Rates of chronic diseases are high among Black South Africans. Few studies have tested cognitive-behavioral health-promotion interventions to reduce chronic diseases in South Africa. We tested the efficacy of such an intervention among adolescents in a cluster-randomized controlled trial. We randomly selected 9 of 17 matched-pairs of schools and randomized one school in each pair to the cognitive-behavioral health-promotion intervention designed to encourage health-related behaviors and the other to a HIV/STD risk-reduction intervention that served as the control. Interventions were based on social cognitive theory, the theory of planned behavior, and qualitative data from the target population. Data collectors, blind to participants’ intervention, administered confidential assessments at baseline and 3, 6, and 12 months post-intervention. Primary outcomes were fruit and vegetable consumption and physical activity. Participants were 1,057 grade 6 learners (mean age = 12.4 years), with 96.7% retained at 12-month follow-up. Generalized estimating equations revealed that averaged over the follow-ups, a greater percentage of health-promotion intervention participants than HIV/STD control participants met 5-a-Day fruit and vegetable and physical activity guidelines. The intervention also increased health-promotion knowledge, attitude, and intention, but did not decrease substance use or substance-use attitude and intention. The findings suggest that theory-based, contextually appropriate interventions may increase health behaviors among young adolescents in sub-Saharan Africa.

To test the efficacy of a school-based human immunodeficiency virus/sexually transmitted disease (HIV/STD) risk-reduction intervention for South African adolescents.Design: A cluster-randomized, controlled design with assessments of self-reported sexual behavior collected before intervention and 3, 6, and 12 months after intervention.Setting: Primary schools in a large, black township and a neighboring rural settlement in Eastern Cape Province, South Africa.Participants: Nine of 17 matched pairs of schools were randomly selected. Sixth-grade students with parent or guardian consent were eligible.Interventions: Two 6-session interventions based on behavior-change theories and qualitative research. The HIV/STD risk-reduction intervention targeted sexual risk behaviors; the attention-matched health promotion control intervention targeted health issues unrelated to sexual behavior.Outcome Measures: The primary outcome was self report of unprotected vaginal intercourse in the previous 3 months averaged over the 3 follow-ups. Secondary outcomes were other sexual behaviors.Results: A total of 1057 (94.5%) of 1118 eligible students (mean age,12.4 years) participated, with 96.7% retained at the 12-month follow-up. Generalized estimating equation analyses adjusted for clustering from 18 schools revealed that, averaged over the 3 follow-ups, a significantly smaller percentage of HIV/STD risk-reduction intervention participants reported having unprotected vaginal intercourse (odds ratio [OR] ,0.51; 95% confidence interval [CI], 0.30-0.85), vaginal intercourse (OR,0.62; 95% CI, 0.42-0.94), and multiple sexual partners (OR,0.50; 95% CI, 0.28-0.89), when adjusted for baseline prevalences, compared with health-promotion control participants. Conclusion:This is the first large-scale, community-level, randomized intervention trial to show significant effects on the HIV/STD sexual risk behavior of South African adolescents in the earliest stages of entry into sexual activity.

This study compared the predictive value of the theory of planned behavior in university students in South Africa (N = 251) and the United States (N = 160) who completed an anonymous self-administered questionnaire. Multiple regression analyses revealed that condom use and intention were significantly predicted by positive condom attitude, subjective norm, self-efficacy, and attending university in South Africa. Significant interactions between country and predictors indicated that subjective norm predicted condom use and intention more strongly in the American sample than in the South African sample; attitude predicted intention more strongly in the American sample than in the South African sample; but self-efficacy predicted intention more strongly in the South African sample than in the American sample. The theory of planned behavior may provide a useful framework for interventions to reduce South African students' risk of HIV/and sexuality transmitted diseases. Such interventions should especially focus on building self-efficacy to use condoms.

Objective Little research has tested HIV/STI risk-reduction-interventions’ effects on early adolescents as they age into middle and late adolescence. This study tested whether intervention-induced reductions in unprotected intercourse during a 12-month period endured over a 54-month period and whether the intervention reduced sexually transmitted infections (STIs), which increase risk for HIV. Method Grade-6 learners (mean age = 12.4 years), participants in a 12-month trial in Eastern Cape Province, South Africa in which nine matched-pairs of schools were randomly selected and within pairs randomized to a theory-based HIV/STI risk-reduction intervention or an attention-control intervention, were eligible, provided parental consent, and completed 42- and 54-month postintervention measures of unprotected intercourse, the primary outcome, other sexual behaviors, theoretical constructs, and, at 42- and 54-month follow-up only, biologically confirmed curable STIs (chlamydial infection, gonorrhea, and trichomoniasis) and herpes-simplex virus 2. Results The HIV/STI risk-reduction intervention reduced unprotected intercourse averaged over the entire follow-up period, OR = 0.42, 95% CI [0.22, 0.84], an effect not significantly reduced at 42- and 54-month follow-up compared with 3, 6, and 12-month follow-ups. The intervention caused positive changes on theoretical constructs averaged over the five follow-ups, though most effects weakened at long-term follow-up. Although the intervention’s main effect on STI was nonsignificant, an Intervention-Condition x Time interaction revealed it significantly reduced curable STIs at 42-month follow-up in adolescents who reported sexual experience. Conclusion These results suggest that theory-based behavioral interventions with early adolescents can have long-lived effects in the context of a generalized severe HIV epidemic.

To evaluate the efficacy of a health-promotion intervention in increasing self-reported physical activity among university students in Sub-Saharan Africa. Randomly selected second-year students at a university in South Africa were randomized to an intervention based on social cognitive theory: health-promotion, targeting physical activity and fruit, vegetable, and fat consumption; or HIV risk-reduction, targeting sexual-risk behaviors. Participants completed assessments via audio computer-assisted self-interviewing pre-intervention and 6 and 12 months post-intervention. A total of 176 were randomized with 171 (97.2%) retained 12 months post-intervention. Generalized-estimating-equations analyses indicated that the health-promotion-intervention participants were more likely to meet physical-activity guidelines than were control participants, post-intervention, adjusting for pre-intervention physical activity (odds ratio [OR] = 3.35; 95% CI: 1.33-8.41). Health-promotion participants reported a greater number of days they did vigorous-intensity (risk ratio [RR] = 2.01; 95% CI: 1.43-2.83) and moderate-intensity (RR = 1.40; 95% CI: 1.01-1.95) aerobic activity, but not strength-building activity (RR = 1.37; 95% CI: 0.091-2.07). The intervention reduced self-reported servings of fried foods (mean difference = -0.31; 95% CI: -0.60, -0.02). The findings suggest that theory-based, contextually appropriate interventions may increase physical activity among university students in Sub-Saharan Africa.