Youth Assets and Alcohol, Tobacco, and Other Drug Use: The Importance of Family Structure.

This research analyzed data from the Youth Asset Study (YAS), a 4-year longitudinal investigation designed to examine the prospective influence of youth assets, which are believed to influence behavior at the individual, family, and community levels, on youth risk behaviors. The purpose was to determine if specific youth assets (e.g., responsible choices, family communication, community involvement) differentially protected adolescents from alcohol, tobacco, and other drug use (ATODU) according to family structure (one-parent and two-parent households). Five waves of data were collected annually over four years from a racially/ethnically diverse sample of adolescents (N = 722, 51.5% male, baseline mean age = 14.1 years). Pearson chi-square tests for independence were used to test for significant differences in the prevalence of assets between one-parent and two-parent households. Generalized linear mixed models were used to identify prospective associations between 17 youth assets and ATODU while stratifying by family structure and controlling for sociodemographic characteristics. Compared to adolescents living in one-parent households, adolescents living in two-parent households were significantly more likely to possess six of 17 assets. Among adolescents living in one-parent households, those who possessed any one of eight youth assets were significantly less likely to use ATODU. Among adolescents living in one-parent households, those with any one of seven assets were significantly less likely to use ATODU. Family- and community-level assets had the most significant asset/ATODU associations for adolescents living in one-parent households (AORs ranged from 0.23 to 0.61). Individual-level assets had the most significant asset/ATODU associations for adolescents living in two-parent households (AORs ranged from 0.38 to 0.60). The results suggest that developing asset-based interventions tailored to the adolescents' family structure may be useful in preventing adolescents from engaging in ATODU.

Youth Assets, Neighborhood Factors, Parental Income, and Tobacco Use: A Longitudinal Study of Health Disparities.

This study aimed to assess how the relationship between youth assets and future no-tobacco use among youth might differ according to race/ethnicity, neighborhood factors and socio-economic status. Five waves of annual data were collected from 1111 youth/parent pairs living in Oklahoma, USA who were randomly selected to participate in the Youth Asset Study (YAS). A marginal logistic regression model using all five waves of no-tobacco use, demographics, and their interaction was used to compare the change in tobacco use over time. Among 1111 youth, (Mean age = 14.3; 53% female; 39% White, 28% Hispanic, 24% Black, and 9% other), the percentage of youth tobacco use increased significantly from baseline to wave 5 (4 years after baseline) for all racial/ethnic groups and all parental income groups. Assets were prospectively associated with no tobacco use in the past 30 days for Black, White and Hispanic youth and for youth in all income categories (adjusted odds ratio range = 1.9-2.7). There was one statistically significant association between the neighborhood environment and future no tobacco use. To conclude, the protective effects of youth assets in terms of prevention of tobacco use among youth do not differ by youth race/ethnicity or parental income in the presence of neighborhood environmental factors.

Youth Assets and Initiation of Sexual Intercourse by Family Structure: A Longitudinal Cohort Study.

BACKGROUND: The purpose of this study was to assess the protective influence of individual, family, and community assets from the initiation of sexual intercourse (ISI) for adolescents living in one-parent households compared with adolescents living in two-parent households. METHODS: Five waves of data were collected annually over a 4-year period (N = 591, 52.5% female, mean age = 14.0 years) from a racially/ethnically diverse sample of adolescents. Extended Cox models were used to assess the relationship between assets and time of ISI while controlling for demographic variables. Potential interactions between adolescent's household structure and assets were examined. RESULTS: Five of 17 assets were prospectively and significantly associated with a reduced risk of ISI among adolescents living in one-parent households compared with 11 of 17 assets for adolescents living in two-parent households. Adolescents living in one-parent households who possessed any one of five assets (e.g., general aspirations for the future, relationship with mother, positive peer role models) had between a 27% and 57% lower risk of ISI, whereas adolescents living in two-parent households who possessed any of one of 11 assets (e.g., responsible choices, family communication, community involvement) had between a 20% and 42% lower risk of ISI. CONCLUSION: The results suggest that strengthening specific youth assets across multiple dimensions of behavioral influence may decrease the risk of ISI for adolescents living in both one-parent and two-parent households. Public health efforts focused on developing programs to promote asset building tailored to adolescent's family structure are warranted.

The mobile emergency recovery intervention trial (MERIT): Protocol for a 3-year mixed methods observational study of mobile recovery outreach teams in Nevada's emergency departments.

BACKGROUND: The Substance Abuse and Mental Health Administration awarded State Targeted Response grants to support states' efforts to address the opioid epidemic. In Nevada, one component of this grant was mobile recovery outreach teams (MROTs) that utilized peer recovery support specialists to provide care for qualifying patients in emergency departments (EDs). The Mobile Emergency Recovery Intervention Trial (MERIT) is a mixed methods study to assess the feasibility/acceptability and effectiveness of the MROT intervention. This protocol mainly describes the R33 research activities and outcomes. The full protocol can be found protocols.io. METHODS: Data will be derived from state-level data sets containing de-identified emergency department visits, substance use disorder treatment records, and mortality files; in-person mixed methods interviews; participant observation; and self-report process evaluation forms. Primary outcomes include Medication Assisted Treatment (MAT) initiation and non-fatal overdose; secondary outcomes include MAT retention and fatal overdose. Quantitative hypotheses will be tested using generalized linear mixed effects models, Bayesian hierarchical models, and marginal Cox models. Qualitative interview data will be analyzed using an inductive thematic analysis procedure. DISCUSSION: It is impossible to conduct a randomized controlled trial of the effectiveness of the MROTs, given the ethical and logistical considerations of this intervention.This study's innovative design employs a mixed methods formative phase to examine feasibility and acceptability, and a quasi-experimental outcomes evaluation phase employing advanced statistical methods to mitigate bias and suggest causal inference regarding the effectiveness of the MROTs.Innovative interventions have been deployed in many states; evidence regarding their effectiveness is lacking, but critical to informing an effective public health response to the opioid epidemic.

A longitudinal study of the protective influence of youth assets on juvenile arrest.

BACKGROUND: The objective of this study was to determine the separate and cumulative influence of individual, family and community assets on juvenile arrest rates in a cohort of youth. METHODS: Five waves of data were collected from 1111 youth and their parents living in randomly sampled census tracts in a Midwestern state. Computer-assisted, in-person data collection methods were used to measure assets within individual (six assets), family (four assets) and community (six assets) domains. Extended Cox models were used to assess the relationship between the number of assets and time to first juvenile arrest, while controlling for known confounders. RESULTS: Nine of 16 assets across individual, family and community domains were prospectively associated with a reduction in arrest rates. There was a relationship between the number of assets youth possess within individual, family and community domains and rates of arrest. For example, compared to youth with zero to one community assets, those with three [adjusted hazard ratio (AHR): 0.52; 95% confidence interval (CI): 0.30-0.88], four [AHR: 0.57; 95% CI: 0.34-0.97] or five to six [AHR: 0.45; 95% CI: 0.25-0.82] community assets had lower risk of arrest. CONCLUSIONS: Public health efforts focused on developing policies and programs to promote asset building across multiple domains of influence are warranted.

Adverse Childhood Experiences and Suicidal Behaviors Among Youth: The Buffering Influence of Family Communication and School Connectedness.

PURPOSE: The main objectives of this study were to determine (1) whether family communication and school connectedness offer protection against suicidal behaviors in the presence of adverse childhood experiences (ACEs; direct protective effect) and (2) whether family communication or school connectedness buffer the association between ACEs and suicidal behaviors (interacting protective effect) on the multiplicative and additive scales. METHODS: Data were obtained from a western state's 2019 Youth Risk Behavior Survey that included 5,341 middle school and 4,980 high school participants. Generalized linear models were used to estimate whether family communication and school connectedness offered direct protection against suicidal behaviors or buffered the association between ACEs and suicidal behaviors using adjusted prevalence ratios and corresponding 95% confidence intervals. RESULTS: Family communication and school connectedness offered direct protection against suicidal behaviors in the presence of ACEs (a 1-unit higher score was associated with a 32%-42% lower prevalence of suicidal behaviors for middle school youth and a 27%-39% lower prevalence of suicidal behaviors for high school youth). There was evidence that family communication and school connectedness buffered the association between ACEs and suicidal behaviors on the multiplicative scale. CONCLUSIONS: The findings provide support for the development and implementation of interventions that build family communication and school connectedness to reduce suicidal behaviors. Furthermore, screening for trauma and suicidal behaviors is warranted.

Healthcare Utilization, Unmet Service Needs, and Medication Adherence Among People Living with HIV/AIDS.

BACKGROUND: Comorbidity rates and service needs are high among people living with HIV/AIDS (PLWHA). The effects of service utilization and unmet service needs on antiretroviral therapy (ART) adherence are not well understood. The purpose of this study was to investigate associations among PLWHA's service utilization, unmet service needs, and ART adherence. METHODS: PLWHA (N=162) 18 years or older were recruited from a Nevada statewide needs assessment project in 2016. Participants completed a self-administered questionnaire on paper or online. The independent variables were service utilization and unmet service needs. The outcome variable was ART adherence. Multivariable logistic regression analyses were conducted to examine associations between the amount of utilized services and unmet service needs with ART adherence. RESULTS: Only 12 (7.5%) participants reported they received all the needed services. The ART nonadherence group showed significantly higher unmet medical service needs compared to the ART adherence group (p=0.007). Unmet medical service needs (Adjusted Odds Ratio (AOR) 0.69, CI 0.53-0.90) and unmet support service needs (AOR 0.68, CI 0.48-0.97) were negatively associated with ART adherence. However, utilizing medical services (AOR 1.06, CI 0.87-1.30) and support services (AOR 0.88, CI 0.74-1.04) in the current year were not significantly associated with ART adherence. CONCLUSION: The results of this study indicate that health promotion programming should focus not only on introducing new services at the community level, but also work to optimize the availability and awareness of current services. Furthermore, health promotion programs should focus on filling service coverage gaps and improving the facilitation of services.

"It's Gonna be a Lifeline": Findings From Focus Group Research to Investigate What People Who Use Opioids Want From Peer-Based Postoverdose Interventions in the Emergency Department.

STUDY OBJECTIVE: Postoverdose interventions that deploy peer recovery support specialists to emergency departments (EDs) are a promising response to opioid overdoses among patients presenting in EDs. The objective of this study was to elicit patients' perspectives regarding the feasibility and acceptability of such an intervention and to ensure that their perspectives are represented in intervention design, implementation, and evaluation. METHOD: In 2019 the study investigators conducted focus groups with people who use opioids to elicit perspectives about a postoverdose intervention delivered in the ED by using a semistructured interview guide that asked about feasibility, acceptability, perceived benefits, and concerns. Focus groups were digitally recorded, transcribed, and analyzed for emerging themes. RESULTS: Nine focus groups with 30 people who use opioids were conducted. Key findings that could improve feasibility and acceptability of the intervention include the following: the importance of balancing the urgency of seeing patients quickly with a need to accommodate the experience of precipitated withdrawal symptoms; the need to address privacy concerns; and the need to address concerns related to cost, insurance coverage, and sustainability. Perceived benefits of the intervention included the ability of the peer recovery support specialist to provide advocacy and support, serve as a model of hope and encouragement for behavior change, and fill key service gaps. CONCLUSION: Postoverdose interventions in the ED provide the opportunity to integrate harm reduction-based interventions into traditional biomedical care facilities. These interventions can fill gaps in services and provide additional care and comfort for people who use opioids, but design, implementation, and evaluation should be informed by a patient-centered care perspective.

Prospective relationships between youth assets, negative life events, and binge drinking in a longitudinal cohort of the youth.

PURPOSE: The purpose of this study was to investigate whether individual, family, and community assets can 1) protect youth from binge drinking in the face of negative life events and 2) modify the relationship between negative life events and binge drinking. METHODS: Data from waves 2-5 of the Youth Asset Study were analyzed. Generalized estimating equations were used to assess the relationship between negative life events, assets, and binge drinking. Multiplicative and additive interaction between negative life events and assets was evaluated. RESULTS: When included in the same model as negative life events, individual, family, and community assets had a graded, protective relationship with binge drinking, with strongest protection for those with the greatest number of assets. For example, youth with 3 [adjusted odds ratio (AOR):0.78, 95% confidence interval (CI): 0.65-0.93], 4 [AOR: 0.60, 95% CI: 0.49-0.73], 5 [AOR: 0.53, 95% CI: 0.41-0.69], and 6 [AOR: 0.42, 95% CI: 0.28-0.63] assets within the community domain had a significantly lower odds of binge drinking than youth with 0-2 community assets. No significant interactions were observed. CONCLUSIONS: The findings suggest that while youth who are exposed to negative life events are at risk for binge drinking, building assets across individual, family, and community domains can have a protective influence.

"Another tool for the tool box? I'll take it!": Feasibility and acceptability of mobile recovery outreach teams (MROT) for opioid overdose patients in the emergency room.

Drug poisoning deaths involving opioids have increased exponentially in the United States. Post-overdose outreach to patients in the emergency room (ER) is a promising strategy for increasing uptake of medication assisted treatment and reducing subsequent overdose. We conducted a mixed methods study to investigate the feasibility and acceptability of a mobile recovery outreach team (MROT) program for opioid overdose patients presenting in Nevada's ERs, which was funded by the SAMHSA Opioid State Targeted Response (STR) grant. We interviewed 25 ER staff using quantitative questions informed by Diffusion of Innovation (DOI) theory and qualitative questions regarding their experiences caring for overdose patients, perceived benefits, and concerns about the MROT program. Respondents expressed strong support and enthusiasm for the program, identified advantages of the program relative to standard of care, highlighted logistical issues that must be addressed prior to implementation, and illustrated how the MROT program is compatible with their personal and professional values. Our results suggest that the STR-funded MROT program could reduce burden and stress among ER staff and improve patient outcomes, but must be informed by formative research that addresses issues of logistical complexity and cultural compatibility.

Prospective Associations Among Youth Religiosity and Religious Denomination and Youth Contraception Use.

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

Youth assets and alcohol-related problems among male and female youth: Results from a longitudinal cohort study.

Youth who experience alcohol-related problems are at increased risk for developing alcohol dependence. Identifying factors associated with adolescent alcohol-related problems is essential, but most studies have focused on risk factors or a limited number of protective factors, with little attention to sex differences. We assessed the prospective association between 17 assets and alcohol-related problems among male and female youth. A 4-year cohort study with 1, 111 youth living in randomly-selected census tracts in the Oklahoma City Metropolitan Area was conducted. Follow-up for the current study began at wave 2 (2004/2005; N = 1079). Seventeen assets at the individual-, family-, and community-levels were measured. Five questions documented alcohol-related problems in the past 12 months. Generalized linear mixed models evaluated the prospective influence of assets on alcohol-related problems, separately for males and females. Models controlled for age, race/ethnicity, family structure, and parental income. Overall, females had more assets than males, but the protective influence of assets on alcohol-related problems over time was stronger for males. Six assets uniquely protected males (responsible choices [AOR = 0.58, 95% CI = 0.36-0.94], educational aspirations [AOR = 0.54, 95% CI = 0.31-0.93], parental monitoring [AOR = 0.41, 95% CI = 0.27-0.64], community involvement [AOR = 0.57, 95% CI = 0.34-0.97], use of time for groups/sports [AOR = 0.64, 95% CI = 0.42-0.97], and school connectedness [AOR = 0.51, 95% CI = 0.34-0.77]), and 3 uniquely protected females (general self-confidence [AOR = 0.62, 95% CI = 0.40-0.96], good health practices [AOR = 0.67, 95% CI = 0.47-0.95], and relationship with mother [AOR = 0.53, 95% CI = 0.36-0.80]). Strengthening youth assets across multiple domains may decrease alcohol-related problems for both males and females; however, gender-specific approaches to asset building are also warranted.

The Revised Youth Asset Survey (YAS-R).

PURPOSE: The study's purpose was to improve the psychometric properties of the Youth Asset Survey (YAS). DESIGN: Longitudinal cohort study with youth and parents recruited via door-to-door canvassing to participate in a 5-wave, 4-year study that assessed prospective associations among youth assets and youth health-related behaviors. Additional test items were added in the last 2 waves of a study to improve the YAS. SETTING: Households in randomly selected census tracts located in the Oklahoma City metropolitan area. PARTICIPANTS: Youth and their parents (N = 1111 parent/child dyads). Youth demographic characteristics at wave 4 were mean age = 17.3 (standard deviation = 1.62) years; 53% female, 41% white, 28% Hispanic, 24% African American, and 6% other. MEASURES: Sixty-eight items assessing 17 youth asset constructs and 8 single items assessing youth risk behaviors. ANALYSIS: Confirmatory factor analysis and generalized linear models were conducted to assess construct reliability and predictive validity, respectively. RESULTS: Cronbach α for the revised asset constructs ranged from .72 to .82, predictive validity was strong, and all revised asset constructs were assessed via 4 items. CONCLUSIONS: Researchers and practitioners have an improved 68-item YAS-Revised, freely available for their use, which measures 17 youth assets with good reliability, validity, and functionality.

Prospective impact of individual, family and community youth assets on adolescent suicide ideation.

BACKGROUND: Studies have found that youth assets have a protective influence on many risk behaviours. However, the relationship between youth assets and adolescent suicide ideation is poorly understood. The purpose of this study was to determine if youth assets were prospectively associated with suicide ideation. METHODS: Four waves of data were collected from 1111 youth and their parents living in randomly sampled census tracts that were stratified by income and race/ethnicity using census data. Computer-assisted, in-person data collection methods were used to measure assets at the individual (6 assets), family (4 assets) and community (6 assets) levels. Generalised linear mixed models were used to prospectively assess the relationship between the number of individual-level, family-level and community-level assets and suicide ideation, while controlling for known confounders. RESULTS: About half of the sample was female (53%). Participants were racially/ethnically diverse (white (41%), Hispanic (29%) and black (24%)). Eleven of the 16 assets were associated with reduced odds of suicide ideation. In addition, there was a graded relationship between the number of assets at each level (individual, family and community) and the odds of suicide ideation. For example, compared with youth with 0-2 family assets, those with 3 (OR 0.61; 95% CI 0.42 to 0.90) or 4 (OR 0.32; 95% CI 0.21 to 0.51) family assets had lower odds of suicide ideation. CONCLUSIONS: This prospective analysis showed a protective relationship between youth assets and suicide ideation, with the greatest protection among youth with the most assets. Interventions designed to build youth assets may be a useful strategy for reducing adolescent suicide ideation.

An Investigation of Youth Assets and Physical Activity and BMI Using a Longitudinal Cohort Design.

PURPOSE: Substantial research has demonstrated that assets (eg, family communication, school connectedness) protect youth from participation in numerous risk behaviors. However, very few studies have explored the relationship between assets and positive health behaviors. This study investigated prospective associations among assets and physical activity (PA) and body mass index (BMI). DESIGN: Longitudinal design with 5 waves of data collected annually over a 4-year period. SETTING: Community-based setting with participants recruited via door-to-door canvasing of homes located in stratified (by race and income) randomly selected census tracts and blocks. PARTICIPANTS: Participants were 1111 youth (baseline mean age = 14.3 years [SD = 1.6]; 53% female; 40.6% white, 28.6% Hispanic, 24.4% black, 6.4% other) and their parents. MEASURES: Weekly participation in PA, BMI, and 14 youth assets representing multiple levels of influence (individual, family, and community). ANALYSIS: Generalized linear mixed models assessed associations among the assets and PA and BMI over the 5 waves of data. RESULTS: There was a significant and graded relationship between assets and weekly participation in PA. For example, at the community-asset level, PA minutes were higher among youth with 2 assets ( P = .006), 3 assets ( P = .0006), and 4 to 5 assets ( P < .0001) compared to youth with 0 to 1 assets. No effects were found for BMI. CONCLUSION: Asset-based health promotion programs for youth may promote positive health behaviors and prevent participation in risk behaviors.

Adolescent Pregnancy Prevention Among Youths Living in Group Care Homes: A Cluster Randomized Controlled Trial.

OBJECTIVES: To determine if the Power Through Choices (PTC) intervention can increase the use of birth control and reduce pregnancy among system-involved youths living in group care homes. METHODS: We performed a 2-arm cluster randomized controlled trial involving group care homes operated by child welfare or juvenile justice systems in California, Maryland, and Oklahoma with assessments immediately before and after the intervention, and at 6- and 12-month follow-up. We collected data from 2012 to 2014 via self-administered questionnaires. Participants (n = 1036) were young (mean age = 16.1 years), predominantly male (79%), racially/ethnically diverse (37% Hispanic, 20% Black, 21% White, 17% multiracial), and sexually experienced (88%). RESULTS: At 6-month follow-up, participants in the intervention group had significantly lower odds of having recent sexual intercourse without using birth control (adjusted odds ratio [AOR] = 0.72; 95% confidence interval [CI] = 0.52, 0.98). At 12-month follow-up assessment, participants in the intervention group had significantly lower odds of ever being pregnant or getting someone pregnant (AOR = 0.67; 95% CI = 0.46, 0.99). CONCLUSIONS: The results suggest that PTC is an effective sexual health education intervention that can be implemented with system-involved youths who represent a sexually experienced multiracial youth population.

Beyond the Effects of Comprehensive Sexuality Education: The Significant Prospective Effects of Youth Assets on Contraceptive Behaviors.

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

Demographic Factors Predict Disparities in Number of Assets Youth Possess.

OBJECTIVES: This study's purpose was to determine if youth race/ethnicity, youth age and sex, parent income and education, household wealth, family poverty, and family structure were prospectively associated with youth assets in a community-based sample of racially/ethnically and economically-diverse youth and their parents. METHODS: Five waves of data were collected annually (2003 to 2008) from youth (N = 1111; Mean age = 14.4 years, SD = 1.6) and their parents using in-person, computer-assisted interviewing methods. Marginal logistic regression models and generalized estimating equations were conducted to assess prospective associations between the demographic factors and the number of assets the youth possessed (more than or less than the median number of 12 assets). RESULTS: Results indicated that 1-parent families (Odds Ratio = 0.62, 95% CIs = 0.50-0.76) lower parental education, (OR = 0.67, CI = 0.48-0.95 and OR = 0.77, CI = 0.61-0.97), and youth age (OR = 0.70, CI = 0.55-0.88 and OR = 0.59, CI = 0.45-0.77) were the only demographic factors that independently, prospectively, and significantly predicted which youth would possess less than the median number of assets. CONCLUSIONS: Youth assets may be 1 mechanism that explains the negative effects of some demographic factors, particularly 1-parent families and low-parent education, on youth risk behaviors and health.

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

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