Keywords
sexual behaviors
SEXUALLY TRANSMITTED INFECTIONS, BLIND
This study aims to investigate whether Girl2Girl, a text messaging-based pregnancy prevention program for cisgender LGB+ girls, had different effects on subgroups based on age, sexual identity, and experience with penile-vaginal sex. A total of 948 girls, 14–18 years old, were recruited nationally via social media and enrolled over the telephone. Once they completed the baseline, they were randomized to either Girl2Girl or an attention-matched control program that discussed “healthy lifestyle” topics (e.g., self-esteem). Both programs were 5 months long: Girls received daily messages for 8 weeks, and then went through a “latent” period of 3 months, and finished with a 1-week review. Outcome measures included condom-protected sex, uptake of other types of birth control, abstinence, and pregnancy. Measures were collected at baseline; 3-month, 6-month, 9-month, and 12-month post-intervention end, which was 17 months after enrollment. Effect modification was examined using longitudinal mixed effects models. Overall, results suggested significant moderating effects of age, Clinical Trial Registration: ClinicalTrials.gov ID# NCT03029962.
The teenage birth rate has been steadily falling for the past three decades (Martin et al., Universal interventions endeavor to affect the behavior of all youth. It is important to examine the impact that a program may have on important subgroups of youth as this has implications for future adaptations and intervention development. Indeed, previous work has noted differences by gender and ethnicity: Kirby et al. (Teen pregnancy prevention programs targeted to LGB+ girls need to take into account and affect the behavior of important subgroups: Research consistently shows that youth who identify as bisexual, as compared to lesbian or gay, have higher rates of sexual behaviors that increase their risk for sexually transmitted infections and other negative sexual health outcomes (Rosario et al., To address the lack of sexual minority-inclusive teen pregnancy prevention programming, we developed and tested Girl2Girl, an mHealth pregnancy prevention program tailored to the unique needs of sexually experienced and inexperienced LGB+ adolescent girls. Participants received between 4 and 12 messages per day for 7 weeks. Girls then experienced a “latency” period of 12 weeks when they received 1–2 messages per week but were otherwise not contacted. A 1-week “booster” that reinforced the main program messages was delivered at the end of the latency period. The total intervention period was 5 months.Messages were written to address the components of the Information-Motivation-Behavioral Skills (IMB) model (Fisher & Fisher, Each Girl2Girl intervention participant also was paired with another participant, her “Text Buddy.” Buddies were encouraged to text with each other about what they were learning in the program. Messages were routed through the study server so that messages could be monitored and individuals’ phone numbers could be kept private.The control arm received a similar number of messages for the same number of days as the intervention group. Content addressed topics relevant to adolescents, such as self-esteem and how to deal with bullying. To help blind this arm, 2 days of pregnancy prevention content readily available online was included. Interactive components, including Text Buddy, Badges (i.e., girls earned a “badge” for attaining pre-set goals, such as getting tested for HIV, getting condoms), and other two-way messages, were not available to the control group.At intervention end, 5 months after girls were enrolled, youth randomly assigned to the intervention arm reported higher rates of condom use and use of other types of birth control (Ybarra et al., 