Impact of a relationship‐based intervention, Love Notes, on teen pregnancy prevention

• Published date: 01 December 2023
• Author: Anita P. Barbee,Michael R. Cunningham,Becky F. Antle,Cheri N. Langley
• Date: 01 December 2023
• DOI: http://doi.org/10.1111/fare.12798

RESEARCH

Impact of a relationship-based intervention,

Love Notes, on teen pregnancy prevention

Anita P. Barbee

1

|Michael R. Cunningham

2

|Becky F. Antle

1

|

Cheri N. Langley

1

1

Center for Family and Community Well-

Being, Kent School of Social Work and

Family Science, University of Louisville,

Louisville, KY

2

Department of Communication, University of

Louisville, Louisville, KY

Correspondence

Anita P. Barbee, Center for Family and

Community Well-Being, University of

Louisville, 2213 S. 3rd Street, Louisville,

KY 40292, USA.

Email: anita.barbee@louisville.edu

Funding information

The study was funded by the Office of

Adolescent Health, U.S. Department of Health

and Human Services, grant number

TP2AH000010-01-00.

Abstract

Objective: In this research, a randomized controlled trial

(RCT) tested the efficacy of two teen pregnancy preven-

tion (TPP) curricula, Reducing the Risk and Love Notes,

compared with a group of adolescents in a control condi-

tion, on primary pregnancy prevention among youth at

high-risk for teen pregnancy. A secondary purpose was to

examine two potential mediators, negative beliefs about

teen pregnancy and intentions to follow the sequence of

completing education, marrying or establishing a commit-

ted relationship, and then having children.

Background: Teen pregnancy rates for racial/ethnic minor-

ity youth in the United States are disproportionately high

compared with White youth. Given the positive view of

children in these populations and the drive for youth to

form peer relationships and explore their sexuality, meet-

ing these cultural and developmental needs within TPP

may be critical.

Methods: The study examined the number of reported preg-

nancies across the first year after the interventions from a

three-arm, cluster RCT engaging 1,448 youth living in

poverty between the ages of 14 and 19 years in 23 commu-

nity-based organizations in a southeastern U.S. city.

Results: At the 1-year follow-up, youth in Love Notes report

significantly fewer pregnancies compared with the control

condition (18 pregnancies, 3.51%), F(2, 1,309) =4.17,

p=.02, d=0.11. There was no significant difference

between Reducing the Risk (31 pregnancies, 6.14%) and the

control condition (27 pregnancies, 6.49%) in number of preg-

nancies. Less favorable attitudes about having a child as a

teenager and other attitudes were associated with predicted

outcomes.

Received: 6 January 2021Revised: 27 July 2022Accepted: 11 September 2022

DOI: 10.1111/fare.12798

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits

use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or

adaptations are made.

© 2022 The Authors. Family Relations published by Wiley Periodicals LLC on behalf of National Council on Family Relations.

Family Relations. 2023;72:2569–2588. wileyonlinelibrary.com/journal/fare 2569

Conclusions: This study provides additional evidence for

the efficacy of Love Notes, which embeds sex education

into a larger curriculum on life planning and healthy rela-

tionship formation and maintenance.

Implications.

TPP approaches need to add content on planning and rela-

tionships to comprehensive sexual education.

KEYWORDS

adolescent pregnancy, family relations, Love Notes, sexual behavior, teen

pregnancy

This study compares the efficacy of two teen pregnancy prevention (TPP) programs to a group in

a control condition using a cluster randomized controlled trial (CRCT) with participants from

communities that are marginalized. Teen pregnancy rates remain an issue in the United States,

although the rates of teen pregnancy declined 37% between 1990 and 2010. The Obama adminis-

tration created the Office of Adolescent Health in 2009 and funded grants to study the efficacy of

TPP programs, especially among those most at risk. Overall, by 2009 the rates of teen pregnancy

for Black youth were more than double those of White youth (59.1 pregnancies per 1,000 Black

adolescents compared with 25.6 pregnancies per 1,000 White adolescents). The rates for Latina

youth were almost three times those of White youth (70.1 pregnancies per 1,000 Latina youth com-

pared with the 25.6 pregnancies per 1,000 for White youth (Centers for Disease Control and

Prevention, 2011). The rates continued to drop after 2010 (Centers for Disease Control and

Prevention, 2011). Abma and Martinez (2017) assessed sexual activity of never-married adolescent

young men and adolescent young women aged 15 to 19 years at five points in time (1988, 1995,

2002, 2006–2010, 2011–2015) and showed that vaginal sexual intercourse for adolescent young

women steadily dropped from a high of 51% in 1988 to a low of 42% in the 2011–2015 period,

whereas for males the drop was from a high of 60% in 1988 to a low of 44% in 2011–2015.

Race differences were assessed starting in 2002 and found higher sexual activity among

non-Hispanic Black youth compared with White youth. Among adolescent young women,

56.6% of Black versus 45.1% of White adolescent young women had had vaginal inter-

course in 2002, which dropped for both groups to 46.6% of Black versus 44.3% of White

adolescent young women by 2015. Among adolescent young men, 63.3% of Black versus

40.8% of White adolescent young men had had vaginal intercourse in 2002. The percent-

ages dropped for Black adolescent young men to 58.6% but rose for White adolescent

young men to 42.8%. Latina vaginal intercourse increased over the same period from

37.1% to 41.4%, but both rates were lower than their non-Hispanic Black and White coun-

terparts. Among Latinos, engagement in vaginal intercourse decreased during that time

from 54.8% to 45.7%. In 2002, Latino adolescent young men were less sexually active

than non-Hispanic Black but more sexually active than White adolescent young men, and

that pattern persisted.

These numbers show that by the 2011–2015 period (during which the current study was con-

ducted), the higher rate of vaginal intercourse in the African American group was largely driven

by males, for Black female rates were only slightly higher than for White adolescent young

women by 2011–2015 (47% vs. 44%, respectively). Pregnancy rates of Black adolescent young

women were higher than for White adolescent young women, but this difference was not

accounted for by contraceptive use. In terms of ever having used contraception, percentages of

adolescent young women using contraception rose from 80% in 1988 to 90% in 2011–2015 and

rose for adolescent young men from 84% to 95% in the same period, but race differences were

not noted. As sexual activity dropped and contractive use rose, other variables must have

affected teen pregnancy rates.

2570 FAMILY RELATIONS