Molly Secor-Turner

Prime Time: 12-month sexual health outcomes of a clinic-based intervention to prevent pregnancy risk behaviors.

PURPOSE Prime Time, a youth development intervention, aims to reduce pregnancy risk among adolescent girls seeking clinic service who are at high risk for pregnancy. This article examines sexual risk behaviors and hypothesized psychosocial mediators after 12 months of the Prime Time intervention. METHODS This study was a randomized controlled trial with 253 girls aged 13-17 years meeting specified risk criteria. Intervention participants were involved in Prime Time programming plus usual clinic services for 18 months, control participants received usual clinic services. The intervention used a combination of case management and peer leadership programs. Participants in this interim outcomes study completed self-report surveys at baseline and 12 months after enrollment. Surveys assessed sexual risk behaviors and psychosocial factors targeted for change by Prime Time. RESULTS At the 12-month interim, the intervention group reported more consistent use of condoms, hormonal contraception, and dual contraceptive methods with their most recent partner as compared with the control group. The intervention group also reported greater stress management skills with trends toward higher levels of prosocial connectedness at school and with family. No between-group differences were noted in psychosocial measures specific to sex and contraceptive use. CONCLUSION Preventing early pregnancy among high-risk adolescents requires multifaceted, sustained approaches. An important research focus involves testing youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful and few efforts have emphasized a dual approach of building protective factors while addressing risk. Findings suggest that youth development interventions through clinic settings hold promise in reducing pregnancy risk among high-risk youth.

Prime Time: Sexual Health Outcomes at 24 Months for a Clinic-Linked Intervention to Prevent Pregnancy Risk Behaviors

IMPORTANCE Preventing early pregnancy among vulnerable adolescents requires innovative and sustained approaches. Prime Time, a youth development intervention, aims to reduce pregnancy risk among adolescent girls seeking clinic services who are at high risk for pregnancy. OBJECTIVE To evaluate sexual risk behaviors and related outcomes with a 24-month postbaseline survey, 6 months after the conclusion of the Prime Time intervention. DESIGN Randomized controlled trial. SETTING Community and school-based primary care clinics. PARTICIPANTS Of 253 sexually active 13- to 17-year-old girls meeting specified risk criteria, 236 (93.3%) completed the 24-month follow-up survey. INTERVENTION Offered during an 18-month period, Prime Time includes case management and youth leadership programs. MAIN OUTCOME MEASURES Self-reported consistency of condom, hormonal, and dual-method contraceptive use with most recent male sex partner and number of male sex partners in the past 6 months. RESULTS At 24-month follow-up, the intervention group reported significantly more consistent use of condoms, hormonal contraception, and dual-method contraception than the control group. Intervention participants also reported improvements in family connectedness and self-efficacy to refuse unwanted sex, and reductions in the perceived importance of having sex. No between-group differences were found in the number of recent male sex partners. CONCLUSIONS AND RELEVANCE This study contributes to what has been a dearth of evidence regarding youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful but few efforts have emphasized a dual approach of strengthening sexual and nonsexual protective factors while addressing risk. Findings suggest that health services grounded in a youth development framework can lead to long-term reductions in sexual risk among vulnerable youth.

Homeless Health Needs: Shelter and Health Service Provider Perspective

The effects of homelessness on health are well documented, although less is known about the challenges of health care delivery from the perspective of service providers. Using data from a larger health needs assessment, the purpose of this study was to describe homeless health care needs and barriers to access utilizing qualitative data collected from shelter staff (n = 10) and health service staff (n = 14). Shelter staff members described many unmet health needs and barriers to health care access, and discussed needs for other supportive services in the area. Health service providers also described multiple health and service needs, and the need for a recuperative care setting for this population. Although a variety of resources are currently available for homeless health service delivery, barriers to access and gaps in care still exist. Recommendations for program planning are discussed and examined in the context of contributing factors and health care reform.

Engaging Vulnerable Adolescents in a Pregnancy Prevention Program: Perspectives of Prime Time Staff

INTRODUCTION Evaluating interventions for reducing unintended adolescent pregnancy is necessary to ensure quality and efficacy. The purpose of this study was to examine core case management practices and processes for engaging high-risk girls in Prime Time, an intensive multi-component intervention from the perspectives of intervention program staff. METHOD Structured individual interviews were conducted with the entire Prime Time program staff (N = 7) to assess successes and challenges in engaging adolescent girls at high risk for early pregnancy. The girls were recruited from school and community clinics. RESULTS Program staff described different capacities of adolescents to engage with the program (those who connected easily, those in the middle range of connecting, and those who had difficulty connecting) and provided specific recommendations for working with the different types of connectors. DISCUSSION Findings from this study support the supposition that persons engaging in preventive interventions with vulnerable groups of adolescents must pay careful attention to strategies for establishing trusting youth-adult relationships. The ability of staff (e.g., case managers and nurses) to engage with adolescents is a crucial step in improving health outcomes. The identified strategies are useful in helping adolescents build skills, motivations, and supports needed for healthy behavior change.

Culturally Sensitive Community Engaged Research With African American Young Women: Lessons Learned

The use of culturally sensitive research approaches is of paramount importance in conducting community-engaged research with African American communities. The purpose of this article is to describe the development and use of culturally and community sensitive research methods in a study to understand social messages about pregnancy and childbearing among low-income urban African American adolescent girls. Key elements of this community accepted focused ethnography study are described, including study design, recruitment, data collection, and analysis techniques.

Social messages, social context, and sexual health: Voices of urban african american youth

OBJECTIVE To describe aspects of the social context that low-income, urban African American young women articulate as having influenced social messages they received during adolescence about pregnancy timing and childbearing. METHODS Individual interviews were conducted with 20 African American young women ages 18-22. RESULTS Findings clustered into 5 themes: first sex; getting ready and getting it over with; the path for African American girls; gender expectations: insecurity and independence; living into a future; and living in a context of instability and uncertainty. CONCLUSIONS Findings portray a complex relationship between social context, social messages, and decisions about pregnancy timing and childbearing.

Prime Time: Long-Term Sexual Health Outcomes of a Clinic-Linked Intervention

CONTEXT Evidence about long-term effects of preventive health services for youth with complex needs is lacking. Prime Time, a youth development intervention, aims to reduce pregnancy risk among vulnerable adolescent females seeking clinic services. METHODS In a randomized trial, 253 sexually active females aged 13-17 who were at high risk for pregnancy were assigned to the Prime Time intervention or usual clinic services. The 18-month intervention, initiated in 2007-2008, comprised regular meetings with case managers and participation in youth leadership groups. Trial participants completed surveys at baseline and 30 months. Regression analyses were used to evaluate differences between groups in sexual and psychosocial outcomes at follow-up. RESULTS At 30 months, the intervention group reported more months of consistent condom use (adjusted means, 1.8 vs. 1.1) and dual contraceptive use (0.9 vs. 0.3) in the past seven months than did controls. The intervention was most effective in promoting consistent use among participants with relatively high levels of connectedness to family or school. Fifteen percent of intervention participants, but only 6% of controls, reported having abstained from sex in the past six months (adjusted odds ratio, 2.9). Moreover, among high school graduates, those in the intervention group were more likely than those in the control group to have enrolled in college or technical school (72% vs. 37%; odds ratio, 4.5). CONCLUSION Health services grounded in a youth development framework can lead to reductions in sexual risk among vulnerable youth that are evident one year following conclusion of services.

Implementing community-based comprehensive sexuality education with high-risk youth in a conservative environment: lessons learned

Abstract Although comprehensive sexuality education programmes have the potential to improve the sexual health and well-being of young people, many socially conservative rural states in the USA have laws and policies restricting school-based comprehensive sexuality education and supporting abstinence-only education. This paper describes the process of building a community-university partnership to implement a community-based comprehensive sexuality education peer education programme for high-risk young people and presents preliminary findings from a longitudinal evaluation. Through purposive recruitment, the sample included 386 young people (mean age) who were more diverse than the local community. Important university-community partnership components included (1) establishing local connections and legitimacy, (2) adapting and tailoring programmes to meet community context, (3) sustainability planning, and (4) flexibility, persistence, and patience. Building community trust and capitalising on the mutual benefits of community-university partnerships are effective methods of building community sexuality education programming in a conservative environment. Tailoring evidence-based approaches to comprehensive sexuality education in a politically restrictive environment shows promise in improving the sexual and reproductive health of young people.

Characteristics of violence among high-risk adolescent girls

INTRODUCTION Recent evidence demonstrates increasing rates of involvement with violence among adolescent girls. The objective of this study was to describe the types and sources of violence experienced within social contexts of adolescent girls at high risk for pregnancy. METHOD Qualitative data for this analysis are drawn from intervention summary reports of 116 girls participating in Prime Time, a youth development intervention for adolescent girls. Descriptive content analysis techniques were used to identify types and sources of violence experienced by girls within their daily contexts. RESULTS Types of violence included physical fighting, witnessing violence, physical abuse, gang-related violence, verbal fighting, verbal abuse, and sexual abuse. Sources of violence included family, peers and friends, romantic partners, community violence, and self-perpetrated violence. Many girls in this study experienced violence in multiple contexts. DISCUSSION It is imperative that efforts to assess and prevent violence among adolescent girls include paying attention to the social contexts in which these adolescents live.

Barriers and Facilitators of Adolescent Health in Rural Kenya

Purpose: The purpose of this research was to identify perceived barriers and facilitators of health from the perspective of rural Kenyan adolescents and to characterize the cultural context that shapes these barriers and facilitators. Design: Following a semistructured interview guide, qualitative focus group interviews were conducted at day schools with 64 upper-primary and secondary students in rural central Kenya. Participants provided written parental consent and individual assent for study participation. Results: Findings were organized into seven categories (individual, family, peer, school, community, institutional, and cultural) according to a social–ecological framework to highlight the multiple social and environmental contexts that shape health the experiences rural Kenyan youth. Conclusions: The prevalence and complexity of factors that shape the health experiences of young people in rural Kenya displayed in these findings adds context to the importance of utilizing multipronged approaches to improving adolescent health by focusing on the social contextual determinants of health behaviors and outcomes.