Jakevia Green at Tulane University presented the results of a clinical trial of the BUtiful program - Be yoU! Talented Informed Fearless Uncompromised and Loved- a social media pregnancy prevention program for New Orleans women.

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You Geaux Girl!,
A randomized control trial of an Internet-based
pregnancy prevention intervention
for young African American women
Jakevia L. Green
Tulane University
Department of Epidemiology
Sixth Annual Conference on Youth + Tech + Health
April 7,8 & 9, 2013
San Francisco, CA

2. Background

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Unintended Teen Pregnancy
• UTP in the US has significantly declined among youths
in their early teens, but has continued to remain high
among older teens
– One-half to two-thirds of teen pregnancies are to teens 18-201
• 2005:
– Pregnancy rate among African American teens 15-19 2: 123 per
1000 compared to 43 per 1000 for non-Hispanic white teens 15-
19
• Half of UTPs occur among contraception users, resulting
from either inconsistent or incorrect use.3

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Louisiana State Data4
• 2005:
– Pregnancy rate among 18-19 year old teens:
118 per 1000 vs. national teen birth rate of
53.9 births per 1000
• 2008:
– 28% of teens 16-19 years-old live in poverty
– 11% of teens 16-19 years-old not in school
– 10% of teens 16-19 years-old dropped out of
school

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Problem
• Most prevention programs are school-based and
implemented at younger ages
– Older teens who may no longer be in school have little
to no access to such programing
• Competing priorities among older teens
transitioning to adulthood
– Need for innovative approaches to administer health
information to even the busiest individual

6. Translating SiHLE to e-SiHLE

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Goal & Aims
• To reduce unintended pregnancy (UTP) among older
teenage African American women in the Greater New
Orleans area
1. To adapt EBI SiHLE for delivery via the internet
2. To test the feasibility and acceptability of the internet-based intervention
in AA teen women 18-19years
• completion rate of 80% or greater of modules by the end of the study
3. To test the hypothesis that women who receive the intervention will have
a 35% increase in their use of effective contraception compared to
attention controls

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From SiHLE to e-SIHLE
• SiHLE (Sisters Informing, Healing, Living, and Empowering)
– HIV/STI EBI developed by DiClemente
Wingood of Emory University5
– Target audience: AA teens,14-18 yrs
– 4-module curriculum given in four,
4-hour interactive group sessions
– Administered in a randomized controlled
trial (RCT) alongside a general health
program

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From SiHLE to e-SIHLE
• e-SiHLE
– Worked with creators of SiHLE and used the ADAPT-
ITT model to translate
• ADAPT-ITT is a guide to translate an evidence-based
intervention into a new intervention with a new sample, for a
new setting, or using a new implementation format6
– Target audience: AA teens,18-19 years
– Self-paced 8-module curriculum in 4 week period
– Administered in a randomized controlled trial (RCT)
alongside a general health promotion program

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Innovation of e-SiHLE
•Web-based delivery affords youth the freedom to access
this valuable health information when convenient for them
•Could provide a model for UTP programs that could be
conveniently disseminated to organizations nation-wide

11. Curriculum Development &
Formative Research

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Curriculum Development
• The intervention:
– Main focus is reproductive health and contraceptive
options
– Relevant SiHLE modules and activities translated to
electronic medium
– New content was developed that focused on
contraceptive choices and STIs
• The control:
– A nutrition and wellness attention control
– Similar in length and appearance to the reproductive
health intervention.

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Formative Research
• Formative work to identify key elements of
intervention development
– Worked with SiHLE developers and their staff
– Formed a Community Advisory Panel (CAP)
• African American women provided feedback regarding
recruitment strategies, intervention content and design,
motivation for participation and retention in the study, and
more
• Research on electronic delivery options, website
development, video/audio production, etc

14. Curriculum/Production
• Content would be delivered through the stories of 4
young women
– Diversity of characters (physical and situational)
– Each facing specific reproductive health challenges
– Addition of a moderator – a slightly older woman who could
provide information from an objective viewpoint
• Once curriculum was outlined scripts had to be created
for each of the actors
• Production teams were assembled

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Production
• Local production companies
provided video/audio services
• Local graphic artist created
logos with CAP
• Local actors and actresses
portray relatable characters
who work through true-to-life
circumstances
• Website developers used by
the University created sites

16. Pilot Testing

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Pilot Testing
• 13 AA women were recruited to pilot-test both
the intervention and control websites prior to
launch of the RCT
– 7 BUtiful; 6 DIVAS
– Allotted one month to engage in their respective websites
– Asked to provide qualitative feedback of their experiences in a
follow-up interview
• Feedback was used to complete final edits of the websites before
publishing to the Internet

18. “You Geaux Girl!,”
a randomized control trial

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“You Geaux Girl!”
• Marketing alias for e-SiHLE
– Used to mask the names of the intervention and
control websites pre-randomization
• Promoted as a health education and
empowerment program for African American
teen women
YGG!

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Inclusion Criteria
• African American female
• Aged 18 or 19 years
• Resides in Jefferson or Orleans Parish
• Not currently pregnant or intending to become
pregnant within the next year
• Not a woman who has sex exclusively with
women (WSW)
• Speaks and reads English
• Has access to a computer with internet access

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Recruitment
• Sample size: 700
• 5 ‘sites’:
– 2 historically Black universities
– A community college
– An adolescent drop-in clinic
– Community events
• Active and Passive recruitment
• Phase-In Model

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Enrollment
• Informed consent
• Obtain participant contact information
• Biological testing (urine)
– Pregnancy, Chlamydia/Gonorrhea
• Surveys: ACASI [Audio Computer-Assisted Self Interview]
– Demographics
– Contraception and sexual behaviors
– Psychosocial scales
• Randomization
– Butiful [Intervention]
– DIVAS [Control]

26. Intervention: BUtiful
Be yoU!, Talented, Informed,
Fearless, Uncompromised and
Loved

36. Control: DIVAS
Diversity, Individuality, Vitality,
Activity, and Strong

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Intervention Period
• 28 days of site access
– Reminders of deactivation at 2 weeks, 1
week, and 1 day prior
• Staff monitoring:
– Session progress
– Time spent on each session
– # of activities engaged in + time spent on
activities
– Blogging feature/Shares

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Follow - Up
• 3, 6 and 12 months post intervention
• Obtain updated participant contact
• Surveys
• Biological testing
– Pregnancy, Ct/GC

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Incentives
$50
+ Swag
Bag
$25
+ up to
$40
$75 $75 $265
• Baseline: $50 gift card
+ BUtiful or DIVAS Swag Bag
• 3-Month Follow-Up: $25 gift card
+ Incentives earned from session completion
• 6-Month Follow-Up: $75 gift card
• 12-Month Follow-Up: $75 gift card

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Summary of Study Period
Baseline
28-day Intervention
Period
3-Month Follow-Up
6-Month Follow-Up
12-Month
Follow-Up

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Communication
• Bi-Weekly ‘Fun Fact’ Text Messages
• Birthday Cards
• Quarterly Newsletter
• Weekly posts on Facebook pages created
for program graduates
– “We R Butiful”
– “We R DIVAS”

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Lessons Learned
• Formative research is extremely important.
– Understanding your target audience
– Finding out how best to adapt and revise your intervention to
meet the needs of your target audience
• Flexibility and creativity is key.
– Recruitment strategies
– Working with the often limited availability of this age group
• An e-intervention is by no means a ‘hands-off’ endeavor.
• Session completion: all at once vs. pacing
• Field staff must appeal to target audience.

49. What’s happening with YGG! now?

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Final Remarks
• Methods used for translating an EBI to the
Internet are transferable to other projects
• An internet-delivered sexual health intervention
1. presents info in a familiar, easily accessible medium
2. empowers young women with decision-making tools
and strategies for obtaining and adhering to
contraceptive choices

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References
1. Guttmacher Institute, U.S. Teenage Pregnancy Statistics: National and State
Trends and Trends by Race and Ethnicity. . 2006, Guttmacher Institute: New York.
2. Kost, K., Henshaw, S., & Carlin, L. , U.S. Teenage Pregnancies, Births and
Abortions: National and State Trends and Trends by Race and Ethnicity. . 2010,
Guttmacher: New York.
3. Mosher, W.D., et al., Use of contraception and use of family planning services in the
United States: 1982-2002. Advance Data, 2004(350): p. 1-36.
4. Foundation, T.A.E.C., Kids Count 2008 data book 2008, The Annie E. Casey
Foundation Baltimore.
5. DiClemente RJ, Wingood GM, Harrington KF, et al. Efficacy of an HIV prevention
intervention for African American adolescent girls: a randomized controlled trial.
Jama. Jul 14 2004;292(2):171-179.
6. Wingood GM, DiClemente RJ. The ADAPT-ITT model: a novel method of adapting
evidence-based HIV Interventions. J Acquir Immune Defic Syndr. Mar 1 2008;47
Suppl 1:S40-46.

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You Geaux Girl! Research Team
Patricia Kissinger, PhD.
Co-Principal Investigator
Caroline Johnson, PhD.
Co-Principal Investigator
Aubrey Madkour, PhD.
Evaluator
Gretchen Clum, PhD.
Evaluator
Ralph DiClemente, PhD.
Consultant
Gina Wingood, PhD.
Consultant
Norine Schmidt, MPH
Program Manager
Jakevia Green
Program Coordinator
Jen Latimer, MPH
Field Research Analyst
Upama Aktaruzzaman
Research Assistant
Emily Flanigan
Research Assistant
Braeanna Hillman
Research Assistant
Yewande Olugbade
Research Assistant
YGG!

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Funding Agency
•DHHS Office of Adolescent Health TPP program
– Large federal initiative
– $105 million to support evidence-based TPP approaches
– Addresses rising teen pregnancy rates
• supporting grantees in replicating evidence-based models
• implementation of programs to develop and test additional models
and innovative strategies
•5-year grant for Innovative Approaches in Teen
Pregnancy Prevention (TPP)
– 9/1/10 through 8/31/15

54. Thank You