Evaluating the Real-World Effectiveness of an Evidence Based Teen Pregnancy Prevention Curriculum

Background. Delivering evidence-based prevention programs (EBIs) in public schools offers promise for reaching students in disadvantaged communities, yet few public schools have the capacity to do so with sufficient fidelity to change the behavior of students. This project sought to reduce teenage pregnancy risk in Los Angeles area communities with elevated rates by implementing an EBI found to delay sexual onset, “It’s Your Game…Keep It Real (IYG),” in 24 middle schools with existing 7^th and 8^th grade science, health and PE teachers.

Method. Six strategies addressed fidelity and sustainability: schools and teachers participated voluntarily; teachers provided input on protocols; staff offered extensive technical assistance and support; teachers received training and all materials; procedures included extensive follow-up and performance measurement (observations and teacher-completed curriculum logs); and an advisory board of “veteran” teacher implementers guided later project stages. Seventh grade implementation began in the 2011-12 school year, and both grades continued each year thereafter. Teachers received up to $600 yearly based on number of classes, starting on time, and completing fidelity and attendance reports for each lesson. To assess effectiveness in delaying sexual onset, we surveyed 9^th grade students each spring from 2012 through 2015 in 10 high schools that project middle schools fed into (N=6,339; approximately 80% attended a project middle school for 7^th and 8^th grades). The 2012 and 2013 surveys comprised the pre-implementation comparison group (“No-IYG”), and the 2014 and 2015 surveys represented the intervention group (“IYG”).

Results. Across the 2011-12 through 2013-14 school years, approximately 15,000 students received lessons in 7^th and 8^th grade classes.  Across the 24 schools, 64 to 73 teachers implemented in each grade each year. Completion of the required lessons posed a significant challenge, but teachers reported completing 93% of the lessons planned. Of activities in lessons observed, agreement between teacher and observer reports of key fidelity indicators was 95%. Ninth grade survey respondents reflected the school population: half were female (49%); 86% reported Latino and 10% African-American ethnicity. Average age was 15.1 years (sd=0.50).  Compared to the No-IYG group, the odds of having engaged in any vaginal, oral or anal intercourse were reduced among the IYG group (AOR=0.79, 95% CI .69, .91), after controlling for demographic and family variables. 

Discussion. By facilitating and monitoring implementation fidelity, this project demonstrated that existing teachers in public middle schools provided high-quality delivery of an evidence-based intervention, which may have delayed sexual onset by 9^th grade.