Testing the POWER Project: A Neighborhood Intervention Trial

Testing the POWER project: A Neighborhood Intervention Trial PROTOCOL SUMMARY Sheana S. Bull, Ph.D. Principal Investigator Protocol # 02-978

Background The POWER project (Prevention Options for Women Equals Rights) was a social marketing pilot project Targeting African American and Latina women aged 15-25 to promote the "mixing" of female and male condoms conducted in Denver, Colorado in 2000 and 2001. The results of the project show promise for increasing awareness and use of female condoms and use of male condoms (Bull et al., 2002). Sixty-four percent of the women in the follow-up study were able to identify one or more unique aspects of the POWER campaign. There was a significant increase in awareness and use of female condoms and in use of male condoms from baseline to follow-up. Being exposed to the POWER campaign was significantly correlated with having heard of (r = 0.13) and seen (r = 0.20) the female condom, and with having talked about female condoms more frequently with friends, family and acquaintances (r = 0.15). Chi-square analyses using follow-up study data (n=269) showed that women exposed to the campaign had significantly greater positive outcome expectancies toward female condom use (p<0.10) and talked about female condoms more frequently with more people (p<0.01).

The CDC reports increasing prevalence of Chlamydia among women in Oakland/Alameda County, San Diego, Las Vegas and Los Angeles and increasing rates of gonorrhea in Los Angeles and Las Vegas (Centers for Disease Control and Prevention, 2000, 2002). National data on teen births indicate that while teen births have been declining, the number of births to women aged 20-24 are increasing as are births to unmarried women. With the advent of the female condom as an efficacious female controlled barrier method for STD/HIV and pregnancy prevention in the early 1990's (Bounds, 1997; Farr, Gabelnick, Sturgen, & Dorflinger, 1994; Fontanet et al., 1998; McCabe, Golub S., & Lee, 1997; Soper et al., 1993; Trussell, Sturgen, Strickler, & Dominik, 1994), women at risk for these conditions were given a greater range of choices to control fertility and prevent disease.

Social marketing utilizes marketing and advertising concepts, integrated with social science theory for the development of behavior promotion campaigns targeted to specific subgroups. Such targeting is a key element of the social marketing approach. Social marketing approaches have been shown to be effective for changing blood cholesterol levels (Lefebvre, Lasater, Carleton, & Peterson, 1987), smoking behaviors (Kotler & Roberto, 1989), and women's and children's health (Hornick, 1991; Rasmuson, Seidel, & Smith, 1988).

The intent of this project is to replicate the POWER pilot campaign using a randomized controlled trial with neighborhoods as the unit of randomization and analysis. We plan to rigorously test the effects of the POWER campaign on women's knowledge of, attitudes toward and use of female and male condoms for the prevention of sexually transmitted disease (STD) and unintended pregnancy. We will work in 12 non-contiguous neighborhoods in four southwestern U.S. cities (four each in Oakland/Alameda County and Los Angeles and two each in San Diego and Las Vegas). We will complete a baseline assessment in all 12 neighborhoods to document knowledge of, attitudes toward and use of female and male condoms. We will then randomly assign six neighborhoods to intervention status and six neighborhoods to control status. We will adapt the campaign for each city, and implement it in six intervention neighborhoods for nine months, and will complete a follow-up assessment similar to the baseline assessment, with added questions regarding exposure to the POWER campaign. Study partners include Dr. Sheana Bull and research staff from the Colorado Health Outcomes Program (COHO) of the University of Colorado Health Sciences Center, Educational Message Services (EMS), and Centers for Disease Control and Prevention (CDC).