Despite young men’s crucial role in preventing unintended teen pregnancy, there are few evidence-based teen pregnancy prevention programs designed specifically for young men in the United States. To address this gap, Child Trends conducted a rigorous evaluation of Manhood 2.0, an innovative teen pregnancy prevention program developed by Promundo for young men and adapted from its flagship program, Program H. The program examines rigid gender norms and partner communication about sex, focuses on intimate partner violence prevention, and supports female partners in contraceptive use.
The Latin American Youth Center (LAYC) implemented Manhood 2.0 in Washington, DC from November 2017 to July 2018, with young men ages 15 to 18. For this evaluation, Child Trends and LAYC recruited mostly Black and Latino young men from the broader Washington, DC metropolitan area through LAYC and local high schools.
This resource provides a brief introduction to the Manhood 2.0 intervention, describes Child Trends’ approach to evaluating Manhood 2.0, and provides implementation and evaluation successes and lessons learned for program evaluators and implementors in the teen pregnancy prevention field.
Birth rates for Black and Hispanic teens are fifty percent higher than the national average, and around 75 percent of these pregnancies are unintended. A promising approach to addressing these disparities is to include young men—especially Black and Latino young men, who have been historically underserved by sexual and reproductive health programs—in teen pregnancy prevention programming. Some research suggests that single-gender programs are particularly promising for pregnancy prevention; however, most of these programs focus solely on females. Developing and implementing effective programs that support young men in making informed decisions about having sex and using contraception can play a key role in reducing unintended teen pregnancy in the United States.
Inequitable gender norms and gender-based power imbalances have been linked to poor sexual and reproductive health outcomes, intimate partner violence, and low rates of condom use. Incorporating content related to gender and power into sexual and reproductive health programming has been linked to more gender equitable relationships and reduced teen pregnancy and incidence of sexually transmitted infections (STIs).
The Manhood 2.0 program seeks to prevent unintended teen pregnancy and promote healthy relationships by increasing sexual and reproductive health knowledge; fostering perceptions about healthy and equitable gender norms; and improving self-efficacy to communicate with partners around sex, contraception, and preventing unintended pregnancy. In addition, Manhood 2.0 seeks to improve social competence and social support among young men.
Manhood 2.0 is a pregnancy prevention program designed to engage young men in the United States in questioning and challenging inequitable gender norms to enhance gender equality. Employing a lens of intersectionality, Manhood 2.0 strives to do the following:
Child Trends used an individual randomized controlled trial to evaluate the impact of Manhood 2.0 on contraceptive knowledge, attitudes toward relationships, communication, self-efficacy, gender norms, social support, and intentions about contraceptive use and sexual activity. Due to initial difficulty enrolling older teens and a reduced evaluation timeline, the study recruited 110 young men—a smaller-than-anticipated sample for the evaluation. Immediately following completion of the program, the study team conducted five focus groups with 28 young men (50%) who participated in Manhood 2.0. The study team also conducted long-term follow-up through focus groups and interviews with 14 of the young men (25%) in the spring of 2020.
The evaluation study recruited young men ages 15 to 22 from LAYC’s existing participants, local high schools, and the broader Washington, DC metropolitan area. However, because of challenges enrolling older age groups, the evaluation team revised the recruitment criteria and implemented the study with young men ages 15 to 18. The study took place from November 2017 to September 2018. To participate in the study, individuals had to meet all the following criteria:
The study had nine months of enrollment before the study period ended due to funding cuts. One hundred and ten young men were enrolled in the study across six cohorts. Depending on recruitment, each cohort had an average of eight participants who participated in Manhood 2.0 over the course of one month. Of the 110 total participants, 56 were randomly assigned to receive Manhood 2.0 and 54 were assigned to the control condition, which received a Post-High School Readiness program. All participants (100% of the intervention and control groups) completed a baseline survey on the day of randomization. We achieved a response rate of 89 percent for the immediate post-intervention survey (91% for the intervention group and 87% for the control group), which is an especially high survey response rate for a community-based intervention.
Across all six cohorts, 89 percent of intervention participants attended at least one Manhood 2.0 session and 61 percent of participants attended six out of the eight Manhood 2.0 sessions (75% of the sessions). This is a strong attendance rate for a community-based program for young men.
This included the content (knowledge of the full range of birth control methods, sexual consent, rigid gender norms) and the social support they received:
Reproductive health knowledge, attitudes, and communication
For more information about young men’s experiences with Manhood 2.0, see this research brief.
Based on interviews and focus groups conducted with young men 1.5 to 2 years after participating in Manhood 2.0, participants indicated that the program had:
The team learned many lessons that will be useful for future program implementation and evaluation, especially for recruiting and retaining young men in a community-based teen pregnancy prevention program and evaluation.
Manhood 2.0 facilitators were trained intensively on the Manhood 2.0 curriculum, including practice through “teach backs.” During teach backs, new facilitators facilitated each activity and received immediate feedback on their facilitation style, along with recommendations for improvement. Facilitators also participated in weekly check-ins with Promundo staff for technical assistance, which allowed them to ask questions and increase their confidence with the curriculum content.
Young men who participated in the Manhood 2.0 study identified discrimination and racism as the biggest issues they face as young men of color. Discrimination is linked to masculinity; research suggests that young men who experience racial discrimination may feel more pressure to conform to rigid gender norms to increase their feelings of self-empowerment. Therefore, it is important to offer Black and Latino young men a space to critically reflect on how discrimination has impacted their views on masculinity. Promundo modified Manhood 2.0 to provide a space for this discussion, and facilitators approached sexual and reproductive health issues with a racial lens throughout the program.
We focused heavily on in-school recruitment for the study; specifically, we recruited at local schools that had existing relationships with our implementation partner. Recruiting at local schools in addition to our community-based center expanded our recruitment pool and allowed youth to regularly attend program sessions. Because the implementation site was local for most participants, common barriers to participation (e.g., travel time and location) were greatly reduced.
Initially, the evaluation team enrolled participants, conducted the baseline survey, and randomized participants before the start of the program. We then asked participants to return for the first session at a later date. However, it was difficult to get participants to attend an after-school community-based program with which they had yet to engage, so we added a “welcome session” and revised our enrollment process. The revised process allowed participants to complete the baseline survey, immediately be randomized, and participate in an introductory activity with their cohort to build interest in the program. This and other approaches—such as providing dinner, allowing participants to co-enroll with friends, and offering multiple randomization days—increased the percentage of participants attending at least one program session from 21 percent (at the start of the study) to 89 percent.
Providing incentives and food to participants aided in the recruitment of young men for the study; however, strong personal connections between facilitators and participants maintained participant retention. Facilitators often reached out to participants via text or phone to remind them about upcoming sessions and to check in on participants who were absent from a session. Throughout the program, facilitators articulated and reinforced expectations around accountability, which was a significant motivator for participants to attend. Facilitators were open, relatable, and assumed an attitude of wanting to learn from the youth, rather than talk at or teach them. Many facilitators shared similar backgrounds to the young men and approached conversations from a place of empathy.
Early in the study, we observed low post-intervention survey response rates among control participants, likely because there was no specified programming in place for them. Due to the study’s local implementation, groups of friends often signed up together and were randomized to separate conditions. However, because there was initially no structured program for the control group, treatment group participants would sometimes leave class to join their control group friends, thus reducing intervention group attendance rates. To address this, our team delivered a structured program—the Post-High School Readiness Program—to the control group. Although not part of the original study design, this program became a critical component to the implementation of the Manhood 2.0 study. Offering structured programming, with the same dosage for both groups, allowed friends to feel equally involved in the study experience. In addition, a viable control group program allowed us to recruit from public schools in Washington DC, which had restrictions on implementing a randomized control trial without a comparable program for control group participants. The high attendance rates for control participants also improved post-test response rates.
Our team offered the post-intervention survey to all participants, in person, immediately following the last program session. Staff followed up with participants who did not attend the final session by sending a unique survey link to participants via text and email. To account for participants who did not respond remotely, we worked with our implementation partner to follow up with youth in person at their schools (including during lunch hours) or at the community center. Meeting students in person at their respective high schools was a successful way to reach participants.
To download the publicly available and open-source Manhood 2.0 curriculum, see here. For more information on the Manhood 2.0 program and evaluation results, see here.
This publication was made possible by Grant Number 5U01DP006129, which is a partnership between the Office of Population Affairs (OPA), the U.S. Department of Health and Human Services (HHS), the Teenage Pregnancy Prevention Research and Demonstration Program, and the Centers for Disease Control and Prevention’s (CDC) Division of Reproductive Health. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official position of the OPA, HHS, or CDC. The authors would like to thank Heather Wasik for her review of this brief.
 The study team used Dedoose, a qualitative data analysis software, to analyze interview and focus group transcripts and identify common themes.
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