Use of tobacco price-minimization strategies among public housing residents compared to U.S. low-income adults.

BACKGROUND: Price minimization strategies (PMS) are ways for people to save money on tobacco purchases especially among those of lower socioeconomic status. This study assesses PMS and coupon receipt among public housing residents compared to U.S. low-income adults. METHODS: Data were from adults who currently use tobacco and live in District of Columbia Housing Authority (DCHA) public housing (n=270) and a US nationally representative sample of low-income adults who currently use tobacco (n=820). We examined the prevalence of PMS use across demographic characteristics and smoking behaviors, and qualitatively compared them across the two datasets. RESULTS: Most DCHA resident participants (84.2 %) and US low-income adults who currently use tobacco (91.5 %) recently used at least one PMS to save money on tobacco. The top-three most common strategies among DCHA residents were saving cigarettes to finish later (35.6 %), smoking fewer cigarettes (32.2 %), and finding cheaper places to buy cigarettes (30.4 %), while among U.S. low-income adults these strategies were using coupons or promotions (62.7 %), purchasing by bulk (55.5 %), and finding cheaper places to buy tobacco products (53.6 %). People who lightly smoke in DCHA were more likely than people who heavily smoke to use PMS in general (25.0 % vs. 13.7 %) and smoke fewer cigarettes to save money (35.8 % vs. 19.2 %). US low-income people who lightly smoke were more likely than people who heavily smoke to cut back on tobacco use (61.9 % vs. 39.8 %). CONCLUSION: Most U.S. low-income individuals and DCHA residents who smoke engaged in PMS. Regulating these strategies while supporting tobacco use cessation may reduce the impact of tobacco in these populations.

Resident Support for the Federally Mandated Smoke-Free Rule in Public Housing: 2018-2022.

This study examines support for the Department of Housing and Urban Development's (HUD) mandatory smoke-free rule up to four years post-rule among smokers and non-smokers. A repeated cross-sectional design was used where District of Columbia public housing residents aged 18+ (n = 529) completed surveys during three time points: July 2018 (pre-rule), November 2018-March 2020 (post-rule), and September 2020-December 2022 (post-rule + COVID-19). Full support for the rule was indicated by agreeing that smoking should not be allowed in all indoor locations and within 25 feet of buildings. Descriptive statistics showed significant differences in support across time for smokers (5.3%, 30.7%, and 22.5%, respectively) and similar support across time for nonsmokers (48.2%, 52.2%, and 40.0%, respectively). In unstratified regression analysis, pre-rule support was lower than when the rule was in effect (aOR = 0.47, 95% CI = 0.25, 0.90), and tobacco users were less likely to support the rule (aOR = 0.34, 95% CI = 0.23, 0.50). Stratified logistic regression results showed that pre-rule support was lower among smokers compared to post-rule support (aOR = 0.14, 95% CI = 0.03, 0.59); support among nonsmokers did not vary by time. Findings overall indicate low support for the smoke-free rule up to 4 years post-implementation. Engaging residents with the rule and promoting health and well-being may further enhance policy effectiveness and acceptance.

Are excluding e-cigarettes a loophole in the smokefree public housing rule?

The U.S. Department of Housing and Urban Development (HUD) required all Public Housing Authorities to become smokefree in July 2018, following an 18-month implementation period that began February 2017. The HUD rule included all combustible tobacco products; e-cigarettes were not included. This purpose of this study is to characterize e-cigarette use overall and initiation after the implementation of the smokefree rule among tobacco users living in public housing. Data were collected from 396 adult (18+ years) current tobacco users at the time of rule implementation residing in the District of Columbia Housing Authority between July 2018 and November 2021. Measures include e-cigarette use, age of initiation, reasons for e-cigarette use, e-cigarette use susceptibility (among non-users), and sociodemographic characteristics. Descriptive and crosstab statistics were calculated to characterize e-cigarette use. Nearly-one-quarter of tobacco users reported lifetime use of e-cigarettes (24 %, n = 95) and 4.8 % (n = 19) indicated past 30-day e-cigarette use. Of the lifetime users, twenty-two (23.2 %) initiated their use after the smoke-free rule went into effect, with only two of those residents indicating they did so because of the rule. Of those who never used an e-cigarette, 23.5 % (n = 70) indicated being curious about e-cigarettes and 10.7 % (n = 40) said they may use e-cigarettes in the next year. Results indicate low use of e-cigarette products and low uptake due to the rule. Few tobacco users who never used e-cigarettes indicated intentions to use. Results suggest that omitting e-cigarettes from the HUD rule has not led to significant use of these products in this sample.

Behavioural intentions in response to a potential menthol cigarette sales ban: a survey examining smokers in Washington, DC public housing.

OBJECTIVES: Local, national and international policies are being proposed to ban the sale of menthol-flavoured tobacco products. With more bans being implemented, it is increasingly important to understand reactions to these bans among smokers of low socioeconomic status. This study examined public housing residents' behavioural intentions if menthol-flavoured cigarettes were no longer sold. SETTING: 15 District of Columbia Housing Authority properties between March 2019 and March 2021. PARTICIPANTS: 221 District of Columbia Housing Authority residents ages 18-80 years who reported smoking menthol cigarettes (83.3% African-American/black). PRIMARY AND SECONDARY OUTCOMES: Cigarette quitting and switching intentions due to a hypothetical menthol-flavoured cigarette sales ban. RESULTS: Nearly one-half (48.0%) of residents said they intended to quit cigarette use if menthol-flavoured products were no longer sold, while 27.2% were unsure if they would quit, and 24.9% reported they would not quit. Older residents (OR 0.94 per year, 95% CI 0.91 to 0.97), senior/disabled building versus family building residents (OR 0.50, 95% CI 0.25 to 0.97), those who smoked within 30 min of waking (OR 0.48, 95% CI 0.23 to 0.98) and daily smokers (OR 0.42, 95% CI 0.21 to 0.84) had lower odds of reporting quit intentions associated with a menthol ban. Of those not intending to quit, 40.7% reported they would switch to non-menthol cigarettes, 20.4% to another non-menthol product, 13.0% to menthol e-cigarettes and 20.4% to another menthol product. CONCLUSIONS: Results suggest banning the sale of menthol-flavoured products has the potential to impact cigarette smoking cessation. Nearly three-quarters of smokers in public housing indicated a possibility of quitting smoking because of a menthol cigarette ban. Bans that include all flavours in all tobacco products may be most effective for facilitating overall tobacco cessation.

E-cigarette initiation predicts subsequent academic performance among youth: Results from the PATH Study.

Research shows cigarette smoking is associated with lower academic performance among youth. This study examines how initiating e-cigarette use is associated with subsequent academic performance. Data from Waves 2-4 youth and parent surveys of the Population Assessment of Tobacco and Health (PATH) Study were analyzed. Youth (12-15 years old) who reported never using any tobacco products at Wave 2 were included in the analysis (n = 4960). Initiation of e-cigarettes and cigarettes was assessed at Wave 3. Weighted multivariable linear regression models were tested to assess the association between e-cigarette and cigarette initiation at Wave 3 and academic performance at Wave 4, controlling for covariates at Wave 2. At Wave 3, 4.3% and 1.9% of youth initiated e-cigarette and cigarette use, respectively. Youth who initiated e-cigarette use at Wave 3 had lower academic performance at Wave 4, compared to those who did not initiate e-cigarette use (adjusted regression coefficient [ARC] -0.22, 95% confidence interval [CI] -0.43, -0.02). Initiating cigarettes was also associated with lower academic performance (ARC -0.51, 95% CI -0.84, -0.18). Results indicate that e-cigarette use initiation is associated with lower subsequent academic performance, independent from the association between cigarette use initiation and lower academic performance among U.S. youth. Future research needs to examine whether preventing youth e-cigarette and cigarette use can lead to improvement in academic performance.

Smoking cessation intentions and attempts one year after the federally mandated smoke-free housing rule.

The present study examines public housing residents' smoking cessation intentions, expectancies, and attempts one year after implementation of the Department of Housing and Urban Development's mandatory smoke-free rule in public housing. The sample includes 233 cigarette smokers, ages 18-80, who reside in the District of Columbia Housing Authority. Data collection occurred between March and August 2019. Descriptive statistics, chi-square, and Wilcoxon two-sample test analyses assessed smoking cessation intentions, expectancies, and attempts across resident demographics and characteristics. Findings showed 17.2% of residents reported not thinking about quitting, 39.1% reported thinking about quitting, and 48.6% reported thinking about quitting specifically because of the rule. Residents ages 60-80 were more likely to consider quitting because of the rule, compared to residents ages 18-59. Of those thinking of quitting, 58.6% were sure they could quit if they tried. Those thinking of quitting due to the rule (62.0%) were more likely to have made at least one quit attempt in the past 3 months than those i not attributinging thinking of quitting to the rule. Res Residents trying to quit reported an average of 2.7 attempts in the last 3 months;; most perceived evidence-based cessation supports as not helpful. A A majority reported thinking about quitting and attempting to quit but continuing to smoke, indicating a significant gap between intent to quit and successfully quitting. Results suggest that the rule positively influenced smoking behaviors. However, additional interventions are needed to assist public housing residents with successfully quitting smoking.

Campus tobacco control policies and cessation interventions in college students: a commentary calling for research and action to address tobacco-related health disparities.

Tobacco-related health disparities (TRHDs) have a significant impact on population health in the USA. Effectively preventing and controlling TRHDs among young adult populations require multiple prevention and cessation points, including within college/university contexts. This commentary addresses current campus tobacco control policies and cessation interventions for U.S. college students, with an emphasis on TRHDs and opportunities for research and research translation to reduce these disparities. This commentary is informed by literature published between 2010 and 2020 regarding (a) prevalence and impact of campus tobacco control policies; and/or (b) behavioral outcomes from cessation interventions for young adults attending colleges. Despite a doubling of college campuses adopting tobacco-free policies from 2012 to 2017, roughly two-thirds continue to operate without such policies. Few policies address alternative tobacco products (e.g., e-cigarettes, cigars/cigarillos, and hookah), and communication about and enforcement of existing policies is extremely limited. A broad range of cessation intervention strategies have targeted individuals in this age group, but with little focus on TRHDs and limited intervention dissemination. Importantly, college students representing populations at risk for TRHDs (e.g., racial/ethnic/sexual/gender minorities, low socioeconomic status) are less likely to be exposed to strong tobacco control policies or supports for cessation. There are untapped opportunities for behavioral medicine approaches to reduce TRHDs in college settings. Research findings regarding multilevel (policy, community-level, and individual-level) interventions must be translated to policy/practice in order to address tobacco use, particularly among vulnerable college student populations.

Racial and Ethnic Differences in the Relationship between Aspirin Use and Non-Small Cell Lung Cancer Risk and Survival.

BACKGROUND: African Americans (AA) experience higher incidence and mortality of lung cancer as compared with European Americans (EA). Inflammation is associated with lung cancer, many aspects of which differ between AA and EA. We investigated whether use, frequency, and duration of the anti-inflammatory drug aspirin were associated with lung cancer risk and survival, separately among AA and EA populations. METHODS: Using data from the Maryland Non-Small Cell Lung Cancer (NSCLC) Case-Control Study (1,220 cases [404 AA and 816 EA] and 1,634 controls [1,004 EA and 630 AA]), we estimated the adjusted odds ratios (OR) and hazard ratios (HR) with 95% confidence intervals (CI) of the associations between aspirin use and NSCLC risk and survival, respectively. RESULTS: Any aspirin use (OR: 0.66; 95% CI, 0.49-0.89), daily use of ≥ 1 tablet (OR: 0.68; 95% CI, 0.50-0.90), and use for ≥ 3 years (OR: 0.61; 95% CI, 0.44-0.85) was associated with lower NSCLC risk only among men, even after adjustment for covariates including body mass index and global genetic ancestry. These variables were also associated with improved survival, but only among AA (HR: 0.64; 95% CI, 0.46-0.91; HR: 0.61; 95% CI, 0.42-0.90; and HR: 0.60; 95% CI, 0.39-0.92, respectively). Tylenol and other NSAIDs were either associated with elevated or no NSCLC risk. CONCLUSIONS: Aspirin use is associated with lower risk of NSCLC among men and improved survival among AA. IMPACT: Preventive regular aspirin use could be considered among men and AA.

Differences in Cigarette Use and the Tobacco Environment Among Youth Living in Metropolitan and Nonmetropolitan Areas.

PURPOSE: To examine cigarette use and the tobacco-related environment among adolescents living in metropolitan and nonmetropolitan areas. METHODS: Data from adolescents ages 14-17 that completed the 2012 Florida Youth Tobacco Survey were analyzed (n = 40,746). This includes a representative sample of middle and high school students throughout the state. RESULTS: Nonmetropolitan adolescents were more likely than metropolitan adolescents to report lifetime smoking, past 30-day smoking, daily smoking, initiating smoking at younger ages, having smoked a greater number of cigarettes in their lifetime and in the past 30 days, friend acceptance of adult smoking, a parent offering them a cigarette, living with a smoker, and that smoking was allowed in their home. Nonmetropolitan adolescents were also more likely to have seen tobacco ads the last time they visited convenience marts, gas stations, grocery stores, and big box stores, and flavored tobacco products or ads for them. These differences persisted after controlling for demographics. CONCLUSIONS: The present results suggest vast differences in smoking behavior among nonmetropolitan and metropolitan adolescents and that targeting social and environmental factors may be beneficial for reducing tobacco disparities among nonmetropolitan adolescents.

College law enforcement and security department responses to alcohol-related incidents: a national study.

BACKGROUND: Campus police and security personnel are often the first to respond to alcohol-related incidents on campus. The purpose of this study is to examine how campus law enforcement and security respond to alcohol-related incidents, and how consequences and communication differ based on characteristics of the incident. METHODS: Directors of campus police/security from 343 colleges across the United States completed a survey regarding usual practice following serious, underage, and less serious alcohol incidents on and off campus. RESULTS: Campus law enforcement and security most commonly reported contacting campus officials. A minority reported issuing citations and referring students to the health center. Enforcement actions were more commonly reported for serious and underage incidents than for less serious incidents. Large (vs. small) colleges, public (vs. private) colleges, and those located in small (vs. large) towns more consistently reported taking actions against drinkers. CONCLUSIONS: Understanding how campus police and security respond to alcohol-related incidents is essential for reducing alcohol-related problems on college campuses.

Community characteristics associated with smokefree park policies in the United States.

INTRODUCTION: Outdoor smokefree (SF) policies have the potential to decrease secondhand smoke exposure and denormalize smoking. In order to inform dissemination and evaluation of this emergent tobacco control strategy, this study examined the prevalence of SF park policies in the United States and the community-level characteristics associated with enactment of such policies. METHODS: Counties with existing SF park policies in one or more jurisdictions were identified using passive surveillance data from the American Nonsmokers' Rights Foundation (ANR). ANR data were validated in a random subsample of counties. County-level characteristics were obtained from public data sources and included population demographics, socioeconomic status (SES), urbanicity, and voter affiliation. State-level tobacco control variables included presence of indoor SF policies and adult smoking prevalence. General estimating equations were used to identify predictors of having a SF park policy while accounting for clustering of counties within states. RESULTS: Eleven percent (n = 355) of counties in the United States (n = 3,143) had at least 1 jurisdiction with a SF park policy. The odds of a county having a SF park policy decreased as the percentage of older residents, recent movers, and smokers increased, and the odds increased as the percentage of Democratic voters increased. Odds were higher for counties with higher SES versus low-SES counties and urban/suburban versus rural counties. CONCLUSIONS: SF park policies are currently limited to relatively few jurisdictions, and there is evidence of disparities in adoption of these policies. Public health practitioners should focus promotion of SF park policies on low-SES communities with children and youth and rural areas.

Characteristics associated with initiation of the human papillomavirus vaccine among a national sample of male and female young adults.

PURPOSE: To examine rates of human papillomavirus vaccine initiation, and characteristics associated with initiation, among a national sample of male and female young adults. METHODS: Participants (n = 3,448; 48% female) were recruited using a Web-based, respondent-driven sampling strategy and completed a Web-based survey between October and December 2010. RESULTS: A total of 45% of females and 4% of males initiated the vaccine. Females who were younger, never married, were in school, attended religious services less than once a month, were sexually active, and reported a greater number of lifetime sex partners, and who had been tested for human immunodeficiency virus were more likely to report initiation. Males who were African-American, attended religious services less than once a month, and reported a greater number of sex partners in their lifetime, and who had been tested for human immunodeficiency virus were more likely to report initiation. CONCLUSIONS: Factors associated with human papillomavirus vaccine initiation may differ for males and females. Further research with larger samples of males is needed to fully understand characteristics associated with male initiation. Regardless of gender, however, most young adults who have not initiated sexual activity have not received the vaccine. Further research is needed to examine how to increase vaccination rates among this population, because they may benefit most from vaccination.

Nondaily smoking patterns in young adulthood.

PURPOSE: Many young adult smokers routinely smoke less than daily. Prospective, longitudinal data are needed to describe and predict the influences on smoking patterns among nondaily young adult smokers. METHODS: Latent class growth analysis was used to examine developmental trajectories and predictors of nondaily cigarette smoking among young adults aged 18 to 21 in the Upper Midwestern United States. RESULTS: There were three distinct groups of nondaily smokers during young adulthood (n=519). College status, previous quit attempts, attitudes toward the meanings of cigarettes, and situational factors influencing smoking were significant predictors of group membership. CONCLUSIONS: Nondaily smoking in young adulthood may result in several discrete patterns of smoking between age 18 and 21. Predictors that differentiate smoking trajectories may be useful to promote cessation or reduction in young adult smoking.

Effects of smoke-free laws on alcohol-related car crashes in California and New York: time series analyses from 1982 to 2008.

We examined effects of New York and California's statewide smoke-free restaurant and bar policies on alcohol-related car crash fatalities. We used an interrupted time-series design from 1982 to 2008, with 312 monthly observations, to examine the effect of each state's law on single-vehicle-nighttime crashes and crashes involving a driver with a blood alcohol concentration of 0.08 grams per deciliter or greater. Implementation of New York and California's statewide smoke-free policies was not associated with alcohol-related car crash fatalities. Additionally, analyses showed no effect of New York's smoke-free policy on alcohol-related car crash fatalities in communities along the Pennsylvania-New York border. Statewide smoke-free restaurant and bar laws do not appear to affect rates of alcohol-related car crashes.

Minnesota's comprehensive statewide smokefree law: short-term effects on young adults.

BACKGROUND: Young adults have the highest rate of smoking among any age group. PURPOSE: The purpose of this study is to assess the short-term effects of Minnesota's comprehensive statewide smokefree law on young adult smoking perceptions and behavior. METHODS: Telephone surveys were conducted before and up to 18 months after Minnesota's statewide smokefree law went into effect on October 1, 2007 (data analyzed 2010-2011). Participants included young adults from a population-based cohort in Minnesota (n=1458) and from five other upper Midwest states that serve as a comparison (n=248). Differences in perceptions and smoking behavior were examined between Minnesota participants who lived with and without a local smokefree law prior to Minnesota's statewide law, and participants who lived in the comparison states. RESULTS: The majority of youth in Minnesota were aware of the smoking restrictions in restaurants and bars following the law. After implementation of the law, Minnesota participants who previously lived without a local law (versus comparison) were more likely to perceive fewer adult and peer smokers and less likely to report leaving social events early because it was too smoky. No changes in smoking behaviors were observed before and after the law. Minnesota participants, however, who lived without a prior law (versus participants with a prior law) were more likely to attribute a quit attempt after the law to smoking restrictions in restaurant and bars. CONCLUSIONS: Results suggest that Minnesota's law has changed perceptions of the tobacco environment. Longer-term follow-up may be needed to observe changes in smoking behavior.

Smoking initiation during young adulthood: a longitudinal study of a population-based cohort.

PURPOSE: To examine the extent to which young adults initiate smoking between the ages of 18 and 21 years; to characterize the frequency and quantity of use among initiators; and to examine predictors of initiation. METHODS: Participants included youth who were part of the Minnesota Adolescent Community Cohort Study and had not smoked a whole cigarette before age of 18 (n = 2,034). Initiation in the present study was defined as having smoked a whole cigarette or more between the ages of 18 and 21. Predictors of initiation were measured at age 18 and included sociodemographic characteristics, social influences, and attitudes and beliefs about smoking. RESULTS: Twenty-five percent (n = 510) of participants initiated smoking between the ages of 18 and 21 years. Among those who initiated, the majority (64%) reported smoking during the past 30 days, and approximately one-quarter (24%) reported smoking 100 cigarettes or more. Predictors of young adult initiation included being male, living in a metropolitan area, having friends who smoke, and the belief that smoking can calm someone down when they are angry or nervous. CONCLUSIONS: This study indicates that smoking initiation during young adulthood is not uncommon. These results highlight the need for tobacco prevention programs that target young adults.

Young adult perceptions of smoking in outdoor park areas.

PURPOSE: Smoking restrictions in recreational settings are established to promote anti-smoking norms and reduce exposure to secondhand smoke. Outdoor smoke-free policies are increasing, yet little is known about the perceptions of such restrictions. METHODS: Data were collected from a population-based sample of young adults (n=2289) in upper Midwestern United States. Cross-sectional multivariate logistic regression was used to assess predictors of the perceived difficulty to smoke in outdoor park areas. RESULTS: Living in an area with a smoke-free park policy was associated with a 1.4 times higher odds of perceiving difficulty to smoke compared to those living in an area without such a policy, after controlling for past month smoking, physical activity, age, and gender. Both smokers and non-smokers living in an area with a smoke-free park policy had higher odds of perceiving difficulty to smoking in park areas (OR=1.6 and 1.3 respectively) compared to smokers and non-smokers living in areas without such policies. CONCLUSION: Banning smoking in park areas was associated with a heightened perception of difficulty in smoking for young adult smokers and non-smokers.

Risk and direct protective factors for youth violence: results from the National Longitudinal Study of Adolescent Health.

BACKGROUND: The majority of studies on youth violence have focused on factors that increase the risk for youth violence. PURPOSE: To assess whether determinants of violence operate as risk factors, direct protective factors, or both during adolescence and young adulthood. METHODS: Data from participants in the National Longitudinal Study of Adolescent Health, aged 13 years at Wave 1, were analyzed. Individual, family, school, peer, and community factors during adolescence (Wave 1 [1995]; age 13 years) were examined as predictors of violence involvement during adolescence (Wave 2 [1996]; age 14 years) and in young adulthood (Wave 3 [2001-2002]; ages 18-20 years). RESULTS: Twelve percent of participants aged 14 years and 8% of participants aged 18-20 years reported serious violence involvement during the past 12 months. Bivariate analyses revealed risk and direct protective factors for violence at both time points. Risk for violence at age 14 years was increased by earlier attention-deficit hyperactivity disorder (ADHD) symptoms, low school connectedness, low grade-point average, and high peer delinquency. Direct protective factors for youth violence at age 14 years included low ADHD symptoms, low emotional distress, high educational aspirations, and high grade-point averages. Bivariate analyses showed a lower risk of violence among youth aged 18-20 years who reported low peer delinquency at age 13 years. Multiple logistic regression analyses predicting violence involvement showed direct protective effects for low ADHD symptoms and low emotional distress at age 14 years, and a direct protective effect for low peer delinquency at ages 18-20 years, after controlling for demographic characteristics. CONCLUSIONS: Findings suggest that violence involvement remains difficult to predict but indicate the importance of assessing both risk and direct protective factors for understanding violent behavior.

Multilevel predictors of smoking initiation among adolescents: findings from the Minnesota Adolescent Community Cohort (MACC) study.

OBJECTIVE: To understand how factors at multiple levels of influence impact adolescent smoking initiation. METHOD: Data from the Minnesota Adolescent Community Cohort, a population-based cohort, were analyzed. Adolescents were recruited from randomly selected geopolitical units (GPUs) in Minnesota at ages 12 to 13 (n=1953), and were surveyed every six months (2000-2006) until 18. The association between baseline social factors and smoking initiation was analyzed using logistic regression. Linear regression was used to analyze predictors and age of initiation among smokers (n=603). RESULTS: Higher proportion of 15-16 year-olds who smoke at the area-level (GPU) was associated with younger initiation (15.47 vs 15.87, p<.05). Higher proportion of the population employed and higher median household income were associated with older initiation (15.90 vs. 15.56 p<.05). Parent education, living with parents or siblings who smoke, living in homes that allow smoking, and having friends who smoke at baseline were associated with smoking initiation or younger initiation (p<.05). Participants whose parents had less than a high school education were 1.6 times more likely than those with college educated parents to have smoked at least a whole cigarette (CI=1.06, 2.26). CONCLUSION: Factors at multiple levels of influence effect adolescent smoking initiation. Smoking by older age peers and lower SES predicts earlier smoking.

A clinic-based youth development program to reduce sexual risk behaviors among adolescent girls: prime time pilot study.

Multifaceted, sustained efforts are needed to reduce early pregnancy and sexually transmitted diseases among high-risk adolescents. An important area for research is testing youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful and few efforts have rigorously evaluated a dual approach of building protective factors while addressing risk. This article presents findings from a pilot study of Prime Time, a clinic-based youth development intervention to reduce sexual risk behaviors among girls at risk for early pregnancy. Girls aged 13 to 17 years meeting specified risk criteria were assigned to Prime Time treatment groups. The Prime Time intervention included a combination of case management services and peer leadership groups. Participants completed self-report surveys at baseline, 12 and 18 months following enrollment. At 12 months, the intervention group reported significantly fewer sexual partners than the control group. At 18 months, the intervention group reported significantly more consistent condom use with trends toward more consistent hormonal and dual method use. Dose-response analyses suggested that relatively high levels of exposure to a youth development intervention were needed to change contraceptive use behaviors among adolescents at risk for early pregnancy. Given promising findings, further testing of the Prime Time intervention is warranted.