摘要：Objectives. To determine if the Power Through Choices (PTC) intervention can increase the use of birth control and reduce pregnancy among system-involved youths living in group care homes. Methods. We performed a 2-arm cluster randomized controlled trial involving group care homes operated by child welfare or juvenile justice systems in California, Maryland, and Oklahoma with assessments immediately before and after the intervention, and at 6- and 12-month follow-up. We collected data from 2012 to 2014 via self-administered questionnaires. Participants (n = 1036) were young (mean age = 16.1 years), predominantly male (79%), racially/ethnically diverse (37% Hispanic, 20% Black, 21% White, 17% multiracial), and sexually experienced (88%). Results. At 6-month follow-up, participants in the intervention group had significantly lower odds of having recent sexual intercourse without using birth control (adjusted odds ratio [AOR] = 0.72; 95% confidence interval [CI] = 0.52, 0.98). At 12-month follow-up assessment, participants in the intervention group had significantly lower odds of ever being pregnant or getting someone pregnant (AOR = 0.67; 95% CI = 0.46, 0.99). Conclusions. The results suggest that PTC is an effective sexual health education intervention that can be implemented with system-involved youths who represent a sexually experienced multiracial youth population. In 2015, an estimated 649 970 persons younger than 18 years were arrested in the United States, 1 and approximately 427 910 youths were in foster care. 2 There is considerable overlap in these 2 populations with an estimated third of foster care youths becoming involved with the juvenile justice system. 3 Youths involved with the juvenile justice system and foster care system report higher rates of early initiation of sexual intercourse, more sexual partners, and lower rates of condom use and other forms of birth control compared with the general adolescent population. 4–9 Such behavioral risk taking puts system-involved youths at high risk for negative sexual health outcomes such as unintended pregnancy. Approximately one third of female juvenile offenders have ever been pregnant. 7,8 Similarly, nearly 1 in 3 young women in the foster care system are pregnant at least once by age 17 or 18 years, and by age 19 years, more than half have experienced a pregnancy. 10,11 By contrast, nationally representative data indicate that 1 in 4 girls become pregnant before age 20 years. 12 Male adolescents involved with the juvenile justice and foster care systems are also at high risk for getting someone pregnant with 18% to 31% reporting that they have fathered a child. 7,8,13 System-involved youths often have limited support and may not be prepared for the challenges of adolescent parenting. 13 Pregnancy in this young population can also have an impact on developmental outcomes during young adulthood. For example, one study found that delinquent girls who became pregnant within 2 years of placement in an out-of-home care setting were at increased risk for subsequent illicit drug use, 1 or more pregnancies resulting in a miscarriage, and being reported to child welfare regarding their parenting. 14 Despite the elevated rates of sexual risk behaviors and unintended pregnancy among system-involved youths, few studies have evaluated pregnancy prevention interventions for this population. Limited research has shown that behavioral interventions can increase pregnancy knowledge, skills, and attitudes among system-involved youths 11–14 ; however, behavioral outcomes have generally not been assessed and long-term effects have not been found. 15–17 One exception is a randomized controlled trial that determined if a delinquency intervention titled Multidimensional Treatment Foster Care could have an impact on pregnancy rates among female adolescents mandated to community-based out-of-home care. The study found significantly fewer postbaseline pregnancies among Multidimensional Treatment Foster Care adolescents (26.9%) compared with the control group (46.9%). 18 There is a need to develop and rigorously evaluate sexual health interventions for youths in the child welfare and juvenile justice systems. Youths are typically placed in residential group care because they were removed from a dangerous home environment, failed foster home placement, or were referred by the juvenile justice system. 19 Youths living in group homes have experienced multiple forms of trauma 20 and may lack the skills and resources necessary to avoid risky sexual behaviors and adolescent pregnancy. 21 Furthermore, the group-home setting for foster care and delinquent youths provides a unique opportunity to reach a high-risk population before they transition to young adulthood. Power Through Choices (PTC) is an age-appropriate and medically accurate sexual health education intervention for youths living in group-home foster-care settings and other out-of-home placements. The PTC intervention is also sensitive to the issues of abuse and other trauma that may be part of the youth’s life story and it addresses these issues that may motivate system-involved youths to become pregnant or engage in sexual risk-taking behavior. The PTC curriculum provides opportunities for youths to examine how those experiences might influence feelings and behaviors related to sexual decision-making. 22 The PTC intervention was delivered to youths living in group homes operated or contracted by child welfare (foster care) or the juvenile justice agencies. The purpose of this cluster randomized controlled trial was to test the effectiveness of the PTC intervention in this understudied and underserved population. Specific outcomes included increased use of birth control and decreased adolescent pregnancy.
