Challenging the Evidence Base: The Impact of Teen Pregnancy Prevention Curricula on Disconnected Youth

Background. Rates of pregnancy and sexually transmitted infections are substantially higher for youth in foster care, juvenile detention, homeless shelters and substance use rehabilitation facilities.  However, these “disconnected youth” face multiple barriers in accessing sexual health information.  This study uses data from a multi-site federally funded project to examine the usefulness and effectiveness of teen pregnancy prevention evidence based programs (EBPs) with youth in high risk settings. 

Methods. Paired sample t-tests are used to measure the change in behavioral intent and knowledge related to sexual activity (n=592).  Process evaluation components include individual interviews with youth (n=15) and interviews with agency staff (n=5) that were analyzed using conventional content analysis.

Results. Youth who receive EBPs are reporting significant changes in their knowledge and behavioral intent which is line with the goals of the EBPs.  They improve scores on validated measures related to sexual health trauma and report that they are less likely to have sex within the next three months.  Youth who participated in the process evaluation report that they like the curricula, but felt that they needed the information much sooner in their lives.  However, findings from the process evaluation also suggest that youth have negative views of sex and sexuality, lack understanding of consent and have unrealistic views of relationships.  For instance, youth who had completed the curricula utilize rigid ideas about gender related to who initiates sex, how consent is obtained and who is supposed to enjoy sex. Additionally, they report portions of the EBPs to be uncomfortable likely based on their prior trauma histories.  For instance, youth reported not liking videos required by the curricula and condom demonstrations.

Implications. Study findings suggest that there are unique barriers to implementing EBPs in more high risk settings where youth have likely experienced trauma.  While agencies look to implement EBPs based on funding patterns, it is important to supplement programming to include topics related to positive sexuality, consent and healthy relationships, particularly for youth who have experienced trauma.  Agencies must understand that an EBP is not a substitute for an on-going dialogue with youth.