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Hip-Hop 2 Prevent Substance Abuse and HIV (H2P)

Hip-Hop 2 Prevent Substance Abuse and HIV (H2P) is designed to improve knowledge and skills related to drugs and HIV/AIDS among youth ages 12-16 with the aim of preventing or reducing their substance use and risky sexual activity. The program incorporates aspects of hip-hop culture--including language, arts, and history--as a social, cultural, and contextual framework for addressing substance use and HIV risk behaviors.

H2P uses a curriculum consisting of 10 modules, called "ciphers," delivered in 10 2-hour sessions. Through the curriculum's use of hip-hop culture, an interactive, multimedia CD, and a mix of traditional teaching methods, students learn information about drugs, HIV/AIDS, and sexual behavior; resistance and refusal skills; effective communication and negotiation skills; information about healthy alternatives to sex and drugs; and prevention self-efficacy skills.

School staff (e.g., teachers, counselors) deliver the first four modules in after-school or in-school sessions and the remaining modules at H2P camp, a 3-day retreat offering students structured learning and recreational activities, team-building experiences, mentoring, and opportunities for creative expression. Prior to serving as instructors, school staff participate in a 1-day training to learn about the genesis, ideology, and cultural components of hip-hop.

Descriptive Information

Areas of Interest Substance abuse prevention
Outcomes Review Date: November 2009
1: Perceived risk of harm from drug use
2: HIV knowledge
3: Self-efficacy to refuse sex
4: Disapproval of drug use
Outcome Categories Alcohol
Drugs
Tobacco
Ages 13-17 (Adolescent)
Genders Male
Female
Races/Ethnicities Black or African American
Hispanic or Latino
Race/ethnicity unspecified
Settings School
Other community settings
Geographic Locations Urban
Implementation History H2P was implemented during the 2005-2006 and 2006-2007 school years in an urban middle school in Prince George's County, Maryland. Both implementations were evaluated.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: No
Adaptations No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Universal
Selective

Quality of Research
Review Date: November 2009

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Strategic Community Services, Inc. (2006). Year 02 (2004-05) project evaluation report, Hip-Hop 2 Prevent Substance Abuse & HIV (H2P). Prince George's County, MD.

Turner-Musa, J. O., Rhodes, W. A., Harper, P. T. H., & Quinton, S. L. (2008). Hip Hop To Prevent Substance Abuse and HIV among African American youth: A preliminary investigation. Journal of Drug Education, 38(4), 351-365.  Pub Med icon

Study 2

Strategic Community Services, Inc. (2007). Year 03 (2005-06) project evaluation report, Hip-Hop 2 Prevent Substance Abuse & HIV (H2P). Prince George's County, MD.

Supplementary Materials

ADIA Research & Evaluation Associates, Inc. (2005). H2P power analysis.

Center for Substance Abuse Prevention. (2003). Core Measures Initiative Phase I recommendations.

H2P Curriculum Monitoring Forms

H2P Participant Survey

Outcomes

Outcome 1: Perceived risk of harm from drug use
Description of Measures Perceived risk of harm from drug use (use of alcohol, tobacco, marijuana, and other drugs) was measured by self-report using 4 items from the H2P Participant Survey developed for the studies. These questions were modified from items in the Perceived Harm Scale of the Monitoring the Future questionnaire and the Perceived Drug Use Scale from the Student Survey of Risk and Protective Factors. For each item (e.g., "How much do you think people risk harming themselves (physically or in other ways) if they try marijuana once or twice"?), participants responded using a 4-point scale (no risk to great risk). The survey was administered at pretest, at posttest immediately after the intervention, and 6 months after the intervention was completed.
Key Findings In two studies implemented in the same school in 2 consecutive years, 7th- and 8th-grade students were randomly assigned to an intervention group receiving H2P or to an assessment-only control group.

In the first study, from pretest to posttest, H2P participants had a significant increase in perceived risk associated with marijuana use compared with control group participants (p < .05). No other statistically significant results were found from pretest to posttest. From pretest to 6-month follow-up, H2P participants had a significant increase in overall drug risk perception compared with control group participants (p < .05), with no other statistically significant results found.

In the second study, H2P participants perceived greater risk of harm associated with marijuana use than participants from the control group at posttest (p = .009). No other significant differences between the two groups were observed at posttest or at 6-month follow-up.
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 2.7 (0.0-4.0 scale)
Outcome 2: HIV knowledge
Description of Measures HIV knowledge was measured by self-report using 10 items from the H2P Participant Survey developed for the studies. For each item (e.g., "You can get AIDS by kissing someone who has AIDS," "Birth control pills protect a woman from HIV"), participants responded with "true," "false," or "don't know." The survey was administered at pretest, at posttest immediately after the intervention, and 6 months after the intervention was completed.
Key Findings In two studies implemented in the same school in 2 consecutive years, 7th- and 8th-grade students were randomly assigned to an intervention group receiving H2P or to an assessment-only control group.

In the first study, no statistically significant differences on HIV knowledge were found between the groups at posttest. From pretest to 6-month follow-up, however, H2P participants had a significant increase in HIV knowledge compared with the control group (p < .01).

In the second study, H2P participants had significantly greater HIV knowledge than the control group at posttest (p < .05), with no statistically significant differences between the groups at 6-month follow-up.
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 2.4 (0.0-4.0 scale)
Outcome 3: Self-efficacy to refuse sex
Description of Measures Self-efficacy to refuse sex was measured by self-report using 6 items from the H2P Participant Survey developed for the studies. A sample item includes the following: "Imagine that you and your boyfriend or girlfriend have been going together, but you have not had sex. He or she really wants to have sex. Still, you don't feel ready. How sure are you that you could keep from having sex until you feel ready?" Participants responded to the items using a 4-point scale (very unsure to very sure). The survey was administered at pretest, at posttest immediately after the intervention, and 6 months after the intervention was completed.
Key Findings In two studies implemented in the same school in 2 consecutive years, 7th- and 8th-grade students were randomly assigned to an intervention group receiving H2P or to an assessment-only control group.

In the first study, no statistically significant differences were found across time between the two groups on self-efficacy to refuse sex.

In the second study, however, a significantly higher percentage of H2P participants compared with control group participants reported confidence in their ability to show love without sex at posttest (p = .008) and 6-month follow-up (p = .04). In addition, at 6-month follow-up, H2P participants compared with their control group counterparts reported significantly greater confidence in their ability to resist having sex despite their partner's desire to do so (p = .005) and in their ability to abide by their decision not to have sex yet (p = .007).
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 2.3 (0.0-4.0 scale)
Outcome 4: Disapproval of drug use
Description of Measures Disapproval of drug use (use of alcohol, tobacco, marijuana, and other drugs) was measured by self-report using 4 items from the H2P Participant Survey developed for the studies. For each item (e.g., "How wrong do you think it is for someone your age to smoke cigarettes?"), participants responded using a 4-point scale (very wrong to not wrong at all). The survey was administered at pretest, at posttest immediately after the intervention, and 6 months after the intervention was completed.
Key Findings In one study, 7th- and 8th-grade students were randomly assigned to an intervention group receiving H2P or to an assessment-only control group. At posttest, a significantly higher percentage of participants in the H2P group than the control group believed it was wrong for youth their age to drink alcohol regularly (p = .045), smoke cigarettes (p = .03), or use marijuana (p = .007). At 6-month follow-up, the percentage of participants disapproving of marijuana use remained significantly higher in the H2P group than in the control group (p = .01).
Studies Measuring Outcome Study 2
Study Designs Experimental
Quality of Research Rating 2.4 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 13-17 (Adolescent) 61% Female
39% Male
89% Black or African American
6% Race/ethnicity unspecified
5% Hispanic or Latino
Study 2 13-17 (Adolescent) 58% Female
42% Male
89% Black or African American
11% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Perceived risk of harm from drug use 3.5 3.5 3.0 2.3 2.3 1.5 2.7
2: HIV knowledge 2.9 2.3 3.0 2.3 2.3 1.5 2.4
3: Self-efficacy to refuse sex 2.8 2.3 3.0 2.3 2.3 1.5 2.3
4: Disapproval of drug use 3.0 2.5 3.0 2.3 2.0 1.5 2.4

Study Strengths

The reliability coefficients for the scales used are generally high. The scale used to measure the perceived risk of harm from drug use appears to have been developed using items from tools with established validity. A good attempt was made to implement the program as designed (e.g., consistent training was provided to H2P instructors, curriculum monitoring forms were used, the average rate of curriculum completion was 86% to 96% in the studies evaluated). Random assignment to intervention and control groups was used in both studies.

Study Weaknesses

Only face validity was reported for measures related to HIV knowledge, self-efficacy to refuse sex, and disapproval of drug use. The retention rate for each study was low at the 6-month follow-up, and the attrition analyses used in the studies were very weak. The data analysis strategies failed to take into account other confounding variables (e.g., participation of siblings, which could contaminate the effects) or to support treatment effects (e.g., by controlling for pretest scores in the examination of differences at posttest).

Readiness for Dissemination
Review Date: November 2009

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Center for Substance Abuse Prevention. (2003). Core Measures Initiative Phase I recommendations.

Harper, P. T. H. (2005). H2P student manual. Clinton, MD: Youth Popular Culture Institute and Strategic Community Services.

Harper, P. T. H. (2005). Hip Hop 2 Prevent Substance Abuse and HIV/AIDS: A youth development curriculum 4 adolescents. Clinton, MD: Youth Popular Culture Institute and Strategic Community Services.

Harper, P. T. H. (2008). Hip-hop development: Exploring hip-hop culture as a youth engagement tool for successful community building. Clinton, MD: Billo Communications and Youth Popular Culture Institute.

Program Web site, http://www.ypci.org/

Youth Popular Culture Institute, Inc. (n.d.). Certificate of training. Clinton, MD: Author.

Youth Popular Culture Institute, Inc. (n.d.). H2P camp protocol. Clinton, MD: Author.

Youth Popular Culture Institute, Inc. (n.d.). H2P curriculum monitoring form. Clinton, MD: Author.

Youth Popular Culture Institute, Inc. (n.d.). H2P weekend intervention agenda. Clinton, MD: Author.

Youth Popular Culture Institute, Inc. (n.d.). Hip-hop 101 [PowerPoint slides]. Clinton, MD: Author.

Youth Popular Culture Institute, Inc. (n.d.). Hip Hop 2 Prevent SA & HIV: Curriculum training [PowerPoint slides]. Clinton, MD: Author.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.0 2.3 3.3 2.8

Dissemination Strengths

The curriculum is comprehensive and well organized, and it includes specific information on the use of all materials. The student manual and the accompanying CDs are engaging and likely to resonate with young people. The training package provides prospective implementers with important background information on the hip-hop culture, underlying theoretical framework of the program, and expected outcomes. The developer provides fidelity and outcome measures to support quality assurance.

Dissemination Weaknesses

More guidance is needed to help program administrators prepare for implementation in the recommended settings (i.e., school, after-school programs, community settings). No information is provided for parents of youth involved in the program. Information on training, such as locations, scheduling, and costs, is not readily available to potential implementers. There are no specific instructions on the use of the fidelity or outcome measures.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Hip-Hop 2 Prevent Drugs.Digital (H2P.D) CD-ROM $59.95 each Yes
Leader guides $7.99 each Yes
Youth guides $7.99 each Yes
The WAIT Project Music CD $12 each Yes
Are You With Me? DVD $65 each Yes
8.5-hour, on-site training $12,500 for up to 20 participants, plus $625 for each additional participant and travel expenses for two trainers Yes
Technical assistance and consultation by phone or email Free No
On-site technical assistance and consultation Varies depending on location and site needs No

Additional Information

The estimated cost of implementing the intervention with 75 students is $64,700. This estimate includes a part-time program manager ($27,000) and part-time program assistant ($10,000); 2 instructors for every 25 students ($9,900 for 6 instructors); marketing ($3,000); supplies ($600); and costs for the camp, including program staff ($6,000), the facility ($3,200), and food ($5,000).

Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

* Strategic Community Services, Inc. (2007). Year 03 (2005-06) project evaluation report. Hip-Hop 2 Prevent Substance Abuse & HIV (H2P). Prince George's County, MD.

Contact Information

To learn more about implementation, contact:
Sylvia L. Quinton, Esq.
(410) 295-7177
SylviaQuinton@me.com

To learn more about research, contact:
Warren A. Rhodes, Ph.D.
(302) 736-1671
warhodes@yahoo.com

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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