Child Trends collaborated with EngenderHealth and the University of Texas at Austin (UT-Austin) to evaluate the Re:MIX teen pregnancy prevention program. The Re:MIX program and evaluation were funded by the U.S. Department of Health and Human Services, Office of Adolescent Health (OAH) in 2015–2018 under a grant to rigorously evaluate “new or innovative approaches to prevent teen pregnancy.” Child Trends completed impact analyses and will, in the future, publicly release the impact results and an extensive report on the evaluation’s implementation.
This resource provides a brief introduction to the Re:MIX intervention and describes Child Trends’ approach to evaluating Re:MIX’s impact on teen pregnancy.
Based on our evaluation design, Child Trends keeps all randomized participants in our study sample, including those who subsequently opted out. On August 23, 2019, we corrected for one late opt-out who was mistakenly dropped from the sample. The updated final sample includes 626 study participants, of whom 347 were allocated to the treatment group (compared to the previously listed 625 participants, with 346 allocated to the treatment group). Participant demographics remain unchanged, as students who opted out were not included in any analysis.
Although pregnancy and birth rates to teens in the United States have reached historic lows, Hispanics have had the highest teen birth rates since the mid-1990s. Birth rates among Hispanic teens are roughly twice as high as among their white peers.1 A peer education approach is a promising way to deliver sexual health information to youth. This approach makes use of individuals who are similar in age and background to participants, allowing for more relatable peer-to-peer transfer of information. And while adolescents often prefer peer educators as facilitators of information, making this approach worthy of further exploration, few peer education programs have been evaluated with Latino populations.
Re:MIX is a sexual health education program aimed at reducing rates of unplanned pregnancy and sexually transmitted infections (STIs) among mostly Latino students in Texas, a state with one of the highest teen pregnancy rates in the country. Re:MIX pairs peer educators who are young parents with professional health educators to co-facilitate its health curriculum among a target population of students in grades 8–10.
The Re:MIX intervention includes ten 55-minute lessons with information on sexual and reproductive health topics, and contains activities that engage youth with the content. The co-facilitation team delivers information using nontraditional approaches, such as game-based tools, technology (tablet computers, mobile applications, and videos), theater and hip-hop techniques, and storytelling. The program covers a range of educational topics:
Child Trends used a clustered randomized controlled design to evaluate the impact of Re:MIX on measures of knowledge, attitudes, self-efficacy, and intentions about sexual activity, contraceptive use, and healthy relationships. These measures were targeted by the Re:MIX curriculum.
For more information about the implementation of the Re:MIX peer education model, see the research brief.
The evaluation study enrolled students in grades 8–10 in three Austin, TX charter schools across five semesters from 2016 to 2018. To participate in the study, students had to return parent consent and student assent forms. The project team worked with schools, teachers, parents, and students to fill out the required consent forms, with an 89 percent return rate. Overall:
Fifty-seven (57) classes and 626 students were enrolled in the study, as shown in the figure below. Across all schools and semesters, 30 classes were randomly assigned to receive Re:MIX (347 students) and 27 classes were assigned to the control condition (279 students). The control classrooms could receive either a general health education curriculum or continue with their regularly scheduled classes (not related to sexual health). The evaluation had strong response rates: 95 percent of participants who took the baseline survey completed the post-intervention survey. The final analytic sample following post-test consisted of 327 treatment students and 267 control students.
Participant characteristics at the time of enrollment in the study were similar for the intervention and comparison groups.
Intensive outreach increases consent rates. The study team obtained completed consent forms for 89 percent of students by:
Reaching out to parents helps limit the number of program opt-outs. The state of Texas mandates that all students and their parents can opt out of sexual health education delivered in schools. Re:MIX experienced an opt-out rate of 16 percent during the first semester, which was higher than expected. High opt-out rates reduce the number of students who participate in the study and could make findings less generalizable. The study team achieved an overall opt-out rate of 11 percent across all five semesters by:
The evaluation team must comply with mandatory reporting laws. These laws vary by state; Texas requires that researchers and educators must report any child who has had sex before the legal age of consent (age 14). The Re:MIX study enrolled eighth graders (many of whom were age 13) and included a question about sexual experience on all surveys. To comply with mandatory reporting, the evaluation team:
On-the-ground local data collectors and online mobile-friendly surveys help maintain high response rates. The project team reached a 95 percent response rate on the post-intervention surveys (and an 85 percent response rate on the one-year follow-up) by:
This brief was updated on June 10, 2019. You can download the original text here.
This publication was made possible by Grant Number TP2AH000033 from the Office of Adolescent Health (OAH), U.S. Department of Health and Human Services (HHS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the OAH or HHS.
Photographs courtesy of Will Gallagher from Will Gallagher Studios
1Office of Adolescent Health. (2018). Trends in teen pregnancy and childbearing. Washington, DC: U.S. Department of Health and Human Services.
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