Association for Public Policy Analysis & Management

This paper will present findings and lessons learned from a randomized controlled trial (RCT) of a culturally responsive Teen Pregnancy and Sexually Transmitted Infection Prevention  (TPP/STI) program targeting youth in the state of Hawai‘i.  Despite recent improvements in some adolescent sexual health indicators, policymakers in Hawai‘i recognize a continuing need for effective reproductive health education for its youth.  Hawai‘ian youth had the lowest rate of condom use in the nation in 2011. Only 44% of 9-12th graders reported using a condom in their last intercourse, compared to 60% nationwide (CDC 2012), even though the state’s standards for sexual health instruction emphasize skill development in the use of condoms (Hawai‘i Content and Performance Standards, code HE 9-12.1.2). The state also had the tenth highest teen pregnancy rate in 2008 (7.6% of 15-19 year old females, compared to 6.8% nationwide). Furthermore, in this culturally distinctive and racially diverse state, where the population is 26% white, 39% Asian, 10% Hawai‘ian/Pacific Islander, and 34% mixed races (2010 US Census), “minority” (non-white) female youth are disproportionately at high risk of teen pregnancy (CDC 2013).  With these challenges, finding evidence-based TPP/STI curricula that can impact youth in Hawai‘i has become a priority for the state.  The study responds to this policy need. 

Pono Choices is an TPP/STI program developed exclusively for youth in Hawai‘i by the University of Hawai‘i , Planned Parenthood, and Alu Like.  The program consists of 10 classroom sessions and emphasizes Hawai‘ian cultural values, practices, and terms to promote positive character development and “pono” (right) choices.  No other state-approved curricula incorporated unique values and perspectives of the Hawai‘ian host culture.  This paper is based on an RCT,  led by the authors as an independent evaluator, to assess whether this culturally-response intervention improves sexual behaviors as well as knowledge, skills and attitudes toward reproductive health among youth in Hawai‘i. The RCT involves 36 middle schools randomly assigned to either the treatment or control condition (“business as usual”).  Health education teachers in the treatment group were trained to deliver the Pone Choices curriculum in their 7th and 8th grade classes, while teachers in control schools were offered delayed treatment. Impacts are estimated at the student level, specifying a mixed-level model to account for clustering effects. The student sample consists of 1,781 youths enrolled in the target health education classes whose parents consented to their participation in the study. The primary sources of data are student surveys collected at baseline, one year after baseline, and two years after baseline. The second year survey will be completed in June 2015.

In addition to addressing challenges faced by any multi-year school-based RCT targeting youth on a sensitive topic, the study took into account the local cultural context to minimize attrition and maintain response rates. The paper highlights strategies used to achieve our successful implementation of the RCT (the first-year analysis meets the WWC evidence standards) as well as lessons learned, and shares preliminary findings from impact analyses on the effectiveness of the culturally-responsive TPP/STI program.