Innovative program promotes positive romantic relationships among adolescents and the use of effective contraceptives

Romantic relationships play an important role in adolescent development. Most young people have had at least one romantic relationship by mid-adolescence (ages 14 to 17). However, it has proven difficult to successfully promote healthy sexual behavior to reduce the risk of unintended pregnancies and sexually transmitted infections in this adolescent population.

Arthur Owora, PhD, MPH, a research scientist at the Regenstrief Institute and Indiana University, quantitative epidemiologist and applied biostatistician, is first author of a new multi-site randomized controlled study that evaluates an innovative healthy relationships program promoting positive romantic relationships among adolescents and the use of effective contraceptives. The study found that the program may have influenced abstinence but not relational communication.

Known as About UsThe blended learning program was designed specifically for youth experiencing sexual health disparities, including exposure to violence. Delivered by qualified health educators, the program focuses on improving behaviors, attitudes and intentions related to sexual intercourse, relational communication and conflict resolution. The study examined the impact of About Us on 533 students from seven California high schools from 2018 to 2021.

Compared to a control group of students, the About Us product programs:

• a positive effect on abstinence
• a positive impact on condom use intentions but not on condom use itself
• little impact on contraceptive attitudes
• no impact on relational communication
• no impact on use of a school-based health center, which typically provides primary care, mental health services, and health education (including reproductive health)
• different results depending on the school site

All seven study sites are in counties with high rates of free and reduced school lunch participation at the secondary level, as well as birth rates higher than the California average.

Adolescence is a critical time to implement efforts to promote healthy sexual behavior and relationships throughout life. Effective communication with this population is complex and carries considerable influence with incorrect information taken as fact and sometimes peer pressure. Efforts to reach 14 to 17 year olds require appropriate messages and materials that will resonate with them. What works at school 1 may be less successful at school 2 or more successful at school 3. Additional research is needed to help refine programs such as About Us finding the right balance that helps teens learn the skills they need to maintain healthy relationships. As we saw in our study, this will not be a universal solution. »

Arthur Owora, PhD, MPH, Regenstrief Institute and Research Scientist at Indiana University

The research team reports About Us produced evidence of promising trends at the individual school level, suggesting the need for tailored program components, implementation approaches and delivery options (in-class versus virtual versus fully mobile, for example) to address the unique environmental contexts of participants in a specific school.

One-fifth of the students in the study identified as LGBTQ+ and four-fifths identified as heterosexual. A total of 74 percent identified as Hispanic. Four percent identified as black. Four percent identified as white. Eighteen percent were identified as Other. Sixty-two percent were female at birth. All participants received consent from their parents to participate in the randomized, controlled clinical trial.

“Programs may become more successful as the stresses placed on students during the pandemic, such as school closures and virtual learning, are reduced,” noted Dr. Owora.

Supported by U.S. Department of Health and Human Services Administration for Children and Families Grant 90AP2682-05-00, “Promoting Healthy Adolescent Romantic Relationships: Results of a Parallel Randomized Clinical Trial multisite and in two groups” is published in Journal of Adolescent Health.

This study received external funding or support from ETR Associates and the Family Youth Services Bureau, Department of Health and Human Services Administration for Children and Families, through a Personal Responsibility Education Innovative Strategies (PREIS) Program grant (ClinicalTrials #NCT03736876).