The low rate of condom use among Hawaiian high school students, combined with the state's higher-than-national-average chlamydia rate, prompted the University of Hawai'i at Manoa to develop the Pono Choices curriculum. Pono Choices was developed as a culturally responsive adolescent pregnancy and sexually transmitted infection (STI) prevention program to target middle school youths in Hawai'i. Researchers Linda Toms Barker, Yasuyo Abe, and others evaluated the effectiveness of Pono Choices, and authored a report entitled "Culturally Responsive Adolescent Pregnancy and Sexually Transmitted Infection Prevention Program for Middle School Students in Hawaii," published in the American Journal of Public Health.
Researchers evaluated the effectiveness of Pono Choices using a cluster randomized controlled trials. These trials were conducted over three semesters between 2012 and 2013, using a sample of 36 middle schools and 2203 students. Researchers administered student surveys to collect baseline outcomes, student demographic data, and outcomes at 12 months after baseline.
Researchers found that this intervention positively affected the knowledge assessment, which focused on basic understanding of adolescent pregnancy and STI prevention. Students in the treatment group averaged 73.6 percent for correct responses compared to 60.4 for the control group. They did not find statistically significant effects on behavioral outcomes (initiation of sexual activity or engagement in high-risk sexual behavior) or on other non-behavioral outcomes (attitudes, skills, intentions). However, the average age of students was relatively low (12 years), meaning most students were not yet sexually active. Because of this, researchers believe that the 12-month follow-up was not enough time to observe changes. These results call for an exploration of longer-term outcomes to assess effects on knowledge retention and behavioral changes.