Prime time youth development intervention improves contraceptive use and sexual awareness among sexually active adolescent girls
- Correspondence to
: Dr Deborah Fallon
Nursing, Midwifery and Social Work, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, Lancashire, M13 9PL, UK;
Implications for practice and research
This study encourages consideration of the strengths and assets of a young person as well as risks factors.
This study encourages the consideration of ways to interrupt the chain of negative effects in vulnerable young people's lives, offering positive experiences that facilitate the enhancement of individual strengths.
The causes and consequences of unintended teenage pregnancy have, quite rightly, been the focus of considerable research attention in the industrialised Western world over the past 15 years, since it is associated with disproportionately poor outcomes for young parents and their children.
The UK as well as the USA have signalled that despite current historic reductions in teenage pregnancy rates, the statistics only indicate partial success. The USA particularly still has the highest rates of teenage pregnancy and childbearing among industrialised nations (750 000 aged 15–19 each year, resulting in more than 4 00 000 births) with disproportionately high rates among Hispanic black and Hispanic teenagers who experience twice the rate of their non-Hispanic counterparts.
This study is a randomised controlled trial that took place across four community and school-based primary care clinics in Minnesota. The participants were 253 sexually active 13-year-old to 17-year-old girls from diverse cultural backgrounds, who met the specified risk for pregnancy criteria and participated in the 18-month Prime Time project: a ‘multicomponent youth development intervention’ that included one-to-one case management and youth leadership activities that aimed to reduce the precursors of teenage pregnancy. This study outlines the findings from a follow-up survey, conducted 6 months after the conclusion of Prime Time to examine the enduring impact on contraceptive use, number of sex partners and ‘related psychosocial attributes’. A total of 236 (93.3%) participants completed the survey via an audio computer-assisted interview which was also completed at baseline. Two specific measures were considered: first, contraceptive use consistency with most recent sex partner and second, the number of male sex partners in the last 6 months.
A total of 88.4% participants completed at least four (of a possible 18) case management visits. The youth leadership aspect involved two activities; 66.9% completed at least four of the peer education sessions and 30.6% completed at least four of the service learning sessions. The intervention participants reported significantly more consistent use of condoms, hormonal contraception and dual method contraception than the control group. They also reported improvements in family connectedness and self-efficacy to refuse unwanted sex and reductions in the perceived importance of having sex. There were no between-group differences found in the number of sex partners.
This project fits in well with current thinking as it advances the notion of building on young people's assets and strengths. In the USA as well as the UK the concept of resilience has become popular as an approach in understanding how vulnerable young people adapt to difficult circumstances.
The authors draw on Rew and Horner's1 ‘Youth Resilience Framework’, which facilitates the consideration of risk and protective factors that may be amenable to early intervention, therefore, providing opportunities to enhance protective factors to offset vulnerability. The intervention was ambitious because it incorporated individual support and youth leadership activities in order to include prevention as well as promotion strategies. Measuring the impact of such an ambitious project is complex and the study had a rigorous evaluative design, although the definitions of ‘high’ when discussing participation rates were not always convincing. The short paper only allowed a summary of the interventions but the authors signpost to papers related to the screening tool they used to determine teenagers at high risk for pregnancy and how they established their measures for sexual risk behaviours.
The limitations included the use of self-report surveys that are subject to bias. The study also lacked measures assessing relational elements of the intervention, so the authors could not assess the extent to which the intervention effects were mediated through ongoing individualised attention from a supportive adult professional. Thus the project itself may have provided opportunities for connectedness, found to buffer the effect of risk conditions such as poverty, crime and violence. Interestingly, high risk is described as disproportionate in terms of race, rather than poverty and deprivation in this study which is given little attention. This is important because assets-based approaches should not be a replacement for investing in service improvement or attempting to address the structural causes of health inequalities.