Short-Term Impact of a Teen Pregnancy-Prevention Intervention Implemented in Group Homes.

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.

Comparing School-Based Teen Pregnancy Prevention Programming: Mixed Outcomes in an At-Risk State.

BACKGROUND: The purpose of this study is to compare the effectiveness of a national comprehensive teen pregnancy prevention (TPP) intervention to a national abstinence-only TPP intervention on middle school students' knowledge, attitudes, and behaviors related to teen sexual behaviors in a state with high teen birth rates. METHODS: Pre- and post-intervention data were collected annually (2005-2010) from seventh-grade students to evaluate school-based TPP programs that implemented a comprehensive (N = 3244) or abstinence-only (N = 3172) intervention. Chi-square and t tests, logistic regressions, and hierarchical multiple regressions examined relationships between sexuality-related behavioral intentions, knowledge, and attitudes. RESULTS: Students in both interventions reported significant (p < .05) improvements post-intervention. Youth in the comprehensive TPP intervention were more likely (p < .05) to have significantly improved their attitudes (odds ratios [ORs] = 1.35, 1.83, 1.23) and behavior regarding abstinence decisions in the past 3 months (OR = 1.39). The interventions' improvements in attitudes were more explanatory for behavioral intentions for students in the abstinence-only intervention than for students in the comprehensive TPP intervention. CONCLUSIONS: The mixed results suggest the comprehensive TPP intervention was only slightly more effective than the abstinence intervention, but that changing student attitudes and perceptions may be a key component of more effective TPP interventions.

A longitudinal study of youth assets, neighborhood conditions, and youth sexual behaviors.

PURPOSE: To prospectively determine whether individual, family, and community assets help youth to delay initiation of sexual intercourse (ISI); and for youth who do initiate intercourse, to use birth control and avoid pregnancy. The potential influence of neighborhood conditions was also investigated. METHODS: The Youth Asset Study was a 4-year longitudinal study involving 1,089 youth (mean age = 14.2 years, standard deviation = 1.6; 53% female; 40% white, 28% Hispanic, 23% African American, 9% other race) and their parents. Participants were living in randomly selected census tracts. We accomplished recruitment via door-to-door canvassing. We interviewed one youth and one parent from each household annually. We assessed 17 youth assets (e.g., responsible choices, family communication) believed to influence behavior at multiple levels via in-person interviews methodology. Trained raters who conducted annual windshield tours assessed neighborhood conditions. RESULTS: Cox proportional hazard or marginal logistic regression modeling indicated that 11 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for ISI; seven assets (e.g., educational aspirations for the future, responsible choices) were significantly associated with increased use of birth control at last sex; and 10 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for pregnancy. Total asset score was significantly associated with all three outcomes. Positive neighborhood conditions were significantly associated with increased birth control use, but not with ISI or pregnancy. CONCLUSIONS: Programming to strengthen youth assets may be a promising strategy for reducing youth sexual risk behaviors.

School-related assets and youth risk behaviors: alcohol consumption and sexual activity.

BACKGROUND: Two risk behaviors, alcohol consumption and early initiation of sexual intercourse (ISI), can have devastating consequences for youth. The purpose of this study was to determine the association of school connectedness and school-related behaviors (eg, academic performance, skipping school, getting into trouble at school) with these 2 risk behaviors. METHODS: The Youth Asset Survey (YAS) was administered to 1117 youth/parent pairs in their homes using Computer-Assisted Personal/Self-Interviewing (CAPI/CASI). The YAS measures 17 youth assets and risk behaviors including alcohol consumption and sexual activity. RESULTS: The mean age of the sample was 14.3 years; 53% were female; and 70% were from 2-parent homes. Five school-related behaviors were positively associated with no ISI. Four school-related behaviors were positively associated with reporting no alcohol consumption in the past 30 days, including the School Connectedness asset (only among 12- to 13-year-olds), not skipping school (only among non-Hispanic Caucasians), staying out of trouble, and paying attention. CONCLUSIONS: School is very much a part of the lives of youth and therefore the relationship they have with their school experience is important and may influence their involvement in risk behaviors. Feeling connected to school is a positive asset that can protect youth from such risky behaviors as sexual initiation and alcohol consumption.

Parental youth assets and sexual activity: differences by race/ethnicity.

OBJECTIVES: To examine how the relationship between parental-related youth assets and youth sexual activity differed by race/ethnicity. METHODS: A random sample of 976 youth and their parents living in a Midwestern city participated in the study. Multivariate logistic regression analyses were conducted for 3 major ethnic groups controlling for the other demographics. RESULTS: Parental monitoring had the strongest association with sexual abstinence for all 3 ethnic/racial groups. Family communication and relationship with mother were also important for white and black youth respectively. CONCLUSIONS: Parental youth assets, especially parental monitoring, can be important in the decision to delay sexual intercourse.

Methodological considerations in a community-based longitudinal study.

OBJECTIVES: To describe methodological issues and strategies relevant to conducting a community-based longitudinal study. METHODS: Study participants (N=1117 youth/parent pairs) residing in neighborhoods that were randomly selected using a multistage sampling procedure and 2000 census data. Data were collected annually using in-home, in-person, computer-assisted interviewing methods. Numerous retention methods were used to track and retain participants. RESULTS: The initial response rate was 61%. The retention rate is 97%, and the valid interview completion rate is 93% after nearly 4 waves of data collection. CONCLUSIONS: In order for community-based longitudinal studies to overcome barriers to enrollment and retention, particular attention must be given to appropriate planning and available resources.

Youth-parent communication and youth sexual behavior: implications for physicians.

BACKGROUND AND OBJECTIVES: This study explores youth and parent agreement about conversations on specific topics related to sexual risk behavior and youth-parent relationship. The study's objective was to determine if the amount of agreement was associated with youth sexual behavior. METHODS: Data were collected using a computer-assisted data entry system from one parent and one youth in 1,350 randomly selected households in inner-city areas of two Midwestern cities. RESULTS: Youth-parent positive agreement scores about these conversations were significant after controlling for youth age, race, gender, family structure, and parental income and education. Scores were associated with youth abstinence and with the use of contraception if the youth had become sexually active. CONCLUSIONS: In this study, youth-parent agreement regarding their communication was associated with positive youth behaviors, including abstinence and the use of contraception if sexually active.

Youth assets and sexual abstinence in Native American youth.

Compared with youth of other races/ethnicities, Native American youth (ages 15-19 years) are more likely to have participated in sexual intercourse, thus placing them at greater risk for sexually transmitted diseases (STDs) and unintended pregnancies. This study's purpose was to investigate relationships among protective factors (assets) and sexual intercourse in a Native American youth population. Data were collected from Native American youth and their parents (N=126 youth/parent pairs) living in randomly-selected households using in-person, in-home interview methods. Nine youth assets were the independent variables and never had sexual intercourse was the dependent variable. Data were analyzed using logistic regression. One significant (p<.05) asset main effect and one asset by youth age interaction were found. Youth with the Non-Parental Adult Role Models asset were 3.8 times more likely to have never had sex compared with youth without the asset. Further study of the influence of protective factors among Native American youth is warranted.

A collaborative approach to program evaluation of community-based teen pregnancy prevention projects.

The purpose of this article is to demonstrate a model for collaboration between program providers and program evaluators. The article describes how university-based evaluators, a state health department, and local program providers collaborated to evaluate 12 projects implementing commercially developed teenage pregnancy prevention (TPP) programs in school settings. Approximately 2,200 students participate annually in the programs. Program evaluation staff and local program providers worked together to construct logic models that helped guide the intervention and evaluation design. The local providers also participated in training sessions, conducted by the evaluation team, to increase their understanding and skills related to program evaluation methods. Student-level outcomes related to knowledge, attitudes, skills, behaviors, as well as an assessment of curricula fidelity were included in the evaluation. The result of this collaborative model has been a quality program evaluation for the projects while maintaining community input regarding program improvements that reflect local population needs.