Evaluation of safe dates for teen mothers - although teen pregnancy and births have decreased in recent years, repeat births still comprise nearly 1 in 5 teen births

Teen girls who are pregnant or parenting also report high rates of risk behaviors associated with sexually transmitted infections (stis) and higher rates of postpartum stis than non-pregnant teens. Repeat teen birth may exacerbate the educational and economic challenges associated with teen childbearing, and stis can have adverse consequences for the health of pregnant teens and their infants. Whereas healthy relationships are protective against repeat pregnancy and stis, intimate partner violence (IPV), including sexual and reproductive coercion, is a key risk factor for unintended pregnancy and stis, including among pregnant and parenting teens. Nonetheless, a focus on healthy relationships is notably lacking from community-based teen pregnancy prevention (TPP) and STI prevention programs for this population, which have largely had limited evidence of effects on behavioral outcomes. The proposed study builds on a successful grant in which we adapted the evidence-based safe dates program to be relevant for teens who are pregnant or parenting. Safe dates is a 10-session, theoretically based, interactive group program with demonstrated efficacy in preventing psychological, physical, and sexual IPV. We adapted safe dates by integrating pregnancy and parenting themes throughout program sessions, increasing the focus on overcoming unique barriers to seeking help for IPV, and revising sexual assault content. We then conducted a randomized pilot study with four community-based organizations in north carolina, which each delivered the original and adapted programs to separate groups of pregnant and parenting teens. Effect sizes suggested that the adapted program was more feasible to implement with fidelity, more acceptable to participants, and likely to be more effective in improving outcomes than the original program. Given the promising evidence derived from the pilot study, we propose to conduct a rigorous effectiveness and process evaluation of safe dates for teen mothers (sdtm) using a convergent mixed-methods design. This study will use a randomized controlled trial with 400 teen girls (up to age 21) who are pregnant or parenting and receiving services from community-based organizations in three U.S. States to (1) test the short-term and longer-term efficacy of sdtm for key behavioral risk factors underlying unintended teen pregnancy, including condom use, contraceptive use, and sexual and reproductive coercion; (2) test the short-term and longer-term efficacy of sdtm for other associated risk and protective factors, including healthy relationship attitudes and behaviors and IPV; (3) examine participant and implementation factors associated with better outcomes to inform future use of the program; and (4) examine the hypothetical effect of sdtm when applied to all pregnant and parenting young women across the study states. Our evaluation design is consistent with the highest quality standards of the TPP evidence review protocol. The sdtm curriculum manual and teaching materials are ready for implementation; implementation and evaluation of the program in study sites will be driven by end user input via an advisory board comprising site staff and youth to ensure fit with local contexts. Building on the adaptation and pilot study, this application will enable a rigorous evaluation of the implementation and outcomes of sdtm and extend the focus of the program and research to sexual health outcomes, with the goal of building the evidence base for supporting healthy relationships and preventing unintended repeat pregnancy and stis among teens who are pregnant or parenting. Effective interventions are likely to be adopted by community organizations serving pregnant and parenting teens and could have wide-ranging impact on the well-being of young parents and their children.