In recent years, young people’s access to sexual and reproductive health care has improved due to the expanded reach of services, including an increase in the number of school-based health centers. Still, many youth experience significant barriers not only to accessing sexual and reproductive health care, but also to care that is inclusive and trauma-informed. Young people who identify as LGBTQ+, Black, or Latine[i] have greater sexual and reproductive health disparities than other young people their age. And if these young people live in a rural area or in a southern U.S. state, accessing sexual and reproductive health care is often even more difficult.

To determine the efficacy of a mobile intervention that may reduce barriers to care, Power to Decide is collaborating with Child Trends, MyHealthEd, and Healthy Teen Network to conduct a five-year (2021-2026) randomized control trial evaluation of SafeSpace, an app-based sexual health intervention designed for LGBTQ+, Black, and Latine youth. Funding for this evaluation comes from the Family and Youth Services Bureau (FYSB) through the Personal Responsibility Education Innovation Strategies (PREIS) program.

SafeSpace is a 10-week program delivered via a mobile application adapted from Real Talk by MyHealthEd. The SafeSpace developers designed the program to provide youth a secure space to share personal stories and build health literacy. Users receive lessons several times per week that center around real youth stories about a range of subjects. Users are encouraged to complete a short reflection and to check out the resources provided at the end of each lesson. The information and resources provided through SafeSpace are intended to 1) illustrate positive health decision making, 2) correct misconceptions about adolescent sexual behavior, 3) provide evidence of peer approval for healthy decision making, 4) promote communication with parents, and 5) provide teens with opportunities to build communication skills around these topics.

As the evaluator, Child Trends is measuring the impact of receiving the SafeSpace program on five behavioral outcomes:

• Decreases in participants reporting recent penile-vaginal sex without a condom or a more effective method of contraception (primary outcome)
• Decreases in participants reporting recent penile-vaginal or anal sex without a condom (secondary outcome)
• Increases in participants reporting they recently utilized sexual health services (secondary outcome)
• Increases in participants reporting recent communication with a trusted person about sexual and reproductive health topics (secondary outcome)
• Increases in participants reporting they had sexual agency during recent sexual experiences or had no recent sexual experiences (secondary outcome)

The study is enrolling approximately 1,000 young people ages 14-18 who were assigned female or intersex at birth and live in a southern U.S. state, with an emphasis on recruiting young people who are LGBTQ+, Black, and/or Latine, and/or people living in rural areas.

Study Activities

To complete this goal, Child Trends, Power to Decide, MyHealthEd, and Healthy Teen Network are conducting the following study activities:

• Plan for evaluation study. Key activities include identifying study outcomes, designing survey instruments, conducting cognitive interviews with young people, obtaining IRB approval for the pilot study, designing and programming the SafeSpace app, and setting up the logistical components needed to conduct an automated program and evaluation.
• Conduct pilot study. Key activities include recruiting approximately 50 youth using social media ads, administering the 10-week program, collecting data at three time points, interviewing a subset of participants after they complete the program to identify areas for improvement, and identifying these areas of improvement before the evaluation study.
• Complete evaluation study. Key activities include recruiting 1,000 youth using social media ads, administering the 10-week program, collecting data at three time points, administering incentives, and retaining participants in the study over the course of a year.
• Conduct analysis and dissemination. Key activities include analyzing survey data, reporting on performance measures, documenting study procedures, and disseminating impact analysis findings via products and presentations over the course of the five years.

Project Contacts

Child Trends evaluation leads

• Jennifer Manlove, PhD | 240-233-9262 | jmanlove@childtrends.org
• Elizabeth Cook, MSPH | 240-223-9323 | ecook@childtrends.org

Project lead

• Riley Steiner, MPH, PhD | rsteiner@powertodecide.org

Implementation lead

• Marisa Cervantes, PhD | marisa@myhealthed.org

Recruitment lead

• Milagros Garrido, MS, PMP | mila@healthyteennetwork.org

Federal program officer

• Katherine Godesky | Katherine.godesky@acf.hhs.gov

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Footnote

[i] We utilize the word “Latine” as a nonbinary, gender-inclusive term to refer to individuals of Latin American and Caribbean background. Unlike “Latinx,” which is mostly used in the mainland United States, Latine can be pronounced and conjugated in Spanish and other Latin languages. We acknowledge that the limitation of these terms is that, at this point in time, they are not widely used by the majority of the members of the communities that they are used to represent.