PEDIATRICS Vol. 95 No. 4 April 1995, pp. 480-486
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A Randomized, Controlled Trial of a School-based, Multi-faceted AIDS Education Program in the Elementary Grades: the Impact on Comprehension, Knowledge and Fears

David J. Schonfeld MD1, Linda L. O'Hare MS2, Ellen C. Perrin MD3, Marcia Quackenbush MS4, Donald R. Showalter MPH5, and Domenic V. Cicchetti PhD6

1 Department of Pediatrics and the Child Study Center, Yale University School of Medicine, New Haven, CT
2 Department of Pediatrics, Yale University School of Medicine, New Haven, CT
3 Department of Pediatrics, University of Massachusetts, Worcester, MA
4 AIDS Health Project, University of California San Francisco, San Francisco, CA
5 West Haven VA Medical Center, West Haven, CT
6 Department of Psychiatry and the Child Study Center, Yale University School of Medicine, New Haven, CT and the West Haven VA Medical Center, West Haven, CT

Objective. Several educational theorists have suggested that young children are unlikely to benefit from detailed instruction regarding AIDS prevention because of inherent developmental cognitive limitations. This study aims to determine whether AIDS education in the elementary grades can advance young children's understanding of this illness.

Methods. A randomized, controlled trial was used to measure the impact of a 3-week, multifaceted AIDS education program on conceptual understanding, factual knowledge, and fears about AIDS in 189 students in grades kindergarten through 6th. The ASK (AIDS Survey for Kids), a standardized, semistructured interview that measures conceptual understanding, factual information, and fears about AIDS, was administered before and after the intervention.

Results. Children in the intervention group, as compared to those in the control group, showed significant (P < .0001) gains in their level of understanding of the concepts of causality and prevention of AIDS. These results were unaffected by controlling for grade, gender, race, socioeconomic status, and verbal fluency. The gains in children's understanding of causality of AIDS represented at least 2 years' growth in the level of conceptual sophistication and persisted at a follow-up evaluation several months later. After the intervention, more children (P < .001) in the intervention group than in the control group accurately identified causes of AIDS in response to open-ended questions: germ/germ theory (41% vs 13%), mother-to-infant transmission (54% vs 15%), blood transmission (83% vs 40%), and sexual transmission (56% vs 30%). Fewer than half as many children in the intervention group responded incorrectly to each of five direct questions about transmission of HIV through casual contact. The intervention did not increase children's fears about the illness.

Conclusions. A short, developmentally based, multifaceted AIDS education program in the elementary grades can advance children's conceptual understanding and factual knowledge about AIDS and decrease their misconceptions about casual contact as a means of acquiring the illness, without increasing their fears. Significant advances in conceptual understanding about AIDS can be achieved through direct educational interventions.

Submitted on May 3, 1994
Accepted on July 26, 1994




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