1. Going to Scale with an Evidence-Based Teen Pregnancy Prevention Program: Research Agenda, Business Plan, or Both? Renee E. Sieving, PhD, RN, FAAN, FSAHM Professor, School of Nursing Director, Healthy Youth Development - Prevention Research Center, Department of Pediatrics, Medical School University of Minnesota

2. Prime Time Research Team Co-Is: L. Bearinger, A. Garwick, M. Resnick Study Manager: K. Beckman Intervention Coordinators: J. Oliphant, K. Rush Evaluation Coordinator: S. Plowman Analysis Team: B. McMorris, A.L. McRee, A. Gower, M. Secor-Turner, A. Seppelt, R. Shlafer Dissemination Team: G. Shea, J. Baumgartner

3. Teen Birth Rates: US, 1940-2010

4. MN Teen Birth Rates by Race/Ethnicity

5. Teen Pregnancy & Prevention Teen pregnancy & childbearing are important public health issues with substantial personal & public costs Teen pregnancy & childbearing are important public health issues with substantial personal & public costs Preventing early pregnancy among vulnerable youth requires approaches that address diverse array of psychosocial issues Preventing early pregnancy among vulnerable youth requires approaches that address diverse array of psychosocial issues Promise of youth development approaches Promise of youth development approaches

6. Prime Time Youth development intervention designed for use by primary care clinics Youth development intervention designed for use by primary care clinics 1-on-1 Case Management + Peer Leadership Groups Aims to reduce precursors of teen pregnancy including sexual risk behaviors and school disconnection Aims to reduce precursors of teen pregnancy including sexual risk behaviors and school disconnection

7. Youth as resources to be developed, rather than problems to be fixed. Building young women’s skills, confidence, opportunities and social supports. Prime Time Intervention Guiding Framework

8. Case Management 1-on-1 teen-centered relationships 1-on-1 teen-centered relationships Topics: social & emotional skills; healthy relationships; responsible sexual behaviors; positive family, school & community involvement Topics: social & emotional skills; healthy relationships; responsible sexual behaviors; positive family, school & community involvement Peer Leadership Groups Multi-session training as peer health educators Multi-session training as peer health educators Employ 16-session standardized curriculum Employ 16-session standardized curriculum Pay teens to reach & teach others as peer educators Pay teens to reach & teach others as peer educators Prime TimeIntervention Components Prime Time Intervention Components

9. Prime Time Pilot Study RCT with 128 participants (1999-2004) Prime Time’s youth development approach is feasible & acceptable to adolescent girls from urban, economically challenged communities Prime Time’s youth development approach is feasible & acceptable to adolescent girls from urban, economically challenged communities Involvement in Prime Time associated with reductions in risky sexual behaviors Involvement in Prime Time associated with reductions in risky sexual behaviors

10. Prime Time Efficacy Study Design: Randomized controlled trial (2006-2011) Setting: Community & school-based primary care clinics in Minneapolis & Saint Paul, Minnesota

11. Study Sample 253 sexually active girls meeting specified risk criteria Ages 13-17 years Ages 13-17 years Mean=15.6 years Mean=15.6 years Mean # male sex partners: 1.7 in past 6 months Mean # male sex partners: 1.7 in past 6 months 30.5% noted consistent condom use, past 6 months 30.5% noted consistent condom use, past 6 months Mean hormonal method use: 2 of past 6 months Mean hormonal method use: 2 of past 6 months  Race/ethnicity African American Multiple Hispanic/ Latina Asian European American Indian

12. Sexual Behavior Measures Number of Male Sex Partners, Past 6 Months Number of Male Sex Partners, Past 6 Months Partner-Specific Sexual Behaviors Condom Use Consistency, Past 6 Months Condom Use Consistency, Past 6 Months Hormonal Use Consistency, Past 6 Months Hormonal Use Consistency, Past 6 Months Dual Method Use Consistency, Past 6 Months Dual Method Use Consistency, Past 6 Months

13. Outcomes Analyses Analytic Sample Analytic Sample Participants completing study surveys at baseline and follow-up point Participants completing study surveys at baseline and follow-up point Example: 237 teens completing surveys at baseline and 30 month follow-up points (93.7% of full sample) Analytic Approach Analytic Approach Each outcome regressed on participation in Prime Time (intervention vs. control) controlling for baseline measure of the outcome & adjusting for within-clinic clustering Each outcome regressed on participation in Prime Time (intervention vs. control) controlling for baseline measure of the outcome & adjusting for within-clinic clustering

14. Prime Time Intervention Effects 12-month survey (intervention interim point) 18-month survey (intervention completion) 24-month survey (6 mo. post intervention) 30-month survey (12 mo. post intervention) Condom use consistency  (p<.01) Hormonal use consistency  (p<.01) Dual method use consistency  (p<.05)  (p<.01) Recent sexual abstinence  (p<.05) Attending college/tech school  (p<.01)

15. Intervention Effects: Qualitative Case Exemplar

16. Discussion Study addresses dearth of evidence re. long-term effects of clinic-linked youth development interventions Study addresses dearth of evidence re. long-term effects of clinic-linked youth development interventions Health services grounded in a youth development framework hold great promise for preventing multiple risk behaviors among youth most vulnerable to poor health outcomes Health services grounded in a youth development framework hold great promise for preventing multiple risk behaviors among youth most vulnerable to poor health outcomes Adolescent health services grounded in a youth development frame can facilitate positive transitions into adulthood Adolescent health services grounded in a youth development frame can facilitate positive transitions into adulthood

17. Planned Next Step, Research-to Practice Agenda Effectiveness study: Can Prime Time be successfully implemented in natural settings by staff from youth- serving clinics? Effectiveness study: Can Prime Time be successfully implemented in natural settings by staff from youth- serving clinics? Comparison of full-strength intervention to partial-strength intervention (CM only) Comparison of full-strength intervention to partial-strength intervention (CM only) Participant self-reports & biomarkers; cost-effectiveness & cost-benefit data Participant self-reports & biomarkers; cost-effectiveness & cost-benefit data Context: ACA & expanded access and funding for preventive services Context: ACA & expanded access and funding for preventive services

18. “Prime Time Program added to Short List of Effective Pregnancy Prevention Programs Highlighted by Feds” [February 2015]

20. http://z.umn.edu/primetime

22. Sources of Support This research supported by:  NIH-NINR #R01-NR008778 (R. Sieving, PI)  CDC #U48-DP001939 (M. Resnick, PI)  BHP-HRSA #T32-HP22239 (I. Borowsky, PI)  University of Minnesota CTSI Dissemination Grant (R. Sieving, PI)

23. Selected Prime Time Manuscripts Ghobadzadeh M, Sieving R, Gloppen K (2015). Positive youth development and contraceptive use consistency. In press, Journal of Pediatric Health Care. Lando-King E, McRee A, Gower A, Schlafer R, McMorris B, Pettingell S, Sieving R (2015). Relationships between social emotional intelligence and sexual risk behaviors in adolescent girls. In press, Journal of Sex Research. Johnson A, Sieving R, Pettingell S, McRee AL (2015). The roles of partner communication and relationship status in adolescent contraceptive use. Journal of Pediatric Health Care, 29, 61-69. Secor-Turner M, Garwick A, Sieving R, Seppelt A (2014). Characteristics of violence among adolescent girls at high risk for early pregnancy. Journal of Pediatric Health Care. 28, 227-233. Sieving R, McRee AL, Secor-Turner M, Garwick A, Bearinger L, Beckman K, McMorris B, Resnick M (2014). Prime Time: Long-term sexual health outcomes of a clinic-linked intervention. Persp Sexual & Reproductive Health, 46, 91-100. Sieving R, McMorris B, Secor-Turner M, Garwick A, Shlafer R, Beckman K, Oliphant J, Pettingell S, Seppelt A (2014). Prime Time: 18-month violence outcomes of a clinic-based intervention. Prevention Science, 15, 460-472. Gower A, Shlafer R, Polan J, McRee AL, McMorris B, Pettingell S, Sieving R (2014). Brief report: Associations between adolescent girls’ social emotional intelligence and violence perpetration. Journal of Adolescence, 37, 67-71. Secor-Turner M, McMorris B, Sieving R, Bearinger L (2013). Life experiences of instability and sexual risk behaviors among high risk adolescent girls. Perspectives on Sexual & Reproductive Health, 45, 101-107.

24. Selected Prime Time Manuscripts Sieving R, McRee AL, McMorris B, Beckman K, Pettingell S, Bearinger L, Garwick A, Oliphant J, Plowman S, Secor- Turner M, Resnick M (2013). Prime Time: 24-month sexual health outcomes of a clinic-linked intervention to prevent pregnancy risk behaviors. JAMA Pediatrics, 167, 333-340. Shlafer R, McMorris B, Sieving R, Gower A (2013).The impact of family and peer protective factors on girls’ violence perpetration and victimization. Journal of Adolescent Health, 52, 365-371. Tanner A, Secor-Turner M, Garwick A, Sieving R, Rush K (2012). Engaging vulnerable adolescents in a pregnancy prevention program: Perspectives of Prime Time staff. Journal of Pediatric Health Care, 26(4), 254-265. Sieving R, Bernat D, Resnick M, Oliphant J, Pettingell S, Plowman S, Skay C (2012). A clinic-based youth development program to reduce sexual risk behaviors among adolescent girls: Prime Time pilot study. Health Promotion Practice, 13(4), 462-471. Sieving R, McMorris B, Beckman K, Pettingell S, Secor-Turner M, Kugler K, Garwick A, Resnick M, Bearinger L (2011). Prime Time: 12-month sexual health outcomes of a clinic-based intervention to prevent pregnancy risk behaviors. Journal of Adolescent Health, 49,172-179. Bearinger L, Sieving R, Duke N, McMorris B, Stoddard S, Pettingell S (2011). Adolescent condom use consistency over time: Global versus partner-specific measures. Nursing Research, 60(3), S68-S78. Sieving R, Resnick M, Garwick A, Bearinger L, Beckman K, Oliphant J, Plowman S, Rush K (2011). A clinic-based, youth development approach to teen pregnancy prevention. American Journal of Health Behavior, 35(3), 346-358

25. Questions, ideas, suggestions? sievi001@umn.edu