Increasing Condom Usage for African American and Hispanic Young Fathers in a Community Based Intervention

Background/Purpose

In 2010, there were approximately 614,000 pregnancies to women younger than age 20. In Hartford, Connecticut the teen birth rate approached three times the state average. Adolescent fathers are often absent: nationally, one-third of 20- to 24-year-old African-American men are absent fathers. Teen fathers are more likely to engage in unsafe sex and the rate of unintended repeat fatherhood may be more than double the rate for teenagers not previously fathers. Father absence may be detrimental: children of single mothers are at greater risk for behavioral problems, school drop-out, incarceration, intergenerational teen parenting, and unemployment. This paper tested an adaptation to an evidence based program (FatherWorks) in a randomized control trial design against standard care (24/7 Dads) hypothesizing that the Fatherworks intervention would increase intent to use condoms and condom usage compared to the control condition of 24/7 Dads. This paper will also investigate differences in race/ethnicity for these outcomes.   

Methods

Eligible fathers were ages 15-24 and living in Greater Hartford. This individual Randomized Control Trial randomized participants at a 1:1 ratio to the FatherWorks or 24/7 Dads conditions through sealed envelopes. Data for analyses was collected through a self-administered, paper-and-pencil survey taken at baseline and four follow-up time points.  The intervention condition, FatherWorks, has five components: a 15-session group parenting intervention called Supporting Father Involvement; an employment class; a paid internship; case management; and behavioral health services. The control condition, or usual service, 24/7 Dads, has three components: a 15-session parenting education class; case management; and outside referrals.

We compared intervention vs. control outcomes at 15 weeks (n=273), controlling for baseline values, age, race, and stage of change using logit regression for categorical outcomes and standard regression for the continuous stage of change. (There are 5 stages of change when beginning a new health-related behavior, like condom usage.) We repeated analyses for the two racial/ethnic groups to test for differences.

Results

Intervention participants mean level of stage of change increased from baseline to 15 weeks, while controls decreased. Means of changes were: .55 vs. -.11, t=2.46, p = .016. Regressing the 15-week condom stage of change on its baseline value, intervention, age, and Hispanic race, shows a higher outcome level by .51 for intervention vs. controls (p = .060). This improvement was seen only in Black participants, t=2.27, p = .029 (for Hispanics:  t=1.11, p = .275) and was confirmed with race-specific regression models. The impact of the intervention compared to the control on condom use during last sexual intercourse was not significant. 

Conclusions

The study findings indicate that FatherWorks, a community based program, is successful in increasing condom use intent for African-American fathers, compared to a control condition, 24/7 Dads.  Condom use intent was not increased among Hispanic fathers, suggesting differential effects of the intervention possibly in relation to group engagement, retention, and cultural responsiveness. Condom use was not significant for African-American or Hispanic fathers compared to the control group but the data collection at 15 weeks may not capture a delayed influence of the intervention.