Effectiveness of Teen Pregnancy Evidence Based Curricula with Disconnected Youth

Background: In order to bridge gaps in teen pregnancy and sexual health, evidence is needed to inform programs serving populations of youth at high-risk of pregnancy and STIs.  Most research on evidence based teen pregnancy prevention curricula has been conducted with youth in normal school settings.  Disconnected youth who are often absent from school may include foster youth, youth in the juvenile detention, homeless youth and youth in substance use treatment.  The Connections Project is a multi-site, three year study in Texas examining the efficacy of evidence based teen pregnancy prevention curricula (EBPs) with “disconnected youth.  This study examines findings from the first year of the three year project.

Methods:  Youth at six study sites across Texas participated in the first year of the project. Sites included two juvenile detention centers, two foster care shelters, one homeless shelter and one substance use treatment facility.  Sites chose an evidence based teen pregnancy curricula based on the needs of the site.  Two sites chose the Be Proud! Be Responsible! curricula and four sites chose the Making Proud Choices curricula.  Curricula were delivered by trained sexual health educators not affiliated with the site.  Parental consent or consent from child welfare caseworkers was obtained.  Assent was obtained from youth. Multiple IRBs were needed to comply with site specific requirements.   Youth (n=201) completed a pre and post-test to collect demographic information and information regarding their sexual health knowledge and behavioral intent.  Descriptive statistics and paired sample t-tests were conducted.

Results: Across all sites, 87.9% of youth reported having had sexual intercourse and 31.6% reported getting someone pregnant or having been pregnant.  60% of the youth were male.  53% identified as Hispanic and 28% identified as Black. 78% identified their sexual orientation as “straight.” The median age of youth was 15.39.  Findings suggest the curricula are improving knowledge of sexual health and some aspects of behavioral intent.  Youth showed statistically significant increases in knowledge of HIV/STIs (t=7.095 p≤.000), condoms (t=5.887, p≤.000), and pregnancy (t=5.737, p≤.000).  However, youth did not increase in their perceived self-efficacy to negotiate condom use or report an increased likelihood to use other forms of birth control.

Conclusion:  While the curricula are improving the sexual health knowledge of youth, they are not impacting behavioral intent or attitudes about safer sex practices.  Qualitative information gathered from the sites and facilitators suggests that many youth have experienced high levels of trauma and need sexual health curricula that are more trauma informed.  Because these curricula were tested with youth in normal school settings, scare tactics, negative language about STDs and shame around the loss of virginity is incorporated throughout.  These messages do not resonate with youth who have been sexually abused.  The program is currently developing trauma informed curricula adaptations to test their impact on youth.