Implementation and Effectiveness of Reducing the Risk in a Community Setting

Introduction:  Finding ways to reduce teen pregnancy and improve adolescent sexual health is a priority for the Department of Health and Human Services. Accordingly, evidence-based teen pregnancy prevention programs are being implemented across the country. There is much to be learned about what it takes to implement evidence-based programs in different settings with different populations, as well as whether evidence-based programs remain effective when implemented in these different contexts. To contribute to the knowledge based of evidence-based teen pregnancy prevention programs, this study focuses on the implementation and effectiveness of Reducing the Risk (RtR), an evidence-based sexual health curriculum for high-school-age adolescents (Lezin et al, 2010), in a community setting. As RtR has primarily been implemented and has only been evaluated in schools, examining its implementation and effectiveness in a community setting will provide key information for future implementation.

Methods:  Youth were recruited through juvenile hall, day centers, or community centers in San Diego County; 972 youth were randomly assigned to receive RtR or individualized case management services. Program implementation was closely monitored by program staff and external evaluators. Youth in treatment and control groups completed a web-based survey on sexual behavior and intermediate outcomes (e.g., knowledge, attitudes, skills, intentions) at baseline, 12 months after baseline, and 24 months after baseline. The majority of youth were Hispanic, about half were female, and the average age was 15. Almost half of the sample was sexually active at baseline.

Results:  Implementing RtR in a community setting proved challenging for several reasons including hesitancy to allow a sexual health curriculum into the community, the curriculum was too long, and the content was not always relevant for this population of high-risk youth. However, innovative solutions and approved adaptations were employed to improve program fit with this population.

Using intent-to-treat models in a regression framework, preliminary results on the effectiveness of RtR in this community setting suggest that RtR achieved its intended effects on intermediate outcomes, including knowledge of pregnancy and STI risk, attitudes towards condoms and birth control, and intentions to engage in sexual behavior. Early evidence also suggests that among youth who were sexually active at baseline, RtR youth were less likely to have oral sex without a condom. Ongoing analysis will determine long-term effectiveness of RtR in this setting.

Conclusions:  Results thus far are promising. We will discuss what it takes to implement RtR in a community setting and its overall effectiveness in this non-traditional setting.