Potter & Tracy Unti

  3. University of Texas Medical Branch, Galveston, TX, USA

    Melanie A. Thiel

  4. The Cornerstone Consulting Group, Houston, TX, USA

    Sharon Edwards

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  1. Melissa F. Peskin
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Corresponding author

Correspondence to Melissa F. Peskin.

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Data Availability

This trial has been registered at clinicaltrials.gov (NCT03533192). Some results were published in a technical report submitted and published by OAH (http://www.hhs.gov/ash/oah/oah-initiatives/evaluation/grantee-led-evaluation/reports/uthsc-final-report.pdf).

Conflict of Interest

Drs. Peskin, Markham, Shegog, and Tortolero Emery are creators of the It’s Your Game…Keep it Real! program which is licensed to ETR by the University of Texas Health Science Center at Houston. The creators are eligible to receive royalty payments under this license agreement. ETR now disseminates the program, but was not disseminating the program at the time of the study.

Research Involving Human Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Peskin, M.F., Coyle, K.K., Anderson, P.M. et al. Replication of It’s Your Game…Keep It Real! in Southeast Texas. J Primary Prevent 40, 297–323 (2019). https://doi.org/10.1007/s10935-019-00549-0

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