Color it Real

About the program

Color it Real is a program designed to increase condom use and reduce substance abuse and perceived stress. The program emphasizes access to health resources, making condoms available, training young adults on personal risks and stress reduction.

Core program goals include self-efficacy, problem-solving and the development of health-promoting behaviour and responsibility.

Who does it work for?

This program was designed for 18–24-year-old youth identifying as African American.

Color it Real has only been evaluated in the USA. A quasi-experimental design study (Zellner et al. 2015) was conducted with 192 participants (122 in the intervention group and 70 in the control group). Participants in both intervention and control groups were an average of 20 years old. Almost all students in the intervention group were African American (96%) and 90% of students in the control group were African American. Students were predominantly female in both the intervention (81%) and control (61%) groups. Students in the control group had slightly higher levels of completed education than the intervention group on all measures (did not complete high school, completed high school and some college education and higher).

Color it Real has not been evaluated in Australia or with Aboriginal Australians.

What outcomes does it contribute to?

Positive outcomes:

• Color it Real participants experienced a decrease in perceived stress.
• Color it Real participants reported a decreased intention to drink five or more alcoholic drinks in one sitting in the next 3 months
• Color it Real participants reported an increased intention to use clean needles when injecting drugs in the next 6 months.
• Color it Real participants reported increased intentions to use a female condom during a sexual encounter in the next 3 months.

No effect:

• The program had no effect on participants’ intentions to use any illegal drugs (including prescription drugs) to get high in the next 6 months
• The program had no effect on participants’ intentions to use injection drugs without a doctor’s orders, just to feel good or to get high in the next 6 months
• The program had no effect on participants’ intentions to use a condom during next sexual encounter
• The program had no effect on participants’ intentions to use a condom during a sexual encounter in the next 3 months.

How effective is it?

Overall, the program had a mixed effect on client outcomes.

How strong is the evidence?

Mixed research evidence (with no adverse effects):

• At least one high-quality randomised controlled trial (RCT)/quasi-experimental design (QED) study reports statistically significant positive effects for at least one outcome, AND
• An equal number or more RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
• No RCT/QED studies show statistically significant adverse effects.

How is it implemented?

Color it Real is delivered in locations convenient to local participants over the course of 7 weeks. The program includes 7 two-hour HIV/substance use prevention sessions, outreach and recruitment services, peer education, life skills development, social media, and referral services for screening, testing, counselling and treatment.

Trained staff are central to supporting the young adults in changing their behaviour and risk perceptions. Activities to promote positive attitudes and build effective communication included games, exercises, and role-playing.

In small groups, participants discuss the following topics:

• HIV/STI risk knowledge
• Assessing personal risk and avoiding sexual risk
• The correct use of male and female condoms
• Identifying and managing triggers for unsafe sex
• Substance use
• Problem-solving

How much does it cost?

No program costs reported for Color it Real.

What else should I consider?

The study intentionally selected health educators who were socially and contextually congruent to participants which may have assisted with rapport building and positive outcomes.

Where does the evidence come from?

1 QED conducted in the USA with 192 participants (Zellner et al., 2015).

Further resources

Zellner, T, Trotter, J, Lenoir, S, Walston, K, Henry-Akintobi, T, & Miller, A 2016, ‘Color it real: A program to increase condom use and reduce substance abuse and perceived stress’, International Journal of Environmental Research and Public Health, vol. 13, no. 1, article number 13010051, https://doi.org/10.3390/ijerph13010051