Oman, R. F., et al. (2018). Adolescent pregnancy prevention among youths living in group care homes: A cluster randomized controlled trial. American Journal of Public Health, 108, 38-44.
This study sought to determine whether the Power Through Choices (PTC) intervention increases birth control use and reduces pregnancy among youth living in group care homes in California, Maryland, and Oklahoma. As sexual health programs for child welfare and juvenile justice involved youth are limited, the development of an effective preventative sexual health education program is needed. Power Through Choices (PTC) is a sexual health education intervention developed for youth involved in the child welfare and juvenile justice systems living in out-of-home care facilities. The program is delivered over ten sessions (90 minutes each session, twice per week) by two trained program facilitators.
This study used data collected from 1036 youths (aged 13 to 18 years) in 80 residential group homes between 2012 to 2014 to measure contraceptive use and pregnancy at 6 and 12 months following baseline. Additional descriptive data collected from the Youth Risk Behaviour Surveillance Study, Prevention Minimum Evaluation Data Set, and the All About Youth Study were included to assess responses to 3 items – ever had sex, had sex in the past 3 months, and had sex in the past 3 months without using condoms. Utilizing a 2-arm cluster randomized controlled design, group homes were randomly assigned to a treatment group that offered the PTC intervention (40 clusters) or to a control group that offered ‘usual care’ (40 clusters). Random intercept logistic regression models were used to compare the behavioural outcomes at 6 and 12 months.
On average, the overall attendance rates for the intervention group were high (87%) and 87% of the youths found the intervention extremely or very helpful to them. At baseline, results showed no significant differences between the intervention and control groups in regard to demographic or sexual behaviour variables. At the 6-month assessment, the intervention group showed significantly lower odds of engaging in sexual intercourse in the past 3 months without using contraceptives compared to the control group. However, this difference did not carry forward at the 12-month assessment. Additionally, the intervention group at 12-months had significantly lower odds of ever being pregnant or getting someone pregnant compared with those in the control group. Therefore, the results demonstrate the potential benefit to delivering pregnancy prevention programs geared toward system-involved youths.
When recruiting the group homes for this study, the researchers used purposive sampling rather than random sampling. This purposive sampling method was used because researchers wanted homes to have the capacity and commitment to support the study before randomization of the sample was conducted. Furthermore, the response rate for eligible youths was extremely high at enrollment (98%) and dropped minimally to 82% at the 6-month assessment and 85% at the 12-month assessment. These high response rates, in addition to the utilization of a cluster randomized controlled design strengthen the results of the study.