Penn State Research Tackles Drug Use, HIV in South African Youth

From the Spring 2011 RPTM Newsletter

Penn State researchers aim to reduce drug use, risky sexual behavior, and violence among South African youth by expanding a leisure education and life skills program to reach fifty-six South African high schools. The researchers, led by Dr. Linda Caldwell, professor of recreation, park, and tourism management, and Dr. Edward Smith, associate director of the Penn State Prevention Research Center for the Promotion of Human Development, received a $2.8-million grant from the National Institute on Drug Abuse.

Caldwell and her colleagues will be implementing HealthWise, a curriculum they developed that “teaches youth how to best utilize their free time,” says Caldwell. HealthWise teaches adolescents to examine personal motivations and other factors leading to their decision making, and it also provides information on safe sexual practices and how to avoid risky situations. In better understanding why they make decisions, youth can successfully prevent poor outcomes that result from certain risky decisions.

Recent studies have shown that nearly one-quarter of HIV-infected individuals in South Africa are under the age of 25, and AIDS is responsible for 71 percent of all deaths in the 15-49 year age group. One in eight South African high school students begins drinking alcohol before the age of 13, and in grades 8 through 11, more than 10 percent of children have tried marijuana, and about 30 percent of children have smoked cigarettes.

Caldwell and Smith first implemented HealthWise in the Cape Town Metro South Education District (MSED) in 2001 as a pilot program and later as a randomized trial involving nine schools and over 7,000 youth. Results from the trial indicated HealthWise was effective in reducing both substance use and sexual risk. Cigarette and alcohol use, for example, were significantly lower among those in the HealthWise schools. In addition, fewer males initiated sexual behavior and were less likely to push girls into unwanted sex. Importantly, from the perspective of reducing HIV risk, both males and females reported less use of substances at sexual encounters and were less likely to report having sex with someone they had recently met. There was also increased perception of condom availability, condom skills, and conversations with partners surrounding condom use.

Following the success of the first trial, MSED administrators approached Caldwell and Smith and requested that they help with a large-scale implementation. “We saw great success in HealthWise over the past decade. We hear constantly from teachers and district administrators of how good HealthWise is. The kids like it, too, because it’s so positive,” Caldwell says. “Now we’re looking at what factors of success are important for a large-scale rollout of the program.”

Many preventive interventions become less effective as they transition from a controlled testing environment to the real world, says Caldwell. One primary goal of her research is to assess how to best implement HealthWise in a large-scale manner. The researchers are looking at the effectiveness of different methods for enhancing the school environment, such as “branding” the school as a HealthWise school through posters in hallways, integrating the HealthWise curriculum into normal school operations, or creating a leadership team among school administrators. They will also be studying variations of teacher training, including how long training sessions should last (one day-long session vs. multiple half-day sessions) and the use of follow-up training. Finally, they will test different methods for providing ongoing support and supervision, such as having teachers keep daily journals of how they implement HealthWise.

After this next five-year project, Caldwell, Smith, and their research team plan to hand the project off to researchers and administrators in South Africa, who, Caldwell says, are eager to be in charge of the curriculum.

The results of this research should have implications in areas outside of South Africa, too, says Caldwell. “Many areas in the United States mirror some of what we see in South Africa, in terms of socioeconomic status. The lessons we learn here should translate to other geographic regions.”

Other Penn State researchers on the project include Dr. John Graham, professor of biobehavioral health; Dr. Linda M. Collins, director, Methodology Center; Dr. Mark Greenberg, director, Prevention Research Center; Dr. Damon Jones, research associate, Prevention Research Center, Dr. Donna Coffman, research associate, Methodology Center; and graduate students Mary Lai (Project Coordinator), Stephanie Bradley, Jacqui Cox, Jason Scott, and Elizabeth Weybright.

In South Africa, partners include Joachim Jacobs, project director, University of the Western Cape; Dr. Tania Vergnani, associate professor and director of the University of the Western Cape’s HIV/AIDs Program; Dr. Lisa Wegner, associate professor and chair of the Department of Occupational Therapy, University of the Western Cape; and Dr. Catherine Mathews, associate professor, University of Cape Town.