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To estimate the effect of the Making Proud Choices! (MPC) curriculum, one of the most popular evidence-based teen pregnancy prevention curricula being implemented nationwide. A cluster randomized trial was used to assign high schools to receive the MPC program or to serve as a standard care comparison group. The study took place in 15 schools in four cities in the United States. A total of 31 clusters and over 2,800 youth (predominantly in grades 9 and 10) were assigned to condition between 2016 and 2019. Student surveys administered at baseline and approximately 9 months after baseline were used to estimate the effects of MPC on risk and protective factors (knowledge, attitudes, self-efficacy) as well as sexual behavior outcomes. The evaluation showed several large, statistically significant, and favorable impacts on nearly all of the risk and protective factors for risky sexual behavior. In addition, the study found a favorable effect of MPC on reducing the number of episodes of sex in the past 3 months. The evaluation showed that MPC, as it is commonly implemented today, has evidence of effectiveness on improving both risk and protective factors, and sexual behavior outcomes. Based on these findings, MPC will continue to be seen as an evidence-based teen pregnancy prevention program for implementation through federal grant programs. [ABSTRACT FROM AUTHOR]

This study characterized the patterns and predictors of pre-post changes in knowledge, attitudes, beliefs, behaviors, and intentions (KABBIs) among 641 youth who completed evidence-based teen pregnancy prevention programs. At follow-up, 64.0% of youth showed changes knowledge, communication, and attitudes; 22.5% showed changes in knowledge, attitudes, beliefs, communication, and increased sexual intentions; and 13.6% showed changes in attitudes and decreased sexual intentions. The strongest predictors of changes were youth baseline KABBI scores, mode of delivery, and number and type of adaptations made to the curricula. Results underscore the importance of examining the role of youth and program characteristics in predicting KABBI change patterns. [ABSTRACT FROM AUTHOR]

Congress has provided funding for the federal Teen Pregnancy Prevention (TPP) Program since 2009 for spending beginning in Fiscal Year 2010. Designated TPP programs develop, test, and evaluate innovations for reducing teen pregnancy, teen pregnancy disparities, and associated risk factors and for promoting positive youth development. Since its inception, the TPP Program has experimented with multiple uniquely structured cohorts of innovation and demonstration projects, producing critical insights into equitable and effective public health innovation while also serving as a highly productive contributor of evidence-based, TPP innovations for scale. This article briefly documents the innovation history of the TPP Program and its iterations in response to the shifting needs of the field. We then synthesize findings from the fifteen TPP innovators published in this special edition. We highlight emergent priorities of the TPP Program informed by this federal experiment in rigorous adolescent sexual health innovation development, testing, evaluation, and scaling and conclude by discussing how the TPP program adapted and refined its approach for fostering dynamic innovation-to-scale projects over time. [ABSTRACT FROM AUTHOR]

From 2015 to 2021, the US Department of Health and Human Services' Teen Pregnancy Prevention (TPP) program funded Power to Decide, a national reproductive health nonprofit organization, to catalyze innovation in adolescent sexual and reproductive health through the development of technology-based interventions. Power to Decide's initiative, Innovation Next, supported twenty innovation teams in using human-centered design (HCD) to develop new products, services, and programs. We describe the Innovation Next implementation model, which can inform future efforts to develop innovative, technology-based TPP programs using HCD. To that end, we draw on quantitative and qualitative data collected for program improvement to summarize key implementation findings. [ABSTRACT FROM AUTHOR]

Many sexual health programs transitioned to virtual implementation during the COVID-19 pandemic. Despite its devastation, the pandemic provided an opportunity to learn about virtual compared to in-person implementation of a sexual health promotion program—El Camino. This study assessed differences in program attendance, engagement, quality, and student ratings for virtual versus in-person implementation of El Camino as part of a rigorous evaluation in high schools with high Latino populations in Maryland. Drawing on positive youth development practices, El Camino helps participants identify personal goals and learn about sexual reproductive health and healthy relationships. This mixed-methods study incorporates data from performance measures, baseline and post-intervention participant surveys, observations, monthly implementation reports, and debriefs with facilitators to describe and compare virtual and in-person program implementation. At baseline, participants were an average of 16.2 years old; between 8 and 12th grade; 61% female; 79% Hispanic, Latino, or of Spanish origin; and 54% spoke mostly Spanish at home. Recruitment and retention of students outside of school classes were challenging for both forms of implementation. However, attendance was higher during in-person implementation and in schools where the organization implementing El Camino had a strong presence before the pandemic. Findings indicate high fidelity, excellent quality ratings, and positive student perceptions of the program and facilitators in both the virtual and in-person cohorts, which suggest that both forms of implementation were comparable and furthermore highlight the strength of the virtual adaptation of the El Camino program. [ABSTRACT FROM AUTHOR]

In 2019, Native youth had the highest rate of teen pregnancy of all racial/ethnic groups. "Respecting the Circle of Life" (RCL) is one of the first evidence-based teen pregnancy prevention programs for Native teens and there is interest in replicating the program across tribal communities. To inform replication, it is important to consider process data including quality, fidelity, and dosage as these may all moderate impact of the program. Participants were Native youth aged 11–19 and a trusted adult. This study includes participants randomized to the RCL program only (N = 266). Data sources include independent observations, facilitator self-assessments, attendance logs, and self-report assessments completed by enrolled youth at baseline and 3 months post assessment. Data was compiled and summed by cohort. Dosage was number of minutes participating in activities separated by theoretical constructs. Linear regression models were utilized to assess moderation of the effects of the intervention dosage on outcomes of interest. Eighteen facilitators delivered RCL. One hundred eighteen independent observations and 320 facilitator self-assessments were collected and entered. Findings indicate RCL was implemented with high fidelity and quality (4.40 to 4.82 out of a 5-point Likert scale; 96.6% of planned activities completed). Dosage was high with an average completion of 7 out of 9 lessons. There was no association between theoretical construct dosage and outcomes of interest. Overall, this study indicates RCL was delivered with high fidelity, quality, and dosage in this trial. This paper informs future replication of RCL and provides support for hiring paraprofessionals from the local community as facilitators, delivering the RCL to peer groups of the same age and sex, delivering the RCL with short duration and high frequency, and encouraging youth to attend all RCL lessons, but continue to serve youth who have missed one or more lessons. [ABSTRACT FROM AUTHOR]

To advance the field of teen pregnancy prevention, new interventions must be developed and tested. The federal Teen Pregnancy Prevention program (TPP) funds the evaluation of promising interventions. We report on a funding disruption to 21 TPP Tier 2B research grantees across the US that was unusual for its ideological causation, sudden timing, severity, and ultimately court decisions compelling the agency to reverse the decision. We address the following question: How did challenges presented by the attempted funding termination impact grantees’ ability to continue with their intended research? Results from grantee surveys in 2019 demonstrate the funding disruption negatively impacted participant recruitment, organizational collaboration, program delivery, research rigor, and compromised grantees’ ability to complete high-quality evaluations. Results also show most projects could continue, with modified research goals, when funding was reinstated. We conclude administrations should avoid arbitrarily and prematurely terminating research projects. However, there is merit in reinstating funds to projects should a disruption occur. Results from this work are particularly relevant as we anticipate how health research projects may manage other disruptions to funding or timetables, such as those caused by COVID-19. Results are relevant to policy makers, researchers, government and private funders, grantees, and technical assistance teams.

Although U.S. adolescent birth rates in general have declined in recent decades, they continue to be a primary public health concern due to notable disparities among adolescent birth rates. In response, pregnancy prevention program development has increasingly focused on understanding how to better serve the needs of adolescents in underserved populations. To inform future program development and implementation efforts, this qualitative study explored which attributes of programs facilitated and hindered youth engagement. We collected data from educators (N = 43) and a subset of youth program participants (N = 249) from programs implemented by 14 organizations in different community-based settings. We used three data collection methods: (1) post-session surveys completed by educators, (2) post-program implementation interviews with educators, and (3) individual and focus group interviews with youth participants. Qualitative analyses revealed that educators who skillfully facilitated interactive activities and safe and inclusive learning environments promoted engagement. Feeling uncomfortable and awkward during program activities, learning in mixed-gender settings, and COVID-19 disruptions hindered engagement. Additionally, we found that youth participants had conflicting views on learning about sexual relationships at churches. Participants and educators had conflicting views on the benefit of youth attending programs with previously acquainted friends. [ABSTRACT FROM AUTHOR]

Mobile technology allows delivery of sexual and reproductive health (SRH) information directly to youth. We tested the efficacy of Crush, a mobile application aimed at improving sexual health by promoting the use of SRH services and contraception among female adolescents. We recruited 1,210 women aged 14–18 years through social media advertising and randomized them into a Crush intervention group and a control group that received a wellness app. At 3 and 6 months post randomization, we compared changes from baseline in behaviors, attitudes, self-efficacy, perceived social norms, birth control knowledge, perceived control and use intentions, and SRH service utilization. Odds ratios were estimated with multivariable logistic regression and adjusted for baseline outcome, age, race/ethnicity, mother's education, and sexual experience. There was no difference in accessing SRH services according to study group. Three months post baseline, Crush users had higher odds (p <.05) than control participants of reporting confidence in accessing SRH services (adjusted odds ratio [aOR] = 1.6, 95% confidence interval [CI]: 1.1–2.3) and of believing that it is a good thing to use birth control consistently (aOR = 2.3, 95% CI: 1.4–3.8). Six months after baseline, Crush users had higher odds than control participants of reporting they can control whether birth control is used every time they have sex (aOR = 1.8, 95% CI: 1.2–2.6) and perceiving they would get pregnant if they did not use birth control (aOR: 1.5, 95% CI: 1.1–2.2). Impacts on other behavioral constructs were also found. Crush was associated with improvements in knowledge, attitudes, and self-efficacy related to key SRH behaviors and may be a strategy to deliver SRH education to adolescent women. Studies including larger numbers of sexually active adolescents are needed to demonstrate behavioral impacts. [ABSTRACT FROM AUTHOR]

Beginning in 2010, the U.S. Department of Health and Human Services (HHS) sponsored numerous studies testing the effectiveness of Adolescent Pregnancy Prevention programs on youths' risky sexual behaviors. This article presents results from a meta-analysis of such studies completed between 2015 and 2019 and provided to us by HHS. Studies were eligible for inclusion if they used an experimental/quasi-experimental design, included a comparison condition, assigned at least 10 study participants to each condition, and measured and reported at least one outcome related to sexual behavior or consequences. Data were extracted using a standardized coding protocol and outcomes were coded as, or transformed to, log odds ratio effect sizes for analysis and then transformed to odds ratio effect sizes for presentation in the text. All outcomes were coded such that log odds ratios greater than zero (odds ratios greater than 1) indicate beneficial effects (e.g., reductions in risky sexual behavior). A total of 52 studies met the inclusion criteria. Across 7 outcome types, pooled effects were generally small, the direction of effects was mixed, and none achieved statistical significance: recent pregnancy (OR = 1.30, 95% CI [1.00, 1.68]), ever had sex (OR = 1.07, 95% CI [0.99, 1.15]), recent sexual activity (OR = 0.95, 95% CI [0.84, 1.09]), recent unprotected sexual activity (OR = 1.05, 95% CI [0.96, 1.16]), ever pregnant (OR = 1.21, 95% CI [0.51, 2.89]), number of sexual partners (OR = 1.08, 95% CI = [0.28, 4.22]), and proportion of recent sexual experiences that were unprotected (OR = 0.74, 95% CI = [0.43, 1.31]). Moderator analyses pooling across all 7 outcome types indicated minor differences in program effectiveness between program settings, with those delivered in classroom settings being the least effective (b =  - 0.17, 95% CI [- 0.33, - 0.01]). These findings do not lend meaningful support for the overall effectiveness of this group of pregnancy prevention programs. However, because the meta-analysis sample only included programs recently funded by HHS, these findings may have limited generalizability to programs funded by other entities or implemented in other countries. [ABSTRACT FROM AUTHOR]

Background: In teen pregnancy prevention (TPP) evidence-based program replication, fidelity toolkits (FTKs) provide structure to ensure that essential curricular components are delivered as intended. Objective: The purpose of this project was to extend quality improvement efforts (Flinders, 2017) through analysis of FTKs from four years of TPP implementation. Methods: An evidence-based TPP program was delivered to females, 15–19 years of age (n = 1,658) from four suburban Ohio counties. Fidelity rates were calculated by agency staff and undergraduate nursing students. Grounded theory was used to identify themes from the narrative sections of the FTKs. Plan-Do-Study-Act methodology (Agency for Healthcare Research and Quality, 2008) guided this quality improvement work. Results: Staff fidelity was reported as 98.38%. Student fidelity was reported at 99.05%. Key themes, identified as a result of the qualitative analysis, were categorized as participant factors, site factors, or presenter factors. Conclusions: Toolkits created an effective safeguard to ensure the replication of the evidence-based TPP program, with fidelity. Implications for Nursing: Undergraduate students are capable of implementing evidence-based programming, with fidelity, to meet the educational needs of their communities. Analysis of narrative comments from toolkits can influence FTK revisions to improve program delivery. [ABSTRACT FROM AUTHOR]

Abstract Background Early sexual initiation is associated with higher risk for sexually transmitted infection, teen pregnancy, domestic violence and substance use in later adolescence and early adulthood. Native American adolescents are more likely to have early sexual initiation compared to other racial/ethnic groups. Few programs designed with and for Native adolescents to delay sexual initiation and substance use have been tested through rigorous evaluations. This is the protocol for the randomized controlled trial of the Asdzáán Be’eena’ program, a teen pregnancy and substance use prevention program for young Native girls and their female caregivers. Methods N = 410 female adolescents ages 10–14 and their female caregivers will be enrolled in the study and randomized to the intervention or control arm. The intervention consists of the 11-session Asdzáán Be’eena’ program. The control arm consists of mailed non-monetary incentives. All participants will complete evaluations at baseline and 3 follow-up timepoints (immediate, 6 and 12 months post intervention). Evaluations include measures to assess protective factors associated with delayed sexual initiation and substance use. Discussion This is one of the first rigorous evaluations of a gender-specific, culturally tailored teen pregnancy and substance use primary prevention program for Native girls and their female caregivers. If proven efficacious, Native communities will have a culturally appropriate program for promoting protective factors associated with delayed substance use and sexual risk taking. Trial registration NCT04863729 ; April 27, 2021.

BackgroundLocal implementation of evidence-based curricula, including sex education, has received increasing attention. Although there are expectations that practitioners will implement evidence-based programs with fidelity, little is known regarding the experiences of instructors in meeting such standards. During 2005 to 2009, the California Department of Public Health funded local agencies through its Teen Pregnancy Prevention Programs (TPP) to provide comprehensive sex education.MethodsTo improve understanding of how agencies implemented curricula, in-depth telephone interviews with 128 coordinators were conducted in 2008 to 2009. Qualitative data were analyzed for content and themes. Selected data were quantified and analyzed to examine differences in curriculum adaptations across settings and curricula type.ResultsWhereas over half of the TPP agencies (59%) implemented evidence-based curricula, most agencies (95%) reported adapting the curriculum, with the majority (83%) adding content. Reasons for adaptations included ensuring that the material was accurate and appropriate; responding to logistical or time constraints; and other factors, such as parental and institutional support.ConclusionThese adaptations reflected agencies' efforts to balance state and local requirements, maintain curriculum fidelity, and provide more up-to-date and accessible information. These experiences highlight the need for guidelines that enable appropriate adaptations, while maintaining fidelity to the core components of the original curriculum.

Purpose: This case study discusses Mathematica's experience providing large-scale evaluation technical assistance (ETA) to 65 grantees across two cohorts of Teen Pregnancy Prevention (TPP) Program grants. The grantees were required to conduct rigorous evaluations with specific evaluation benchmarks. This case study provides an overview of the TPP grant program, the evaluation requirements, the ETA provider, and other key stakeholders and the ETA provided to the grantees. Finally, it discusses the successes, challenges, and lessons learned from the effort. Conclusion: One important lesson learned is that there are two related evaluation features, strong counterfactuals and insufficient target sample sizes, that funders should attend to prior to selecting awardees because they are not easy to change through ETA. In addition, if focused on particular outcomes (for TPP, the goal was to improve sexual behavior outcomes), the funder should prioritize studies with an opportunity to observe differences in these outcomes across conditions; several TPP grantees served young populations, and sexual behavior outcomes were not observed or were rare, limiting the opportunity to observe impacts. Unless funders are attentive to weaning out evaluations with critical limitations during the funding process, requiring grantees to conduct impact evaluations supported by ETA might unintentionally foster internally valid, yet underpowered studies that show nonsignificant program impacts. The TPP funder was able to overcome some of the limitations of the grantee evaluations by funding additional evidence-building activities, including federally led evaluations and a large meta-analysis of the effort, as part of a broader learning agenda. [ABSTRACT FROM AUTHOR]

The IN·clued: Inclusive Healthcare – Youth and Providers Empowered, program is an educational intervention designed to reduce unintended pregnancies and sexually transmitted diseases among lesbian, gay, bisexual, transgender, queer, and questioning youths. The goals are to increase sexual health knowledge, healthcare self-efficacy, and sexual healthcare use, and to reduce unprotected sexual behaviors. Through funding from the federal Office of Adolescent Health Teen Pregnancy Prevention Initiative, IN·clued was evaluated using a cluster randomized control trial. The study took place in 16 states with 1,401 youths; 1,182 of whom (84.4%) completed surveys one year after the workshop. This analysis uses an intent-to-treat framework using ordinary least squares regressions to estimate the effects on each outcome. One year after the workshop, compared with the control youths, a significantly smaller proportion of IN·clued participants had vaginal sex without a condom in the past three months and did so significantly fewer times. Youths who received IN·clued demonstrated significantly higher knowledge and healthcare self-efficacy scores. A significantly greater proportion of the program youths had been to a doctor or clinic for and received contraception or birth control. A significantly greater proportion of the program youths reported feeling they could advocate for their own relevant sexual health care. IN·clued sought to change risky sexual behaviors, sexual health knowledge, receipt of sexual health care services, and self-efficacy regarding health care and achieved these goals. Findings were extremely positive with a population that has been neglected in sex education programs. [ABSTRACT FROM AUTHOR]

This study uses a randomized controlled trial (RCT) to evaluate the effectiveness of a mass media campaign designed to reduce pregnancy among Latina teenagers. We aired public service announcements (PSAs) on terrestrial radio stations in California. The sample includes 28 radio stations and over 11,000 births to Latina teenagers in 2016. The PSA, narrated by a young Latina, stressed the opportunity costs to teenage mothers of having a baby, e.g., missed opportunities for fun, socializing with friends, or attending school. Although this message expresses themes articulated by Latina teens and young mothers whom we interviewed, geocoded birth records suggest the PSAs had little effect. With data on all births in the state obtained from the California Department of Public Health, we can reject the hypothesis that the PSAs reduced births to Latina teenagers by 9% or more based on the 90% confidence interval of the estimated average treatment effect. In addition to shedding light on this particular radio campaign, this study provides a template for the design and analysis of mass media campaigns to improve other public health outcomes. [ABSTRACT FROM AUTHOR]

Background: Early sexual initiation is associated with higher risk for sexually transmitted infection, teen pregnancy, domestic violence and substance use in later adolescence and early adulthood. Native American adolescents are more likely to have early sexual initiation compared to other racial/ethnic groups. Few programs designed with and for Native adolescents to delay sexual initiation and substance use have been tested through rigorous evaluations. This is the protocol for the randomized controlled trial of the Asdzáán Be'eena' program, a teen pregnancy and substance use prevention program for young Native girls and their female caregivers.Methods: N = 410 female adolescents ages 10-14 and their female caregivers will be enrolled in the study and randomized to the intervention or control arm. The intervention consists of the 11-session Asdzáán Be'eena' program. The control arm consists of mailed non-monetary incentives. All participants will complete evaluations at baseline and 3 follow-up timepoints (immediate, 6 and 12 months post intervention). Evaluations include measures to assess protective factors associated with delayed sexual initiation and substance use.Discussion: This is one of the first rigorous evaluations of a gender-specific, culturally tailored teen pregnancy and substance use primary prevention program for Native girls and their female caregivers. If proven efficacious, Native communities will have a culturally appropriate program for promoting protective factors associated with delayed substance use and sexual risk taking.Trial Registration: NCT04863729 ; April 27, 2021. [ABSTRACT FROM AUTHOR]

Objective: In this study, we isolated primary messaging strategies of sexuality education curricula to improve tailored delivery of group-based interventions. Specifically, our aim was to define single-message programs (eg, messaging about avoiding sexual risk or messaging about reducing sexual risk) and multiple-message programs (eg, avoiding sexual risk and reducing sexual risk), and to investigate their comparative effectiveness. Methods: We used a descriptive approach with publicly available data from US Department of Health and Human Services-funded teen pregnancy prevention programs to categorize 16 different curricula as single-message or multiple-message. We coded primary messages using a curriculum mapping rubric and scoring that was evaluated by a panel of experts for content validity. Forest plots compared behavioral outcomes. Results: Scores for primary messages achieved inter-rater reliability of 91%-100%; curricula were scored on 20 items within each category to calculate mean scores. Spearman correlations for items ranged from .43 to .93. Conclusions: No outcome differences were observed between single- or multi-message programs. Effective delivery of primary messaging may rely more on identifying moderators of classroom climate typically underrepresented in evaluations of school-based programs. [ABSTRACT FROM AUTHOR]

BACKGROUND Teen pregnancy continues to burden families, communities, and society. Programs continue to educate and impower youth and young adults to make positive behavioral decisions. METHODS: We evaluated a program aimed at high‐risk youth in after‐school programs. The goal of the program was to instill a sense of community and empathy, as well as sexual health decision‐making. The evaluation was a multiyear evaluation from external evaluators. RESULTS: There were statistically significant changes in empathy toward others in the community and a feeling of safety at school. Other positive changes noted were that students felt empowered to use condoms, other barriers, or birth control in the future when having sexual relations. The program noted a positive direction in students feeling they develop plans or goals and stick to them. CONCLUSIONS: These programs serve to instill a sense of empowerment, community, and responsibility in students. Evaluation data can serve as a metric of the merit of these programs and the impact on school health programs and communities. [ABSTRACT FROM AUTHOR]

Involving faith-based organizations in community health promotion has gained widespread interest and has been a successful approach in addressing various health disparities in vulnerable communities. However, there is comparatively little evidence regarding sexual health promotion among faith-based organizations. Some agencies have responded to the challenge of reducing teen pregnancy with broad-based initiatives involving many different sectors of the community including faith-based organizations. Focus groups with key church leaders (n = 25) from zip codes with identified birth rates of 95 or higher were conducted to explore their perception of teen pregnancy among their communities. Purposive and snowball sampling were utilized. Recruitment was conducted through calls, email, and flyers. This study identified the barriers that church leaders encounter in their efforts to address teen pregnancy in their communities. Common themes that emerged include church education, parent support and communication, cultural barriers, availability of resources, awareness of services, and the need for comprehensive sexual education. Findings and recommendations to help those working in the faith community overcome identified barriers are addressed. Recent decreases in teen birth rates should not lead to complacency; rather they should inspire public health practitioners to do more, especially when some communities have not experienced the same success. Collaborating with faith-based organizations is one method to consider when considering community prevention efforts. [ABSTRACT FROM AUTHOR]

Implementation support can improve outcomes of evidence-based programs (EBP) for adolescents, but with a cost. To assist in determining whether this cost is worthwhile, this study estimated the cost of adding Getting To Outcomes© (GTO) implementation support to a teen pregnancy and sexually transmitted infection prevention EBP called Making Proud Choices (MPC) in 32 Boys and Girls Clubs (BGCs) in Alabama and Georgia. Enhancing Quality Interventions Promoting Healthy Sexuality (EQUIPS) was a 2-year, cluster-randomized controlled trial comparing MPC with MPC + GTO. We used micro-costing to estimate costs and captured MPC and GTO time from activity logs completed by GTO staff. Key resource use and cost components were compared between the randomized groups, years, and states (to capture different community site circumstances) using 2-sample t tests. There were no significant differences between randomized groups in attendees per site, resource use, or costs for either year. However, there were significant differences between states. Adding GTO to MPC increased the societal costs per attendee from $67 to $144 (2015 US dollars) in Georgia and from $106 to $314 in Alabama. The higher Alabama cost was due to longer travel distances and to more BGC staff time spent on GTO in that state. GTO also improved adherence, classroom delivery, and condom-use intentions more in Alabama youth. Thus, Alabama's GTO-related BGC staff time costs may be better estimates of effective GTO. If teen childbearing costs taxpayers approximately $20,000 per teen birth, adding GTO to MPC would be worthwhile to society if it prevented one more teen birth per 140 attendees than MPC alone. Trial registration.ClinicalTrials.gov, NCT01818791. Registered March 26, 2013, https://clinicaltrials.gov/ct2/show/NCT01818791?term=NCT01818791&draw=2&rank=1 [ABSTRACT FROM AUTHOR]

Although rural youth experience marked inequities in adolescent pregnancy, there is little guidance for implementing evidence-based programs (EBPs) in rural settings. When implementation occurs in rural communities, it frequently focuses on deficits, rather than strengths or capacity for growth. Using the consolidated framework for implementation research (CFIR), we describe a resiliency-focused implementation of two middle school EBPs in rural Midwestern communities, including the intervention, outer and inner settings, individuals, implementation processes and preliminary outcomes. Data included program staff interviews, feedback from local partners, community meetings notes, and participant surveys. Using the CFIR, we describe the engagement of rural communities themselves in a resilience-based implementation of adolescent pregnancy prevention EPBs. Communities self-described as rural, traditional and religious. They identified adolescent pregnancy, substance use, and academic success as priorities. To address infrastructure needs and build on local strengths, funds were used to hire local partners to implement the program. As small communities, stakeholders were closely networked and wanted to address local needs. Local partners selected the EBP based upon community values and priorities. Champions, including local partner organizations and schools were locally based and were well connected. Intensive training of local staff and piloting with adaptation assured fidelity and sustainability, while increasing community implementation skills and comfort. In Clinton County, enrollment was 1946 with students receiving the program in 6th, 7th, and/or 8th grades. In Southern Indiana, 7275 students received the program once in either 6th, 7th, or 8th. We conclude that the CFIR can facilitate the implementation of a community resilience-focused adolescent pregnancy prevention intervention in rural communities. [ABSTRACT FROM AUTHOR]

BACKGROUND: School‐based pregnancy prevention programs should optimally be offered while students are still engaged in school since early disengagement is strongly associated with risk of a teen birth. METHODS: We used linked New York City birth and enrollment data (2005–2013), a sample of 6,809 teen mothers (mean age conception = 16.2 years). We measured preconception disengagement using monthly absences, age 12 until conception, and identified five attendance trajectories using group‐based trajectory modeling. RESULTS: We identified five attendance trajectories that were heterogeneous with respect to age of onset and rate of increase of absenteeism. In two groups, 80% were chronically absent (CA) [2–<4 absences/month] or severely chronically absent (SCA) [4+ absences/month] at age 12, and over 90% by age 13, when they averaged 3.8–5.1 absences/month. Despite heterogeneity, 37% of teen mothers were CA or SCA at age 12, increasing to 56% by age 14. By early high school, age 15, 63% of teen mothers had absenteeism problems; 26% were CA and 37% SCA. CONCLUSIONS: Most teen mothers were disengaged before high school, years before conception. School‐based pregnancy prevention programs should be offered in middle school or earlier when at‐risk students are not missing significant amounts of school and may be more receptive to prevention messages. [ABSTRACT FROM AUTHOR]

This study prospectively investigates associations among youth religiosity, religious denomination, and contraception use. Associations between youth religiosity and religious denomination, and type of contraceptive used and consistent contraceptive use among sexually active youth (N = 757) were analyzed using multinomial and binomial logistic regression. Identifying with a religious denomination was a predictor of dual contraceptive use relative to using no method of contraception (AOR = 2.17). There was no association between youth religiosity and type of contraceptive use or contraceptive consistency. Religious leaders and public health practitioners should collaborate to develop strategies to engage in conversations with sexually active youth about contraceptive use. [ABSTRACT FROM AUTHOR]

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]

Although long-acting reversible contraceptives (LARC) such as intrauterine devices and subdermal implants remain the most effective methods of contraception for teenagers, most adolescents continue to use less reliable methods. The purpose of this study was to determine: (1) the distribution of contraceptive type according to age of the patients in our clinic system (Baylor Teen Health Clinic); and (2) the differences in this distribution over the past decade. This study was a comprehensive chart review of at least 15,500 charts for the years 2005 to 2014. Baylor Teen Health Clinic. Charts of patients less than 25 years of age who attended one of the 9 Baylor Teen Health Clinics were reviewed. Contraceptive uptake by age and year was the main outcome measured. The percentage of women younger than age 25 years who used LARC increased for all age groups from 2005 to 2014, with the greatest increase for women 20-24 years old (<1% to 9%). The percentage of women using no method decreased for all age groups from 2005 to 2014 with the greatest decrease for women 15-19 years old (9% to 5%). The percentage of women using less effective methods decreased for teenagers younger than 18 years old, but increased for women 20-24 years old and remained the same for women 18-19 years old. Use of pills/patches/rings decreased for all age groups and use of hormonal injections increased for all age groups, with the greatest increase for teenagers younger than 15 years of age (35% to 68%). Our clinic population has a greater proportion of teenagers and young women using LARC than the national average, possibly because of the increased access to LARC when these women enter our clinic system. Nevertheless, less than 10% of all age groups studied used LARC, with the proportion being lowest in teenagers younger than 18 years. More efforts need to be placed on determining the reasons for low LARC uptake despite greatest efficacy in this young, vulnerable population. [ABSTRACT FROM AUTHOR]

Despite the declining national teen birth rates, racial disparities persist. Black and Hispanic teens in some communities continue to experience disproportionately higher teen birth rates. This pilot study explored parental perspectives regarding teen pregnancy and parental self-efficacy in communicating with teens about sex. Seven focus groups were conducted with 35 Black and Hispanic parents who reside in five targeted zip codes with exceptionally high teen birth rates, ranging from 84.2 to 112.9 per 1,000. These rates exceed the 26.5 per 1,000 national teen birth rate by more than 300%. Results reveal cultural differences in parental self-efficacy between Black and Hispanic parents in communicating with teens. Black parents reported higher self-efficacy. Hispanic parents reported cultural beliefs as communication barriers with teens. [ABSTRACT FROM AUTHOR]

Background: Teen pregnancy is associated with increased risk of school dropout, employment challenges and long-term poverty; these risks are exacerbated for foster youth who are at elevated risk for teen pregnancy. Sex education and relationship education can facilitate the development of attitudes and skills associated with behaviors that reduce risky sexual behaviors. However, research on sex education with foster youth is limited as is research exploring the potential benefits of combining relationship education with sex education. Objective: This study examines variations in the experiences and outcomes of non-foster youth (n = 160) and foster youth (n = 165) who participated in a federally funded teen pregnancy prevention program that included both relationship and sex education. Methods: Path analysis models examined the relationship between several exogenous variables (i.e., youth characteristics, pre-program risky sexual behavior, program experience) and three endogenous variables (i.e., post-program perceived change in intercourse, condom use, and contraceptive use intentions). Multi-group analyses were used with foster youth status as a moderator to determine if the model was invariant by foster youth status. Results: Although foster youth entered programming with elevated rates of risky sexual behavior, both groups reported positive program experiences and safer sexual behavior intentions post-programming. Conclusion: Regardless of their elevated rates of risky sexual behavior prior to receiving programming, foster youth, like non-foster youth, may benefit from both relationship and sex education. For foster youth specifically, their positive program experience and reduced intentions to engage in risky sexual behaviors is an encouraging finding that contrasts with existing literature. [ABSTRACT FROM AUTHOR]

Abstract Purpose Inequitable access to quality adolescent sexual and reproductive health (ASRH) care may contribute to the high rate of teen pregnancy in the Bronx, New York. Bronx Teens Connection (BxTC), a community-wide intervention, sought to increase the number of ASRH best practices implemented and the number of females 12–19 years old receiving services by health centers in the Bronx. Methods To promote best practices, BxTC provided training and technical assistance to partnering health centers from 2011 to 2014. Health center staff completed a 26-item survey annually to document clinic practices and service utilization. Significance of changes was assessed with paired t tests. Results BxTC provided 285 hours of training and technical assistance to 12 partnering health centers. Eight health centers consistently completed the survey. Of the possible 31 ASRH best practices, the average number implemented increased from 23 in 2011 to 28 in 2014. Increases in unduplicated female adolescent patients were observed among Hispanics/Latinas (p =.026) and all females aged 15–17 (p =.035). Contraceptive coverage reported by six of the eight health centers increased among Hispanic/Latinas (32%–55%, p =.006), patients ages 15–17 (33%–53%, p =.005), and patients 18–19 (38%–56%, p =.036). The total number of hormonal implants provided to teens increased from two in 2011 to 173 in 2014. Conclusions Other jurisdictions may consider prioritizing clinical linkages in order to improve ASRH outcomes by supporting best practices and expanding access to services in the most disinvested neighborhoods. [ABSTRACT FROM AUTHOR]

Teen pregnancy and sexually transmitted infections remain a major health concern and are linked to a number of poor outcomes. Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth are particularly at risk for these issues. Although evidence-based teen pregnancy prevention (TPP) programs exist, they are not necessarily tailored to meet the needs of LGBTQ youth. This paper reports on the development and implementation of a LGBTQ training for TPP facilitators working for the Augusta Partnership for Children in Augusta, GA. The four-hour workshop covered a range of topics including terminology, identity, intersectionality, and risk/resilience factors through a combination of lecture, video clips, and interactive activities. The training was well-received with most facilitators rating the training as excellent on satisfaction surveys completed one-week after the training. Qualitative comments were also largely positive; areas for improvement included discussion of the legal context around LGBTQ issues and the impact of race on LGBTQ issues. Future work is needed to expand on these findings by examining the impact of such trainings on TPP program implementation and, ultimately, on LGBTQ youth.

This paper reviews the changing strategies for both process and outcome evaluations of teen pregnancy prevention programs over the past few decades. Implementation evaluations have emphasized discovery of what program attributes are most effective in reducing teen pregnancy and its antecedents. Outcome evaluations have moved from collecting data to measure knowledge, attitudes, and program satisfaction to measuring behavior change including postponement of sexual involvement, increased used of contraception, or reduction in teen pregnancy. High quality randomized control trials or quasi-experimental designs are being increasingly emphasized, as are sophisticated analysis techniques using multi-variate analyses, controls for cluster sampling, and other strategies designed to build a more solid knowledge base about how to prevent early pregnancy.

The article deals with the important role played by evidence and scientific facts in creating a U.S. federal policy aimed at reducing unplanned pregnancy and improve the lives of children and families.

In 2013, South Carolina implemented a multiyear program providing support services for pregnant and parenting teens. Local lead sites were responsible for coordinating service delivery in partnership with other multidisciplinary community-based organizations. We used social network theory and analyses (SNA) to examine changes in partnerships over time. Using two-stage purposeful sampling, we identified three lead sites and their self-reported community partners. We administered two web-based surveys grounded in social network theory that included questions about partnership relationships and organizational characteristics. We calculated selected whole-network measures (size, cohesion, equity, diversity). Following the Year 1 surveys, we reviewed our findings with the lead sites and suggested opportunities to strengthen their respective partnerships. Following the Year 3 surveys, we observed changes across the networks. Survey response rates were 91.5% (43/47) in Year 1 and 68.2% (45/66) in Year 3. By Year 3, the average network size increased from 15.6 to 20.3 organizations. By Year 3, one lead site doubled its measure of network cohesion (connectedness); another lead site doubled in size (capacity). A third lead site, highly dense in Year 1, increased in size but decreased in cohesion by Year 3. Innovative use of SNA findings can help community partnerships identify gaps in capacity or services and organizations needed to fulfill program aims. SNA findings can also improve partnership function by identifying opportunities to improve connectedness or reduce redundancies in program work. The ability of lead sites to strategically reconfigure partnerships can be important to program success and sustainability. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to report sexual knowledge, attitudes, and behaviors of system-involved youth living in group homes, and when appropriate, contrast these data with equivalent national data. Methods: Data were collected from a sample of racially/ethnically diverse youth (N= 1036, 79% male, Mean age=16.1 years). Results: Nearly all comparisons indicate that persons in this sample were more likely to engage in sexual risk behaviors compared to other youth populations. For example, 90% of the participants reported having had sexual intercourse compared to 54% of youth in the child welfare system and 47% of youth in the general population. Conclusions: Youth living in out-of-home care can benefit from programs that provide skills enabling them to reduce sexual risk-taking and prevent pregnancy. [ABSTRACT FROM AUTHOR]

Objective: We determined whether Power Through Choices (PTC) significantly reduced oral sex and increased dual method contraceptive use among teens. Methods: The design was a cluster randomized controlled trial involving 1036 youth recruited from 44 group care homes who completed surveys at pre-intervention, post-intervention, 6-month post-intervention, and 12-months post-intervention. Results: PTC intervention youth living outside of the homes at 6-months post-intervention were less likely to report ever having oral sex (AOR = 0.23, 95% CI = 0.08-0.67). PTC intervention youth had reduced odds of ever participating in oral sex at 12-months post-intervention (AOR = 0.47, 95% CI = 0.23-0.93). Conclusions: The PTC intervention had a positive effect on the reduction of youth oral sex behavior; however, future research should identify factors contributing to dual contraceptive methods use. [ABSTRACT FROM AUTHOR]

Purpose The purpose of the study was to prospectively determine if youth assets were significantly associated with contraception use after accounting for the effects of youths' exposure to comprehensive sexuality education programming. Methods Prospective associations between youth asset scores, comprehensive sexuality education topics received, type of contraceptive used, and consistent contraceptive use were analyzed using multinomial and binomial logistic regression in a sample of 757 sexually active youth. Results Higher youth asset scores were associated with condom use (adjusted odds ratio [AOR] = 1.51, 95% CI = 1.01–2.28), hormonal birth control use (AOR = 2.71, 95% CI = 1.69–4.35), dual method use (AOR = 2.35, 95% CI = 1.44–3.82), and consistent contraceptive use (AOR = 1.97, 95% CI = 1.38–2.82). After controlling for youths' experience with comprehensive sexuality education, higher youth asset scores remained a significant predictor of hormonal birth control use (AOR = 2.09, 95% CI = 1.28–3.42), dual method use (AOR = 2.58, 95% CI = 1.61–4.15), and consistent contraceptive use (AOR = 1.95, 95% CI = 1.36–2.80). Conclusions Youth serving organizations that are interested in preventing teen pregnancy should consider widespread implementation of evidence-based youth development programs that focus on building and strengthening specific youth assets. [ABSTRACT FROM AUTHOR]

Purpose Youth in out-of-home care have higher rates of sexual risk behaviors and pregnancy than youth nationally. This study aimed to determine if Power Through Choices (PTC), a teen pregnancy prevention program developed for youth in out-of-home care, significantly improves knowledge and psychosocial outcomes regarding HIV and sexually transmitted infections (STIs), sexual activity and contraception methods, long term. Methods A cluster randomized controlled trial was conducted with 1,036 ethnically diverse youths (aged 13–18 years) recruited from 44 residential group homes in three states. Intervention participants received the 10-session PTC intervention; control participants received usual care. Participants were administered self-report surveys at baseline, after intervention, 6 and 12 months after the intervention. Survey items assessed knowledge, attitudes, self-efficacy, and behavioral intentions regarding HIV and STIs, sexual activity and contraception methods. Random intercept logistic regression analyses were used to assess differences between the intervention and control groups. Results Compared with youth in the control group, youth in the PTC intervention demonstrated significant improvements in knowledge about anatomy and fertility (adjusted odds ratio [AOR] = 1.07, 95% confidence interval [CI] = 1.03–1.11), HIV and STIs (AOR = 1.03, 95% CI = 1.002–1.07), and methods of protection (AOR = 1.06, 95% CI = 1.03–1.09), as well as self-efficacy regarding self-efficacy to communicate with a partner (AOR = 1.14, 95% CI = 1.04–1.26), plan for protected sex and avoid unprotected sex (AOR = 1.16, 95% CI = 1.04–1.28), and where to get methods of birth control (AOR = 1.13, 95% CI = 1.01–1.26) 12 months after the intervention. Conclusions Findings suggest that the PTC intervention can have positive long-term knowledge and psychosocial effects regarding contraception methods on youth in out-of-home care. [ABSTRACT FROM AUTHOR]

Sexually transmitted infection (STI) and birth rates among American Indian/Alaska Native (AI/AN) youth indicate a need for effective middle school HIV/STI and pregnancy prevention curricula to delay, or mitigate, the consequences of early sexual activity. While effective curricula exist, there is a dearth of curricula with content salient to AI/AN youth. Further, there is a lack of sexual health curricula that take advantage of the motivational appeal, reach, and fidelity of communication technology for this population, who are sophisticated technology users. We describe the adaptation process used to develop Native It's Your Game, a stand-alone 13-lesson Internet-based sexual health life-skills curriculum adapted from an existing promising sexual health curriculum, It's Your Game-Tech (IYG-Tech). The adaptation included three phases: (1) pre-adaptation needs assessment and IYG-Tech usability testing; (2) adaptation, including design document development, prototype programming, and alpha testing; and (3) post-adaption usability testing. Laboratory- and school-based tests with AI/AN middle school youth demonstrated high ratings on usability parameters. Youth rated the Native IYG lessons favorably in meeting the needs of AI/AN youth (54-86 % agreement across lessons) and in comparison to other learning channels (57-100 %) and rated the lessons as helpful in making better health choices (73-100 %). Tribal stakeholders rated Native IYG favorably, and suggested it was culturally appropriate for AI/AN youth and suitable for implementation in tribal settings. Further efficacy testing is indicated for Native IYG, as a potential strategy to deliver HIV/STI and pregnancy prevention to traditionally underserved AI/AN middle school youth. [ABSTRACT FROM AUTHOR]

Fidelity monitoring is an essential component of evidence-based replication in teen pregnancy prevention. Fidelity toolkits ensure that core curriculum is adhered to, by providing a detailed checklist of expected activities. When systematically reviewed, fidelity toolkits offer critical information on challenges and barriers that can inform and improve future programming. The purpose of this project was to implement an educational program to improve sexual health in teens, using a fidelity toolkit to promote and evaluate program fidelity. Participants, from a suburban Ohio county, included faculty, junior-level baccalaureate nursing students, and females, 15-19 years of age. Plan- do-study-act methodology was used to carry out this quality improvement initiative. Twenty-three nursing students, divided among 3 clinical sections, and their 3 faculty members completed the fidelity toolkits. Part I fidelity ranged from 82.73% to 100% (M = 97.8%), Part II fidelity ranged from 75% to 95.83% (M = 92.76%), Part III fidelity ranged from 81.5% to 95.83% (M = 91.8%), and Part IV fidelity ranged from 57% to 100% (M = 98.2%). Overall, fidelity of the program averaged 96.4%. Several themes were identified as a result of the qualitative analysis of narrative toolkit responses, in the categories of participant factors, site factors, and presenter factors. Toolkit use led to a high level of program fidelity. [ABSTRACT FROM AUTHOR]

Background: Systematic reviews help policy makers and practitioners make sense of research findings in a particular program, policy, or practice area by synthesizing evidence across multiple studies. However, the link between review findings and practical decision-making is rarely one-to-one. Policy makers and practitioners may use systematic review findings to help guide their decisions, but they may also rely on other information sources or personal judgment. Objectives: To describe a recent effort by the U.S. federal government to narrow the gap between review findings and practical decision-making. The Teen Pregnancy Prevention (TPP) Evidence Review was launched by the U.S. Department of Health and Human Services (HHS) in 2009 as a systematic review of the TPP literature. HHS has used the review findings to determine eligibility for federal funding for TPP programs, marking one of the first attempts to directly link systematic review findings with federal funding decisions. Conclusions: The high stakes attached to the review findings required special considerations in designing and conducting the review. To provide a sound basis for federal funding decisions, the review had to meet accepted methodological standards. However, the review team also had to account for practical constraints of the funding legislation and needs of the federal agencies responsible for administering the grant programs. The review team also had to develop a transparent process for both releasing the review findings and updating them over time. Prospective review authors and sponsors must recognize both the strengths and limitations of this approach before applying it in other areas. [ABSTRACT FROM AUTHOR]

To advance the field of teen pregnancy prevention, new interventions must be developed and tested. The federal Teen Pregnancy Prevention program (TPP) funds the evaluation of promising interventions. We report on a funding disruption to 21 TPP Tier 2B research grantees across the US that was unusual for its ideological causation, sudden timing, severity, and ultimately court decisions compelling the agency to reverse the decision. We address the following question: How did challenges presented by the attempted funding termination impact grantees' ability to continue with their intended research? Results from grantee surveys in 2019 demonstrate the funding disruption negatively impacted participant recruitment, organizational collaboration, program delivery, research rigor, and compromised grantees' ability to complete high-quality evaluations. Results also show most projects could continue, with modified research goals, when funding was reinstated. We conclude administrations should avoid arbitrarily and prematurely terminating research projects. However, there is merit in reinstating funds to projects should a disruption occur. Results from this work are particularly relevant as we anticipate how health research projects may manage other disruptions to funding or timetables, such as those caused by COVID-19. Results are relevant to policy makers, researchers, government and private funders, grantees, and technical assistance teams., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Declarations of financial interest: none. Other potential competing interest: Some of the authors served in some capacity on or with the grantee projects being described in this paper., (© 2023 The Authors.)

Purpose Youth living in group home settings are at significantly greater risk for sexual risk behaviors; however, there are no sexual health programs designed specifically for these youth. The study's purpose was to assess the effectiveness of a teen pregnancy-prevention program for youth living in group home foster care settings and other out-of-home placements. Methods The study design was a cluster randomized controlled trial involving youth (N = 1,037) recruited from 44 residential group homes located in California, Maryland, and Oklahoma. Within each state, youth (mean age = 16.2 years; 82% male; 37% Hispanic, 20% African-American, 20% white, and 17% multiracial) in half the group homes were randomly assigned to the intervention group (n = 40 clusters) and the other half were randomly assigned to a control group that offered “usual care” (n = 40 clusters). The intervention (i.e., Power Through Choices [PTC]) was a 10-session, age-appropriate, and medically accurate sexual health education program. Results Compared to the control group, youth in the PTC intervention showed significantly greater improvements ( p < .05) from preintervention to postintervention in all three knowledge areas, one of two attitude areas, all three self-efficacy areas, and two of three behavioral intention areas. Conclusions This is the first published randomized controlled trial of a teen pregnancy-prevention program designed for youth living in foster care settings and other out-of-home placements. The numerous significant improvements in short-term outcomes are encouraging and provide preliminary evidence that the PTC program is an effective pregnancy-prevention program. [ABSTRACT FROM AUTHOR]