Karin Coyle

Sexual Risk Behavior Beliefs and Self-Efficacy Scales

The Sexual Risk Behavior Beliefs and Self-efficacy (SRBBS) scales were developed to measure impor... more

Implications for Adoption and Implementation of Effective Sexual Health Education Programs

The journal of applied research on children : informing policy for children at risk, Oct 18, 2011

Download

Promoting Adolescent Healthy Relationships (The About Us Program): Protocol for a Randomized Clinical Trial (Preprint)

Background: Romantic relationships play a critical role in adolescent development, and by middle ... more Background: Romantic relationships play a critical role in adolescent development, and by middle adolescence, most young people have been involved in at least one romantic relationship, a context in which most sexual interactions occur. Research suggests adolescents lack positive models and skills related to building healthy relationships. Objective: This project aims to test the impact of an innovative healthy relationships intervention, called About Us, implemented in school-based health centers (SBHCs) in California in a randomized controlled trial. Methods: About Us is being tested using a 7-site, 2-group, parallel randomized controlled trial with a treatment versus control allocation ratio of 3:2 to assess the impact of the intervention relative to the standard of care among adolescents aged 14 to 18 years. Adolescents with active parental consent provide study assent at each of the 3 survey time points: baseline, 3 months postintervention, and 9 months postintervention. A stratified randomization procedure was used to ensure balance in key covariates and screening criteria across intervention groups. Through benchmark intent-to-treat analyses, we will examine the primary outcome of this study-the impact of About Us relative to the standard of care 9 months following the end of the intervention on the prevalence of vaginal or anal sex without condoms in the past 3 months. The secondary outcomes are four-fold: what is the impact of About Us relative to the standard of care 3 and 9 months following the end of the intervention, on (1) the prevalence of abstinence from vaginal or anal sex in the past 3 months, (2) composite scores of relationship communication and positive conflict resolution among participants involved in a relationship at baseline, (3) the prevalence of SBHC service use or information receipt in the past 3 months, and (4) composite scores of condom use intentions and attitudes regarding condoms and other birth control? Additionally, as part of our sensitivity analyses, two additional analyses will be implemented: modified intent-to-treat and complete case analysis. Results: This project (ClinicalTrials.gov #NCT03736876) was funded in 2016 through the Family Youth Services Bureau as part of the Personal Responsibility Education Innovative Strategies program. Baseline data collection took place between February 2018 and March 2020, yielding a total of 5 cohorts and 533 study participants: 316 assigned to treatment and 217 assigned to control. Ongoing follow-up data collection continued through May 2021. Conclusions: About Us draws on developmental science to create a contextually and developmentally relevant program that addresses motivation and emotional influences in sexual decision-making. The intervention was designed for implementation within SBHCs, an understudied venue for relationship and sexual health promotion interventions. Unfortunately, COVID-19 pandemic restrictions led to school closures, interrupting ongoing programming, and in-person follow-up data collection, which has affected study attrition.

Download

Promoting Adolescent Healthy Relationships (The About Us Program): Protocol for a Randomized Clinical Trial

JMIR Research Protocols, Sep 1, 2021

Background: Romantic relationships play a critical role in adolescent development, and by middle ... more Background: Romantic relationships play a critical role in adolescent development, and by middle adolescence, most young people have been involved in at least one romantic relationship, a context in which most sexual interactions occur. Research suggests adolescents lack positive models and skills related to building healthy relationships. Objective: This project aims to test the impact of an innovative healthy relationships intervention, called About Us, implemented in school-based health centers (SBHCs) in California in a randomized controlled trial. Methods: About Us is being tested using a 7-site, 2-group, parallel randomized controlled trial with a treatment versus control allocation ratio of 3:2 to assess the impact of the intervention relative to the standard of care among adolescents aged 14 to 18 years. Adolescents with active parental consent provide study assent at each of the 3 survey time points: baseline, 3 months postintervention, and 9 months postintervention. A stratified randomization procedure was used to ensure balance in key covariates and screening criteria across intervention groups. Through benchmark intent-to-treat analyses, we will examine the primary outcome of this study-the impact of About Us relative to the standard of care 9 months following the end of the intervention on the prevalence of vaginal or anal sex without condoms in the past 3 months. The secondary outcomes are four-fold: what is the impact of About Us relative to the standard of care 3 and 9 months following the end of the intervention, on (1) the prevalence of abstinence from vaginal or anal sex in the past 3 months, (2) composite scores of relationship communication and positive conflict resolution among participants involved in a relationship at baseline, (3) the prevalence of SBHC service use or information receipt in the past 3 months, and (4) composite scores of condom use intentions and attitudes regarding condoms and other birth control? Additionally, as part of our sensitivity analyses, two additional analyses will be implemented: modified intent-to-treat and complete case analysis. Results: This project (ClinicalTrials.gov #NCT03736876) was funded in 2016 through the Family Youth Services Bureau as part of the Personal Responsibility Education Innovative Strategies program. Baseline data collection took place between February 2018 and March 2020, yielding a total of 5 cohorts and 533 study participants: 316 assigned to treatment and 217 assigned to control. Ongoing follow-up data collection continued through May 2021. Conclusions: About Us draws on developmental science to create a contextually and developmentally relevant program that addresses motivation and emotional influences in sexual decision-making. The intervention was designed for implementation within SBHCs, an understudied venue for relationship and sexual health promotion interventions. Unfortunately, COVID-19 pandemic restrictions led to school closures, interrupting ongoing programming, and in-person follow-up data collection, which has affected study attrition.

Download

Implications for Adoption and Implementation of Effective Sexual Health Education Programs

Journal of Applied Research on Children: Informing Policy for Children at Risk

Download

High School FLASH Sexual Health Education Curriculum: LGBTQ Inclusivity Strategies Reduce Homophobia and Transphobia

Prevention Science, Mar 17, 2023

Homophobic and transphobic beliefs that lead to bias-based harassment remain a critical concern f... more Homophobic and transphobic beliefs that lead to bias-based harassment remain a critical concern for young people in the USA. The aim of the present study was to examine the impact of an inclusive comprehensive sex education program (High School FLASH) on homophobic and transphobic beliefs. Data from this study come from a randomized controlled trial that evaluated the impact of High School FLASH on students' sexual behaviors and related outcomes with 20 schools in two U.S. regions (Midwest and South). Following the baseline survey, the 20 schools were randomly assigned to receive FLASH or a comparison curriculum. Ninth and 10th grade students completed follow-up surveys 3 and 12 months after the instructional period. We examined changes in homophobic beliefs using multilevel linear regression models in the full sample and two sub-groups: straight cisgender young people versus those who identified as not straight or cisgender. Mean scores on the homophobic and transphobic beliefs scale were statistically significantly lower among young people receiving FLASH relative to the comparison at both the 3-and 12-month timepoints (p-values for adjusted mean differences were < 0.01, n = 1357 and 1275, respectively). Specifically, FLASH's positive impact on reducing homophobic and transphobic beliefs was statistically significant for straight and cisgender youth at both survey follow-ups (p < 0.01, n = 1144 and p = 0.05, n = 1078, respectively); the effects for the LGBTQ sub-group reached statistical significance at only the final follow-up (p = 0.01, n = 197). Our results show that carefully designed, inclusive comprehensive sexual health education programs like High School FLASH can play a role in promoting better school climates for all youth by reducing beliefs that may lead to bullying, violence, and victimization.

Download

The Positive Choices trial: update to study protocol for a phase-III RCT trial of a whole-school social-marketing intervention to promote sexual health and reduce health inequalities

Trials

Background Positive Choices is a whole-school social-marketing intervention to promote sexual hea... more Background Positive Choices is a whole-school social-marketing intervention to promote sexual health among secondary school students. Intervention comprises the following: school health promotion council involving staff and students coordinating delivery, student survey to inform local tailoring, teacher-delivered classroom curriculum, student-run campaigns, parent information and review of sexual/reproductive health services to inform improvements. This trial builds on an optimisation/pilot-RCT study which met progression criteria, plus findings from another pilot RCT of the Project Respect school-based intervention to prevent dating and relationship violence which concluded such work should be integrated within Positive Choices. Young people carry a disproportionate burden of adverse sexual health; most do not report competence at first sex. Relationships and sex education in schools can contribute to promoting sexual health but effects are small, inconsistent and not sustained. S...

Download

The Positive Choices trial: study protocol for a Phase-III RCT trial of a whole-school social marketing intervention to promote sexual health and reduce health inequalities

Trials, 2021

Background Positive Choices is a whole-school social marketing intervention to promote sexual hea... more Background Positive Choices is a whole-school social marketing intervention to promote sexual health among secondary school students. Intervention comprises school health promotion council involving staff and students coordinating delivery; student survey to inform local tailoring; teacher-delivered classroom curriculum; student-run campaigns; parent information; and review of sexual/reproductive health services to inform improvements. This trial builds on an optimisation/pilot RCT study which met progression criteria, plus findings from another pilot RCT of the Project Respect school-based intervention to prevent dating and relationship violence which concluded such work should be integrated within Positive Choices. Young people carry a disproportionate burden of adverse sexual health; most do not report competence at first sex. Relationships and sex education in schools can contribute to promoting sexual health but effects are small, inconsistent and not sustained. Such work needs...

Download

Promoting Adolescent Healthy Relationships (The About Us Program): Protocol for a Randomized Clinical Trial (Preprint)

BACKGROUND Romantic relationships play a critical role in adolescent development, and by middle a... more BACKGROUND Romantic relationships play a critical role in adolescent development, and by middle adolescence, most young people have been involved in at least one romantic relationship, a context in which most sexual interactions occur. Research suggests adolescents lack positive models and skills related to building healthy relationships. OBJECTIVE This project aims to test the impact of an innovative healthy relationships intervention, called About Us, implemented in school-based health centers (SBHCs) in California in a randomized controlled trial. METHODS About Us is being tested using a 7-site, 2-group, parallel randomized controlled trial with a treatment versus control allocation ratio of 3:2 to assess the impact of the intervention relative to the standard of care among adolescents aged 14 to 18 years. Adolescents with active parental consent provide study assent at each of the 3 survey time points: baseline, 3 months postintervention, and 9 months postintervention. A stratif...

Download

Exploring Alternative Outcome Measures to Improve Pregnancy Prevention Programming in Younger Adolescents

American Journal of Public Health, 2016

similar to those in the general population, with 75% using the Internet and 78% using a cell phon... more similar to those in the general population, with 75% using the Internet and 78% using a cell phone at least daily or weekly. And, as with the rest of the country, AI/AN Internet use will only expand. Anecdotally from our work, many tribal members attest to the pervasiveness of social media for connecting people and families within and across tribes, particularly among tribal youths. Technology, of course, does not solve every challenge commensurate with conducting rigorous adolescent pregnancy prevention research within tribal communities. Aside from issues of hardware, connectivity, data plans, and the fast pace of industry change, technology cannot replace community engagement and meaningful participation in the research process, or the trust and rapport such partnership builds. Technology cannot replace the value of cultural connectedness among family, kin, and community that makes AI/AN tribal communities unique, vital, and resilient. However, when used judiciously and in the context of strong research partnerships, technology can complement the community and cultural life of AI/AN adolescents, provide adolescent pregnancy prevention information and skills-building they may otherwise not receive, and facilitate youth and family participation in rigorous evaluation research to generate evidence for interventions relevant to their communities.

Download

It's Your Game…Keep It Real in South Carolina: A Group Randomized Trial Evaluating the Replication of an Evidence-Based Adolescent Pregnancy and Sexually Transmitted Infection Prevention Program

American journal of public health, 2016

To evaluate the effectiveness of an evidence-based HIV/sexually transmitted infection (STI)/pregn... more To evaluate the effectiveness of an evidence-based HIV/sexually transmitted infection (STI)/pregnancy prevention program for middle schools implemented by school staff in South Carolina. Twenty-four schools, representing 3143 youths, participated in a randomized trial from 2011 to 2014. Students completed surveys before programming (fall of seventh grade), after completing the 2-year It's Your Game…Keep It Real program (spring of eighth grade), and 1-year postprogram (spring of ninth grade). There was no statistically significant effect on initiation of vaginal sex between baseline and eighth grade. Significantly fewer students in the comparison condition reported initiating sex at ninth grade, relative to the intervention condition. No group differences existed on other behavioral outcomes that addressed sexual activity in the past 3 months at ninth grade. Seven of 26 psychosocial outcomes (3 knowledge, 1 attitude, 1 self-efficacy, 2 personal limits) were positively affected at...

Download

Safer Choices: a multicomponent school-based HIV/STD and pregnancy prevention program for adolescents

The Journal of school health, 1996

Given the serious consequences of HIV infection, other STDs, and pregnancy among teens, professio... more Given the serious consequences of HIV infection, other STDs, and pregnancy among teens, professionals must develop and evaluate new approaches to reduce risks associated with adolescent sexual behavior. The Safer Choices intervention is a comprehensive, theoretically based program designed to reduce risk behaviors and increase protective behaviors to prevent HIV, other STDs, and pregnancy among high school adolescents. The program includes five components: a School Health Promotion Council involving administrators, school staff, students, parents, and community members; curriculum and staff development activities; school environment activities designed and implemented by a team of peer educators; parent education activities; and school-community linkage activities. The School Health Promotion Council is responsible for planning and overseeing program implementation. This article describes the theoretical framework, process for intervention development, and key intervention strategie...

Distributing free fresh fruit and vegetables at school: results of a pilot outcome evaluation

Public health reports (Washington, D.C. : 1974)

Consumption of fruit and vegetables among children is generally below recommended levels. This ev... more Consumption of fruit and vegetables among children is generally below recommended levels. This evaluation addressed two questions: (1) To what extent did children's attitudes toward, familiarity with, and preferences for fruit and vegetables change during the school year? and (2) To what extent did children's consumption of fruit and vegetables change during the school year? During the 2004-2005 school year, the Mississippi Department of Education, Child Nutrition Programs initiated a pilot program to distribute free fruit and vegetables to students (kindergarten through 12th grade) during the school day. Data were collected in 2004-2005 within a one-group pretest/posttest design using a self-report questionnaire (n=725) and 24-hour dietary recalls (n=207) with a sample of students from five schools in Mississippi. Data were analyzed in 2006-2007. Results showed greater familiarity with fruit and vegetables at all grade levels (p<0.05) and increased preferences for fruit ...

Download

Boyfriends, Girlfriends and Teenagers' Risk of Sexual Involvement

Perspectives on Sexual and Reproductive Health, 2006

Having a boyfriend or girlfriend, especially an older one, is associated with increased sexual ri... more Having a boyfriend or girlfriend, especially an older one, is associated with increased sexual risk in early adolescence. The mechanisms underlying this association are unclear. METHODS: Middle school students in Northern California were surveyed annually from 1997 to 2000. For a sample of 1,214 males and 1,308 females who were sexually inexperienced in seventh grade, logistic and linear regression were used to explore associations between relationship status in seventh grade and sexual activity in ninth grade, controlling for sixth-grade and eighth-grade characteristics. RESULTS: Males who had had a girlfriend their age by seventh grade were more likely than those who had had no relationship to report sexual activity in ninth grade (odds ratio, 2.1). Similarly, for females, the odds of being sexually active in ninth grade were elevated among those who had had a boyfriend their age (2.9); however, they also were higher among those who had had an older boyfriend than among those who had had one their age (2.1). With sixth-grade risk factors controlled, relationship status in seventh grade remained significant only for females; the association was explained by early menarche and by participation in situations that could lead to sex and riskier peer norms in eighth grade. For males, eighth-grade situations that could lead to sex, Hispanic ethnicity and sixth-grade peer norms explained ninth-grade sexual behavior. To reduce the risk of adolescent sexual activity, parents and communities should encourage youth in middle school, especially females who experience early menarche, to delay serious romantic relationships.

Download

Manifestations of Poverty and Birthrates among Young Teenagers in California Zip Code Areas

Family Planning Perspectives, 2001

Context: Given that many communities are implementing community-wide initiatives to reduce teenag... more Context: Given that many communities are implementing community-wide initiatives to reduce teenage pregnancy or childbearing, it is important to understand the effects of a community's characteristics on adolescent birthrates. Methodology: Data from the 1990 census and from California birth certificates were obtained for zip codes in California. Regression analyses were conducted on data from zip code areas with at least 200 females aged 15-17 between 1991 and 1996, to predict the effects of race and ethnicity, marital status, education, employment, income and poverty, and housing on birthrates among young teenagers. In bivariate analyses, the proportion of families living below poverty level within a zip code was highly related to the birthrate among young teenagers in that zip code (r=.80, p<.001). In multivariate analyses, which controlled for some of the correlates of family poverty level, the proportion of families living below poverty level remained by far the most important predictor of the birthrate among young teenagers (b=1.54), followed by the proportion of adults aged 25 or older who have a college education (b=-0.80). Race and ethnicity were only weakly related to birthrate. In all three racial and ethnic groups, poverty and education were significantly related to birthrate, but the effect of college education was greater among Hispanics (b=-2.98) than among either non-Hispanic whites (b=-0.53) or blacks (b=-1.12). Male employment and unemployment and female unemployment were highly related to the birthrate among young teenagers in some racial or ethnic groups, but not in others. Conclusions: Multiple manifestations of poverty, including poverty itself, low levels of education and employment, and high levels of unemployment, may have a large impact upon birthrates among young teenagers. Addressing some of these issues could substantially reduce childbearing among young adolescents.

Download

Short‐Term Impact of Safer Choices: A Multicomponent, School‐Based HIV, Other STD, and Pregnancy Prevention Program

Journal of School Health, 1999

ABSTRACT: This study evaluated the effectiveness of the first year of Safer Choices, a theoretica... more ABSTRACT: This study evaluated the effectiveness of the first year of Safer Choices, a theoretically based, multicomponent HIV, STD, and pregnancy prevention program for high school youth. The study featured a randomized trial involving 20 schools in California and Texas, with a cohort of 3,869 ninth‐grade students. Students who completed both the baseline and the first follow‐up survey approximately seven months later were included in the analysis (n = 3,677). Safer Choices enhanced 9 of 13 psychosocial variables including knowledge, self efficacy for condom use, normative beliefs and attitudes regarding condom use, perceived barriers to condom use, risk perceptions, and parent‐child communication. Safer Choices also reduced selected risk behaviors. Specifically, Safer Choices reduced the frequency of intercourse without a condom in the three months prior to the survey, increased use of condoms at last intercourse, and increased use of selected contraceptives at last intercourse.

Download

Integrating service learning into a curriculum to reduce health risks at alternative high schools

Journal of School Health, 2005

Download

The Safer Choices Project: Methodological Issues in School-Based Health Promotion Intervention Research

Journal of School Health, 1997

Randomized trials of school-based health promotion programs present unique design and analytical ... more Randomized trials of school-based health promotion programs present unique design and analytical issues noi widely discussed in the research literature. This article describes the Safer Choices studya school-based program for prevention of HlV, other sexually transmitted diseases, and pregnancyto illustrate critical methodological issues involved in large-scale, schoolbased intervention trials, particularly those evaluating interventions with a school-wide focus. The issues presented are: I ) comparability ofthe intervention and control groups even when few units are randomized: 2) factors that affect the decision to use a cohort or cross-sectional design: and 3 ) appropriate analysis strategy when the unit of randomization and intervention is at the school level, but observations are at the student level. (3 Sch Health. 1997;67(9):365-371) chools provide a point of access to most adolescents: S Nearly 95% of all children and adolescents attend elementary or secondary schools.' Because its primary mission is to impart knowledge and teach skills, school is the ideal place for promoting health among adolescents. Some school-based programs -such as those for children with asthma or for young people who use drugstarget specific student groups based on special health needs or risks. Other programs -such as those on smoking prevention, AIDS prevention, or nutrition education curriculaare designed to change risky behavior by targeting all students in the classroom. By establishing school-wide norms for drug use or unprotected sex, for example, these programs can also address students in the larger school environment. For those involved in school-based health promotion research, differences between individual-level and school-wide programs raise several important methodological issues, such as identifying the proper unit of randomization and analysis, randomizing a small number of units, and identifying the most appropriate research design and data collection strategy.

Download

An Exploratory Study of Adolescent Pimping Relationships

The Journal of Primary Prevention, 2014

In the last decade, public attention to the problem of commercially sexually exploited children (... more In the last decade, public attention to the problem of commercially sexually exploited children (CSEC) has grown. This exploratory qualitative study examines adolescent pimping relationships, including how urban youth perceive these types of relationships. Study data stem from interviews with three young adult informants with first-hand knowledge of adolescent pimping, as well as three gender-specific focus group discussions with a convenience sample of 26 urban high school students who have first-or second-hand knowledge of adolescent pimping. Findings indicate that respondents believe teen pimping exists in their schools and communities, and that those exploited typically do not self-identify as victims. Respondents also believed that younger pimps are more likely to use violence to induce compliance among the girls they exploit, whereas older pimps are more likely to emotionally manipulate young women into exploitation. Further, respondents indicated that some young people agreed to exchange or sell sex for money as a favor to their boyfriends or girlfriends, and some young people believed that selling sex is acceptable under certain circumstances. The growing attention to CSEC provides an important opportunity to expand prevention efforts to reach those most affected and at risk for exploitation. The findings highlight critical areas for augmenting traditional content in school-based HIV/ STI and sexuality education classes.

Download

Interventions to Reduce Sexual Risk Behaviors Among Youth in Alternative Schools: A Randomized Controlled Trial

Journal of Adolescent Health, 2013

Purpose-This paper presents results from a randomized controlled trial that assessed the shortand... more Purpose-This paper presents results from a randomized controlled trial that assessed the shortand longer-term impact of a skills-based HIV/STI/pregnancy prevention curriculum, service learning, and the combination. Methods-The study featured a four-arm experimental design involving 47 classrooms (765 youth) from continuation high schools. Classrooms were randomly assigned to one of four conditions: (1) HIV/STI/pregnancy prevention curriculum only, (2) service learning only, (3) HIV/ STI/pregnancy prevention curriculum plus service learning, or (4) an attention control curriculum. Students completed 3 surveys over 18 months. Multilevel analysis was used to adjust for the correlation among students within the same classroom and school, and the correlation of repeated measurements.

Download

Uploads

Papers by Karin Coyle

Log In