The Impact of Making Proud Choices! on Youth's Sexual Health Attitudes, Knowledge, and Behaviors

PURPOSE

To estimate the effect of the Making Proud Choices! (MPC) curriculum, one of the most popular evidence-based teen pregnancy prevention curricula being implemented nationwide.

METHODS

A cluster randomized trial was used to assign high schools to receive the MPC program or to serve as a standard care comparison group. The study took place in 15 schools in four cities in the United States. A total of 31 clusters and over 2,800 youth (predominantly in grades 9 and 10) were assigned to condition between 2016 and 2019. Student surveys administered at baseline and approximately 9 months after baseline were used to estimate the effects of MPC on risk and protective factors (knowledge, attitudes, self-efficacy) as well as sexual behavior outcomes.

RESULTS

The evaluation showed several large, statistically significant, and favorable impacts on nearly all of the risk and protective factors for risky sexual behavior. In addition, the study found a favorable effect of MPC on reducing the number of episodes of sex in the past 3 months.

DISCUSSION

The evaluation showed that MPC, as it is commonly implemented today, has evidence of effectiveness on improving both risk and protective factors, and sexual behavior outcomes. Based on these findings, MPC will continue to be seen as an evidence-based teen pregnancy prevention program for implementation through federal grant programs.

The Impact of Brief Interventions With Condom Demonstrations on Youth: A Systematic Review

PURPOSE

This review examined whether there is evidence that brief interventions with condom demonstration lessons have impacts on behavioral and nonbehavioral outcomes for youth and young adults.

METHODS

We conducted a systematic review using a prespecified search strategy and processes consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We identified a pool of 11 eligible studies that tested the effectiveness of a single-session intervention that was no longer than 60 minutes and included a condom demonstration. We included all outcomes at all time points and organized them into eight domains.

RESULTS

Single-session interventions with condom demonstrations showed favorable short-term and long-term impacts for samples of largely sexually active youth. Studies found statistically significant impacts in 29%-50% of the tests for effects on attitudes toward condoms, knowledge of sexual health and condom use, perceptions of condom use and sexuality, and condoms use intentions.

DISCUSSION

Our review found evidence that brief interventions with condom demonstrations have potential effects on behavioral and nonbehavioral outcomes for vulnerable and transient sexually active youth warranting future studies to assess condom demonstrations in isolation.

How accurately can we predict repeat teen pregnancy based on social ecological factors?

Many factors at the individual, relationship, family, and community or environmental levels could predict repeat teen pregnancies or births, but research on certain factors is limited. In addition, few studies have examined whether these factors can accurately predict whether teen mothers will have a repeat pregnancy. This study examined theoretically selected predictors of repeat teen pregnancy among 945 pregnant and parenting teens (M age = 17), most of whom were Hispanic/Latina (86%). Logistic regression with 47 predictors measured at baseline was used to predict repeat pregnancy. Predictors were selected based on backward selection that aimed for a balance between model performance and model complexity. A random forest model was also used to determine how accurately repeat pregnancy could be predicted based on all predictors. Significant predictors of repeat pregnancy were the teen mother having a parent with a serious drinking or drug problem when she was a child, being older, not living with a mother figure, not intending to abstain from sex or use a long-acting reversible contraceptive, and having lower resiliency skills. However, predictors explained limited variance in repeat pregnancy, and their accuracy in predicting repeat pregnancy was low. More research is needed to identify accurate predictors of repeat pregnancy because this could inform program providers or developers about areas that warrant more focus in programming for teen parents, and it could help identify teen mothers at higher risk of a repeat pregnancy so they could be the focus of specific programming. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Putting Rigorous Evidence Within Reach: Lessons Learned from the New Heights Evaluation

PURPOSE

This article uses an evaluation of New Heights, a school-based program for pregnant and parenting teens in the District of Columbia Public Schools, to illustrate how maternal and child health programs can obtain rigorous evaluations at reasonable cost using extant administrative data. The key purpose of the article is to draw out lessons learned about planning and conducting this type of evaluation, including the important role of partnerships between program staff and evaluators.

DESCRIPTION

This article summarizes the evaluation's research design, data sources, and lessons learned about ingredients contributing to the successful implementation of this study. The evaluation employed a difference-in-differences design to estimate program impacts using administrative data merged across agencies.

ASSESSMENT

Several features of New Heights and its context facilitated an evaluation. First, New Heights leaders could clearly describe program components and how the program was expected to improve specific student education outcomes. These outcomes were easy to measure for program and comparison groups using administrative data, which agencies were willing to provide. Second, buy-in from program staff facilitated study approval, data agreements, and unanticipated opportunities to learn about program implementation. Finally, time spent by evaluators and program staff in conversation about the program's components, context, and data resulted in greater understanding and a more useful evaluation.

CONCLUSION

The New Heights evaluation is a concrete example of how a small program with a modest evaluation budget can obtain evidence of impact. Collaborative relationships between researchers and program staff can enable these informative studies to flourish.

A Systematic Review of Programs to Promote Aspects of Teen Parents' Self-sufficiency: Supporting Educational Outcomes and Healthy Birth Spacing

Introduction

Expectant and parenting teens experience many challenges to achieving self-sufficiency and promoting their children’s healthy development. Teen parents need support to help them address these challenges, and many different types of programs aim to support them. In this systematic review, we examine the research about programs that aim to support aspects of teen parents’ self-sufficiency by promoting their educational outcomes and healthy birth spacing.

Methods

We conducted a comprehensive literature search of published and unpublished literature to identify studies of programs to support teen parents that met this review’s eligibility criteria. The quality and execution of the eligible study research designs were assessed to determine whether studies’ findings were at risk of bias. We then extracted information about study characteristics, outcomes, and program characteristics for studies considered to provide rigorous evidence.

Results

We identified 58 eligible studies. Twenty-three studies were considered to provide rigorous evidence about either education, contraceptive use, or repeat pregnancy or birth. Seventeen of these studies showed at least one favorable effect on an outcome in one of these domains, whereas the other six did not show any significant or substantial effects in these domains. These 17 studies represent 14 effective programs.

Discussion

Effective programs to support expectant and parenting teens have diverse characteristics, indicating there is no single approach for promoting teens’ education and healthy birth spacing. More rigorous studies of programs to support teen parents are needed to understand more about how to support teen fathers and the program characteristics associated with effectiveness.

Electronic supplementary material

The online version of this article (10.1007/s10995-019-02854-w) contains supplementary material, which is available to authorized users.

Supporting Expectant and Parenting Teens: New Evidence to Inform Future Programming and Research

Until recently, federal programs had not explicitly focused on improving the outcomes of highly vulnerable teen parents. Established in 2010, the Pregnancy Assistance Fund (PAF) aims to improve the health, social, educational, and economic outcomes for expectant and parenting teens and young adults, their children, and their families, through providing grants to states and tribes. This article introduces the Maternal and Child Health Journal supplement “Supporting Expectant and Parenting Teens: The Pregnancy Assistance Fund,” which draws together the perspectives of researchers and practitioners to provide insights into serving expectant and parenting teens through the PAF program. The articles in the supplement include examples of programs that use different intervention strategies to support teen parents, with programs based in high school, college, and community settings in both urban and rural locations. Some of the articles provide rigorous evidence of what works to support teen parents. In addition, the articles demonstrate key lessons learned from implementation, including allowing some flexibility in implementation while clearly outlining core programmatic components, using partnerships to meet the multifaceted needs of young parents, hiring the right staff and providing extensive training, using strategies for engaging and recruiting teen parents, and planning for sustainability early. The studies use a range of qualitative and quantitative methods to evaluate programs to support teen parents, and three articles describe how to implement innovative and cost effective methods to evaluate these kinds of programs. By summarizing findings across the supplement, we increase understanding of what is known about serving expectant and parenting teens and point to next steps for future research.

Roadmap for Effective School-Based Practices to Support Expectant and Parenting Youth: Lessons from the New Heights Program in Washington, DC

INTRODUCTION

New Heights is a voluntary school-based program that provides a well-defined system of supports for expectant and parenting students in Washington, DC, and was found to be effective at improving educational outcomes. This study explores the program elements and practices that, when used together, improved academic outcomes for New Heights participants and define a possible roadmap for service providers interested in replicating the program's success.

METHODS

The study team collected data through site visits, key informant interviews, staff surveys, program observations, case files, and program materials.

RESULTS

The core design and implementation elements of the New Heights program are (1) placing a trained staff member in the school to provide advocacy, case management, education, and in-kind incentives; (2) bringing community-based service providers into the school; (3) giving trained staff autonomy and a strong grounding in local context; and (4) using a highly collaborative process to hire and support school-based coordinators.

DISCUSSION

Staff and funders interested in improving outcomes for young parents in school could use the experience of New Heights and the key practices that were critical to its success as a guide: (1) ensure that the program is well defined but can be tailored to the needs of schools and students, (2) engage community partners to bring services to participants, (3) hire and train the right staff who are committed to "do whatever it takes," (4) actively cultivate a culture of collaboration among program staff, and (5) develop buy-in with school staff and illustrate program value.

Meeting the Multifaceted Needs of Expectant and Parenting Young Families Through the Pregnancy Assistance Fund

INTRODUCTION

The Pregnancy Assistance Fund (PAF) program funds states and tribes to provide a wide range of services to improve health, social, educational, and economic outcomes for expectant and parenting teens and young adults, their children, and their families. This introductory article to the Maternal and Child Health Journal supplement Supporting Expectant and Parenting Teens: The Pregnancy Assistance Fund provides a description of the PAF program, including the program goals and structure, participants and communities served, and services provided; presents data on the reach and success of the program; and describes lessons learned from PAF grantees on how to enhance programs and services to have the best outcomes for expectant and parenting young families.

METHODS

Performance measure data are used to describe the reach and success of the PAF program, and implementation experiences and lessons learned from PAF grantees were gathered through a standardized review of grantee applications and from interviews with grant administrators.

RESULTS

Since its establishment in 2010, the PAF program has served 109,661 expectant and parenting teens, young adults, and their families across 32 states, including the District of Columbia, and seven tribal organizations; established more than 3400 partnerships; and trained more than 7500 professionals. Expectant and parenting teens and young adults who participated in the PAF program stay in high school, make plans to attend college, and have low rates of repeat pregnancy within a year.

CONCLUSIONS

Expectant and parenting teens and young adults in the PAF program demonstrated success in meeting their educational goals and preventing repeat unintended pregnancies. In addition, the staff who implemented the PAF programs learned many lessons for how to enhance programs and services to have the best outcomes for expectant and parenting young families, including creating partnerships to meet the multifaceted needs of teen parents and using evidence-based programs to promote program sustainability.

Impacts of a Home Visiting Program Enhanced with Content on Healthy Birth Spacing

OBJECTIVES

This study sought to determine the impact of Healthy Families Healthy Futures (HFHF) enhanced with Steps to Success (STS). HFHF is a structured home visiting program for teen parents in Houston that focuses on improving parenting skills and preventing child abuse. HFHF enhanced with STS includes content and activities aimed to reduce repeat pregnancies within 24 months after the first child's birth.

METHODS

The study team recruited 248 young mothers for the study, primarily through local health clinics and schools, and then randomly assigned them to either a treatment group that was eligible to participate in HFHF enhanced with STS or to a control group. The control group was not offered any other program through the study. Outcomes were measured by a survey administered 12 months after program intake, in five domains aligned with the program's logic model: (1) exposure to information related to program content, (2) contraception knowledge, (3) contraception use, (4) enhanced family functioning, and (5) child health and development. To estimate program impacts, we used ordinary least squares regression, controlling for demographics and baseline measures of the outcome variables, if available. We use both frequentist approaches (calculations of statistical significance) and Bayesian posterior probabilities to interpret the findings.

RESULTS

HFHF enhanced with STS significantly (p < .05) impacted exposure to information on parenting and birth control, with effects of 20.8 and 15.4 percentage points, respectively. Using Bayesian posterior probabilities, there is an 85% chance that the program had a favorable effect on these outcomes. We also calculate a probability of 77% that the program had a favorable impact on long-acting reversible contraceptive (LARC) use, but a probability of 89% that the program reduced knowledge of birth control pills; these two results were not statistically significant (p = .17 and .10, respectively).

CONCLUSIONS FOR PRACTICE

These findings are primarily favorable and consistent with the program content and goals. Smaller than anticipated sample sizes due to recruitment challenges increased the chances for random error to affect the ability to detect statistically significant differences on many of our other outcomes; Bayesian posterior probabilities can therefore aid in interpreting the impact estimates. More research of this promising model is warranted.