Teen Pregnancy Prevention Programs Research Articles

My Journey: Development and Practice-Based Evidence of a Culturally Attuned Teen Pregnancy Prevention Program for Native Youth.

A clear need exists for teen pregnancy prevention programs that are responsive to the specific needs and cultural contexts of Native American communities. Recent data indicates that the birth rate for Native teens is nearly two and a half times the rate for White teens (32.9 versus 13.2). To address this disparity, we conducted formative research with Northern Plains Native American community members, resulting in My Journey, a culturally attuned curriculum for 6–8th graders. My Journey is grounded in traditional values and teachings to promote self-efficacy in sexual health decision-making and engagement in prosocial behaviors. We conducted a pilot study with 6–8th grade students (n = 45), aged 11–14 years (22 females, 23 males). Pilot study findings confirm program feasibility and acceptability. The process evaluation revealed that teachers liked the curriculum, particularly its adaptability of cultural components and ease of student engagement. The outcome evaluation demonstrated that My Journey provided an avenue for NA youth to increase their sex refusal self-efficacy. Application of the culture cube framework revealed My Journey has made a meaningful practice-based evidence contribution as a community-defined, culturally integrated curriculum that is effective. Future directions include broader implementation of My Journey, including adaption for additional populations.

227. Utilization of Social Network Analysis To Understand Birth Control Uptake In Youth Who Experience Homelessness

Within the U.S., 4.3% of 13-17-year old’s and 12.5% of 18-25-year old’s experienced homelessness during the past year. Female homeless youth become pregnant at a rate five times greater than that of the general U.S. population, with nearly half becoming pregnant at least once during adolescence. Developing trusted, healthy relationships is a challenge for youth who are homeless. Networks can represent a potentially diverse groups of people who provide tangible or intangible resources to the individual, but also may encourage engagement in unhealthy or risky behavior. This exploratory study examines implementation data from a teen pregnancy prevention program to better understand how homeless youth social networks share information and how that information can impact the uptake of birth control. To measure interpersonal relationships, we used a social network analysis (SNA) to assess the quality and strength of peer relationships. SNA is an ideal technique for this study because the study population is part of a bounded network defined by program participation. Eleven 14 to 18 years old participants took part in this study. Most participants were sexually active (n=9) and had first engaged in consensual sex at 13 to 18 years (M=15 years) of age. None of the participants were using birth control before the program. Data were collected through interviews and participants were asked which peers in the program they knew, who they trusted, and if they shared (or received) information on birth control. Data was symmetrized and density and centrality statistics were analyzed. At the end of the program, 73% of the network participants were on some type of birth control at one-month follow-up. However, network density showed that only 14.3% of the network shared information about birth control. To understand if one or a few people controlled the information, centralization was analyzed on birth control information sharing. The whole network centralization was 0.339. This means that the sharing information network was centralized (> than 0.25). Degree centrality was then examined to understand who controlled information flow. One participant had a degree of 8 ties and four others had a degree of 5 ties each. Four of these 5 participants adopted some form of long-acting reversible contraception (LARC) by the end of the program. One person was using condoms. While overall network density was not very high, centralization was significant which means that a few key players controlled the information flow. The majority of these individuals (4 of 5) adopted LARC by the end of the program, which may indicate that the information they shared with their peers about birth control influenced other youth’s decisions on adoption. This exploratory study expands the limited research on the impact of social support on homeless youth and pregnancy prevention. 73% birth control utilization, one-month post-intervention, among a high-risk subpopulation that was not previously on birth control represents important findings for research on homeless youth.

Variations in Outcomes Between Foster and Non-foster Youth Following Sex and Relationship Education

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. 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. 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. 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. 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.

Ecological Approaches to Teen Pregnancy Prevention: An Examination of Evidence-Based Interventions.

Over the past 20 years, teenage birth rates in the United States have declined substantially but continue to persist among certain populations. During this time period, a series of rigorously tested teen pregnancy prevention (TPP) programs were developed, and a number of evidence-based interventions (EBIs) emerged. In April 2017, researchers reviewed EBIs in TPP and examined each program's socioecological levels of intervention, measurements approaches, and other ecological aspects. Findings indicate that the majority of TPP EBIs are aimed at the individual and/or interpersonal level of intervention. Furthermore, the programs were evaluated using the individual as the unit of analysis, regardless of what level the EBI targets. These findings represent serious gaps, specifically a lack of system-, environmental-, and policy-level EBIs. Future TP approaches should target multiple levels of social ecology, ensure measurements appropriately capture changes within these levels, and shift to a focus on a longer term population health improvement.

Sexual Orientation and Pregnancy Among Adolescent Women in the National Survey of Family Growth, 2002–2015

Purpose: Given elevated pregnancy rates, fluctuating sexual identity, and varying sexual experience among adolescent sexual minority women (ASMW; lesbian/bisexual identity, attraction to/sex with females), research should assess adolescent pregnancy by sexual attraction with identity and experience. This study examined associations of three aspects of sexuality-identity, attraction, and experience-with pregnancy among ASMW versus non-ASMW. Methods: Population-weighted data were drawn from the 2002 to 2015 National Survey of Family Growth (NSFG), 15- to 19-year-old female subsample (n = 5481). Multivariable logistic regression models (adjusted for age, race/ethnicity, and survey cycle) compared pregnancy among ASMW versus non-ASMW by sexual identity, attraction, and experience separately, and in a combined model in which interaction of aspects of sexuality and survey cycle was tested. The combined model was then stratified by survey cycle. Results: Although not significant in the combined model, sexual minority versus heterosexual identity (adjusted odds ratio [aOR] = 1.74, 95% confidence interval [CI] = 1.21-2.51, p = 0.003) and sexual minority versus exclusive male attraction (aOR = 1.49, 95% CI = 1.10-2.01, p = 0.011) individually predicted higher pregnancy odds. There was significant interaction between attraction and survey cycles. Sexual minority attraction predicted significantly decreased pregnancy odds (aOR = 0.59, 95% CI = 0.38-0.90, p = 0.014) in combined 2002 to mid-September 2013 NSFG data, but increased odds (aOR = 1.59, 95% CI = 0.63-4.02, p = 0.324) in the rest of 2013-2015. Conclusion: These results suggest the importance of measuring sexual attraction when examining pregnancy disparities among ASMW. Sex education and teen pregnancy prevention programs should reflect sexual diversity.

Testing implementation support for evidence-based programs in community settings: a replication cluster-randomized trial of Getting To Outcomes\xae

BackgroundCommunity organizations can have difficulty implementing evidence-based prevention programs. More research is needed on implementation support interventions designed to help these organizations implement programs with quality.MethodsPreparing to Run Effective Programs (PREP) is a randomized controlled trial testing Getting To Outcomes (GTO), a 2-year implementation support intervention. It compares 15 Boys and Girls Club sites implementing CHOICE (control group), a five-session evidence-based alcohol and drug prevention program, with 14 similar sites implementing CHOICE supported by GTO (intervention group). PREP replicates a previous GTO study that had the same design, but featured a teen pregnancy prevention program instead. All sites received typical CHOICE training. Fourteen intervention sites received GTO manuals, training, and onsite technical assistance to help practitioners complete implementation best practices specified by GTO (i.e., GTO steps). During the first year, technical assistance providers helped the intervention group adopt, plan, and deliver CHOICE. Then, this group was trained on evaluation and quality improvement steps of GTO using feedback reports summarizing their own data, which yielded revised plans for subsequent implementation of CHOICE. This paper presents results regarding GTO’s impact on CHOICE fidelity (adherence, quality of delivery, dosage) and the proximal outcomes of the youth participants (aged 10–14)—attitudes and intentions regarding cigarettes, alcohol, and marijuana use. Fidelity was assessed at all sites by observer ratings and attendance logs. Proximal outcomes were assessed via survey at baseline, 3, and 6 months.ResultsAfter 1 year, fidelity and proximal outcomes were similar between Intervention and control groups. After 2 years (which included GTO quality improvement activities that took place between years 1 and 2), intervention sites had higher ratings of CHOICE adherence and quality of delivery (dosage remained similar). Proximal outcomes did not differ between groups in either year, although there was universally high endorsement of prosocial responses to those outcomes from the start.ConclusionsFindings suggest that systematic implementation support provided by GTO can help community organizations achieve better fidelity. Findings replicate the implementation results from a previous GTO study using the same design, but with a different evidence-based program and different fidelity measures. Although proximal outcomes did not change, in large part due to ceiling effects, the implementation findings suggest GTO can support a variety of programs.Trial registrationThis project is registered at ClinicalTrials.gov with number NCT02135991. The trial was first registered on May 12, 2014.

Addressing a Critical Gap in U.S. National Teen Pregnancy Prevention Programs: The Acceptability and Feasibility of Father-Based Sexual and Reproductive Health Interventions for Latino Adolescent Males

The purpose of the research was to examine the feasibility and acceptability of a father-based sexual and reproductive health intervention designed to reduce sexual and reproductive (SRH) disparities and increase correct and consistent condom use among Latino adolescent males. The current study conducted in-depth semi-structured interviews with Latino father-son dyads (N=30) designed to elicit perspectives on communication regarding sex and condom use. In addition, the interview protocol included father-son preferences regarding paternal involvement in condom instruction and perceived obstacles and advantages of father direct involvement in education efforts designed to increase correct and consistent condom use among their adolescent sons. Three independent coders conducted both vertical and horizontal analyses of the data to identify emergent themes and reach theoretical saturation. The main findings from this study suggest that Latino fathers can be impactful in shaping Latino adolescent male sexual decision-making and correct and consistent condom use. However, our data highlight that while both feasible and acceptable, Latino fathers identify needing additional support in how best to communicate and seek opportunities to master their own knowledge and skills regarding condom use and effective communication with their adolescent sons about sex. Latino father-based interventions represent an acceptable and feasible option for building upon the recent success of U.S. national efforts to reduce teen pregnancy rates and STI disparities among Latino youth. However, there exists a need for father-based programs that will support Latino fathers in best educating their sons about condom use and better addressing their SRH. Ongoing national efforts to reduce Latino teen SRH disparities warrant the consideration of father-son interventions for Latino adolescent males in the United States.

A Holistic Approach to Adolescent Pregnancy Prevention

An editorial presented which discusses the issue of teenage pregnancy prevention programs. It mentions the Adolescent Pregnancy Prevention (APP) Program which teaches and supports healthy sexual choices, the individual programs APP supports, and the need to promote such programs and disseminate the successes.

Effectiveness of School-Based Teen Pregnancy Prevention Programs in the USA: a Systematic Review and Meta-Analysis.

School-based programs have been a mainstay of youth pregnancy prevention efforts in the USA. We conducted a systematic review and meta-analysis to assess their effectiveness. Eligible studies evaluated the effect on pregnancy rates of programs delivered in elementary, middle, or high schools in the USA and Canada, published between January 1985 and September 2016. The primary outcome was pregnancy; secondary outcomes were delay in sexual initiation, condom use, and oral contraception use. Randomized controlled trials (RCTs) and non-RCTs with comparator groups were eligible. We developed a comprehensive search strategy, applied to major bibliographic databases, article bibliographies, gray literature, and contact with authors. We calculated risk ratios (RR) with 95% confidence intervals (CI) for each outcome and pooled data in random effects meta-analysis. We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess evidence quality. Ten RCTs and 11 non-RCTs conducted from 1984 to 2016 yielded 30 unique pooled comparisons for pregnancy, of which 24 were not statistically significant. Six showed statistically significant changes in pregnancy rates: two with increased risk (RR 1.30, 95% CI 1.02-1.65; and RR 1.39, 95% CI 1.10-1.75) and four with decreased risk ranging from RR 0.56, 95% CI 0.41-0.77, to RR 0.75, 95% CI 0.58-0.96. All studies were at high risk of bias, and the quality of evidence was low or very low. Identified evidence indicated no consistent difference in rates of pregnancies between intervention recipients and controls.

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.

A Cluster-Randomized Trial of Getting To Outcomes' Impact on Sexual Health Outcomes in Community-Based Settings.

The USA has high teen pregnancy rates compared to other developed nations. Many community-based organizations need assistance conducting evidence-based teen pregnancy prevention programs (EBPs) appropriately. This study evaluated the impact of an implementation support intervention called Getting To Outcomes (GTO) designed to help such organizations. This cluster randomized controlled trial compared 16 Boys and Girls Clubs (BGCs) implementing a teen pregnancy prevention EBP called Making Proud Choices for two years, with 16 BGCs implementing MPC augmented with GTO training, tools, and technical assistance. Participating middle school youth were compared on proximal outcomes (knowledge, attitudes, and intentions about sex and condoms from baseline to post) and sexual behaviors (frequency of sex and condom use, from baseline to 6-month follow-up). In year 1, there were no significant effects of GTO for any proximal outcome. After GTO-stimulated quality improvement in year 2, the GTO group improved significantly more on condom attitudes and use intentions. Frequency of sex and condom use did not differ between the two groups in either year; however, base rates of these behaviors in the sample were very low. Findings suggest that in typical community-based settings, detailed manuals and training common to structured EBPs may be sufficient to yield some improvement in key proximal outcomes, but that more systematic implementation support is needed to achieve greater improvement in these outcomes. Using GTO with many communities, as currently supported by various federal agencies, could yield public health impact via improvements in condom attitudes and use intentions.

The Trump Administration and the Abandonment of Teen Pregnancy Prevention Programs

The Trump Administration and the Abandonment of Teen Pregnancy Prevention Programs

Long-Term Improvements in Knowledge and Psychosocial Factors of a Teen Pregnancy Prevention Intervention Implemented in Group Homes

PurposeYouth 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. MethodsA 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. ResultsCompared 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. ConclusionsFindings suggest that the PTC intervention can have positive long-term knowledge and psychosocial effects regarding contraception methods on youth in out-of-home care.

Implementation of Community-Wide Teen Pregnancy Prevention Initiatives: Focus on Partnerships

Seeking to reduce teen pregnancy and births in communities with rates above the national average, the Centers for Disease Control and Prevention, in partnership with the U.S. Department of Health and Human Services Office of Adolescent Health Teen Pregnancy Prevention Program, developed a joint funding opportunity through which grantees worked to implement and test an approach involving community-wide teen pregnancy prevention initiatives. Once these projects had been in the field for 2.5 years, Centers for Disease Control and Prevention staff developed plans for a supplemental issue of the Journal of Adolescent Health to present findings from and lessons learned during implementation of the community-wide initiatives. When the articles included in the supplemental issue are considered together, common themes emerge, particularly those related to initiating, building, and maintaining strong partnerships. Themes seen across articles include the importance of (1) sharing local data with partners to advance initiative implementation, (2) defining partner roles from the beginning of the initiatives, (3) developing teams that include community partners to provide direction to the initiatives, and (4) addressing challenges to maintaining strong partnerships including partner staff turnover and delays in implementation.

Encouraging Innovation in Teen Pregnancy Prevention Programs

While there is widespread support for implementing evidence-based interventions to improve adolescent health, health programs either become out dated and the participants are not engaged or new programs are needed for under-served populations. Innovation receives attention in health care and health systems. However, in health education the focus on innovation surrounds translating programs into practice; there is a lack of information on developing innovative programs which address disparities in teen pregnancy prevention. Given no guidelines exist to support the development of innovative programs in health, this skill is generally lacking and not widely used nor considered especially in content areas like teen pregnancy prevention. This paper discusses the gaps and opportunities for supporting and fostering innovation in adolescent health and teen pregnancy prevention programming.

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.

Video for Adolescent Pregnancy Prevention: Promises, Challenges, and Future Directions.

The authors reflect on the use of video recordings and Internet videos in adolescent pregnancy prevention interventions, and it mentions the cost effectiveness of video prevention programs, as well as information about a multi-site randomized controlled trials to evaluate the Seventeen Days interactive video intervention. Increased sexual abstinence and reduced condom failures are examined in relation to teenage pregnancy prevention programs. The limitations of technology are assessed.

High-Stakes Systematic Reviews: A Case Study From the Field of Teen Pregnancy Prevention.

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. 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. 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.

Implementation in Practice: Adaptations to Sexuality Education Curricula in California.

Local 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. To 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. Whereas 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. These 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.

Sustaining Teen Pregnancy Prevention Programs in Schools: Needs and Barriers Identified by School Leaders.

To reduce teen pregnancy rates, prevention programs must be consistently available to large numbers of youth. However, prevention efforts have been historically conducted with little emphasis on ensuring program sustainability. This study examined the needs and barriers to sustaining teen pregnancy prevention (TPP) programming in schools after grant funding has ended, as identified by school leadership. A total of 11 qualitative interviews were conducted between June and September 2012 with middle school leaders from 11 schools involved in current implementation of a TPP program in South Carolina. Interviews were audio-recorded, transcribed verbatim, and thematically coded. Identified needs and barriers to sustainability varied across schools. Common barriers to program sustainability included: lack of materials and supplies, insufficient funding (at the school and district level), lack of support and/or parental opposition, and other school/district priorities. School leaders also identified several needs to continue TPP programming, including: continued funding, trainings, outcome/effectiveness data to support the program, and regularly updated curriculum. Schools with greater perceived needs and barriers may be less likely to sustain. Knowledge gained through this research may be used to inform future interventions and sustainability planning efforts, allowing us to maximize prevention programming.