Couple-Focused Human Immunodeficiency Virus Prevention for Young Latino Parents: Randomized Clinical Trial of Efficacy and Sustainability | HIV | JAMA Pediatrics | JAMA Network
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April 4, 2011

Couple-Focused Human Immunodeficiency Virus Prevention for Young Latino Parents: Randomized Clinical Trial of Efficacy and Sustainability

Author Affiliations

Author Affiliations: School of Nursing (Drs Koniak-Griffin, Lesser, and Takayanagi) and Department of Biostatistics, School of Public Health (Dr Cumberland), University of California, Los Angeles. Dr Lesser is now with the School of Nursing, The University of Texas Health Science Center, San Antonio.

Arch Pediatr Adolesc Med. 2011;165(4):306-312. doi:10.1001/archpediatrics.2011.28

Objective  To evaluate the efficacy and sustainability of a couple-focused human immunodeficiency virus (HIV) prevention intervention in reducing unprotected sex and increasing intent to use condoms and knowledge about AIDS.

Design  Randomized controlled trial.

Setting  Urban community settings in Southern California.

Participants  Primarily Latino couples (168 couples; 336 individuals) who were aged 14 to 25 years, English or Spanish speaking, and coparenting a child at least 3 months of age.

Intervention  A 12-hour theory-based, couple-focused HIV prevention program culturally tailored for young Latino parents, with emphasis on family protection, skill building, and issues related to gender and power. The 1½-hour control condition provided basic HIV-AIDS information.

Main Outcome Measures  Primary outcome measures included self-report of condom use during the past 3 months; secondary, intent to use condoms and knowledge about AIDS.

Results  The HIV prevention intervention reduced the proportion of unprotected sex episodes (odds ratio, 0.87 per month from baseline to 6 months; 95% confidence interval [CI], 0.82-0.93) and increased intent to use condoms (slope increase, 0.20; 95% CI, 0.04-0.37) at the 6-month follow-up; however, these effects were not sustained at 12 months. Knowledge about AIDS was increased in both groups from baseline to 6 months (slope estimate, 0.57; 95% CI, 0.47-0.67) and was maintained in the intervention group only through 12 months. Female participants in both groups had higher intent to use condoms and knowledge about AIDS than male participants (P ≤ .01).

Conclusions  The couple-focused HIV prevention intervention reduced risky sexual behaviors and improved intent to use condoms among young Latino parents at the 6-month evaluation. A maintenance program is needed to improve the sustainability of effects over time.

Adolescent parents of ethnic/racial minority background are at high risk for sexually transmitted infections, including human immunodeficiency virus (HIV). Behaviors leading to early pregnancy and continued high-risk sexual behaviors after childbirth1-4 make these youth vulnerable to disease transmission. The adolescent birth rate in the United States, now rising after more than a decade of declining rates,5 is highest among Latina women.6 Thus, greater efforts must be directed toward prevention of teen pregnancy, sexually transmitted infections, and HIV among young parents, especially Latinos.

Most HIV prevention programs for adolescents are designed to reduce sexually risky behaviors (hereinafter referred to as risk behaviors) among general populations of youth and are attended by individuals rather than couples. Participants are predominantly African American youth7-13 or represent mixed ethnic/racial groups.14-21 We found only 2 randomized controlled trials involving entirely Latino samples of young adolescents among US studies.22,23

Although results support the effectiveness of theory-based HIV prevention interventions for adolescents,7,10,12,14,23-26 findings are inconsistent, and the length of follow-up varies. Treatment effects may wane to insignificant levels over time14,19 or be delayed up to 2 years.10,27 Some interventions have been ineffective in improving condom use and decreasing risk behaviors.28

The efficacy of an HIV prevention program for pregnant and parenting adolescents was demonstrated in one randomized clinical trial involving Latina and African American girls attending alternative schools.29 At the 6-month follow-up, participants reported fewer sexual partners, higher intent to use condoms, and greater knowledge about AIDS. Similarly, integrating HIV prevention into prenatal care increases condom use and decreases unprotected sex in African American samples.30,31

In one of the few clinical trials involving couples, condom use and unprotected sex did not significantly differ between women (18-25 years) and their male partners receiving the couple-focused HIV prevention intervention and a comparison condition. Consistency of condom use increased significantly in both groups at the 3-month (women and men) and 6-month (women only) follow-up visits.32,33 A relationship-based intervention provided individually to adult heterosexual couples and the same intervention provided to the women alone were equally efficacious in reducing unprotected sex.34,35 Significant reductions in HIV/sexually transmitted infection risk behaviors were reported in a multisite randomized clinical trial involving serodiscordant African American couples.36

Preliminary evaluation of the couple-focused HIV prevention intervention, conducted before the larger clinical trial reported herein, revealed significant reductions in unprotected sex and an increase in intent to use condoms among young Latino child-rearing couples at the 6-month follow-up.37 Unlike earlier work, this study examines the efficacy and sustainability of the intervention, which addresses relational dynamics affecting sexual behavior within the context of romantic partnerships. This report is in compliance with the Consort 2010 recommendation for reporting of clinical trials.38,39



One hundred sixty-eight couples (including 336 young mothers and fathers) were recruited from Women, Infants, and Children programs; alternative schools; community-based service organizations; and clinics in Southern California from August 1, 2001, through September 30, 2004. We initially recruited couples through the mothers via small-group presentations and individual contacts; follow-up telephone calls confirmed the eligibility of the mothers and their male partners. The lengthy recruitment period and large number of sites were the result of complexities associated with identifying teenaged parents in a romantic relationship and willing to attend an HIV prevention program with their partners.


The institutional review board of the University of California, Los Angeles, approved the study, waiving the requirement for parental consent for participants younger than 18 years. Couples aged 14 to 25 years and coparenting a child at least 3 months of age were eligible if they spoke English and/or Spanish. The broad age range is consistent with the current belief that young adults have developmental and health needs similar to those of adolescents40 and may participate jointly in HIV prevention programs.31

Couples were randomized to the experimental or control condition with a 1:1 allocation within strata defined by geographic area. The sequence was created by the team's statistician using commercially available software (Stata 7; StatCorp, College Station, Texas) and with a block size of 4. Group assignment was revealed to participants after completion of the baseline questionnaire. The Figure shows the number assigned to each condition.

Cohort table displaying progress of participants throughout the study.

Cohort table displaying progress of participants throughout the study.

The intervention was delivered in small groups of 1 to 5 couples (average, 2 couples). Eight intervention and 3 control series were conducted in Spanish and the remainder in English. Community-based service organizations and a hospital provided space for program implementation. Participants received $15 for each class attended, with child care and transportation provided.

Experimental and control condition

Couple-Focused HIV Prevention Program

The 6-session (12-hour), couple-focused HIV prevention program (Respecting and Protecting Our Relationships) was developed through a community-academic partnership formed to design a culturally appropriate and innovative HIV prevention intervention for young Latino parents. Details on this collaboration and pilot testing have been previously reported.3,37 The intervention was based on principles from social cognitive theory,41 the theory of reasoned action,42,43 the theory of gender and power,44-46 and a theoretical framework derived from extensive clinical work with Latino youth.47 The highly structured curriculum emphasized protecting the family to promote safer sexual behaviors. Pairs of male and female facilitators involved participants in small-group discussions about HIV prevention (eg, transmission modes and vulnerability) and attitudes and beliefs about HIV and “safer” sex. Unique features included facilitated discussions (“talking circles”) in which issues of gender norms and power were discussed in terms of effect on partner relationships and healthy sexual decision making. Discussions integrated cultural teachings to enhance positive aspects of relational norms and motivate reduction of risky sexual behaviors. Interactive activities (eg, games), writing exercises, and skill-building activities (eg, condom use and sexual negotiation) were incorporated throughout the curriculum. In separate groups, male and female participants explored issues related to sexuality, gender roles, and relationship violence. In 1 session, young parents identified people who made up their “Palabra Circle” (circle of relationships) and how others would be affected if they became infected with HIV; then a young mother who was seropositive for HIV shared her experiences living with HIV and how her health affected her family, friends, and life plans.

Control Condition

The 1½-hour (1 session) control condition, modeled after the usual care standard used in National Institute of Mental Health trials,48 presented basic information (lecture format) to couples on HIV/AIDS transmission, signs and symptoms, and methods of prevention, including a brief demonstration of condom use.48 The session was conducted by specially trained facilitators not involved in delivery of the HIV prevention program.

Facilitators and Facilitator Training

The facilitators of the couple-focused HIV prevention program were 4 men and 3 women, all Latino except 1 bilingual African American facilitator, with backgrounds in community health and social services involving high-risk Latino youth. About 40 hours of didactic and experiential training prepared facilitators to act as role models, nurturers, and teachers/guides, using their own experience whenever possible. The facilitation was based on a process known as espejo (mirror) teaching, using strategies such as storytelling, reflection, and guidance.


Participants completed questionnaires before and after the intervention and at 3-, 6-, and 12-month follow-up visits; only 5.0% chose to complete these in Spanish. At the baseline evaluation, a research assistant read each item aloud to small groups as they recorded their responses. Follow-up evaluations were generally performed in the home via individual interviews (60 minutes) conducted with female and male partners separately but concurrently. Participants received $25 for each questionnaire.

Questionnaires were pilot tested for cultural relevance and readability and to ensure acceptable psychometric characteristics. Sociodemographic variables were assessed at baseline only. All questionnaires evaluated sexual behavior, intent to use condoms, and knowledge about AIDS.

The primary outcome was sexual behavior measured by the reported number of vaginal sex episodes with and without condoms during the past 3 months. Condom use was evaluated in relation to vaginal sex only, because reports of anal sex were low (17.3% among male and 15.5% among female participants). Secondary outcomes were evaluated by a 30-item questionnaire on knowledge about AIDS and a 4-item assessment of intent to use condoms. Other variables included multiple sexual partners, history of physical and sexual abuse, and substance use.

Data collectors, who received 16 hours of training, were blinded to participants' group assignment. Several steps were taken to maximize reliability and validity of the self-report measures on sexual behavior, as recommended and practiced by other researchers.11,49 Standard and familiar sex terms were used, with clear definitions provided. Participants were asked to report sexual behavior during a relatively short time frame to increase the validity of self-reported sexual data.11,23,50 Data collectors assisted recall of behavior by providing anchor dates (eg, school breaks and holidays) and calendars for reference.

Sample size and statistical analysis

An intention-to-treat model was used to evaluate intervention effects. All randomized participants were included in the analysis. To minimize potential bias resulting from missing data, we used multiple imputation, creating 20 imputed data sets. This technique corrects for the underestimation of variance that occurs with a single imputation. The data sets were analyzed separately, and the results were combined to calculate the estimates, significance levels, and confidence intervals.51

The data consisted of linked measurements on the female-male dyads and of repeated measurements taken longitudinally on these dyads. This meant that, in the data analysis, the correlations between the partners in the dyad and those among the repeated measurements over time on the same couple had to be taken into account. To this end, we used hierarchical models with fixed and random effects.52 We assessed the effect of the intervention by testing for a group × time interaction. Because of the potential for different effects during the 12-month follow-up, we fit piecewise linear models to the data with a single knot at 6 months. This allowed us to estimate separately and to compare effects of the intervention over the 2 time periods: baseline to 6 months and 6 to 12 months. For continuous outcomes, mixed models with normally distributed errors were used. To model the probability of unprotected sex and the effect of the intervention on this outcome, each sexual episode in the preceding 3 months was considered as a Bernoulli random variable with probability p of no condom use. A logit link was used to relate p to individual and/or couple characteristics, including group × time interactions, and random effects were included on the logit scale. We used commercially available software for data imputations and mixed model analyses (SAS, version 9.1.3; SAS Institute, Inc, Cary, North Carolina) and descriptive analyses (SPSS, version 17; SPSS, Inc, Chicago, Illinois).


Sample characteristics

Table 153 provides participant characteristics at baseline. The mean age of mothers was 18.5 (SD, 1.7) years; male partners were slightly older (20.4 [SD, 2.2] years). The large majority self-identified as Latino. Most had 1 child and shared biological parenthood, with the exception of 11 male participants, who nonetheless reported being actively engaged in coparenting. The mean length of relationship was 35.2 (range, 3-120) months. Childhood history of abuse was common. Most participants reported that they were in a monogamous relationship. No significant differences were found in baseline characteristics between the experimental and control groups (Table 1).

Table 1. 
Sociodemographic Characteristics of Female and Male Participants at Baseline by Intervention Conditiona
Sociodemographic Characteristics of Female and Male Participants at Baseline by Intervention Conditiona

Intervention attendance and follow-up retention

Most participants (90.3%) attended at least 8 hours of the intervention; 70.1% received the full 12 hours. The Figure displays the number completing questionnaires at each data collection point. Data are presented for individuals to avoid excluding those with a partner having missing data. Of the original sample, 74.7% completed the 12-month evaluation.

Effects on primary outcome

Table 2 presents estimates of the parameters from fitting a logit model for the probability of unprotected sex in the past 3 months. A number of different models were evaluated to test the effect of gender on the outcome and to test for potential effect modification by gender. The best-fitting model included gender only as a main effect and had terms for group (control = 0; intervention = 1), time1 (baseline to 6 months), time2 (6-12 months), and group × time interactions. The effect of the intervention is measured through these latter terms, with a significant group × time term indicating that the intervention participants modified their behavior at a faster (or slower) rate compared with the controls. Because parameter estimates on a logit scale are difficult to interpret, odds ratios and 95% confidence intervals are also presented in Table 2. The odds ratio, 0.87 per month, for the group × time1 interaction is significant (P < .001), showing a sharper decline in unprotected sex from baseline to 6 months in the intervention group. This effect was reversed in the 6- to 12-month period, with the intervention group increasing unprotected sex (P = .03) at a more rapid rate. The slopes for the control group were near zero and nonsignificant over both time periods (P = .54 and P = .31), suggesting no changes over time. Gender, even as a main effect, was not significant.

Table 2. 
Logit Models for Intervention Effect on Probability of Unprotected Sex
Logit Models for Intervention Effect on Probability of Unprotected Sex

Effects on secondary outcomes

Table 3 presents the estimates, significances, and confidence intervals for the linear models for intent to use condoms and knowledge about AIDS. No interactions of gender with treatment were found. Thus, the predictors in these models are exactly the same as in Table 2. For both secondary outcomes, gender was significant as a main effect, with female participants having higher values across the entire study for intent to use condoms (0.724 higher; P = .01) and knowledge about AIDS (0.649 higher; P = .04). There was a significant group × time1 interaction for intent to use condoms (P = .02) with a higher slope for the intervention group in the baseline to 6-month period. The slopes for the control group were near zero and nonsignificant during both times, implying little or no change. Knowledge about AIDS increased in the intervention and control groups from baseline to 6 months (P < .001), with no significant difference in the slopes for the 2 groups (P = .95). From 6 to 12 months, the control group significantly declined in knowledge (P = .003), whereas the intervention group did not. A test for the difference between the intervention and control groups during this period showed a significant difference in slopes (P = .03), further confirming that knowledge in the intervention group remained constant during this interval.

Table 3. 
Linear Models for Intent to Use Condoms and Knowledge About AIDS
Linear Models for Intent to Use Condoms and Knowledge About AIDS


The 6-month results indicate that the couple-focused HIV prevention program was efficacious in reducing unprotected vaginal sex acts and increasing intent to use condoms and knowledge about AIDS among young Latino parents. Participants receiving the intervention showed a sharp decrease in unprotected sex acts between baseline and the 6-month evaluation; however, this pattern was followed by an almost equal increase between 6 and 12 months. No significant changes in unprotected sex or intent to use condoms were observed for couples receiving the control condition. These findings on condom use at the 6-month follow-up support our earlier work.37 The odds ratio for risk behavior between the 2 groups was reduced by more than 50% during the first 6 months. This decrease in unprotected sex was somewhat larger than the pooled odds ratio estimate of 0.75 reported in a meta-analysis of behavioral interventions to reduce HIV risk in Hispanics.54 Other interventions measuring condom use show similar reductions in risk behavior for Latino youth23 and African American couples.36

Knowledge about AIDS significantly increased for participants in both groups through the 6-month evaluation. Within the 6- to 12-month interval, knowledge was maintained by participants in the couple-focused HIV program, whereas knowledge scores decreased for those receiving standard information. Gender differences were significant as main effects only for intent to use condoms and knowledge about AIDS; female participants scored higher in both groups.

Our findings support the need for an intervention maintenance program to help sustain behavior change. Maintenance, tailored to the original intervention, should be implemented approximately 6 months after completion of the sessions. The efficacy of maintenance programs in HIV prevention studies is being tested, with some positive effects reported.11

An important issue raised by these results concerns whether programs with 6 months or less of follow-up should be disseminated for replication as evidence-based models of intervention. Although establishment of intervention efficacy is essential, sustainability of program effects cannot be assumed on the basis of short-term outcomes.

Several challenges existed in conducting this clinical trial. Enormous efforts were required to recruit male partners and to retain couples for long-term evaluation, using computer-based tracking systems, frequent telephone calls, and incentives. Because we recruited through young mothers, women had to convince their partners to participate, and some young men changed their minds before enrollment. Most couples had a lengthy relationship, raising the possibility that stability of the relationship or partner commitment influenced recruitment efforts. Delivery of the intervention required extensive time and resources. Including a cost analysis in future studies will enhance understanding about resources needed for this type of research. Despite these challenges, addressing relationship issues within the context of an HIV prevention intervention was more effective than traditional education. Our results suggest that extending this approach to other age groups and non–child-rearing populations may be advantageous. In future research, we recommend that recruitment efforts be directed toward the couple rather than facilitated through women, as this approach may increase enrollment of individuals in less committed relationships. Strategies for dyadic outreach should focus on how the intervention may improve couple communication and negotiation of condom use and build healthy relationships in which sharing of personal information is safe.

The limitations of this trial warrant consideration. The design of the study does not allow us to determine how various intervention components contributed to the outcomes. Sexual behaviors were based on self-report data, which may be influenced by memory recall and social desirability. Responses of male and female partners, particularly concerning the number of protected and unprotected sexual episodes, may be inconsistent. At baseline, we found moderate concordance between partners' reports about whether condoms were used during the last sex episode; if one partner reported that condoms were not used, the probability that the other partner agreed was substantial.2 Reports of frequency of sex and condom use between partners in another couple intervention were often found to be inconsistent.36 Our findings may not be representative of other groups of youth because the participants were predominantly young Latino parents.

Despite these limitations, this randomized clinical trial is important, as it represents the first long-term evaluation of a couple-focused HIV prevention program for Latino childbearing teenagers and young adults. Additional research is needed to examine whether promoting condom use as the key prevention strategy in couple-focused HIV intervention programs is the best approach for young parents who report being in committed and monogamous relationships. Promoting self-protective behaviors in relationships may require alternative strategies (eg, continued monogamy with HIV testing) not tested in this trial.

Correspondence: Deborah Koniak-Griffin, EdD, RNC, School of Nursing, University of California, Los Angeles, 10833 LeConte Ave, Los Angeles, CA 90095 (

Accepted for Publication: September 22, 2010.

Author Contributions: Dr Koniak-Griffin had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Koniak-Griffin, Lesser, and Cumberland. Acquisition of data: Koniak-Griffin and Cumberland. Analysis and interpretation of data: Koniak-Griffin, Takayanagi, and Cumberland. Drafting of the manuscript: Koniak-Griffin, Takayanagi, and Cumberland. Critical revision of the manuscript for important intellectual content: Koniak-Griffin, Lesser, Takayanagi, and Cumberland. Statistical analysis: Takayanagi and Cumberland. Obtained funding: Koniak-Griffin, Lesser, and Cumberland. Administrative, technical, and material support: Koniak-Griffin. Study supervision: Koniak-Griffin.

Financial Disclosure: None reported.

Funding/Support: This study was supported by grant R01-NR04957 from the National Institute of Nursing Research (NINR) (Dr Koniak-Griffin) and grant 5P30AI028697 from the Center for AIDS Research.

Role of the Sponsors: The NINR had no role in the study design; in the collection, analysis, or interpretation of data; or in the writing of the article.

Disclaimer: This article is solely the responsibility of the authors and does not necessarily represent the official views of the NINR.

Previous Presentation: This study was presented in part at the 136th Annual Meeting of the American Public Health Association; October 29, 2009; San Diego, California; and at the International Council of Nurses Quadrennial Congress; July 3, 2009; Durban, South Africa.

Online-Only Material: This article is featured in the Archives Journal Club. Go to download teaching PowerPoint slides.

Additional Contributions: Evelyn González-Figueroa, PhD, MPH, served as project director, Ralph DiClemente, PhD, acted as a research consultant, and Carmen Turner, BMus, contributed as an editorial reviewer.

Ickovics  JRNiccolai  LMLewis  JBKershaw  TSEthier  KA High postpartum rates of sexually transmitted infections among teens: pregnancy as a window of opportunity for prevention.  Sex Transm Infect 2003;79 (6) 469- 473PubMedGoogle Scholar
Koniak-Griffin  DHuang  RLesser  JGonzález-Figueroa  ETakanayagi  SCumberland  WG Young parents' relationship characteristics, shared sexual behaviors, perception of partner risks, and dyadic influences.  J Sex Res 2009;46 (5) 483- 493PubMedGoogle Scholar
Lesser  JVerdugo  RLKoniak-Griffin  DTello  JKappos  BCumberland  WG Respecting and protecting our relationships: a community research HIV prevention program for teen fathers and mothers.  AIDS Educ Prev 2005;17 (4) 347- 360PubMedGoogle Scholar
Meade  CSIckovics  JR Systematic review of sexual risk among pregnant and mothering teens in the USA: pregnancy as an opportunity for integrated prevention of STD and repeat pregnancy.  Soc Sci Med 2005;60 (4) 661- 678PubMedGoogle Scholar
Guttmacher Institute, US teenage pregnancies, births and abortions: national and state trends and trends by race and ethnicity.  January2010; Accessed May 19, 2010
 The National Campaign to Prevent Teen and Unplanned Pregnancy: a look at Latinos: an overview of Latina teen pregnancy & birth rates.  The National Campaign Web site. May2008; Accessed July 21, 2010Google Scholar
DiClemente  RJWingood  GMHarrington  KF  et al.  Efficacy of an HIV prevention intervention for African American adolescent girls: a randomized controlled trial.  JAMA 2004;292 (2) 171- 179PubMedGoogle Scholar
DiClemente  RJWingood  GMRose  ES  et al.  Efficacy of sexually transmitted disease/human immunodeficiency virus sexual risk-reduction intervention for African American adolescent females seeking sexual health services: a randomized controlled trial.  Arch Pediatr Adolesc Med 2009;163 (12) 1112- 1121PubMedGoogle Scholar
Dolcini  MMHarper  GWBoyer  CBPollack  LM Project ORE: a friendship-based intervention to prevent HIV/STI in urban African American adolescent females.  Health Educ Behav 2010;37 (1) 115- 132PubMedGoogle Scholar
Jemmott  JB  IIIJemmott  LSBraverman  PKFong  GT HIV/STD risk reduction interventions for African American and Latino adolescent girls at an adolescent medicine clinic: a randomized controlled trial.  Arch Pediatr Adolesc Med 2005;159 (5) 440- 449PubMedGoogle Scholar
Jemmott  JB  IIIJemmott  LSFong  GT Efficacy of a theory-based abstinence-only intervention over 24 months: a randomized controlled trial with young adolescents.  Arch Pediatr Adolesc Med 2010;164 (2) 152- 159PubMedGoogle Scholar
Jemmott  JB  IIIJemmott  LSFong  GTMorales  KH Effectiveness of an HIV/STD risk-reduction intervention for adolescents when implemented by community-based organizations: a cluster-randomized controlled trial.  Am J Public Health 2010;100 (4) 720- 726PubMedGoogle Scholar
Stanton  BFLi  XGalbraith  J  et al.  Parental underestimates of adolescent risk behavior: a randomized, controlled trial of a parental monitoring intervention.  J Adolesc Health 2000;26 (1) 18- 26PubMedGoogle Scholar
Coyle  KKKirby  DBRobin  LEBanspach  SWBaumler  EGlassman  JR All4You! a randomized trial of an HIV, other STDs, and pregnancy prevention intervention for alternative school students.  AIDS Educ Prev 2006;18 (3) 187- 203PubMedGoogle Scholar
Di Noia  JSchinke  SP Gender-specific HIV prevention with urban early-adolescent girls: outcomes of the Keepin’ It Safe Program.  AIDS Educ Prev 2007;19 (6) 479- 488PubMedGoogle Scholar
Kennedy  MGMizuno  YHoffman  RBaume  CStrand  J The effect of tailoring a model HIV prevention program for local adolescent target audiences.  AIDS Educ Prev 2000;12 (3) 225- 238PubMedGoogle Scholar
Robin  LDittus  PWhitaker  D  et al.  Behavioral interventions to reduce incidence of HIV, STD, and pregnancy among adolescents: a decade in review.  J Adolesc Health 2004;34 (1) 3- 26PubMedGoogle Scholar
Rotheram-Borus  MJO’Keefe  ZKracker  RFoo  HH Prevention of HIV among adolescents.  Prev Sci 2000;1 (1) 15- 30PubMedGoogle Scholar
Roye  CPerlmutter Silverman  PKrauss  B A brief, low-cost, theory-based intervention to promote dual method use by black and Latina female adolescents: a randomized clinical trial.  Health Educ Behav 2007;34 (4) 608- 621PubMedGoogle Scholar
Shrier  LAAncheta  RGoodman  EChiou  VMLyden  MREmans  SJ Randomized controlled trial of a safer sex intervention for high-risk adolescent girls.  Arch Pediatr Adolesc Med 2001;155 (1) 73- 79PubMedGoogle Scholar
Siegel  DMAten  MJEnaharo  M Long-term effects of a middle school- and high school-based human immunodeficiency virus sexual risk prevention intervention.  Arch Pediatr Adolesc Med 2001;155 (10) 1117- 1126PubMedGoogle Scholar
Pantin  HPrado  GLopez  B  et al.  A randomized controlled trial of Familias Unidas for Hispanic adolescents with behavior problems.  Psychosom Med 2009;71 (9) 987- 995PubMedGoogle Scholar
Villarruel  AMJemmott  JB  IIIJemmott  LS A randomized controlled trial testing an HIV prevention intervention for Latino youth.  Arch Pediatr Adolesc Med 2006;160 (8) 772- 777PubMedGoogle Scholar
Caron  FGodin  GOtis  JLambert  LD Evaluation of a theoretically based AIDS/STD peer education program on postponing sexual intercourse and on condom use among adolescents attending high school.  Health Educ Res 2004;19 (2) 185- 197PubMedGoogle Scholar
Kirby  DBBaumler  ECoyle  KK  et al.  The “Safer Choices” intervention: its impact on the sexual behaviors of different subgroups of high school students.  J Adolesc Health 2004;35 (6) 442- 452PubMedGoogle Scholar
Sikkema  KJAnderson  ESKelly  JA  et al.  Outcomes of a randomized, controlled community-level HIV prevention intervention for adolescents in low-income housing developments.  AIDS 2005;19 (14) 1509- 1516PubMedGoogle Scholar
Prado  GPantin  HBriones  E  et al.  A randomized controlled trial of a parent-centered intervention in preventing substance use and HIV risk behaviors in Hispanic adolescents.  J Consult Clin Psychol 2007;75 (6) 914- 926PubMedGoogle Scholar
Walker  DGutierrez  JPTorres  PBertozzi  SM HIV prevention in Mexican schools: prospective randomised evaluation of intervention.  BMJ 2006;332 (7551) 1189- 1194PubMedGoogle Scholar
Koniak-Griffin  DLesser  JNyamathi  AUman  GStein  JACumberland  WG Project CHARM: an HIV prevention program for adolescent mothers.  Fam Community Health 2003;26 (2) 94- 107PubMedGoogle Scholar
DiClemente  RJWingood  GMRose  ESales  JMCrosby  RA Evaluation of an HIV/STD sexual risk-reduction intervention for pregnant African American adolescents attending a prenatal clinic in an urban public hospital: preliminary evidence of efficacy.  J Pediatr Adolesc Gynecol 2010;23 (1) 32- 38PubMedGoogle Scholar
Kershaw  TSMagriples  UWestdahl  CRising  SSIckovics  J Pregnancy as a window of opportunity for HIV prevention: effects of an HIV intervention delivered within prenatal care.  Am J Public Health 2009;99 (11) 2079- 2086PubMedGoogle Scholar
Harvey  SMHenderson  JTThorburn  S  et al.  A randomized study of a pregnancy and disease prevention intervention for Hispanic couples.  Perspect Sex Reprod Health 2004;36 (4) 162- 169PubMedGoogle Scholar
Harvey  SMKraft  JMWest  SGTaylor  ABPappas-Deluca  KABeckman  LJ Effects of a health behavior change model–based HIV/STI prevention intervention on condom use among heterosexual couples: a randomized trial.  Health Educ Behav 2009;36 (5) 878- 894PubMedGoogle Scholar
El-Bassel  NWitte  SSGilbert  L  et al.  The efficacy of a relationship-based HIV/STD prevention program for heterosexual couples.  Am J Public Health 2003;93 (6) 963- 969PubMedGoogle Scholar
El-Bassel  NWitte  SSGilbert  L  et al.  Long-term effects of an HIV/STI sexual risk reduction intervention for heterosexual couples.  AIDS Behav 2005;9 (1) 1- 13PubMedGoogle Scholar
El-Bassel  NJemmott  JBLandis  R  et al. NIMH Multisite HIV/STD Prevention Trial for African American Couples Group, National Institute of Mental Health Multisite Eban HIV/STD Prevention Intervention for African American HIV serodiscordant couples: a cluster randomized trial.  Arch Intern Med 2010;170 (17) 1594- 1601PubMedGoogle Scholar
Koniak-Griffin  DLesser  JHenneman  T  et al.  HIV prevention for Latino adolescent mothers and their partners.  West J Nurs Res 2008;30 (6) 724- 742PubMedGoogle Scholar
Moher  DHopewell  SSchulz  KF  et al.  CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomized trials.  BMJ 2010;340c869PubMed10.1136/bmj.c869Google Scholar
Schulz  KFAltman  DGMoher  DCONSORT Group, CONSORT 2010 Statement: updated guidelines for reporting parallel group randomized trials.  Ann Intern Med 2010;152 (11) 726- 732PubMedGoogle Scholar
National Adolescent Health Information Center (NAHIC), University of California, San Francisco, Fact Sheet on Demographics: Adolescents.  San Francisco University of California, San Francisco2009;
Bandura  A Social Foundations of Thought and Action.  Englewood Cliffs, NJ Prentice-Hall1986;
Ajzen  IFishbein  M Understanding Attitudes and Predicting Social Behavior.  Englewood Cliffs, NJ Prentice-Hall1980;
Fishbein  MAjzen  I Belief, Attitude, Intention, and Behavior.  Boston, MA Addison-Wesley1975;
Amaro  H Love, sex, and power: considering women's realities in HIV prevention.  Am Psychol 1995;50 (6) 437- 447PubMedGoogle Scholar
Connell  RW Gender and Power: Society, the Person, and Sexual Politics.  Stanford, CA Stanford University Press1987;
Wingood  GMDiClemente  RJ Partner influences and gender-related factors associated with noncondom use among young adult African American women.  Am J Community Psychol 1998;26 (1) 29- 51PubMedGoogle Scholar
Tello  J El hombre noble buscando balance: the noble man searching for balance. Carillo  RTello  J Family Violence and Men of Color: Healing the Wounded Male Spirit. New York, NY Springer1998;31- 52Google Scholar
National Institute of Mental Health (NIMH), Methodological overview of a multisite HIV prevention trial for populations at risk for HIV: NIMH Multisite HIV Prevention Trial.  AIDS 1997;11 ((suppl 2)) S1- S11PubMedGoogle Scholar
Catania  JAGibson  DRChitwood  DDCoates  TJ Methodological problems in AIDS behavioral research: influences on measurement error and participation bias in studies of sexual behavior.  Psychol Bull 1990;108 (3) 339- 362PubMedGoogle Scholar
Peragallo  NDeforge  BO’Campo  P  et al.  A randomized clinical trial of an HIV-risk-reduction intervention among low-income Latina women [published correction appears in Nurs Res. 2005;54(4):264].  Nurs Res 2005;54 (2) 108- 118PubMedGoogle Scholar
Little  RJARubin  DB Statistical Analysis With Missing Data. 2nd ed. Hoboken, NJ Wiley-Interscience2002;
Verbeke  GMolenberghs  G Linear Mixed Models for Longitudinal Data.  New York, NY Springer2000;
Marín  GSabogal  FMarín  BOtero-Sabogal  RPérez-Stable  EJ Development of a short acculturation scale for Hispanics.  Hispanic J Behav Sci 1987;9 (2) 183- 20510.1177/07399863870092005Google Scholar
Herbst  JHKay  LSPassin  WFLyles  CMCrepaz  NMarín  BVHIV/AIDS Prevention Research Synthesis (PRS) Team, A systematic review and meta-analysis of behavioral interventions to reduce HIV risk behaviors of Hispanics in the United States and Puerto Rico.  AIDS Behav 2007;11 (1) 25- 47PubMedGoogle Scholar