Tapping into Community Resiliency in Rural Adolescent Pregnancy Prevention: An Implementation Sciences Approach.

Although rural youth experience marked inequities in adolescent pregnancy, there is little guidance for implementing evidence-based programs (EBPs) in rural settings. When implementation occurs in rural communities, it frequently focuses on deficits, rather than strengths or capacity for growth. Using the consolidated framework for implementation research (CFIR), we describe a resiliency-focused implementation of two middle school EBPs in rural Midwestern communities, including the intervention, outer and inner settings, individuals, implementation processes and preliminary outcomes. Data included program staff interviews, feedback from local partners, community meetings notes, and participant surveys. Using the CFIR, we describe the engagement of rural communities themselves in a resilience-based implementation of adolescent pregnancy prevention EPBs. Communities self-described as rural, traditional and religious. They identified adolescent pregnancy, substance use, and academic success as priorities. To address infrastructure needs and build on local strengths, funds were used to hire local partners to implement the program. As small communities, stakeholders were closely networked and wanted to address local needs. Local partners selected the EBP based upon community values and priorities. Champions, including local partner organizations and schools were locally based and were well connected. Intensive training of local staff and piloting with adaptation assured fidelity and sustainability, while increasing community implementation skills and comfort. In Clinton County, enrollment was 1946 with students receiving the program in 6th, 7th, and/or 8th grades. In Southern Indiana, 7275 students received the program once in either 6th, 7th, or 8th. We conclude that the CFIR can facilitate the implementation of a community resilience-focused adolescent pregnancy prevention intervention in rural communities.

Only Yes Means Yes: Sexual Coercion in Rural Adolescent Relationships.

PURPOSE: Sexual consent is important to healthy relationships; however, sexual coercion is common. We examine modifiable risk and protective factors for sexual coercion among high school students in a rural community. METHODS: We surveyed 10th graders (N = 442) in a rural, Midwestern, low-to-middle income county before receiving an evidence-based sex education program. Sexual coercion was a single item, "has anyone you were dating or going out with forced you to do sexual things that you did not want to do?" We examined associations between sexual coercion and demographics, risk behaviors, sexual self-efficacy, controlling relationship behaviors, parent communication, and adverse childhood experiences. RESULTS: Approximately 22% of females and 8% of males reported experiencing sexual coercion at least once in their lifetime. Gender differences emerged in associated risk and protective factors, including sexual sex efficacy, controlling relationship behaviors, parent-adolescent communication about sex, and adverse childhood experiences. CONCLUSIONS: Sexual coercion is common among adolescents in rural communities. Prevention interventions should target modifiable risk and protective factors.