Reducing the Risk: Building Skills to Prevent Pregnancy, STD and HIV

1. Reducing the Risk: Building Skills to Prevent Pregnancy, STD and HIV Richard P. Barth, 1993 Trainers: Pam Cupp, Ph.D. Derek R. Lane, Ph.D.

2. AGENDA • Introductions • HIV Update • Overview of Institute for HIV, STDs, and Pregnancy • Overview of ISLE Project • Fidelity Issues • Scheduling surveys and curriculum • Intervention • Curriculum Training • Modeling and hands-on application • Skills-based curriculum

3. HIV Prevention: Individual Differences, Theories and Intervention Development Rick S. Zimmerman University of Kentucky Professor of Communication Principal Investigator, Institute for HIV, STD, and Pregnancy Prevention Projects Funded by NIAAA, NIMH, NINR, and NIDA

4. Collaborators Eric Anderman, Co-PI Pamela K. Cupp, Co-I Derek Lane, Co-I Tom Guskey, Co-I Matt Waitkus and Meredith Briggs, Project Coordinators Chris Boelter, Research Assistant Joe Hansel, Research Assistant Danelle Stevens-Watkins, Research Assistant

5. Program of Theory-Based Applied Research • Key Theory-Related Questions: • How are individual differences related to risk-taking and intervention design? • How do substance use, situational variables, and individual differences jointly affect risk-taking behaviors? • What variables influence recall and use of intervention messages in high-risk situations?

6. Program of Theory-Based Applied Research • Applied Research Questions: • In changing HIV-related risk behavior, what are the most effective: • messages, presenters, and methods of presentation for classroom, community, and media HIV preventive interventions? • How can we successfully bring our HIV prevention work to Africa?

7. Individual Difference Variables related to Sexual Behavior • Sensation-Seeking • Impulsivity/Impulsive Decision-making

8. Measure of Sensation-Seeking • I like to do scary things. • I would like to explore strange places. • I like wild parties. • I like to try new foods and drinks. • I prefer friends who are exciting and unpredictable.

9. Measure of Impulsive Decision-Making • I think about all of my choices very carefully. • I do the first thing that comes into my mind. • I do whatever I think will be the most fun. • I consider if it will be good or bad for my future • I go with whatever feels right to me.

10. Study 1 • Adapt successful skills-based school curriculum for high sensation-seekers and impulsive decision-makers • Create radio (PSA) campaign to increase effectiveness of school intervention

11. Intervention Design • Schools randomized to Comparison, Reducing the Risk, and Modified Reducing the Risk conditions • Main classroom intervention occurred during 9th grade; booster intervention during 10th grade • 8-week High Sensation-Value radio PSA campaigns in media community • Communities randomized to media and no-media conditions

12. Novel, creative, or unusual Complex Intense (strong sound and visual effects) Physically Arousing (exciting, stimulating) Fast-paced Graphic or explicit Unexpected Absence of “preaching” Emotionally strong Unconventional Use of close-ups Message Sensation ValueHigh Sensation-Seekers tend to prefer the following message characteristics:

13. Learning Needs of Impulsive Decision-Makers • Awareness of impulsive decision-making style • Learning about decision-making steps • Affective encoding of information • Learning to structure situations in advance to reduce risk

14. Initiation of Sex by Condition and Individual Difference, end of 10th Grade

15. Study 2 • Goal of Study 2 to adapt interventions for young women in housing developments, young MSM, and boys in detention facilities to be especially effective with high sensation-seekers and impulsive decision-makers

16. Study 3 • Adapt school-based curriculum for high sensation-seekers and impulsive decision-makers (HSS/IDM) in rural Kentucky • Assess impact of media campaign targeted at HSS/IDM---> small media • Assess impact of trained peer leaders and young person living with HIV

17. Study 4 • Goal of Study 4 to understand relationship of impulsive decision-making, sexual arousal, and substance use with young adults’ sexual decision-making

18. Study 5 • Goal of Study 5 to design, implement, and assess Two-City Mass Media Intervention Targeted at Safer Sex for Young Adults

19. Current Study • Focus is on primarily on learning more about the most effective strategies for the presentation of an HIV-prevention curriculum • This differs from earlier work where the emphasis was on creating the most effective materials.

20. Current Study: Phase 1 6 semester-long experiments, in which the following content or training vary across schools: • Classroom teacher vs. outside health educator • Co-curricular reinforcement • Adapted content for impulsive decision-makers • Values/Relevance enhancement • Teacher immediacy • Teacher efficacy

21. Current Study: Phase 2 • Combining effective components from the six experiments into a best-practices intervention vs. RTR intervention without additional components • 12-18 month follow-up period

22. International Studies • Pietermaritzburg, South Africa--Developing school-based HIV prevention intervention targeted at HSS/IDM, centered around alcohol use • Addis Ababa, Ethiopia--Determining via formative research and pilot experiment effective use of anti-AIDS clubs in high schools

23. Immediacy Intervention Derek R. Lane, Ph.D. EXPERIMENTAL CONDITION (Intervention Manipulation)

24. Immediacy Intervention • Students are drawn to teachers they trust and perceive as responsive, competent, and caring. • Teacher immediacy positively influences student willingness to talk, student ratings of instruction, and teacher credibility.

25. Teacher Immediacy • the degree of perceived physical or psychological closeness between teachers and students. • Teacher immediacy behaviors (also known as “teacher enthusiasm” and “teacher expressiveness”) enhance closeness to and nonverbal interaction with students.

26. Teacher Immediacy • Approach-avoidance theory • People are drawn toward persons and things they like, evaluate highly, and prefer; they avoid and move away from things they dislike, evaluate negatively, or do not prefer (Mehrabian, 1971). • Immediacy behaviors indicate a teacher’s willingness to approach and be approached by students.

27. Teacher Immediacy • What (and how) teachers do and say directly affect student learning outcomes. • Teacher influence can be increased through verbal and nonverbal immediacy behaviors. • Your students’ motivation to learn in health class is directly affected by your instructional practices!

28. Teacher Immediacy Immediacy represents sets of verbal and nonverbal communication behaviors that indicate a teacher’s willingness to approach and be approached by students and is influential in reducing the perceived physical and psychological distance between communicators.

29. Verbal Immediacy • Appropriate use of praise as reinforcement • Appropriate use of humor • Use of student names • Teacher self-disclosure • Teacher clarity • Use of inclusive pronouns (we, us, our) when referring to coursework • Asking students about their perceptions of the RTR curriculum

30. Nonverbal Immediacy • Variety in vocal pitch, loudness, and tempo • Smiling • Appropriate eye contact • Leaning toward a person • Face-to-face body position • Decreasing physical barriers (such as a podium or desk) • Relaxed body movements and positions

31. Focus of Study: Effectively Communicating Immediacy • How do you as a health teacher effectively incorporate verbal and nonverbal immediacy behaviors in your teaching? • How can you improve your verbal and nonverbal immediacy behaviors in a credible/believable way?

32. What we believe will happen in the present study: • Students in the “immediacy” condition will learn and remember more about HIV prevention. • Students in the “immediacy” condition will be more motivated in health class. • Students in the “immediacy” condition will use the information learned in health class when they are confronted with risky choices.

33. Communicating Immediacy Enhancing Verbal & Nonverbal Immediacy Behaviors

34. Examples of High and Low Immediacy Behaviors • View low male videotape example • View high male videotape example • View low female videotape example • View high female videotape example

35. Instructional Strategies for Enhancing Student Perceptions of Immediacy • PREPARE each lesson in advance so that optimal eye contact with students is established • Vary pitch, volume, and tempo to increase interest • Move around the classroom • Remove physical barriers • Learn student names • Encourage student participation • Use inclusive pronouns • Solicit frequent student feedback • AVOID the “talking head” syndrome • Smile and express genuine interest in students

36. Modeling Immediacy Behaviors • Randomly select an RTR lesson to present • 5-10 minute presentation will be videotaped • Discussion and Feedback

37. Curriculum Training • Trainees as students • Ground Rules • Pregnancy Prevention Emphasis • HIV Prevention Emphasis • Abstinence: Not Having Sex • Refusals • Using Refusal Skills • Delaying Tactics • Avoiding High Risk Situations • Getting and Using Protection • Knowing and Talking about Protection

38. Curriculum Training • Preventing HIV and other STDs • HIV Risk Behaviors • Implementing Protection from STDs & Pregnancy • Sticking with Abstinence and Protection • Questions? • Final logistics

39. NO Revisions to the Curriculum

40. Reducing the Risk . . . • Summary of Curriculum • Curriculum Fidelity • Interactive • Abstinence-based • SKILL building • Reduce the Risk!

41. ANY QUESTIONS????

42. Remember . . . • What (and how) teachers do and say directly affect student learning outcomes. • Teacher influence can be increased through verbal and nonverbal immediacy behaviors. • Your students’ motivation to learn in health class is directly affected by your instructional practices!

43. Communicating Immediacy! We ask that you, the classroom teacher, use the strategies we discussed today to convey high levels of verbal and nonverbal immediacy to your students.

44. Thank you very much for your enthusiasm and commitmentto the project!