Twenty-four months after enrolling in a youth development intervention for females at high risk of pregnancy (and six months after completing the program), participants reported more consistent use of condoms, hormonal contraceptives and dual methods than did a comparison group of teenagers.[1] They also felt more connected to their families, were more likely to say that they felt able to refuse unwanted sex and were less likely to report that they had sex in exchange for material things. However, the two groups did not differ in their reported numbers of recent male partners or in a range of other psychosocial characteristics that may be linked to risky behavior.
The intervention, Prime Time, was evaluated in a trial involving youth recruited from community and school-based clinics in Minneapolis and St. Paul in 2007–2008. Sexually active females aged 13–17 were eligible to enroll if they met one of six risk criteria (e.g., they received STD treatment, reported sexual risk behavior when completing a screening tool or reported behavior indicating school disconnection). A total of 253 females enrolled, of whom 126 were randomly assigned to receive the 18-month intervention and 127 to serve as controls. The intervention group received monthly visits from a case manager, with whom they worked to address the program's core topics: healthy relationships, responsible sexual behavior, and positive involvement with family and school. They also participated in youth leadership programs aimed at building skills relevant to these topics. Researchers used data gathered through audio computer-assisted self-interview at baseline and 24 months later (i.e., six months after the intervention ended) to assess adolescents’ sexual and contraceptive behavior, as well as theoretically related psychosocial characteristics.
In both the intervention and the control groups, participants were about 15.5 years old at baseline, and roughly four in 10 were black; about half lived with no or only one parent or guardian. Nearly all (94–96%) were enrolled in school, and the majority (65–75%) had been suspended at least once. On average, adolescents reported having had 1.5–1.8 male sex partners in the previous six months. Some 31–32% of each group said they had used condoms consistently during that period, but 10–14% had not used them at all. On average, participants in both groups reported about two months of hormonal contraceptive use in the six months prior to enrollment.
The researchers used generalized estimating equations, adjusting for a variety of characteristics (including the outcome measure at baseline), to assess the effectiveness of the intervention. Results indicate that 24 months after study enrollment, Prime Time participants were more likely than other teenagers to say that in the last six months, they had used condoms consistently (relative risk, 1.6), had used hormonal contraceptives consistently (1.3) and had used dual methods consistently (1.4). Both groups reported the same number of male partners in the preceding six months.
Psychosocial outcomes were largely similar for intervention participants and teenagers in the control group. For example, the analyses reveal no differences by group assignment in adolescents’ feelings of school connectedness, desire to use contraceptives, interpersonal skills or communication with their partners about sexual risk. However, adolescents who had received the intervention were less likely than controls to say that they had sex to obtain material things (odds ratio, 0.5), and reported higher levels of connection to family and self-efficacy to refuse unwanted sex (mean differences of 0.3 and 0.1, respectively, on scales of 0–3).
Along with notable strengths of their study (participants’ similarity to eligible nonparticipants on a range of measures and minimal loss to follow-up), the researchers acknowledge a number of weaknesses, including the use of self-reported data and lack of generalizability to high-risk young females who do not use clinic services. On balance, they contend that their work "contributes to what has been a dearth of evidence about long-term effects of preventive services for youth with complex, multisystem needs." Their results, they conclude, suggest that a youth development approach that includes case management and youth leadership components "holds great promise for preventing multiple risk behaviors" among the most vulnerable young people and for fostering "social and intrapersonal attributes needed to sustain healthy behaviors."—D. Hollander
Reference
1. Sieving RE et al., Prime Time: sexual health outcomes at 24 months for a clinic-linked intervention to prevent pregnancy risk behaviors, JAMA Pediatrics, 2013, 167(4):333–340, doi: 10.1001/jamapediatrics. 2013.1089, accessed Apr. 2, 2013.