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Black and Latinx women aged 18–20 years have high rates of unplanned pregnancy. Furthermore, this age group is less likely than school-aged youth to be served by pregnancy prevention programs typically administered in schools. The study's purpose was to assess the effectiveness of a new app-based teen pregnancy prevention program created for this population using an online- and texting-only recruitment and evaluation approach. The study design was a randomized controlled trial with individual-level assignment of 1,304 women aged 18–20 years recruited online. Seventy-six percent of participants were black or Latinx. Women were randomized to the Pulse reproductive health app or a general health app and received regular text messages with program content and reminders to view the app. An intention-to-treat approach was used for analyses, and significance tests were adjusted to account for permuted block random assignment and multiple hypothesis testing. Linear probability models controlling for the baseline measure of each outcome, whether the participant reported ever having vaginal sex, age, and race/ethnicity, assessed program impacts for 1,124 participants 6 weeks after randomization. Participants who received the intervention were 7.6 percentage points less likely (p =.001) to report having had sex without a hormonal or long-acting contraceptive method. Intervention participants also scored 7.1 percentage points higher on contraceptive knowledge (p =.000) and were 5.7 percentage points more likely to be confident that they can use birth control during every sexual intercourse (p =.027). Impacts at 6 weeks are promising, particularly for a self-led intervention with no direct contact with study staff. [ABSTRACT FROM AUTHOR]

Purpose: To examine how cohort trends in family, individual, and relationship characteristics are linked to trends in adolescent reproductive health outcomes to provide a better understanding of factors behind recent declines in teenage birth rates. Methods: We examine a sample of three cohorts of females and males aged 15–19 in 1992, 1997, and 2002, based on retrospective information from the 2002 National Survey of Family Growth. We identify how family, individual, and relationship characteristics are associated with the transition to sexual intercourse, contraceptive use at first sex, and the transition to a teen birth. Results: Cohort trends and multivariate analyses indicate changes in family and relationship characteristics among American teens have been associated with positive trends in reproductive health since the early 1990s. Factors associated with improvement in adolescent reproductive health include positive changes in family environments (including increases in parental education and a reduced likelihood of being born to a teen mother) and positive trends in sexual relationships (including an increasing age at first sex and reductions in older partners). These positive trends may be offset, in part, by negative changes in family environments (including an increased likelihood of being born to unmarried parents) and the changing racial/ethnic composition of the teen population. Conclusions: Recent increases in the U.S. teen birth rate highlight the continued importance of improving reproductive health outcomes. Our research suggests that it is important for programs to take into consideration how family, individual, and relationship environments influence decision-making about sex, contraception, and childbearing. [Copyright &y& Elsevier]

Abstract: Purpose: To explore relationships between immigration measures and risk of reproductive and sexual events among U.S. Hispanic adolescents. Methods: We examined generation status, language in the home and country of origin in relation to sexual activity, contraception, and childbearing among 1614 Hispanic adolescents, using nationally representative 1997–2003 longitudinal data. Multivariable analyses controlled for potentially confounding variables. Tests for effect modification by gender and Mexican origin were conducted. Results: Fewer first generation adolescents transitioned to sexual intercourse before age 18 (odds ratio [OR]=.80, 95% confidence interval [CI]=.66–.98) and fewer first and second generation sexually active teens used contraceptives consistently at age 17 (OR=.32, 95% CI=.17–.60 and OR=.50, 95% CI=.31–.80, respectively) than third-generation teens. Language was similarly associated with the transition to sexual intercourse and contraceptive practices. Versus teens of Mexican origin, teens of Puerto Rican origin and origins other than Cuba and Central/South America had greater odds of becoming sexually active; youth of all origins except Central/South America had fewer multiple live births (OR=.14–.31). Gender modified the effects of generation on consistent use of contraceptives and condoms at age 17. Gender also modified the effect of country of origin on transitioning to sexual intercourse before age 18 years. Conclusions: Results expand on previous observations that generation, language, and country of origin are predictors of reproductive and sexual risks for Hispanic adolescents. These immigration measures may therefore be useful in targeting community and clinical preventive services. [Copyright &y& Elsevier]

Abstract: Purpose: To incorporate a behavioral model of health services utilization to examine whether male adolescents'' family, individual, sex education, and partner factors are associated with several measures of condom use and consistency in heterosexual relationships. Methods: We examine a sample of sexually experienced male adolescents 15–19 years of age in the 2002 National Survey of Family Growth (NSFG) to identify factors associated with condom use at first sex and last sex, condom consistency with their most recent sexual partner, and condom consistency in the past 4 weeks. Results: Male adolescents who were Hispanic and those who did not receive formal sex education had lower odds of condom use and/or consistency, whereas African-American male adolescents and those with more positive attitudes about condoms had greater odds. Males who were older at most recent sex, who had an older sexual partner or a casual first sexual partner, who had a partner who used a method of contraception, who were in longer relationships, or who engaged in more frequent sex had reduced odds of contraceptive use. Conclusions: Findings highlight multiple domains of influence on condom use behaviors among male adolescents. Programs that provide targeted services, address condom use attitudes, and help teens to negotiate condom use decision making with sexual partners may help to reduce high rates of sexually transmitted infections among male adolescents in the United States. [Copyright &y& Elsevier]

Abstract: Purpose: To examine whether multiple dimensions of parent and family religiosity—including parental religious attendance, denomination, beliefs, and family religious activities—are associated with the timing of sexual initiation or contraceptive use at first sex. Methods: We analyze a sample of sexually inexperienced adolescents aged 12–14 years in the 1997 National Longitudinal Survey of Youth (NLSY97) to test the association between multiple dimensions of parent and family religiosity and the transition to first sexual experience and contraceptive use at first sex during the teen years. We assess the association between parent and family religiosity and the timing of adolescent sexual experience using multivariate event history models, and examine contraceptive use outcomes using logistic regressions. All analyses are conducted separately by gender and race/ethnicity. Results: More frequent parental religious attendance is associated with a delayed timing of first sex among all sub-populations except among black adolescents. Engaging in family religious activities on a daily basis is associated with delayed sexual initiation among male, female, and white teens. Results for contraceptive use differ, however. Only strong parental religious beliefs and more frequent participation in family religious activities are associated with contraceptive use at first sex, in a negative direction, among males. Conclusion: More frequent parental religious attendance and family religious activities are related to later timing of sexual initiation, highlighting an important dimension of family environments that can help improve reproductive health outcomes for children. However, stronger family religiosity does not translate into improved contraceptive use. [Copyright &y& Elsevier]