Yo Puedo: Future Opportunities for Youth

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DESCRIPTION (provided by applicant): Adolescent pregnancy rates in the United States remain higher than in any developed nation, with disproportionately high pregnancy rates in Latina adolescents. The proposed study builds on our research with Latino adolescents in San Francisco's Mission District that revealed the strong connection between gang affiliation and unintended pregnancy and the important role that street gangs play in shaping social networks. We propose to conduct formative design research and pilot the feasibility of an innovative intervention (Yo Puedo ["I can"]: Future Opportunities for Youth) that combines conditional cash transfers (CCTs) and a life skills education to address social network influences and socioeconomic opportunities in a neighborhood where youth experience substantial gang exposure and high rates of early childbearing. Informed by behavioral economics and social learning theory and developed with input from community partners, Yo Puedo will target youth 16 to 21 years old and same-aged members of their social network. Criteria for receipt of the CCTs will be established by youth themselves and will be tied to educational and skill development and participation in reproductive health activities. We will complement the CCTs with life skills training derived from effective unintended pregnancy prevention curriculum that addresses norms that influence early childbearing and partnerships, and that will be tailored to support youth in achieving intervention objectives. We will begin by conducting formative methodological research to design a CCT incentive structure best suited to promoting educational and reproductive health wellness for youth in San Francisco's Mission District (Aim 1). We will design the incentive structure using adapted contingency valuation methods from economics. To evaluate the feasibility of implementing Yo Puedo (Aim 2), we will conduct a pilot with randomization of 60, 3-person social networks (180 youth in total) to the intervention or observational control group. We will assess our ability to recruit youth to a randomized study with an observational control arm; our ability to recruit and retain 3-person social networks; and our integration of the CCTs and life skills curriculum. Finally, through the randomized study and 8 focus groups conducted post- intervention with youth participants, adult mentors and community providers, we will determine whether distributing reward payments to youth directly had negative effects and examine preliminary patterns in intermediary outcomes over time (Aim 3). Based on the study results, we will revise the intervention and design a future Phase 3 effectiveness evaluation. PUBLIC HEALTH RELEVANCE: Innovative interventions to prevent persistently high rates of unintended pregnancy among Latino youth are needed. This study consists of novel formative methodological research using approaches from economics and a feasibility evaluation of a combined conditional cash transfer and tailored life skills intervention (Yo Puedo ["I can"]: Future Opportunities for Youth) designed for youth aged 16 to 21 in San Francisco. The study findings will guide design of a future Phase 3 effectiveness evaluation of this intervention.