Impact of HealthWise South Africa on polydrug use and high-risk sexual behavior
Impact of HealthWise South Africa on polydrug use and high-risk sexual behavior
Melissa K. Tibbits 0 4
Edward A. Smith 1 4
Linda L. Caldwell 2 4
Alan J. Flisher 3 4
0 Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center , Omaha, NE 68198- 6075 , USA
1 Prevention Research Center, The Pennsylvania State University , University Park, PA 16802 , USA
2 Department of Recreation, Parks, & Tourism Management, The Pennsylvania State University , University Park, PA 16802 , USA
3 Division of Child and Adolescent Psychiatry, The University of Cape Town , Rondebosch 7700 , South Africa
4 The Author 2011. Published by Oxford University Press. All rights reserved. Downloaded from https://academic.oup.com/her/article-abstract/26/4/653/748317 by guest on 16
This study was designed to evaluate the efficacy of the HealthWise South Africa HIV and substance abuse prevention program at impacting adolescents' polydrug use and sexual risk behaviors. HealthWise is a school-based intervention designed to promote social-emotional skills, increase knowledge and refusal skills relevant to substance use and sexual behaviors, and encourage healthy free time activities. Four intervention schools in one township near Cape Town, South Africa were matched to five comparison schools (N 5 4040). The sample included equal numbers of male and female participants (Mean age 5 14.0). Multiple regression was used to assess the impact of HealthWise on the outcomes of interest. Findings suggest that among virgins at baseline (beginning of eighth grade) who had sex by Wave 5 (beginning of 10th grade), HealthWise youth were less likely than comparison youth to engage in two or more risk behaviors at last sex. Additionally, HealthWise was effective at slowing the onset of frequent polydrug use among non-users at baseline and slowing the increase in this outcome among all participants. Program effects were not found for lifetime sexual activity, condomless sex refusal and pastmonth polydrug use. These findings suggest that HealthWise is a promising approach to HIV and substance abuse prevention.
Introduction
HIV/AIDS and substance use are two significant
threats to South African adolescents? health.
Among youth ages 15?19 years, approximately
3% of males and 7% of females are HIV positive;
among youth ages 20?24 years, the prevalence
increases dramatically to 5% of males and 20% of
females [
1
]. Although substance use generally
receives less publicity, a recent survey found that
over 25% of ninth graders had used alcohol and/or
cigarettes in the past-month and 21% of males and
7% of females had used marijuana [
2
]. These
findings have important implications not only for later
substance abuse [
3, 4
] but also for HIV
transmission given that use of substances such as alcohol
and marijuana may precede sexual risk behavior [
5,
6
]. Taken together, these findings indicate that there
is an urgent need for comprehensive interventions
aimed at promoting health and reducing sexual risk
behaviors and substance use among South African
youth.
The HealthWise program [
7?9
] was developed to
meet this need. HealthWise was inspired by
Botvin?s LifeSkills Training [
10
], Caldwell?s
TimeWise: Taking Charge of Leisure [
11
] and best
practices in sexual risk prevention. Theories that
guided the development of the intervention include
selective optimization with compensation [
12, 13
],
Self-Determination Theory [
14, 15
] and Social
Cognitive Theory [
16
]. HealthWise was designed
based on the premise that increasing basic life
skills, increasing knowledge of the risks of
substance use and sexual behaviors and the skills
needed to resist substance use and sex and
providing and promoting healthy free time experiences
will decrease substance use and sexual risk
behaviors among youth. Therefore, HealthWise
incorporates lessons aimed at developing social-emotional
skills such as decision-making and stress and anger
management, promoting prosocial attitudes,
increasing knowledge and skills in regard to
substance use and sex and encouraging engagement
in personally meaningful healthy free time
experiences (see Caldwell et al. [
7
] for a detailed
description of HealthWise). Each of the 12 eighth grade
lessons and 6 ninth grade booster lessons are
delivered by teachers over two to three regularly
scheduled class periods. In addition to the
schoolbased curriculum, two Youth Development
Specialists coordinate utilization of school and community
resources and opportunities. Beginning in 2003,
three subsequent cohorts of youth were involved
in the HealthWise efficacy trial. Each cohort was
followed for at least five waves of data collection.
The results for Cohort 1 are promising [
8, 17
].
Relative to the comparison group of adolescents in
comparable schools who received the
governmentmandated Life Orientation curriculum, the
HealthWise group had smaller increases in recent alcohol
and cigarette use, (...truncated)