A program evaluation of the Innovative Teen Pregnancy Prevention Programs (iTP3) Project

Background Teen pregnancy prevention in the United States has traditionally focused on the development, testing, and subsequent implementation of a set of evidence-based programs (EBPs), recommended nationally. However, these existing EBPs often do not prioritize the most at-risk or vulnerable populations. Methods The Innovative Teen Pregnancy Prevention Programs (iTP3) project was funded to facilitate the development of new, innovative programs to reach disparate populations. Through a mixed methods design, iTP3 evaluated the process and resulting innovative programs from five iterative cohorts of funded organizations, referred to as Innovators. iTP3 utilized both a traditional funding model with more traditional methods of capacity building assistance, but transitioned over time to a design-focused funding model in which organizations and individuals developed innovative programs through an intensive human centered design process. Results Evaluation results showed that the resulting portfolio of programs had differences in the types of programs resulting from the differing funding models. Notable differences among programs from the two funding models include program length, along with personnel, time, and resources needed to develop and manage. Conclusion Both traditional and design funding models led to innovative programs, with notable differences in the development process and resulting programs.

E hine, ngā whāea: Teen mothering in the gaze

<p>In Aotearoa New Zealand, teen pregnancy is associated with social disadvantage and being ‘Māori’. Research on teen motherhood typically focuses on ‘risks’ and ‘dangers’, such as lower educational attainment and welfare ‘dependency’. These images cast young Māori mothers as abnormal and deviant – as perpetually deficit. Hence, public (and public service) perceptions of these women are often negative. This study displaces the deficit lens, and explores the lived realities of fifteen young (teen) Māori mothers, and the perspectives of their whānau. The purpose of this research was to understand the life circumstances of young Māori mothers, to examine the role of the state in their lives, and to make suggestions for service improvements. It draws on data from the E Hine study (Women’s Health Research Centre, Otago University, Wellington). Young mothers participating in E Hine were interviewed three to seven times over a three-year period, with up to two whānau interviews conducted for each young woman. The data set for this thesis, comprising of fifteen young Māori mothers and their whānau, totalled eighty-four in-depth, semi-structured interviews. Data analysis was thematic, and was informed by Foucault’s concepts of the medical and disciplinary gazes, and postcolonial notions of the colonial gaze. The research suggests that public health and social services, as well as public perceptions, seek to regulate these young women according to Eurocentric conceptions of normality; and in doing so, stigmatize and disengage them, thus creating barriers to positive outcomes. Despite this, these young mothers resist disempowerment, and hope for a better future for themselves and their whānau. Their stories are a testament to the fact that being young and Māori and mothering does not equate to failure. By treating young Māori mothers with respect and empathy, support services could be improved.</p>

E hine, ngā whāea: Teen mothering in the gaze

<p>In Aotearoa New Zealand, teen pregnancy is associated with social disadvantage and being ‘Māori’. Research on teen motherhood typically focuses on ‘risks’ and ‘dangers’, such as lower educational attainment and welfare ‘dependency’. These images cast young Māori mothers as abnormal and deviant – as perpetually deficit. Hence, public (and public service) perceptions of these women are often negative. This study displaces the deficit lens, and explores the lived realities of fifteen young (teen) Māori mothers, and the perspectives of their whānau. The purpose of this research was to understand the life circumstances of young Māori mothers, to examine the role of the state in their lives, and to make suggestions for service improvements. It draws on data from the E Hine study (Women’s Health Research Centre, Otago University, Wellington). Young mothers participating in E Hine were interviewed three to seven times over a three-year period, with up to two whānau interviews conducted for each young woman. The data set for this thesis, comprising of fifteen young Māori mothers and their whānau, totalled eighty-four in-depth, semi-structured interviews. Data analysis was thematic, and was informed by Foucault’s concepts of the medical and disciplinary gazes, and postcolonial notions of the colonial gaze. The research suggests that public health and social services, as well as public perceptions, seek to regulate these young women according to Eurocentric conceptions of normality; and in doing so, stigmatize and disengage them, thus creating barriers to positive outcomes. Despite this, these young mothers resist disempowerment, and hope for a better future for themselves and their whānau. Their stories are a testament to the fact that being young and Māori and mothering does not equate to failure. By treating young Māori mothers with respect and empathy, support services could be improved.</p>

596 Although teen pregnancy, defined by the US Centers for Disease Control and Prevention as pregnancies between the ages of 15 and 19, has declined in the US over recent years to 16.7 births per 1000 girls, it continues to represent an enormous risk factor for poorer economic, educational, and health outcomes, both for the teen and the baby.1 Sexually transmitted infections (STIs) also continue to be a concern among this age group, with nearly half of the 26 million new STIs reported each year occurring in young people aged 15 to 24.2 To mitigate this problem, the US Department of Health and Human Services (USDHHS) provides funding to organizations and communities to prevent teen pregnancy and sexually transmitted infections (STIs). Unfortunately, reviews of the evaluations of these programs show limited positive impacts on pregnancy, sexual delay, and STI prevention methods or contraceptive use.3,4 Juras et al4 conducted a meta-analysis of 34 of the 43 adolescent pregnancy prevention program evaluations funded by the USDHHS between 2010 and 2016. On average, the programs showed small, statistically non-significant improvements in sexual risk behaviors and in pregnancy and STI Kayla Knopp, University of California San Diego School of Medicine, San Diego, CA, United States. Galena K. Rhoades, Research Professor, Department of Psychology, University of Denver, Denver, CO, United States. Lisa A. Rue, Senior Advisor for Adolescent and Behavioral Health at cliexa, Denver, CO, United States. Michael A. Floren, Assistant Professor of Data Analytics, Department of Finance, Economics and Data Analytics, University of North Alabama, Florence, AL, United States. Kiley M. Floren, Director of Evaluation Services at Practical Statistics, Florence, AL, United States. Correspondence Dr Knopp; [email protected] Messaging Considerations in Teen Pregnancy and Sexually Transmitted Infection Prevention

Objective: Teen pregnancy and sexually transmitted infection (STI) prevention are top public health goals. Despite decades of research, programs to prevent adverse sexual health outcomes among adolescents show limited effectiveness in broad dissemination. In the current study, we aimed to identify understudied factors that may impact effectiveness of teen pregnancy and STI prevention (TPP) programs, with goals of informing innovation in program development and outlining future research priorities. Methods: A panel of experts in TPP programs generated a list of understudied constructs in evaluation research, distilled to 3 considerations regarding messaging: single versus multiple messages, adverse effects of safety messages, and sociocultural context. We conducted an exploratory search of published literature in health promotion fields targeted toward messaging strategies, and we synthesized information from relevant empirical and review papers. Results: Limited evidence was found suggesting multiple messages or adverse message impacts are likely to impair TPP program effectiveness overall, although both may emerge in certain contexts and populations. In contrast, considerable evidence highlighted the importance of cultural context and individual differences. Conclusions: Effective TPP program messaging should be consistent, tailored, and systemic. Future research should evaluate these messaging strategies to determine whether they may enhance program impacts.

Identifying Implementation Drivers for Teen Sexual Health Education Curricula

This article focuses on examining the implementation of evidence-based teen pregnancy prevention programming in a select school district. Results are presented based on the following implementation drivers: (1) actions taken by leadership to make decisions, provide guidance, and support how the school site and community-based organizations are functioning in support of implementation; (2) actions taken to ensure competent staff delivery of the curricula; and (3) actions taken to create and sustain a hospitable context in order to implement the interventions at the school site. The need for adolescent sexual health education is evident in this geographic location where Hispanic or Latino teens consistently have higher birth rates among race and ethnicities that are routinely reported. For 2018, when this project started, those rates were 40 births per 1,000 females aged 15 to 19 years. For 2018, the birth rates for African Americans was 31 and for Whites was 17 per 1,000 females aged 15 to 19 years. The project goals were to reduce teen birth rates by (1) providing evidence-based teen pregnancy prevention curricula to youth aged 11 to 19 years over the course of the 5-year project period, (2) training school staff and community members in the curricula, and (3) generating community support of youth access to reproductive health care and education. Despite a funding interruption to implementation of the project and the impact of COVD-19, educational programming was provided to 9,616 youth. The article details the key implementation strategies and solutions so that other practitioners can consider application of these implementation drivers in their own adolescent health education programming.

83 Understanding complex community structures to improve sexual reproductive health for adolescents in Uganda

Primary Subject area Global Child and Youth Health Background Based on the 2014 census, 35% of Uganda’s population is between 10-24 years old. Health indicators show concerning sexual and reproductive health (SRH) trends such as high teen pregnancy, unsafe abortions, limited contraceptive use, and access to antenatal and postnatal care. However, the barriers to adolescents seeking and receiving care are complicated due to pre-existing social structures in smaller, closely linked communities. Objectives To understand the social structures and motivation of communities in western Ugandan districts that impact SRH in adolescents to better implement Healthy Adolescent and Young people (HAY!). Design/Methods In September 2020, a qualitative study was conducted in 2 districts, in southwestern Uganda. Fourteen focus group discussions and 3 key informant interviews consisted of 94 participants were carried out with a purposive sample of adolescents, parents, community health workers (CHWs), community leaders, health facility staff, and district health officers. Ethics approval was obtained and COVID-19 prevention guidelines were strictly followed. Data was audio-recorded, transcribed, and thematically analyzed. Results Based on our qualitative inquiry, participants recognized that adolescents face numerous SRH challenges and expressed their tension for change and motivation to support interventions that may positively impact SRH behavior and outcomes in adolescents. However, participants who were mothers highlighted that their motivation was due to better marriage prospects for their daughters, which is determined by respect and social standing in the community. In situations of unwanted pregnancies, participants shared that because of the fear of shame, and desire to keep adolescents in school, mothers often supported unsafe abortion to maintain community standing. This is an unusual and interesting finding. Similarly, aunties and uncles were traditionally regarded as champions for protecting and guiding adolescents, but participants highlighted a negative shift in this dynamic; aunties and uncles put female adolescents at risk by connecting them with interested men in exchange for gifts and money. Consequently, they are no longer trusted. Despite these gaps, volunteer CHWs who work closely within their communities by conducting home visits, educating, and providing referrals, emerged as a trusted resource by adolescent participants in accessing SRH related information. CHW participants also shared that adolescents often confided in them when unable to speak openly with their parents. Conclusion Although participant groups were motivated towards supporting adolescents, interventions must first understand and navigate complex community structures to deliver a comprehensive and targeted intervention to improve SRH outcomes in adolescents.

Diné (Navajo) female perspectives on mother–daughter communication and cultural assets around the transition to womanhood: a cross-sectional survey

Background The inclusion of protective factors (“assets”) are increasingly supported in developing culturally grounded interventions for American Indian (AI) populations. This study sought to explore AI women’s cultural assets, perspectives, and teachings to inform the development of a culturally grounded, intergenerational intervention to prevent substance abuse and teenage pregnancy among AI females. Methods Adult self-identified AI women (N = 201) who reside on the Navajo Nation completed a cross-sectional survey between May and October 2018. The 21-question survey explored health communication around the transition to womanhood, cultural assets, perceptions of mother–daughter reproductive health communication, and intervention health topics. Univariate descriptive analyses, chi squared, and fisher’s exact tests were conducted. Results Respondents ranged in age from 18 to 82 years, with a mean age of 44 ± 15.5 years. Women self-identified as mothers (95; 48%), aunts (59; 30%), older sisters (55; 28%), grandmothers (37; 19%), and/or all of the aforementioned (50; 25%). 66% (N = 95) of women admired their mother/grandmother most during puberty; 29% (N = 58) of women were 10–11 years old when someone first spoke to them about menarche; and 86% (N=172) felt their culture was a source of strength. 70% (N = 139) would have liked to learn more about reproductive health when they were a teenager; 67% (N = 134) felt Diné mothers are able to provide reproductive health education; 51% (N = 101) reported having a rite of passage event, with younger women desiring an event significantly more than older women. Responses also indicate a disruption of cultural practices due to government assimilation policies, as well as the support of male relatives during puberty. Conclusions Results informed intervention content and delivery, including target age group, expanded caregiver eligibility criteria, lesson delivery structure and format, and protective cultural teachings. Other implications include the development of a complementary fatherhood and/or family-based intervention to prevent Native girls’ substance use and teen pregnancy.

Faktor-Faktor yang Mempengaruhi Perilaku Remaja ke Posyandu di Wilayah Kerja Puskesmas Muara Bulian

Posyandu is expected to be a place to facilitate youth in understanding adolescent health problems, find alternative solutions to problems, form youth support groups, expand the reach of PKPR Puskesmas, especially for regional youth who have limited access Data shows that Muara Bulian Health Center, one of the Puskesmas in Batang Hari has provided health services to adolescents through PKPR activities. In 2018 the teen pregnancy rate was 24 teenagers (1.4%), in 2019 there were 27 teenagers (1.6%) An increase of 0.2%. In December 2019, two pilots polyandrous were formed in the work area of the Muara Bulian Community Health Center.This research is a descriptive analytic study with cross sectional method. The population in this study were adolescents who came to Posyandu cendana and singkawang which amounted to 75 people,while the number of samples is 43 people. This research uses purposive sampling technique. Data collection is done by questionnaire. The analysis was carried out univariately and bivariately. Results of the study Some respondents had bad behavior (51.2%) visited Posyandu Most respondents had poor knowledge (55.8%), positive attitude (51.2%), and good family support (62.8%), a good source of information (58.1%), most cadres had a good role (53.5%) in providing services in the Posyandu area of Muara Bulian Puskesmas in 2020. There is a meaningful relationship between knowledge and adolescent behavior . There is a significant relationship between attitude and adolescent behavior. There is a significant relationship between distance with adolescent behavior, there is a significant relationship between information sources and adolescent behavior, there is a relationship between the role of officers with adolescent behavior, and there is a significant relationship between family support and adolescent behavior to the Posyandu in the Public Health Service Muara Bulian Work Area