Office Of Adolescent Health Research Articles

Adapting to Changes in Teen Pregnancy Prevention Research: Social Media as an Expedited Recruitment Strategy

PurposeTeen pregnancy prevention projects funded by the U.S. Office of Adolescent Health were disrupted by the Trump administration in the July 2017 announcement that funding would be terminated. Although funding was later reinstated toward the end of 2018 after a class-action lawsuit, we needed to change our recruitment protocol to mitigate this disruption to the study timeline and staffing. This led to a natural experiment comparing in person and social media recruitment strategies. MethodsThe original approach was to recruit girls, aged 15–19 years, who were using intrauterine or subdermal contraception, in person in clinic settings. After the funding disruption, we transitioned to an online recruitment strategy. Costs associated with each approach (in-person and online recruitment) were tracked, and we compared cost of per-person enrollment with each approach. ResultsIn-person, clinic-based recruitment enrolled 118 participants over 293 days from eight high-volume clinics. Online recruitment enrolled 518 participants over 146 days. Online recruitment resulted in cost savings and a diverse sample representing a larger geographic region. ConclusionOnline recruitment can cut costs and be more efficient than a clinic-based recruitment strategy, but special considerations are warranted when considering social media recruitment.

227. Adapting to Political Barriers in Conducting Teen Pregnancy Prevention Research: Use of Social Media as an Expedited Recruitment Strategy

This study describes an innovative approach to recruit adolescent and young adult females who use long acting reversible contraceptives (LARCs) for a teen pregnancy prevention (TPP) intervention. This was one of 62 TPP, Office of Adolescent Health (OAH) grantees initially funded in 2016, then terminated by the Trump administration in 2017. After a class action lawsuit (and six different lawsuits), funding was re-instated toward the end of 2018. This caused significant disruption to the study timeline and staffing. To achieve our objectives, we adapted our in-person methodology to an on-line recruitment approach.

Pono Choices: Lessons for School Leaders From the Evaluation of a Teen Pregnancy Prevention Program.

The US Office of Adolescent Health (OAH) funded studies of teen pregnancy and sexually transmitted infection (STI) prevention programs in 2010. The results of a 5-year OAH study conducted in the state of Hawai'i with middle school youth has implications for school leaders in the selection and implementation of comprehensive sex education curricula yielding positive outcomes for youth. A cluster randomized controlled trial was conducted across 34 middle school in the state of Hawai'i with 1783 student participants in pre-, post-, and 1-year follow-up surveys to determine effectiveness of a culturally responsive teen pregnancy prevention curriculum, called Pono Choices, specifically developed for youth in Hawai'i. Students receiving the Pono Choices curriculum had significantly higher rates of knowledge gains than students in control schools, although there were no statistically significant differences in initiation of sexual activity between the groups at the 1-year follow-up. Teachers implemented the curriculum at high rates of adherence to fidelity making this a model for implementation. Knowledge and retention of medically accurate teen pregnancy and STI prevention information can be attributed to implementation of a comprehensive program with attention to factors such as fidelity, program quality, engagement, and dosage.

Use of Small Grants to Support and Enable Innovation in Teen Pregnancy Prevention

Over the years, the number of programs shown to be effective in preventing teen pregnancy has increased. While support continues to grow for evidence-based programs (EBP), gaps and disparities in current EBPs oblige the development of new and innovative approaches. Funded by the Office of Adolescent Health from the Department of Health and Human Services, the iTP3 project was charged with supporting and enabling the development of innovative teen pregnancy prevention programs. The iTP3 project, administered at Texas A&M University, awarded small grants of approximately $100,000 to 15 organizations across the United States to develop innovative programs to prevent teen pregnancy among underserved populations. This paper describes the funding and selection criteria of awardees, evaluation methods, characteristics of programs/ideas and corresponding organizations, capacity building assistance provided to program developers, and selected accomplishments. Small grant programs, such as that discussed here, can serve as models for others interested in working with program developers to create innovative programs.

Replication Typology and Guidelines for Adolescent Pregnancy Prevention Initiatives.

An introduction is presented in which the authors discuss the supplemental issue of the journal which examines the replication typology and guidelines for adolescent pregnancy prevention programs in America, as well as the U.S. Department of Health and Human Services' Office of Adolescent Health.

Adolescent Pregnancy Prevention Programs and Research: A Time To Revisit Theory.

The authors argue that researchers and developers need to revisit the theory of planned behavior, social cognitive theory, and the social, psychological theories that are predictive of sexual behavior, and it mentions innovations and research involving adolescent pregnancy prevention programs in America. Funding from the U.S. Department of Health and Human Services' Office of Adolescent Health is examined, along with the efforts to reduce adolescent sexual risk behaviors.

Comprehensive Reporting of Adolescent Pregnancy Prevention Programs.

An introduction is presented in which the author discusses the special issue of the journal which examines the impacts of American adolescent pregnancy prevention programs on behavioral outcomes and funding by the U.S. Department of Health and Human Services' Office of Adolescent Health.

Establishing an Evaluation Technical Assistance Contract to Support Studies in Meeting the US Department of Health and Human Services Evidence Standards.

An introduction is presented in which the authors discuss the special issue of the journal which examines evidence review standards and the U.S. Department of Health and Human Services' Office of Adolescent Health's investment in rigorous evaluations of teen pregnancy prevention programs.

The Teen Pregnancy Prevention Program (2010-2015): Synthesis of Impact Findings.

The authors discuss the findings of the U.S. Department of Health and Human Services (HHS) Office of Adolescent Health (OAH) Teen Pregnancy Prevention (TPP) Program from 2010 to 2015, and it mentions how the OAH TPP is designed to reduce the risky behavior that is associated with adolescent pregnancy. American government funding for organizations to replicate evidence-based TPP programs and additional teenage pregnancy prevention plans is examined, along with organizational goals.

A Framework for Evaluation Technical Assistance.

The authors reflect on the U.S. Department of Health and Human Services (HHS) Teen Pregnancy Prevention (TPP) evidence review standards and the framework for evaluation technical assistance (TA) as of 2016. Approval for funded grantees' proposed evaluation designs is examined, along with the monitoring of the application of evaluations plans to real-world problems. Group TA presentations are assessed, along with the evaluation TA contract funded by the HHS Office of Adolescent Health (OAH).

Mobilizing Communities in Support of Teen Pregnancy Prevention: "Communitywide Initiatives" Findings.

The U.S. Office of Adolescent Health and the Centers for Disease Control continue to promote a community mobilization model in support of teen pregnancy prevention in new grant initiatives. The most recent federal grant program-the "Communitywide Initiatives (2010-2015)" grant-promoted pregnancy prevention using three teams within the nine targeted communities to promote evidence-based sexuality education programs and enhanced access to contraceptive services among adolescents. The "lessons" reported in this article are compiled from three key informant interviews conducted with all project coordinators over the course of the 5 years (2010-2015) that this grant was implemented. Both successes and challenges to community mobilization in support of teen pregnancy prevention are presented and discussed.

Evidence-Based Sexuality Education Programs in Schools: Do They Align with the National Sexuality Education Standards?

While many states mandate some type of sexuality education in schools, state legislation varies widely across the United States. Nevertheless, though much has been written about the behavioral outcomes of sexuality education programs shown to be effective at reducing one or more risky sexual behaviors in teenagers, less is known about the exact content taught by these programs, and whether it aligns with national recommendations for sexuality education programming in school. This article reviews the content of evidence-based sexuality education programs in schools (n = 10) from the Office of Adolescent Health (OAH) to assess the extent to which programs are following a comprehensive model of sexual health endorsed by the National Sexuality Education Standards. Results indicate that the majority of programs provide education on sexually transmitted diseases and unplanned pregnancy, abstinence, and contraceptive use. Far fewer address components related to healthy dating relationships, including interpersonal violence and an understanding of gender roles. No programs address nonheterosexual orientations. Analysis of the programs and implications of the findings are discussed.

Teenage Pregnancy And Sexually Transmitted Infection Prevention: A Pilot Study Exploring Knowledge And Reported Behaviors

The Teen Pregnancy Prevention Program (TPP) is administered by the Office of Adolescent Health, with a goal of addressing the rising teen pregnancy rates in the United States. One TPP initiative includes the replication of evidence-based program models that seek to prevent teen pregnancies and sexually transmitted infections (Department of Health and Human Services, 2014). FOCUS Butler County, in Southwestern Ohio, is one such women’s health program. In a pilot study, conducted between March and August 2011, 96 female participants between the ages of 16 and 23 were surveyed to capture a “snapshot” of their baseline knowledge and behaviors. Following their completion of the questionnaire, respondents participated in eight hours of evidenced-based, comprehensive sexual education. Four months post-intervention (n=49) and 12 months post-intervention (n=28), participants were re-surveyed to assess knowledge and behaviors. This longitudinal, observational study explored the frequency and means of reported responses. For further analysis, questions were assigned to one of ten categories: 1) demographics/history, 2) knowledge-based, 3) reported behaviors, 4) opinions, 5) perceived opinions of friends, 6) intentions for future practice, 7) perception of risk, 8) attitudes regarding condom use, 9) attitudes related to alcohol use, and 10) perception of comfort related to health seeking behaviors. Significant findings were noted in the category of knowledge-based questions.

Historical Context for the Creation of the Office of Adolescent Health and the Teen Pregnancy Prevention Program

In Fiscal Year 2010, Federal funds were dedicated to support evidence-based approaches to effectively target teen pregnancy prevention and resulted in the establishment of the Office of Adolescent Health (OAH) and the Teen Pregnancy Prevention (TPP) Program. Through the tiered TPP Program, OAH supports replication and evaluation of programs using models whose effectiveness has been demonstrated through rigorous evaluation and the development and testing of promising or innovative pregnancy prevention strategies and approaches. This article documents the creation of OAH and the development of the TPP Program, the identification of a TPP evidence base, current program and evaluation efforts at OAH, and government coordination and partnerships related to reducing teen pregnancy. This article is of interest to those working to improve the health and wellbeing of adolescents.

Practical Experience From the Office of Adolescent Health's Large Scale Implementation of an Evidence-Based Teen Pregnancy Prevention Program

After 3 years of experience overseeing the implementation and evaluation of evidence-based teen pregnancy prevention programs in a diversity of populations and settings across the country, the Office of Adolescent Health (OAH) has learned numerous lessons through practical application and new experiences. These lessons and experiences are applicable to those working to implement evidence-based programs on a large scale. The lessons described in this paper focus on what it means for a program to be implementation ready, the role of the program developer in replicating evidence-based programs, the importance of a planning period to ensure quality implementation, the need to define and measure fidelity, and the conditions necessary to support rigorous grantee-level evaluation.

From Mission to Measures: Performance Measure Development for a Teen Pregnancy Prevention Program

The Office of Adolescent Health (OAH) sought to create a comprehensive set of performance measures to capture the performance of the Teen Pregnancy Prevention (TPP) program. This performance measurement system needed to provide measures that could be used internally (by both OAH and the TPP grantees) for management and program improvement as well as externally to communicate the program's progress to other interested stakeholders and Congress. This article describes the selected measures and outlines the considerations behind the TPP measurement development process. Issues faced, challenges encountered, and lessons learned have broad applicability for other federal agencies and, specifically, for TPP programs interested in assessing their own performance and progress.

What Does It Take? How Federal Initiatives Can Support the Implementation of Evidence-Based Programs to Improve Outcomes for Adolescents

Over the last 20 years, there has been a growing emphasis on developing and identifying evidence-based programs and practices for children and families and within the last decade an increasing number of federally funded initiatives have been dedicated to replicating and scaling evidence-based programs with the hope of achieving socially meaningful impact. However, only recently have efforts to promote high-fidelity implementation been given the attention needed to ensure evidence-based practices are used as intended and generate the outcomes they were designed to produce. In this article, we propose that the wide-scale implementation of evidence-based practices requires: (1) careful assessment and selection of the “what”; (2) a stage-based approach that provides adequate time and resources for planning and installation activities; (3) the co-creation of a visible infrastructure by a triad of key stakeholders including funders and policymakers, program developers, and implementing sites; and (4) the use of data to guide decision-making and foster curiosity into continuous improvement among grantees. Each of these strategies is explored in greater detail through the lens of the Teen Pregnancy Prevention (TPP) Program, a $100 million initiative overseen by the Office of Adolescent Health (OAH) in the U.S. Department of Health and Human Services.

Office of Adolescent Health Medical Accuracy Review Process—Helping Ensure the Medical Accuracy of Teen Pregnancy Prevention Program Materials

The Office of Adolescent Health (OAH) developed a systematic approach to review for medical accuracy the educational materials proposed for use in Teen Pregnancy Prevention (TPP) programs. This process is also used by the Administration on Children, Youth, and Families (ACYF) for review of materials used in the Personal Responsibility Education Innovative Strategies (PREIS) Program. This article describes the review process, explaining the methodology, the team implementing the reviews, and the process for distributing review findings and implementing changes. Provided also is the definition of “medically accurate and complete” as used in the programs, and a description of what constitutes “complete” information when discussing sexually transmitted infections and birth control methods. The article is of interest to program providers, curriculum developers and purveyors, and those who are interested in providing medically accurate and complete information to adolescents.

Using Data to Improve Fidelity When Implementing Evidence-Based Programs

In fall 2011, the South Carolina Campaign to Prevent Teen Pregnancy (SC Campaign), with funding from Office of Adolescent Health, began replicating an evidence-based curriculum, It's Your Game, Keep It Real in 12 middle schools across South Carolina. Fidelity of the curriculum was monitored by the use of lesson fidelity logs completed by curriculum facilitators and lesson observation logs submitted by independent classroom observers. These data were monitored weekly to identify possible threats to fidelity. The innovative model Fidelity Through Informed Technical Assistance and Training was developed by SC Campaign to react to possible fidelity threats in real time, through a variety of technical assistance modalities. Fidelity Through Informed Technical Assistance and Training guided the 55 hours of technical assistance delivered by the SC Campaign during the first year of It's Your Game, Keep It Real implementation to 18 facilitators across 12 SC middle schools, and achieved 98.4% curriculum adherence and a high quality of implementation scores.

Strong, Smart and Bold Strategies for Improving Attendance and Retention in an After-School Intervention

The Volunteers of America Greater Los Angeles (VOALA) Girls Inc. program is implementing and rigorously evaluating its Preventing Adolescent Pregnancy curriculum as part of a demonstration grant to identify effective teen pregnancy prevention programs sponsored by the U.S. Department of Health and Human Services Office of Adolescent Health (OAH). A total of 517 participants from Title I urban middle and high schools were randomly assigned to either Preventing Adolescent Pregnancy (treatment) or Economic Literacy (control) in two cohorts. Programming occurred after school weekly at middle and high schools. Low attendance and loss of sample (attrition) are common challenges in after-school programming, negatively affecting both the ability of a program to be successful and the integrity of a randomized controlled trial. The current article discusses challenges encountered with recruitment, incentives, and school factors during a first cohort of youth and innovative implementation changes during a second cohort that resulted in increased attendance rates and decreased attrition rates. Commentary is provided by the OAH Project Officer as well as lessons learned after 2 years of implementing the program.