Evidence-Based Sexual Health Programs with Youth Involved with Juvenile Justice and Child Welfare Systems: Outcomes across Settings

Background/Purpose: Research establishes that youth involved in child welfare and juvenile justice systems are at an increased risk for pregnancy and STIs, and that curriculum-based sexual health programs can be effective for the general population. However, little research exists regarding the effectiveness of evidence-based teen pregnancy and STI prevention curricula with youth in child welfare and juvenile justice systems. Several existing evidence-based programs to reduce teen pregnancy and risk of STI’s are beginning to be tested with system-involved youth, namely Be Proud! Be Responsible! and Making Proud Choices!. The current study builds upon the current knowledge base by exploring: 1) the effect of evidence-based sexual health curricula on measures of sexual health knowledge and attitudes delivered across multiple juvenile justice and foster care settings, and 2) whether the efffects vary by the circumstance of the youth (i.e., foster care versus juvenile justice) at the time of intervention.

Methods: Data for this study were drawn from a multi-site intervention with five agencies located across Texas, each of which implemented an evidence-based sexual health curriculum (Be Proud! Be Responsible! or Making Proud Choices!). Youth aged 11-19 years (N=1,018) participated in the study, and attended an average of 92% of sessions. Pre- and post-intervention survey data measuring sexual health knowledge and attitudes were collected. Sexual health knowledge was measured by a 24 item scale, and attitudes related to using condoms and birth control were single item measures. Analyses included a series of t-tests to examine change from pre- to post-intervention, and regression analyses to examine predictors of change in knowledge and attitudes.

Results: Results of paired sample t-tests on knowledge and attitudes found significant increases in sexual health knowledge from pre to post-test for youth in both foster care and juvenile justice settings (p < .001). Attitudes towards birth control and condom use significantly increased from pre to post-test in juvenile justice settings (p < .001), but not in foster care settings. In multivariate analyses assessing change, being in juvenile justice (p=.037) was associated with greater increases in knowledge, though setting of the youth was not associated with greater influence on using condoms or birth control. Identifying as female (p=.031) was associated with greater increases in knowledge; identifying as heterosexual/straight was associated with greater influence condom use (p=.005); and having ever had sex (p<.001) at baseline was associated with greater program influence on condom (p<.001) and birth control use (p=.006). Though regression models predicting change in were significant, each explained relatively little variance with small R squares (.020, .027, .029).

Discussion/Implications: Results indicate that existing evidence-based sexual health education programs affect system-involved youth’s sexual health knowledge, and that setting of the youth may impact the effect on attitudes. The few significant predictors of change may be a result of the intense need for sexual health education among such marginalized groups. Future studies with a longitudinal design, and more sophisticated measures of attitudes are needed to examine whether improved knowledge and attitudes among these high-risk populations translates into reduced pregnancy and STI rates.