Trial of an urban adolescent sexual risk-reduction intervention for rural youth: a promising but imperfect fit.

PURPOSE The purpose of this study was to assess the effectiveness of Focus on Kids (FOK), a sexual risk reduction intervention, shown to be effective among urban, African-American adolescents living in communities with high rates of sexually transmitted diseases, in reducing sexual risk behaviors among rural, white adolescents living in communities with low rates of sexually transmitted diseases. The subjects were 1,131 youth ages 12 to 16 years from 12 rural counties in West Virginia. METHOD The study was a randomized, controlled, longitudinal trial of a theory-based prevention intervention. Outcomes included self-reported sexual behaviors and perceptions assessed at baseline and at 3, 6, and 9 months after intervention. RESULTS At baseline, 21% of youth were sexually experienced; 80% reported using a condom at last episode of intercourse. Rates of behaviors did not differ based on intervention assignment (FOK vs control group) after adjusting for baseline differences at any follow-up period among the full cohort or among the subset of youth who completed the intervention curriculum to which they were assigned. Perceptions of risk and protective behaviors were positively influenced by FOK at 3, 6, and 9 months in a fashion consistent with the guiding model of behavioral change and the FOK curriculum. CONCLUSIONS Consistent with previous studies of FOK in high-risk urban areas, some perceptions were positively altered by FOK in these rural areas, although many of these changes did not persist through 9 months of follow-up. In contrast to previous studies, self-reported sexual risk behaviors did not decrease among FOK youth. FOK was not associated with any increases in sexual risk behaviors.